Allianz EFU Health Insurance Corporate Finance Assignment

Submitted To Submitted By ID#3373

Mr. Kashif Yaqoob Asma TauqirS.R. Khawar- ID#3456

Allianz EFU Health Insurance

Allianz EFU Health Insurance Limited is the first specialized health insurer in Pakistan. It is a joint venture between Allianz AG of Germany and EFU General of Pakistan. The company has a paid up capital of Rs. 250 million with majority share holding of Allianz AG. As a result of this joint venture, the entire health insurance portfolio of EFU General has been taken over and managed by Allianz EFU Health. Before amalgamation in the joint venture, EFU General managed a health insurance portfolio of over 90 companies and 25,000 insured lives.

Allianz Group is one of the largest composite insurers in the world. "AA" claims paying rating from Standard & Poors. Annual Premium Income exceeding US$65 billion. Assets Under Management in excess of US$1 trillion. Active presence in more than 70 countries.

EFU Group is one of the largest insurers in Pakistan covering both life and non-life risks. EFU General's annual revenues over R.s.2.5 billion. Active presence in this region for almost 70 years.

QUALITY COST MEDICAL ADVISORY COMPLETE EFFICIENT PANEL HEALTHCARE SYSTEM Integrated Health Care HEALTHCARE is a Total Quality Our Medical Advisory The Allianz EFU Health Management (TQM) Hospital network form Panel comprises Insurance team has process in which both the basis of the eminent physicians and been specifically set up insurers and providers integrated healthcare surgeons. Their key to help your focus on only the needs system. Networks role is to localize organization manage of the patient. members are required International Best and administer a to provide care of Practice Guidelines. complete healthcare specified standards of Click here to for a list of programme for all your quality to customers. our panel. employees. Click here to check out the

TQM

PROCESS

The following chart gives the medical and premium benefits of the Family Plan:
Description of Benefits Plans Premier Deluxe Standard Basic

Overall Maximum Limit Per Annum Per Insured Room Rent Limit Hospitalization Benefits ICU charges (15 days per annum) Pre & Post Hospitalization OP Treatment Day Care Surgeries, Dialysis & Cancer Treatment MRI, CT Scan & Endoscopy in Outpatient (With prior approval) Fractures and Lacerated Wounds Emergency Local Road Ambulance Emergency Dental (Accident only) Treatment for pain relief only

Rs. 500,000 Rs. 3,900 Covered Actual Covered Covered Covered Covered Covered Covered Covered

Rs. 250,000 Rs. 1,650 Covered Actual Covered Covered Covered Covered Covered Covered Covered

Rs. 150,000 Rs. 1,050 Covered Actual Covered Covered Not Covered Covered Covered Covered Not Covered

Rs. 100,000 Rs. 500 Covered Actual Covered Covered Not Covered Covered Covered Covered Not Covered

Emergency Evacuation

Policy Limitations And Exclusions

Allianz EFU Health plans do not cover expenses arising out of: Pregnancy, childbirth and related costs. Charges for immunizations or general health tests or examinations that are not due to or part of the treatment of any injury or illness. Charges for food supplements and medical appliances such as Nebulizers, Glucometers, etc. Charges in connection with congenital birth defects. Medical expenses arising due to war, invasion, civil unrest. Outpatient treatment and all those treatments that could otherwise be taken from outpatient. Treatment of infertility and obesity. Treatment in connection with pre-existing health conditions is not covered, unless specifically accepted in writing by Allianz EFU.

Frequently Asked Questions (FAQ's)

Q.1) Who can apply? If you are over 21 years of age and below 57 years and resident of Karachi, Lahore and Islamabad/Rawalpindi you can apply for the insurance cover. Q.2) Can I cover my family members? Yes! Your spouse, and all dependent unmarried children upto 25 years of age can be covered under the scheme. Q.3) Do I need pre-authorization for inpatient services? How do I obtain it? If you would like us to pay directly to the Network Hospital and not get yourself involved in the claims reimbursement procedure, you need to have preauthorization. To schedule hospital admissions, you should contact our medical department at least three days in advance from the hospitalization date. They will guide you in obtaining the pre-authorization. The Medical Hotline Number is mentioned on your health card. Q.4) How do I make an inpatient claim? When will I receive the claim reimbursement? If you have taken pre-authorization from Allianz EFU, you will not be required to pay to the network hospital. However, if you prefer to go directly to our network panel hospital, then the following procedure will apply:

