Health Insurance in Nepal | Eye Health Treatment Package

By Eye Health Nepal Last updated May 23, 2021

Here is the details of Health Insurance in Nepal and its coverage for Eye Health Treatment

Social Health Security Progam, Health Insurance is the Government program based on the comprehensive social contributory scheme with the subsidy to the poor and Universal Health Coverage.

Objective:

To ensure access to quality health service (equity & equality).
To protect from financial hardship and reduce out-of-pocket payments.

Features of Health insurance in Nepal:

Contributory/Family Based
Subsidy to Poor
Purchaser and Provider Split
Cash-less (Upper Cap )
IT-based (IMIS)
Public and Private Providers

Major features of the Social Health Security Program (Health insurance) of Nepal

Universal coverage: People of all ages are eligible.
Family size: five members. Additional members can be added.
Premium payment is annual. Annual renewal.
Registration: door to door visit by enrollment assistance.
Co-payment: yes for medicine but not for free medicine
Referrals: Available in central, regional and zonal hospitals.
Premium: NPR 3500 for five members of the family per year, NPR 700 for each additional member of the family per year
The HIB has the provision to provide subsidy for the poor and vulnerable to get enrol into the scheme (100% subsidy for ultra-poor families, elderly population, Female community health

volunteers and patients with HIV/AIDS, MDR-TB, Leprosy, Null-Disability.

Benefit package

The benefits package consists of services from primary health care centres, hospitals and public and private referral hospitals including outpatient, inpatient and emergency care. The ceiling is NPR 100,000 per year per family of up to 5 members, with an extra NPR 20,000 for each additional member (up to a total of NPR 200,000). In addition, there is an additional benefit of NPR 100,000 for every elderly population and for each case of chronic diseases.

Does National Health Insurance (Social Health Security Program) Cover for Eye treatment?

Yes, it covers eye examination fees, medicines, surgeries and eyeglasses.

Where insurance holder of the National Health Insurance program need to go for Eye Treatment?

Tilganga Institute of Ophthalmology, Kathmandu, Nepal has a separate registration system for national health insuree of Nepal, they get cashless registration, cashless eye examination, medicine, cashless surgery and eyeglasses up to Rs 1000 per year per person. For Bhaktapur district, BP eye foundations, District Community Eye Centre is providing cashless eye care services to National Health Insurees.

Here is the detailed list of all eye hospitals of Nepal where you can get cashless insurance covered eye treatment.

Eye Health Service providers health institutions (Eye Hospitals Providing Health Insurance Service)

Province 1

Mechi Eye Hospital
Mechi Drishti Eye Hospital, Birtamod
Birtamod Eye Hospital P. LTD
Eye Care Center Khotang
Biratnagar Eye Hospital
District Community Eye Center Solukhumbu

Province 2

Sagarmatha Chaudhary Eye Hospital, Lahan
Nava Dristi Eye Hospital Pvt. Ltd, Sunsari
Janaki Eye Hospital, Janakpur
R.M Kedia Eye Hospital, Birgunj
Kiran Eye Hospital, Birgunj
Birgunj Drishti Eye Care Centre Pvt. Ltd
Gaur Eye Hospital, Rautahat

Bagmati Province

District Community Eye Center, Bhaktapur
B P Eye Foundation, CHEERS, Bhaktapur
Bharatpur Eye Hospital, Chitwan
Reiyukai Eiko Masunaga Eye Hospital, Kavrepalanchok
Tilganga Institute of Ophthalmology, Kathmandu
Hetauda Community Eye Hospital, Makawanpur
District Community Eye Centre, Ramechhap

Gandaki Province

Himalaya Eye Hospital, Kaski

Lumbini Province

District Eye Care Center, Arghakhanchi
Fateh Bal Eye Hospital Nepalgunj, Banke
Rapti Eye Hospital, Dang
Palpa Lacoul Eye Hospital, Palpa
Kali Gandaki Eye Care Centre, Palpa
Lumbini Eye Institute & Research Center, Rupandehi

Karnali Province

Eye Hospital Salle Rukum
Surkhet Eye Hospital, Surkhet

Sudurpaschim Province

Geta Eye Hospital, Kailali

Eye Health Package

1. Eye hospital OPD package: Rs 200 Per Visit

Eye hospital OPD package includes – Consultation, Slit lamp examination, Refraction test, Eye Pressure and Eye dryness test

2. Eye hospital Emergency package :Rs 400 per visit

Eye hospital Emergency package includes – Consultation, Slit lamp examination, Refraction test, Eye Pressure, Eye dryness test and Foreign body removal eye

3. Surgery and Medicine Pacakage

As mentioned on the list below

List of Insurance Covered Eye Surgical / LASER Services : View in PDF

4. Optical (Eye Glasses) Coverage

For Eye glasses insuree have the limit of NRs 1,000 each members per years, which means the insurance members having refractive error will not have to pay for their eyeglasses up to NRs 1,000.

Additional Information

There is cash-less system for Health Insurance members seeking health services, upon presenting their SHSP membership card at a above mentioned eye hospitals / contact point, members are able to receive the eye health services, medicine and spectacles covered by the benefit package without having to pay at any stage

For emergencies, insures can access eye care services and other health services from any service point without a referral slip.

Health insurance