INTRODUCTION: In Egypt, health insurance organization (HIO) was established since 1964 as the governmental health insurer for public servants. Since then, it has significantly grown both in coverage and services as it currently covers 58% of the population, with more population groups covered with all three levels of care; primary, secondary and tertiary. However, informal sector, the most challenging sector worldwide, is not covered through HIO. HIO acts as both service purchaser and provider through a widely distributed owned health facilities, in addition to outsourcing some secondary and tertiary care services. With the government’s plan to implement universal health coverage (UHC) by 2030, HIO is considered as the strategic future national purchaser, especially with HIO long experience, covering more than half of the population. However, HIO needs to acknowledge its structural and operational challenges, and address them, in order to be able to carry on this responsibility of being the nation’s health insurer. OBJECTIVES: This paper discusses the capabilities of the current HIO, highlighting its strengths and challenges that need to be addressed before being able to be the sole health services purchaser in Egypt. METHODS: A qualitative study, using information from the literature and official government documents, describing the laws and regulations that govern the work of HIO. It also provides insights into some of the foreseen challenges from a health system perspective, discussing challenges to be faced by HIO, and other stakeholders like private health insurance and pharmaceutical companies. It will also provide recommendations on how to overcome some of these challenges in the future. RESULTS: Allignment between different stakeholders; e.g. government, pharma and healthcare professionals is a must to achieve UHC in Egypt. CONCLUSIONS: HIO is the strategic national payer in Egypt, but this requires structural and operational reform, so that its objective of UHC.