Private Health Insurance in Nepal: Compare Medical Plans from Licensed Insurers

In Nepal, 'private health insurance' refers to a medical or hospitalisation insurance policy bought from a licensed private company that pays for treatment costs when you are hospitalised because of illness or accident. In insurance terminology this is a non-life (general) insurance product, not a life-insurance product, and it is regulated separately from the government's own health scheme. People also search for it in Nepali as swasthya bima (health insurance) or aspatal bima (hospital insurance).

It is important to separate two very different things that both use the words 'health insurance'. The first is the government's National Health Insurance Program (NHIP), run by the Health Insurance Board (Swasthya Bima Board), a contributory social-security scheme launched in April 2016 (Baisakh 2073 BS) that charges roughly NPR 3,500 per year for a family of up to five and provides a benefit ceiling of about NPR 100,000 per family, used at empanelled public and community facilities. The second is the commercial, indemnity-based medical policy sold by private non-life insurers, which is what this comparison page is about.

Private plans are voluntary. You choose a sum insured (the maximum the insurer will pay in a policy year), pay an annual premium based on your age and that sum insured, and in return the insurer reimburses eligible hospital bills or, at network hospitals, settles them directly through a cashless arrangement. Because terms differ sharply between products, the sensible way to shop is to compare a small number of standard features rather than headline slogans such as 'best health insurance in Nepal'.

All private insurers in Nepal are licensed and supervised by the Nepal Insurance Authority (NIA), known in Nepali as Beema Pradhikaran. The NIA was created under the Insurance Act 2079 (2022 AD), replacing the earlier Insurance Board (Beema Samiti), and it operates under the Ministry of Finance. The detailed operating rules, including the classes of non-life business that cover health, are set out in the Insurance Regulation 2081, published in the Nepal Gazette on 12 Falgun 2081 BS (24 February 2025 AD).

Health insurance in Nepal is a non-life class of business, so only companies licensed as non-life (general) insurers can sell standalone medical plans. As of May 2026 there are 14 licensed non-life insurers. This number fell sharply after 2022 because the NIA raised the minimum paid-up capital for non-life companies to NPR 2.5 billion, which forced a wave of mergers (for example Himalayan Insurance and Everest Insurance combined into Himalayan Everest Insurance).

Before buying, verify that a company is currently licensed by checking the NIA register, and confirm that the specific health product you are being sold is a filed, approved product schedule. Agents sometimes market group corporate medical cover, travel medical insurance and personal-accident cover as 'health insurance', but these are different products with different terms.

There is no single 'best' medical plan in Nepal because the right choice depends on your budget, your age, whether you want treatment in India, and how much of the bill you are willing to pay yourself. Instead of trusting marketing, compare the same handful of variables across products. Getting these right matters far more than the brand name, because two policies with an identical sum insured can pay out very differently once caps and waiting periods are applied.

The most decisive variable is the sum insured, the annual ceiling the insurer will pay. Across the market, published health products commonly offer options roughly from NPR 100,000 (one lakh) up to NPR 2,000,000 (20 lakh) or more, in graded slabs. A higher sum insured raises the premium, but a very low sum insured can be exhausted by a single major surgery, so match it to realistic private-hospital costs in Kathmandu.

Almost as important are the internal caps that shrink your effective cover. The room-rent cap is the big one: many policies limit the eligible daily room charge (for example to a single standard or AC room, or to a fixed percentage of the sum insured), and if you take a costlier room the insurer may 'proportionately' reduce every associated bill. Watch also for disease-wise or surgery-wise sub-limits, co-payment clauses (a fixed percentage you pay on each claim, sometimes higher for outpatient or for treatment in India), and deductibles.

Claims are settled in one of two ways. Under reimbursement, you pay the hospital yourself and then submit bills, discharge summary and documents to the insurer for repayment. Under cashless, you are treated at a hospital in the insurer's network and the insurer settles the approved amount directly with the hospital, so you pay only the excluded items, co-payment and anything above your sum insured. 'Cashless health insurance' is heavily searched precisely because it removes the need to arrange large sums up front.

