Pre-Authorization Change in Insured Status Claim Family Health Questionnaire: English Urdu FEQ Form

 

The following chart guides you to the medical and Benefits and premium cost:

 
 
Description of BenefitsPlans
Diamond
Gold
Silver
Bronze  
IN-PATIENT & DAY CARE BENEFITS
   
  Overall Maximum Inpatient Limit Per Annum Per Person
  1. Hospitalization Benefits
  Due to Accidents, Illnesses & Surgeries
  2. Hospital Room Entitlement
  3. ICU Charges  (15 days per annum)
  4. Pre-and Post-Hospitalization OP Benefits
  5. Hospitalization for Pregnancy and Childbirth (10 months waiting period; 100% increase in case of caesarean section)
  6. Day Care Surgeries, Dialysis & Cancer Treatment
  7. MRI, CT Scan & Endoscopy in Outpatient (With prior approval)
  8. Treatment for Fractures & Lacerated Wounds
  9. Emergency Local Road Ambulance
 
 
Rs. 350,000
Rs. 200,000
Rs. 125,000
Rs. 75,000
 
 
 
 
Covered
Covered
Covered
Covered
 
 
Executive
Private A/C
Private Non A/C
Semi-Private
 
Actual
Actual
Actual
Actual
 
Covered
Covered
Covered
Covered
 
 
Rs. 20,000
Not Covered
Not Covered
Not Covered
 
 
Covered
Covered
Covered
Covered
 
 
Covered
Covered
Covered
Covered
 
 
Covered
Covered
Covered
Covered
 
 
Covered
Covered
Covered
Covered
 
 
 
OUT-PATIENT BENEFITS
   
  Overall Maximum Outpatient Limit Per Annum Per Person
  Co-Insurance Rate (per claim)
  Number of Consultation Visits (per person per year)
  Doctor's Consultation
  Prescribed Investigations and Tabs
  Prescribed Medicines
 
 
Rs. 10,000
Rs. 6,000
Rs. 4,000
Rs. 3,000
 
 
20%
20%
20%
20%
 
 
08
06
05
04
 
 
Covered
Covered
Covered
Covered
 
Covered
Covered
Covered
Covered
 
Covered
Covered
Not Covered
Not Covered
 
 
   
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