Health insurance in Pakistan, and what the Sehat Card covers

Health insurance in Pakistan comes in two layers. The government Sehat Card pays for hospital admissions for permanent residents of Khyber Pakhtunkhwa, Punjab, Islamabad, AJK and Gilgit-Baltistan, with your CNIC as the card, up to Rs 4 lakh a family a year for major treatment (official FAQs, 2025). It does not pay for OPD (outpatient) visits. Private plans from Jubilee, Adamjee, TPL and EFU Life add Rs 2.25 lakh to Rs 10 lakh of cover a year, as of October 2026.

What does the Sehat Card cover?

The Sehat Card is cashless: the hospital bills the programme, not you. It pays only when a doctor admits you. The official FAQs say:

• Who is covered: husband, wife and unmarried children, with no limit on family size, based on NADRA records.
• What is covered: treatment that needs admission, including heart procedures, cancer treatment, dialysis, burns and road accidents.
• What is not: OPD visits, and cash if you never use the card.

The family limits below come from the two programme FAQs we could open, both archived in spring 2025. We couldn’t open a 2026 version of either page, so treat them as the last published figures.

The limit refills once a year.

Is the Sehat Card still working in 2026?

It depends on where your CNIC says you live. The programme has changed in several regions since 2024.

Khyber Pakhtunkhwa. State Life Insurance runs the scheme, with 700 empanelled hospitals, 169 of them in the province. Payment delays have hit hospitals: in March 2026, ProPakistani reported that Ayub Teaching Hospital had received Rs 38 million against Rs 700 million owed. In September 2026 the chief minister reviewed proposals to add basic health units and a top-up package for government employees; in the reports we found, these were still proposals.

Punjab. The Punjab Health Initiative Management Company (PHIMC) closed the scheme in public hospitals on 30 June 2025. A PHIMC official told The News that the scheme carries on in private hospitals. In December 2025, Chief Minister Maryam Nawaz ordered separate cards for cardiac and cancer patients, worth up to Rs 10 lakh each, for 45,000 patients in the first phase, Dawn reported.

Islamabad, AJK and Gilgit-Baltistan. About 70 hospitals were being empanelled at the January 2026 relaunch. Cardholders from these regions can also use 16 designated hospitals in Karachi.

How do I check if my family has a Sehat Card?

Send your CNIC number by SMS to 8500. In Khyber Pakhtunkhwa you can also use 9780. The federal programme’s helpline is 0800-09009.

If you aren’t showing up, the problem is usually your NADRA family record. In Khyber Pakhtunkhwa, newly married couples and widows or divorced women who register as head of family are added on 1 January and 1 July. A newborn is covered for its first month; after that it needs a Form-B.

What do private health insurance plans offer?

Private plans pay hospital bills up to a yearly limit, usually cashless at the insurer’s panel hospitals. They help if you live in Sindh, want a private room, or want cover the Sehat Card no longer gives you in Punjab.

Limits are from each insurer’s page on 13 October 2026. TPL’s general FAQ says its health plans don’t cover maternity, so check what Women Shield’s policy wording says. Salaam Sehat is takaful, run on Islamic principles. EFU Life is a life insurer; its Mukammal Sehat is a standalone health plan.

How much does health insurance cost in Pakistan?

We found no published price list at any of the five insurers above. You get a quote after entering ages. Jubilee prices its family plan on the age of the eldest member; TPL says the premium depends on age, the cover and the yearly limit.

There is no tax break either. Section 62A of the Income Tax Ordinance, which gave a tax credit for health insurance premiums, was removed by the Finance Act 2022. For what you pay in tax, see the salary tax calculator.

What should I check before I buy?

• Waiting period. Adamjee’s cover starts 30 days after the policy is issued in the first year, except for accidents.
• Pre-existing illness. Adamjee excludes it; Jubilee covers it after 48 months of renewals. TPL says the insurer’s medical panel decides what counts as pre-existing, using your proposal form, so declare everything.
• The limit shrinks after a claim. TPL’s example: Rs 5 lakh of cover minus a Rs 2 lakh claim leaves Rs 3 lakh for the rest of the year.
• OPD and tests. Tests prescribed in OPD are generally not paid; tests within 30 days before and after an admission are (TPL, Adamjee).
• Room limit. Jubilee’s cheaper plan pays for a semi-private room; its dearer plan pays for a private room.
• Panel hospitals. Cashless treatment works only at the insurer’s panel. Elsewhere you pay and claim it back.
• Free look. Jubilee gives 14 days to cancel if you change your mind.

You can hold two policies. TPL says the second one pays once the first limit runs out.

Health insurance for parents and senior citizens

This is the hardest gap to fill. Adamjee’s plans stop at 60, and Jubilee takes new adults only up to 49. Of the plans we checked, EFU Life’s Mukammal Sehat goes furthest: cover continues to 80 if you join by 64. Buy before your parents reach those ages.

If you want a payout for your family rather than hospital bills, that is life insurance. For cover abroad, see travel insurance.

What if my claim is refused?

The Federal Insurance Ombudsman handles disputes between policyholders and insurers, free of cost; you can file online or call 1082. Our car insurance guide covers the 90-day legal limit for paying claims.

More guides: life insurance in Pakistan, travel insurance, pension funds, income tax slabs 2026-27, Credit Cards & Insurance.