Group Health Presentation: Trademor Marketing (PVT) Limited

Group Health Presentation
Trademor Marketing (Pvt) Limited

Flow of Presentation…
• About Us – Pak Qatar Group
• About:
• Group Health Takaful Plan
• Benefit Criteria
• How to Enroll?
• How to claim?
• Disadvantages of using Non-Panel Hospital
• Advantages of using Panel Hospital
• Panel Hospitals – Locations
About Us: Pak-Qatar Takaful Group
About Us: OUR SPONSORS
About Us: Our Credit Rating
About Us: Our Re-Takaful Arrangements
Pak Qatar Takaful Product’s
Benefits Covered…
 Hospital Care Benefit:
Covers all expenses incurred during the course of hospitalization which is in result of
sickness, accident or surgery.
 Maternity Benefit:
Covers medical expenses related to child birth, pregnancy and (Pre natal
treatments) if Limit permits after delivery.
Hospital Care Benefit:
Covers expenses incurred during hospital stay up to the “Per Annum Per Year
Limit” including the charges for :
• Room, Operation theatre and ICU

• Physician, Surgeon and Anaesthetist fee
• Diagnostic tests including MRI and CT Scan
• Medicines required during hospital stay
• Kidney Dialysis and Cancer treatment
• Organ transplant
• Endoscopy and Angioplasty
• Oxygen and blood supplies
• Day Care surgeries
• Emergency treatment
Maternity Care Benefit:
Expenses related to the 9 months pregnancy period and
child birth however it aims to settle Delivery episode
first and then pays for pre-natal expenses if benefit
amount is unutilized.
No maternity related expenses are payable from Hospital

Care
Maternity Care Benefit:
Under Normal Delivery
• Gynaecologist fees for delivery and consultation
• Labour room / operation theatre charges
• Medicines required during hospital stay
• Diagnostic tests
• Baby’s nursing care while mother is in hospital
• Pre & post natal expenses (Part of the Annual Maternity
Limit)
• Under Caesarean Delivery or Complicated Delivery
 The Limit is enhanced to agreed amount without any
additional charges.
Benefits & Limits
Hospitalization Limits Covered Upto Age 65
Category Room & Board Hospital Care Major Medical
Plan A Rs. 12,500 Rs. 500,000
Plan B Rs. 9,500 Rs. 400,000
Plan C Rs. 5,500 Rs. 300,000
Maternity Limits Covered Upto Age 45
Category Room & Board Normal Delivery Complicated / Multiple Births Delivery
Plan A Rs. 12,500 Rs. 70,000 Rs. 100,000
Plan B Rs. 9,500 Rs. 60,000 Rs. 80,000
Plan C Rs. 5,500 Rs. 50,000 Rs. 60,000

Unique Benefits
• No deductions on Non-Panel Hospitals if cost is
reasonable and customary
• Medical Emergencies are also covered (Extra
Benefit of approx. 8-10 %)
• Coverage of Accidental Emergencies even if not
Hospitalized
• Coverage of Pre-Natal and Post Natal Expenses
if Maternity Limit permits
• Coverage of Day Care Surgeries and Specialized
Investigations
• Cancer Treatment (Chemotherapy) and Kidney
Dialysis covered
Unique Benefits Cont…
• International Cover in case of Emergency
• Mobile Application for covered members
• Coverage of newly born babies from their own
limits
• Circumcision of baby boys from their own limits
How to Utilize the Health Card?
Planned & Emergency

@ Network Hospital
@ Non-Network Hospital
Procedure for Hospital Admission
Emergency case:
• Pre-Authorization is not recommended in an “Emergency Medical Condition”
• Proceed to the nearest hospital and go to the emergency ward.
• It is advisable, if possible, to visit a Network hospital as they are all located in major
localities of the city. (A hospital that is not on our Network will require Cash payment
before admitting the patient. In addition, you cannot be sure of the quality of care
available).
• Within 24 hours of hospital admission, please contact us with the following
information:
1. Company’s Name and Employee ID Number
2. Name of the treating hospital
3. The reason of admission (Diagnosis)
Procedure for Hospital Admission
Non-Emergency Case:
• Identify yourself as Pak-Qatar Covered Member to a consultant at our Panel
hospital.
• Get the pre-authorization form from your Admin/HR Department and have it
filled by the Physician/Consultant.
• Submit the Pre-Authorization form with Pak-Qatar to obtain pre-
authorization for you.
• Deposit a copy each of Health card and a Photographic identification to the
hospital at the time of admission.
• Proceed for Optimal Treatment.
Pre-Authorization Form
Disadvantages of Using a
non-Network Hospital
You have to Pay cash and then seek reimbursement
You are responsible for collecting all required documentation.
You are responsible for completing the claim form and getting it
signed by the treating physicians/surgeons.
You have to wait for10- 15 working days after submitting
complete documentation to receive the reimbursement cheque.
You cannot be sure if the Hospital is adequately equipped or that
the Doctor is qualified to perform the procedure.
You will not be sure if the treatment is covered or not.

