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स्वास्थ्य विमा ऐन २०७४
स्वास्थ्य विमा ऐन २०७४
np
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g]kfnsf] ;+ljwfg cg's"n agfpg s]xL g]kfn P]gnfO{ ;+zf]wg ug]{ P]g, @)&% 4f/f ;+zf]lwt .
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kl/R5]b–@
:jf:Yo aLdf sfo{qmd
#= :jf:Yo aLdf sfo{qmddf cfj4 x'g] M -!_ k|To]s g]kfnL gful/s :jf:Yo aLdf
sfo{qmddf cfj4 x'g' kg]{5 .
-@_ gjhft lzz', afnaflnsf, h]i7 gful/s, ckfËtf ePsf JolQm tyf
czQmnfO{ :jf:Yo aLdf sfo{qmddf cfj4 ug{' lghsf] ;+/Ifs tyf cleefjssf]
st{Jo x'g5
] .
-#_ j[¢f>d, cgfyfno, afn ;'wf/ u[x nufotsf ;+:yfx¿df cfl>t
JolQmnfO{ :jf:Yo aLdf sfo{qmddf cfj4 ug{' To:tf] ;+:yfsf] Joj:yfkssf] st{Jo
x'g5
] .
-$_ k|rlnt sfg"g adf]lhd /fi6« ;]js dflgg] JolQm tyf a}b]lzs /f]huf/Ldf
hfg] sfdbf/sf] kl/jf/n] :jf:Yo aLdf sfo{qmddf cfj4 x'g' kg{5
] .
-%_ k|rlnt sfg"g adf]lhd :yfkgf ePsf tf]lsPsf ;+:yfn] ;f] ;+:yfdf
sfo{/t JolQmnfO{ :jf:Yo aLdf sfo{qmddf cfj4 u/fpg'
kg{5
] .
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-^_ o; bkmf adf]lhd :jf:Yo aLdf sfo{qmddf cfj4 x'g] kl/jf/nfO{ af]8{n]
tf]lsP adf]lhd :jf:Yo aLdf n]v hf/L ug{]5 .
-&_ pkbkmf -^_ adf]lhdsf] :jf:Yo aLdf n]vdf aLldtn] k|fKt ug{] ;]jf, ;]jf
pkof]u u/] afkt a'emfpg' kg{] of]ubfg /sd nufotsf ljifo ;dfj]z x'g]5g .
$= kl/jf/nfO{ OsfO{ dflgg] M -!_ :jf:Yo aLdf sfo{qmddf cfj4 x'g] k|of]hgsf nflu
kl/jf/nfO{ OsfO{ dflgg]5 .
-@_ pkbkmf -!_ adf]lhd :jf:Yo aLdf sfo{qmddf cfj4 x'g] k|lqmof ;DaGwL
Joj:yf tf]lsP adf]lhd x'g]5 .
%= ;]jf M -!_ :jf:Yo aLdf sfo{qmd cGtu{t b]xfosf] ;'lawf k|bfg x'g]5 :-
-s_ of]u, kf]if0f lzIff, afgL Joxf]/f ;'wf/, dgf]–;fdflhs k/fdz{
h:tf k|j4{gfTds ;]jf,
-v_ vf]k, kl/jf/ lgof]hg, ;'/lIft dft[Tj h:tf k|ltsf/fTds ;]jf,
-u_ alx/Ë, egf{ pkrf/, cfsl:ds, zNolqmof, cf}iflw, :jf:Yo
;xfotf pks/0f h:tf pkrf/fTds ;]jf ,
-3_ lgbfgfTds jf k'g:y{fkgf ;DaGwL ;]jf,
-ª_ PDa'n]G; ;]jf,
-r_ tf]lsP adf]lhdsf cGo ;]jf .
-@_ pkbkmf -!_ df h'g;'s} s'/f n]lvPsf] eP tfklg s'g} JolQmnfO{ lgMz'Ns
¿kdf cfwf/e"t :jf:Yo ;]jf tyf k|rlnt sfg"g adf]lhd kfPsf] s'g} :jf:Yo ;]jf
lng afwf k'u]sf] dflgg] 5}g .
:ki6Ls/0f M o; pkbkmfsf] k|of]hgsf] nflu æcfwf/e"t :jf:Yo ;]jfÆ eGgfn] g]kfn
;/sf/n] tf]s] adf]lhdsf] :jf:Yo ;]jf ;Demg' k5{ .
