The Health Insurance Board (HIB), the government body managing Nepal’s national health insurance program, announced it will make the National Identity Card, a federal multi-purpose certificate containing biometric and demographic details of Nepali citizens, mandatory for citizens aged 16 and older to enroll, renew, and access health insurance services starting mid-December (Pus 1, 2083 BS). This move is part of a broader digital transformation aimed at streamlining the program and enhancing service delivery.
Dr. Subash Pyakurel, president of HIB, stated that a new digital system will consolidate detailed information on service access, making the health insurance program more effective. This system will also help identify misuse of services or instances where beneficiaries are deprived. The HIB decided to adopt a technology-friendly system for beneficiary identification, claims management, and service procurement, expecting improved personal detail updates, enhanced reliability, and scaled-up services.
The Board will issue a public notice requiring all insured families, across both general and targeted categories, to update their details through HIB’s electronic system. This measure aims to curb duplicate enrollments and ensure accurate beneficiary identification.
HIB also decided to form a task force to study strategic procurement, aiming for scientific, cost-effective, and sustainable health service procurement and payment systems. This task force is mandated to submit a report within two months of its formation, covering criteria for selecting providers, service classification, payment methods, contractual standards, and a phased implementation plan.
In a move to reduce reliance on manual processes, the Board will recognize health-related details and treatment claims obtained from health institutions through electronic health record systems. This aims to gradually reduce handwritten medical prescriptions and paper-based records. HIB also plans to utilize data from electronic health records in future claim verification systems based on artificial intelligence and machine learning, enabling the identification of unusual or suspicious claims.
Nepal’s health insurance program commenced in Kailali district on April 7, 2016 (Chaitra 25, 2072 BS). As of April 7, 2026 (Chaitra 25, 2082 BS), approximately 7.74 million people, representing 26.54 percent of the total population, are enrolled. The program has expanded to all 77 districts and 750 local levels, achieving nationwide coverage. For the current fiscal year, the government has allocated Rs 10 billion in subsidies, while Rs 3.73 billion was collected in premiums last fiscal year, bringing the total fund to approximately Rs 14 billion. HIB had previously mandated the acceptance of digital insurance cards by all service providers on March 7, 2024 (Falgun 24, 2080 BS).
Despite its expansion, the program faces challenges such as resource scarcity and payment crises, leading to delays in reimbursing hospitals. The government aims to enroll all citizens in the health insurance program by 2090 BS and HIB is also preparing to make health insurance mandatory for government employees.
However, the exact formation date of the strategic procurement task force is not specified, making the precise deadline for its 60-day report unclear. Furthermore, while the National Identity Card distribution campaign began on November 19, 2018 (Mangsir 3, 2075 BS), and a goal was set to distribute cards to all Nepalis within a year by July 28, 2026 (Shrawan 13, 2083 BS), the current number of citizens who have received their National Identity Cards is not readily available. This lack of data could pose challenges to the mandatory implementation.