a) All medical bills will be paid by you to the concerned Network hospital. b) You will obtain Receipts of all payments, discharge summary card & reports of all investigations. c) Send all these documents to Allianz EFU as soon as possible together with the filled claim form. You should expect to receive the reimbursement within 4 weeks from the date of the receipt of your complete claim papers in our office. However, please keep in mind that if we need any additional information or there are any discrepancies in your claim papers, claims reimbursement may get delayed. Q.5) If I or any of my family member is suffering from any disease/illness, will that family member be covered? Existing diseases, illnesses, injuries and chronic illnesses such as diabetes, arthritis, will not be covered. We reserve the right of not paying the claim directly or indirectly related to any pre-existing illness/injury. Q.6) What are some of the expenses which are not covered? Expenses arising from or related to pregnancy and childbirth, congenital birth defects, war, invasion, civil unrest, pre-existing illnesses, outpatient treatment, infertility and cosmetic treatment, medical checkup and medical appliances. Q.7) Which are some of your Network Hospitals? Many of the country's best known hospitals are on our network, including (but not limited to) Aga Khan, Liaquat National, Dr. Ziauddin, Karachi Adventist, Medicare, Ittefaq, Fatima Memorial, Shaukat Khanum, Shalamar, Shifa International, etc. If you would like an updated listing of our network hospitals one can be provided to you. Q.8) Can I go to a hospital that is not on your network? You can only go to a non-network hospital in case of medical emergencies. However, you need to inform us within 24 hours of all such hospitalizations through phone, fax or e-mail. Your claim will be reimbursement according to the rates of our network hospital of the same standard, located in the same city, for the same treatment.

Network Hospitals
Allianz EFU has developed a network of hospitals that meet a stringent quality criterion. These hospitals are accredited based upon the credentialing of their physicians/surgeons and favorable assessment of their facilities. In addition to better quality care, you get the following benefits: No cash payment required. We reimburse hospitals directly.

No claims forms and no waiting time for reimbursement cheque.

Less administrative work

HealthPlus Features:
Comprehensive Coverage: HealthPlus offers Hospitalization and Outpatient coverage to you and your family. Hospitalization treatment due to illnesses, surgeries as well as accidental injuries is covered. HealthPlus also pays for Outpatient expenses such as consultations, lab test and medicines to provide you maximum 'peace of mind'. '24-hour' Help Line: You have round-the-clock access to friendly and qualified doctors for help during medical emergencies. Health Card: Your assurance of fast and easy access to medical treatment at LNH. It's your passport to the best possible medical care. Preferred Treatment: Allianz EFU and Liaquat National Hospital (LNH) will take care of you like a family member and that's why we have made special arrangements for you. For example 'facility of advance appointments' for outpatient consultations, waiting period not more than 30 minutes at outpatient clinic, 'get well' cards for hospitalized patients, separate help/information desk at LNH and last but not the least friendly and courteous attitude of the LNH staff so that you have maximum peace of mind!

The following chart guides you to the medical and Benefits and premium cost:

Description of Benefits IN-PATIENT & DAY CARE BENEFITS

Plans

Diamond

Gold

Silver

Bronze

Overall Maximum Inpatient Limit Per Annum Per Person 1. Hospitalization Benefits Due to Accidents, Illnesses & Surgeries 2. Hospital Room Entitlement 3. ICU Charges (15 days per annum) 4. Pre-and Post-Hospitalization OP Benefits

Rs. 350,000

Rs. 200,000

Rs. 125,000

Rs. 75,000

Covered Executive Actual Covered

Covered Private A/C Actual Covered Not Covered Covered Covered Covered Covered

Covered Actual Covered Not Covered Covered Covered Covered Covered

Covered Actual Covered Not Covered Covered Covered Covered Covered

Private Non A/C Semi-Private

5. Hospitalization for Pregnancy and Childbirth (10 months waiting period; 100% increase in case of Rs. 20,000 caesarean section) 6. Day Care Surgeries, Dialysis & Cancer Treatment Covered 7. MRI, CT Scan & Endoscopy in Outpatient (With Covered prior approval) 8. Treatment for Fractures & Lacerated Wounds 9. Emergency Local Road Ambulance Covered Covered

