Unique Benefits

FAMILY TAHAFFUZ is an In-patient Hospitalization policy which provides coverage to you, your spouse and your children above ninety (90) days old under a single policy for the same Annual Family Limit. Family Tahaffuz is a policy which covers more than one family member for a fixed cover. Here the 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. FAMILY TAHAFFUZ is a simple, valuable and affordable health insurance plan. A single policy that will provide financial protection, up to the selected benefit limit, in case an unfortunate illness or accident leads to hospitalization. Moreover, in case of an accident, family can also avail the benefit of additional accidental limit in each plan. Some of the unique benefits offered under FAMILY TAHAFFUZ are:

♦ CREDIT FACILITY
FAMILY TAHAFFUZ is designed to provide you access to large network of carefully selected Hospitals across the country for quality healthcare, on Credit Basis, in case of hospitalization.

24-Hour Medical Hotline
You have round-the clock 24 hours access to our staff doctors for help during medical emergencies. Medical Hotline Numbers will be printed on your Health Card.

Customer Service / Call Center
In case you need any clarification or facilitation regarding your policy, our dedicated customer relations / call center staff will be pleased to assist you.

Health Card
You will receive a Health Card with your 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.

DISCOUNT CENTERS
To add greater value to our services, Allianz EFU Health Insurance Ltd has entered into a contract with some reputable providers in Karachi, Lahore, Islamabad and Rawalpindi whereby our insured members can avail discounts on Out Patient Consultation and Investigations upon presenting their Health Cards (even where outpatient treatment is not covered under the policy).These discount centers include diagnostic centers / laboratories, eye clinics and dental clinics.

However, credit will be extended for MRI, CT Scan and Thallium Scan (where available) provided prior approval has been taken from Allianz EFU Health Insurance Ltd. Discount Centers List

NETWORK HOSPITALS?
Allianz EFU has developed a network of around 170 carefully selected hospitals spread across the country. Some of these include: Aga Khan University Hospital (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 get a complete list of Network Hospitals from our representative or download it at our website

No Claim Bonus
In case there is NO Claim on any of the family members insured under the Policy for a period of two consecutive Policy Years, the Basic Annual Limit will be enhanced by 10% with effect from the following Policy Year, free of charge. This increase in cover of your family’s health protection will help to keep pace with medical inflation and provide you peace of mind.

Medical Plans

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
Room Entitlement General Semi-Private Private
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

Above mentioned financial limits are Annual Family Limits for members enrolled under the policy
You can get further details from Family Tahaffuz Brochure.


Disclaimer: The above provides only an introduction of the benefits available under the policy. For exact terms and conditions, please refer to the Policy Document.

Exclusions

The following Treatments, events, conditions, activities and their related or consequential expenses are excluded from the Policy, unless specifically agreed upon in writing by the Company:

Pre-existing Medical Condition, except if covered by the Company, in writing, after four policy years.

  • Any charges in respect of the donor for organ transplant Claims.
  • Any medical condition diagnosed or treated within the General Waiting Period of fifteen (15) days from the effective date of this policy, except for the Accidental Emergencies. This exclusion will not apply for subsequent renewals with the Company without a break.
  • Any increase in the expenses incurred for Treatment on account of the Insured Member being admitted to more expensive accommodation than allowed by his room and board entitlement.
  • Routine medical examinations or check-ups including charges arising out of any Hospital confinement or admission primarily for diagnostic purposes unless specifically authorized by the company, routine eye or ear examinations, vaccinations, 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 and any Treatment not considered Medically Necessary.
  • All dental Treatment or oral surgery apart from Emergency Accidental Dental Treatment for pain relief only within forty eight (48) hours of an Accident.
  • Any Out-Patient Treatment, except Emergency Accidental Out-Patient Treatment within forty eight hours of the Accident.
  • Cosmetic or plastic surgery, unless it is re-constructive surgery that is medically necessary and results as a consequence of an Accidental Injury that occurred within the duration of the Policy.
  • Pregnancy and complications thereof, childbirth (including surgical delivery), miscarriage, abortion and/or any related prenatal or postnatal care.
  • Tests or Treatment relating to fertility, infertility, contraception or sterilisation.
  • Birth defects or congenital Illness.
  • Prostheses, corrective devices and medical appliances 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.
  • Self-inflicted Injury, attempted suicide, abuse of alcohol, drug addiction or abuse and Treatment of any sexually transmitted diseases.
  • Psychotic, mental or nervous disorders (including any neuroses and their physiological or psychosomatic manifestations) or sexual reassignment (whether or not for psychological reasons).
  • Any experimental or unproven Treatment.
  • Injury or Illness due to participation in or training for any dangerous or hazardous sport pastime or competition or any professional sport (for example: sky diving, mountaineering, boxing, scuba diving etc).
  • Injury or Illness resulting from war, riots, invasion, 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.
  • Injury or Illness due to Natural Catastrophes, Epidemic, including, but not limited to, flood, earthquake, avalanche and cyclone.
  • Injury or Illness resulting from participating in exercises or operations while serving with either of the armed or paramilitary forces or while performing any form of police duty or armed security guard duty.
  • Aviation other than as a fare-paying passenger of a recognized commercial airline or a chartered service.
  • Injuries as a result of an illegal act of an Insured Member.
  • Ionizing radiation or contamination by radioactivity from any nuclear fuel or nuclear waste, from the process of nuclear fission or from any nuclear weapons material.
  • Services or Treatment in any spa, hydro clinic, sanatorium, nursing home or long-term care facility that is not a Hospital.