^= :jf:Yo aLdf sfo{qmddf ;dfj]z gx'g] ;]jf M :jf:Yo aLdf sfo{qmd cGtu{t b]xfosf]
;]jf ;dfj]z x'g] 5}g M–
-s_ tf]lsPsf] d"No eGbf a9L /sdsf r:df, >j0foGq nufotsf
:jf:Yo ;DaGwL ;xfos oGq,
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-@_ pkbkmf -!_ adf]lhdsf] :jf:Yo ;+:yfn] aLldtnfO{ cfjZos ;]jf pknAw
u/fpg g;Sg] ePdf ;f]xL Joxf]/f pNn]v u/L To:tf] ;]jf pknAw x'g] :jf:Yo
;+:yfdf k]|if0f ug'{ kg]{5 .
-#_ pkbkmf -@_ adf]lhd k|]if0f eO{ cfPsf aLldtnfO{ ;DalGwt :jf:Yo
;+:yfn] k|fyldstfsf ;fy ;]jf k|bfg ug'{ kg]{5 .
-$_ :jf:Yo ;]jf lng] ;DaGwL cGo Joj:yf tf]lsP adf]lhd x'g]5 .
!!= e'QmfgL ;DaGwL Joj:yf M af]8{n] ;]jf k|bfosaf6 k|bfg ePsf] ;]jf afktsf] e'QmfgL
b]xfosf] cfwf/df ug]{5 :-
-s_ Soflk6]zg z'Ns,
-v_ k|lt s]; /sd -s]; /]6_,
-u_ k|lt ;]jf z'Ns,
-3_ tf]lsP adf]lhdsf cGo pko'Qm cfwf/ .
!@= ;Demf}tf /2 ug{' kg]{ M -!_ bkmf ( adf]lhd af]8{n] ;]jf k|bfos;Fu u/]sf] ;Demf}tf
b]xfosf] cj:yfdf /2 ug]{5 :-
-s_ lghn] bkmf ( sf] pkbkmf -%_ adf]lhdsf] cjlwleq ;Demf}tf gjLs/0f
gu/]df,
-v_ lghn] ;Demf}tf cg';f/ aLldtnfO ;]jf k|bfg gu/]df,
-u_ lghn] ;Demf}tfdf plNnlvt zt{ af/Daf/ pNnª\3g u/]df,
-3_ lghn] kfngf ug{' kg{] /fli6«o pkrf/ k4lt gckgfPdf,
-ª_ lghn] em'§f sfuhft jf ljj/0f agfO{ e'QmfgL dfu u/]df,
-r_ af]8{n] lgw{f/0f u/]sf dfkb08 jf ;]jfsf cGo zt{ kfngf gu/]df,
-5_ tf]lsP adf]lhdsf cGo cfwf/df .
-@_ pkbkmf -!_ adf]lhd ;Demf}tf /2 ug{' cl3 af]8{n] ;DalGwt ;]jf
k|bfosnfO{ cfˆgf] ;kmfO{ k]z ug]{ dgfl;a df}sf lbg' kg]{5 .
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kl/R5]b–#
af]8{sf] u7g tyf sfd, st{Jo / clwsf/
!#= af]8{sf] u7g M -!_ :jf:Yo aLdf ;DaGwL sfd sf/afxL ug{ Ps :jf:Yo aLdf af]8{
/xg]5 .
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-%_ af]8{df tTsfn sfod /x]sf] ;b:o ;ª\Vofsf] krf; k|ltzteGbf a9L
;b:o pkl:yt ePdf af]8{sf] a}7ssf nflu u0fk'/s ;ª\Vof k'u]sf] dflgg]5 .
-^_ af]8{sf] a}7sdf ax'dtsf] lg0f{o dfGo x'g]5 / dt a/fa/ ePdf a}7ssf]
cWoIftf ug]{ JolQmn] lg0ff{os dt lbg]5 .
-&_ af]8{sf] a}7sdf ;DalGwt kbflwsf/L tyf :jf:Yo aLdf ;DaGwL
ljz]if1nfO{ cfdGq0f ug{ ;lsg]5 .
-*_ af]8{sf] a}7ssf] lg0f{o ;b:o–;lrjn] k|dfl0ft ug]5
{ .
-(_ af]8{sf] a}7s ;DaGwL cGo sfo{ljlw af]8{n] lgwf{/0f u/] adf]lhd x'g]5 .
