Health Insurance Brochure-The Universal Insurance Company Ltd.


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Health Insurance Brochure-The Universal Insurance Company Ltd.

  1. 1. Universal Insurance House 63,Shahrah-e-Quaid-e-Azam Lahore-54000,Pakistan Tel: Off: 042-7353458- 7355426-7324194-7353453-7324222 Fax:042-7230326, 7353209 Email:
  2. 2. INTRODUCTION This is an exclusive Group Medical Insurance Programme specially designed for organizations to take care of Health related issues of employees. We offer a wide range of traditional plan designs paired with a spectrum of innovative, consumer-directed options. You'll find the right mix for your employees need to facilitate your organization to maintain affordable Health care system with economy in efforts and cost. Group Medical Insurance covers medical cost of In-patients (IPD), Out-patients (OPD), Surgical treatment, Maternity, Dread Diseases & Specialized Investigations as per your choice and requirements. <ul><li>What is Covered ? </li></ul><ul><li>Any sickness or accidental injuries necessitating </li></ul><ul><li>hospitalization, surgical and critical illness expenses, day-care surgeries and pregnancy-related hospitalization. </li></ul><ul><li>Who is Covered ? </li></ul><ul><li>All categories of employees and their spouses are </li></ul><ul><li>covered up to </li></ul><ul><li>the age of 60 years. </li></ul><ul><li>All un-married children are covered up to the age of 23 </li></ul><ul><li>years. </li></ul><ul><li>A parents health cover is also available up to the age of </li></ul><ul><li>65 years. </li></ul><ul><li>You have the choice to choose any combination of above, </li></ul><ul><li>suitable to your organizational need / budgetary limits. </li></ul>
  3. 3. OUR HEALTH PLANS <ul><li>Universal Basic </li></ul><ul><li>Annual Hospitalization Limit Plan for employee and his family </li></ul><ul><li>It Covers IPD,OPD, Maternity , Specialized Investigations, </li></ul><ul><li>Dread Disease with moderate limits which takes care of average pay group and provides cheaper </li></ul><ul><li>and economical solution to take care of health related problems. </li></ul><ul><li>Universal Standard </li></ul><ul><li>Annual Hospitalization Limit Plan per Insured </li></ul><ul><li>It Covers IPD,OPD, Maternity , Specialized Investigations, </li></ul><ul><li>Dread Disease with enhanced limits. It takes care of middle management cadre. </li></ul><ul><li>Universal Premier </li></ul><ul><li>Annual Hospitalization Limit Plan per Aliment per Insured </li></ul><ul><li>It Covers IPD,OPD, Maternity , Specialized Investigations, </li></ul><ul><li>Dread Disease , Accidental Death. This plan is suitable for higher management cadre. </li></ul><ul><li>It provides Health coverage as per ailment. </li></ul>We offer a broad spectrum of leading-edge products and services designed specifically for organizations of all sizes, their employees, and families. We offer solutions that will fit your company's needs and also offer customized Health Care Programme if so desired. 
