Allianz EFU Health Insurance Corporate Finance Assignment

Submitted To Submitted By ID#3373

Mr. Kashif Yaqoob Asma TauqirS.R. Khawar- ID#3456

5 billion. Assets Under Management in excess of US$1 trillion. Before amalgamation in the joint venture. 250 million with majority share holding of Allianz AG. Active presence in more than 70 countries. Allianz Group is one of the largest composite insurers in the world. EFU General's annual revenues over R. Active presence in this region for almost 70 years. . The company has a paid up capital of Rs.Allianz EFU Health Insurance Allianz EFU Health Insurance Limited is the first specialized health insurer in Pakistan.2. As a result of this joint venture.000 insured lives. EFU Group is one of the largest insurers in Pakistan covering both life and non-life risks.s. the entire health insurance portfolio of EFU General has been taken over and managed by Allianz EFU Health. Annual Premium Income exceeding US$65 billion. It is a joint venture between Allianz AG of Germany and EFU General of Pakistan. EFU General managed a health insurance portfolio of over 90 companies and 25. "AA" claims paying rating from Standard & Poors.

1. Networks role is to localize organization manage of the patient. Click here to check out the TQM PROCESS The following chart gives the medical and premium benefits of the Family Plan: Description of Benefits Plans Premier Deluxe Standard Basic Overall Maximum Limit Per Annum Per Insured Room Rent Limit Hospitalization Benefits ICU charges (15 days per annum) Pre & Post Hospitalization OP Treatment Day Care Surgeries.050 Covered Actual Covered Covered Not Covered Covered Covered Covered Not Covered Rs.000 Rs. 3. Dialysis & Cancer Treatment MRI.A QUALITY COST MEDICAL ADVISORY COMPLETE EFFICIENT PANEL HEALTHCARE SYSTEM Integrated Health Care HEALTHCARE is a Total Quality Our Medical Advisory The Allianz EFU Health Management (TQM) Hospital network form Panel comprises Insurance team has process in which both the basis of the eminent physicians and been specifically set up insurers and providers integrated healthcare surgeons.900 Covered Actual Covered Covered Covered Covered Covered Covered Covered Rs.000 Rs. complete healthcare specified standards of Click here to for a list of programme for all your quality to customers. 500.650 Covered Actual Covered Covered Covered Covered Covered Covered Covered Rs. CT Scan & Endoscopy in Outpatient (With prior approval) Fractures and Lacerated Wounds Emergency Local Road Ambulance Emergency Dental (Accident only) Treatment for pain relief only Rs.000 Rs. 250. 1. 100. employees. our panel. 150.000 Rs. 500 Covered Actual Covered Covered Not Covered Covered Covered Covered Not Covered Emergency Evacuation Policy Limitations And Exclusions . members are required International Best and administer a to provide care of Practice Guidelines. Their key to help your focus on only the needs system.

Treatment of infertility and obesity. Outpatient treatment and all those treatments that could otherwise be taken from outpatient. and all dependent unmarried children upto 25 years of age can be covered under the scheme. Charges in connection with congenital birth defects.Allianz EFU Health plans do not cover expenses arising out of: Pregnancy. Lahore and Islamabad/Rawalpindi you can apply for the insurance cover. Frequently Asked Questions (FAQ's) Q. Charges for immunizations or general health tests or examinations that are not due to or part of the treatment of any injury or illness.3) Do I need pre-authorization for inpatient services? How do I obtain it? If you would like us to pay directly to the Network Hospital and not get yourself involved in the claims reimbursement procedure. childbirth and related costs. They will guide you in obtaining the pre-authorization. civil unrest. etc. However. Medical expenses arising due to war. then the following procedure will apply: .1) Who can apply? If you are over 21 years of age and below 57 years and resident of Karachi. Glucometers. you will not be required to pay to the network hospital. Q. if you prefer to go directly to our network panel hospital.2) Can I cover my family members? Yes! Your spouse. To schedule hospital admissions. Q. you should contact our medical department at least three days in advance from the hospitalization date. unless specifically accepted in writing by Allianz EFU. Charges for food supplements and medical appliances such as Nebulizers. Treatment in connection with pre-existing health conditions is not covered. The Medical Hotline Number is mentioned on your health card. invasion.4) How do I make an inpatient claim? When will I receive the claim reimbursement? If you have taken pre-authorization from Allianz EFU. Q. you need to have preauthorization.

