Health Insurance Policy

Objective:
To communicate Telenor Pakistan’s Health Insurance policy and procedure.

Philosophy:
Telenor Pakistan aims to provide practical health benefits to its employees to provide support during
times of sickness for them and their families with maximum ease and convenience.

Eligibility:
All full time/Permanent employees are covered along with his/ her spouse, children and dependent
parents/ legal guardians living in Pakistan.

Entitlement:
Limits against each category are as below:

Entitlement Details Amount PKR

Out Patient (OPD) Limit (per family / year) 140,000
OPD Sub-Limit – Optical (per person / year) 10,000
OPD Sub Limit – Dental (per family / year) 40,000
OPD Sub-Limit – Vaccination (per family / year) 40,000
OPD Sub-Limit – Over the Counter (per family per month) 3,000
Hospitalization (IPD) Limit (per person / ailment per year) 250,000
Maternity Limit – Covered under IPD (per person per year) 250,000
Daily Room Limit 14,000
Major Medical Care (MMC) Limit (per slot) 300,000

All limits of OPD / IPD are Pro Rated. Your health insurance coverage starts from 1st January OR from
your joining date (whichever is latest) and expires on 31st December OR till your last working day
(whichever is earlier).

Enrolment Procedure:
You are required to send your dependents information to your regional health insurance representative
through Telenor Toolkit as per following:

• CNIC number & scanned copies of all dependents are required.

• For addition of spouse attested scanned copy of marriage certificate is required.
• For addition of child attested scanned copy of birth certificate is required.
• No supporting document is required for deletion of dependents.
• 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 years (i.e. the guardianship role was assumed before
the employee reached the legal age of 18 years).

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• In case of siblings/spouse/parents working at Telenor Pakistan, dependents should be added &

consequently covered with one employee only. Coverage of the same dependent with multiple
employees is a violation of the policy & liable to disciplinary action.
• Dependents can only be enrolled once under the policy if two immediate family members are
employed with Telenor. If you and your spouse are both employed by TP, then the same
expense can only be claimed once.

Dependent addition/deletion details are to be shared by the employee within 10 working days with the
Regional Health team. If the information is shared within this timeline, then the dependent enrollment
date would be the effective date otherwise the enrollment date would be the date on which complete
details are shared by the employee.

Your health insurance card/letter will be issued to you within 10 working days starting from the date the
self & dependent details are shared by you with the health insurance representative. You will be
emailed for card collection by the respective health insurance representative once the card is received.

Overseas Treatment:
• 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).
• Emergency / Accidental medical treatment (OPD/IPD) is covered within assigned limits in all
cases.
• Maternity related expenses are not covered (unless it is an employee herself & the expense was
medically mandated (medical need) and occurred during an official business trip).

A. OPD

OPD Inclusion / Exclusion

OPD covers medical expenses including consultancies, registrations, investigations, checkups, therapies
(osteopathy, chiropody, accupunture, hajama), vaccinations, physiotherapy, treatments
(allopathic/homeopathic/herbal), OTC, medical items/accessories/equipment/devices, nutritional
supplements (malnourishment /maternity / chronic illness) and prescribed medicines for existing and
pre-existing medical conditions (if any).

1. Medical Equipment & Aids:

• Selected 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 are covered.
• Clinical details, current prescription and advice for the subject medical equipment by the
treating specialist are required for these claims. Also, prior approval from the health team is
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mandatory before purchase of any medical aid/equipment. Insurance Company has the right to
decline reimbursement if prior approval was not taken by the employee.
• Baby milk formulas are not covered under the policy.

2. Dermatology
Dermatology covers any prescribed treatment medically required including acne treatment
/Eczema /Dermatitis /Autoimmune skin diseases etc. Sun blocks are covered only in cases of
photosensitivity/SLE.
Cosmetic Treatment including whitening cream and medication, hair fall treatment, face washes
moisturizers, soaps, laser treatment etc are not covered.

3. Dental
Dental covers treatment of teeth/gum (only if medically required) including root canal,
crowning, bridging, capping, filling, dentures, braces, scaling/polishing and X-rays. Dental
implants are not covered. Original dental x-ray (where applicable) is mandatory for claiming
dental expenses.
Dental implants, toothpaste, tooth brushes, mouthwash are not covered.

