Jubilee LUFE INSURANCE FAQS | GROUP HEALTH INSURANCE What is Health Insurance and why important? 1. Health Insurance Policy fulfils your medical needs. It covers all expenses related to hospitalization. It provides you financial support and peace of mind via physician's / surgeon’s examination through hospitalization expenses. 4. I prepares you for any unforeseen accidents or ailments. What are the Benefits? © Hospital & Related Services: All medically necessary trealment and services provided by or advised by « Physician to the Insured Person when ‘admitted as a registered in-patient 1o a Hospital. The cover includes the following: * Hospital accommodation (up to the cost of the Room & Board Sub-Limit stated in the Digital Card) . Nursing care, Physician / Surgeon charges: * Medicines during admission + Operating theater charges + Intensive/Cardiac care unit charges (ICU/CCU) + Oxygen/ Blood transfusion during admission + Treatment of fracture/wound + Anesthetist fees + Other diagnostic, laboratory or medically necessary facilities and services, prescribed by the treating Physician for in-Hospital use Note: All the above faciliies are available in case of hospitalization only © Pre-Hospitalization Diagnosis: This is a very unique benefit, which provides reimbursement of all expenses incurred for consultation, diagnosis ‘and/or medicines prior to hospitalization. This facility can be uiilzed up 10 30 days before admission into thi hospital but related to the treatment for which hospitalization has been recommended and subject to the ‘vailabiliy of Hospitalization & Room and Board Limi. © Post-Hospitalization Follow-up Treatment: This is another unique feature, which provides reimbursement of post-hospitalization follow up. This facility can be uilized up 0 30 days after discharge but related to the treaiment for which hospitalization has been recommended and subject fo the availability of Hospitalization & Room and Board Limit. © Day Care Surgery: Doy Care Surgery covers all medically necessary surgical procedures and rolated froatmont by order of a Physician to the Insured Person at a Hospital. Day Care Surgery - covers but excludes all non-surgical procedures and related treatment. © Specialized Investigations: The cover provided by the Hospital & Related Services Benefit extends to include Specialized Investigations provided by or on order of a Physician to the Insured Person. Specialized Investigations means all medically necessary hematological, radiological and other diagnostic investigations few examples are Endoscopy, Gasiroscopy, MRI, Angiography, Thallium Scan, Colonoscopy, Echo, ETT, CT Scan, Mammography, Barium Meal, Barium Enema, Biopsy, Carotid Doppler, EEG, EMG, HAULTER'S monitoring etc.© Dread Disease: Myocardial Infarction (Hear attack) Coronary Artery Disease Requiring Surgery Congenital Heart Disease Electrical Conduction Disorder of Heart Rheumatic Heart Disease Stroke Paralysis Cancer Brain Tumor AIDS Major Organ Transplant Knee Replacement Organ Failure (Renal Failure & Cardiac Failure) Hepaiitis-B and C Liver Cirthosis Severe Burns Meningitis Pulmonary Embolism Aortic Aneurysm Multiple Sclerosis (MS) Parkinson’s Disease Muscular Dystrophy Alzheimer’s Disease Myasthenia Gravis Syringomyelia Motor Neuron Disease Thalassemia SLE mp MDS Home Dialysis Post Organ Transplant Medications Pulmonary Fibrosis Hip Replacement Femto Phaco ICU Admissions Ventilator Support Sepsis Complications of chemotherapy Peritoneal Dialysis Pre Dialysis Treatment Congenital Heart Diseases © Ailments are covered under the policy: Angina/Cardiac Problem Road Traffic Accident Diabetes Jaundice/Hepatitis Pneumonia ‘yphoid Fever Dengue Fever Hypertension Diarrhea COPD/Asthma Malaria Kidney Stone Gall Stone Cancer Note: All the above facilities are available in case of hospitalization onlyWhat is a PPN(Panel Hospitals Network)? PPN - is a network of Panel hospitals wherein the person insured from Jubilee Life can get the medical treatment by uitlizing credit facility. Jubilee Insurance has developed a Panel Hospitals Network that includes best hospitals which provide professional service from skilled resources to support them in time of medical urgency. How to utilize the benefits? If the hospital falls under the Jubilee Network