Nepal Life Insurance

Increasing access of people towards health insurance

प्रकाशित मिति: १७ कार्तिक २०७४, शुक्रबार ११:४२

सागर चन्द

Beemanews

Nov-3, Kathmandu/

The number of individuals availing services from health insurance programme seems to be increasing.Under the health insurance programme run by the government, till the end of asadh 2074, 2 lakh 28 thousand 1 hundred 13 individuals have participated. According to the Social Health protection Development Committee, till the end of asadh 2074, 22 thousand 2 hundred 28 individuals have availed health service. The committee has collected the insurance fee (subsidy) of 63 Million 4 hundred 81 thousand and 3 hundred 1 rupees. Till now, the government has regulated these programmes in 22 districts. By the end of asadh, the committee has paid rupee 18 million, 4 hundred 56 thousand, four hundred and 81. Among the individuals, who took the health policies, the patient of high blood pressure formed a large fraction. The government has planned to expand this programme to additional fifteen districts by the end of this financial year. The plan of expansion has been limited up Bhojpur, Khotang, Siraha, Ramechaap, Rautahat, Kapilvastu, Argakhanchiu, Pyuthan, Rukum, Dolpa, Kalikot, Mugu, Humla, Bajura and bajhang by the end of this financial year.
Up to now, this programme has operated in 22 districts. With a plan to take the health insurance of all citizens, recently a health insurance bill has been passed by the parliament.

What is Health Insurance?

There is a system to get treatment relief for any accidental illness, physical ailments. Free treatment service after paying a certain sum of money is the health insurance. The government has started this programme to make certain the fundamental health service among common citizens by providing financial security. The government had declared to run the health insurance programme in the budget of financial year 2069/70 to make access to health service among all citizens. But this plan could be implemented. However, in the budget of financial year 2072/73, the government declared to run health insurance in Kailali, Baglung and Ilam for testing right from 2072 Kartik. Based on the health insurance policy 2071, the government has run social health protection programme by running insurance programme.

How to do health insurance?

According to the insurance plan, five-member per family can take health insurance for the payment of rupees two thousand five hundred for five members. That particular family can avail the health insurance of rupees 50 thousand. Provided, the number of members exceeds more than five, per member rupees, four hundred 25 has to be paid.But for the very poor group, the insurance premium is 100 % free. Likewise, for those who are in the marginal line of poverty, 75% and for the risked family, 50% discount is available. Based on the identity card issued by poverty elimination ministry, the government provides such discount identifying their poverty level.


For the districts, selected for the health insurance programme, health insurance registration team have been channelized to approach every citizen’s house. They would assist every member to fill the separate forms. This sort of forms have to be filled by all the members . all the particulars have to be disclosed to the registration team.
While filling the registration form, you have to choose the viable health institution. In this way, while choosing the health institution, the viable health institution has to opt.But with that health institution government should have an agreement, the registration team will provide the identity card of insurance registration to every member.As per the identity card, medical treatment service can be availed from the particular hospital. the health insurance policy is for only one year.

How to avail health service?

For the health treatment, the government has done an agreement with various health institutions. From health posts at a local level to facilitated hospitals, the government has done agreement. In case of illness, first of all, local health post must be visited. If the district level health service centre cannot do the treatment, with the referral of central, health service from regional level can be availed. Provided, more than five members in a family, additional ten thousand valued health service can be availed.
The free health service and facilities being given before this health insurance, remain unaffected by this policy.

In what case, the insured amount is not available?

The health insurance policy bought by the government for common citizens doesn’t include however cosmetic service, sex change, dental surgery, physical ailments owing to personal issues, alcohol or drug addiction caused accidents, abortion, etc.

Can Health insurance be taken from the insurance company?

According to the plan brought by the health insurance company, by paying a certain sum of money personally, health insurance can be done . in the developed countries, the health insurance policy has long been in practice however in Nepal, it was introduced from the decade of 2040BS.In this way, personal health insurance can be done.Personal health insurance introduction card (Citizenship card )is essential. For doing the health insurance, minimum five years and maximum 65 years should be met. But it is different among companies. For health insurance, from 10 lakhs to 35 lakhs can be insured . as per the maximum sum of insurance, the premium is fixed.
In this case, health insurance is not recognized.
In case, the insured party is suffering from prolonged illness, within 28 days being ill or pregnant insured party, the insurance policy is not recognized.

 


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