If you don’t renew your health insurance on time, you could end up paying as much as Rs 17,500.

The government has introduced a new rule that penalizes people who don’t renew their health insurance on time. According to the new Health Insurance Program Guidelines 2082 BS, those who miss the renewal deadline will now have to pay much more instead of being able to use health services right away.

Under the updated rules approved by Health Insurance Board Executive Director Dr. Raghuraj Kafle, here’s how the penalties work:

  • If you renew within 3 months of expiry, you’ll pay the regular premium (Rs 3,500 for a family of five) plus Rs 350.

  • Renewing within 6 months costs Rs 4,550.

  • Within a year: Rs 5,250

  • After 1 year: Rs 7,000

  • After 2 years: Rs 10,500

  • After 3 years: Rs 14,000

  • After more than 3 years: Rs 17,500

These changes took effect from Asar 24 (July 8).

Critics say the policy punishes citizens instead of helping them

The Health Insurance Board says the goal is to make people renew regularly and stop the habit of only joining when they get sick. "This isn’t a punishment—it’s to keep the system running smoothly," said Board spokesperson Bikesh Mall.

But many experts disagree. Former Board Chair Dr. Gunaraj Lohani said the policy will discourage people from joining at all. "Instead of attracting people, the government is pushing them away. This could collapse the entire program," he warned.

Dr. Ramesh Pokharel, former director of the Board, also criticized the fines. He said unless hospitals improve service quality—like timely treatment, proper infrastructure, and no long waits—the penalties won’t work. Many patients already struggle to get medicines and tests under the current insurance system.

Program losing sight of its original purpose

When the health insurance program was launched in 2071/72 BS, it aimed to provide affordable healthcare for all Nepalis within five years. It promised better services and lower out-of-pocket costs. But experts now say the program is drifting away from those goals.

Public health expert Dr. Sharad Onta said the system should be fairer. "The poor and the rich shouldn’t pay the same premium. That’s not social justice," he said. He also called for broader reforms—more health facilities, better equipment, easier referral systems, and timely hospital payments.

Experts say there’s poor coordination between the Health Insurance Board, hospitals, and the Ministry of Health. On top of that, other similar programs like the Social Security Fund and Citizens Investment Trust are run separately, which weakens the overall impact.

Without serious changes and better service, trust in the system will likely keep falling.

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