A cashless facility only works at the specific hospitals an insurer has empanelled, so the size and quality of that network is a genuine differentiator. Several insurers publish network lists covering major private hospitals in Kathmandu (such as Norvic, Grande, Mediciti, Om and Medicare) plus centres in Pokhara, Biratnagar, Bhairahawa, Nepalgunj and Dhangadhi, and some also offer cashless or reimbursement treatment in India. These hospital counts are insurer-published figures that change frequently, so always confirm the current list before you buy or before you are admitted.

Cashless approval is not automatic. For planned admissions you (or the hospital insurance desk) must send a pre-authorisation request; for emergencies there is usually a short window to notify the insurer or its third-party administrator (TPA). Approval covers only medically necessary, policy-eligible charges, which is why patients are sometimes surprised by a shortfall at discharge even in a 'cashless' hospital.

The snapshots below are illustrative of how products are structured; exact figures, networks and rates are set in each insurer's filed schedule and change over time, so treat them as indicative and verify current terms directly. They are included to show the shape of the market rather than to rank companies.

Shikhar Insurance markets a dedicated health plan (Shikhar Swasthya Surakshya) offering sum-insured options roughly from NPR 150,000 up to NPR 2,000,000, with room cover framed around a single standard/AC room, a 30-day initial waiting period, pre-hospitalisation and post-hospitalisation cover (about 30 and 60 days), a stated 2-year wait before pre-existing conditions are covered, and a co-payment on outpatient expenses. The company also publishes a network of Nepal hospitals plus a large panel of hospitals in India for cashless or reimbursement treatment.

Other non-life insurers offer comparable medical products. IGI Prudential markets IGI Health Care with sum insured commonly quoted from about NPR 100,000 up to NPR 2,000,000 and cashless access at empanelled hospitals in Nepal and India. NLG Insurance offers a medical insurance policy reimbursing hospitalisation from illness and accident, with cashless benefit at its network hospitals in Nepal and extension to SAARC countries when the required treatment is unavailable in Nepal. Sagarmatha Lumbini, Neco, Siddhartha Premier, Himalayan Everest and Sanima GIC likewise file individual or group medical products.

A pre-existing disease (PED) is a condition you already had before the policy started. Nepali medical policies do not cover PEDs immediately; they impose a waiting period, commonly in the range of 2 to 4 years of continuous cover, after which the condition becomes payable. If you let a policy lapse and rebuy it, that waiting clock can reset, so continuous renewal is valuable for anyone with a chronic condition.

There is also a general initial waiting period, usually 30 days from the policy start date, during which only accident-related hospitalisation is covered. Many plans additionally list specific ailments (such as certain surgeries, cataract, hernia or maternity) with their own longer waiting periods of one to two years. Read these tables carefully, because they determine whether a claim in the first year or two is actually payable.

Every policy also carries permanent exclusions, and disputes usually arise from them rather than from the sum insured. Typical exclusions include cosmetic treatment, self-inflicted injury, most congenital conditions, expenses arising from war or from breaking the law, and non-medical consumables. Confirm how maternity, mental health, day-care procedures and outpatient (OPD) costs are treated, since these vary widely and are frequently excluded or sub-limited.

Start by deciding your sum insured against real costs: a serious surgery or an ICU stay at a private Kathmandu hospital can run into several hundred thousand rupees, so a one-lakh plan offers only thin protection. Then compare, side by side, the room-rent cap, co-payment, PED waiting period and network hospitals of two or three shortlisted products before looking at premium, because the cheapest premium often hides the tightest caps.

Disclose your medical history honestly on the proposal form. Non-disclosure is the single most common reason clean-looking claims are rejected, and it can void the whole policy. Keep every original bill, prescription, diagnostic report and the discharge summary, and note the insurer's or TPA's notification deadline for both cashless pre-authorisation and post-treatment reimbursement claims.

Finally, remember that private cover and the government scheme are not mutually exclusive. Lower-income households may find the National Health Insurance Program's NPR 3,500-per-family contribution better value for basic care at public facilities, while private medical insurance is aimed at those who want higher limits and cashless access at private hospitals. Some families hold both. If a dispute arises with a private insurer that you cannot resolve directly, you can escalate a complaint to the Nepal Insurance Authority.