Expat insurance and health insurance in Pakistan

Since the devolution under the 18th constitutional amendment (2010-2011), health is essentially a provincial responsibility in Pakistan: the federal Ministry of National Health Services, Regulations and Coordination (created in 2011) retains interprovincial coordination, regulation and global health programmes, while the four provinces (Punjab, Sindh, Khyber Pakhtunkhwa, Balochistan) directly run public hospitals and day-to-day health programmes. The public network suffers from chronic underfunding and very unequal access between major cities and rural areas.

The only public hospitalisation-cost scheme, the Sehat Sahulat Program (national health card), targets exclusively low-income Pakistani households identified through the BISP and NSER social registers; it is not open to foreign nationals. Alongside it, a dense private sector has developed, concentrated in Karachi, Lahore and Islamabad, where several leading facilities hold international JCI (Joint Commission International) accreditation and have teams partly trained in Europe or the United States, at the patient's or their international health insurer's expense. Air quality in Islamabad, Lahore and the Punjab region worsens sharply towards the end of the year, with peaks that particularly affect older people, children, pregnant women and people with chronic conditions.

• Mandatory e-visa for any individual traveller (tourism, business) since the suspension, on 1 January 2026, of the free visa on arrival (Visa Prior to Arrival): applications are made exclusively via the official Pakistan Online Visa System (NADRA) portal, with an announced processing time of 7 to 20 working days and a cost of around US$35 for an EU national, varying by visa category. A 30-day multiple-entry tourist visa can still be issued on arrival, but only to organised tourist groups travelling through an accredited Pakistani tour operator.
• Health/repatriation insurance strongly recommended: France Diplomatie describes it as essential before any departure, since medical or repatriation costs cannot be covered by the French embassy.
• Registration with the foreigners' registration office (Foreigners Registration Office, FRO) for any stay exceeding 30 days; any extension of stay falls under the visa department of the Pakistani Ministry of Interior.
• No France-Pakistan coordination: without a bilateral social security agreement, no card equivalent to the EHIC and no form allows a French insured person to assert their rights locally; care outside the public sector accessible to nationals is billed at the facility's own rate, not published uniformly.
• Seconded employee: in the absence of an agreement, staying on the French scheme is governed solely by French law (unilateral secondment), for a period of 3 years renewable once, without exemption from any contributions that may be owed in Pakistan.

The main risk remains financial in the absence of suitable insurance: since the public Sehat Sahulat programme is not accessible to foreigners, any resident or visitor without cover must pay directly for care at private facilities.

France and Pakistan are not bound by any bilateral social security agreement: Pakistan does not appear on the official list of agreements in force published by CLEISS (updated December 2023). There is therefore no applicable European health insurance card, no A1 or S1 form enforceable against Pakistani authorities, and no direct reimbursement mechanism between the two systems.

• Temporary stay: no European or bilateral coordination applies; only health/travel insurance taken out before departure covers costs on the ground, which France Diplomatie describes as essential.
• Secondment from France: in the absence of an agreement, French law provides for unilateral secondment of 3 years renewable once. The employee stays affiliated to the French scheme, with contributions paid in France, but is not exempt from any contributions that may be owed in Pakistan. Care received locally is reimbursed after the fact by the French fund, within the limit of French rates, on presentation of receipts and form S3125.
• Long-term move: the only public hospitalisation-cost scheme, the Sehat Sahulat Program, is reserved for low-income Pakistani households identified via the national social registers (BISP, NSER); no equivalent mechanism, and no transfer of rights from France, is open to foreign residents. A voluntary enrolment with the CFE remains possible.

1. Before departure: notify the French agencies of your departure (CPAM, CAF, France Travail, pension funds).
2. Before applying for a visa: take out health/travel insurance covering medical expenses and repatriation, described as essential by France Diplomatie, since the French embassy cannot cover these costs.
3. Prepare and submit the e-visa application on the official Pakistan Online Visa System (NADRA) portal, several weeks before departure (processing time of 7 to 20 working days).
4. Seconded employee: arrange unilateral secondment with the employer through your French fund before departure (maximum duration of 3 years renewable once).
5. Update vaccinations (DTP, hepatitis A and B, typhoid fever, depending on the length and conditions of the stay) and check whether a polio vaccination may be required when leaving Pakistani territory.
6. Beyond 30 days of stay: register with the relevant Foreigners Registration Office.
7. Keep proof of care and form S3125 for any after-the-fact reimbursement request to the French fund (secondment case).
8. Register with the roll of French nationals living abroad (French Embassy in Islamabad).