How does the government health insurance work?
सरकारी स्वास्थ्य बीमा कसरी काम गर्छ?
A family of five pays Rs 3,500 a year for up to Rs 1 lakh of treatment. Outpatient care is capped at Rs 25,000 and some hospitals paused the scheme.
- Cost
- Rs 3,500 a year
- For a family of up to five. The government pays the premium for people below the poverty line in some districts, people over 70 and people with disabilities.
- How long
- Varies
- Where
- Health Insurance Board
- Last checked
- 8 Oct 2026
- Awaiting official confirmation
What it is
The Health Insurance Board runs Nepal's government health insurance. A family of up to five pays Rs 3,500 a year for treatment worth up to Rs 1 lakh, at hospitals and health posts that take part in the scheme.
The scheme has been under strain. The board owed hospitals billions of rupees in 2026, and many paused services until they were paid. Outpatient care is now capped at Rs 25,000, so most of the cover is kept for hospital admissions. Check that your hospital is taking the scheme before you go.
Who needs it
- Any family in Nepal wanting cover for hospital and outpatient treatment at a low yearly cost.
What you need
- Official
A copy of each family member's citizenship or National ID
- Official
A photo of each member
Usually taken by the enrolment assistant.
- Official
The yearly premium
Rs 3,500 for up to five people, Rs 700 for each extra person.
How it works
- 1
Enrol with an enrolment assistant
Enrolment assistants for the Health Insurance Board fill in a form for each family member with a copy of their citizenship or National ID, take a photo and give you an insurance card. Ask your ward or municipal health office for yours.
- 2
Show your card at a listed facility
Since July 2025 you can start treatment at any government facility on the board's first service point list, 377 public hospitals in all, instead of one pre-set facility. They refer you to bigger hospitals if needed.
- 3
Renew every year
Renew before the year ends. Renewal can be done in the board's mobile app. Only about six in ten enrolled people had active cover in 2026.
Where to go
Health Insurance Board
Kathmandu
Cost and time
- Official fee
- Rs 3,500 a year
- For a family of up to five. The government pays the premium for people below the poverty line in some districts, people over 70 and people with disabilities.
| Service | Fee |
|---|---|
| Premium, family of up to five | Rs 3,500 a year |
| Each extra family memberAdds Rs 20,000 of cover | Rs 700 a year |
| Total cover per family | Rs 1 lakh a year |
| Outpatient capSince early 2026 | Rs 25,000 |
| Cover for chronic diseases | Rs 2 lakh |
Common problems
My hospital says it isn't taking health insurance.
Many hospitals paused the scheme in 2026 because the board owed them money. TU Teaching Hospital and Manmohan Hospital resumed in July 2026. Private hospitals were limited to outpatient care. Call the hospital before you go.
Why was my outpatient claim refused?
From early 2026 outpatient care is capped at Rs 25,000 for each patient or family member, down from the full Rs 1 lakh. The rest of the cover is for admissions.
Is the scheme changing?
The 2083/84 budget set aside Rs 15 billion for the scheme and plans to restructure it, aiming to cover 90% of people within three years. Rules may change, so check before renewing.
Do I pay anything at the hospital?
A 10% co-payment of treatment costs within your limit was reported from 2024. Ask the hospital what you'll pay.
What does the premium cover?
Treatment at listed facilities, including medicines, check-ups and counselling, up to the family's yearly limit.
Real experiences
Been through this recently? Tell the next person which office you went to and what they asked for. Reports are published as community notes, apart from the official information.
Share your experienceSources
- The Kathmandu Post: TU Teaching Hospital and Manmohan Hospital resume the scheme (July 2026)kathmandupost.com
- The Kathmandu Post: private hospital services halted under the scheme (May 2026)kathmandupost.com
- The Himalayan Times: insured can use any of 377 public hospitals (July 2025)thehimalayantimes.com
- openIMIS: Health Insurance Board enrolment processopenimis.atlassian.net
- Kantipur: how to raise health insurance resources, on the 10% co-payment (2024)ekantipur.com
- Rising Nepal: outpatient insurance limit set at Rs 25,000risingnepaldaily.com
Written from the sources above and last checked on 8 Oct 2026. Some details aren't confirmed against an official page yet, so check fees and documents with the office before you go.
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