THE KHYBER PAKHTUNKHWA UNIVERSAL HEALTH COVERAGE ACT, 2022

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THE KHYBER PAKHTUNKHWA UNIVERSAL HEALTH COVERAGE ACT, 2022. 
(KHYBER PAKHTUNKHWA ACT NO. XVII OF 2022) 
 
CONTENTS 
PREAMBLE 
SECTIONS 
CHAPTER-I 
PRELIMINARY 
 
1. 
Short title, extent and commencement.  
2. 
Definitions.  
CHAPTER-II 
THE PROGRAMME 
 
3. 
Sehat Card Plus Programme.  
4. 
Additional package. 
5. 
Service providers. 
6. 
Central Management Information System. 
CHAPTER-III 
            THE POLICY BOARD 
 
7. 
Khyber Pakhtunkhwa Universal Health Coverage Policy Board. 
8. 
Meetings of the Policy Board. 
9. 
Functions of the Policy Board. 
10. Chief Executive Officer. 
11. Employees of the Policy Board. 
12. Appointment of advisors and consultants. 
13. Existing employees. 
CHAPTER-IV 
FINANCES 
14. Fund. 
15. Budget and accounts. 
16. Audit of accounts. 
CHAPTER-V 
MISCELLANEOUS 
17. Delegation of powers. 
18. Directions of Government. 
19. Succession and validation. 
20. Savings. 

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21. Annual report. 
22. Public servants. 
23. Removal of difficulties. 
24. Overriding effect. 
25. Power to make rules. 
26. Power to make regulations. 
 
 
 

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THE KHYBER PAKHTUNKHWA UNIVERSAL HEALTH COVERAGE ACT, 2022. 
(KHYBER PAKHTUNKHWA ACT NO. XVII OF 2022) 
 
[First published after having received the assent of the Governor of 
the Khyber Pakhtunkhwa in the Gazette of Khyber Pakhtunkhwa, 
(Extraordinary), dated the 12th  June, 2022]. 
 
AN 
ACT 
 
to provide for health protection to the all the families in the  
Province of Khyber Pakhtunkhwa. 
 
WHEREAS it is expedient to provide for health protection of all the 
permanent resident families of the Province of Khyber Pakhtunkhwa through a 
systematic approach and clear delineation of roles of key stakeholders towards 
better performance in the health system and to ensure that all the permanent resident 
families of the Province of Khyber Pakhtunkhwa registered with NADRA are 
guaranteed equitable access to a predefined package of healthcare services and to 
provide for other matters ancillary herewith and incidental thereto; 
 
It is hereby enacted by the Provincial Assembly of the Khyber Pakhtunkhwa 
as follows: 
 
CHAPTER-I 
PRELIMINARY 
 
1. 
Short title, extent and commencement.---(1) This Act may be called the 
Khyber Pakhtunkhwa Universal Health Coverage Act, 2022. 
 
(2) 
It shall extend to the whole of the Province of Khyber Pakhtunkhwa. 
 
(3) 
It shall come into force at once.  
 
2. 
Definitions.---In this Act, unless there is anything repugnant in the subject or 
context,- 
 
(a) 
“additional income” means income generated by the 
empanelled hospitals through the Programme; 
 
(b) 
“basic package” means the free of cost healthcare service 
provided under the Programme; 
 
(c) 
“beneficiary” or “beneficiaries” mean any member of the 
family registered with NADRA as permanent resident of the 
Province; 
 
(d) 
“Department” means the Health Department of Government; 
 
(e) 
“empanelled hospital” means a hospital, nursing or maternity 
home or such other medical service providers in public and 
private sectors, selected for provision of healthcare services to 
the beneficiaries and policy holders of the Programme; 

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(f) 
“family” means a group of persons registered as family with 
NADRA; 
 
(g) 
“Fund” means the Fund established under section 14 of this 
Act; 
 
(h) 
“Government” means the Government of the Khyber 
Pakhtunkhwa; 
 
(i) 
“health insurance services” mean the healthcare services 
under the basic package offered to the beneficiaries under this 
Act; 
 
(j) 
“member” means a member of the Policy Board; 
 
(k) 
“NADRA” means the National Database and Registration 
Authority established under section 3 of the National Database 
and Registration Authority Ordinance, 2000 (Ordinance No. 
VIII of 2000); 
 
(l) 
“Policy Board” means the Khyber Pakhtunkhwa Universal 
Health Coverage Policy Board established under section 7of 
this Act; 
 
(m) 
“policy holder” means an individual, family or a group who 
has purchased an additional package under section 4 of this 
Act; 
 
