Health insurance now requires you to chip in 10% of the cost starting today.

Starting today (January 15), under the health insurance program, patients receiving treatment will be required to pay 10% of the limited expenses themselves, as informed by Dr. Damodar Barseu, the Executive Director of the Health Insurance Board. The board has implemented a co-payment system where patients will cover 10% of their medical costs when availing health services under the health insurance program. Previously, the board did not impose any responsibility on the patients for the expenses incurred. Families with up to five members contributing an annual sum of NPR 3,500 to NPR 100,000 can avail themselves of this facility.

Additionally, the board has introduced a co-payment system for unnecessary medical examinations to discourage such practices. According to Dr. Barseu, co-payment of 10% will only apply to medical examinations conducted in primary health centers and hospitals up to the level of district hospitals. Health services provided in hospitals with 25 beds or more will not incur a 10% co-payment. This co-payment system is applicable in federal hospitals, provinces with more than 25 beds, and all private and community hospitals. The board emphasizes that the 10% co-payment does not apply to primary health centers and hospitals with up to 25 beds. The co-payment system is part of the health insurance program and applies to all federal, provincial, and community hospitals, as well as private hospitals.

As of now, 4.86 million individuals are actively insured, with 3.4776 million having availed health services under the health insurance program, according to information provided by the board’s spokesperson, Om Kumari Kandel. Currently, there are 4.859 million active policyholders. Among them, 3.476 million policyholders have availed health services through the Health Insurance Board. The board mentions that the co-payment system will not be enforced on extremely poor individuals, those above 70 years old, critically ill patients, those infected with HIV/AIDS, leprosy patients, and female health volunteers.