Health Insurance
Life’s twists and turns can be unpredictable, but with TPL Health Insurance, you don’t face them alone as your well-being matters the most to us, we’re not just about policies; we’re your reliable partner, providing confidence and support as your life unfolds. Because when life changes, your insurance should change with you. Discover the assurance that comes from a company that cares – discover TPL Health Insurance.
Key Features
Women Shield
Protecting women 18-55 with coverage for 8 distinct health issues. Prioritizing women’s wellness.
Group Health Insurance
TPLI offers exclusive health coverage, lightening employee medical insurance load with unique health packages.
Micro Health Insurance
TPL Insurance, Telenor Micro Finance Bank unite for ‘Telenor Sehat o Sakun’ micro health coverage.
| Coverage | Health Insurance |
|---|---|
| Daily Room & Board | |
| Enhancement of H&R Limit in case of accident injuries | |
| Emergency Treatment Due to Accidental Injuries Per Incident | |
| Day Care Surgeries: Cataract (foldable lens), Dialysis, Treatment of Fractures & Lacerated wound. | |
| Specialized scans: MRI, CT Scan, Endoscopy, Angiography, Thallium Scan. | |
| Local road ambulance for emergencies only | |
| Emergency dental treatment due to accidental injuries (within 48 hours for pain relief only) | |
| Pre & Post Hospitalization: Diagnostic Test, Consultation Charges & Prescribed Medicines within 30 days prior to or after Hospitalization. |
|
| Coverage for Non Accidental Emergencies |
| Coverage | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Sports Activities | War (Active participation) | ||||||||||
| Self-inflicted injuries | Terrorism (Active participation) | ||||||||||
| Vaccinations | Daycare treatment and procedures | ||||||||||
| AIDS | Congenital Birth Diseases | ||||||||||
| Infertility treatment | Elective Cosmetic Treatment | ||||||||||
| Dental Treatment | Abuse of Alcohol and Drugs | ||||||||||
| Chronic Renal Dialysis | Prescribed Medical Aids | ||||||||||
| Pat Scan | Optical and/or vision care | ||||||||||
| Cosmetic Treatment | Dietary supplements and vitamins | ||||||||||
| Anti-Retro Viral Drugs | Hormone Replacement Therapy | ||||||||||
| Period of Insurance | One year from the date of enrollment | ||||||||||
| Geographical Limit | Pakistan | ||||||||||
| Mode of Payment | Advance Yearly | ||||||||||
| Waiting period | 30 days waiting period will be applicable for hospitalization due to natural illness/sickness from date of enrollment | ||||||||||
| Pre-existing conditions | Not Covered | ||||||||||
| Co-Payment | |||||||||||
| 100% | Prescribed Medical Aids | ||||||||||
| Non-Panel Hospital | 60%-40% | ||||||||||
Frequently Asked Questions
Yes. You will need insurance. Even if you’re young, healthy and haven’t had to see a doctor in years, you will need coverage against unexpected events like accidents or an emergency.
Health insurance policies are issued for a period of 1 year only. At the end of expiry date of your insurance policy, you must renew your policy to continue the health insurance coverage without any interruption.
Yes, you can buy more than one Health Insurance policy. In case of a claim, claimant will avail the best coverage option or can use additional coverage for first coverage is fully used.
For example, Customer was billed Rs 400,000 from insurer A his coverage was Rs. 100,000 and then the second policy( Insurer B) can help him out to cover the excess amount for paying the billed amount up to Insurer B coverage amount.
For example, Customer was billed Rs 400,000 from insurer A his coverage was Rs. 100,000 and then the second policy( Insurer B) can help him out to cover the excess amount for paying the billed amount up to Insurer B coverage amount.
Every health insurance policy has a set of exclusions, which can vary plan to plan. However, there are some standard exclusion which remain same in all health insurance plans/options
While filling up the proposal form for insurance you need to provide details of the illnesses you have suffered during your lifetime. At the time of insurance, you should be aware whether you have any disease and whether you are undergoing any treatment. The insurers refer such health issues to their medical panel to differentiate between pre-existing and newly contracted illnesses.
Note: It is important to disclose any disease you might be suffering with before buying the health insurance policy. Insurance is a contract based on good faith and any willful non-disclosure of facts might lead to problems in future.
