Key FactsRate: 1% of basic salary/month · Starts: After 3 months (OPD/IPD), After 12 months (Maternity) · Co-payment: 20% · Empanelled hospitals: 100+ [Source: Operating Procedure 2075]
Coverage Limits
| Benefit | Limit / Amount | Your Share |
|---|---|---|
| OPD (Outpatient) | NPR 25,000 per year | 20% co-pay |
| IPD (Inpatient) | NPR 1,00,000 per year | 20% co-pay |
| Fatal diseases (cancer, kidney failure) | NPR 1,00,000 | 20% co-pay |
| Critical/severe (board approved) | Up to NPR 7,00,000 | 20% co-pay |
| Workplace accident at empanelled hospital | 100% covered | None |
| Maternity leave | 98 days | — |
| Paternity leave | 15 days | — |
| Newborn lump sum | 1 month minimum wage | — |
| Funeral grant | NPR 25,000 | — |
✅ Coverage Continues 2 Years After You Stop WorkingMedical coverage (OPD and IPD) continues for up to 24 months after your last SSF contribution. [Source: Operating Procedure 2075]
How to Claim
Cashless at Empanelled Hospital
- Visit any SSF-empanelled hospital (100+ nationwide)
- Show your SSFID or digital SSF card
- Hospital verifies with SSF system directly
- You pay only your 20% co-payment
- Hospital bills SSF directly for the remaining 80%
Find Empanelled Hospitals Full list at ssf.gov.np/affiliated-hospitals
Emergency at Non-Empanelled Hospital
- Seek emergency treatment at the nearest available hospital
- Collect all bills, receipts, discharge summary
- Notify SSF within 7 days of treatment
- Submit reimbursement claim within 30 days
- SSF reimburses 80% up to the scheme limits
⚠️ 7-Day Notification RuleFailure to notify SSF within 7 days of non-empanelled emergency treatment may result in claim rejection.
Maternity Benefits
Eligibility: 12 months of contributions within previous 18 months
Mother: 98 days paid maternity leave · Father: 15 days paternity leave · Newborn: 1 month minimum wage lump sum granted.
Maternity treatment (prenatal, delivery, postnatal) at empanelled hospital — cashless within limits. Complications covered under medical limits. [Source: Operating Procedure 2075 · courtmarriageinnepal.com 2026]
Maternity treatment (prenatal, delivery, postnatal) at empanelled hospital — cashless within limits. Complications covered under medical limits. [Source: Operating Procedure 2075 · courtmarriageinnepal.com 2026]
⚠️ 12-Month Waiting Period for MaternityUnlike OPD/IPD (3 months), maternity requires 12 months of contributions within the previous 18 months before the expected delivery date.
What Is the Waiting Period?
OPD & IPD: 3 Months
After your employer deposits contributions for 3 consecutive months, OPD and IPD coverage activates. Both have the same waiting period. [Source: Operating Procedure 2075 · nepaldivorce.com 2026 — corrected from incorrect 6-month IPD claim]
After your employer deposits contributions for 3 consecutive months, OPD and IPD coverage activates. Both have the same waiting period. [Source: Operating Procedure 2075 · nepaldivorce.com 2026 — corrected from incorrect 6-month IPD claim]
Maternity: 12 Months
Must have 12 months of contributions within the previous 18 months. Plan ahead if you expect to claim maternity benefits.
Must have 12 months of contributions within the previous 18 months. Plan ahead if you expect to claim maternity benefits.