Private Hospitals Removed from First Point of Care Under Health Insurance Scheme

Kathmandu – The Health Insurance Board has decided to remove private hospitals from the list of first point of care centers under the national health insurance program, effective from Shrawan 1 (July 17).

This move comes by Sub-section (6) of Section 9 of the Health Insurance Act, 2074 (Second Amendment) and Clause (6) of Rule 2 of the Health Insurance Regulations, 2075 (First Amendment), which clearly state that only government hospitals shall serve as the initial service point for insured patients.

The Board has formally issued a letter to enforce this provision, clarifying that the implementation will be effective from the start of the new fiscal year. As a result, patients enrolled in the health insurance scheme must now first seek services at designated government hospitals before being referred elsewhere if necessary.