(n) 
“premium” means an amount paid annually by the Policy 
Board or by a policy holder to the hired insurance firm/third 
party, in order to provide them a basic package or, as the case 
may be, the additional package alongwith the basic package of 
services as explained in sections 3 and 4 of this Act; 
 
(o) 
“prescribed” means prescribed by rules or regulations; 
 
(p) 
“Procurement law and rules” means respectively the Khyber 
Pakhtunkhwa Public Procurement Regulatory Authority Act, 
2012 (Khyber Pakhtunkhwa Act No. XI of 2012) and the 
Khyber Pakhtunkhwa Public Procurement of Goods, Works 
and Services Rules, 2014; 
 
(q) 
“Programme” means the Sehat Card Plus Programme as 
provided in section 3 of this Act; 
 
(r) 
“Province” means the Province of the Khyber Pakhtunkhwa; 
 
 

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(s) 
“registered population” means the population registered with 
NADRA as permanent residents of the Province; 
 
(t) 
“regulations” mean the regulations made under this Act; 
 
(u) 
“rules” mean rules made under this Act; 
 
(v) 
“Social Health Protection Initiative” means the Social Health 
Protection Initiative of the Province branded as Sehat Card 
Plus Programme; and 
 
(w) 
“universal health coverage” means provision of needed 
healthcare services to the beneficiaries of the Programme when 
and where they need them, without financial hardship in the 
manner as provided in section 3 of this Act. 
 
CHAPTER-II 
THE PROGRAMME 
 
3. 
Sehat Card Plus Programme.---(1) Soon after the commencement of this 
Act, Government shall, under the auspices of the Policy Board, provide health 
protection to the beneficiaries under a Programme to be known as the Sehat Card 
Plus Programme in accordance with section 5 of this Act. 
 
(2) 
The Programme shall be a body corporate having perpetual succession 
and a common seal with powers to acquire and hold property, enter into contract, 
sue and be sued by its name. 
 
 
(3)  
The Programme shall be executed by the Policy Board through a third 
party insurance firm having expertise in the field of health insurance. The third 
party insurance firm shall be selected through a transparent bidding process, in 
accordance with the provisions of the Procurement law and rules. 
 
 
(4) 
For the purpose of sub-section (3), the Policy Board shall enter into an 
agreement with the selected insurance firm, covering all the matters relating to the 
execution of the Programme, including the basic package, claims management and 
other ancillary matters. 
 
 
(5) 
The Computerized National Identity Card of each beneficiary shall 
serve as the basis of eligibility for availing benefits under the Programme. 
 
 
(6) 
Subject to the available budget, all the beneficiaries of the Programme 
shall be provided with a basic package of inpatient healthcare services to be 
determined by the Policy Board with the approval of Government. 
 
(7) 
The maximum limit of the basic package, in terms of money, shall be 
fixed by Government on the recommendations of the Policy Board.  
 

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4. 
Additional package.---(1) The insurance firm may, with the approval of the 
Policy Board, offer additional package, which is over and above the basic package, 
to interested individuals, families and groups on payment of such additional 
premium, as determined by Government on the recommendation by the Policy 
Board, in the manner as may be prescribed in rules. 
 
 
(2) 
The additional package under sub-section (1), shall be regulated in the 
manner as may be prescribed by rules. 
 
5. 
Service providers.---(1) Healthcare services to the beneficiaries under the 
basic package as provided in section 3 or an additional package as provided in 
section 4, shall be provided through empanelled hospitals. 
 
(2) 
Service providers shall be empanelled in the manner, as may be 
prescribed by regulations.  
 
(3) 
The empanelled hospitals shall be paid by the insurance firm for the 
provision of services in a manner, as may be prescribed by regulations. 
 
(4) 
Public hospitals shall retain, without loss of budget, all of the 
additional income. 
 
(5) 
The additional income under sub-section (4), shall be retained and 
utilized for the improvement of quality of healthcare services and payment of 
incentives to the hospital staff in such a manner as may be prescribed in regulations.  
 
6. 
Central Management Information System.---(1) For the purpose of 
managing information regarding the Programme, the Policy Board shall establish a 
Central Management Information System. The Policy Board may procure the 
services of a third party for the purpose of establishing the Central Management 
Information System. 
 
(2) 
All 
the 
information 
regarding 
enrolment 
of 
beneficiaries, 
empanelment, admissions and treatment in hospitals, claims data, beneficiaries’ 
grievances and any other information approved by the Policy Board, shall be 
collected and processed on the Central Management Information System.  
 
