Health Insurance Act, 2074 (2017)
स्वास्थ्य बीमा ऐन, २०७४
Issued by Parliament of Nepal · 2017
In short: Sets up the national social health insurance programme run by the Health Insurance Board. Families pay a premium for an annual benefit package.
Overview
The Act set up the Health Insurance Board and a contributory national health insurance scheme. Its purpose is to reduce out-of-pocket spending, which is still a large share of health spending in Nepal. Families enrol by paying a yearly premium. The government subsidises premiums for poor and vulnerable groups.
Key provisions
- Families enrol through enrolment assistants and pay a yearly premium.
- Premiums are subsidised for ultra-poor households, senior citizens and other listed groups.
- Members get an annual benefit ceiling and treatment at accredited first-contact and referral facilities.
- The Health Insurance Board pays claims to facilities and accredits service providers.
Why it matters
Social health insurance is Nepal's main tool for financial protection and for moving toward universal health coverage.
What it means for practitioners
- Follow the referral rules from the first service point. Claims can be rejected when patients bypass them.
- Submit claims correctly and on time to keep facility income stable.
Frequently asked questions
Who runs health insurance in Nepal?
The Health Insurance Board, set up under the Health Insurance Act 2074, runs the national health insurance programme.
Related guides
Editorial summary by PHC-Nepal for education only. It is not legal advice. Laws may be amended, so always check the official text.