Medical Services Agreement (Pakistan)

A Medical Services Agreement in Pakistan governs the supply of professional services, fixing the fee, the standard of performance expected and how either side may end the engagement.

The Contract Act 1872 (Act No. IX of 1872) governs the Medical Services Agreement as a contract for the provision of services. Section 37 of the Contract Act 1872 requires the parties to a contract to perform or offer to perform their respective obligations under the contract at the time agreed. A healthcare provider's obligation under a Medical Services Agreement is to provide medical services with the standard of care expected of a competent medical practitioner — the Bolam standard applied by Pakistani courts in medical negligence cases. A corporate client's obligation is to pay the agreed fee schedule on time.

The Pakistan Medical Commission Act 2020 (PMC Act 2020) establishes the regulatory framework within which all medical services in Pakistan must be provided. Only practitioners registered with the Pakistan Medical Commission (PMC) may provide medical services under the agreement. Under the PMC Act 2020 and the PMC Conduct, Ethical Standards and Disciplinary Procedures Regulations 2021, medical service providers are bound by professional standards including the duty of confidentiality, the duty to refer when outside one's competence, and the prohibition on charging excessive fees without disclosure.

The provincial Healthcare Commission Acts — the Punjab Healthcare Commission Act 2010, the Sindh Healthcare Commission Act 2013, and KPK and Balochistan equivalents — require all healthcare facilities in Pakistan to be licensed by the relevant provincial Healthcare Commission. The facility's licence number should be referenced in any Medical Services Agreement. Healthcare facilities operating without a valid licence are subject to closure and prosecution by the provincial Healthcare Commission.

The Insurance Ordinance 2000, administered by the Securities and Exchange Commission of Pakistan (SECP), regulates health insurance in Pakistan. Health insurers — including the State Life Insurance Corporation of Pakistan (SLIC), EFU Health, and Jubilee Health Insurance — enter into Medical Services Agreements (also called Panel Agreements or Provider Agreements) with hospital networks to create approved provider panels. These agreements define the tariff schedule, pre-authorisation procedures, claims submission timelines, and audit rights that govern the insurer-hospital relationship.

The Employees' Old-Age Benefits Act 1976 and the Pakistan Employees Social Security Ordinance 1965 create an additional category of Medical Services Agreements — Social Security Medical Institutions (SSMIs) contracted by provincial Social Security Institutions (SSIs) to provide medical care to registered workers and their dependents. These SSMI agreements are governed by the SSI's standard terms and the relevant provincial social security legislation.

The Drug Regulatory Authority of Pakistan (DRAP), established under the DRAP Act 2012, regulates the supply and use of medicines and medical devices in Pakistan. A Medical Services Agreement covering the supply of medicines or medical devices must comply with DRAP's registration and licensing requirements — only DRAP-registered drugs and devices may be dispensed or used in contracted medical services.

A Medical Services Agreement in Pakistan is required whenever a healthcare provider and a recipient of medical services need to formalise their relationship beyond a single patient encounter, creating ongoing or structured service delivery obligations.

A Medical Services Agreement is needed when a corporate employer — a manufacturing company, bank, or government department — contracts with a private hospital or panel of doctors to provide occupational health services, pre-employment medical examinations, routine health checkups, and emergency medical care for its employees. Corporate health service contracts are common in Pakistan's formal sector, particularly for companies listed on the Pakistan Stock Exchange (PSX) or regulated by the State Bank of Pakistan (SBP) that must demonstrate employee welfare compliance.

A Medical Services Agreement is required when a health insurance company — EFU Health, Jubilee Health, Allianz EFU Health Insurance, or any other SECP-licensed health insurer — contracts with a hospital or clinic to include it on their approved provider panel (APL). The panel agreement defines the fee schedule (also called the tariff), pre-authorisation procedures, direct billing arrangements, claims submission requirements, and audit rights. Patients covered by the insurer can receive cashless treatment at panel facilities under this agreement.

A Medical Services Agreement is needed when a Non-Governmental Organisation (NGO), the United Nations High Commissioner for Refugees (UNHCR), or an international development organisation contracts with a Pakistani hospital or clinic to provide medical care to a specific population — refugees, disaster victims, or beneficiaries of a health programme. Such agreements are governed by the Contract Act 1872 and include specific reporting, monitoring, and audit provisions required by the international organisation's donor compliance framework.

A Medical Services Agreement is required when a government department — a federal ministry, the Pakistan Army Medical Corps (AMC), or a provincial health department — contracts with a private hospital for specialist medical services not available within the government's own hospital network. Government contracts are subject to the Public Procurement Regulatory Authority (PPRA) Rules 2004, which require competitive bidding for contracts above specified thresholds.