(3) 
The Policy Board, the empanelled hospitals and the insurance firm 
shall provide necessary data for the establishment and updation of the Central 
Management Information System. 
 
CHAPTER-III 
THE POLICY BOARD 
 
7. 
Khyber Pakhtunkhwa Universal Health Coverage Policy Board.---(1) 
Soon after the commencement of this Act, the Department shall, by notification in 
the official Gazette, establish a Policy Board to be known as the Khyber 
Pakhtunkhwa Universal Health Coverage Policy Board. 
 

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(2) 
The Policy Board shall consist of the following, namely: 
 
(a) 
Minister for Health, Khyber Pakhtunkhwa; 
 
Chairperson 
(b) 
Secretary 
to 
Government, 
Health 
Department or his nominee not below the 
rank of an Additional Secretary; 
 
Member 
(c) 
Secretary 
to 
Government, 
Finance 
Department or his nominee not below the 
rank of an Additional Secretary; 
 
Member 
(d) 
Director General Health Services, Khyber 
Pakhtunkhwa;  
 
Member 
(e) 
three persons from private sector to be 
appointed by the Chief Minister on the 
recommendations of the Department; and  
 
Members 
(f) 
Chief Executive Officer. 
Member 
-cum- 
Secretary. 
 
 
(3) 
The members at clause (e) of sub-section (2), may include health 
insurance expert, retired civil servants, retired officers of medical profession or 
patient’s safety, financial management experts, philanthropists having significant 
contribution in health, quality assurance experts and a representative of civil 
society. 
 
 
(4) 
The members at clause (e) of sub-section (2), shall hold office for a 
term of three years or during the pleasure of the Chief Minister, whichever is 
earlier. 
 
 
(5) 
The members at clause (e) of sub-section (2), may resign from his 
office by tendering resignation to the Chief Minister: 
 
Provided that the member shall continue to hold the office until his 
resignation is accepted. 
 
 
(6) 
Any vacancy caused due to death, resignation or removal of any 
member at clause (e) of sub-section (2), shall be filled in by the Chief Minister 
through appointment of another person as member and such appointee shall hold 
such office for the unexpired term of his predecessor. 
 
8. 
Meetings of the Policy Board.---(1) The Policy Board shall hold at least six 
meetings every year or as frequently as required. The meeting of the Policy Board 
shall be convened by the Chairperson. 
 
 

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(2) 
The Chairperson shall preside over the meeting of the Policy Board. 
In case of his absence, the Secretary of the Department shall act as Chairperson of 
the Policy Board. 
 
(3) 
The quorum for the meeting shall be five members. 
 
(4) 
The member count shall be determined by actual members present or 
those attending through duly authorized video link. 
 
(5) 
All decisions of the Policy Board shall be taken by consensus and in 
case of division of opinion, the decision shall be taken by majority of votes: 
 
Provided that in case of equality of votes, the Chairperson shall have a 
casting vote. 
 
(6) 
No act or proceedings of the Policy Board shall be invalid merely 
because of the existence of any vacancy. 
 
(7) 
Special meetings of the Policy Board shall be convened on the request 
of at least one-third of the members. 
 
9. 
Functions of the Policy Board.---(1) The Policy Board shall perform such 
functions and exercise such powers, as may be required to ensure health protection 
of beneficiaries and to improve quality of healthcare services offered to them under 
the basic package or any additional package. 
 
(2) 
Without prejudice to the generality of the provisions of sub-section 
(1), the Policy Board shall,- 
 
(a) 
ensure that objectives of the Programme are achieved in light 
of the National Health Vision and policies of the Government; 
 
(b) 
oversee the effective management and providing strategic 
directions to the Programme; 
 
(c) 
approve regulations prescribing procedure for appointment, 
terms and conditions of service, disciplinary matters and other 
service matters for employees of the Policy Board and oversee 
the process of appointment of employees of the Policy Board; 
 
(d) 
approve annual business plan, financial plans, annual budget 
and major transactions; 
 
(e) 
select insurance firm or third party for execution of the 
Programme in accordance with the Procurement law and rules; 
 
(f) 
acquire, hold and dispose of property;  
 
 

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(g) 
enter into contracts with any entity organization or person; 
 
(h) 
approve the hospitals or service providers for empanelment or 
de-panelment; 
 
(i) 
approve rates for different services provided through 
empanelled hospitals under the Programme; 
(j) 
constitute committees for any purpose in relation to the 
implementation of the Programme; 
 
(k) 
regulate the service providers through policy guidelines issued 
from time to time; 
 
