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 publishes no separate overseas claim procedure, and the procedure it does publish is built end to end around Sri Lanka — a serving public officer, a Sri Lankan employing institution, and a Sri Lankan salary account. That is the honest starting point, and it explains most of the difficulty people hit from abroad.

First, check you are still a member.Agrahara cover follows employment, not citizenship. The claim form's Head of Department and Accountant sections exist specifically to certify that you are a permanent employee of the institution, and the premium is deducted from your salary. If you have left government service, you are not a member and there is nothing to claim. If you are abroad on leave, ask your institution's Agrahara subject officer whether your contribution is still being deducted before you count on the cover. On retirement, NITF states that only government employees who retired after 01.01.2016 can claim, and then under Agrahara Retirement Health Insurance rather than the serving-employee scheme.

What the published procedure physically requires. Each of these is a documented NITF requirement, and each is harder to satisfy from overseas:

• The application must be received at an NITF branch office or head office within 90 days of the date of discharge — the deadline is on arrival at NITF, not on posting.
• The original final bill and all original receipts bearing a “PAID” seal must be sent. Bills and receipts must be computer-printed; NITF does not accept handwritten ones, and photocopies are not accepted for bills or receipts.
• Photocopies of other documents are accepted only when the Head of Department certifies each as a true copy with signature and seal.
• The Head of Department and Accountant sections are mandatory, as is the doctor's section for private hospitals.
• You must attach a certified copy of the bank account your monthly salary is credited to, which is where the reimbursement is paid. Three months of pay sheets are also required unless your salary is remitted through SLIPS.

Read together, those requirements mean the practical route from abroad is through your institution rather than around it: have your Agrahara subject officer or a family member in Sri Lanka assemble and hand in the file while you courier the originals, and start early enough that the 90 days are not spent in transit. NITF says a defect-free application is settled within 14 working days, so the delay people actually experience is almost always a missing certification or a missing original, not NITF processing.

What NITF does not publish — so do not assume it. There is no published schedule for treatment obtained outside Sri Lanka, no published rule on translating or attesting foreign-language medical bills, and no published option for paying a reimbursement to a non-Sri Lankan bank account. This page will not guess at any of them. If your situation depends on one of these points, confirm it with NITF directly before you are treated where possible — the helpline is +94 11 2 308 308 — and get the answer in writing. Separately, NITF states that inpatient treatment is mandatory and that claims for external (outpatient) treatment are not possible, the only exception being cancer.

A lot of searches for “Agrahara insurance for housemaids” are really about one of three different schemes. They are administered by different bodies, cover different things, and a claim on one is never a claim on another. Getting the wrong one costs real money, so here is the distinction plainly.

1. Agrahara (NITF) — public officers only.Agrahara covers permanent employees of Sri Lankan government and provincial institutions and their registered dependants. Working abroad does not make anyone an Agrahara member. A migrant domestic worker is covered only if she is herself a public officer, or is a registered dependant of one — and in that case the claim still runs through that officer's institution and follows the procedure above. The figures in the calculator at the top of this page apply to this scheme and this scheme alone.

2. The SLBFE insurance scheme — the one that actually covers migrant workers. Every Sri Lankan who registers with the Sri Lanka Bureau of Foreign Employment is covered by its insurance scheme, included with registration at no separate charge. SLBFE publishes cover including Rs 600,000 for death from any cause while working abroad during the contract period, Rs 250,000 for death in Sri Lanka within three months of arrival from an illness or accident met while working abroad, and compensation plus a return air ticket for permanent total, permanent partial and qualifying temporary disability. Note the shape of the medical cover carefully: it is for expenses incurred after returning to Sri Lanka — up to Rs 50,000 per worker per contract, with a Rs 700 per day government-hospital allowance for up to 30 days — not for routine hospitalisation while you are still overseas. Documents must generally be submitted within six months of arrival in Sri Lanka. An unregistered worker is not entitled to any of it, which is the single strongest argument for registering before departure.

3. The health cover your foreign employer or sponsor arranges.This is a host-country arrangement under that country's own law and has nothing to do with NITF or SLBFE. In the UAE, for example, the employer is responsible for the domestic worker's medical care or health insurance, and a valid policy is required to issue or renew residency. If you are treated abroad, this is usually the policy that pays — and the claim goes to your employer and their insurer, not to NITF. An employer-provided policy abroad is not Agrahara, and NITF cannot help you claim on it. Confirm the specifics with the labour authority in your host country or the nearest Sri Lankan diplomatic mission.

Checking an Agrahara policy or membership number online. If you are a genuine Agrahara member, this is done on NITF's Agrahara Web Portal, not here. One detail catches people out: NITF states that your details will not appear until you enter them in the portal through the Agrahara member login and they are approved by the Agrahara subject officer of your institution. If the portal shows nothing, that approval step is the usual reason — contact your institution rather than assuming the membership is missing.

• SLBFE — insurance cover and welfare benefits for registered migrant workers →
• What SLBFE registration costs before you travel (on this site) →
• Check a foreign employment contract before you sign (on this site) →

• 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
• NITF — Agrahara FAQ (90-day claim window, 14-working-day settlement, mandatory certifications, inpatient-only rule)
• NITF — official Agrahara claim checklist v2.1 (original bills and receipts, certified copy of the salary bank account, pay sheets)
• SLBFE — insurance cover and welfare benefits for registered migrant workers (the scheme that covers workers abroad, not Agrahara)

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.