Universal health insurance in Egypt: contributions and rollout phases

The employer pays 4% of the contribution wage for universal health insurance, at least EGP 50 a month, and the worker pays 1%, for every worker who lives in a governorate the system has reached; on top of that, businesses pay a solidarity contribution of two and a half per thousand of their total annual revenues. The rates are in the Universal Health Insurance System Law, Law 2 of 2018 (Official Gazette Issue 2 continued (B), 11 January 2018, in force from 12 July 2018), and Law 155 of 2026 amending certain provisions of that Law (Official Gazette Issue 31 bis (A), 2 August 2026, in force from 3 August 2026) made the Egyptian Tax Authority responsible for examining, assessing and collecting the contribution.

The system reaches the governorates gradually, and published decrees describe seven governorates as within its scope, the latest being Minya, where Decree 1449 of 2026 sets 1 June 2026 as the start of trial operation. The employer owes the contributions for workers permanently resident in a governorate where the system applies and pays them with social insurance contributions, and does not pay the work-injury treatment contribution under the Social Insurance Law for them, since it is limited to those outside the new system. The solidarity contribution is paid by sole proprietorships, companies and economic public authorities to the Tax Authority no later than the end of the income tax return deadline.

Contributions on wages

Law 2 applies compulsorily to all citizens residing in Egypt and optionally to Egyptians working abroad (issuing article 1), and the family is the main unit of coverage (article 2 of Law 2). But an insured person is someone the law applies to under the rules of geographic phasing (article 1, item 26), and an employer is anyone who employs one or more of those people (item 27).

Table 1 puts the two dependants' rates in a separate column and does not state their base, and the Universal Health Insurance Authority's published examples compute them on the father's total income. Contributions for children and dependants continue until they take up work or, for females, marry, and a person who holds more than one job contributes on all income received (article 40, item 1, of Law 2).

The contribution wage here is the one Law 2 defines, not the social insurance one: all cash consideration the insured person receives from their employer or employers, including the contract wage and its raises, incentives, official commissions and allowances, except certain allowances whose excluded total may not exceed 25% of the insured person's total wage (article 1, item 31). Table 2 sets a minimum for the employer's share, and neither it nor the definition sets a maximum; the Authority's published answer on the insured person's contribution states that there is no maximum. The social insurance wage and its limits are covered in Egypt's insurable wage in 2026.

The employer pays the contributions due monthly to the National Organization for Social Insurance, covering its own share and the share deducted from the worker's wage for the worker and those they support, on the same dates as social insurance contributions (article 41, item 1). Those dates are set out in Egypt's social insurance contributions and in Egypt's tax and social insurance compliance calendar. Late payment carries an annual additional amount for the period of delay, from the due date until the end of the month of payment (article 43).

The solidarity contribution on revenues

Article 40, item 9, of Law 2 imposes "a solidarity contribution at (0.0025%) (two and a half per thousand) of the total annual revenues of sole proprietorships and of companies, whatever their nature or the legal regime that governs them, and of economic public authorities" (unofficial translation). The Gazette prints the figure with a percent sign, but the words fix it at two and a half per thousand, as does article 46 of the executive regulations (Prime Minister's Decree 909 of 2018, Official Gazette Issue 18 bis (A), 8 May 2018). The Authority's published answers say it is not part of the employer's contributions for its workers but a community contribution.

Article 40, item 9, does not tie the contribution to a governorate of application, and the Authority has computed it from 12 July 2018, the date the law came into force. We therefore consider it due from a business wherever it is located. The Authority's page on the contribution, last updated before the amendment, computes it on total revenues without excluding any amounts, and a company that sells on commission computes it on its commission income together with its other revenues. On annual revenues of EGP 10 million it comes to EGP 25,000.

Law 155 added two paragraphs to article 42 of Law 2. The first reads: "The solidarity contribution provided for in item nine of article (40) of this Law is tax revenue, and the Egyptian Tax Authority is responsible for examining, assessing and collecting it from those subject to its provisions, no later than the end of the period set for filing the income tax return" (article 1 of Law 155; unofficial translation). For that purpose the Tax Authority may take the measures the law provides for. The other paragraph sends the proceeds to the State treasury, which must pass an equivalent amount to the Authority without any deduction. Law 155 also deleted from article 40, item 9, the words excluding the contribution from deductible costs under the Income Tax Law and the words on collecting it under the executive regulations (article 2 of Law 155).

A few days earlier, Law 151 of 2026 amending certain provisions of the Income Tax Law (Official Gazette Issue 30 bis (A), 28 July 2026, in force from 29 July 2026) added the value of the solidarity contribution to the deductible costs under the Income Tax Law, Law 91 of 2005: item 10 of article 23 for commercial and industrial profits, which article 51 applies to legal persons, and item 5 of article 33 for non-commercial professional income (article 2 of Law 151). Neither law states the first tax period in which the deduction applies, and the point is unsettled: no express provision or published judgment resolves it. Until the point is settled, we recommend checking the Tax Authority's instructions before preparing the 2026 return.

