Table 1. Key Features of NHIP .
| Features | Description |
| Roll out year | - April 2016 |
| Administration | - Currently administered by an autonomous Health Insurance Board (During the implementation of this study, the scheme was administered by Social Health Security Development Committee, a semi-autonomous body) The board provides membership cards, makes decisions on contribution amounts, develops mechanisms for subsidies to poor and disadvantaged groups, as well as negotiates with service providers on benefit package, their costs and deals with provider payments |
| Membership | - Voluntary scheme based on family contributions20 |
| Sources of revenue | - Budget allocated by Government of Nepal - Premium contributions from households where families with up to 5 members contribute NPR 2500 (US$21.59a) per year and NPR 425 (US$3.67) per additional member13,20 |
| Exemptions | - 100% exemption in annual premium for ultra-poor, 75% for poor and 50% for marginalized20 |
| Service delivery channels | - Public Health Facilities - Private health facilities selected through contracting |
| Benefit Package | - Benefits of up to NPR 50 000 (US$431.70) per year are provided to insured families of up to 5 members with an additional NPR 10 000 (US$86.34) covered for each additional member. The maximum amount of benefit available to a family per year is NPR 100 00020 - Covers emergency services, outpatient consultations, selected inpatient services, drugs and diagnostic services - Includes 928 types of medicines13 |
| Co-payments | - No co-payments or other cost sharing arrangements |
| Exclusion list | - Services considered to be unnecessary or very expensive are on the exclusion list - Excludes cosmetic surgery, spectacles costing more than NPR 500 (US$4.32), hearing aids, artificial insemination, dental services and treatment for injuries suffered in a drunken brawl20 |
| Provider payment mechanisms | - Case-based payment for outpatient and emergency services - Fee for service for inpatient and diagnostic services |
| Claim management | - Service provider health institutions submit claim to Health Insurance Board through IMIS - Health Insurance Board reviews and approves the claim for reimbursement to service provider health institutions |
| Information system used | - Uses an internet-based IMIS. This system is used for registration of membership and renewal, claim management, feedback and reporting |
Abbreviations: NPR, Nepali Rupees; NHIP, National Health Insurance Program; IMIS, insurance management information system.
aNote: 1 US dollar equivalent to 115.82 NPR based on exchange rate of Nepal Rastra Bank.22