Health insurance district office in Chitwan (Nepal)

Owned by Konstanze Lang
Last updated: Aug 02, 2023
2 min read

Background info

  • Chitwan district with population of 720.000 (made up by 7 municipalities), out of them 449.000 people (60%) insured under HIB; 6 HIB empanelled hospitals

  • In charge of all administrative processes on district level eg. managing enrolment, organising community events for awareness (of health insurance offer / services), trouble shooting on insurance related issues (no claims review or management at this level!)

 Enrolment

  • formal Coordination Committee of HIB under municipality government in place formed by representatives of HIB and hospitals empanelled under HIB, this committee develops strategy on raising enrolment level and service quality at medical service providers

  • Enrolment assistants directly visit households to enrol people, commission of 10% on each enrolment is paid to the enrolment assistant as incentive

  • National Social Health Insurance is a voluntary program, based on family contributions; families of up to five members have to contribute NPR 3,500 per year and NPR 700 per additional member

  • premium per year for 1 household - up to 5 people - about 763 USD (100.000 NRP), since 2023 premiums can be paid via app and mobile wallet

  • subsidies for the registration fee of 100%, 50% and 25% are provided (paid) by the government for ultra-poor, poor and marginalised groups respectively, based on a poverty card 

  • Process:

    • Enrolment assistants collect data in the enrolment form + copy of proof of citizenship (national ID), take picture and hand over an insurance card (enrolment form and insurance card are linked by an identification number)

    • one form is filled in for each family member so that they all receive separate insurance cards; forms for one family will all be linked to the (marked) head of household; in openIMIS you can see all family members belonging to one household

    • Enrolment officers at the health insurance disctrict office have divided enrolment (data) entry on newly enrolled people by area (address of beneficiary), in case of Chitwan district office 7 municipalities overall - covered by 5 enrolment officers; enrolment officers

    • Enrolment has to be done manually to combine data entry with verification of documents; but re-newel can be done online via mobile app

 

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