EPF Expands Healthcare Program, Includes Spouses of Savers

The Employee Provident Fund (EPF) is gearing up to broaden the scope of its healthcare program by incorporating the spouses of savers into its healthcare facilities.

This expansion of healthcare facilities for savers is set to take effect from the annual festival on the 31st of Bhadra, but specific procedures for implementation are yet to be finalized.

In the current fiscal year's budget, there was a mention of provisions being made to include spouses in the savers' healthcare program managed by the Employees' Provident Fund.

Under the existing program, savers are eligible for up to Rs 1 lakh for general medical expenses and up to Rs 10 lakh for severe illnesses based on hospital expenses. Following the fund's announced expansion, savers' husbands and wives will also have access to these healthcare benefits.

The precise conditions and procedures for spouses to benefit from this healthcare plan are yet to be determined.

Before 2076, the Fund operated the 'Sanchayakarta Medicine and Fatal Disease Scheme' through Rastriya Beema Company Limited. It was later transformed into the 'Sanchayakarta Swasthopachar Yojana'.

Presently, the fund supports medical research expenses for savers admitted to hospitals. This scheme is a continuation of the Accumulator Medicine Support Program 2070 and the Accumulator Medicine and Critical Illness Insurance Scheme 2075.

The government specifies 12 diseases covered by this scheme, including heart attacks, kidney failure, cancer, Alzheimer's, Parkinson's, severe head injuries, spinal injuries, sickle cell anaemia, liver damage, paralysis, brain haemorrhage, and lung transplants.

To be eligible, savers must have been regularly depositing savings with the fund for at least 6 months. Regular savers and those who haven't received fund payments for 6 years due to age or term limitations can benefit from this program.

Claims for treatment expenses are accepted in hospitals, nursing homes, health centers, or other similar healthcare facilities operating within Nepal with government permission. In cases where treatment is not available in Nepal and is recommended by a doctor, expenses for treatment in foreign hospitals can also be claimed. However, expenses for treatment in a private clinic are not covered.

Currently, sick savers receive up to Rs 1 lakh for research when admitted to the hospital and can avail of this twice in a fiscal year. They also receive Rs 40,000 for operation fees and Rs 30,000 each for examination fees, medicine, equipment, and hospital charges.

For fatal diseases, the coverage includes up to Rs 1 lakh for diagnosis expenses, up to Rs 7 lakhs for post-hospitalization treatment, and up to Rs 2 lakhs for post-discharge follow-up. Kidney and cancer patients are eligible for up to Rs 9 lakhs for follow-up treatments like chemotherapy and dialysis.

In the unfortunate event of a depositor's demise, beneficiaries can also claim medical expenses incurred prior to the death.

The fund is currently working on establishing procedures to determine the healthcare facilities that will be extended to savers' spouses while maintaining the existing arrangements. Currently, the fund has 598,000 depositors across 27,862 offices.