Does the Sehat Card Cover Diabetes? What It Pays For, and What You Still Pay

For a lot of families, the Sehat Card is the first thing that comes to mind after a diabetes diagnosis: does this mean the treatment is free now? It is a fair question. Diabetes is not a rare or unusual diagnosis here — the IDF Diabetes Atlas (opens in a new tab) put Pakistan's adult diabetes prevalence at 31.4% in 2024, the highest age-standardised rate in the world — and the running cost of managing it is the part that quietly wears households down.

The honest answer is: partly, and probably not in the way you are hoping. Diabetes is genuinely on the covered list. But the card is an inpatient scheme — it pays when you are admitted to a hospital bed. The strips, the tablets, the insulin, the three-monthly HbA1c, the doctor's fee: that is outpatient spending, and outpatient spending is exactly what the card was not designed to cover. Knowing that in advance changes how you plan, so it is worth understanding properly rather than finding out at a hospital counter.

What the Sehat Card actually is

The Sehat Card (Sehat Sahulat) is a government-funded health insurance scheme that pays for cash-free treatment at empanelled hospitals. There is no separate plastic card to protect any more in most of the country — your CNIC is the card. You show it at an empanelled hospital, and if the treatment falls inside the benefit package, the hospital bills the programme instead of billing you.

One thing that confuses people: it is not a single national scheme. It is run province by province, with different administrators, different coverage ceilings, and different hospital lists. In Punjab it is managed by the Punjab Health Initiative Management Company (opens in a new tab); in Khyber Pakhtunkhwa it runs as Sehat Card Plus (opens in a new tab). Advice a relative gives you from another province may simply not apply where you live, and the rules and hospital panels have changed more than once in recent years. Always check your own province's current position rather than assuming.

What it covers for diabetes — and what it doesn't

Diabetes appears on the covered list in both major provincial schemes. PHIMC lists "diabetes complications" among the priority conditions in Punjab, and Sehat Card Plus in KP lists "diabetes and endocrine disorders" among its covered secondary and tertiary services. What that means in practice is that the serious, expensive, hospital-based end of diabetes is covered — and the daily end of it is not.

PHIMC's own FAQ states it plainly: only in-patient services (admissions) are covered, and OPD is not covered. The same holds across the provincial streams — KP handles outpatient care through an entirely separate scheme rather than through Sehat Card Plus.

The gap that actually costs the most

This is the part worth sitting with. Researchers writing in The Lancet Regional Health – Southeast Asia (opens in a new tab) noted that outpatient expenditures account for most — up to 80% — of the catastrophic health spending Pakistani households face. Diabetes is a near-perfect illustration of that. Almost none of the money a person with diabetes spends in a normal year goes through a hospital admission:

• Test strips, which are the single biggest recurring cost for most people who monitor at home
• Monthly medicines — metformin, a sulphonylurea, a statin, a blood pressure tablet, or insulin and pen needles
• HbA1c every three to six months, plus a yearly lipid profile, kidney tests and urine ACR
• Consultation fees, and the fare and lost working day that come with each visit
• An annual eye screening and a foot check

Add those up over a year and, for most households, they exceed anything the card is likely to pay out — because the card pays out only if something goes wrong enough to need a bed. That is not an argument against the card. It is an argument for being clear-eyed about what it is: protection against the catastrophic bill, not a subsidy for staying well.

How to check whether your family is covered

1. 1In Khyber Pakhtunkhwa, send your CNIC number in an SMS to 9780, or call the 24/7 helpline 0800 89898.
2. 2In Punjab, call the PHIMC helpline on 0800-07542, or check phimc.punjab.gov.pk for the current eligibility position and empanelled hospital list.
3. 3Take your original CNIC with you — in most provinces it functions as the card, and a photocopy will not do.
4. 4Before you travel to a hospital, ring that specific hospital and confirm it is currently empanelled and that the treatment you need is inside the package. Panels change, and arriving to find out otherwise is an expensive way to learn.
5. 5If your CNIC is not recognised or your family record is out of date, that is usually a NADRA record problem rather than a health scheme problem — get the record corrected first.

If the card doesn't cover your day-to-day care

Most of managing diabetes well is not glamorous and not covered, so it is worth knowing where costs can genuinely come down without cutting care:

• Government hospital diabetes and medical OPDs charge a nominal fee and often dispense some medicines free — the queue is the price, but the care is real.
• Ask your doctor whether a locally manufactured generic of the same molecule is acceptable. For older drugs like metformin, the price difference between brands can be substantial and the molecule is identical.
• Buy test strips in larger packs where you can, and check the expiry — a cheap pot near expiry is not a saving.
• Charitable and trust hospitals, and the diabetes clinics run by the Diabetic Association of Pakistan (opens in a new tab), Pakistan's IDF member association, run outpatient, eye and foot services at reduced or no cost.
• Agree a testing schedule with your doctor rather than testing at random. Fewer, better-timed readings cost less and tell you more than scattered ones.

And keep the paperwork. If an admission does happen, having your recent HbA1c results, prescriptions and discharge summaries in one place makes the claim process at the hospital desk considerably less painful.

Know what your diabetes actually costs you

Logging your readings, medicines and test results in Diatic gives you one place to see what is working — and a record you can hand to a doctor or a hospital desk without hunting through a drawer of old slips.

Start your sugar diary (opens Diatic on Google Play in a new tab)