Expected Health Insurance Coverage & Tentative Premium Plan

Following Expected Group Health Insurance coverage for employees and immediate dependents
(as per definition of Family) will be available on deduction of part of medical allowance (which
will be fixed at the stage of bidding and remaining part of medical allowance will be paid to
employee):

Minimum Requirement Criteria

 Largest Panel Hospital Network in Pakistan (350 + Hospitals)
 24/7 dedicated helpline for assistance and support
 IBTF Facility (Inter Bank Transfer Facility) for Reimbursements Claim
 Web Portal Facility (Online Review of Health Policy)
 Health Application- (Hospital Locator – Insured Person- Complaint- Claim Status- Inpatient- Out Patient))
 Online Credit Letter Facility (Intimated HR on time on employee(s) Hospitalization)
 Claim Reimbursements 12 Working Days
 Claim receiving confirmation to HR through designated email
 Largest Discount Centers in Pakistan (On Health Card in different Hospital/Labs on OPD)
 52 Specialized Investigation Test /Day Care covered under Hospital Benefit

Required Coverage Detail

 Every Individual must be assigned with independent limit i.e per person/year.
 Pre-existing conditions coverage 100% of available hospitalization & Related benefit Limit
 Congenital Condition covered 100 % of available hospitalization & Related benefit Limit
 Interferon therapy coverage up to 100% of available hospitalization & Related benefit Limit
 Day Care Procedure are also cover under H&R Limit
 Circumcision is covered under H&R Limit
 Pre & Post covered up to 30 Days
 D&C covered from complicated delivery limit
 No waiting period in Maternity (Covered from day one)
 Accidental Emergencies covered of the H&R limit

Health Insurance Covers

 Hospitalization (In-patient)
 Pre-Hospitalization
 Post Hospitalization
 Accidental Emergencies
 Specialized Investigation Tests
 Day Care Surgeries
 Maternity and Its Related Expense
 Pre and Post Natal Expenses

Hospitalization and Related Services (H&R) Must Cover

 All in hospital accommodation, treatment & Services
 Doctors’ Visits
 Inpatient treatment/drugs expenses
 ICU charges
 Surgical Expenses
 Hospital Day Care Surgery
 Diagnostic Tests
 Local Ambulance Services for Emergency cases
 Casualty Ward Accident & Emergency Services.
Maternity Benefits
 Maternity Benefit covers the following expenses of up to the sub-limit for Normal Delivery:
 Pre-natal treatment
 Child birth
 Post-natal treatment
 Complicated delivery; wherein the maternity sub-limits are increased from the amount of normal.

Day Care Procedures & Specialized Investigation Test

Policy Must cover day care & specialized investigations test form employee hospitalization limit, brief summary
of covered tests is as under:

 Endoscopy,
 MRI
 Colonoscopy,
 Echo.
 ETT
 CT Scan
 Mammography
 Barium Meal
 Barium Enema etc
 Angiography
 EMG
 Gastroscopy
 Thallium Scan
 EEG etc…………………
 Annex-E
Annex E

JUBILEE HEALTH INSURANCE

GROUP HEALTHCARE INSURANCE PROPOSAL FOR
BENAZIR INCOME SUPPORT PROGRAMME ( OPTION-I)
Hospitalization & Related Benefits
Plan A Plan B Plan C Plan D
H&R Limits (Per Person / Per Year) Rs.400,000 Rs.300,000 Rs.250,000 Rs.200,000
Enhancement in H&R limits in case of accidental injuries 50% 50% 50% 50%
Room & Board (per day) Rs.12,000 Rs.8,000 Rs.5,000 Rs.3,000
Per Hospitalization
Pre-Hospitalization Sub Limit (Diagnosis, 30 Days 30 Days 30 Days 30 Days
Consultation, & Medicines)
Post-Hospitalization Sub Limit (Follow-Ups) 30 Days 30 Days 30 Days 30 Days

Daycare Surgeries & Specialized Investigations In

Outpatient Settings Including but not limited to:

Dialysis, Cataract Surgery, MRI, CT Scan, Endoscopy, Thallium COVERED

Scan, Angiography, Treatment of Fractures, Local Road
Ambulance for Emergencies only, Emergency Dental Treatment
due to accidental injuries within 48 hours (for pain relief only).

