Nepal - Social Security Fund

Owned by Saurav Bhattarai
Last updated: Jul 24, 2024 by Konstanze Lang
2 min read

Overview

Country/Region

Nepal

Solution

Health Insurance, Employment Injury Insurance

Program Operator

Social Security Fund Nepal

Program type

Employment Injury Insurance , Health Insurance (formal + informal), Migrant scheme

Implemented since

2020

Implementing Partner(s)

GIZ Nepal, ILO

Supporting Partner(s)

Financial Assistance: German Development Cooperation / BMZ

Version

v1.5.1 (build 2021.4.12.1030)

Functionalities used

  • Claims Management

  • Claims Review

  • Reports

Coverage

Nationwide

Number of beneficiaries

6,000,000 beneficiaries (1,5 Mio enrolled)

Number of users

-

Number of health facilities

110

Last update

Jun 2024

Scheme Features

Scheme implemented since
Note: This can be different from openIMIS implementation start date

2020

Number of products managed by the scheme and using openIMIS

2

Number of households covered

N/A

Average size of a household

N/A

Total number of employees using openIMIS

-

Product Features

Household contribution amount

N/A

Individual contribution

31% (20% from employer and 11 % from contributor) of basic salary in formal sector, 21.33% of basic salary (solely by contributors) in migrant sector, 31% of basic salary (solely by contributors) in self employed sector and 20.37% (9 % from contributor and 11.37% from local government) in informal sector workers

 

Average amount paid for a claim

medical (OP and IP) up to NRs. 100 thousand per annum
Accident: up to NRs. 700 thousand for non work related accident , and unlimited coverage for work related accident.

Last Update

Dec 2021

Specifications of the openIMIS used:

Version

v1.1.3 (build 2021.4.12.1030)

Version

v1.1.3 (build 2021.4.12.1030)

Has anything been modified (customization)

Customizations done for interoperability with SSF’s in-house beneficiary and payment management system (SoSYS).

The Insuree Balance booking mechanism has been added via REST API. This update ensures that the balance and premium are updated in real-time during the eligibility check. The live balance check is now seamlessly integrated, providing accurate and up-to-date financial information for users.

What standards are used to code services, items, diagnosis and products

ICD 11 for diagnosis

Internal coding mechanism (same as HIB Nepal) for services and items

 

 

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