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The insurance program started by the government from Chait 25, 2072 in Kailali district has now been implemented in all 77 districts. Based on the payment of 3,500 per family (up to 5 people), there is a provision for health facilities of up to 1 lakh per year and if the amount is increased at the rate of 700 per member, services equal to 20,000 per member will be added.
The maximum service facility limit is up to 2 lakh (10 family members). The insured has to pay 2 percent amount for the service . The insurance program is applicable to government health institutions and private medical colleges.
Health Insurance Regulations, Section 16, 2075, 100% of the contribution amount of the family of the very poor, 100% of the contribution of the family of the extremely disabled, disabled, leprosy, HIV-infected, complicated tuberculosis patients, 100% of the contribution of the senior citizens who have reached the age of 70, and 50% of the contribution of the family of women health volunteers. About the latest state of health insurance Executive Director of Health Insurance Board Dr. Interview with Raghuraj Kafle
How do you manage insufficient budget?
If people's representatives, national service employees, and employees working in the organized sector can be included in insurance, premiums of around 40 billion rupees can be collected annually. To increase the number of insured persons, we have issued a circular to all local levels through the Ministry of General Administration through the Ministry of Health to join the insurance . It is not possible for the Ministry of Health and the Board alone to make insurance successful. All agencies had to be involved. The Minister of Finance has informed in the budget speech that arrangements have been made to transfer the pending payment claim amount in the next financial year . We are hopeful that more budget will come from the ministry.
What is the plan to reduce fake claims?
A committee is being formed on June 14, 2082 under the coordination of Prof. Dr. Pradeep Vaidya to make a facility bag scientific to reduce fake claims. We are working to reduce fake claims to zero . We are trying to review the punishment for not providing services as per the contract and standards, submitting false details, not providing quality services as specified and not paying premiums . We are taking action against those who make false claims.
From July 1, the health protection program will be operated through the board.
12 billion rupees are being spent every year in the social health security program under the Department of Health Services. The ministry is seriously discussing the issue of conducting this program through the insurance board. We come to a conclusion .
What initiatives have you taken to increase the service quality of the hospital? It is not possible for the board to provide quality service to
service providers. The concerned hospital should take it seriously . We have recruited one hundred and eighty more medical officers to see the claims to pay the service providers on time . To make the insurance successful, there had to be support from the Prime Minister.
![In order to make insurance successful, there had to be support from the Prime Minister's level: Executive Director Dr. Raghuraj Kafle [Interview]](https://assets-cdn-api.ekantipur.com/thumb.php?src=https://assets-cdn.ekantipur.com/uploads/source/news/kantipur/2025/third-party/raghuraj-khafle-0972025044520-1000x0.jpg&w=1001&h=0)