  4. 4. HOSPITALIZATION COVER <ul><li>IN-PATIENT HOSPITALIZATION AND SURGICAL BENEFITS </li></ul><ul><li>The costs for visits and consultations by a general practitioner or specialist whilst in hospital. </li></ul><ul><li>The costs for diagnostic examinations and non-surgical procedures at consulting rooms by specialists. </li></ul><ul><li>The surgical procedures and operations undertaken by general practitioners and specialists, including anesthesia conducted during such procedures </li></ul><ul><li>and operations. </li></ul><ul><li>Hospitals and nursing home charges, </li></ul><ul><li>plus the charges of intensive or high </li></ul><ul><li>care units. </li></ul><ul><li>Cost for dressings, medicines and </li></ul><ul><li>injections administered in the ward </li></ul><ul><li>whilst a patient is hospitalized. </li></ul>
  5. 5. MATERNITY COVER <ul><li>Maternity cover is an annual limit cover and extends to </li></ul><ul><li>both normal delivery and cesarean cases. The antenatal </li></ul><ul><li>& postnatal checkups are not included. </li></ul><ul><li>It includes: </li></ul><ul><li>Hospital’s room charges. </li></ul><ul><li>Medicines </li></ul><ul><li>Hospital service and supplies. </li></ul><ul><li>Labour room and theatre charges. </li></ul><ul><li>Delivery fees and visiting dues for in-hospital check-ups by a doctor. </li></ul><ul><li>Nursery care while the mother is hospitalized. </li></ul><ul><li>Hospitalization due to antenatal & postnatal complications and miscarriages. </li></ul><ul><li>FREE BENEFITS </li></ul><ul><li>Circumcision of male babies within the first month of birth, free of </li></ul><ul><li>charge. </li></ul><ul><li>A free enhancement in the maternity limit in case of cesarean section. </li></ul>
  6. 6. SPECIALISED INVESTIGATIONS This includes benefits to cover costs incurred on highly specialized investigations consequent upon recommendation of a specialist only within ailment. The limit is confined within the hospitalization coverage and subject to an annual / ailment limit. The tests include the following: <ul><li>CT SCANS </li></ul><ul><li>MRI </li></ul><ul><li>NUCLEAR SCANS </li></ul><ul><li>ENDOSCOPIES </li></ul><ul><li>DIAGNOSTIC LAPOROSCOPIES </li></ul><ul><li>ERCP (ENDOSCOPIC RETROGRADE CHOLANGIO-PANCREATOGRAPHY) </li></ul><ul><li>ANGIOGRAPHIES </li></ul>
  7. 7. DREAD DISEASE COVER <ul><li>This is an annual limit cover and package includes cover for </li></ul><ul><li>the ‘Dread Diseases’ which are as follows: </li></ul><ul><li>Myocardial Infarction (Heart Attack) </li></ul><ul><li>Coronary Artery Disease (Heart By-pass) </li></ul><ul><li>Cerebro vascular Accidents- Stroke </li></ul><ul><li>Cancer </li></ul><ul><li>Kidney Failure </li></ul><ul><li>Renal and other major organ transplants </li></ul><ul><li>Hepatitis ‘B’ (Chronic Hepatitis) </li></ul><ul><li>Major Burns </li></ul><ul><li>Coma </li></ul>
  8. 8. OPD COVER <ul><li>The OPD cover has an </li></ul><ul><li>Annual Family Limit </li></ul><ul><li>Annual Family Limit per Insured </li></ul><ul><li>The plan covers the following benefits; </li></ul><ul><li>The consultant’s fees </li></ul><ul><li>Prescribed laboratory & radiology </li></ul><ul><li> investigations </li></ul><ul><li>Prescribed pharmacy </li></ul>
  9. 9. HOW TO GET HEALTHCARE INSURANCE <ul><li>Kindly provide details of your Company, employees, their spouses and dependent children with respect to relationship and age. </li></ul><ul><li>If the package is offered and some changes with respect to the categories of employees, their package, the benefit limits or any other adjustment is desired, we will incorporate the same and revise the package accordingly. </li></ul><ul><li>Please mail Proposal Form (attached at the end of this Brochure ) or handover the same to our representative, we will take care of the rest. </li></ul><ul><li>Forward the Insured Data Form (It will be made available once proposal is finalized). </li></ul>HOW TO GET BENEFITS <ul><li>PANEL HOSPITALS </li></ul><ul><li>Patient may get treatment from any of our panel Hospitals listed at the end of this Brochure subject to production of following documents to the Hospital staff. These documents will be issued to each insured by us:- </li></ul><ul><li>A Universal Healthcare Identification Card </li></ul><ul><li>A letter of Authority (to visit our Panel Hospitals) </li></ul><ul><li>Your employees will be entitled to any of our panel hospitals by using the above two documents. In order to prepare the above documents, we need the following from each insured employee: </li></ul><ul><li>Filled Insured Data Form </li></ul><ul><li>01 Passport size photograph </li></ul><ul><li>Photostat of Computerized NIC </li></ul>
  10. 10. <ul><li>PAYMENT PROCEDURE </li></ul>PANEL HOSPITAL Universal Insurance has credit arrangements with the panel hospitals. Patients do not have to pay anything for hospitalizations unless limit is exceeded. The patients will have to show their insurance cards to panel Hospital, The Universal Insurance Co. Ltd. will take care of the rest. NON-PANEL HOSPITAL A non-panel hospital can only be accessed in case of an emergency situation involving accidents, stroke, etc. and also in areas where panel facility is not available. The employees are reimbursed subject to the maximum of our panel hospitals charges limits on the production of actual hospital bills (in original) such as cost of hospital stay, admission and discharge certificates, receipts of consultant’s fees, bills related to pharmacy, laboratory and radiology along-with their supporting prescriptions & reports.
