We understand that in this era of globalization of the economy, employee mobility, the high cost of employee replacement, and the necessity to hold valuable employees, have posed new challenges for businesses. At the same time, the cost of medical treatment is ever-increasing at a distressing and shocking rate.
Allianz EFU understands that health is the most precious thing an individual possesses. Today incidents range from high-frequency low-cost situations to major incidents requiring surgical procedures requiring intensive care costing Rs. 200,000 or more. keeping this in view, Allianz EFU understands the employee’s demand and the weightage it has in choosing an organization that offer medical benefits.
Allianz EFU helps in managing the health facilities required for individuals, families and organizations and knows that it needs a combination of clinical knowledge, predetermined administration, tracking systems and healthcare management expertise.
The answer is to take onboard your healthcare specialist, for your health care management system for a growing number of leading businesses in Pakistan is Allianz EFU.
Benefits at a Glance
Comprehensive Care, Convenience, Choice, all at the same time!
Allianz EFU takes pride in offering its customers high-quality health insurance plans for your staff. The insurance provider takes care of their health, you can enjoy the extra peace of mind.
Allianz EFU provides healthcare cover through a network of hospitals, where your staff and their dependent family members can receive the most suitable treatment. Allianz EFU has a system in place to make the process simple and transparent.
Allianz EFU offers choice and flexibility to choose amongst the following six different plans.
|Suggested Eligibility Criteria||CEO & Directors||Departmental Heads||Middle Management||Clerical Staff||Non-Clerical||Support staff|
Pays for expenses incurred during hospital stay up to the Per Annum Per Insured Limit
|Overall Maximum Annual Limit Per Person||150,000||100,000||75,000||50,000||35,000||25,000|
|Daily Room & Board Sub-Limit||19,000||6,950||5,160||2,500||1,500||1,000|
|Daily Room & Board Sub-Limit||19,000||6,950||5,160||2,500||1,500||1,000|
|Operating Theatre Charges|
|Prescribed Medicines Used During Hospital Stay|
|Blood and Oxygen Supplies|
|Ventilators and Allied Services|
|Kidney Dialysis & Cancer Treatment|
|Daycare Surgeries / Procedures (including Endoscopy, Angiography, Dialysis etc.)|
|Diagnostic Investigations conducted during the hospital stay|
|MRI, CT Scan long-term care forty-eight reconstructive, Thallium Scan, PET Scan (specialized investigations covered as OPD)|
|Fractures and Lacerated Wounds|
|Local Ambulance (in Emergency from home to hospital within the same city on reimbursement)|
|Pre & Post Hospitalization |
(OP Expenses covering Consultations, Medicines and Diagnostic Tests 30 days before and after hospital confinement)
|Major Medical Care|
|Additional Annual Limit Per Insured (Enhances the annual limit of Hospital Care for each insured)||450,000||300,000||250,000||200,000||150,000||125,000|
|the provider pays for medical expenses related to Pregnancy and Childbirth. All Maternity related expenses are payable from Maternity Limit|
|Caesarean Section /Multiple Births / Assisted Deliveries||246,000||174,400||133,450||60,000||40,000||30,000|
|Annual Limit Per Family||25,000||20,000||15,000||10,000||7,500||5,000|
- The employer can elect to offer different plans to employees based on seniority and Management Grade
- Customized plans are available for large Groups
Exclusions from the Policy
The following Treatments, events, conditions, activities and their related or substantial expenses are excluded from the procured Policy unless specifically agreed upon in writing by the Company:
- Any expenses directly or indirectly suffered for the treatment of any Pre-existing Medical Conditions.
- Any expenses in respect of the donor for organ transplant Entitlements.
- Services or Treatment in any health spa, hydro clinic, infirmary, nursing home or long-term care facility that is not a Hospital.
- Routine medical checkups or inspection including charges arising out of any hospital detention or admission primarily for diagnostic reasons unless precisely approved by the Company, routine eye or ear examinations, vaccinations (except WHO recommended EPI vaccinations for Children), medical certificates, examination for employment or travel, spectacles, contact lenses, hearing aids. Cost of correction of refractive errors of the eye and procedures such as Radial Keratotomy and Excimer Laser.
- Entire dental Treatment or oral surgery apart from Emergency Accidental Dental Treatment that the insured may require.
- Any OPD Treatment, except Emergency Accidental OPD Treatment within forty-eight hours of the Accident.
- Cosmetic or plastic surgery shall not be covered by the provider unless it is reconstructive surgery needed by a grievance that occurred during the period while the insured individual was protected under this Policy concerning the limits in the Benefits Table.
- Pregnancy and problems related to childbirth (including surgical delivery), miscarriage, abortion and/or any related prenatal or postnatal care unless covered under this Policy in the optional/additional benefits section.
- Tests or Treatment for fertility, infertility, contraception or sterilisation.
- Birth defects or congenital Illness.
- Prostheses, corrective devices and medical applications which are not surgically required.
- Psychotic, mental or nervous disorders or sexual reassignment (whether or not for psychological reasons).
- Experimental or unverified Treatment.
- Self-inflicted Injury means attempted suicide or abuse of alcohol or drug dependence.