(l) 
recommend policy proposals for the approval of Government 
on the expansion of Programme, coordination with other safety 
net and development programs like Zakat, Bait-ul-Mal or 
Benazir Income Support Programme and others; 
 
(m) 
devise 
and 
implement 
necessary 
Standard 
Operating 
Procedures to ensure that empanelled public and private 
hospitals provide services as per the approved health package 
and to take action against them in case of non-compliance; 
 
(n) 
undertake in the manner, as may be prescribed by regulations, 
the promotional campaigns to create awareness amongst the 
population for optimum utilization of the healthcare services 
offered through the Programme; and 
 
(o) 
perform any other function as may be assigned to it by 
Government or as may be prescribed in rules. 
 
10. 
Chief Executive Officer.---(1) There shall be a Chief Executive Officer  of 
the Programme who shall be responsible for day-to-day administration of the affairs 
of the Programme and shall exercise such powers and perform such functions, as 
may be prescribed by regulations or assigned to him by the Policy Board. 
 
(2) 
The Chief Executive Officer shall be appointed by the Policy Board in 
such a manner, with such qualifications and on such terms and conditions, as may 
be prescribed by regulations. 
 
(3) 
The Chief Executive Officer shall serve during the pleasure of the 
Policy Board for a term up to three years which may be extended for another such 
term. 
 

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11. 
Employees of the Policy Board.---(1) To support the Chief Executive 
Officer in the performance of his functions under this Act, the Policy Board shall 
appoint such number of employees, in such a manner and on such terms and 
conditions, as may be prescribed by regulations. 
 
(2) 
The Policy Board may fill in the vacant positions of the Policy Board 
through deputation of employees from the Department till hiring of the employees 
from the market. 
 
12. 
Appointment of advisors and consultants.---The Policy Board may 
appoint advisors, consultants and technical experts, as it may considers necessary, 
for the performance of its functions under this Act, on such terms and conditions, as 
may be prescribed by regulations. 
 
13. 
Existing employees.---(1) Within one hundred and twenty days of the 
commencement of this Act, all the existing employees of the Social Health 
Protection Initiative regularized under the Khyber Pakhtunkhwa Employees 
(Regularization of Services) Act, 2018, shall be given one time option of absorption 
in the Programme or to remain employees of the Department.  
 
 
(2) 
Those employees who opt for absorption in the Programme, shall be 
absorbed in the Policy Board on such terms and conditions, as may be prescribed by 
regulations. The employees, who do not opt for absorption, shall remain as the 
employees of the Department and shall serve in the Programme on their existing 
terms and conditions.  
 
 
(3) 
All the contract employees of Social Health Protection Initiative shall 
be considered as the employees of the Programme till their contract period is 
completed on the same terms and conditions as agreed at the time of their 
appointment. 
 
CHAPTER-IV 
FINANCES 
 
14. 
Fund.---(1) There shall be a fund of the Programme to be known as the 
Khyber Pakhtunkhwa Universal Health Coverage Fund. 
 
(2) 
The Fund shall consist of- 
 
(a) 
grants from Government; 
 
(b) 
grants from the Federal Government; 
 
(c) 
unutilized premium or savings from the previous year; 
 
(d) 
annual fee received from empanelled hospitals in the 
prescribed manner; 
 
(e) 
voluntary contributions or donations; and 
 
(f) 
grants and income from other sources. 

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(3) 
The Fund account shall be maintained at such bank or treasury, as 
may be prescribed.  
 
(4) 
The Fund shall be kept in such custody and shall be utilized and 
regulated in such manner, as may be prescribed by regulations. 
 
(5) 
The Fund shall be used for payment of premium and other costs of the 
Programme, as may be prescribed by regulations. 
 
(6) 
A portion of the Fund shall be specified as “Reserve Fund” to be used 
in the manner, as may be prescribed by regulations, for payment of cost exceeding 
the basic package limit or to cover cost of those procedures or treatments not 
covered under the Programme. 
 
(7) 
The Policy Board may invest money not required for immediate 
expenditure in a manner, as may be prescribed by rules. 
 
15. 
Budget and accounts.---(1) The Policy Board shall prepare and approve 
annual budget for a financial year in the prescribed manner. 
 
(2) 
No expenditure shall be made for which provision has not been made 
in any approved budget, except if made from any previously approved contingency 
funds, unless further approval is sought and obtained from the Policy Board. 
 
(3) 
The Policy Board shall keep proper accounts and shall, as soon as 
practicable, after the end of each financial year, prepare a statement of accounts of 
the Policy Board through the Chief Executive Officer for the financial year which 
shall include a balance sheet and an account of income and expenditure. 
 
