Nepal - Social Security Fund

Overview

Country/Region	Nepal
Scheme Operator	Social Security Fund Nepal
Scheme type	Employment Injury Insurance , Health Insurance
Implemented since	2020
Implementing Partner(s)	GIZ Nepal, ILO
Supporting Partner(s)	Financial Assistance: German Development Cooperation
Version	v1.5.1 (build 2021.4.12.1030)
Functionalities used	Claims Management Claims Review Reports
Coverage	Nationwide
Number of beneficiaries	303,000
Number of users	-
Number of health facilities	110
Last update	Dec 2021

Number of households covered	N/A
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
Average size of a household	N/A
Total number of employees using openIMIS	-

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

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).

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