Health Insurance

Health Insurance

Health Sure offers a managed care solution to corporate clients and organizations to provide healthcare needs backed by professional staff, financial strength and insurance experience accumulated over a period of fifty years.

Health Sure covers personal health covers, hospitalization covers and maternity covers. In addition, the product covers pre- and post-hospitalization expenses as well. The covers also have a credit facility at IGI Insurance's panel of hospitals across Pakistan, Health Cards; discounts at pharmacies and diagnostic laboratories; 24-hour medical hotline with staff doctors etc.

  • Coverage extended to: Working employees & their dependent spouses & children
  • Age limits: For employees & their spouses up to 65 years of age; unmarried/ unemployed daughters; sons up to 25 years age if unemployed; divorced / separated / widowed daughters dependent on the employees without any age limit.
  • Health declaration:Each insured employee must complete a health questionnaire form, for underwriting purposes.
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HOSPITALISATION BENEFITS

INPATIENT MEDICAL COVER

This pertain to hospitalization confinement expenses for non pregnancy related conditions as follows:

  • Hospital room charges for confinements inclusive of patient's meal charges
  • Hospital services and supplies including:
  • Physician, surgeon or anesthetist fees;
  • Prescription drugs;
  • Prescribed Pathological and Radiological investigations;
  • Blood transfusions;
  • Operation theater charges;
  • Physiotherapy;
  • Radiotherapy and Chemotherapy;
  • Diagnostic or therapeutic endoscopic procedures;
  • Post-hospitalization medical care;
  • Any other medically necessary services.
  • Pre-hospitalization cover: prescribed diagnostic tests and treatments followed by an immediate and related hospitalization within 30 days.
  • Post-hospitalization out-patient expenses: e xpenses in post hospitalization period (30 days) after discharge from the hospital

EXTENDED MEDICAL COVER (OPTIONAL)

Per person annual benefit up to the age of 59 years for treatment upon hospitalization when Inpatient Medical Cover Limit is exhausted.

ADDITIONAL BENEFITS

  • Terrorist cover: hospitalization cover of any innocent insured person (not taking part in terrorist activities) injured in any act of terrorism.
  • Day surgery : Pertains to coverage of specialized procedures as follows:
  • Cataract;
  • Lithotripsy;
  • Hernia
  • Endoscopy
  • Other day surgeries
  • Specialized Investigations: covered from hospitalization:
  • CT Scan;
  • MRI;
  • Thallium Scan
  • Angiography etc.
  • International cover: Coverage of emergency hospitalization during overseas travel of insured persons with reimbursement in Pak Rupee equivalent to cost for similar procedure in Pakistan.
  • Complimentary cover for accidental injury: A utomatic enhancement of In Patient Medical Limit by 100 % for hospitalization due to an accidental injury.

OPTIONAL BENEFITS:

MATERNITY BENEFITS

  • Maternity (hospitalization relating to pregnancy) pertains to:
  • Normal delivery/Forceps;
  • Caesarean section;
  • Multiple birth;
  • Ectopic/extra-uterine pregnancy;
  • This entails the following services and supplies:
  • Hospital room charges with patient meal charges.
  • Miscellaneous hospital services and supplies.
  • Labor room or operation theatre charges.
  • Doctor's fees for delivery and subsequent visits during confinement.
  • Nursery care for the baby while the mother is confined.
  • This optional cover for maternity benefits is available to married female employees and wives of employees.
  • Pre-natal (up to 9 months before delivery) and post natal (up to 6 weeks after delivery) expenses for medicines, consultation and diagnostic tests related to pregnancy
  • Midwife expenses for delivery at home
  • Circumcision expenses of newly born baby boy.

