Nepal - Social Security Fund
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 worker scheme |
Implemented since | 2020 |
Implementing Partner(s) | |
Supporting Partner(s) | Financial Assistance: German Development Cooperation / BMZ |
Version | v1.5.1 (build 2021.4.12.1030) |
Functionalities used |
|
Coverage | Nationwide |
Number of beneficiaries | March 2025: 9.7 Mio beneficiaries (2.436.389 Mio enroled / members) *With relatively small formal sector of around 30% of the country’s workforce, over 22,000 employers are currently registered with the SSF. (Oct 2025 / SSF) |
Number of users | - |
Number of health facilities | 110 |
Status |
|
Last update | March 2025 |
Scheme Features
Scheme implemented since | 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 |
Last Update | Dec 2021 |
Specifications of the openIMIS used:
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 |
More info / references:
Study tour country delegations Senegal, Zambia, Ethiopia (with EU / ILO support) to Nepal, documentation of presentations by SSF (Jan 2025) - see agenda Study Tour & Formal Sector Requirements Workshop Nepal - openIMIS - openIMIS Wiki
Potential for AI in Health Insurance, as part of contribution to Amref - GIZ - ADB Learning Exchange on AI in Health Insurance (March 2025), scroll down to country presentation by Nepal HIB/SSF AI in Health Insurance (Learning exchange with Amref) - openIMIS - openIMIS Wiki
SSF implementation mentioned in ‘Policy Basket’ of the “Alliance to end Hunger and Poverty” (September 2024) Nepal: openIMIS
SSF presentation (recording) on Status of program management with openIMIS in Nepal, during AeHIN hour (April 2024) AeHIN Hour - Status of @openIMIS in Nepal
Funder Group (BMZ+SDC) field trip to Nepal, documentation of visit to SSF (March 2023) Social Security Fund Nepal - openIMIS - openIMIS Wiki
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