The government has announced a major restructuring of government’s Health Insurance Program to improve service delivery, prevent misuse, and expand coverage.
Unveiling the budget for fiscal year 2025/26 on Thursday, May 29, Finance Minister Bishnu Paudel said the program will be reformed to ensure better implementation of legal provisions and to reach more beneficiaries. “As part of the reform, insured individuals will be given the option to choose from multiple policy types,” Paudel stated. “The program will also eliminate service duplication to curb the misuse of insurance benefits.”
The benefit package for insured families will be gradually enhanced. Currently, a family of five is entitled to receive up to Rs 100,000 in medical coverage annually.
In a significant move, the government will integrate the Social Health Security Program into the national Health Insurance Program. An institutional administration system will be established to tackle insurance fraud and reduce financial leakages, Paudel added.
To support these initiatives, the government has allocated Rs 10 billion for the Health Insurance Program in the upcoming fiscal year—an increase from Rs 7.5 billion in the current year. However, the Health Insurance Board still owes over Rs 16 billion to healthcare service providers.
Paudel added that a third party will be appointed to settle the outstanding dues within the current fiscal year.
Click here to see out budget 2025/26 coverage.
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