Under health insurance, the first point of service at private hospitals has ended

Nepal Health News, Kathmandu – From Shrawan 1 (mid-July), participants in the national health insurance program across the country will only be able to access primary healthcare services through government health institutions.

According to Sub-section (6) of Section 9 of the Second Amendment to the Health Insurance Act, 2074 (2017), and Clause (cha) of Rule 2 of the First Amendment to the Health Insurance Regulations, 2075 (2018), a decision has been made that the first point of service will be limited to government health institutions only.

The Health Insurance Board has already sent this directive to all provincial and district offices, as well as to the Information Technology branch. Branch Officer Jhalakraj Joshi of the Board has provided necessary instructions regarding the new implementation process.

Until now, both community and private health institutions were providing initial services to insured individuals. However, moving forward, these services will be available only through government hospitals, health posts, or other government entities.

The Board has expressed gratitude to the private and community institutions for the services they have provided so far and has formally informed them about this change.

As a result of this decision, beneficiaries of the health insurance program across the country will now have to rely solely on government health institutions for receiving services. This may affect access, service time, and increase congestion at some locations.