Sri Lanka Agrahara Insurance Benefit Calculator

Agrahara is the medical insurance scheme for Sri Lankan government and provincial public servants, administered by the National Insurance Trust Fund (NITF). Roughly a million state employees, their dependants and pensioners are enrolled. Members contribute monthly at one of three tiers — Normal, Silver or Gold — and pensioners follow a separate schedule. This tool applies the published NITF benefit schedule deterministically; there is no live data and no guesswork.

Hospitalization. Room charges are reimbursed per day up to a per-admission day limit, then the eligible benefit is:

benefit = min(days, dayLimit) × dailyRate

The daily rate depends on tier and hospital type. For a private hospital the rate is Rs 3,000 (Normal), Rs 5,000 (Silver) and Rs 8,000 (Gold), each for up to 10 days per admission. Government-hospital room rates are lower (Rs 500 to Rs 3,000per day). The result is also bounded by each tier's overall annual medical ceiling — the calculator's output can never exceed the published per-stay maximum, which is the cross-check it performs internally.

Surgery. Major surgeries carry flat lifetime limits looked up by tier. Heart surgery is covered up to Rs 800,000 (Silver) and Rs 1,000,000 (Gold); kidney transplant up to Rs 1,200,000 on Gold; and brain surgery up to Rs 1,200,000 on Gold. The Normal and Pension schemes have no separate surgery sub-limits, so a listed surgery is reimbursed under the general surgical/medical limit of Rs 50,000 per case.

Childbirth, death and optical.Private childbirth, the lump-sum death donation (natural and accidental) and the spectacles benefit are all fixed amounts per tier — the calculator simply looks them up and shows them across all tiers so you can see what upgrading would give. Where a tier publishes no figure for a claim (for example natural death on the higher tiers, or any childbirth claim under the Pension scheme), the result reads “Not covered” rather than a guessed number.

Every figure traces back to the NITF Agrahara schedule cited below and carries a LAST_VERIFIED date in the source file. NITF revises the schedule by gazette periodically, so confirm the current figures with NITF before you file.

• NITF — Agrahara scheme schedule (tiers, premiums, daily rates, surgery and childbirth limits)
• NITF — Government member benefits (per-tier daily room rates, Pension scheme schedule)
• NITF — Semi-Government Gold Agrahara scheme (separate gazetted schedule)
• National Insurance Trust Fund — official site

The premiums, daily rates and benefit limits on this page were last cross-checked against the NITF sources on 2026-06-24. Actual reimbursement is subject to NITF approval, the hospital bill, and any remaining lifetime limit. This is an estimate from the published schedule, not a guarantee of payment.