How to enroll in the Swasthya Beema Board scheme - get up to NPR 1,00,000 cashless healthcare coverage for a family of five across public hospitals.
The National Health Insurance Program (Rastriya Swasthya Beema Karyakram) is a social health protection system established under the Health Insurance Act 2074. Administered by the semi-autonomous Health Insurance Board (HIB / स्वास्थ्य बिमा बोर्ड), it pools community financial risk to guarantee equitable, affordable access to essential inpatient, outpatient, and diagnostic healthcare services across all 77 districts of Nepal.
Over 60% of total healthcare spending in Nepal is paid out-of-pocket by patients at hospital cash counters, frequently forcing families to sell land, livestock, or borrow from local moneylenders at 24% interest. The government scheme ensures that for just NPR 3,500 per year (less than NPR 10 per day for an entire family), everyday illnesses, lab tests, emergency care, and essential medicines are completely covered.
Each municipal Ward has an official Enrollment Assistant (Darata Sahayogi). Contact your Ward office or Darata Sahayogi with citizenship cards of adults and birth certificates of children.
Pay NPR 3,500 for a family up to 5 members (add NPR 700 per person for members 6+). Extremely poor families (identified by poverty identity cards), FCHVs (50% discount), and severely disabled citizens receive fully subsidized enrollment.
Choose your primary health post, primary hospital, or district hospital as your Pratham Sewa Bindu. All routine care must originate here.
Present your digital Health Insurance Card at the hospital counter. Routine care is cashless. If advanced surgery or tertiary care is needed, your FPOC issues a formal Referral Slip (Refer Purji) to specialized hospitals (e.g., Bir Hospital, TUTH Teaching Hospital).
| Household Category | Annual Family Premium | Annual Medical Cover Limit | Special Subsidies & Exemptions |
|---|---|---|---|
| Standard Family (Up to 5 Members) | NPR 3,500 / year | Up to NPR 1,00,000 / family | Covers OPD, IPD, labs & listed medicines |
| Large Family (6+ Members) | NPR 3,500 + NPR 700 / extra person | Up to NPR 1,00,000 + NPR 20k / extra member (max 2L) | Proportional cap expansion |
| Senior Citizens (Age 70+) | 100% Free (Government Paid) | NPR 1,00,000 (Individual cover) | Exclusive envelope not shared with family |
| Severely Disabled / Ultra-Poor | 100% Free (Government Subsidized) | Up to NPR 1,00,000 / family | Requires Red/Blue disability or Poverty card |
| Female Community Health Volunteers (FCHV) | 50% Discount (NPR 1,750 / year) | Up to NPR 1,00,000 / family | Recognized community service incentive |
While the SBB scheme is operational nationwide, users often experience administrative friction: long pharmacy queues, stock-outs of government-listed medicines forcing out-of-pocket purchases at external pharmacies, and bureaucratic referral hurdles. However, for chronic disease patients needing monthly medications (blood pressure, diabetes, thyroid) and standard diagnostics, the scheme saves tens of thousands of rupees annually.
Hari suffered from chronic kidney stones requiring urological surgery, while his wife required daily diabetes and hypertension medications costing NPR 2,500 every month. The private hospital quoted NPR 80,000 for his surgery, which would have forced him to sell a milking buffalo.
He enrolled his family in the Swasthya Beema Board scheme through his Ward Darata Sahayogi for NPR 3,500. His surgery at Bharatpur Government Hospital was completed completely cashless under the NPR 1,00,000 ceiling, and his wife receives her monthly diabetes and BP medications free of cost through the hospital pharmacy.
Goal & Dilemma: Covering routine healthcare for a family of 4 in Pokhara with aging parents.
All immediate family members residing in the same household under one kitchen.
Flat annual government contribution for up to 5 family members.
Additional fee for each member beyond the base 5-member threshold.
Maximum cashless treatment limit provided per family per fiscal year.
Family of 7 members enrolling in SBB. Annual premium = 3,500 + (7 - 5) * 700 = 3,500 + 1,400 = NPR 4,900/year. Total family coverage ceiling = 1,00,000 + (2 * 20,000) = NPR 1,40,000 in cashless healthcare benefits.
Going directly to a central tertiary hospital in Kathmandu without a referral slip.
Always visit your designated First Point of Contact (FPOC) first to get a formal Refer Purji.
Forgetting to renew the policy annually before the expiry deadline.
Renew your subscription every year during your enrollment quarter via your Darata Sahayogi or eSewa/Khalti.
Assuming the government card covers private corporate hospitals.
Care is strictly restricted to designated government and contracted community hospitals.
Yes. You can renew your annual subscription digitally via digital wallets like eSewa and Khalti by entering your Health Insurance Card number.
Yes! Unlike private insurance, the Government Health Insurance Board covers pre-existing diseases (hypertension, diabetes, heart conditions) from Day 1 without exclusion.
Yes. Any Nepali citizen aged 70+ can be enrolled individually 100% free of cost by the local ward, receiving a dedicated NPR 1,00,000 benefit card.
Under the Health Insurance Board (स्वास्थ्य बिमा बोर्ड - HIB), a family of up to 5 members pays NPR 3,500 per year for up to NPR 100,000 in medical benefits. Each additional family member costs NPR 700 for NPR 20,000 extra coverage.
No. You must first visit your registered Primary Service Point (First Point of Contact). A tertiary hospital can only be accessed with an official referral slip, except during medical emergencies.