Govt’s Health Insurance Program settles only 66.49 pc claim

Kathmandu: The claim settlement ratio of Health Insurance Program run by the Health Insurance Board(HIB) is only 66.49 percent. According the 6 years’ date unveiled by the HIB, out of the total claim of Rs. 25.25 billion only Rs. 16.79 billion has been paid.

The board has stated that Rs. 6.5 billion has been paid under health insurance claims during the current fiscal year while Rs 7.43 billion remains unpaid. According to the officials of the Board, the incomplete documents and claim beyond the insurance coverage has resulted huge differences between claim received and claim intimated.

Though the program is running on the seventh year, so far only 20.03 percent of the total population or 5.3 million 4 thousand 270 people has been insured.  Out of them, 39.39 percentage of the total enrolled population have continued the participation in this program.

The current year’s renewal rate of HIP is only 70 percent. Till date, the total number of insured families is 1.615 million 689 or 29.67 percent of total households.

Similarly, the number of insured members of extremely poor families in this program till now is 4 lakh 88 thousand 4. There are  634,735 families of senior citizens, 25,289 families of HIV infected, 93,629 families with severe disabilities, 2,849 families of leprosy patients, 2,474 families of MDR tuberculosis and 83 thousand 626 families of women health volunteers are included in this program.

The HIB has signed agreements with 441 local government and private health institutions for offering health services. Majority of the health insurance recipients are from Province No. 1 while Karnali Province has the poorest enrollment followed by Madhes Province.

The HIB has stated that all the claims have been paid by mid-Kartik. Now, after mid-Kartik, five months’ payment is yet to be paid, the board said. From the premium collected from the insured, the health insurance board cannot support all the programs and manpower for which the board needs government grant. The government has been providing Rs 7 billion in grants to the HIB every year but due to exceeded number of enrollment and claim, the grant will not be enough to cover all the expenses.

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