The Health Insurance Board has capped annual outpatient department (OPD) service coverage at Rs 25,000 per insured household. Information Officer Bikesh Malla said the new provision will come into effect from February 13. Previously, OPD services were covered without a specific sub-limit under the total insurance ceiling. The board said the decision was taken to manage financial strain, as OPD claims account for 71 percent of total insurance claims. While the board’s annual income stands at around Rs 14 billion, expenditures have exceeded Rs 24 billion, causing delays in payments. Currently, a premium of Rs 3,500 covers a family of five for treatment expenses of up to Rs 100,000.