FAQ's

1) What is An Application Form? When is it required?
An Application Form is the basic enrollment form for the health coverage. It is also used to add additional dependents under the Policy.

2) Can anyone enroll under Family Tahaffuz Policy?
The Policy is not available to people suffering or suffered from Cancer, Diabetes or HIV/AIDS.

2) What is a Pre-authorization Form? When is it needed?
In case of a hospitalization, Pre-authorization Form is the Company’s standard Form used to obtain Credit Facility at Network Hospital.

3) What is a Claim Form? When is it needed?
A Claim Form is the Company’s standard Form required for filing a Claim for re-imbursement when the treatment is obtained without the credit facility and you have settled the hospital bill out of pocket.

These forms are included in your welcome pack. The forms can be downloaded from the website of the Company, www.allianzefu.com or requested from the Individual Health Department. You can also use a photocopy of these forms

3) Whom I can Enroll under my Policy?
You can include your spouse and a maximum of 4 dependent children, above 90days old, in your policy.Once enrolled at 59, the coverage can be continued up to age of 60years

4) What are the Eligibility Terms for this product?

Eligible Relations: Self and Dependents (Spouse & Children maximum (04) dependent Children three (03) months or older)
Admissible Ages: Up to Fifty nine(59) years at the time of enrolment
Children should be at least three (03) months old

Once enrolled, the coverage can be continued up to the age of 65 years.

5) When will the coverage start?
The coverage will start after Fifteen (15) days of General Waiting Period from the Effective Date of your Policy once Allianz EFU receives the completely filled Application Form along with the premium payment. The coverage Effective Date is mentioned in your Policy Document and Health Card.

5) How does my Policy work?
Suppose you, your spouse and your child are covered for Rs.100,000/- each, under an Individual Health Insurance Policy. This means you are paying premiums against coverage of Rs 100,000/- for three separate policies In an unforeseen situation, if one of the insured member requires hospitalization and the medical expenses amounts to Rs.180,000/-, the Individual Health Insurance Policy would cover only up to Rs.100,000/-, while the remaining amount of Rs.80,000/- would have to be borne by yourself.

But if you opt for Family Plan of Rs.350,000/- the total limit would be shared among all the insured members. This means all the insured members enrolled under the policy, individually and collectively, enjoys health insurance cover of upto Rs.350,000/- In this scenario the above medical expense of Rs.180,000/- will be fully covered under your policy.

The maximum amount that can be claimed under the policy during a policy year will be limited to the Annual Family Limit selected by you.

6) Can I include any of my dependents if currently I do not have any?
They can be included in the policy, if eligible, within 30 days of your first acquiring them or within 30 days of them becoming eligible, subject to Eligibility Terms. All new dependants must be enrolled by completing the Application Form.

7) What if I was unable to enroll my dependents within thirty (30) days of eligibility?
Enrollment of any dependent will not be accepted after thirty (30) days. In case you don’t apply for his insurance within thirty (30) days of eligibility, you may still get them enrolled under your policy from the next renewal date.