If you would like an updated listing of our network hospitals one can be provided to you. Shalamar. b) You will obtain Receipts of all payments. Q. Medicare.7) Which are some of your Network Hospitals? Many of the country's best known hospitals are on our network. please keep in mind that if we need any additional information or there are any discrepancies in your claim papers. will that family member be covered? Existing diseases. injuries and chronic illnesses such as diabetes.8) Can I go to a hospital that is not on your network? You can only go to a non-network hospital in case of medical emergencies. invasion. etc. Q. will not be covered. you get the following benefits: No cash payment required. arthritis. c) Send all these documents to Allianz EFU as soon as possible together with the filled claim form. These hospitals are accredited based upon the credentialing of their physicians/surgeons and favorable assessment of their facilities. In addition to better quality care. Dr. Q. outpatient treatment. fax or e-mail. Shifa International. including (but not limited to) Aga Khan.a) All medical bills will be paid by you to the concerned Network hospital. Ziauddin. Karachi Adventist. claims reimbursement may get delayed. We reimburse hospitals directly. Your claim will be reimbursement according to the rates of our network hospital of the same standard. medical checkup and medical appliances. Shaukat Khanum. illnesses. you need to inform us within 24 hours of all such hospitalizations through phone. congenital birth defects. Ittefaq. Liaquat National. Q. located in the same city. You should expect to receive the reimbursement within 4 weeks from the date of the receipt of your complete claim papers in our office. However. pre-existing illnesses. . civil unrest. discharge summary card & reports of all investigations. However. No claims forms and no waiting time for reimbursement cheque. war. Network Hospitals Allianz EFU has developed a network of hospitals that meet a stringent quality criterion.6) What are some of the expenses which are not covered? Expenses arising from or related to pregnancy and childbirth.5) If I or any of my family member is suffering from any disease/illness. infertility and cosmetic treatment. for the same treatment. Fatima Memorial. We reserve the right of not paying the claim directly or indirectly related to any pre-existing illness/injury.

Less administrative work HealthPlus Features: Comprehensive Coverage: HealthPlus offers Hospitalization and Outpatient coverage to you and your family. '24-hour' Help Line: You have round-the-clock access to friendly and qualified doctors for help during medical emergencies. waiting period not more than 30 minutes at outpatient clinic. separate help/information desk at LNH and last but not the least friendly and courteous attitude of the LNH staff so that you have maximum peace of mind! The following chart guides you to the medical and Benefits and premium cost: Description of Benefits IN-PATIENT & DAY CARE BENEFITS Plans Diamond Gold Silver Bronze . Preferred Treatment: Allianz EFU and Liaquat National Hospital (LNH) will take care of you like a family member and that's why we have made special arrangements for you. surgeries as well as accidental injuries is covered. For example 'facility of advance appointments' for outpatient consultations. HealthPlus also pays for Outpatient expenses such as consultations. lab test and medicines to provide you maximum 'peace of mind'. It's your passport to the best possible medical care. Hospitalization treatment due to illnesses. Health Card: Your assurance of fast and easy access to medical treatment at LNH. 'get well' cards for hospitalized patients.