Note: It is important to disclose any disease you might be suffering with before buying the health insurance policy. Insurance is a contract based on good faith and any willful non-disclosure of facts might lead to problems in future.
No. Life Insurance protects your family (or dependents) from financial loss that may arise in the event of your untimely death and/or permanent disability. The payout is made only post the death of the person insured or at the maturity of the policy. Health Insurance protects you against illness/diseases by covering the expenses you might incur (for treatment, diagnosis etc.) in case you are affected by disease or injury.
In the event of hospitalization, the patient or their family will have a bill to pay the hospital. Under Cashless Hospitalization the patient does not settle the hospitalization expenses at the time of discharge from hospital. The settlement is done directly by the health insurer. This is for your convenience. However, prior approval is required before the patient is admitted into the hospital. In case of emergency hospitalization, approval can be obtained post-admission.
All we need to process your application is a copy of your CNIC, no documents are required for purchasing health insurance.
In health insurance, the age, insurance coverage and annual benefit amount of cover are the factors that decide the premium. Usually, younger people are considered healthier and thus pay lower annual premium. Older, people pay a higher health insurance premium as their risk of health problems or illness is higher.
If you cancel the policy, your cover will cease to exist from the date of cancellation of policy. Additionally, your premium should be refunded to you on short period cancellation rates, as per the terms and conditions of the policy and you will find these terms and conditions in the policy document. However, no refund will be applicable if you have any claim availed during the covered period of the cancelled health insurance policy.
It is strongly advised to have health insurance on your own as well because of reasons of continuity. Firstly, if you change your job, you might not necessarily get health insurance from your new employer.
In any case you will be exposed to health costs in the transition period between jobs. Secondly; the track record that you have built in health insurance at your old employer will not transfer to the new company policy.
It will also help in case your limit has exhausted in first policy, you need to pay from your own pocket. In this case, you can use your second policy to pay your remaining medical bills.
Therefore to avoid the above problems, it is advisable to take a private policy in addition to your company provided group health insurance policy.
In any case you will be exposed to health costs in the transition period between jobs. Secondly; the track record that you have built in health insurance at your old employer will not transfer to the new company policy.
It will also help in case your limit has exhausted in first policy, you need to pay from your own pocket. In this case, you can use your second policy to pay your remaining medical bills.
Therefore to avoid the above problems, it is advisable to take a private policy in addition to your company provided group health insurance policy.
No, we do not require policyholder to undertake medical checkups.
Yes, you can cover your entire family under one policy in case all of you live in Pakistan. Your health insurance policy is in force across Pakistan. Our policy does not cover coverage outside Pakistan.
Coverage amount is the extent to which the insurance company will make payment for the medical expenses incurred by you.
No. Maternity/ pregnancy related complications and procedures are not covered under health insurance plans.
Coverage amount is the maximum amount payable in the event of a claim. It is also known as “Annual Limit”. The premium of the policy is dependent on the age, insurance coverage and annual limit.
Health Insurance covers all diagnostic test like X- ray, MRI, blood tests etc. as long they are associated with the patients during stay in the hospital for at least one night. Any diagnostic tests which have been prescribed in the OPD are generally not covered. However, in case of above test done within 30 days before and after hospitalization, the expenses incurred will be paid to you.
After a claim is filed and settled, the policy coverage is reduced by the amount that has been paid out on settlement.
For Example: In January you start a policy with coverage of Rs. 500,000 for the year. In April, you make a claim of Rs 200,000. The coverage available to you from May to December will be the balance of Rs. 300,000.
For Example: In January you start a policy with coverage of Rs. 500,000 for the year. In April, you make a claim of Rs 200,000. The coverage available to you from May to December will be the balance of Rs. 300,000.
No, our health insurance policy is only allowed to avail treatment in the hospitals. We have a network of Panel Hospitals across the country where our insured can avail cashless medical treatment.
In case of treatment availed in non-panel hospital (not at home), insurance company will reimburse the claim amount as per policy terms and condition.
In case of treatment availed in non-panel hospital (not at home), insurance company will reimburse the claim amount as per policy terms and condition.
Any number of claims is allowed during the policy period. However the sum insured is the maximum limit under the policy.
