ADAMJEE INSURANCE COMPANY LIMITED

“Build a Healthy Network in your company and beyond”

HEALTH INSURANCE DEPARTMENT

3rd Floor, Tanveer Building, 27-C III, MM Alam Road, Gulberg III, Lahore- 54000, Pakistan
TELEPHONE +92 423 5772960-79, FACSIMILE (042) 35772878, Email:health@adamjeeinsurance.com
Why damjee Health Insurance?

Our financial strength, backed by a customer-centric approach, has helped us

in
achieving our basic objective of fulfilling our customers’ needs effectively and
efficiently. The primary feature of Adamjee Health Insurance is the increasing
customer base within esteemed organizations that includes prominent
organizations and multinational enterprises. Backed by extensive experience of
customizing health insurance products to cater to all size groups, Adamjee Health
Insurance has the expertise to provide premium quality services across the
nation.
We have some of the most renowned names within the healthcare field who
work
closely with hospitals to guarantee that suitable treatment is made available to
our
clients. In addition to this, our Information Technology systems have assisted us in
providing MIS reporting which is a must-have for organizations to keep abreast of
their utilization and trend in an appropriate fashion.

HEALTH INSURANCE DEPARTMENT

3rd Floor, Tanveer Building, 27-C III, MM Alam Road, Gulberg III, Lahore- 54000, Pakistan
TELEPHONE +92 423 5772960-79, FACSIMILE (042) 35772878, Email:health@adamjeeinsurance.com
Hospitalization Benefits & Premiums
Benefit Limits

Description of Benefits Silver Gold Platinum

Room Entitlement General Ward Semi-Private Room Private Room
Hospitalization Limits: Including Hospital /
Surgical & Miscellaneous expenses. Some of the
covered expenses are: In-Hospital Consultation,
Intensive Care Charges, Surgical Fees,
naesthitist’s Fee, Operation Theater Charges, Rs. 225,000 Rs. 350,000 Rs. 500,000
Prescribed Medicines, Diagnostic Investigations,
Blood & Oxygen Supplies, Ventilator & Allied
Services, Day Care Procedures including Kidney
Dialysis/ Chemotherapy & Radiotherapy for
Cancer
Intensive Care Unit Actual Actual Actual
Pre/Post Hospitalization Investigations 30 Days 30 Days 30 Days
Pre/Post Hospitalization Consultations 30 Days 30 Days 30 Days
Pre/Post Hospitalization Medicines 30 Days 30 Days 30 Days

* Above mentioned financial limits are Annual Family Limits for members enrolled under the policy.

Premium Rates.
Silver Plan
Age (Next Birthday) Self + Self + Spouse + Self + Spouse + Self + Spouse + 3
of Eldest Member Self Spouse 1 Child 2 Children Children
18 to 29 years 3,942 6,449 8,228 9,918 11,284
30 to 34 years 4,153 7,207 8,709 10,375 11,667
35 to 39 years 5,420 8,867 10,541 12,327 13,544
40 to 44 years 6,907 11,179 12,777 14,347 15,570
45 to 49 years 9,273 14,497 16,239 17,988 19,287

50 to 54 years 11,360 17,560 19,324 21,111 22,432

13,551 20,069 21,832 23,919 25,353

55 to 59 years

HEALTH INSURANCE DEPARTMENT

3rd Floor, Tanveer Building, 27-C III, MM Alam Road, Gulberg III, Lahore- 54000, Pakistan
TELEPHONE +92 423 5772960-79, FACSIMILE (042) 35772878, Email:health@adamjeeinsurance.com
 Gold Plan
Age (Next Birthday) Self + Self + Spouse + Self + Spouse + Self + Spouse + 3
of Eldest Member Self Spouse 1 Child 2 Children Children

18 to 29 years 5,286 8,101 10,886 13,117 15,420

30 to 34 years 5,534 9,063 11,675 13,979 15,909

35 to 39 years 7,238 12,312 15,075 17,921 19,369

40 to 44 years 9,363 15,608 18,101 20,729 22,387

45 to 49 years 11,922 18,687 21,344 23,979 25,661

50 to 54 years 14,729 22,591 25,339 27,958 29,505

55 to 59 years 16,239 24,415 27,132 29,693 31,322

Platinum Plan
Age (Next Birthday) Self + Self + Spouse + Self + Spouse + Self + Spouse + 3
of Eldest Member Self Spouse 1 Child 2 Children Children

