{ "schema_version": "qanun-law-text/1", "id": "kp-code-4afea28715a53951", "title": "THE KHYBER PAKHTUNKHWA UNIVERSAL HEALTH COVERAGE ACT, 2022", "source_collection": "Khyber Pakhtunkhwa", "content_kind": "stored_law_text", "content_extent": null, "source_url": "https://kpcode.kp.gov.pk/homepage/lawDetails/1485", "version": null, "source_snapshot": null, "legal_status": "not independently verified", "text_quality": "Owned source variant; not asserted identical to master snapshot. PDF bytes preserved; derived text extraction unreviewed. This is an owned source variant, not asserted identical to the master catalogue snapshot.", "text_sha256": "513ee98b9c201adbca25a5bf7e68e34a77f5540848841b6f93dc3d640316e93e", "source_sha256": "513ee98b9c201adbca25a5bf7e68e34a77f5540848841b6f93dc3d640316e93e", "text_version_id": "law:kp-code-4afea28715a53951:sha256:513ee98b9c201adbca25a5bf7e68e34a77f5540848841b6f93dc3d640316e93e", "quality_flags": [ "owned_source_variant", "consolidation_unverified", "current_legal_status_unverified" ], "encoding": "UTF-8", "text": "1 | P a g e \n \n \nTHE KHYBER PAKHTUNKHWA UNIVERSAL HEALTH COVERAGE ACT, 2022. \n(KHYBER PAKHTUNKHWA ACT NO. XVII OF 2022) \n \nCONTENTS \nPREAMBLE \nSECTIONS \nCHAPTER-I \nPRELIMINARY \n \n1. \nShort title, extent and commencement. \n2. \nDefinitions. \nCHAPTER-II \nTHE PROGRAMME \n \n3. \nSehat Card Plus Programme. \n4. \nAdditional package. \n5. \nService providers. \n6. \nCentral Management Information System. \nCHAPTER-III \n THE POLICY BOARD \n \n7. \nKhyber Pakhtunkhwa Universal Health Coverage Policy Board. \n8. \nMeetings of the Policy Board. \n9. \nFunctions of the Policy Board. \n10. Chief Executive Officer. \n11. Employees of the Policy Board. \n12. Appointment of advisors and consultants. \n13. Existing employees. \nCHAPTER-IV \nFINANCES \n14. Fund. \n15. Budget and accounts. \n16. Audit of accounts. \nCHAPTER-V \nMISCELLANEOUS \n17. Delegation of powers. \n18. Directions of Government. \n19. Succession and validation. \n20. Savings. \n\n2 | P a g e \n \n \n21. Annual report. \n22. Public servants. \n23. Removal of difficulties. \n24. Overriding effect. \n25. Power to make rules. \n26. Power to make regulations. \n \n \n \n\n3 | P a g e \n \n \nTHE KHYBER PAKHTUNKHWA UNIVERSAL HEALTH COVERAGE ACT, 2022. \n(KHYBER PAKHTUNKHWA ACT NO. XVII OF 2022) \n \n[First published after having received the assent of the Governor of \nthe Khyber Pakhtunkhwa in the Gazette of Khyber Pakhtunkhwa, \n(Extraordinary), dated the 12th June, 2022]. \n \nAN \nACT \n \nto provide for health protection to the all the families in the \nProvince of Khyber Pakhtunkhwa. \n \nWHEREAS it is expedient to provide for health protection of all the \npermanent resident families of the Province of Khyber Pakhtunkhwa through a \nsystematic approach and clear delineation of roles of key stakeholders towards \nbetter performance in the health system and to ensure that all the permanent resident \nfamilies of the Province of Khyber Pakhtunkhwa registered with NADRA are \nguaranteed equitable access to a predefined package of healthcare services and to \nprovide for other matters ancillary herewith and incidental thereto; \n \nIt is hereby enacted by the Provincial Assembly of the Khyber Pakhtunkhwa \nas follows: \n \nCHAPTER-I \nPRELIMINARY \n \n1. \nShort title, extent and commencement.---(1) This Act may be called the \nKhyber Pakhtunkhwa Universal Health Coverage Act, 2022. \n \n(2) \nIt shall extend to the whole of the Province of Khyber Pakhtunkhwa. \n \n(3) \nIt shall come into force at once. \n \n2. \nDefinitions.---In this Act, unless there is anything repugnant in the subject or \ncontext,- \n \n(a) \n“additional income” means income generated by the \nempanelled hospitals through the Programme; \n \n(b) \n“basic package” means the free of cost healthcare service \nprovided under the Programme; \n \n(c) \n“beneficiary” or “beneficiaries” mean any member of the \nfamily registered with NADRA as permanent resident of the \nProvince; \n \n(d) \n“Department” means the Health Department of Government; \n \n(e) \n“empanelled hospital” means a hospital, nursing or maternity \nhome or such other medical service providers in public and \nprivate sectors, selected for provision of healthcare services to \nthe beneficiaries and policy holders of the Programme; \n\n4 | P a g e \n \n \n \n(f) \n“family” means a group of persons registered as family with \nNADRA; \n \n(g) \n“Fund” means the Fund established under section 14 of this \nAct; \n \n(h) \n“Government” means the Government of the Khyber \nPakhtunkhwa; \n \n(i) \n“health insurance services” mean the healthcare services \nunder the basic package offered to the beneficiaries under this \nAct; \n \n(j) \n“member” means a member of the Policy Board; \n \n(k) \n“NADRA” means the National Database and Registration \nAuthority established under section 3 of the National Database \nand Registration Authority Ordinance, 2000 (Ordinance No. \nVIII of 2000); \n \n(l) \n“Policy Board” means the Khyber Pakhtunkhwa Universal \nHealth Coverage Policy Board established under section 7of \nthis Act; \n \n(m) \n“policy holder” means an individual, family or a group who \nhas purchased an additional package under section 4 of this \nAct; \n \n(n) \n“premium” means an amount paid annually by the Policy \nBoard or by a policy holder to the hired insurance firm/third \nparty, in order to provide them a basic package or, as the case \nmay be, the additional package alongwith the basic package of \nservices as explained in sections 3 and 4 of this Act; \n \n(o) \n“prescribed” means prescribed by rules or regulations; \n \n(p) \n“Procurement law and rules” means respectively the Khyber \nPakhtunkhwa Public Procurement Regulatory Authority Act, \n2012 (Khyber Pakhtunkhwa Act No. XI of 2012) and the \nKhyber Pakhtunkhwa Public Procurement of Goods, Works \nand Services Rules, 2014; \n \n(q) \n“Programme” means the Sehat Card Plus Programme as \nprovided in section 3 of this Act; \n \n(r) \n“Province” means the Province of the Khyber Pakhtunkhwa; \n \n \n\n5 | P a g e \n \n \n \n \n(s) \n“registered population” means the population registered with \nNADRA as permanent residents of the Province; \n \n(t) \n“regulations” mean the regulations made under this Act; \n \n(u) \n“rules” mean rules made under this Act; \n \n(v) \n“Social Health Protection Initiative” means the Social Health \nProtection Initiative of the Province branded as Sehat Card \nPlus Programme; and \n \n(w) \n“universal health coverage” means provision of needed \nhealthcare services to the beneficiaries of the Programme when \nand where they need them, without financial hardship in the \nmanner as provided in section 3 of this Act. \n \nCHAPTER-II \nTHE PROGRAMME \n \n3. \nSehat Card Plus Programme.---(1) Soon after the commencement of this \nAct, Government shall, under the auspices of the Policy Board, provide health \nprotection to the beneficiaries under a Programme to be known as the Sehat Card \nPlus Programme in accordance with section 5 of this Act. \n \n(2) \nThe Programme shall be a body corporate having perpetual succession \nand a common seal with powers to acquire and hold property, enter into contract, \nsue and be sued by its name. \n \n \n(3) \nThe Programme shall be executed by the Policy Board through a third \nparty insurance firm having expertise in the field of health insurance. The third \nparty insurance firm shall be selected through a transparent bidding process, in \naccordance with the provisions of the Procurement law and rules. \n \n \n(4) \nFor the purpose of sub-section (3), the Policy Board shall enter into an \nagreement with the selected insurance firm, covering all the matters relating to the \nexecution of the Programme, including the basic package, claims management and \nother ancillary matters. \n \n \n(5) \nThe Computerized National Identity Card of each beneficiary shall \nserve as the basis of eligibility for availing benefits under the Programme. \n \n \n(6) \nSubject to the available budget, all the beneficiaries of the Programme \nshall be provided with a basic package of inpatient healthcare services to be \ndetermined by the Policy Board with the approval of Government. \n \n(7) \nThe maximum limit of the basic package, in terms of money, shall be \nfixed by Government on the recommendations of the Policy Board. \n \n\n6 | P a g e \n \n \n4. \nAdditional package.---(1) The insurance firm may, with the approval of the \nPolicy Board, offer additional package, which is over and above the basic package, \nto interested individuals, families and groups on payment of such additional \npremium, as determined by Government on the recommendation by the Policy \nBoard, in the manner as may be prescribed in rules. \n \n \n(2) \nThe additional package under sub-section (1), shall be regulated in the \nmanner as may be prescribed by rules. \n \n5. \nService providers.