Health Insurance Policy Year 2016

Frequently asked questions

How can I update / add / delete my dependents?

What is the period of my Health Insurance Coverage?

Your health insurance coverage starts from 1st January 2016 OR from your joining
date (whichever is latest) and expires on 31st December, 2016 OR till your last
working day (whichever is earlier).

You can send your dependents information to your regional health insurance
representative as per following:
CNIC of all dependents required.
For addition of spouse attested copy of marriage certificate is required.
For addition of child attested copy of birth certificate is required.
No supporting document is required for deletion of dependents.

What are my Health Insurance Limits?

Out Patient (OPD) Limit (per family / year)
OPD Sub-Limit Optical (per person / year)
OPD Sub Limit Dental (per family / year)
OPD Sub-Limit Vaccination (per family / year)
OPD Sub-Limit Over the Counter (per family / month)
Hospitalization (IPD) Limit (per person / ailment per year)
Maternity Limit Covered under IPD (per person per year)
Daily Room Limit
Major Medical Care (MMC) Limit (per slot)

PKR 120,000
PKR 10,000
PKR 40,000
PKR 40,000
PKR 3,000
PKR 250,000
PKR 250,000
PKR 11,000
PKR 500,000

If I exhaust my existing OPD limit, can I get any additional limit?

No, unfortunately there is no such facility.
Please note that any additional utilization over and above OPD entitlement (through credit
facility) is prohibited & would be deducted from salary.

How can I get my health insurance card / letter?

Your health insurance card/letter will be issued within 10 working days starting
from request received by your health insurance representative.

Who is covered under the Health Insurance Policy?

All permanent employees and their dependents including legal spouse, children,
parents or legal guardian* (if any) living in Pakistan are covered under health
insurance policy.
* For enrollment of guardian; legal documentation of guardianship court orders would be
a mandatory requirement. Additionally the date of such assignment / court orders of
guardianship should be prior to age of maturity i.e. 18 yrs. (i.e., the guardianship role was
assumed before the employee reached the legal age of 18 yrs.).
In case of siblings/ spouses working at Telenor Pakistan, dependents will be added under
one employee only.

How can I claim my health insurance expenses?

Employees and their family members are encouraged to prefer panel hospitals or
clinics for any medical needs due to numerous benefits of availing facilities at panel
hospitals.
In case if employee or their family members go to a non-panel hospital or clinic and
paid medical related cost from their own pocket then for reimbursement they have
to follow the below process:
a)

Fill in all the details of OPD or IPD claim form

b) Attached all required documents. For OPD original prescriptions and

payment/bill receipts with copy of supporting document (if any) is
required. Photocopy of all the lab investigations claimed is required.
c) For IPD/hospitalization original payment/bill receipts with itemized
details, copy of discharge slip/certificate/summary and medicines cash
memo (if any) is required.
d) Drop the claim in health insurance claim box or submit/handover it to your
regional health insurance representative.
Please remember to make scanned / hard copies of your claim documentation* before
dispatching them to health insurance representative.

What is the maximum time limit to claim my expenses?

You can claim your expenses within 3 months from the date they are incurred.
Claims submitted after this time period will not be reimbursed.

What is covered under OPD?

This covers medical expenses including consultancies, registrations, investigations,
checkups, treatments, therapies, diagnostics tests, vaccinations, physiotherapy,
OTC, medical items/accessories/equipment/devices, nutritional supplements
(diabetes/ maternity / chronic illness ) ,prescribed medicines .
For existing and pre-existing medical conditions (if any).
Baby milk formulas arent covered under the policy.

Medical Equipment & Aids:

Select medical equipment e.g. BP Apparatus, Glucometer, sugar strips , Nebulizer,
hearing aids etc., if medically necessitated for treatment purposes are covered.
Select rehabilitation items like crutches; wheel chairs, cervical collars, lumbar
support belts, arm slings etc., if medically necessitated for treatment purposes is
covered.
Clinical details, current prescription and advice for the subject medical equipment by the
treating specialist would be required.
Submit the documentation to the regional health team prior to purchase for approval.

Are my medical expenses covered if I am outside Pakistan?

Overseas treatment is a selective coverage area and hence subject to approval from
insurance company & Telenor Pakistan management. If insured member goes
specifically for the medical related treatment then Aga Khan University Hospital,
Karachi (or equivalent) will be used to benchmark cost/expense (for treatments
available in Pakistan).

What is covered under dermatology for OPD?

Emergency / Accidental medical treatment (OPD/IPD) is covered within assigned

limits in all cases.

Dental covers treatment of teeth/gum (only if medically required) including root

canal, crowning, bridging, capping, filling, dentures, braces, scaling and X-rays.

Maternity related expenses arent covered (unless it is an employee herself; the expense
was medically mandated (medical need) and occurred during an official business trip).

Dental implants are not covered.

X rays are required where available for root canal treatments.

Dermatology covers any prescribed treatment (only if medically required) including

acne treatment and sun blocks in cases of photosensitivity/SLE.

What is covered under dental for OPD?

What is covered for Optical in OPD?

Optical covers eyesight checkup/test and related devices like contact lenses,
spectacles, lens solution glasses and frames.

Original dental x-ray (where available, for claiming dental expenses).

What is covered Under OTC medicine in OPD?

This covers standard medicines or medical related items including syrups, pain
killers, antihistamines, ORS, antacids, first aid items, lozenges, etc.

In cases of non-computer generated / manual invoice the stamp of the hospital / pharmacy
is a mandatory requirement. On manual invoices there should be no over writing / cutting.

