Kathmandu, November 4

The Health Insurance Act, 2017 requires every Nepali citizen to get his/her health insured.

Section 3 of the act makes all parents and guardians responsible for insuring the health of their newborn, children, senior citizens and persons with disabilities.

“All persons taking asylum in old age homes, children’s homes and orphanages shall also be brought under health insurance coverage by the concerned organisations,” it says. Civil servants and persons going abroad for foreign employment shall also be required to get their health insured. Similarly, any organisation established under the prevailing laws should involve their employees in the health insurance programme.

Under the health insurance programme, the insured shall enjoy services like nutrition, yoga, psycho-social counselling, vaccination, family planning, safe motherhood, out-patient and emergency health service, operation, medicines, curative and preventive services, rehabilitation and ambulance service, among others.

However, the insurance programme doesn’t cover health-related equipment like spectacles and hearing aid, plastic surgery and artificial reproduction service. “The service to be enjoyed by the concerned insured is not transferable to other persons. Any service provider (health institution) willing to operate health insurance programme shall enter into an agreement with the Health Insurance Board,” the Act says.

There shall be a Health Insurance Fund for the implementation of the programme. Upon signing of the agreement, the concerned health institution may provided service to the insured. The Board pay the medical bill of the insured to the health institution on the basis of per case rate or per service fee. The contribution amount chargeable to the insured shall be determined by taking his/her annual income as its base. However, the persons from economically deprived groups may be entitled to special concession for the insurance premium.

The insured may file a complaint at the Board if he/she thinks that the health institution refused to provide service or did not deliver quality service as per the laws. “If the health institution is found guilty during investigation into the complaint, the board may impose of fine of up to Rs 25,000 on it while issuing order to it to pay a compensation equivalent thereto,” the Act reads.