4. Treatment for Fractures & Lacerated Wounds 9. 75.Overall Maximum Inpatient Limit Per Annum Per Person 1. Illnesses & Surgeries 2. 3. 125. HealthPlus is designed to cover treatment for acute illness or injury. 6. we have to make certain limitations and exclusions. Day Care Surgeries.000 20% 06 Covered Covered Covered Rs.000 Covered Executive Actual Covered Covered Private A/C Actual Covered Not Covered Covered Covered Covered Covered Covered Actual Covered Not Covered Covered Covered Covered Covered Covered Actual Covered Not Covered Covered Covered Covered Covered Private Non A/C Semi-Private 5. 350. Hospitalization for Pregnancy and Childbirth (10 months waiting period. 20. 100% increase in case of Rs. MRI. Dialysis & Cancer Treatment Covered 7. Hospitalization Benefits Due to Accidents. ICU Charges (15 days per annum) 4. Dental treatment except if necessitated due to accident and for pain relief only. Charges for food supplements. 200. Pre-and Post-Hospitalization OP Benefits Rs. .000 Rs.000 caesarean section) 6. there are some exclusion to scheme such as: Pregnancy. Treatment of allergies or obesity.000 20% 05 Covered Covered Not Covered Rs.000 Rs. 10. Hospital Room Entitlement 3. childbirth and related costs (unless covered under specific plan). CT Scan & Endoscopy in Outpatient (With Covered prior approval) 8. Therefore.000 Rs.000 20% 08 Covered Covered Covered Rs.000 20% 04 Covered Covered Not Covered HealthPlus Limitations And Exclusions : In order to keep the cost of your cover as low as possible. Charges for immunizations or general health tests or examinations that are not due to or part of the treatment of any injury or illness. Emergency Local Road Ambulance 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.

Pre-existing conditions are not covered. illnesses or injuries for which an insured receives treatment. Benefit Description Executive Deluxe Standard Value Basic Hospital Care Overall Maximum Annual Limit Per Person Daily Room & Board Sub-Limit Intensive Care Surgical Fees Anaesthetist's Fee 100.700 50. Medical expenses arising due to war.000 75. We offer you choice and flexibility to choose amongst the following five different plans.000 500 . We also exclude ' pre-existing' conditions which are diseases. etc.000 1.000 700 25. With Allianz EFU taking care of their health. where your staff and their dependent family members will receive the most appropriate treatment. Charges in connection with congenital birth defects. Any other treatment in connection with pre-existing conditions is not covered. invasion. at any time prior to applying for the policy. civil unrest. We cover healthcare through our network of hospitals. you can enjoy extra peace of mind. Charges incurred by the insured as an organ donor. incurs an expense or receives a diagnosis from a physician (even if no treatment is provided).000 4.Charges for medical appliances such as Nebulizers. all at the same time! Allianz EFU takes pride in offering high quality insurance plans for your staff. Glucometers.100 35. unless specifically accepted in writing by Allianz EFU Benefits At A Glance Comprehensive Care. Outpatient treatment which are not covered by the policy. And we even have the systems in place to make the process simple and transparent. Convenience.000 1. Choice. Any increase in expenses incurred for treatment on account of the insured member being admitted to a more expensive room than allowed by his daily room and board sub-limit. except for outpatient consultation visit charges.

000 15.000 300. X-Rays and examinations ECG's.000 750 500 350 250 100 100 100 100 100 800 100 700 100 500 100 350 100 350 100 25.000 10.000 15.000 9.Operating Theatre Charges Prescribed Medicines Used During Hospital Stay Blood and Oxygen Supplies Ventilators and Allied Services Kidney Dialysis & Cancer Treatment Daycare Surgeries Diagnostic Investigations MRI.000 30.000 15. ECGs.000 175.000 45. EEG's and other diagnostic tests Hospital Emergency Room treatment Co-payment (per visit) Over-the-counter medicines (per annum per insured) 1.000 20.000 6. CT Scan EEGs. Endoscopy and Angioplasty Organ Transplant In-Hospital Consultation Fractures and Lacerated Wounds Local Ambulance Pre-Hospitalization Diagnostic Tests Post-Hospitalization Follow-up Consultation OPTIONAL BENEFITS Major Medical Care Enhances the annual limit of Hospital Care for each insured Additional Annual Limit Per Insured Maternity Care Normal Delivery Caesarean Section (50% extra fee) Outpatient Care Overall Annual Maximum Limit Per Insured Family Physician's consultatoin charges Co-payment (per visit) Specialist's consultation charges Maximum fee per consultation Co-payment (per visit) Prescribed medicines and drugs Laboratory tests. ETT's.000 At Actuals 50 30.000 At Actuals 50 7.500 At Actuals 50 5.000 200.000 22.000 250.000 150.500 10.000 At Actuals At Actuals 50 50 .