Honduras is a low- and middle-income country with a fragmented health system with less than US$100 per capita per year to meet its health needs. Under its commitment towards Universal Health Coverage, the government decided to design a common health benefits package (HBP). The design of the HBP involved five distinctive steps. (1) An inter-institutional team of the Honduran Ministry of Health and the Social Security Institute defined the fundamental characteristics of the HBP. (2) The universe of the potential candidates for inclusion were identified taking advantage of previous work carried out in the country. (3) Prioritization criteria and decision rules were discussed and operationalized. (4) A “bottom-up” approach was used to cost the HBP with the current low coverage and with different targets of improved coverage levels. (5) Fiscal impact analyses were elaborated, and alternative expansion paths were discussed with the government putting forward ethical criteria on the road towards UHC. The resulting HBP includes 74 essential health interventions. Given the fiscal constraints, a progressive expansion path was suggested, whereby marginal increases in the health budget would be allocated to the HBP. Designing a HBP is a multistep and context-specific process; it goes beyond the implementation of health technology assessment methods and it requires time intensive technical and participatory work and substantial pragmatism to adapt the technical recommendations from the literature to the data and time restrictions on the ground.