Corporate Major Medical Limit for the Whole Group Rs.500,000

Maternity Benefits (Per Pregnancy / Per Person)

Normal Delivery Rs.120,000 Rs.60,000 Rs.50,000 Rs.40,000
Complicated Delivery Rs.180,000 Rs.125,400 Rs.115,000 Rs.85,200

Eligibility : All full time Pakistani employees, Actively at work up to 65 years of age with their dependants

Plan "A" PLAN A (SPS 20-21)

Plan "B" Plan B (SPS 17-19)
Plan "C" Paln C(SPS 11-16)
Plan "D" Plan D (SPS1-9)

All the rates are assumed on the basis of resident country as Pakistan

Plan Wise Census Information

Plan A Plan B Plan C Plan D Total
Total Number of Insured (for ages <=65) 35 1,827 2,629 3,611 8,102
Total Number of Employees 11 495 775 1,112 2,393
Total Number of Spouses 8 444 618 833 1,903
Total Number of Children 16 888 1,236 1,666 3,806

Notes:
* In case of treatment from Non-PPN facilities, reasonable and customary charges as in PPN facilities shall be paid.
* Eligibility Definition for the 4 Plans has to be provided before Policy Confirmation.
* Pre-existing Conditions shall be covered for up to 100% of the respective H&R Limits.
* Interferon therapy for Hepatitis B&C Patients shall be covered for up to 100% of the respective H&R Limits,
* Congenital conditions shall be covered for up to 100% of available H&R Limits
* Rates are tentative and can be changed on receipt of actual data
* Room Limits opted shall also apply to Hospitalization in Maternity Cases.
* Maternity and its related benefits are not covered under H&R benefit.
* For detailed Exclusions / Limitation, please refer to the policy document.

Total H & R Premium Rs.26,957,716

Total Maternity Premium Rs.18,925,692

Total Premium Payable Rs.45,883,408

* The annual premium is subject to change if there is any change in tax rate/tax structure by the Federal or Provincial government
affecting the taxes applicable during the currency of the policy

Validity of Proposal until: 31-03-19

Please note that the description of benefit, given in this proposal are for illustrative purpose.
The actual terms and condition are given in policy document.

Especially prepared by CSD (Technical) for Benazir Income Support Programme ( Option-I) - (GH Proposal # 19261)
 Annex F

JUBILEE HEALTH INSURANCE

GROUP HEALTHCARE INSURANCE PROPOSAL FOR
BENAZIR INCOME SUPPORT PROGRAMME ( OPTION-I)
Premium Calculation

H & R Premium Details

Plan A Plan B Plan C Plan D
AGE BAND No. Of No. Of No. Of No. Of
Rates Premium Rates Premium Rates Premium Rates Premium
Insured Insured Insured Insured
0-17 16 Rs.5,530 Rs.88,476 888 Rs.4,057 Rs.3,602,844 1236 Rs.3,427 Rs.4,235,427 1666 Rs.2,789 Rs.4,646,246
18-29 2 Rs.4,004 Rs.8,008 108 Rs.2,938 Rs.317,270 260 Rs.2,481 Rs.645,096 355 Rs.2,019 Rs.716,850
30-39 10 Rs.5,308 Rs.53,080 606 Rs.3,895 Rs.2,360,118 944 Rs.3,289 Rs.3,105,126 1115 Rs.2,677 Rs.2,984,906
40-49 6 Rs.7,330 Rs.43,977 198 Rs.5,378 Rs.1,064,800 171 Rs.4,542 Rs.776,686 416 Rs.3,697 Rs.1,537,769
50-59 1 Rs.12,377 Rs.12,377 26 Rs.9,081 Rs.236,106 18 Rs.7,670 Rs.138,055 58 Rs.6,242 Rs.362,039
60-64 0 Rs.18,141 Rs.0 1 Rs.13,310 Rs.13,310 0 Rs.11,242 Rs.0 1 Rs.9,149 Rs.9,149
65 0 Rs.21,030 Rs.0 0 Rs.15,430 Rs.0 0 Rs.13,032 Rs.0 0 Rs.10,606 Rs.0
Total 35 Rs.205,918 1827 Rs.7,594,448 2629 Rs.8,900,390 3611 Rs.10,256,959