!&= pk;ldlt u7g ug{ ;Sg] M -!_ af]8{n] cfˆgf] sfd sf/afxLsf] ;DaGwdf cfjZostf
cg';f/ s'g} ;b:osf] ;+of]hsTjdf pk;ldlt u7g ug{ ;Sg]5 .
-@_ pkbkmf -!_ adf]lhdsf] pk;ldltsf] sfd, st{Jo / clwsf/ tyf sfo{ljlw
af]8{n] To:tf] pk;ldlt u7g ubf{sf] avt lgwf{/0f u/] adf]lhd x'g]5 .
kl/R5]b–$
cWoIf, ;b:o, sfo{sf/L lgb]{zs tyf sd{rf/L
!*= cWoIf tyf ;b:o kbsf] nflu of]Uotf M b]xfosf] of]Uotf k'u]sf] s'g} JolQm af]8{sf]
cWoIf tyf ;b:o x'g ;Sg]5 :-
-s_ g]kfnL gful/s,
-v_ dfGotf k|fKt lzIf0f ;+:yfaf6 s'g} ljifodf sDtLdf :gfts pkflw
xfl;n u/L ;DalGwt If]qdf cWoIfsf] xsdf sDtLdf ;ft jif{ /
;b:osf] xsdf sDtLdf kfFr jif{sf] cg'ej ePsf],
t/ bkmf !# sf] pkbkmf -@_ sf] v08 -3_ adf]lhdsf] ;b:osf]
nflu lrlsT;fzf:q, hg:jf:Yo, cy{zf:q jf ljQLo Joj:yfkg
ljifodf :gftsf]Q/ tx pQL{0f u/]sf] x'g' kg]{5 .
-u_ e|i6frf/, ha/h:tL s/0fL, dfgj a]rlavg tyf cf];f/k;f/, nfu"
cf}ifw laqmL ljt/0f tyf lgsf;L jf k}7f/L, ;DklQ z'4Ls/0f, /fxbfgL
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@!= sfo{sf/L lgb]{zssf] kbdf lgo'Qm x'gsf] nflu of]Uotf M sfo{sf/L lgb]{zssf] kbdf
lgo'Qm x'gsf nflu b]xfosf] of]Uotf k'u]sf] x'g' kg]{5 :-
-s_ dfGotf k|fKt lzIf0f ;+:yfaf6 cy{zf:q, Joj:yfkg, sfg"g, lrlsT;f
zf:q, hg:jf:Yo jf :jf:Yo cy{zf:q ;DaGwL ljifodf sDtLdf
:gftsf]Q/ pkflw xfl;n u/L ;DalGwt If]qdf sDtLdf bz jif{sf]
cg'ej k|fKt u/]sf],
-v_ bkmf !* sf] v08 -s_, -u_ / -3_ adf]lhdsf] of]Uotf k'u]sf],
-u_ k}F;¶L jif{ ggf3]sf] .
@@= l;kmfl/; ;ldlt M -!_ sfo{sf/L lgb]{zssf] kbdf lgo'lQmsf nflu l;kmfl/; ug{ b]xfo
adf]lhdsf] Ps l;kmfl/; ;ldlt /xg]5 :-
-s_ nf]s ;]jf cfof]usf] cWoIf jf
lghn] tf]s]sf] cfof]usf] ;b:o –;+of]hs
-v_ cy{zf:q, Joj:yfkg, ljQ, sfg"g,
:jf:Yo cy{zf:q tyf aLdf ljifodf
:gftsf]Q/ pkflw xfl;n u/L ;DalGwt
If]qdf sDtLdf ;ft jif{sf] cg'ej
k|fKt JolQmx¿ dWo]af6 dGqfnon]
dgf]lgt u/]sf] Ps hgf –;b:o
-u_ ;lrj, dGqfno –;b:o–;lrj
-@_ pkbkmf -!_ adf]lhdsf] ;ldltn] tf]lsP adf]lhd v'Nnf k|lt:kwf{sf]
cfwf/df sfo{sf/L lgb]{zssf] kbdf lgo'lQmsf] nflu bkmf @! adf]lhdsf] of]Uotf
k'u]sf] JolQmdWo]af6 tLg hgf JolQmsf] gfd l;kmfl/; ug]5
{ .
-#_ pkbkmf -@_ adf]lhd l;kmfl/; ePsf JolQmx¿ dWo]af6 Ps hgfnfO{
g]kfn ;/sf/n] sfo{sf/L lgb]{zssf] kbdf lgo'lQm ug]{5 .
