Quick Answer (TL;DR)

Swasthya Bima (HIB): Rs 3,500/year = Rs 100,000/year coverage for a 5-member family. Enroll via ward enrollment assistant or hib.gov.np, choose your first service point, wait ~30 days, then get cashless treatment at listed hospitals. Renew yearly — lapse means fresh waiting period.

Premium vs Coverage Table

Family up to 5 membersRs 3,500 premium → Rs 100,000 coverage/year
Each extra member (6th+)+Rs 700 premium → +Rs 20,000 coverage each
Subsidy (ultra-poor, Dalit, senior, FCHV etc.)50–100% premium waived per HIB directive — ward certifies (confirm the current subsidy schedule on hib.gov.np)
Senior 70+ / disabled (targeted)Additional state support is commonly reported — check the live HIB senior-package notice on hib.gov.np; package content changes by notice and could not be pinned to a single figure as of October 2026

Note: budget speeches often propose raising the ceiling (e.g., to Rs 200,000–500,000). Until HIB publishes a new directive, the Rs 100,000 base is the enforceable figure — always check hib.gov.np notice before quoting a higher number.

How to Enroll — Step by Step

  1. Contact your ward enrollment assistant or HIB camp with citizenship of head + family members’ citizenship/birth registration + photos + contact
  2. Fill family form, select first service point (hospital/PHC) — this is where you must go first
  3. Pay premium via assistant / HIB counter / online → get receipt + enrollment slip
  4. Collect Bima card after printing (2–4 weeks) — coverage starts after 30-day waiting period
  5. Online: pre-fill on hib.gov.np → enrollment, then verify in person at ward

How to Use & Claim

  • Go to your first service point first with Bima card + ID — direct OPD at higher hospital without referral is rejected (except emergency)
  • Treatment is cashless up to ceiling — hospital claims HIB; you pay only over-ceiling + non-covered items
  • Covered: OPD, emergency, drugs in HIB list, lab, surgery, maternity within package limits
  • Not covered: cosmetic, non-listed drugs, treatment abroad, above-ceiling balance

Renewal, Waiting Period & Mistakes

RenewalCommonly reported as within ~3 months of expiry — confirm the current grace/renewal window in the live HIB notice on hib.gov.np, as it changes by directive; renew via assistant before lapse; late renewal is commonly reported as triggering a fresh waiting period
Waiting period~30 days for new enrollment before first claim (emergency excepted per directive)
Top mistake #1Skipping referral — going straight to Bharatpur/Bir hospital without PHC referral slip
Top mistake #2Letting card lapse — family must re-wait 30 days after re-enrollment

Official Sources & Final Note

Source: Health Insurance Board (hib.gov.np) enrollment directive + Health Insurance Act 2074. Ceiling/premium revise by Board notice — verify before enrolling.

Last updated: September 27, 2026. SolutionsNepal is an educational guide, not HIB.

Frequently asked questions

What is the premium and coverage?

Family up to 5 members: Rs 3,500/year premium for Rs 100,000/year coverage. Each extra member: +Rs 700 premium for +Rs 20,000 coverage. Ultra-poor, senior and targeted groups get 50-100% subsidy. Verify current notice on hib.gov.np — expansion proposals are announced almost yearly.

Where do I enroll?

At your ward enrollment assistant, HIB enrollment camp, or online pre-registration on hib.gov.np. You need citizenship + family details + photo + premium payment. Card activates after ~30 days waiting period.

Which hospitals accept it?

Listed public + private/community hospitals nationwide — primary point is your first service point (usually nearest PHC/hospital). Referral needed for higher-level care except emergencies. Check the live facility list on hib.gov.np (facility counts change — verify the live list; figures here as of October 2026).

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Written by SolutionsNepal Team

Nepal public-service researchers