Kathmandu, June 25

It has now become mandatory for people migrating for foreign employment to get their health insured as stipulated by health insurance rules.

A person leaving for foreign employment shall have to submit a copy of health insurance ID card along with his/her work permit to the Department of Foreign Employment, as per Rule 4. This provision shall not be compulsory in those districts where health insurance programme has yet to be implemented.

The Health Insurance Act-2017 requires every Nepali citizen to get his/her health insured. The Health Insurance Board shall provide an ID card to members of a family insured, by issuing an insurance policy.

The ID card is valid for one year. Premium amount Rs 2,500 per year covers insurance for five members in a family. Three thousand five hundred rupees has been fixed for a family having more than five members. Each family will be entitled to health facilities worth up to Rs 200,000 in a year.

“If a person enjoys health facilities covering the limits of the insured amount before completion of a year, he/she shall not be entitled to any health facilities for the remaining period of that particular year,” read the rules. Under the health insurance programme, the insured shall enjoy services like nutrition, yoga, psycho-social counseling, vaccination, family planning, safe motherhood, out-patient and emergency health services, operation, medicines, curative and preventive services, rehabilitation and ambulance service. The insurance programme doesn’t cover health-related equipment like spectacles and hearing aid and plastic surgery.

According to the rules, an insured person is free to choose a service provider. In an event where the chosen service provider is unable to provide necessary service to him/her, it shall refer the insured person to other service provider.

The rules also have a provision of granting exemption in premium amount. “If the insured members of a family have not received any services or facilities in a particular year, such a family shall be entitled to enjoy per 10 cent exemption in premium amount, the next year.

The Board shall pay the medical bill of the insured to the service provider from the Health Insurance Fund on the basis of per case rate or per service fee. The insured may file a complaint at the Board if he/she thinks that the service provider refused to provide service or did not deliver quality service, according to the rules. Any service provider found guilty during investigation shall be liable to a fine of up to Rs 25,000 and a compensation to the insured, equivalent to the amount.

As per the rules, the federal government, provincial government or local government shall bear 100 per cent premium amount for a family with an ID card under the category of ‘very poor’ and family that have fully disabled, leprosy and HIV infected members.