---(1) Healthcare services to the beneficiaries under the \nbasic package as provided in section 3 or an additional package as provided in \nsection 4, shall be provided through empanelled hospitals. \n \n(2) \nService providers shall be empanelled in the manner, as may be \nprescribed by regulations. \n \n(3) \nThe empanelled hospitals shall be paid by the insurance firm for the \nprovision of services in a manner, as may be prescribed by regulations. \n \n(4) \nPublic hospitals shall retain, without loss of budget, all of the \nadditional income. \n \n(5) \nThe additional income under sub-section (4), shall be retained and \nutilized for the improvement of quality of healthcare services and payment of \nincentives to the hospital staff in such a manner as may be prescribed in regulations. \n \n6. \nCentral Management Information System.---(1) For the purpose of \nmanaging information regarding the Programme, the Policy Board shall establish a \nCentral Management Information System. The Policy Board may procure the \nservices of a third party for the purpose of establishing the Central Management \nInformation System. \n \n(2) \nAll \nthe \ninformation \nregarding \nenrolment \nof \nbeneficiaries, \nempanelment, admissions and treatment in hospitals, claims data, beneficiaries’ \ngrievances and any other information approved by the Policy Board, shall be \ncollected and processed on the Central Management Information System. \n \n(3) \nThe Policy Board, the empanelled hospitals and the insurance firm \nshall provide necessary data for the establishment and updation of the Central \nManagement Information System. \n \nCHAPTER-III \nTHE POLICY BOARD \n \n7. \nKhyber Pakhtunkhwa Universal Health Coverage Policy Board.---(1) \nSoon after the commencement of this Act, the Department shall, by notification in \nthe official Gazette, establish a Policy Board to be known as the Khyber \nPakhtunkhwa Universal Health Coverage Policy Board. \n \n\n7 | P a g e \n \n \n(2) \nThe Policy Board shall consist of the following, namely: \n \n(a) \nMinister for Health, Khyber Pakhtunkhwa; \n \nChairperson \n(b) \nSecretary \nto \nGovernment, \nHealth \nDepartment or his nominee not below the \nrank of an Additional Secretary; \n \nMember \n(c) \nSecretary \nto \nGovernment, \nFinance \nDepartment or his nominee not below the \nrank of an Additional Secretary; \n \nMember \n(d) \nDirector General Health Services, Khyber \nPakhtunkhwa; \n \nMember \n(e) \nthree persons from private sector to be \nappointed by the Chief Minister on the \nrecommendations of the Department; and \n \nMembers \n(f) \nChief Executive Officer. \nMember \n-cum- \nSecretary. \n \n \n(3) \nThe members at clause (e) of sub-section (2), may include health \ninsurance expert, retired civil servants, retired officers of medical profession or \npatient’s safety, financial management experts, philanthropists having significant \ncontribution in health, quality assurance experts and a representative of civil \nsociety. \n \n \n(4) \nThe members at clause (e) of sub-section (2), shall hold office for a \nterm of three years or during the pleasure of the Chief Minister, whichever is \nearlier. \n \n \n(5) \nThe members at clause (e) of sub-section (2), may resign from his \noffice by tendering resignation to the Chief Minister: \n \nProvided that the member shall continue to hold the office until his \nresignation is accepted. \n \n \n(6) \nAny vacancy caused due to death, resignation or removal of any \nmember at clause (e) of sub-section (2), shall be filled in by the Chief Minister \nthrough appointment of another person as member and such appointee shall hold \nsuch office for the unexpired term of his predecessor. \n \n8. \nMeetings of the Policy Board.