18 to 29 years 9,506 16,228 20,351 24,902 27,570

30 to 34 years 10,949 19,081 23,458 27,385 30,815

35 to 39 years 13,710 22,603 27,004 31,162 35,020

40 to 44 years 18,087 28,760 32,975 37,156 39,686

45 to 49 years 22,650 35,308 40,125 44,444 45,900

50 to 54 years 25,318 40,079 44,941 49,203 50,693

55 to 59 years 32,132 47,089 51,109 55,440 57,045

HEALTH INSURANCE DEPARTMENT

3rd Floor, Tanveer Building, 27-C III, MM Alam Road, Gulberg III, Lahore- 54000, Pakistan
TELEPHONE +92 423 5772960-79, FACSIMILE (042) 35772878, Email:health@adamjeeinsurance.com
Terms and Conditions

o Hospitalization expenses(other than pregnancy) due to sickness or accident will be covered.

o Insurance Coverage will be effective for a period of one (1) year from the date the participant
opts for Insurance Coverage.
o In the first policy year, the coverage would be effective after thirty (30) days once the policy
has been issued, except for Accidental Emergencies which will be covered which shall
commence when premium is deducted from customer account.
o Premium shall be paid in advance.
o Maximum age for coverage is 60 years. No requirement of health declaration or medical
examination.
o Specialized Investigations are not covered.

MAIN EXCLUSIONS:
This insurance policy does not cover claims arising directly or indirectly from or consequent upon
the following:
o Pre-existing Conditions are not covered under the policy.
o ny treatment received in “Non pproved Hospital”
o Birth / congenital defects or illness of any nature whatsoever.
o Costs resulting from self-inflicted injury, attempted suicide, abuse of alcohol or drug
addiction.
o Treatment or investigation of fertility, infertility, sterilization or contraception and any
complication relating thereto or hormone treatment and investigations.
o Injuries as a result of an illegal act other than a minor misdemeanour or minor delinquency
by the insured person.
o Injury or treatment resulting from war, riots, invasion, act of foreign enemies, hostilities or
warlike operations (whether war be declared or not), civil war, mutiny, civil commotion
assuming the proportions of or amounting to a popular uprising, military uprising,
insurrection, rebellion, military or usurped power or any act of any person acting on or on
behalf of or in connection with any organization actively directed towards the overthrow or
to the influencing of any government or ruling body by force, terrorism or violence.
o Services or Treatment in any spa, hydro clinic, sanatorium, nursing home or long term-care
facility that is not a Hospital.

HEALTH INSURANCE DEPARTMENT

3rd Floor, Tanveer Building, 27-C III, MM Alam Road, Gulberg III, Lahore- 54000, Pakistan
TELEPHONE +92 423 5772960-79, FACSIMILE (042) 35772878, Email:health@adamjeeinsurance.com
o Acquired immune deficiency syndrome (AIDS), AIDS related complex syndrome (ARCS) and
all diseases caused by and or related to HIV virus or any other sexually transmitted disease.
o Experimental or unproven treatment.
o All dental Treatments or oral surgery apart from Emergency Accidental Dental Treatment
o Cost of correction of refractive errors of the eye and procedures such as Radial Keratotomy
and Excimer Laser.
o Routine medical examinations or check-ups including charges arising out of any hospital
confinement or admission primarily for diagnostic purposes, unless specifically authorized
by the Company, routine eye or ear examinations, vaccinations, medical certificates,
examination for employment or travel, spectacles, contact lenses, hearing aids and any
treatment that is not considered medically necessary.
o Cosmetic or plastic surgery, unless it is re-constructive surgery necessitated by an Injury that
occurred during the period whilst the insured person was covered under this policy and
subject to the limits and sub-limits stated in the structure of benefits.
o Any increase in the expenses incurred for treatment on account of the insured person being
admitted to a more expensive room than allowed by his daily room and board limit.
o Pregnancy and complications thereof, childbirth (including surgical delivery), miscarriage,
abortion and/or any related prenatal or postnatal care.
o Any Out-patient Treatment, except that arising out of an Accident.
o Any charges in respect of the donor for organ transplant claims.
o Prostheses, corrective devices and medical appliances.
o Aviation other than as a fare-paying passenger of a recognized airline or charter service.
o Personal comfort items such as, charges for telephone, meals for other than the patient or
other items not medically necessary.
o Natural catastrophes including, but not limited to, flood, earthquake, avalanche and cyclone.
o Hospitalization for pain management only without any surgical or disease modifying
treatment given for the underlying medical condition
o Specialized Investigations are not covered.

HEALTH INSURANCE DEPARTMENT

3rd Floor, Tanveer Building, 27-C III, MM Alam Road, Gulberg III, Lahore- 54000, Pakistan
TELEPHONE +92 423 5772960-79, FACSIMILE (042) 35772878, Email:health@adamjeeinsurance.com