4. Optical
Optical covers checkups, tests, and devices like powered contact lenses, powered glasses,
frames and powered lens solutions. Updated eyesight test card from ophthalmologist is
mandatory for claiming spectacles or contact lenses.
Colored lenses are not covered.

5. Medicines
• It covers Over the Counter Medicines (OTC) which are standard medicines or medical related
items including syrups, pain killers, antihistamines, ORS, antacids, first aid items, lozenges, etc.
• Prescriptions will be required for antibiotics / multivitamins.
• Recurring medicines covers prescribed medicines or medical related items used 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 6 months from date of
issuance for reoccurring medicines, after six months new prescription will be required.

OPD Claim procedure

• 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.
o Fill in all the details of OPD (via Telenor Toolkit)/IPD/MMC claim form. Attach all
required documents.

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o For OPD scanned copies/images of original payment i.e. receipts, bills, memo
(mentioning amount) with prescription and supporting document is required to be
submitted through Telenor Toolkit. Patient’s name should be mentioned clearly in
doctor’s prescription. Clear scanned images of all the lab investigations (i.e.
laboratory/diagnostic services tests/reports) claimed is required. Scanned images of
vaccination card is required for claiming child vaccination expenses. Updated eyesight
test card from ophthalmologist (for claiming spectacles or contact lenses) is required.
Original dental x-ray (where available, for claiming dental expenses) is required.
o Employees should also maintain original copies of digitally submitted medical claims
because these can be required by insurance company in case of spot check, audits and
general verification.
o For IPD/hospitalization, original payment/bill receipts with itemized details, original
discharge slip/certificate/summary and medicines cash memo (if any) is required.
Photocopy of all claimed reports to be attached.

• In cases of non-computer generated/manual invoice or receipt, the stamp of the

hospital/pharmacy is a mandatory requirement. On manual invoice/receipts there should be no
over writing / cutting. The date of the manual receipts should match with the prescription date.
• Drop IPD/MMC claims in health insurance claim box or submit/handover it to your regional
health insurance representative.
• Please keep hard/soft record of your claim documents before dispatching them to health
insurance representative. Record keeping of all documents pertaining to the claim is employee
responsibility.
• You can claim your expenses within 3 months from the date they are incurred. Claims submitted
after this time period will not be reimbursed i.e. claims older than 90 days will not be
processed/paid.
• Your claim will be reimbursed within 12–15 working days starting from the time the claim is
received by the Insurance Company. You will be informed about the online reimbursement via
e-mail.
• The insurance company reserves the right to refer any or all bills for further verification
submitted by you for reimbursement.
• Any additional utilization over and above OPD entitlements is will be deducted from employee
salary.
• Any forged billing in this regard will be considered gross misconduct and will therefore, invoke
disciplinary action accordingly, leading to possible dismissal.

OPD Credit Facility:

OPD credit facility is available at selected Panel hospital in every region and can be availed up to 70% of
the total limit. Original health card & patients CNIC copy is mandatory for any expense on health card.
For patient under 18 years of age, copy of bay form is mandatory.

It is employee’s responsibility to keep receipts/ record of medical expenses done on credit facility.

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B. IPD
IPD covers;
• Hospitalization (more than 24 hours) with coverage of pre & post expenses for 30 days: This
includes admissions, consultations, registrations, examinations, treatments, therapies,
procedures, surgeries, prescribed medicines, multivitamins, nutrition (enteral/parenteral) and
first aid items. Pre/post expenses are only claimable and include consultations, medicines, tests,
therapies but exclude medical devices.
• Hospitalization (less than 24 hours) without coverage of pre and post expenses: This includes
day care procedures like cataract surgery/ angiography/ laser keratotomy/ circumcision etc.
• Emergency visits include management of severe life threating conditions only.
Consultations/treatments/tests during emergency visit without any acute threat to life will be
catered under OPD.
• Discharge certificate is mandatory for catering expenses under IPD.