-$_ pkbkmf -!_ adf]lhdsf] ;ldltsf] sfo{ljlw ;f] ;ldlt cfkm}n] lgwf{/0f u/]
adf]lhd x'g]5 .
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@#= sfo{;Dkfbg s/f/ ug]{ M af]8{n] sfo{sf/L lgb]{zs;Fu tf]lsP adf]lhd sfo{;Dkfbg
s/f/ ug{' kg]{5 .
@$= sfo{sf/L lgb]{zssf] sfd, st{Jo / clwsf/ M sfo{sf/L lgb]{zssf] sfd, st{Jo /
clwsf/ b]xfo adf]lhd x'g]5 :-
-s_ :jf:Yo aLdf ;DaGwL gLlt, /0fgLlt, of]hgf, ah]6 tyf sfo{qmd tof/
u/L af]8{ ;dIf k]z ug]{,
-v_ :jf:Yo aLdf ;DaGwL tflnd, cWoog, cg';Gwfg, ;'k/Lj]If0f, cg'udg
tyf d"NofÍg ;DaGwL sfo{ ug]{, u/fpg],
-u_ :jf:Yo aLdf sfo{qmdsf] ;"rgf, ;~rf/ tyf ;dGjo ;DaGwL sfo{
ug]{, u/fpg],
-3_ :jf:Yo aLdf sfo{qmddf cfj4tf ;DaGwL Joj:yf, ;]jf:t/sf] lgwf{/0f,
;]jf k|bfos;Fu ul/g] ;Demf}tfsf] zt{ tyf e'QmfgL ljlw tof/ u/L
af]8{ ;dIf k]z ug]{,
-ª_ af]8{sf] cfo Joosf] n]vf /fVg], cfGtl/s lgoGq0f k|0ffnL nfu" ug]{ /
n]vf k/LIf0f ug]{, u/fpg],
-r_ af]8{sf] lg0f{o sfof{Gjog ug]{, u/fpg],
-5_ jflif{s k|ltj]bg tof/ u/L af]8{ ;dIf k]z ug]{,
-h_ tf]lsP adf]lhd cGo sfo{ ug]{ .
@%= kb l/Qm x'g] M -!_ b]xfosf] cj:yfdf cWoIf, ;b:o tyf sfo{sf/L lgb]{zssf] kb l/Qm
ePsf] dflgg]5 :-
-s_ cWoIf jf sfo{sf/L lgb]{zsn] g]kfn ;/sf/df tyf ;b:on]
cWoIf ;dIf lnlvt /fhLgfdf lbPdf,
-v_ af]8{nfO{ hfgsf/L glbO{ nuftf/ tLg k6s af]8{sf] a}7sdf
cg'kl:yt ePdf,
-u_ bkmf !* sf] v08 -u_ df plNnlvt s;"/df cbfntaf6 bf]ifL
7xl/Pdf,
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kl/R5]b–%
sf]if tyf n]vf
@&= sf]if M -!_ :jf:Yo aLdf sfo{qmd sfof{Gjogsf] nflu Ps :jf:Yo aLdf sf]if /xg]5 .
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#)= /sd lk|mh gx'g] M k|rlnt sfg"gdf h'g;'s} s'/f n]lvPsf] eP tfklg sf]ifsf] /sd
lk|mh x'g] 5}g .
kl/R5]b–^
ph'/L, ;hfo tyf k'g/fj]bg
#!= ph'/L lbg ;Sg] M -!_ ;]jf k|bfosn] aLldtnfO{ ;]jf k|bfg gu/]df, ;]jf k|bfg ug{
l9nf ;':tL u/]df jf lgwf{l/t ;]jf:t/eGbf Go"g u'0f:t/sf] ;]jf lbPdf aLldtn]
To:tf] ;]jf k|bfos pk/ ;f] sfo{ ePsf] ldltn] gAa] lbgleq af]8{ jf af]8{n] tf]s]sf]
s'g} lgsfo ;dIf ph'/L lbg ;Sg]5 .
-@_ ph'/L lbg] ;DaGwL cGo Joj:yf tf]lsP adf]lhd x'g]5 .
#@= ;hfo M -!_ bkmf #! adf]lhdsf] ph'/L hfFra'em ubf{ dgfl;a b]lvPdf af]8{n] To:tf]
;]jf k|bfosnfO{ kG„ xhf/b]lv kRrL; xhf/;Dd hl/afgf u/L ;f] hl/afgf a/fa/sf]
/sd aLldtnfO{ Ifltk"lt{ :j¿k e/fO{ lbg]5 .
