Frequently Asked Questions in English

Is it true that the Health Insurance Program has been stopped?

No, this is not true. The Health Insurance Program has not been stopped. The misunderstanding is due to a change in policy. The program has only been discontinued in government hospitals. However, treatment in government hospitals was already completely free and still remains free. Therefore, the public has not suffered any loss. Under the Health Insurance Program, treatment continues to be provided in empaneled private hospitals across Punjab, which has always been a unique feature of this program. The purpose of including private hospitals was to reduce the burden on government hospitals and to ensure that people could receive medical help from the nearest private hospital in case of emergencies. Both these objectives are still being met.

 

Under the Health Insurance Program, empaneled private hospitals provide free treatment for cancer, ICU, CCU, NICU, medical cases, thalassemia, and all emergency services. For other medical conditions, 50% of the treatment cost is covered by the Health Insurance Program.

 

All permanent residents of Punjab are eligible for the Health Insurance Program.

Please visit the nearest NADRA office to update your family data. Once NADRA updates your record, your eligibility in the program will be corrected.

Or you can reach out to us through

• Email: info@phimc.punjab.gov.pk

• Helplines: 0800-07542 (24/7), 0333-6756390 / 042-99066000 / 042-99066001 (Monday–Saturday, 8:00 AM to 11:00 PM)

 

Your CNIC is your Health Insurance Program. If eligible, simply take your original CNIC to any empaneled hospital to avail services. A Hospital Facilitation Officer (HFO) will guide you with the admission process.

• Husband and wife

• Their unmarried children

• Newborn children (automatically added if born in an empaneled hospital)

Update your family record with NADRA. The updated data will automatically sync with the Health Insurance Program database.

• For newborns not delivered in empaneled hospitals, and for children under 18, provide a Form-B at the hospital helpdesk of SSP.

 

• Only in-patient services (admissions) are covered. OPD is not covered.

• If an empaneled hospital is not nearby, you may consult a local doctor. Otherwise, visit an empaneled hospital where the doctor will guide you if hospitalization is required.

How can I find the list of empaneled hospitals?

Visit Empaneled Hospitals List or call the helpline for assistance:

• 0800-07542 (24/7)

Coverage includes:

• In-patient medical and surgical procedures

• Emergency admissions

• Fractures and injuries

• Heart procedures (angioplasty, bypass)

• Cancer (surgery, chemotherapy, radiotherapy)

• Diabetes complications

• Burns and road traffic accidents (life/limb saving treatment, prosthesis)

• Chronic infections (Hepatitis, HIV, Rheumatology)

• Neurosurgical procedures

• Thalassemia treatment

Yes, medicines, tests, and diagnostics are covered, but only if you are admitted to the hospital. Under the co-payment policy, 50% of the cost is covered by the Health Insurance Program, while the remaining 50% must be paid by the patient’s family.

 

• PKR 60,000 per family per year for secondary care

• PKR 400,000 per family per year for priority care

• Coverage can be extended up to PKR 1,000,000 in special cases

• If admitted and your limit ends, ongoing treatment will continue until recovery.

• Life-threatening conditions will also be covered even after the limit is exhausted.

• No family size limit

• Pre-existing conditions are covered

• Inter-district and inter-provincial portability (treatment across Pakistan)

• One-day pre-hospitalization and up to five days post-hospitalization expenses are covered

• Services are provided through a contracted insurance company

 

The following are not covered under the program or by the insurance company:

• Outpatient visits (OPD)

• Normal delivery and C-sections

• Cosmetic procedures

• Dental treatments

• Eyeglasses

• Drug addiction

• Self-inflicted injuries or injuries from crimes

• Any treatment excluded as per insurance company’s policy

 

1. Confirm that:

o Your case requires admission (not OPD).

o Your treatment is not among the excluded list.

o Your coverage limit is not exhausted (except for emergencies).

2. If denial is still unjustified, contact:

o Hospital Facilitation Officer (HFO) on-site

o Email: info@phimc.punjab.gov.pk

o Helplines:

 0800-07542 (24/7)

(Monday–Saturday, 8:00 AM to 11:00 PM)

 

No. The program only covers hospitalization expenses. Unused coverage has no cash value.

Yes, you can avail services at any empaneled hospital across Pakistan. For details, visit Empaneled Hospitals List or call:

• 0800-07542 (24/7)