---(1) The Policy Board shall hold at least six \nmeetings every year or as frequently as required. The meeting of the Policy Board \nshall be convened by the Chairperson. \n \n \n\n8 | P a g e \n \n \n \n(2) \nThe Chairperson shall preside over the meeting of the Policy Board. \nIn case of his absence, the Secretary of the Department shall act as Chairperson of \nthe Policy Board. \n \n(3) \nThe quorum for the meeting shall be five members. \n \n(4) \nThe member count shall be determined by actual members present or \nthose attending through duly authorized video link. \n \n(5) \nAll decisions of the Policy Board shall be taken by consensus and in \ncase of division of opinion, the decision shall be taken by majority of votes: \n \nProvided that in case of equality of votes, the Chairperson shall have a \ncasting vote. \n \n(6) \nNo act or proceedings of the Policy Board shall be invalid merely \nbecause of the existence of any vacancy. \n \n(7) \nSpecial meetings of the Policy Board shall be convened on the request \nof at least one-third of the members. \n \n9. \nFunctions of the Policy Board.---(1) The Policy Board shall perform such \nfunctions and exercise such powers, as may be required to ensure health protection \nof beneficiaries and to improve quality of healthcare services offered to them under \nthe basic package or any additional package. \n \n(2) \nWithout prejudice to the generality of the provisions of sub-section \n(1), the Policy Board shall,- \n \n(a) \nensure that objectives of the Programme are achieved in light \nof the National Health Vision and policies of the Government; \n \n(b) \noversee the effective management and providing strategic \ndirections to the Programme; \n \n(c) \napprove regulations prescribing procedure for appointment, \nterms and conditions of service, disciplinary matters and other \nservice matters for employees of the Policy Board and oversee \nthe process of appointment of employees of the Policy Board; \n \n(d) \napprove annual business plan, financial plans, annual budget \nand major transactions; \n \n(e) \nselect insurance firm or third party for execution of the \nProgramme in accordance with the Procurement law and rules; \n \n(f) \nacquire, hold and dispose of property; \n \n \n\n9 | P a g e \n \n \n \n(g) \nenter into contracts with any entity organization or person; \n \n(h) \napprove the hospitals or service providers for empanelment or \nde-panelment; \n \n(i) \napprove rates for different services provided through \nempanelled hospitals under the Programme; \n(j) \nconstitute committees for any purpose in relation to the \nimplementation of the Programme; \n \n(k) \nregulate the service providers through policy guidelines issued \nfrom time to time; \n \n(l) \nrecommend policy proposals for the approval of Government \non the expansion of Programme, coordination with other safety \nnet and development programs like Zakat, Bait-ul-Mal or \nBenazir Income Support Programme and others; \n \n(m) \ndevise \nand \nimplement \nnecessary \nStandard \nOperating \nProcedures to ensure that empanelled public and private \nhospitals provide services as per the approved health package \nand to take action against them in case of non-compliance; \n \n(n) \nundertake in the manner, as may be prescribed by regulations, \nthe promotional campaigns to create awareness amongst the \npopulation for optimum utilization of the healthcare services \noffered through the Programme; and \n \n(o) \nperform any other function as may be assigned to it by \nGovernment or as may be prescribed in rules. \n \n10. \nChief Executive Officer.---(1) There shall be a Chief Executive Officer of \nthe Programme who shall be responsible for day-to-day administration of the affairs \nof the Programme and shall exercise such powers and perform such functions, as \nmay be prescribed by regulations or assigned to him by the Policy Board. \n \n(2) \nThe Chief Executive Officer shall be appointed by the Policy Board in \nsuch a manner, with such qualifications and on such terms and conditions, as may \nbe prescribed by regulations. \n \n(3) \nThe Chief Executive Officer shall serve during the pleasure of the \nPolicy Board for a term up to three years which may be extended for another such \nterm. \n \n\n10 | P a g e \n \n \n11. \nEmployees of the Policy Board.---(1) To support the Chief Executive \nOfficer in the performance of his functions under this Act, the Policy Board shall \nappoint such number of employees, in such a manner and on such terms and \nconditions, as may be prescribed by regulations. \n \n(2) \nThe Policy Board may fill in the vacant positions of the Policy Board \nthrough deputation of employees from the Department till hiring of the employees \nfrom the market. \n \n12. \nAppointment of advisors and consultants.