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Benefits Package

(Diseases covered)

  • Benefits package refers to a list of diseases covered under an insurance programme. Since Sehat Sahulat Programme is a health insurance scheme, it has a defined benefits package.
  • The benefits package varies from province to province. Generally, it covers almost all the surgical procedures and medical diseases for which hospital admission is required. Currently, the various provincial streams of Sehat Sahulat Programme do not cover outpatient (OPD) services. The Provincial Government of Khyber Pakhtunkhwa is planning to cover OPD services on an experimental basis in four districts in 2021
Salient Features Sehat Sahulat Program, Khyber Pakhtunkhwa Sehat Sahulat Program, Federal
Initial coverage for secondary care (Basic Treatment) 200,000 PKR per family per year 60,000 PKR per family per year
Additional coverage for secondary care (Basic Treatment) 60,000 PKR per family per year
Secondary care (Basic Treatment).
  • Emergency treatment requiring admission.
  • Maternity Services (Normal deliveries, C-section).
  • Fractures and Injuries.
  • General Surgeries (Gallbladder, biopsy, colon, prostate, hernia).
  • General Medicine (diabetes, hypertension, cardiac).
  • In Patient Services (All Medical and Surgical Procedures).
  • Emergency Treatment requiring admission.
  • Maternity Services (Normal Delivery and C – Section).
  • Maternity Consultancy / Antenatal Checkups (4 times before delivery and one follow up after delivery).
  • Maternal Consultancy for family planning, immunization and nutrition.
  • Fractures / Injuries.
  • Post hospitalization.
  • Local Transportation Cost of PKR 1,000 (thrice per year).
  • Provision of transport to tertiary care hospitals.
    • Coverage for tertiary care (Advanced Treatment) 400,000 PKR per family per year 300,000 PKR per family per year
    400,000 PKR per family per year
    (Additional Coverage)     		300,000 PKR per family per year
    (Additional Coverage)
    Tertiary care (Advanced Treatment)
  • Cardiovascular (Angioplasty, bypass)
  • Diabetes
  • Artificial Limbs (Prosthesis)
  • Kidney Diseases (Dialysis)
  • Breast Cancer Screening
  • Management of Neurosurgical Diseases
  • Cancer Treatment (Chemo, Radio, Surgery)
  • Kidney Transplant
  • Accident and Emergency
  • ICU Care
  • In Patient Services (All Medical and Surgical Procedures).
  • Heart diseases (Angioplasty/bypass).
  • Diabetes Mellitus Completion.
  • Burns and RTA (Life, Limb Saving Treatmen
  • End stage kidney diseases/ dialysis.
  • Chronic infections (Hepatitis/ HIV/ Rheumatology).
  • Organ Failure (Liver, Kidney, Heart, Lungs).
  • Cancer (Chemo, Radio, Surgery).
  • Neurosurgical Procedure.
    • Total coverage for treatment Health expenditure up to 1,000,000 PKR per family per year Health expenditure up to 720,000 PKR per family per year
    Amount of wage loss 250 PKR per day for three days
    Maternity Allowance 1,000 PKR (transportation) 1,000 PKR (transportation)
    Transportation Allowance 2,000 PKR 1,000 PKR (three times per year)
    Funeral Allowance 10,000 PKR

    * Wage-loss replacement will start from second day of hospitalization.
    * Maternity allowance will be paid for need of transportation after a childbirth.
    * Transportation allowance will be paid in case a person is referred by a secondary care hospital to a tertiary care hospital.
    * Funeral allowance will be paid to family if a member dies during a hospital admission.
    For further details, download the brochure.