Meeting with Health Insurance Board (HIB)

Introduction presentation and summary of questions/anwers:

 more general information on HIB: Annual_Report_Factsheet_Summary_English_2022_23.pdf

• The Health Insurance Board (HIB) in Nepal plays a crucial role in advancing the country’s national health insurance efforts, working to provide broader access to healthcare services and financial protection for its citizens

• The primary objective of the HIB is to ensure that Nepali citizens have access to essential health services without facing financial hardship

• The HIB encourages voluntary registration, particularly targeting low-income families and individuals and the informal sector mainly

• The health insurance program is primarily funded through government subsidies, premiums from enrollees, and contributions from various stakeholders to maintain sustainability

• While the HIB has made significant strides in expanding access to health services, challenges remain, such as increasing coverage in remote areas, ensuring timely reimbursements, and managing the financial sustainability of the program.

• The HIB has been expanded to 749 local levels in all 77 districts. Since the inception of the HIB, 33.19% (2,212,814 households) and 24.7% (7,215,098 individuals) have been enrolled

• The insurance scheme covers healthcare services up to a limit of NPR 100,000 per year per family. This includes outpatient services, inpatient care, maternity care, and essential medicines

• The standard annual premium rate for health insurance under HIB varies based on income levels, but typically NPR 3,500 per household, with government subsidies available for low-income families.

• HIB operates in 77 districts in Nepal

• HIB has been integrating digital solutions such as openIMIS to manage beneficiary data, streamline claims processing, and improve transparency and efficiency in operations.

• HIB often conducts information sessions and outreach programs to educate potential beneficiaries about the enrollment process and the benefits of the health insurance scheme (e.g. Facebook)

• Community health workers are essential to the success of the Health Insurance in Nepal. By facilitating enrollment, educating the community, and promoting access to health services

• Community health workers get a promotion of 10% (of the enrolment fee) for each person who gets insured by HIB

• Enrolment to the HIB is also facilitated by an Android-based app openIMIS. Identity cards with photos of each family member are provided upon enrolment and a receipt provided upon payment of contributions.

• HIB receives approx. 40k claims per day

• HIB has data of burden of diseases, mortality etc. However, these data are not public yet but there is a regular analysis of this data

Showcase of openIMIS App

Key Features of openIMIS App for HIB

• The app allows for efficient registration of beneficiaries,

• Users of the app can easily access and manage data related to beneficiaries, treatments provided, and claims history. This centralized data management improves operational efficiency and data accuracy.

• HIB can track service utilization, claims processing times, and overall program performance through analytics provided by the app.

• The app is designed to integrate with existing health management information systems, allowing for seamless data exchange and ensuring that all relevant health data is captured in one place.

• The openIMIS app can be configured to support local languages, ensuring that users can effectively communicate and operate within the system using familiar terms.

• Other countries and scheme can use the app free of charge and adapt it to their needs and language