The government has announced plans to restructure Nepal’s national health insurance programme, acknowledging its current shortcomings and pledging legal and institutional reforms to ensure its effectiveness and sustainability.

Presenting the budget for the fiscal year 2025–26 to the joint session of Parliament on Wednesday, Finance Minister Bishnu Paudel said the Health Insurance Act will be enforced more rigorously, with specific emphasis on institutional discipline, leakage control, and reform in service delivery.

To improve the quality and reach of the scheme, the government plans to gradually increase the benefit cap for insured individuals. In addition, multiple public health initiatives will be integrated into the health insurance programme for more efficient resource management.

Insured citizens will be offered the flexibility to choose between different insurance policies based on their needs, while measures will be implemented to eliminate duplication and prevent misuse of services.

Paudel confirmed that existing health insurance coverage will continue for senior citizens, people with disabilities, Dalits, the extremely poor, and minority communities.

A total of Rs 10 billion has been allocated for the programme in the upcoming fiscal year. Furthermore, pending insurance payment claims will be verified through third-party auditing and settled within the current fiscal year.

The budget speech also addressed financial bottlenecks faced by the Health Insurance Board. Due to delays in reimbursements, many hospitals across the country have withheld certain services under the scheme, prompting urgent calls for reform.