Prescriptions will be required for antibiotics / multivitamins.

What is covered under reoccurring medicines in OPD?

Recurring medicines covers prescribed medicines or medical related items use for a
longer period. Employee can submit copy of the last prescription to claim any
recurring medicines/items (up to 1 month duration at a time).
Regular review is critical to quality medical care. Employees are strongly encouraged to get
a clinical review every 6 months. Prescriptions will be considered valid for six months from
date of issuance for reoccurring medicines, after six months new prescription will be
required.

What is covered under IPD?

IPD covers medical and maternity expenses during, pre or post
hospitalization (up to 30 days) including short or long stays in hospitals,
emergencies or ICU; admissions, consultations, registrations, examinations,
checkups; treatments, therapies, procedures, surgeries, diagnostics, tests;
prescribed medicines, multivitamins, nutrition (enteral/parenteral); and
medical, and first aid items (accessories, devices).
Employees are advised not to avail credit facility for pre and post ipd medical expenses and
to claim them via manual reimbursement so they can be adjusted in ipd limits.

Is OPD credit facility available?

What is covered under maternity?

Yes, OPD credit facility is available at selected Panel hospital in every region and can
be availed up to 70 % of the total limit.

This covers maternity and related IPD treatments including pre and post natal (30
days ) treatment, services, supplies, epidural, multiple births, complications,
ectopic/extra uterine pregnancy, miscarriage, legal abortion, midwife (in case of
home delivery), child circumcision and child nursery care (while mother is confined).

Employees are advised to keep receipts/ record of medical expenses done on

credit facility.

What if the new born child needs medical treatment in the hospital?
How do we claim OPD?
Fill in the OPD claim form and attach the following documents (as & where
applicable):
Photocopy of doctors prescription with date and patients name clearly
mentioned.
Original bill/payment receipt/memo with amount, date and patients name
(where possible) clearly mentioned.
Copy of laboratory/diagnostic services tests/reports.
Copy of vaccination card (for claiming child vaccination expenses).
Updated eyesight test card (for claiming spectacles or contact lenses).

If the new born is retained in the hospital for medical treatment, it will be treated
as a separate hospitalization upon submission of addition enrollment form to the
regional health insurance representative.

What is covered under treatments / therapies for IPD?

This includes anesthesia (epidural/spinal/inhalational), organ transplant, laser,
optical, dental, facio-maxillary, dermatology, physiotherapy, rehabilitation therapy,
acupuncture, osteopathy, chiropody and podiatry.

What is covered under optical for IPD?

It covers eye surgeries/procedures/treatments including cataract, intraocular lens,
radial keratotomy, squint, excimer laser.
Refractive error correction surgery using lasers is covered for employees using low vision
devices. Please note that these procedures carry a serious risk of permanent visual damage
& therefore employees are encouraged to discuss the case with the regional health team,
with all the reports / advise from doctor before embarking on this modality of treatment.

What is covered under diagnostic test for IPD?

This covers diagnostic/scans/tests/procedures including mammography, CT, HRCT,
MR, PET, fluoroscopic, radioisotope, function & perfusion scans, angiographies,
tumor markers, invasive diagnostic, therapeutic procedures, endoscopies, etc.

What is major medical care?

This a reserved & special benefit area available by approval from TP management in
cases of critical illness / sickness predominantly for hospitalized patient where
standard IPD limits are considered insufficient and treatment is medically mandated
& non provision of treatment is likely to result in severe medical outcomes. MMC
benefits may be allowed in a very few outpatient setting like patients with treatable
cancers receiving chemotherapy as an outpatient.
MMC slots arent available by default. These are assigned after detailed technical review &
approvals in hospitalized patients.
MMC slots wont be assigned for cases where hospitalization costs exceed due to extra
room charges, ancillary expenses etc. These are only meant to cover core medical expenses.

What is covered under organ transplant under IPD?

This covers all medical related cost/expenses/charges for insured members and
donor.

What is not covered in the health policy?

Do I need any pre authorization before the IPD treatment?

Cosmetic / aesthetic treatment, skin laser treatment , contraception , infertility , shampoo

,sunblocks , hair treatment/ transplant , obesity treatment , energy drinks, protein
supplements for bodybuilding and physical fitness, baby milks & formulas, sanitation
items, weight machine, digital thermometers, electrical wheel chairs , sunglasses ,
experimental treatment regimens, non-standard treatment regimens, mattresses etc.

No preauthorization for admission in panel hospital is required from employee or

family member (if copy of health card/letter and CNIC of employee and patient is
already provided) during emergency. However, hospital can do the backend
authorization or verification from vendor without effecting/delaying the admission
process.
In case of elective procedures 24 hour prior approval is required .

The following treatments are not covered in the policy:

In case of non-panel hospitals; you are strongly advised to get prior approval from your
regional health insurance team so that you do not have any problems at the time of claim
submission.

Contact information

How do I claim IPD?

You can contact your regional health insurance representative by sending your
query to following email address:

IPD facility can be availed at all the panel hospitals nationwide on the health card
along with the CNIC of the employee and patient, if the employee has availed
services of a non-panel hospital , he can submit the claim manually to the regional
health insurance team with the following documents
Original itemized bill / payment receipts / memo and Original discharge summary is
to be attached with the IPD claim form.

North Region:

health.insurance-n@telenor.com.pk

Central Region:

health.insurance-c@telenor.com.pk

South Region:

health.insurance-s@telenor.com.pk