Insurance

Insurance

A contract represented by a policy under which a person or organization obtains financial protection from an insurance provider against loss is known as insurance. Insurance can be divided into three categories: social, health, and life insurance.

Health Insurance/ Health care social security

The Social Health Security Program is a federal initiative designed to guarantee access to high-quality healthcare (equity and equality), protect citizens from financial hardship, and lower out-of-pocket expenses. It is based on a comprehensive social contributory scheme with subsidies for the poor and universal health coverage.

The Social Health Security Program (SHSP) is a social protection initiative of the Nepalese government that seeks to give its residents access to high-quality medical treatment without adding to their financial burdens.

Currently, enrollment in the family-based health insurance scheme is voluntary but each household is required to make a financial contribution. The government, communities, and households all have a direct stake in this program. The Social Health Security Program, or SHSP, works to keep people out of poverty by covering their medical expenses. Le. catastrophic expenditure due to illness or accidents by combining risk sharing and prepayment with mutual aid. Additionally, this initiative promotes the use of high-quality medical care. As a way of achieving Universal Health Coverage, this program makes an effort to overcome obstacles to the use of health services and assure equity and access for underprivileged and poor populations.

Vision

• To improve overall health status of Nepalese people

Objectives

• Ensure that people have access to good healthcare (equity and equality)
• Protect against monetary hardship and minimize out-of-pocket expenses
• Availability of universal health care

Need for Social Health Security (Health Insurance) Program

Social Health Security (Health Insurance) Program is needed to improve the health situation of the people of Nepal. Specifically, this program is needed to;

• By removing financial barriers to the use of health care services, with an emphasis on the poor and marginalized, we can increase accessibility to and equity in the delivery of health care services.
• Encourage pre-payment and risk-pooling options to allocate money for health in a fair way.
• Improve the efficacy, efficiency, accountability, and quality of care in the provision of healthcare services by encouraging output-oriented spending in the sector.
• strengthen healthcare systems holistically.
• Enhance the public's desire for health by communicating a shift in behavior, boosting awareness, and providing clear entitlement procedures.

Strategies

• Increasing participation of communities towards health insurance program by providing special protection to the poor and marginalized and
• • Extending coordination and cooperation with government and nongovernment service provider health institutions for gradual expansion of health insurance program throughout the country.

Main Features

• It is an initiative supported by family contributions. Families with up to five members must pay NPR 3,500 (35 USD) annually, and NPR 700 (seven USD) for each additional person.
• For families of extremely poor, MOR TB, Leprosy, HIV/AIDS, and disabled individuals who have a poverty identity card and a red card, respectively, the government bears the contribution amount.
• The renewal of an insured's membership requires annual contributions.
• Families with up to five members are eligible for benefits up to NPR 100,000 annually, with an extra NPR 20,000 bears covered for each additional person. The yearly maximum available is NPR 200,000. Citizens up to 70 years old can get benefits of up to NPR 100,000 annually plus a government contribution amount.
• First service point selection is required of insureds. On presentation of a referral slip from their initial point of contact, insured individuals can get specialized treatments elsewhere that are not offered at the first service point.
• For subscribers looking for medical care, it is a cashless method.
• With enrollment assistants using smartphones, the program is IT-based.
• While government and listed private hospitals supply the services, HIB operates as the service purchaser.

Contribution Amount

• NPR 3,500 (about $35) per year for a household of up to five people.
• NPR 700 (7 USD) for each extra member of the household.
• formal sector payroll contribution of 2%.
• Families of patients with severe disabilities, HIV, MDR-TB, leprosy, or extreme poverty will receive a 100% subsidy.
• 100% of the cost is covered for the elderly population over 70.

Benefit Package

• Services for promotion, prevention, and treatment; outpatient, inpatient, and emergency care.
• Hospitals, both public and private. Benefit cap: NPR 100,000 (USD 1000) per year for each family of up to five people.
• Up to a maximum of NPR 200,000 (2000 USD), with an additional NPR 20,000 (200 USD) for each subsequent member.
• For each old population, add an additional NPR 100,000 ($1000).
• For patients with eight chronic conditions, an additional NPR 100,000 (USD 1000) is provided.