---The Policy Board may \nappoint advisors, consultants and technical experts, as it may considers necessary, \nfor the performance of its functions under this Act, on such terms and conditions, as \nmay be prescribed by regulations. \n \n13. \nExisting employees.---(1) Within one hundred and twenty days of the \ncommencement of this Act, all the existing employees of the Social Health \nProtection Initiative regularized under the Khyber Pakhtunkhwa Employees \n(Regularization of Services) Act, 2018, shall be given one time option of absorption \nin the Programme or to remain employees of the Department. \n \n \n(2) \nThose employees who opt for absorption in the Programme, shall be \nabsorbed in the Policy Board on such terms and conditions, as may be prescribed by \nregulations. The employees, who do not opt for absorption, shall remain as the \nemployees of the Department and shall serve in the Programme on their existing \nterms and conditions. \n \n \n(3) \nAll the contract employees of Social Health Protection Initiative shall \nbe considered as the employees of the Programme till their contract period is \ncompleted on the same terms and conditions as agreed at the time of their \nappointment. \n \nCHAPTER-IV \nFINANCES \n \n14. \nFund.---(1) There shall be a fund of the Programme to be known as the \nKhyber Pakhtunkhwa Universal Health Coverage Fund. \n \n(2) \nThe Fund shall consist of- \n \n(a) \ngrants from Government; \n \n(b) \ngrants from the Federal Government; \n \n(c) \nunutilized premium or savings from the previous year; \n \n(d) \nannual fee received from empanelled hospitals in the \nprescribed manner; \n \n(e) \nvoluntary contributions or donations; and \n \n(f) \ngrants and income from other sources. \n\n11 | P a g e \n \n \n \n(3) \nThe Fund account shall be maintained at such bank or treasury, as \nmay be prescribed. \n \n(4) \nThe Fund shall be kept in such custody and shall be utilized and \nregulated in such manner, as may be prescribed by regulations. \n \n(5) \nThe Fund shall be used for payment of premium and other costs of the \nProgramme, as may be prescribed by regulations. \n \n(6) \nA portion of the Fund shall be specified as “Reserve Fund” to be used \nin the manner, as may be prescribed by regulations, for payment of cost exceeding \nthe basic package limit or to cover cost of those procedures or treatments not \ncovered under the Programme. \n \n(7) \nThe Policy Board may invest money not required for immediate \nexpenditure in a manner, as may be prescribed by rules. \n \n15. \nBudget and accounts.---(1) The Policy Board shall prepare and approve \nannual budget for a financial year in the prescribed manner. \n \n(2) \nNo expenditure shall be made for which provision has not been made \nin any approved budget, except if made from any previously approved contingency \nfunds, unless further approval is sought and obtained from the Policy Board. \n \n(3) \nThe Policy Board shall keep proper accounts and shall, as soon as \npracticable, after the end of each financial year, prepare a statement of accounts of \nthe Policy Board through the Chief Executive Officer for the financial year which \nshall include a balance sheet and an account of income and expenditure. \n \n16. \nAudit of accounts.---(1) The accounts of the Programme shall be audited by \nthe Auditor General of Pakistan. The Policy Board shall render all out support to the \nAuditor General Office while carrying out audit of the Programme’s accounts. \n \n(4) The Policy Board shall also engage the services of a reputed private \nsector Chartered Accountancy firm for carrying out external annual audit. Both the \naudit reports shall be submitted in due time to the Department. \n \n(5) The Policy Board shall, within one hundred and twenty days of the \nend of each financial year, together with the annual report of the Policy Board, send \nthrough the Department a copy of the statement of accounts of the Policy Board \ncertified by the auditors and a copy of the auditor’s report and the third-party audit \nto Government. \n \n \n \n \n \n \n \n \n\n12 | P a g e \n \n \nCHAPTER-V \nMISCELLANEOUS \n \n17. \nDelegation of powers.