Total H & R Premium Rs.26,957,716

Maternity Premium Details

No. Of No. Of No. Of No. Of
AGE BAND Rates Premium Rates Premium Rates Premium Rates Premium
Insured Insured Insured Insured
upto 25 0 Rs.38,207 Rs.0 0 Rs.24,119 Rs.0 0 Rs.21,586 Rs.0 0 Rs.16,306 Rs.0
26-30 3 Rs.29,037 Rs.87,112 147 Rs.18,330 Rs.2,694,540 308 Rs.16,406 Rs.5,052,964 313 Rs.12,392 Rs.3,878,824
31-35 1 Rs.17,762 Rs.17,762 176 Rs.11,212 Rs.1,973,384 208 Rs.10,035 Rs.2,087,327 255 Rs.7,580 Rs.1,932,982
36-40 1 Rs.7,761 Rs.7,761 71 Rs.4,900 Rs.347,868 66 Rs.4,385 Rs.289,420 142 Rs.3,312 Rs.470,363
41-45 3 Rs.1,093 Rs.3,279 36 Rs.690 Rs.24,842 27 Rs.618 Rs.16,675 87 Rs.467 Rs.40,588
Total 8 Rs.115,914 430 Rs.5,040,634 609 Rs.7,446,386 797 Rs.6,322,757
All Female Spouses & Married Female Employees are covered for Maternity Benefit up to age 45 Years.

Total Maternity Premium Rs.18,925,692

Total Premium Payable1

Rs.45,883,408
1 (Includes premium for Basic Hospitalization Benefit+Corporate Major Medical Benefit)

Please note that the description of benefit, given in this proposal are for illustrative purpose.
The actual terms and condition are given in policy document.

Especially prepared by CSD (Technical) for Benazir Income Support Programme ( Option-I) - (GH Proposal # 19261)
 Annex-F
Annex E

JUBILEE HEALTH INSURANCE

GROUP HEALTHCARE INSURANCE PROPOSAL FOR
BENAZIR INCOME SUPPORT PROGRAMME ( OPTION-I)
Hospitalization & Related Benefits
Plan A Plan B Plan C Plan D
H&R Limits (Per Person / Per Year) Rs.600,000 Rs.400,000 Rs.300,000 Rs.250,000
Enhancement in H&R limits in case of accidental injuries 50% 50% 50% 50%
Room & Board (per day) Rs.12,000 Rs.8,500 Rs.6,000 Rs.4,000
Per Hospitalization
Pre-Hospitalization Sub Limit (Diagnosis, 30 Days 30 Days 30 Days 30 Days
Consultation, & Medicines)
Post-Hospitalization Sub Limit (Follow-Ups) 30 Days 30 Days 30 Days 30 Days

Daycare Surgeries & Specialized Investigations In

Outpatient Settings Including but not limited to:

Dialysis, Cataract Surgery, MRI, CT Scan, Endoscopy, Thallium COVERED

Scan, Angiography, Treatment of Fractures, Local Road
Ambulance for Emergencies only, Emergency Dental Treatment
due to accidental injuries within 48 hours (for pain relief only).

Corporate Major Medical Limit for the Whole Group Rs.500,000

Maternity Benefits (Per Pregnancy / Per Person)

Normal Delivery Rs.120,000 Rs.70,000 Rs.60,000 Rs.45,000
Complicated Delivery Rs.180,000 Rs.125,300 Rs.115,200 Rs.85,050

Eligibility : All full time Pakistani employees, Actively at work up to 65 years of age with their dependants

Plan "A" PLAN A (SPS 20-21)

Plan "B" Plan B (SPS 17-19)
Plan "C" Paln C(SPS 11-16)
Plan "D" Plan D (SPS1-9)

All the rates are assumed on the basis of resident country as Pakistan

Plan Wise Census Information

Plan A Plan B Plan C Plan D Total
Total Number of Insured (for ages <=65) 35 1,827 2,629 3,611 8,102
Total Number of Employees 11 495 775 1,112 2,393
Total Number of Spouses 8 444 618 833 1,903
Total Number of Children 16 888 1,236 1,666 3,806

Notes:
* In case of treatment from Non-PPN facilities, reasonable and customary charges as in PPN facilities shall be paid.
* Eligibility Definition for the 4 Plans has to be provided before Policy Confirmation.
* Pre-existing Conditions shall be covered for up to 100% of the respective H&R Limits.
* Interferon therapy for Hepatitis B&C Patients shall be covered for up to 100% of the respective H&R Limits,
* Congenital conditions shall be covered for up to 100% of available H&R Limits
* Rates are tentative and can be changed on receipt of actual data
* Room Limits opted shall also apply to Hospitalization in Maternity Cases.
* Maternity and its related benefits are not covered under H&R benefit.
* For detailed Exclusions / Limitation, please refer to the policy document.

