Nepal Health Insurance Scheme: Who Qualifies, What’s Covered and How to Enroll
An overview of the Nepal health insurance scheme, including eligibility criteria, coverage details, enrollment methods, recent enrollment figures and the government's 70% coverage target within two years.
The Nepal health insurance scheme, launched by the Ministry of Health in July 2024, aims to expand universal health coverage across the country.
Eligibility Criteria
Eligibility includes formal sector employees, self-employed individuals registered with the Social Security Fund, and informal workers who opt for subsidized contributions. Low-income households identified through the National Census 2023 receive special provisions, allowing them to join without financial strain.
Formal sector employees
Employees of government agencies, private companies and NGOs are automatically covered once they are on the payroll. Their contributions are deducted directly by their employers, simplifying the enrollment process.
Self-employed and informal workers
Self-employed persons must register with the Social Security Fund and make monthly payments. Informal workers can choose a subsidized contribution plan, which is calculated based on estimated income and verified through local health office records.
Coverage
Core Benefits
The scheme reimburses inpatient hospitalisation up to the annual limit defined in the 2024 NHIS Implementation Report, and covers outpatient services, maternity and neonatal care, mental health counseling, and a defined list of essential medicines. All services are subject to the annual reimbursement cap.
Mental Health and Essential Medicines
Mental health counseling is included at no cost for adults and children. The essential medicines list follows the national formulary, covering more than 150 essential drugs such as antibiotics, antihypertensives and antimalarials, all reimbursed up to the annual cap.
Enrollment
Online Portal
Enrollment is conducted through the online portal at https://nhis.gov.np. Applicants need a valid citizenship card, proof of residence and a payment receipt. The digital form can be completed in under 15 minutes, and confirmation is sent via SMS.
Local District Health Offices
For those who prefer in-person assistance, enrollment can be done at the nearest District Health Office. The same documents are required, and staff help fill out the form on the spot.
Enrollment Progress and Targets
According to the Ministry’s quarterly performance dashboard, about 1.2 million new members have joined since the scheme’s launch, representing a 28% increase compared with the same period last year.
Enrollment targets are updated monthly based on Ministry of Health data, allowing the government to monitor progress toward the 70% coverage goal and adjust outreach strategies accordingly.
The government aims to achieve coverage for at least 70% of the population within two years, as outlined in its health insurance strategy, and has pledged additional budgetary resources to accelerate enrollment in rural hill districts.
Conclusion
The success of the Nepal health insurance scheme will depend on sustained public awareness campaigns, continued simplification of the enrollment process, and transparent reporting of expenditures. As more citizens join, the country moves closer to achieving universal health coverage and improving health outcomes for all.
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