---The Policy Board may, subject to such conditions \nand limitations, as it may deem fit to impose, delegate any of its powers or \nfunctions to the Chairperson, Chief Executive Officer, a committee constituted by \nit, a member or employee, except the powers to- \n \n(a) \nframe, amend or repeal regulations; \n \n(b) \napprove policy decisions, guidelines or procedures for the \noperation of the Fund; \n \n(c) \ndetermine the terms and conditions of service of the employees \nof the Policy Board; \n \n(d) \nconstitute committees; \n \n(e) \napprove the annual budget, audited accounts and annual reports \nof the Policy Board; and \n \n(f) \nconsider audit reports of the Policy Board. \n \n18. \nDirections of Government.---Government or the Department may, from \ntime to time, give policy directions to the Policy Board, including, but not limited \nto, defining the eligibility criteria, revising the entitlement and modifications of \nbasic package. \n \n19. \nSuccession and validation.---On the commencement of this Act,- \n \n(a) \nthe Social Health Protection Initiative shall stand transferred to \nthe Policy Board; \n \n(b) \nall the assets of Social Health Protection Initiative shall stand \ntransferred to the Policy Board; \n \n(c) \nall the employees serving in the Social Health Protection \nInitiative before coming into force of this Act, shall be dealt in \naccordance with section 13 of this Act; \n \n(d) \nall the actions and activities, taken under the Social Health \nProtection Initiative shall stand valid and shall be deemed to be \ntaken under this Act; and \n \n(e) \nexpansion of Sehat Card Plus to all population of the Province \ndone during 2020 and 2021, through State Life Insurance \nCorporation, shall be deemed to have been done under this Act. \n \n\n13 | P a g e \n \n \n20. \nSavings.---Save as otherwise specifically provided, nothing in this Act shall \naffect or be deemed to affect anything done, action taken, proceedings commenced, \norders, rules, regulations, appointments, agreements made, directions given or \ninstruments executed or issued in relation to Social Health Protection Initiative and \nany such things, actions, proceedings, orders, rules, regulations, appointments, \nagreements, directions or instruments shall, if in force at the commencement of this \nAct and not inconsistent with any of the provisions of this Act, continue to be in \nforce and have effect as if they were respectively done, taken, commenced, made, \ndirected, given, executed or issued under this Act. \n \n21. \nAnnual report.---The Policy Board shall within ninety days of the end of \neach financial year, prepare a report on the activities and performance of the Policy \nBoard and submit a copy of the report to Government through the Department. \n \n22. \nPublic servants.---The Chairperson, members and the employees of the \nProgramme shall be deemed to be public servants within the meaning of the section \n21 of the Pakistan Penal Code, 1860 (Act No. XLV of 1860). \n \n23. \nRemoval of difficulties.---If any difficulty arises in giving effect to any \nprovision of this Act, Government may make such order not inconsistent with the \nprovisions of this Act, as may appear to it to be necessary for the purpose of \nremoving such difficulty. \n \n24. \nOverriding effect.---The provisions of this Act shall have effect \nnotwithstanding anything to the contrary contained in any other law for the time \nbeing in force. \n \n25. \nPower to make rules.---Government may, by notification in the official \nGazette, make rules for the purpose of this Act. \n \n26. \nPower to make regulations.---(1) The Policy Board may, by notification in \nthe official Gazette, make regulations not inconsistent with the provisions of this \nAct and the rules, for carrying out the purposes of this Act. \n \n \n(2) \nThe power to make regulations conferred under sub-section (1) shall \nbe subject to the condition of previous publication and before making any \nregulations, the draft thereof shall be published in the official Gazette, two \nnewspapers of wide circulation and on the website of the Programme, for eliciting \npublic opinion thereon within a period of not less than fifteen days from the date of \npublication. \n", "passage_offset_convention": "zero-based Unicode code points and UTF8 bytes; end exclusive", "passages": [ { "passage_id": 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