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Dost Muhafiz Women Health

Specified Healthcare & Insurance Products

WEBDOC

HEALTH + MATERNITY PLAN

 

Premium

Rs. 2,000

 
 

Tenure

Annual

 

Hospitalization – Maximum l Limit

Rs. 100,000

 

Room and board General ward

up to Rs. 5,000

 

Maternity

Rs. 30,000

 

Covid

Rs. 10,000

 

Accidental Emergencies

Rs. 120,000

 

Per month limit for Accidental emergencies

Rs. 10,000

 

Per Confinement

Up to the Limit

 

Nursing Charges

Not Covered

 

Food Charges

Not Covered

 

Co-payment (in case of Treatment at a Non-Panel Hospital

100% re-imbursement

 

Unlimited Doctors Services over the phone, Voice and Video for FAMILY

FAMILY

 
 

Ambulance Maximum

Rs. 1000

 

MRI, CT scan, Endoscopy, Angiography, Thallium Scan

Covered

 

(during hospitalization only)

 

Age Limit

18-65 years

 

Age Limit for Maternity

18-45 years

 

Pre-Existing Conditions (PEC) Except Maternity

Not Covered

 

Claim – EXCLUSIONS

Payment of claims is subject to exclusions, as outlined below. Health Insurance Cover shall not cover

  • Any preexisting conditions
  • Congenial disease is not covered
  • HIV/Aids related disease are not covered
  • Intentional and due to quarrel injuries are not covered
  • OPD of all sorts Any admission less than 24 hours and no overnight stay is considered as OPD, and day care will not be covered
  • Gyne related diseases are not covered
  • Surgical procedures e. cosmetic surgeries, joint replacement, dental procedures are not covered
  • Regular medications such as Insulin
  • Any Special Investigations which are not due to the admission or being
  • War, strikes, riots, civil commotion and any natural or manmade perils (including chemical, nuclear, biological, and radiological) that results in the declaration of a state of emergency on a local or national level

TERMS AND CONDITIONS

  • Claim will be calculated according to normal charges of the hospital around claimant’s city
  • Maximum limit of Surgeon Fee is Rs. 10,000/- in case of surgical procedures and other charges e. anesthesia, operation room charges will be calculated at standard rates
  • In case disease related to fever claimant must provide PCR/Corona report
  • Nursing charges are not payable
  • Medicines on discharges are not covered
  • Food charges are excluded
  • Working ladies and working at home ladies cannot claim for income loss compensation
  • 7 Days waiting period applied
NOTICE OF CLAIMS

The Company shall be notified of the occurrence of Insured Claim as soon as possible, but not later than 15 (Fifteen days) from the date of discharge from hospital, which it shall be treated as time barred and the Company shall not be bound to pay the Claim.

For each Claim reported, the Company shall obtain:

From the Claimant:
  1. Admission Slip of Hospital
  2. Discharge Slip of Hospital
  3. Doctor Prescription/Note for admission or Medical History
  4. Medical Reports, if any
  5. Any Bills to be
  6. CNIC Both Sides
  7. In case of income loss compensation customer must submit proof of income loss e salary slip etc.

If there is a dispute, suspected fraudulent activity on the claim or a unique situation which requires further clarification, the payment period can be extended but shall not exceed fifteen (15) working days, or as long as the dispute takes to resolve in the legal system.