Eye Health Package in National Health Insurance Program - Nepal

Government of Nepal (GoN) has employed national health insurance policy known as “health care package” in fiscal year 2072-73 from Kailali, Baglung and Ilam. Now the health insurance service has been expanded to all seven provinces and almost all districts of Nepal. To join the insurance program a five-member family has to pay Rs. 3500 a year in order to obtain the health benefits worth up to one hundred thousand Nepalese rupees (1 lakh). If a family has more than 5 members then it costs Rs. 700 for each member per annum that furnishes the health benefits of additional Rs. 20, 000 each.

 

 

If one is a job holder in government office or any other private institute, then 1% of the basic salary of the employee will be deducted annually from his account with additional 1% contribution from the office in order to participate in the health insurance program. However, the annual pay from the side of an employee cannot exceed Rs. ten thousand, that is to say however high is the salary of a staff; he will have to pay Rs. ten thousand at maximum annually. For a person aged 70 years and above, the premium amount is Rs. 3500 each which results in an annual health benefits worth Rs 1 lakh each.

 

 

This insurance program has encompassed overall health conditions including mental health, ENT and eye. This is a matter of great pride that Nepal has shown its firm commitment to the WHO's recommendation to integrate eye health in the mainstream health system. This integration also closely aligns with the theme of Universal Health Coverage which states no one should be left behind from obtaining health care. This article is focused on eye health packages and summarizes the following information:

     ·       Province wise distribution of eye health institutions and eye centers that provide eye health services under the national health care package i.e. eye centers affiliated to national insurance program

     ·       Eye Health services and the amount offered by the insurance are discussed in major six topics:

1.    Eye hospital OPD and emergency package

2.    Investigation package

3.    Procedure package

4.    Surgery package

5.    Medicines / drugs

6.    Eye glasses

Coming to the first part, here is the list of eye institutes that are providing health insurance packages:

Eye Health Institutions under National Health Insurance Program

Province #1

District	SN	Eye Centers/Hospital
Jhapa	1	Mechi Eye Hospital
	2	Mechi Drishti Eye Hospital, Birtamod
	3	Mechi Netralaya & Opthalmic Research Center
Khotang	4	Eye Care Center
Morang	5	Biratnager Eye Hospital
Solukhumbu	6	Distrcit Community Eye Center Solukhumbu
Sunsari	7	Nava Dristi Eye Hospital Pvt. Ltd

 

 

Eye Health Institutions under National Health Insurance Program

Province #2

District	SN	Eye Centers/Hospital
Dhanusa	8	Janaki Eye Hospital
Parsa	9	Ram Lal Kedia Eye Hospital
	10	Kiran Eye Hospital
	11	Birgunj Drishti Eye Care Centre Pvt. Ltd
Rautahat	12	Gaur Eye Hospital
Siraha	13	Sagarmatha Chaudhary Eye Hospital

 

 

Eye Health Institutions under National Health Insurance Program

Province #Bagmati

District	SN	Eye Institutions/center
Bhaktapur	13	CHEERS/BPEF
Chitwan	14	Bharatpur Eye Hospital
Kathmandu	15	Tilganga Institute of Ophthalmology
Kavrepalanchok	16	Reiyukai Eye Hospital
Makwanpur	17	Community Eye Hospital Hetauda
Ramechhap	18	District Community Eye Center

 

Eye Health Institutions under National Health Insurance Program

Province #Gandaki

District	SN	Eye Institutions/centers
Kaski	19	Himalaya Eye Hospital

 

Eye Health Institutions under National Health Insurance Program

Province #Lumbini

District	SN	Eye Hospitals
Arghakhanchi	20	District Eye Care Center
Banke	21	Fateh Bal Eye Hospital
Dang	22	Rapti Eye Hospital
Palpa	23	Lacoul Eye Hospital
	24	Kali Gandaki Eye Care Center
Rupandehi	25	Lumbini Eye Institute & Research Center

 

Eye Health Institutions under National Health Insurance Program

Province #Karnali

District	SN		Eye Center
Rukum West	26	Eye Hospital Salle Rukum
Surkhet	27	Surkhet Eye Hospital

 

 

Eye Health Institutions under National Health Insurance Program

Province #Sudurpaschim

District	SN		Eye Center
Kailali	28	Geta Eye Hospital

 To another note, these are all eye institutions I have included. Health Insurance board has enlisted many medical colleges' Teaching Hospitals and general eye hospitals for offering the insurance service package. These institutions also provide eye health package if they offer the eye health services as well.