-@_ s'g} aLldtn] bkmf * ljk/Ltsf] sfo{ u/L af]8n
{ fO{ xflg gf]S;fgL k'¥ofPdf
af]8{n] To:tf] aLldtnfO{ lghaf6 ePsf] gf]S;fgLsf] lauf] a/fa/sf] /sd hl/afgf ug{
;Sg]5 .
-#_ s'g} ;]jf k|bfosn] of] P]g jf o; P]g cGtu{t ag]sf] lgod ljk/Lt cGo
s'g} sfd u/]df af8{n] To:tf] ;]jf k|bfosnfO{ kfFr nfv ?k}ofF;Dd hl/afgf ug{
;Sg]5 .
##= k'g/fj]bg ug{ ;Sg] M bkmf #@ adf]lhd af]8{af6 ePsf] lg0f{odf lrQ ga'‰g] kIfn]
To:tf] lg0f{osf] hfgsf/L kfPsf] ldltn] k}FtL; lbgleq ;DalGwt pRr cbfntdf
k'g/fj]bg ug{ ;Sg]5 .
kl/R5]b–&
ljljw
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#$= ljjfb ;dfwfg M -!_ of] P]g jf o; P]g cGtu{t ag]sf] lgodsf] Joj:yf sfof{Gjog
ug]{ qmddf af]8{, aLldt jf ;]jf k|bfos aLr s'g} ljjfb pTkGg ePdf o:tf] ljjfbsf]
;dfwfg cfk;L ;dembf/Laf6 ul/g]5 .
-@_ pkbkmf -!_ adf]lhd ljjfb ;dfwfg gePdf To:tf] ljjfbsf] ;dfwfg
tf]lsP adf]lhdsf] ljjfb ;dfwfg ;ldltn] ug]{5 .
-#_ pkbkmf -@_ adf]lhdsf] ;ldltn] u/]sf] ljjfb ;dfwfgsf] lg0f{odf lrQ
ga'‰g] kIfn] To:tf] lg0f{osf] hfgsf/L kfPsf] ldltn] k}FtL; lbgleq ;DalGwt lhNnf
cbfntdf k'g/fj]bg ug{ ;Sg]5 .
#%= a}7s eQf M ;b:ox¿n] af]8{sf] a}7sdf efu lnP afkt tf]lsP adf]lhdsf] a}7s
eQf kfpg]5g\ .
#^= g]kfn ;/sf/;Fu ;Dks{ M af]8{n] g]kfn ;/sf/;Fu ;Dks{ ubf{ dGqfno dfkm{t ug{'
kg]{5 .
#&= lgb]{zg lbg ;Sg] M dGqfnon] o; P]gsf] sfof{Gjogsf ;Gbe{df af]8{nfO{ cfjZos
lgb]{zg lbg ;Sg]5 / To:tf] lgb]{zg kfngf ug{' af]8{sf] st{Jo x'g]5 .
#*= k|rlnt sfg"g adf]lhd x'g] M o; P]gdf n]lvPsf] ljifodf o;} P]g adf]lhd / o;
P]gdf gn]lvPsf] ljifosf] xsdf k|rlnt sfg"g adf]lhd x'g]5 .
#(= lgod agfpg ;Sg] M of] P]g sfof{Gjog ug{ g]kfn ;/sf/n] cfjZos lgod agfpg
;Sg]5 .
$)= ljlgod agfpg ;Sg] M af]8{n] of] P]g tyf o; P]g cGtu{t ag]sf] lgodsf] cwLgdf
/xL cfjZos ljlgod agfpg ;Sg]5 .
$!= lgb]{lzsf tyf sfo{ljlw agfpg ;Sg] M af]8{n] of] P]g, o; P]g cGtu{t ag]sf] lgod
tyf ljlgodsf] cwLgdf /xL cfjZos lgb]{lzsf tyf sfo{ljlw agfpg ;Sg]5 .
$@= vf/]hL / arfp M -!_ ;fdflhs :jf:Yo ;'/Iff ljsf; ;ldlt u7g cfb]z, @)&!
vf/]h ul/Psf] 5 .
-@_ pkbkmf -!_ adf]lhdsf] u7g cfb]z adf]lhd eP u/]sf ;a} sfd sf/afxL
o;} P]g adf]lhd eP u/]sf] dflgg]5 .
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