8) What if my health expenditure is more than my available family limit? Can I claim the remaining next year?
Your Basic Annual Family Limit is the maximum amount that can be claimed individually or collectively by all the insured members enrolled under the policy during a single policy period. For an expenditure to be eligible for payment under the policy, it should be incurred on or between the Effective Date and the Expiry Date of your policy. In case, the actual expenditure exceeds the available family limit, the excess amount will have to be borne by the Insured Members themselves.

8) What is a No Claim Bonus / Bonus Family Limit?
In case of NO Claim on your Policy for any two consecutive Policy Years, the Company will give a No Claim Bonus in the form of a Bonus Family Limit. The Bonus Family Limit will be equal to 10% of the Basic Annual Family Limit and it will function in the same way as your Basic Annual Family Limit.

9) What is High Claim Loading?
In case of high claim on your policy during the immediately preceding three policy years (preceding one or two policy years for first two renewals), the Company may increase the Renewal Premium at the following rates.

Claims up to 50% of Premium No Extra
Claims up to 75% of Premium 15%
Claims up to 100% of Premium 20%
Claims more than 100% of Premium 25%

In case of any increase in the basic premium rates (due to increase in age band or revision of premium rates), the loading will be applied on the revised premium.

10) How long can I stay covered?
The maximum enrollment age under this policy is fifty-nine (59) years. Once enrolled in the policy the coverage can continue up to the age of sixty (60) years.

11) I am already covered under my Company’s group health policy. Can I still buy Individual Health Policy?
Yes, you can still buy Individual Health Policy to augment the group health coverage. Your Company’s group health policy’s limits may not be enough to cover your medical expenses. In case a claim is not payable under your group contract due to a lower limit, you can apply for its reimbursement under the individual policy.

Secondly, your company may not be covering your dependants. You can also buy health policy for them so that your whole family can enjoy a peace of mind.

12) Can I claim my medical expenses both from my Individual Policy and My Company’s group health policy?
You can claim your medical expenses under any of the two policies. In case the claim is not fully reimbursed under the first policy, due to shortfall of your annual limit, you can claim the remaining amount from the other policy. Please note that you can not claim more than you spend on the treatment under these policies.

13) What if I was unable to enroll my new born baby within thirty (30) days of eligibility?
Enrollment of new born baby will not be accepted after thirty (30) days of the date of eligibility. In case you don’t apply for his insurance within thirty (30) days of eligibility, you may still get him enrolled under your policy from the next renewal date.

14) I am already covered under my Company’s group health policy. Can I still buy Individual Health Policy?
Yes, you can still buy Individual Health Policy to augment your group health coverage. Your Company’s group health policy’s limits may not be enough to cover your medical expenses. In case a claim is not payable under your group contract due to a lower limit, you can apply for its reimbursement under the individual policy.

Secondly, your company may not be covering your dependants. You can also buy health policy for them so that your whole family can enjoy a peace of mind.

15) Can I claim my medical expenses both from my Individual Policy and My Company’s group health policy?
You can claim your medical expenses under any of the two policies. In case the claim is not fully reimbursed under the first policy, due to shortfall of your annual limit, you can claim the remaining amount from the other policy. Please note that you can not claim more than you spend on the treatment under these policies.

16) What is the purpose of the Health Card?
Your Health Card contains the basic information about your coverage. You will need to show your Health Card each time you seek Treatment at a Network Hospital. It identifies you to the Network Hospitals and supplies them with key information about your Coverage. While making telephone enquiries with us we will also ask for the information on Health Card to identify you.

17) What should I do if I misplace or damage my Health Card?
If you misplace or damage your Health Card, you must report this to Individual Health Department immediately so that a duplicate Health Card can be issued after due verification.

18) What is a Network Hospital?
Network Hospitals have been selected by our team of doctors after due evaluation of the available services, staff and faculty doctors at these hospitals. Company has a credit arrangement with all its Network Hospitals.

 

19) Whom do I contact if I have a problem with a Network Hospital?
In case you have a problem with any of the Network hospitals, please do not hesitate to immediately contact our 24hours Medical Hotline which is managed by our staff doctors for your assistance.

