The Health Insurance Board (HIB) has capped outpatient department (OPD) services coverage under the government health insurance programme to ease financial pressure.
Under the revised structure, a family of up to five members will have an annual OPD benefit ceiling of Rs 25,000, with an additional Rs 5,000 for each extra family member.
In a letter dated February 2 to designated health facilities, the board said the changes were approved at its January 8 meeting.
Currently, a family of up to five members receives insurance coverage of Rs 100,000 per year for OPD and other services, at a premium of Rs 3,500. Families with more than five members pay an additional Rs 700 per extra member for coverage worth Rs 20,000. The maximum coverage a family can receive under the scheme is Rs 200,000.
The board said the new arrangement will take effect from February 13.
The letter also clarified that treatment for eight serious and chronic illnesses — Cancer, Heart Disease, Kidney Disease, Head Injury, Spinal Injury, Sickle Cell Anemia, Parkinson’s Disease, and Alzheimer’s Disease — listed under Schedule 6 of the Health Insurance Regulations, will continue under existing arrangements, with an additional coverage of Rs 100,000.
Earlier, Tribhuvan University Teaching Hospital in Maharajgunj, Kathmandu, announced that it would suspend all health services under the insurance programme from January 15, citing that the board had approved only half of the claims submitted for payment.
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