Nepal - Health Insurance Board
Overview
Country/Region | Nepal |
|---|---|
Solution | |
Program Operator | Health Insurance Board (HIB) Nepal |
Program type | National Social Health Insurance |
Implemented since | 2016 |
Implementing Partner(s) | HIB, GIZ Nepal, and https://openimis.atlassian.net/wiki/spaces/OP/pages/835682333 |
Supporting Partner(s) | Financial Assistance: German Development Cooperation / BMZ |
Software Developer(s) | https://openimis.atlassian.net/wiki/spaces/OP/pages/3723985388 |
Version |
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Functionalities used |
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Coverage | Nationwide, 749 local levels in all 77 districts of Nepal |
Number of beneficiaries | March 2025: 9 Mio individuals Jan 2025: Since the inception of the HIB, 2,212,814 households (33.19%) and 7,215,098 individuals (24.7%) have been enrolled. |
Number of users | 7147 |
Number of health facilities | 375 |
Status |
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Last update | March 2025 |
Scheme Features
Health scheme implemented since | 2016 |
|---|---|
Name of openIMIS focal point | Mr. Suresh Tinkari |
Total number of health scheme employees | - |
Total number of employees using openIMIS | 7147 |
Total number of employees not trained on openIMIS | - |
Number of health insurance products managed by the health scheme and using openIMIS | 3 |
Product Features
Number of households covered | 2,212,814 households (33.19%) |
|---|---|
Average size of a household | 4.6 |
Household contribution amount | NPR 3500 |
Individual contribution | - |
Average amount paid for a claim | - |
More info / references:
Nepal’s Digital Health Insurance Showcased as a Model for Person-Centered Care in World Bank Report (Dec 2025): The @WorldBank’s new publication, Digital Transformation for Person-Centered NCD and Mental Health Care, explores how digital health can revolutionize care for non-communicable diseases (NCDs) and mental health. With a focus on prevention, early detection, and long-term management, the primer highlights the power of digital tools to make healthcare more accessible, integrated, and person-centered – especially in resource-limited settings. Nepal’s digitally managed National Social Health Insurance (NSHI) scheme is featured as a case study (see pages 64-65)! Using the openIMIS platform, the Health Insurance Board of Nepal has streamlined enrollment, claims processing, and service delivery for over 9.2 million beneficiaries across all 77 districts. By combining digital innovation with financial protection, the NSHI ensures that families – especially those below the poverty line – can access essential NCD and mental health care without facing catastrophic expenses.
Recording of presentation by HIB (May 2025) Enhancing Health Financing System in Nepal: The Role of openIMIS in Advancing UHC
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
Study tour country delegations Senegal, Zambia, Ethiopia (with EU / ILO support) to Nepal, documentation of presentation by HIB (Jan 2025) - see agenda Study Tour & Formal Sector Requirements Workshop Nepal - openIMIS - openIMIS Wiki
HIB implementation mentioned in ‘Policy Basket’ of the “Alliance to end Hunger and Poverty” (September 2024) Nepal: openIMIS
Funder Group (BMZ+SDC) field trip to Nepal, documentation of visit to HIB (March 2023) Health Insurance Board Nepal - openIMIS - openIMIS Wiki
Article on openIMIS: Health and social protection’s digital backbone – Healthy DEvelopments, refering to country implementations among them Nepal / HIB (June 2020)
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