Advantages of Using a Network
Hospital
• Credit facility. No drain on your personal cash flows
• No need to collect documents and file claims. We reimburse

network hospitals directly
• Treatment at hospitals with Good functional facilities
• Treatment by Credentialed physicians and surgeons qualified

and trained to discharge the specific treatment.
Documents Required for Claims
Reimbursement (in-Patient)
In Case Of Non-Network Hospitals:
• Duly filled Claim Form both Parts A & B (esp. Part B to be filled in by Treating
Physician and stamped by Hospital.
• Clinical Summary / Discharge Card in Original
• Itemized Hospital Bill in Original on Hospital Bill Format/Book
• All prescriptions for medicines used during hospitalisation (Copies)
• Receipts of Medicines received in Original
• Laboratory Reports (Copies) with payment receipts in Original
• All other payment receipts in Original
• Provisional Birth Certificate (issued by the Hospital) in case of child birth
(COPY)
Claim Form – Part A
Claim Form – Part B
Exclusions of IPD + MAT.
STANDARD EXCLUSIONS, MAY NOT APPLIED IF ALREADY AGREED.
• Routine Medical Examinations (OPD) not covered.

• Treatment Related to Infertility, Contraception, Sterilizations.
• Prosthesis, Corrective Devices and medical appliances which
are not surgically required.
• Treatment of Mental Illness, Psychiatric or Nervous disorders
• Self Inflicted Injuries, Suicide, Abuse of Alcohol, drug
addiction
• STD, AIDS or AIDS related conditions or diseases.
• Elective Overseas treatment
• Experimental or unproved treatment
Exclusions of IPD + MAT. Cont…
STANDARD EXCLUSIONS, MAY NOT APPLIED IF ALREADY AGREED.
• Injuries or Hospitalization due to participation in

dangerous sports like Rock Climbing, mountaineering, pot
holing, Skydiving, parachuting, parasailing, hang-gliding,
ballooning, underwater diving, racing or participation in
Professional Sports
Important Telephone Numbers
24 Hours Medical Hotline: 0301 – 8223385

0302 – 8223385
Customer Service : 111-Takaful (825238)
(During Office Hours) : (021) 34311747 - 56

Our
Panel Hospital Network
Panel Hospitals across Pakistan:
Mirpur (AJK)
Peshawar
Mardan
Islamabad
Rawalpindi
Sargodha
Abbottabad
Quetta
Lahore
Sheikupura
Sialkot
Faisalabad
Gujranwala
Karachi city Rahim Yar Khan
Hyderabad Multan
Sukkur
Your Questions . . . . . . . .
Jazaak Allah o Khairan
Thank you for your patience

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Group Health Presentation

Trademor Marketing (Pvt) Limited

• Room, Operation theatre and ICU

No maternity related expenses are payable from Hospital

Category Room & Board Hospital Care Major Medical

Plan A Rs. 12,500 Rs. 500,000

Plan B Rs. 9,500 Rs. 400,000

Plan C Rs. 5,500 Rs. 300,000

Maternity Limits Covered Upto Age 45

Plan A Rs. 12,500 Rs. 70,000 Rs. 100,000

Plan B Rs. 9,500 Rs. 60,000 Rs. 80,000

Plan C Rs. 5,500 Rs. 50,000 Rs. 60,000

Planned & Emergency

You will not be sure if the treatment is covered or not.

• No need to collect documents and file claims. We reimburse

• Treatment at hospitals with Good functional facilities

• Treatment by Credentialed physicians and surgeons qualified

• Routine Medical Examinations (OPD) not covered.

• Injuries or Hospitalization due to participation in

24 Hours Medical Hotline: 0301 – 8223385

(During Office Hours) : (021) 34311747 - 56

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