Total H & R Premium Rs.30,238,780

Total Maternity Premium Rs.19,716,065

Total Premium Payable Rs.49,954,845

* The annual premium is subject to change if there is any change in tax rate/tax structure by the Federal or Provincial government
affecting the taxes applicable during the currency of the policy

Validity of Proposal until: 31-03-19

Please note that the description of benefit, given in this proposal are for illustrative purpose.
The actual terms and condition are given in policy document.

Especially prepared by CSD (Technical) for Benazir Income Support Programme ( Option-I) - (GH Proposal # 19261)
 Annex F

JUBILEE HEALTH INSURANCE

GROUP HEALTHCARE INSURANCE PROPOSAL FOR
BENAZIR INCOME SUPPORT PROGRAMME ( OPTION-I)
Premium Calculation

H & R Premium Details

Plan A Plan B Plan C Plan D
AGE BAND No. Of No. Of No. Of No. Of
Rates Premium Rates Premium Rates Premium Rates Premium
Insured Insured Insured Insured
0-17 16 Rs.7,498 Rs.119,967 888 Rs.4,677 Rs.4,152,977 1236 Rs.3,639 Rs.4,497,363 1666 Rs.3,196 Rs.5,324,686
18-29 2 Rs.5,429 Rs.10,858 108 Rs.3,386 Rs.365,715 260 Rs.2,635 Rs.684,992 355 Rs.2,314 Rs.821,523
30-39 10 Rs.7,197 Rs.71,973 606 Rs.4,489 Rs.2,720,493 944 Rs.3,493 Rs.3,297,160 1115 Rs.3,068 Rs.3,420,759
40-49 6 Rs.9,938 Rs.59,630 198 Rs.6,199 Rs.1,227,389 171 Rs.4,823 Rs.824,719 416 Rs.4,236 Rs.1,762,312
50-59 1 Rs.16,782 Rs.16,782 26 Rs.10,468 Rs.272,157 18 Rs.8,144 Rs.146,593 58 Rs.7,154 Rs.414,904
60-64 0 Rs.24,598 Rs.0 1 Rs.15,343 Rs.15,343 0 Rs.11,937 Rs.0 1 Rs.10,485 Rs.10,485
65 0 Rs.28,515 Rs.0 0 Rs.17,786 Rs.0 0 Rs.13,838 Rs.0 0 Rs.12,155 Rs.0
Total 35 Rs.279,210 1827 Rs.8,754,074 2629 Rs.9,450,827 3611 Rs.11,754,669

Total H & R Premium Rs.30,238,780

Maternity Premium Details

No. Of No. Of No. Of No. Of
AGE BAND Rates Premium Rates Premium Rates Premium Rates Premium
Insured Insured Insured Insured
upto 25 0 Rs.38,207 Rs.0 0 Rs.25,163 Rs.0 0 Rs.22,674 Rs.0 0 Rs.16,814 Rs.0
26-30 3 Rs.29,037 Rs.87,112 147 Rs.19,124 Rs.2,811,246 308 Rs.17,232 Rs.5,307,440 313 Rs.12,779 Rs.3,999,703
31-35 1 Rs.17,762 Rs.17,762 176 Rs.11,698 Rs.2,058,856 208 Rs.10,541 Rs.2,192,449 255 Rs.7,817 Rs.1,993,220
36-40 1 Rs.7,761 Rs.7,761 71 Rs.5,112 Rs.362,935 66 Rs.4,606 Rs.303,996 142 Rs.3,416 Rs.485,021
41-45 3 Rs.1,093 Rs.3,279 36 Rs.720 Rs.25,918 27 Rs.649 Rs.17,515 87 Rs.481 Rs.41,852
Total 8 Rs.115,914 430 Rs.5,258,955 609 Rs.7,821,399 797 Rs.6,519,797
All Female Spouses & Married Female Employees are covered for Maternity Benefit up to age 45 Years.

Total Maternity Premium Rs.19,716,065

Total Premium Payable1

Rs.49,954,845
1 (Includes premium for Basic Hospitalization Benefit+Corporate Major Medical Benefit)

Please note that the description of benefit, given in this proposal are for illustrative purpose.
The actual terms and condition are given in policy document.

Especially prepared by CSD (Technical) for Benazir Income Support Programme ( Option-I) - (GH Proposal # 19261)