- Involvement in or training for any perilous or unsafe sport, pastime or competition or riding or driving in any form of race or competition or any professional sport.
- Being involved in aviation other than as a fare-paying passenger of a recognized airline or charter service.
- Any treatment or surgery received in a location other than the covered individual’s geographical area of coverage.
- Any damage or Treatment that is due to war, riots, invasion, an act of foreign enemies, hostilities or warlike operations (whether war be declared or not), civil war, mutiny, civil commotion assuming the proportions of or amounting to a popular uprising, military uprising, insurrection, rebellion, military or usurped power or any act of any person acting on or on behalf of or in connection with any organization actively directed towards the overthrow or to the influencing of any government or ruling body by force, terrorism or violence.
- Grievances/injuries due to an illegal act other than a minor misdemeanour or minor delinquency committed by the covered individual.
- Injuries arising from ionizing radiation or contamination by radioactivity from any nuclear fuel or nuclear waste, from the process of nuclear fission or any nuclear weapons material.
- Any upsurge in the expenditures incurred for treatment on account of the policyholder being admitted to a more expensive room than allowed by his daily room and board limit.
- The expenditure of non-medically necessary goods or services including such items as telephone, television, newspapers or accommodation for the insured person’s family members.
- Weight management amenities and management related to weight reduction programs including treatment of obesity.
- Natural catastrophes, epidemics, pandemics including, but are not limited to, flood, earthquake, avalanche and cyclones.
- Any Disability that is directly or indirectly related to or resulting from HIV, AIDS or any other sexually transmitted disease.
- Air ambulance or evacuation or repatriation expenses.
How does Allianz EFU help care for your health?
Allianz EFU is the only company in Pakistan with the means to provide its customers with an effective integrated health care programme that is adequately flexible to develop and grow and mold itself as needs change.
An integrated Health Care system does improve the quality of care most efficiently and effectively for the customer while reducing/maintaining the cost or being cost-effective.
Allianz EFU uses a state-of-the-art computerized mechanism that enables them to track everything related to customers. All this activity is aimed at ensuring that patients receive the most appropriate care.
Components on integrated health care systems:
- Collection of only those hospitals that meet rigorous quality criteria. The facility Assessment is done through an internal grading system.
To provide customer peace of mind, Allianz EFU will issue a personalized health card to each employee. In case of a medicinal emergency, this card serves to identify you to a network hospital. The card has your insurance coverage details, emergency phone numbers and family details.
24 Hours Medical Hotline
In case of a medicinal emergency, the Allianz team of doctors is easily reached 24 hours a day through their hotlines made available for customers. The doctors will guide and help the policyholder in search of cure and admission to the hospital if needed in a network facility.
Allianz EFU has established a dedicated Call Center that assures timely response to all customer queries. The Call Center is available during working hours.
Dedicated Customer Service Hotline
Allianz EFU has also established a committed customer service hotline, which is available for customer queries after working hours.
Allianz EFU has developed and maintained close business associations with a network of hospitals. Today, the company enjoys a strong professional relationship with a network of over 170 judiciously selected hospitals present throughout the country.
These hospitals are qualified based upon the credentials and the presence of their physicians /surgeons and satisfactory evaluation of their facilities. In addition, to get quality care, the customer gets the following benefits:
- No cash payment is required, Allianz EFU reimburses the hospitals directly, meaning “Cashless Hospitalization”.
- No claims form and no waiting time for reimbursement cheques.
- Less administrative work.
- Any expenses incurred with respect to donor for organ transplant Claims.
- Any medical condition identified or treated within the General Waiting Period of fifteen (15) days from the effective date of this policy, except for the Accidental Emergencies. (P.S: This exclusion will not apply for subsequent renewals with the Allianz EFU without a break).
- Any increase in the expenditures suffered for Treatment on account of the policyholder being admitted to more expensive room than allowed in his/her policy and board entitlement.
- Routine medical inspections or check-ups including expenses arising out of any Hospitalization or admission initially for diagnostic purposes unless explicitly sanctioned by the company, routine eye or ear checkups, vaccinations, medical certificates, checkup for employment or travel, eyeglasses, contact lenses, hearing aids. Fee of correction of refractive errors of the eye and procedures such as Radial Keratotomy and Excimer Laser and any other treatment that is not considered medically essential.
- All dental procedure or oral surgery apart from Emergency Accidental Dental Treatment for pain relief only within forty eight (48) hours of an Accident.
- Any OPD consultation or procedures, except Emergency Accidental Out-Patient Treatment within forty eight hours of the Calamity.
- Cosmetic or plastic surgery, unless it is re-constructive operation that is medically compulsory and results as an assessment of an Accidental Injury that befallen within the duration of the Policy period.
- Pregnancy and complications related to it (including surgical delivery), miscarriage, abortion and/or any related prenatal or postnatal care.
- Tests or procedures relating to fertility, infertility, contraception or sterilisation.
- Birth defects or congenital Illness.
- Prostheses, corrective devices and any medical piece of equipment which are not surgically required.