16. 
Audit of accounts.---(1) The accounts of the Programme shall be audited by 
the Auditor General of Pakistan. The Policy Board shall render all out support to the 
Auditor General Office while carrying out audit of the Programme’s accounts. 
 
(4)       The Policy Board shall also engage the services of a reputed private 
sector Chartered Accountancy firm for carrying out external annual audit. Both the 
audit reports shall be submitted in due time to the Department. 
 
(5)       The Policy Board shall, within one hundred and twenty days of the 
end of each financial year, together with the annual report of the Policy Board, send 
through the Department a copy of the statement of accounts of the Policy Board 
certified by the auditors and a copy of the auditor’s report and the third-party audit 
to Government. 
 
 
 
 
 
 
 
 

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CHAPTER-V 
MISCELLANEOUS  
 
17. 
Delegation of powers.---The Policy Board may, subject to such conditions 
and limitations, as it may deem fit to impose, delegate any of its powers or 
functions to the Chairperson, Chief Executive Officer, a committee constituted by 
it, a member or employee, except the powers to- 
 
(a) 
frame, amend or repeal regulations; 
 
(b) 
approve policy decisions, guidelines or procedures for the 
operation of the Fund; 
 
(c) 
determine the terms and conditions of service of the employees 
of the Policy Board; 
 
(d) 
constitute committees; 
 
(e) 
approve the annual budget, audited accounts and annual reports 
of the Policy Board; and 
 
(f) 
consider audit reports of the Policy Board. 
 
18. 
Directions of Government.---Government or the Department may, from 
time to time, give policy directions to the Policy Board, including, but not limited 
to, defining the eligibility criteria, revising the entitlement and modifications of 
basic package. 
 
19. 
Succession and validation.---On the commencement of this Act,- 
 
(a) 
the Social Health Protection Initiative shall stand transferred to 
the Policy Board; 
 
(b) 
all the assets of Social Health Protection Initiative shall stand 
transferred to the Policy Board; 
 
(c) 
all the employees serving in the Social Health Protection 
Initiative before coming into force of this Act, shall be dealt in 
accordance with section 13 of this Act;  
 
(d) 
all the actions and activities, taken under the Social Health 
Protection Initiative shall stand valid and shall be deemed to be 
taken under this Act; and 
 
(e) 
expansion of Sehat Card Plus to all population of the Province 
done during 2020 and 2021, through State Life Insurance 
Corporation, shall be deemed to have been done under this Act. 
 

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20. 
Savings.---Save as otherwise specifically provided, nothing in this Act shall 
affect or be deemed to affect anything done, action taken, proceedings commenced, 
orders, rules, regulations, appointments, agreements made, directions given or 
instruments executed or issued in relation to Social Health Protection Initiative and 
any such things, actions, proceedings, orders, rules, regulations, appointments, 
agreements, directions or instruments shall, if in force at the commencement of this 
Act and not inconsistent with any of the provisions of this Act, continue to be in 
force and have effect as if they were respectively done, taken, commenced, made, 
directed, given, executed or issued under this Act. 
 
21. 
Annual report.---The Policy Board shall within ninety days of the end of 
each financial year, prepare a report on the activities and performance of the Policy 
Board and submit a copy of the report to Government through the Department. 
 
22. 
Public servants.---The Chairperson, members and the employees of the 
Programme shall be deemed to be public servants within the meaning of the section 
21 of the Pakistan Penal Code, 1860 (Act No. XLV of 1860). 
 
23. 
Removal of difficulties.---If any difficulty arises in giving effect to any 
provision of this Act, Government may make such order not inconsistent with the 
provisions of this Act, as may appear to it to be necessary for the purpose of 
removing such difficulty. 
 
24. 
Overriding effect.---The provisions of this Act shall have effect 
notwithstanding anything to the contrary contained in any other law for the time 
being in force. 
 
25. 
Power to make rules.---Government may, by notification in the official 
Gazette, make rules for the purpose of this Act.  
 
26. 
Power to make regulations.---(1) The Policy Board may, by notification in 
the official Gazette, make regulations not inconsistent with the provisions of this 
Act and the rules, for carrying out the purposes of this Act. 
 
 
(2) 
The power to make regulations conferred under sub-section (1) shall 
be subject to the condition of previous publication and before making any 
regulations, the draft thereof shall be published in the official Gazette, two 
newspapers of wide circulation and on the website of the Programme, for eliciting 
public opinion thereon within a period of not less than fifteen days from the date of 
publication.