The Purpose:

The Health Insurance helps to place a limit on Company Liability for hospitalization
expenses and helps to reduce sudden peaks caused by major medical events.

Scope:

Health Insurance Ensures transparency and Uniformity of process, eliminates chances of

misuse, and reduces administration burden on Company.

Entitlement:

All full time permanent employees and Unionized Workers of the company between the
ages of 21-60 years and their dependents spouses and children are covered under the
plan, typically children are covered from the time of their birth up to the age of 25 years.

Claims: How to make claims?

Employees are entitled to claim if visited a non –network hospital for treatment, in case
of Medical Emergency and if no network hospital exist in that city/town of residence.

Documents required for Claims Reimbursement (In-Patient)

 In Case of Non –Network Hospitals:

 Dully filled Claim form

 Clinical Summary/Discharge Card

 Itemized Hospital bill

 All Prescription for medicines used during hospitalization

 Receipts of Medicines Received

 Laboratory Reports with payment receipts.

 All other supporting bills and payment receipts

 Provisional Birth Certificate (Issued by the hospital) in case of Child Birth.

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Disadvantage of using Non-Network Hospital:

 As they are not accredited, you cannot be sure if they are properly equipped.

 No credentialing done by Allianz EFU, Therefore treatment given by not properly

qualified physicians /surgeons is possible.

 No such facility available at non-network hospitals.

 No credit facility –you have to pay cash and then claim reimbursement.

 You are responsible for collecting all required documentation, completing of

claims from and getting it signed by the treating physician/surgeon.

 You have to wait for 15 days for the claims reimbursement and you may not be
sure that all expenses will be reimbursed.

Using a Network Hospital

 Accredited by Allianz EFU based upon assessment of their facilities.

 Treatment by Allianz EFU credentialed physicians and surgeons, qualified and

trained to undertake the specific treatment.

 Allianz EFU doctors visit network hospitals to ensure that our insured are being
treated and looked after properly.

 Credit Facility available –no need to arrange for cash.

 No need to collect documents, lab reports and file claims.

 As you have not made any payments to the network hospital, you don’t need to
wait for claims reimbursement.

 Treatment at hospital with Good Functional Facilities.

 In Emergencies, you do not have to call us this is the responsibility of the

Network Hospital.

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Exclusions:

The following are some of the common product Exclusions:

 Hospital admission not medically necessary and undertaken specifically to

conduct diagnostic and other test.

 Any hospitalization not recommended by licensed physicians surgeons.

 Routine physical examination and inoculations.

 Cosmetic treatment

 Treatment of Infertility /Sterilization and contraception.

 Psychiatric Treatment.

 Personal expenses –Telephone, guest meals, tissue papers

 Self-Inflicted Injury and Dental Treatment

 Eye glasses, contact lenses, hearing aids, artificial limbs etc.

Procedures for Hospital Admission

Emergency Case:

Pre-Authorization is not recommended in an Emergency Medical Condition.

Proceed to the nearest hospital and go to the emergency ward.

It is advisable, if possible to visit a network hospital as they are all located in major
localities of the city (A hospital that is not on our network will require, Cash payment
before admitting the patient. In addition, you cannot be sure of the equality of care
available.

Within 24 Hours of hospital admission, please contact us with the following information.

Company’s Name and employee ID Number.

Name of the treating Hospital

The reason of admission (Diagnosis)

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Procedure for Hospital Admission

Non -Emergency Case:

Pre Authorization is not recommended in an Emergency Medical Condition.

Proceed to the nearest hospital and go to the emergency ward.

It is advisable, if possible to visit a Network hospital, as they are all located in major
localities of the city. (A hospital that is not on our network will require cash payment
before admitting the patient. In addition, you cannot be sure of the quality of care
available. )

Procedure for Hospital Admission:

Non –emergency Case (Pre- Authorization)

Submit the Pre-Authorization format the admission office of the network hospital at least
3 working days in advance of the impending hospital admission. The admission office
will work directly with Allianz EFU to obtain Pre-Authorization for you.

Deposit a copy each of Heath card and a photographic Identification to the hospital at the
time of admission.

Proceed for Optimal Treatment.

Advantage of Pre-Authorization:

No cash (Credit Facility)

The network hospital will treat the patient and send the bill directly to Allianz EFU.

Insured member is informed in advance about the balance limits available under the
health Insurance Plan and any exclusion that may apply.

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Hospitalization:

Hospital Care pays covers hospitalization treatment due to illness, surgeries and
accidents. Its pays for eligible medical expenses incurred when a patient is confined to a
hospital bed. Eligible expenses include (but not limited to)

 Pays for expenses incurred during hospital stay up to the per Annum Limit
including the charges for:

 Room, Operation Theater and ICU

 Physicians, Surgeon and Anaesthetist fee

 Diagnostic tests including MRI and CT Scan

 Medicines required during hospital stay

 Kidney dialysis and cancer treatment

 Organ transplant

 Endoscope an Angioplasty

 Oxygen and blood supplies

 Day care surgeries

 Pre-Hospitalization lab tests (up to 30 days)

 Post –hospitalization consultation visit views (up to 20 days)

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Major Medical Care:

Major Medical care (MMC) Enhances the annual limit of Hospital Care Product for each
insured person. All eligible in-patient expenses covered under hospital care are also
covered under MMC.

MMC is useful if one is suffering from Chronic, major or complicated illness such as

 Thalassemia Major

 Knee Replacement

 Heart by pass surgery

 Stroke

 Heart Attack

 Multiple Sclerosis

 Kidney Failure

 Angioplasty

 Major Burns

 Chemotherapy

 Multiple Fractures

 Organ Transplant

 Cancer

 Hip –bone replacement etc

 Maternity

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Maternity Care:

Maternity Care (MC) Benefits pay for medical expenses related to pregnancy and
childbirth. The maternity limit stated on the health card is the maximum annual limit. All
expenses directly or indirectly related to pregnancy are paid within this annual limit. MC
pays for the following expenses.

 Daily Room and board

 Labour Room charges in case of Normal delivery

 Operation thertre charges in case of Cesarean section

 Anesthetist Fee

 Gynecologist Fee

 In-Hospital Consultations

 Diagnostic investigations during hospital stay

 Blood & Oxygen Supplies (if needed)

 Baby nursing car while the mother is in the hospital

 Prescribed Medicines used during hospital stay

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Important Telephone Numbers:

For Queries regarding policy documents, health cards and claims following concern
people can be dialed for Help.

Karachi/Lahore /Islamabad: 111-Health (111-432584)

For Queries regarding Pre-Authorization, Medical Advice counseling and problems

Karachi/Lahore/Islamabad: 111-Health (111-432584)

Hotlines:

After office hours or during holidays

Medical hotline Karachi –0300-8207000

Medical hotline Lahore –0300-8483818

Medical Hotline Islamabad -0300-8508550

Customer Service Hotline –0303-7291333

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