EPF health plan next fiscal year
KATHMANDU, NOV 25 -
The Employees Provident Fund (EPF) is planning to launch a contribution-based health insurance plan for its members and their families from the beginning of the next fiscal year. The scheme will later be expanded to include people from other sectors.
An internal committee formed by the contractual savings institution to study the plan has recommended that it operate four types of schemes under the health insurance plan — sickness and treatment facility, accidental death or disability facility, delivery facility and dependent facility. The study committee has also prepared a draft regulation to run the health insurance plan. The EPF plans to present the proposal to the government for its endorsement soon.
As per the committee’s recommendation, three types of facilities will be available under the sickness and treatment facility. Compensation will be provided in the event of ordinary illness, surgery and severe disease.
In case of illness, beneficiaries will receive Rs 50,000 in a year or 75 percent of the actual medical cost, whichever is lower. For surgery, beneficiaries will receive up to Rs 150,000 or 75 percent of the actual medical cost, whichever is lower.
Compensation for severe cases such as brain haemorrhage, cancer, kidney transplant, heart surgery, HIV/AIDS and Hepatitis B will be up to Rs 1.5 million or 75 percent of the medical bill, whichever is lower.
The contributor, spouse and two children under the age of 18 will be eligible to get this facility.
In the event of accidental death or disability, the contributor will get Rs 125,000 as compensation. The money will go to the heir named by the contributor in case of death. Under the delivery facility plan, the insured woman or the wife of a male contributor will get a maximum of Rs 30,000 as compensation for delivery or in the event of a miscarriage after more than 24 weeks of pregnancy.
Under the dependent facility plan, the dependents of the deceased contributor will get Rs 75,000 as compensation and Rs 25,000 for funeral rites.
However, deliberately causing harm to oneself, sex change, vaccination inoculation, plastic surgery done for purely cosmetic purposes and not to correct damage caused by an accident, beauty treatment, ayurvedic treatment except for jaundice, madness, health problem due to adventurous sports such as bungee jumping, horse riding and accidents due to contact with radioactive materials, among others, will not be covered by the EPF’s health plan.
EPF Administrator Krishna Acharya said that its health insurance scheme was designed to support the government’s efforts to provide social security to a majority of the people. “As the EPF was established to provide social security to employees, health insurance as a new area of social security emerged as a good option for us to engage in,” he added.
The study committee has suggested arranging a seed fund of Rs 2 billion with contributions of Rs 1 billion each by the EPF and the government. Similarly, the contributor will pay Rs 300 per month from his or her salary, and the employer will contribute an equal amount to the fund, according to the recommendation. The EPF will implement the scheme by constituting an autonomous department. As part of its long-term goal, a separate company will be formed four years after the scheme is started in a bid to include people who are not members of the EPF.
According to the plan, those who keep contributing to the fund even after retirement will continue to enjoy the facilities under the health insurance plan. Those who opt out of the health scheme after retirement will be covered for one year after they leave.
Source: The Kathmandu Post