OUT-PATIENT BENEFITS

Overall Maximum Outpatient Limit Per Annum Per Person Co-Insurance Rate (per claim) Number of Consultation Visits (per person per year) Doctor's Consultation Prescribed Investigations and Tabs Prescribed Medicines

Rs. 10,000 20% 08 Covered Covered Covered

Rs. 6,000 20% 06 Covered Covered Covered

Rs. 4,000 20% 05 Covered Covered Not Covered

Rs. 3,000 20% 04 Covered Covered Not Covered

HealthPlus

Limitations And Exclusions : In order to keep the cost of your cover as low as possible, we have to make certain limitations and exclusions.
HealthPlus is designed to cover treatment for acute illness or injury. Therefore, there are some exclusion to scheme such as: Pregnancy, childbirth and related costs (unless covered under specific plan). Dental treatment except if necessitated due to accident and for pain relief only. Treatment of allergies or obesity. Charges for immunizations or general health tests or examinations that are not due to or part of the treatment of any injury or illness. Charges for food supplements.

Charges for medical appliances such as Nebulizers, Glucometers, etc. Charges in connection with congenital birth defects. Charges incurred by the insured as an organ donor. Medical expenses arising due to war, invasion, civil unrest. Outpatient treatment which are not covered by the policy. Any increase in expenses incurred for treatment on account of the insured member being admitted to a more expensive room than allowed by his daily room and board sub-limit. We also exclude ' pre-existing' conditions which are diseases, illnesses or injuries for which an insured receives treatment, incurs an expense or receives a diagnosis from a physician (even if no treatment is provided), at any time prior to applying for the policy. Pre-existing conditions are not covered, except for outpatient consultation visit charges. Any other treatment in connection with pre-existing conditions is not covered, unless specifically accepted in writing by Allianz EFU

Benefits At A Glance
Comprehensive Care, Convenience, Choice, all at the same time! Allianz EFU takes pride in offering high quality insurance plans for your staff. With Allianz EFU taking care of their health; you can enjoy extra peace of mind. We cover healthcare through our network of hospitals, where your staff and their dependent family members will receive the most appropriate treatment. And we even have the systems in place to make the process simple and transparent. We offer you choice and flexibility to choose amongst the following five different plans.
Benefit Description Executive Deluxe Standard Value Basic

Hospital Care Overall Maximum Annual Limit Per Person Daily Room & Board Sub-Limit Intensive Care Surgical Fees Anaesthetist's Fee 100,000 4,000 75,000 1,700 50,000 1,100 35,000 700 25,000 500

Operating Theatre Charges Prescribed Medicines Used During Hospital Stay Blood and Oxygen Supplies Ventilators and Allied Services Kidney Dialysis & Cancer Treatment Daycare Surgeries Diagnostic Investigations MRI, CT Scan EEGs, ECGs, Endoscopy and Angioplasty Organ Transplant In-Hospital Consultation Fractures and Lacerated Wounds Local Ambulance Pre-Hospitalization Diagnostic Tests Post-Hospitalization Follow-up Consultation

OPTIONAL BENEFITS Major Medical Care Enhances the annual limit of Hospital Care for each insured Additional Annual Limit Per Insured Maternity Care Normal Delivery Caesarean Section (50% extra fee) Outpatient Care Overall Annual Maximum Limit Per Insured Family Physician's consultatoin charges Co-payment (per visit) Specialist's consultation charges Maximum fee per consultation Co-payment (per visit) Prescribed medicines and drugs Laboratory tests, X-Rays and examinations ECG's, ETT's, EEG's and other diagnostic tests Hospital Emergency Room treatment Co-payment (per visit) Over-the-counter medicines (per annum per insured) 1,000 750 500 350 250 100 100 100 100 100 800 100 700 100 500 100 350 100 350 100 25,000 15,000 10,000 At Actuals 50 7,500 At Actuals 50 5,000 At Actuals 50 30,000 45,000 20,000 30,000 15,000 22,500 10,000 15,000 6,000 9,000 300,000 250,000 200,000 175,000 150,000

At Actuals At Actuals 50 50