  11. 11. EXCLUSIONS <ul><li>Confinement or surgical/medical operation or procedure not recommended by a legally licensed / registered physician, surgeon or specialist. </li></ul><ul><li>Pre-existing illnesses injuries, unless fully disclosed in writing prior to the date or at the time of policy commencement and approved by the company. </li></ul><ul><li>Mental illnesses, and any related sickness, or condition arising from drug abuse, alcoholism or an insured’s criminal act. </li></ul><ul><li>HIV or AIDS or any related condition. </li></ul><ul><li>Self-inflicted injuries while sane or insane, including attempt to commit suicide. </li></ul><ul><li>General check-ups, routine physical examinations, routine preventive measures and or rest cures, confinements which are primarily for diagnostic purposes. </li></ul><ul><li>Cost of limbs or supporting equipment for revival or correction of the function of the body, rehabilitation aid equipment like wheelchair, crutches etc. </li></ul><ul><li>Personal comfort items like charges for telephone and meal. </li></ul><ul><li>In-hospital dental examinations, x-rays, extractions or fillings unless necessitated due to accidental injury occurring while the insured was covered under the policy. </li></ul><ul><li>Cosmetic or plastic surgery unless necessitated due to accidental injuries occurring while the insured is covered under the policy. Medication used for cosmetic reasons, dietary products/supplement, medicated pediatric milk products even if advised by a physician. </li></ul><ul><li>Medical expenses or cost of management of rehabilitation of handicapped children. </li></ul><ul><li>Expenses directly or indirectly resulting from or consequent upon congenital defects and deformities of any nature whatsoever both physical and mental. </li></ul><ul><li>Treatment/procedure requiring prosthetic implants (except Intra-Ocular Lens). </li></ul>
  12. 12. <ul><li>All laparoscopic surgeries / procedure. </li></ul><ul><li>Test, treatment and investigation relating to infertility, sterilization, contraception and any related complication. </li></ul><ul><li>Charges for special nursing, inoculation, and circumcision unless covered under any endorsement or policy clause. </li></ul><ul><li>Injuries while traveling by air or marine transportation, except as a fare paying passenger in a licensed aircraft or marine transport being operated by a licensed airline/sea-line according to the public schedules. </li></ul><ul><li>Injury or illness due to war, invasion, civil war, revolution, insurrection or military uprising and the insured taking part in paramilitary forces, treatment from natural hazards such as earthquake, landslide, etc. </li></ul><ul><li>Injury, disease or illness directly or indirectly due to or arising from mountaineering, rock climbing, hunting, steeple chasing, polo or winter sports, or racing or engaging in any hazardous activities such as aviation or ballooning and injuries resulting from involvement in any terrorist and unlawful activities. </li></ul><ul><li>Ionizing radiation or contamination by radioactivity from any nuclear fuel & nuclear waste. </li></ul><ul><li>The radioactive, toxic, explosive or other hazardous properties of any explosive nuclear assembly or nuclear components thereof. </li></ul><ul><li>Naval or Military or Air Force or Police Force operations planned or conducted against bandits, terrorists or other like elements. </li></ul><ul><li>Injuries and ailments pertaining to Industrial or Occupational hazards. </li></ul><ul><li>Deliberate exposure to exceptional danger (except in an attempt to save human life) or the insured person’s own criminal act. </li></ul><ul><li>Custodial care or period of isolation. </li></ul><ul><li>Treatment of any ailment or damages cost resulting from any mismanagement, negligence or malpractice of an unqualified or qualified Physician / person or hospital / institution. </li></ul><ul><li>Any treatment or procedure performed on un-born fetus. </li></ul>
