Table 1. Features of Nepal’s Social Health Insurance Program .

Features	Description
Roll out year	April 2016. The program was rolled out in Pokhara (Kaski district) from December 2016. At the time of the study, the program was being rolled out in 42 districts; 30 districts had completed their 1-year enrolment cycle.
Administration	Administered by HIB, an autonomous body established under Health Insurance Act, 2018. The board provides membership cards, contracts and negotiates with service providers on benefit package, their costs and deals with provider payments.
Sources of revenue	Budget allocated by Government of Nepal. Premium contributions from households where families with up to five members contribute NPR 3500 (US$29.37a) per year and NPR 700 (US$5.87) per additional member. 2% payroll contribution from formal sector not exceeding NPR 10 000 (US$839.20) per year (1% contribution each by the employee and employer).
Exemptions	100% exemption in annual premium for families of ultra-poor, severe disability, leprosy, HIV infected, complicated TB cases (MDR-TB). 100% exemption for senior citizens aged 70 years or above. 50% exemption for female community health volunteers.
Pooling arrangements	Single pool at national level managed by the HIB.
Service delivery channels	Public health facilities as first point of contact. Private health facilities selected through contracting - for emergency and referral services.
Benefit Package	Benefits of up to NPR 100 000 per year are provided to insured families of up to five members with an additional NPR 20 000 (US$167.84) covered for each additional member. The maximum amount of benefit available to a family per year is NPR 200 000 (US$1678.41). 18 Benefits of up to NPR 100 000 per year to be utilized only by senior citizens aged 70 years or above. Additional NPR 100 000 for treatment of cancer, cardiovascular disease, kidney disease, head injury and spinal injury, sickle cell anemia, Parkinson disease and Alzheimer disease. Covers emergency services, outpatient consultations, inpatient services, surgeries, drugs, and laboratory tests, radiological and other diagnostic services. Includes over 1000 types of medicines including 25 types of ayurvedic medicines. 19
Co-payments	No co-payments or other cost sharing arrangements in practice.
Exclusion list	Ambulance services other than during emergency. Plastic and cosmetic surgeries except for treatment related to burns, severe disability and surgery for cleft lip and palate. Spectacles, hearing aids, white canes and crutches costing more than the price determined by the HIB. Dental services except extraction, draining of abscess and primary management of dental injuries (trauma). 18
Provider payment mechanisms	Case-based payment for outpatient and emergency services. Fee for service for inpatient and diagnostic services.
Renewal	Families need to renew their membership one month prior to the end of membership period. Families that are not able to utilize any amount from the benefit package are offered 10% discount in the annual premium during the renewal for next year.

Abbreviations: HIB, Health Insurance Board; MDR-TB, multi-drug resistant tuberculosis; NPR, Nepali Rupees; TB, tuberculosis.

^a 1 USD equivalent to NPR 119.16 based on exchange rate of Nepal Rastra Bank for July 30, 2021.