Missing health insurance renewal deadline could cost up to Rs 17,500

The Government of Nepal has introduced a new policy that imposes steep financial penalties on citizens who fail to renew their health insurance on time. Under the updated Health Insurance Program Implementation Guidelines 2082 BS, individuals who miss their renewal deadlines will face escalating fees—instead of receiving services—based on how long they delay.

According to the Health Insurance Board, the standard annual premium for a family of five is Rs 3,500, which provides up to Rs 100,000 in healthcare coverage. However, if the policy isn't renewed on time, the cost increases:

  • Within 3 months: Rs 3,850 (Rs 3,500 + Rs 350 late fee)

  • Within 6 months: Rs 4,550

  • Within 1 year: Rs 5,250

  • After 1 year: Rs 7,000

  • After 2 years: Rs 10,500

  • After 3 years: Rs 14,000

  • More than 3 years: Rs 17,500

The revised schedule, approved on Asar 24 (July 8) by the Board's Executive Director, Dr. Raghuraj Kafle, aims to reduce the trend of people renewing only when they fall sick. “This isn’t punishment—it’s an incentive to maintain continuous coverage,” said Board spokesperson Bikesh Mall.

Growing criticism over the policy

Health experts and former officials, however, have criticized the move. Dr. Gunaraj Lohani, former chair of the Health Insurance Board, said the high penalties might discourage people from joining the program at all. “Instead of encouraging people, this may push them away and weaken the entire insurance system,” he warned.

Dr. Ramesh Pokharel, another former director, added that penalties won’t solve the problem if service quality remains poor. He pointed to delays in hospital payments, lack of proper facilities, and long wait times as persistent issues. Many citizens also report difficulty accessing medicines and diagnostic services under the program, leading to frustration.

Experts say original goals are being ignored

The health insurance program, launched in fiscal year 2071/72 BS, aimed to provide universal healthcare access, reduce out-of-pocket expenses, and improve service quality. But public health experts now argue that the program is drifting away from its original goals.

Dr. Sharad Onta, a public health expert, stressed the importance of a welfare-based model where people contribute based on their ability and receive care based on need. “It’s unfair to charge the same premium to both billionaires and the poor—it defeats the purpose of social justice,” he said.

Experts have called for major reforms, including better-equipped healthcare facilities, a simpler referral process, timely hospital payments, and stronger coordination between the Health Insurance Board, health institutions, and the Ministry of Health.

They also noted that other social protection programs—like the Social Security Fund, Employees Provident Fund, and Citizen Investment Trust—are operating separately with little coordination. Without unified oversight and reliable service delivery, public trust in the health insurance program is likely to keep eroding.

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