Article 3 of Law 155 requires the Minister of Finance, in coordination with the Authority, to issue the decrees needed to implement it within sixty days of its entry into force. As of 24 October 2026 we have not found any such decree. Law 155 itself does not set how the contribution is declared or paid, and we expect those decrees to do so. The companies' filing deadline is in Corporate tax returns in Egypt.

Phases and governorates

The law applies to the governorates gradually, guided by the phases set out in Table 5 (issuing article 3):

Article 4 of the decree issuing the regulations requires the Authority to plan coverage over a period not exceeding fifteen years from the date the law came into force, that is, by July 2033. Article 5 makes the timeline a matter for a decree of the minister responsible for health; we have not found that decree. The published decrees describe these governorates as within the scope of application:

All three decrees transfer medical facilities to the General Authority for Healthcare within the scope of application of the universal health insurance system in each of these governorates, but Decrees 4874 and 1437 do not fix the date the system started in their governorates, and we have not found a decree that does. Decree 1449 of 2026 applies from the start of trial operation of the system in Minya on 1 June 2026 (its article 4), and its article 2 refers to the date Minya enters the system without fixing it. North Sinai is in the first phase of Table 5 but appears in none of these decrees.

The link with Social Insurance Law contributions

Insured persons continue to receive health insurance services under the existing laws until Law 2 applies to them under geographic phasing, after which every conflicting provision of the Social Insurance Law or any other law is suspended for them (issuing article 3), from the date of application in the governorate (article 7 of the decree issuing the regulations).

In the Social Insurance and Pensions Law, Law 148 of 2019 (Official Gazette Issue 33 bis (A), 19 August 2019), as corrected, articles 46 and 70 both open by providing that they apply without prejudice to Law 2. Article 46 limits the 1% work-injury treatment contribution to those not subject to Law 2. Article 70 sets sickness insurance at 3.25% for private-sector employers and 1% for the worker, of which 4% is for treatment and medical care and 0.25% for wage compensation and transport costs.

Neither article 70 nor the issuing articles of Law 2 say which part of the sickness insurance rate stops in a governorate where the system applies. In our view, taking the opening of article 70 together with issuing article 3, the treatment share is the part the new contribution replaces. The Authority says the same: the new contributions are collected for the whole family for the universal health insurance system and are not paid again as a percentage of social insurance contributions. Table 2 gives the new employer share for sickness, treatment and work-injury insurance services, and we have found no provision in Law 2 dealing with the 0.25% for wage compensation and transport costs.

For the Authority, what counts is the place of permanent residence, not the workplace, and it says that an employer in a governorate outside the scope of application collects universal health insurance contributions only for workers permanently resident in a governorate within the scope. A worker employed temporarily in a covered governorate whose family lives elsewhere is covered against work injuries only.

What the business needs to do

• List workers with each one's governorate of permanent residence, check it against the governorates within the scope of application, and watch the Official Gazette for Minya's entry date and for any decree adding a governorate.
• For those living in a covered governorate: 4% for the employer (minimum EGP 50) and 1% for the worker, on the contribution wage as Law 2 defines it, with the contributions for the wife, children and dependants deducted from the worker's wage, and a letter for any worker who asks confirming that the contribution is deducted from their wage, which the Authority lists among the registration documents for private-sector workers.
• Payment with social insurance contributions on their dates, and written confirmation from the competent social insurance office that the Law 148 treatment share is not charged a second time.
• A computation of the solidarity contribution on the year's total revenues, and payment to the Tax Authority no later than the end of the income tax return deadline.
• A watch for the Minister of Finance's decrees implementing Law 155, and for the Tax Authority's instructions on the first tax period in which the contribution is deducted from the tax base.

The firm's Social Insurance & Labour Department identifies employees covered by universal health insurance, reviews the calculation and payment of the contributions with social insurance contributions, and computes the solidarity contribution, as part of its social insurance and labour compliance services.

Mahmoud Nassef, Founder Partner
Chartered Accountant, Ministry of Finance, Egypt

Member, Egyptian Society of Accountants & Auditors
Member, Egyptian Tax Society
Member, Egyptian Society for Public Finance and Taxation

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Disclaimer: This bulletin is prepared for general information on the legislation in force at the date of its publication. It does not constitute a professional opinion or tax or legal advice on any particular matter, and it should not be relied upon in place of advice based on an examination of the circumstances of each case. Nassef & Partners International accepts no responsibility for any action taken, or refrained from, in reliance on its contents. The positions stated remain subject to subsequent legislation and decisions.