 

Now coming to the second part of the article, let’s see what facilities this insurance client can get from an eye hospital.

      1.    Eye Hospital OPD and Emergency Package

Eye Hospital OPD Package	Price rate
Eye power check-up (refraction), slit lamp examination, eye pressure and dry eye measurement	Rs.200

 

Eye Hospital Emergency Package	Rate
Eye power check-up (refraction), slit lamp examination, eye pressure and dry eye measurement+ Foreign body removal	Rs. 400

 

 

      2.    Investigation Package

SN	Investigation	Rate Rs.
1	USG Biometry (A scan)	360
2	Optical Biometry (IOL Master)	396
3	Orthoptic Test	300
4	Visual Field	2000
5	Color Vision	200
6	Probing (TA)	2500
7	Blood tests before surgery	….

 

      3.    Package for Procedures

SN	Procedure	RateRs
1	Dressing	65
2	Suture removal	300
3	Foreign Body removal	700
4	Stye / abscess drainage	1000
5	cornea Scraping	1500
6	Grid laser (one eye)	1500
7	Prophylactic Laser (one eye)	2000
8	Retinal laser	2500
9	Eyelid chalazion I&D	2800

 

Package for Procedures (continued)

SN	Procedure	Rate (Rs.)
10	Probing (Local Anesthesia)	3000
11	Corneal Stromal FB removal	3000
12	Sutrure removal Under GA	3500
13	DCT	3600
14	Canthoplasty	4000
15	Cyst removal	4500
16	Eyelid Tumor removal and reconstruction	5000
17	Probing under GA	5000

 

 

        4.    Surgery Package

The mostly heard (common) eye surgeries in Nepal include:

SN	Surgery	Rate Rs
1	Pterygium Excision Surgery	6000
2	Small Incision Cataract Surgery (SICS)	9000
3	Cataract surgery Phaco + Fred Hollows IOL	12, 050
4	Penetrating Keratoplasty	20, 000

 

Other surgeries and their rate offered by the insurance

SN	Surgery Types	Rate
1	cornea repair- simple	6000
2	Evisceration	5500
3	Peripheral Iridotomy	6000
4	Eye lid repair	6000
5	Anterior Vitrectomy	5750
6	Conjunctiva repair	7200
7	Retinal Detachment surgery	11, 500
8	Evisceration with Implant	11, 000
9	DCR	12, 500
10	Eye lid Tumor removal (big)	15, 000

 

Surgeries (continued)

SN	Surgery Types	Rate Rs.
11	Eye lid drooping (ptosis)	15, 000
12	Valve Procedure in Glaucoma	15, 000
13	Blepharoplasty	16, 000
14	Posterior Vitrectomy	20, 000
15	combined surgery glaucoma + cataract	21, 000
16	Corneal layers transplant DALK, DMEK, DSAEK	26, 000
17	Squint surgery ( 3 Muscle)	13, 500
18	Squint surgery ( 4 Muscle)	15, 500

 

         5 .    Medicines

          Following medicines can be found for free if you are enlisted client of the program

Eye Drop	Ointment	Tablet /capsule	Injection
Atropin 1% Cyclopentolate, Declofenac, Ketorolac, Ketotifin Fumarate Natamycin, Fluconazole, Gentamicin Neomycin with Betamethasone Norfloxacin, ofloxacin, Pilocarpin, Prednisolone acetate, Sulphacetamide, Timolol maleate Tropicamide Ciprofloxacin	Acyclovir 3% Chloramphenicol (ointment + aplicap) Tetracycline	Acyclovir (400, 800, 800DT) Acetazolamide 250 Aceclofenac 100 Cefixime 100 Cetrizine 10 Doxycyclin Ibuprofen Levocetrizine Fluconazole Meth Pred Acetate Paracetamol Cap Omeperazole Tab ranitidine 100	Cefazolin Vancomycin Gentamicin Triamcinolone acetonide

 

 

Other Eye Drops

Tropicamide with Phenylnephrine, Ofloxacin with dexamethasone, Chloramphenicol with Dexamethasone & Polymixin B, Polyvinyl alcohol with Povidine, Polyvinyl alcohol with Povidine and chlorbutol, Phenylnephrine with naphazolin, menthol and camphor, Chloramphenicol with Lidocaine

 

       6.    Eye glasses services

An insured person can get up to one thousand worth of eye wears in a year recommended by eye hospital.

For further information about the health insurance package, you can go to your ward office and ask the registration officer and registration assistant about the program and how to get enrolled.

The summary of this information can be found in the following video (Nepali Language):

Article last updated: 1st May 2021