How much medical treatment coverage do you get per year?
✓ Verified: 2026-07-11
- Inpatient treatment: up to Rs. 100,000/year including family
- OPD/prescriptions: up to Rs. 20,000/year (within the limit)
- You bear 20% of every claim yourself (co-payment)
- With 60 months of contributions, the Fund additionally covers 50% of Rs. 100,000–1,000,000 at listed hospitals
- Critical illness: up to Rs. 1,000,000 over your service period
📜 Official sources
- सामाजिक सुरक्षा योजना सञ्चालन कार्यविधि, २०७५ (५औँ संशोधनसहित) (मूल २०७५।०८।०६; ५औँ संशोधन २०८१।०९।१०, लागू २०८२।०१।०१)
For legal purposes always consult the original documents and latest amendments. Rates and limits can change through amendments.