19) Can I obtain treatment from a Non-Network Hospital?
Yes! But in case the treatment is obtained at a Non-Network Hospital, the treatment expenses reimbursed subject to the reasonable & customary charges that would have incurred at a comparable Network Hospital for similar treatment. For this reason and also because Network Hospitals are generally better than the Non-Network Hospitals in terms of quality of care, we strongly recommend to use a Network Hospital.

20) What is Credit Facility / Pre-authorization?
Credit Facility means that when you go to a Network Hospital for a covered in-patient treatment you are not required to pay to the hospital. You can receive the covered Medical Treatment on credit at a Network Hospital and Allianz EFU will directly settle the bill to the Network Hospital on your behalf.

In order to avail the credit facility, you need to get a Pre-authorization from Allianz EFU so that it can arrange the credit facility after evaluating your case in line with the terms of the policy. The process is as follows:

When seeking Inpatient Treatment, a Day Care procedure or any of the three specialized investigations (MRI, CT Scan, and Thallium Scan) you should fill in the Pre-Authorization Form available at the admission office of all Network Hospitals and send it to us three days in advance of the Treatment. The form should also be signed by your Treating Physician. We will evaluate your form in light of your policy’s terms of coverage and confirm approval of the credit facility through phone/fax/email/letter. We will also inform the Network Hospital about the credit facility. On the day of admission you can simply go to the Network Hospital, show your Health Card at the admission office and obtain the necessary medical Treatment without having to pay out of pocket. You may however, be asked to pay for your personal convenience items like phone calls, attendant’s meal, tissue paper etc. Some Hospitals might also ask you to make a small initial deposit which will be refundable at the time of discharge after deducting your personal convenience items (phone calls, attendant’s meal, tissue paper box etc.)

Please see the Pre-Authorization/Credit Facility workflow at the end of this booklet for better understanding

21) If the Credit Facility is denied by Allianz EFU, does this mean my claim is not payable?
Not necessarily! Sometimes, there may be an ambiguity in the patient’s history and it may not be feasible to readily confirm the coverage of Treatment under the policy. In this case, the patient will be informed to make the payment to the Network Hospital and claim reimbursement later on. Please obtain all receipts, reports, attending physician’s statement and discharge note from the Hospital and submit to us along with our Claim Form for evaluation. In case it is found that the Treatment falls with in the policy, the claim will be processed within fifteen (15) days.

22) Am I covered for my health expenses incurred outside Pakistan?
Yes! Provided the following conditions are met:

  • the Insured Member did not travel for the sole purpose of getting this treatment
  • the expenses are incurred on ‘emergency’ and ‘medically necessary’ treatment
  • the insured member did travel for the purpose of getting a medical treatment but only because such treatment was not available within Pakistan at any network or non-network hospital
  • the Treatment is otherwise covered under the policy and does not fall in any of the exclusions
  • the Insured Member has cleared the bills of the hospital abroad and then applied to Allianz EFU for reimbursement

In all cases, the claim will be reimbursed subject to availability of Annual Limit of the Insured Member and not more than what such Treatment would have cost in Pakistan at a Network Hospital that the Insured Member was otherwise entitled for.

23) Can I ask for change in my benefit plan during the policy period?
You can not request for change in your benefit plan during the policy period. However, the same can be requested at the time of renewal of the policy. The Company reserves the right to deny such request or to accept them subject to some special conditions.

24) Briefly explain the benefits that are covered under my Policy?

The Policy provides coverage for Treatment/Surgeries and services which are medically necessary. Some of the benefits that the product offers include:

In-patient hospitalization expense

1)Room & Board Charges
2)ICU/CCU Charges
3)Hospital Nursing Fee
4)Physician & Specialist Fee
5)Operation Theatre Charges
6)Oxygen & Blood Supplies
7)Lab Tests (Blood, Ultrasound, X-rays etc)

Day Care Procedures (Dialysis, Chemotherapy, Endoscopies, Angiographies etc)
Specialized Investigations (MRI, CT Scan and Thallium Scan)
Out-patient Expense due to Accidental Emergency (within 48 hours)
Pre Hospitalization Medicines, Investigations & Consultation
Post Hospitalization Medicines, Investigations & Consultation
Emergency International Cover
Emergency Evacuations Cover
Local Road Ambulance
Credit Facility

 

We are just a call away 021  111  HELP  00