KATHMANDU, FEBRUARY 3
The Health Insurance Board has clarified that the total coverage under the health insurance program for families of up to five members remains unchanged, amid circulating claims that the maximum annual treatment limit has been reduced to Rs 100,000.
According to the board, the annual outpatient (OPD) limit has been set at Rs 25,000 per family to ensure fair and economical use, with an additional Rs 5,000 for each extra member. The remaining amount can still be utilized for inpatient (IPD) treatment and emergency healthcare services.
The board stated that the decision aims to safeguard the sustainability of the Health Insurance Fund, prevent unnecessary or duplicate use of services, and reserve resources for serious, complex, and life-saving treatments. All insured families can continue to access hospitalization and emergency services as before.