OUT-PATIENT BENEFITS

This pertains to reasonable and customary charges for medically necessary treatment, & services of a licensed physician/ surgeon to the insured person for day to day illnesses or injuries and may include the following:

  • Consultation charges for allopathic, homeopathic or herbal medicine treatment;
  • Prescribed medicine, diagnostic lab tests, X Rays and other diagnostic tests
  • Dental care except supply of denture, scaling, polishing, capping, dental braces;
  • Physiotherapy/acupuncture, Osteopathy,
  • ECG, EMG and EEG examinations and other diagnostic tests;
  • Pre-natal treatments, test & supplies;
  • Cost of eye testing.

VALUE ADDED FEATURES

  • Photo-ID Health Cards: W e are the first company in Pakistan to offer Photo-ID Health Cards for availing cash free treatment at Network Hospitals.
  • No Pre-Authorization required: for quick hassle-free services at network hospitals.
  • Hospital Network: 125 + facilities nationwide.
  • Facility of direct settlement of hospital bills as per entitlement at network hospitals. The insured person need not pay any cash against security deposit or settlement charges.
  • Emergency Hotline Numbers: 24/7 *365 available nationwide.
  • Claims Settlement Time: Fastest turnaround time of 10 working days.
  • Non-Accidental Emergencies: Selective life threatening conditions are covered as per prudent common person definition.
  • Unlimited ICU stay: I CU cover is available without any limit on the number of days.
  • Coverage for new born babies: Insured automatically from their date of birth, as per policy terms.
  • Vaccinations: 1st dose covered at birth under maternity benefits.

What documentary proof will I be provided that I'm insured with the company under my corporate health insurance?

At policy inception of cover, a Health Card is issued to each insured employee with essential information about the employee and his dependants with benefits available to them.

What is the claim procedure in the case of a medical emergency?

The insured persons are allowed to go to any nearest hospital in case of emergencies (where the health condition of an employee changes suddenly which warrants immediate medical attention). But in all such cases they must inform the Company through their employer within 24 hours of such a happening together with the name of the hospital and the doctor.

What is the hospitalization procedure of availing health insurance at IGI's panel hospitals?

If advised hospitalization, the insured is authorized to use any of our network hospitals for treatment by simply presenting the IGI-Health Card a copy of which will be retained by the attending hospital and the necessary medical services will be extended to the insured patient. The insured patient will not be required to pay any bills to these network hospitals.

The hospitals run by the government (federal, provincial, municipal, district) and armed forces of Pakistan are approved by us for treatment. However, no credit arrangements exist at such hospitals and employees do not need to take our prior approval for using these hospitals. The employees will have to settle the bills at these hospitals and then seek reimbursement from us.

What is the hospitalization procedure of availing health insurance at IGI's non panel hospitals?

Hospitalization bills of a non-approved hospital will be reimbursed according to the rates/charges of an approved hospital in the same town/city.

Documents required would be:

  • Original bill receipts
  • Copies of lab reports (if performed)
  • Copy of discharge card along with a proper signed & stamped claim form
  • Professional Entertainers

What is the procedure of availing OPD treatment?

The insured must first pay the hospital expenses/consultant/doctor's fee/laboratory charges and cost of medicines on their own. Subsequently through your employer you need to submit these bills to IGI for reimbursement on periodical basis.

We in turn reimburse the amounts to the employer for disbursement to the insured persons; provided OPD cover is available through OPD benefits.

IPD CLAIMS

Whether panel or non panel hospital is utilized on cash basis, reimbursement can be claimed as per entitlement. A duly filled IPD claim form with stamp and signature of hospital / consultant must be sent to our office via the employer agency/ company, with the following documents attached:

  • original bill receipts for cash payments made with breakups of hospital bills
  • copies of all lab / diagnostic procedures performed
  • copy of discharge card/ medical summary with diagnosis and treatment given.

OPD CLAIMS

If this benefit is available to insured in policy, they can also send the OPD claim form duly signed and filled to our office via employer agency / company with the following documents attached:

  • Original and dated receipt of medicines purchased/ consultation taken/ tests performed
  • Copy of related prescription
  • Copy of medical reports
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