Emergency treatments in hospital would be covered from OPD or IPD limit (depending on the nature of
the treatment)

Maternity Cover
• It 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).
• 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.
• Pre and Post maternity expenses are only applicable to the mother.
• If the child’s enrollment intimation is not shared with the Regional Health Team by employee
within 10 working days of child’s birth, then medical expense coverage effective date for the
child would be the date on which the addition information was shared.

Treatments / Therapies/ Diagnostic Tests for IPD

• It covers anesthesia (epidural/spinal/inhalational), organ transplant, laser, optical, dental, facio-
maxillary, dermatology, physiotherapy, rehabilitation therapy, acupuncture, osteopathy,
chiropody and podiatry.
• 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.
• 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. 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 proceeding
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• Common OPD/ Pediatric dental procedures Opted under G/A are not covered in IPD.
• In case of Organ Transplant, policy covers all medical/surgical expenses for employee and donor.
Charges for donor will only be covered for immediate family members (blood relations). In case
the organ is purchased then donor charges will only be covered after complete legal
documentation and court orders in accordance to the Pakistani Law pertaining to organ
purchase are secured by the employee.

IPD Claim Procedure

• 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/she can submit the claim manually to the regional health insurance team with the original
payment/bill receipts with itemized details, original discharge slip/certificate/summary and
medicines cash memo (if any). Photocopy of all claimed reports to be attached.
• 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.
• Original health card & patients CNIC copy is mandatory for hospital/clinic admission. For patient
under 18 years of age, copy of bay form is mandatory. This documentation is also a mandatory
requirement while using health card for OPD treatment.
• 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 at-least 24 hour prior approval is required by the health insurance
team. Therefore, employees are required to share information beforehand for smooth
processing of the matter.
• In case of non-panel hospitals; employees 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.

Major Medical Care (MMC):

This is 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 are not available by default. These are assigned after detailed technical review &
approvals from TP management & insurance company.
• MMC slots won’t be assigned for cases where hospitalization costs exceed due to extra room
charges, ancillary expenses etc. These slots are only meant to cover core medical expenses.
• MMC slots are not given for instrument purchase.
• MMC slot in case of IPD, requires IPD Limit to be exhausted first for that ailment/treatment.

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• It is Telenor Pakistan management discretion whether MMC related OPD treatment is paid from
OPD or MMC coverage

Exclusions of the Policy

The following treatments are not covered in the policy:

Cosmetic / aesthetic treatment, skin laser treatment , contraception , fertility treatments , shampoo,
sun-blocks , 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, courier charges, oils etc.

Contact information:
You can contact your regional health insurance representative by sending your query to following email
address:
Region Contact
North health.insurance-n@telenor.com.pk
Central health.insurance-c@telenor.com.pk
South health.insurance-s@telenor.com.pk

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Document Change History

Date Version Essential Changes Editor Approval

Control
January 1, 05 1.0 1. New Policy Faisal Amin Tore Johnsen
January 1, 06 2.0 1. Same limits for all JG with regards to OPD Faisal Amin Tore Johnsen
and IPD
2. Same maternity limits for all JG
3. Increase in maternity limits for both
Normal and Caesarean cases
January 1, 08 3.0 1. Increase in room rent rate with regards to Sobia Haroon Jon Eddy
IPD Abdullah
2. OPD annual limit divided per insured
family member
3. Maternity limits included in IPD
April 1, 09 3.1 1. Overall OPD limit of Rs.100,000 for Sobia Haroon Jon Eddy
employee and family Abdullah
2. Dental limit of Rs.25,000 per employee
family
April 1, 10 3.2 1. Overall OPD limit of Rs. 80,000 for Tariq Mustafa Jon Eddy
employee and family (9 months) Abdullah
2. IPD limit revised to Rs. 500,000 per
insured member per ailment (which was
changed in later years)
3. One health insurance company
nationwide (Allianz EFU)
April 1, 11 3.3 1. Renamed the policy as Health Insurance Tariq Mustafa Christian
Policy Albech
2. Policy ownership changed to
to Total Reward & Policy
3. Details are in the guidelines/FAQs instead
of policy
January 1st, 2020 4.1 OPD entitlements increased from PKR 120K Samia Javed Irfan Wahab
to PKR 140K per employee per year. Khan

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