Pane! Hospital, then the insured may ulize his/her credit facility by producing Jubilee Life Digital card along with a copy of CNIC. A copy of CNIC may be retained by the Hospital. Being 4 par of the Jubilee Network Panel Hospital, the hospital expenses will be settled direally by Jubilee Life and no cash payment would be required by the insured. Some Jubilee Network Hospitals may ask you for an initial deposit before admission to pay for your personal expenses such as telephone calls, guest meals etc. that are not covered under the Insurance Plans. What is the admission process in Jubilee Network Panel Hospital? + Patient in emergency or non-emergency case may get admitted in the Jubilee Network Pane! Hospital by presenting Jubilee Life Digital card. + No cash payment would be required by the insured at Jubilee Network Panel Hospital. In case of a planned treatment from Jubilee Network Panel Hospital, the insured should inform Jubilee Life at the time of or one day prior to the admission. + Ifthe Cost of Hospitalization exceeds the entitled limits, then the insured or dependants has to bear those expenses. + Being part of the Jubilee Network Panel Hospital, the hospital expenses will be settled directly by Jubilee Life. Note: In case of any support or advise please call your regional POC on the following numbers or contact our 24 hours helpline on (021) 111 111 544, POC Details: ‘Mc. Rizwan Shaikh, 0300 8284357 Mr. Muhammad Javed 0300 4007111 What is the admission process in Non-Panel Hospital? For treatment at a non-panel hospital, you must settle the payment in cash. After discharge from the hospital, you may claim the expense however R&C charges shall be applicable. What are R&C Charges? Treatments at non-panel hospitals are reimbursed as per Reasonable & Customary (R&C) charges which means that they are benchmarked against the expense charged by the best panel hospital in a certain location. Expenses in excess of the R&C shall not be reimbursed by Jubilee Health Insurance and shall have to be borne by the employee. Whenever undertaking treatment at a non-panel hospital please ensure that you consult your on-site health insurance POC or contact us directly on our helpline to get clarity regarding R&C. charges applicable for that particular case. List of required documents to get the reimbursement of the treatment talcen from ai Non PPN jospital: + Completely filled Jubilee Health’s claim form + Original Hospital Bill with the breakup of expenses on Hospital letter head + Original/copy of Hospital Discharge summary + Summary of admission + Allthe laboratory reports related to hospitalization + Original payment bills/receipts of all the medicines with prescription + The prescription of an MBBS doctor will be acceptableJubilee ered CLAIM PROCESS Ue Coa ag rN Soc ad Deere Ue reso re Urey roa a ota a RoC oa Ua “Approach ony nearest bios Netwerk Panel Hospital wih ou Digil Cord “6 Aeproec ony nearest uses Network Panel Hospital wih ow Dig! Cord «© Identity yourslf os «Jubtee Heolh Insurance Insured indvidval. « Ldectity yours oso bles Heath Insurance Insured individual. {© Get the rootment on cred, os per policyterms & conditions 1 Get the treatment on credit, os per policy terms & concns ‘Foy only he amoun! thet exceeds he entiloment or no covered under ‘Pay only the amount thot exceeds the eniloment or not covered under Insuronce coverage if any, beloredichorge insrence coverage if ny before discharge. ‘+o owid any inconverione it i edviscbe fo ge prior approval for active neciment/procedvre Per ogo Ta ola Vm RX tooo aa exit Um "Gath wecnent of ony nore! hoagie > Sr i test of concer ce pl xe ola sles teeth vain 2 leo shinies © Jubilee Heath wll approve/disopprove case as per the policyterms ‘Poy cath fo he roam Scondiions. | Submit orignal bils/documerts wih our dim fom fr rebursorers, © Poy cosh forthe reotet. within 30 days of charge rom he hospital ‘Sit al original bie/documents wih our ci frm for reimburerent, in 30 days of dachorge om the hope «Reimbursement of claim willbe done in ine with prior opprovel ond policy toms & conditions. ‘© ‘Stiement of doim willbe done in ne wih he poi toms & condions, Yon Koyo) Dea For any query, please contact the on-site health insurance representative at your office locations or call us on our yee ea