Sahara Health Insurance in partnership with Shikhar Insurance Company is a financial arrangement where an insurer provides coverage for medical expenses in exchange for regular payments, known as premiums, which vary based on the chosen package.
Insurance Coverage
| Coverage Topic | Coverage Amount |
| Medical Expenses | Rs. 100,000/ Rs 200,000/ Rs 500,000 |
| Accidental Treatment | Rs. 100,000 |
| Accidental Death | Rs. 100,000 |
| Funeral and Transport Expenses | Rs. 20,000 |
Inclusions and Exclusions
What’s covered by Sahara Health Insurance?
In-Patient Hospitalization:
- This covers expenses when you’re admitted to a hospital for at least 24 hours.
- It includes room charges (single standard AC room/cabin), doctor and nurse fees, operation theater costs, and expenses for diagnostic tests, medicines, blood, and medical appliances.
Day Care Procedures:
- Recognizing advancements in medical technology, the policy covers approximately 150 specific treatments and procedures that may not require a full 24-hour hospitalization.
- This coverage applies even when the procedure is done with local anesthesia.
Pre- and Post-Hospitalization Coverage:
- It includes medical expenses incurred in the 30 days before hospitalization (pre-hospitalization) and the 30 days after hospitalization (post-hospitalization).
What’s not covered by Sahara Health Insurance?
- General OPD (Outpatient Department) expenses are not covered. OPD expenses shall be covered in case of hospitalization only.
- Medical expenses incurred outside N0epal.
- Pre-existing Conditions for 4 years
- Cosmetic Procedures
- Dental and Vision Care
- Alternative Therapies like Acupuncture, naturopathy, homeopathy
- Fertility Treatments
- Mental Health and Substance Abuse
- Experimental or Investigational Treatments
- Self-inflicted Injuries or Illegal Activities like Injuries from suicide attempts or illegal actions
- War or Nuclear Risks
- Non-prescription Drugs
Also, this is a group insurance policy, So, separate payment receipt is not available. If a separate invoice is required, eSewa will reissue upon request.
Terms and Conditions
- Eligibility: For ages 5–65; health check-up required if over 45 (at user’s cost).
- Coverage: 1-year policy with a 30-day waiting period (except accidents).
- Claims: Submit within 30 days post-discharge.
- Premium: Varies by age and coverage; refund if application is rejected.
- Responsibility: Users must provide correct info.
To learn more about the terms & conditions, click here.
Insurance Partner: Shikhar Insurance
Note: This insurance package provides coverage only for people between 5 and 65 years.