A Medical Services Agreement is needed when a school, college, or university establishes a formal arrangement with a nearby clinic or hospital to provide on-campus or nearby medical services for students and staff — a common arrangement in private educational institutions in Karachi, Lahore, and Islamabad.

A Medical Services Agreement is required when a telemedicine platform — operating under Pakistan Medical Commission guidelines on telemedicine — contracts with a hospital or group of RMPs to provide online consultations, prescription services, and diagnostic referrals to patients across Pakistan, particularly in underserved areas without physical healthcare infrastructure.

A valid Medical Services Agreement in Pakistan under the Contract Act 1872, the PMC Act 2020, and provincial Healthcare Commission regulations must contain the following essential elements.

Party Identification: Full legal name, CNIC or SECP company registration number, PMC facility registration number, and provincial Healthcare Commission licence number of the healthcare provider. Full legal name, CNIC or SECP registration number, and contact details of the recipient (individual patient, corporate employer, insurer, or government department). For insurer panel agreements, the SECP insurance licence number of the insurer must be stated.

Scope of Medical Services: A precise description of the medical services covered by the agreement — outpatient consultation (OPD), inpatient services (IPD), emergency care (A&E), surgical procedures, diagnostic imaging (X-ray, CT, MRI), laboratory tests, pharmacy services, physiotherapy, or specific specialist services. The agreement should specify which services are included in the agreed price and which are additional. The scope must align with the healthcare provider's PMC-registered specialties and provincial Healthcare Commission licensed services.

Service Standards: A commitment by the healthcare provider to deliver services in accordance with: the PMC Code of Conduct and ethical standards; the relevant provincial Healthcare Commission's minimum service standards; the Drug Regulatory Authority of Pakistan (DRAP) guidelines for safe medicine use; and internationally recognised clinical guidelines where applicable. Standard indicators may include waiting times, infection control standards, medical record keeping requirements, and patient satisfaction benchmarks.

Fee Schedule and Payment Terms: A detailed schedule of fees for each category of service covered — consultation fees, procedure fees, diagnostic test fees, room rates, medication charges. For insurer panel agreements, the tariff schedule is typically negotiated annually and attached as a schedule to the agreement. Payment terms must specify the billing cycle, submission timeline, payment due date, and interest or penalties for late payment under the applicable provisions of the Contract Act 1872.

Pre-Authorisation and Referral Procedures: For insurer panel agreements, the process for obtaining pre-authorisation for planned admissions and expensive procedures — including the required medical documents, the insurer's response time commitment, and the escalation process for urgent cases. Failure to obtain pre-authorisation may result in the insurer declining to pay, leaving the patient liable.

Confidentiality and Data Protection: An obligation on the healthcare provider to maintain patient confidentiality consistent with PMC ethical standards and the emerging Personal Data Protection framework in Pakistan. Corporate clients and insurers must also maintain confidentiality of patient health information received under the agreement. Breach of confidentiality is both a PMC disciplinary matter and a potential PECA 2016 offence if electronic data is involved.

Liability and Indemnity: Allocation of liability for medical negligence — whether the healthcare provider indemnifies the corporate client or insurer against claims arising from negligence in service delivery. The healthcare provider's professional indemnity insurance details should be annexed. The agreement should also address consumer protection claims under the Consumer Protection Acts of the relevant province.

Duration and Renewal: The initial term of the agreement (typically one to three years for corporate and insurer agreements), automatic renewal provisions, and the notice period required for non-renewal (typically sixty to ninety days before expiry).

Termination: Events of default triggering immediate termination — loss of PMC registration by the practitioner, suspension of provincial Healthcare Commission licence, DRAP enforcement action, material breach of service standards, insolvency — and the notice period for termination for convenience (typically thirty to sixty days). The treatment of pending patient cases upon termination must be addressed to protect patient welfare.

Dispute Resolution: Designation of the appropriate dispute resolution mechanism — mediation under the ADR Act 2017, arbitration under the Arbitration Act 1940, or litigation before the relevant civil court (typically in Karachi, Lahore, or Islamabad depending on the parties' locations).

Forms-legal.com provides this Medical Services Agreement (Pakistan) template as a practical starting point for hospitals, clinics, insurers, and corporate clients. Given the regulatory complexity — PMC licensing, provincial Healthcare Commission requirements, DRAP compliance, and insurance regulation by SECP — parties should obtain legal advice from an advocate enrolled at a provincial Bar Council with experience in healthcare law.

Under the Companies Act 2017, the Securities and Exchange Commission of Pakistan (SECP) maintains the register of Pakistani companies. Section 16 of the Companies Act 2017 governs company incorporation. The Contract Act 1872 governs general contractual obligations. The Federal Board of Revenue (FBR) administers corporate tax under the Income Tax Ordinance 2001. The High Courts (Lahore, Sindh, Peshawar, Balochistan, Islamabad) have original and appellate jurisdiction.