  15. 15. LIST OF PANEL HOSPITALS <ul><li>KARACHI </li></ul><ul><li>Agha Khan University Hospital </li></ul><ul><li>Agha Khan Hospital for Women, Garden </li></ul><ul><li>Agha Khan Hospital for Women, Karimabad </li></ul><ul><li>Agha Khan Hospital for Women & Children, Kharadar </li></ul><ul><li>7 th Day Adventist Hospital </li></ul><ul><li>Anklesaria Nursing Home </li></ul><ul><li>Atia General Hospital </li></ul><ul><li>Dar – ul – Sehat Hospital </li></ul><ul><li>Habib Medical Hospital </li></ul><ul><li>Hill Park General Hospital </li></ul><ul><li>Imam Clinic </li></ul><ul><li>Liaquat National Hospital </li></ul><ul><li>M. Rab Medical Hospital </li></ul><ul><li>Medicare Medical University Hospital </li></ul><ul><li>Murshid Hospital </li></ul><ul><li>Safia Abedin Hospital </li></ul><ul><li>Samdani Hospital </li></ul><ul><li>South City Hospital </li></ul><ul><li>Zia-ud-Din Medical University Hospital </li></ul><ul><li>Anjum Clinic, North Karachi </li></ul><ul><li>LAHORE </li></ul><ul><li>Ittefaq Hospital, Model Town </li></ul><ul><li>Fatima Memorial Hospital, Shadman </li></ul><ul><li>Shalimar Hospital, Shalimar Link Road </li></ul><ul><li>Adil Hospital, Defence Housing Society </li></ul><ul><li>Family Hospital, Family Road </li></ul><ul><li>Farooq Hospital, Allama Iqbal Town </li></ul><ul><li>Masood Hospital, Garden Town </li></ul><ul><li>Doctor’s Hospital, Johar Town </li></ul><ul><li>Surgemed Hospital, Zafar Ali Road </li></ul><ul><li>Omer Hospital, Jail Road </li></ul><ul><li>National Hospital & Medical Centre, Defence Housing Society </li></ul><ul><li>Hameed Latif Hospital, Garden Town </li></ul>
  16. 16. <ul><li>RAWALPINDI </li></ul><ul><li>Maryam Memorial Hospital </li></ul><ul><li>Bilal Hospital </li></ul><ul><li>Healers Medical Centre </li></ul><ul><li>PESHAWAR </li></ul><ul><li>Al Khidmat Hospital </li></ul><ul><li>Khyber Medical Centre </li></ul><ul><li>ISLAMABAD </li></ul><ul><li>Shifa International Hospital Ltd. </li></ul><ul><li>Ali Medical Centre </li></ul><ul><li>Ali Hospital </li></ul><ul><li>Islamic International Medical Complex </li></ul><ul><li>MULTAN </li></ul><ul><li>Medicare Hospital </li></ul><ul><li>HYDERABAD </li></ul><ul><li>Wali Bai Rajputana Hospital </li></ul><ul><li>Agha Khan Maternity & Child Care Centre </li></ul><ul><li>QUETTA </li></ul><ul><li>Pakistan General Hospital </li></ul><ul><li>ABOTTABAD </li></ul><ul><li>Hira General Hospital </li></ul><ul><li>SIALKOT </li></ul><ul><li>Al Sheikh J. Memorial Hospital </li></ul><ul><li>FAISALABAD </li></ul><ul><li>Sheikh Mian Muhammad Trust Hospital </li></ul><ul><li>Nawaz Medicare Hospital </li></ul><ul><li>Faisal Hospital </li></ul><ul><li>Saahil Hospital </li></ul><ul><li>MURREE </li></ul><ul><li>Rasheed Medical Centre </li></ul><ul><li>SUKKUR </li></ul><ul><li>Dar ul Shifa Hospital </li></ul>
  17. 17. CONTACTS Head Office : Universal Insurance House 63, Shahrah - e - Quaid - e - Azam Lahore. Tel:042-7353458-7353453 Fax:042-7230326 Web:-