Health Insurance Board’s First Service Point Decision Sparks Confusion Among Insured

Kathmandu — A recent circular issued by the Health Insurance Board regarding the designation of “first service points” under Nepal’s health insurance scheme has caused widespread confusion among the insured public.

The circular, based on the Health Insurance Act, 2074 (Second Amendment) and Health Insurance Regulations, 2075 (First Amendment), states that effective from Shrawan 1, 2082, only government health institutions will be recognized as the first service point under the national health insurance system. This means community and private health facilities, which had previously been operating under this status, will no longer be included.

This shift in policy has led to misunderstandings, with many interpreting the circular as the complete removal of the “first service point” requirement and the associated need for referrals. The misinterpretation gained traction on social media after the internal circular began circulating among the public.

Previously, the Board had also considered some key non-government hospitals such as Dhulikhel Hospital, Bayalpata Hospital, AMDA Hospital, and Chaurjahari Hospital as first service points. However, under the new directive, these institutions will lose this designation from Shravan 1 onward.

According to Information Officer Bikesh Malla Thakuri, the Board had not intended to cause public confusion, noting that the circular was originally targeted at health service providers.

The Board has cited Sub-section 6 added to the Health Insurance Regulations (First Amendment), which clearly defines a first service point as a government health institution. This aligns with the provisions already stated in the Health Insurance Act.