Health Plus
Health InsurancePopular
Sum assured
Rs 5 L
Premium / yr
Rs 10,000
Term
1 yrs
Entry age
5–65
About this plan
Comprehensive health insurance covering hospitalization, OPD, and critical medical expenses. Cashless treatment at network hospitals.
What's included
Key highlights
- Cashless treatment
- Wide network
- Fast claims
Features
- Hospitalization cover
- OPD cover
- Pre & post hospitalization
- Ambulance charges
- Day-care procedures
Eligibility & term
- Entry age
- 5 – 65 years
- Policy term
- 1 year (renewable)
Coverage breakdown
HospitalizationUp to Rs 5 lakh
OPDUp to Rs 10,000
Pre-hospitalization (60 days)Included
Post-hospitalization (90 days)Included
AmbulanceUp to Rs 5,000
Day-care proceduresIncluded
MaternityNot included
DentalNot included
Loan & liquidity
- Grace period
- 15 days for renewal
Waiting periods
- Pre-existing diseases
- 2-3 years
- Specific surgeries
- 1 year
- Maternity
- Not covered
Pros & cons
Pros
- Cashless treatment at network hospitals
- Wide network coverage across Nepal
- Day-care procedures included
- Ambulance charges covered
- 100+ branches for easy claim filing
Cons
- No maternity coverage
- Pre-existing diseases excluded for 2-3 years
- No coverage for dental treatments
- Co-payment may apply from 2024
- OPD limit may be lower than expected
What affects your premium
- Age of insured (younger = lower)
- Coverage amount selected
- Pre-existing health conditions
- Family size (if floater)
- Geographic location
How to claim
- 1Cashless: Show insurance card at network hospital
- 2Reimbursement: Pay first, submit bills within 15 days
- 3Submit discharge summary and bills
- 4Settlement within 30 days of document submission
Network
- Network hospitals
- 28
- Coverage area
- Major cities in Nepal + 5,800+ in India
Best for
IndividualsWorking professionalsBudget health coverageFirst-time health insurance
What's not covered
- Pre-existing diseases (first 2-3 years)
- Cosmetic/plastic surgery unless medically necessary
- Self-inflicted injuries
- HIV/AIDS related treatments
- Dental treatments (unless from accident)
- Substance abuse treatment
Other plans from Sagarmatha Lumbini Insurance
Premium / yr
Rs 10,000