- Any Treatment or test in connection with Acquired Immune Deficiency Syndrome (“AIDS”), any AIDS-related Complex Syndrome (ARCS) and any other AIDS-related conditions or diseases.
Allianz EFU Health Insurance Ltd has made agreements with some reputable providers whereby the customers can avail concessions on OPD and Lab-Test upon presenting their Health Cards (even where OPD treatment is not covered under the policy), this step is to facilitate the customer and make the policy more attractive for the consumer.
Allianz EFU has made available a secure online portal service for their corporate clients. This facility enables the corporate customers to track the claim detail and status of their covered employees at any time and is accessible through any place without needing to contact Allianz EFU Customer service representative or without calling on the customer hotlines.
Allianz EFU Family Tahafuz is a health insurance policy which provides coverage to you, your significant other and your children (must be more than 3 months) old under a single policy for the same Annual Family Limit. Allianz EFU Family Tahaffuz is a policy which covers more than one family member for a fixed cover. In this plan one fixed cover is shared by all the family members, i.e. if a family of four takes a cover of Rs. 500,000 the entire family can claim up to Rs. 500,000 together or even one family member can utilize the cover up to its prescribed limit.
Allianz EFU FAMILY TAHAFFUZ is a simple, valuable and affordable health insurance policy. A single policy that will provide financial protection, up to the selected coverage limit, in case an ill-fated illness or mishap leads to hospitalization. Furthermore, in case of an incident, family can also avail the benefit from the supplementary accidental limit in each plan. Some of the distinctive benefits offered under FAMILY TAHAFFUZ are:
Allianz EFU FAMILY TAHAFFUZ plan is designed to afford you access to large network of judiciously selected Hospitals across the country for excellent healthcare, with cashless hospitalization.
24-Hour Medical Hotline
The policyholders have round-the clock 24 hours accessibility to Allianz EFU staff doctors for help during medical emergencies. Medical Hotline Numbers will be printed on the policyholders Health Card.
Customer Service / Call Center
In case the policyholder needs any clarification or facilitation regarding the policy, Allianz EFU dedicated customer relations / call center staff will be available to assist the policyholder.
the policyholder will receive a Health Card from Allianz EFU with their policy that will contain important information about your policy. The Health Card will identify you and any of your dependents enrolled under the policy as Allianz EFU insured at our Network Hospitals and entitles you to the Credit Facility.
To add greater value to their services, Allianz EFU Health Insurance Ltd has entered into a contract with some reputable laboratories and OPD’s in Karachi, Lahore, Islamabad and Rawalpindi whereby the policyholders can avail discounts on OPD and Lab-Test upon presenting their Health insurance Cards (even where outpatient treatment is not covered under the policy).These centers include diagnostic centers / laboratories, eye clinics and dental clinics.
Allianz EFU has established a network of around 170 judiciously selected hospitals across the country. Some of these include: Aga Khan University Hthe ospital (AKUH), Orthopaedic & Medical Institute (OMI), Liaquat National, Dr. Ziauddin Hospital in Karachi, Shifa International Hospital, Bilal Hospital in Islamabad Doctors Hospital, Ittefaq Trust, Fatima Memorial, Shaukat Khanum in Lahore and many more in these and other major cities/towns like Hyderabad, Sukkur, Quetta, Peshawar, Faisalabad & Multan.
You can acquire a complete list of Network Hospitals from your insurance consultants or download it at our website
No Claim Bonus
In case there is NO Claim by any of the family members covered under the Policy for a period of two consecutive Policy Years (means continuing of policy), the Basic Annual Limit will be enhanced by 10% with effect from the following Policy Year, free of charge. This increase in protection of the policyholder family’s health protection will help to keep pace with medical inflation and provide you peace of mind.
TAHAFFUZ is designed to provide you access to a large network of carefully selected Hospitals across the country for quality healthcare, on Credit Basis, in case of hospitalization. The below chart shows some of the salient benefits of the Plan:
|Description of Benefits||Silver||Gold||Platinum|
|Basic Annual Family Limit||Rs.200,000||Rs.350,000||Rs.500,000|
|Additional Annual Family Limit for Accidental Hospitalization||Rs. 40,000||Rs. 70,000||Rs.100,000|
|Intensive Care Unit (At Actual)||Covered||Covered||Covered|
|Day Care Procedures||Covered||Covered||Covered|
|MRI, CT Scan & Thallium Scan||Covered||Covered||Covered|
|Pre/Post Hospitalization Investigations||30 days||30 days||30 days|
|Pre/Post Hospitalization Consultations||30 days||30 days||30 days|
|Pre/Post Hospitalization Medicines||30 days||30 days||30 days|
|Emergency Evacuation Sub Limit||Rs.35,000||Rs.50,000||Rs.50,000|
|Emergency Accidental Out-patient Sub Limit (Within 48 Hours)||Rs.20,000||Rs.35,000||Rs.50,000|
The following Treatments, events, conditions, activities, surgeries and their related or substantial expenditures are not included in the Policy, unless explicitly agreed upon in writing by the Company:
Pre-existing Medical Condition, except if covered by the insurance provider, in writing, after continuous coverage of four years (consecutive).