Four provinces, four schemes

Employee health and cash benefits in Pakistan are paid by provincial employees’ social security institutions, not by one national body. Sindh, Punjab, Khyber Pakhtunkhwa and Balochistan each run their own. Labour law passed to the provinces with the 18th constitutional amendment, so each province has its own social security law.

That history is why the rules now drift apart. Sindh runs its scheme under a provincial act from 2016, amended in 2018, while the Punjab Assembly passed amendments to its own 1965-era ordinance in May 2025. Before you hire, note the province where the employee lives and works, because registration, wage limits and paperwork follow that province’s law.

Workers are brought in by their employer. The Sindh institution lists its core tasks as registering establishments and workers, collecting employer contributions, giving medical care to secured workers and their dependants, and paying cash benefits.

What the employer pays in

Provincial social security is funded by the employer rather than deducted from the worker’s pay. Payroll-provider guidance from 2025 describes the contribution as calculated on the province’s statutory minimum wage, not on the salary the employee actually earns, and reports the same rate in all four provinces.

Sindh’s 2018 amendment adds that no contribution is due on wages above its upper wage limit, yet an employee whose pay exceeds that limit stays covered. The other provinces set their own limits, which the employer or EOR should confirm when the hire is made.

Employers also register staff with the Employees’ Old-Age Benefits Institution (EOBI), a federal programme. Payroll guides list it next to social security, but it pays pensions and does not fund medical care.

What the provincial schemes provide

The Sindh institution says most of its budget goes on medical care for secured workers and their families: GP visits, specialist care, hospital stays, emergency treatment and medicines. That care is delivered mainly through the institution’s own hospitals and dispensaries.

Next to medical care, the provincial schemes pay cash benefits for sickness, maternity, employment injury, disablement and death, plus iddat and survivors’ benefits.

The Sehat Sahulat health card is a separate, tax-funded programme of hospital cover aimed mainly at low-income households. News reports say it was devolved to the provinces in mid-2025, with federal funding kept only for Islamabad, Azad Jammu and Kashmir and Gilgit-Baltistan, and that Punjab and Khyber Pakhtunkhwa run their own broad versions. It is not a workplace benefit, so it does not stand in for anything an employer provides.

Group health as the benefit staff expect

Because the statutory contribution is tied to the minimum wage and treatment runs through a limited institutional network, EOR providers describe private group health insurance as the main medical benefit for professional staff in Pakistan. Their guides call it expected in practice, even though it is not a legal floor for every worker, and say policies often extend to a spouse and children.

Health is a regulated class of insurance in Pakistan, written within general (non-life) business, and insurers must register with the Securities and Exchange Commission of Pakistan. Local insurance rules may limit who can sell cover there, so where a group policy comes from matters as much as what it pays for.

An accounting firm’s tax summary describes an employer’s reimbursement of medical or hospital costs as exempt from the employee’s income tax. Guidance is less clear on employer-paid group premiums, so check with a local adviser or tax professional in Pakistan before choosing between paying premiums and reimbursing costs.

Where an international plan can fit

For a worker inside provincial social security, the employer contribution is statutory, and no international plan can take its place. A global plan can only be added on top, for example to give access to private hospitals outside the institution’s network.

Whether a particular international insurer may cover someone living in Pakistan is for that insurer to confirm. If the employee travels for work or the family wants care abroad, say so early. Our overview of international health insurance for remote employees compares top-up and stand-alone cover across countries, and the Asia-Pacific region page sets Pakistan beside its neighbours, including India.

Employer of record, own entity or contractor

EOR providers describe the usual route for a US company with no Pakistani entity as an employer of record. In their account, the EOR becomes the legal employer, runs payroll, registers the employee with EOBI and provincial social security, and provides group health cover. Ask what that group policy includes before planning anything extra, so the same hospital cover is not bought twice.

A genuine independent contractor is not registered by the client and arranges their own health cover. How the two setups differ, and why the label matters, is explained in our guide to health coverage for EOR employees and contractors abroad. For the US-side lines Mithril1 can request, such as employment practices liability, see insurance changes for remote teams; we request that cover from insurers, and the insurer decides whether to offer it.

Asking for an introduction for Pakistan

Mithril1 does not sell or recommend health plans. Fill in the quote form on this page with the province and city where each person lives, how many people are on the team, whether they are employed through an EOR or your own entity, and which family members should be included. We will pass the request to a benefits partner that works on health cover for international and remote teams, and the partner and the insurer decide eligibility, plans and pricing.

Hiring in the Gulf too? See the United Arab Emirates, or start from the employee benefits hub.

A few useful answers

Common questions

Does Pakistan have national health insurance for employees?

No single national scheme covers workers. Medical care and cash benefits for employees come from provincial social security institutions, which the employer registers with and funds.

Do the rules differ between provinces?

Yes. Sindh, Punjab, Khyber Pakhtunkhwa and Balochistan each run their own employees’ social security institution under provincial law, so wage limits and procedures can vary.

Is EOBI a health benefit?

No. EOBI is a federal old-age pension programme. Employers register workers with it, but it does not pay for medical care.

Can an international plan replace provincial social security?

No. For a covered worker the employer contribution is statutory, so an international plan can only sit on top of it.

Who provides group health cover when I hire through an EOR?

EOR providers describe the EOR as the legal employer that handles social security registration and provides group health cover. A genuine contractor arranges their own.

International Health Insurance for Remote Employees in Pakistan