1) I am account holder of ABC bank, how can I apply for health insurance policy with EFU Life via bank?
If you are an account holder of any of our partner banks, then you can apply for health insurance / takaful
policy of EFU Life. For this, you need to contact your concerned bank branch and they will inform you
about the process in detail and will require you to fulfill some mandatory documents for applying of
health insurance policy.
2)When will I get my policy/insurance contract documents after applying for insurance?
If there are no requirements in your case then policy will be issued and welcome pack including policy/insurance
contract documents will be dispatched to you at correspondence address provided by you in the application
form within 7 working days.
However, if there are any non-medical or medical requirements in your case then EFU Life Coordinators or
Bank personnel will help you in completing those requirements. On receiving all pending requirements, policy
will be issued and welcome pack including policy documents will be dispatched to you at correspondence address
mentioned in the application form within 7 working days.
3) What do my welcome pack includes?
Your welcome pack includes:
- Welcome Letter – which includes brief introduction about your policy.
- Certificate of Insurance / Policy Schedules - which mentions all the details about your policy such
as your Policy Number, Name and Date of Birth of yourself and your dependents (if enrolled), CNIC Number,
Effective and Expiry Date of the Policy, Beneficiary, Benefit Plan, Benefit Structure of the Policy,
Premium Details and other Special Conditions in the policy.
- Policy Document - This describes policy provisions & conditions, definitions and all the legal aspects of insurance contract in detail.
- Network Hospital List –identifies the network hospitals on the panel of EFU Life. This list is updated on regular basis and is also available on our website https://www.efulife.com/health/
- Health Card – it identifies you as an insured member of EFU Life at our panel hospitals.
- Membership Guide Book – it describes the benefits and other procedures like pre-authorization obtaining procedure, claim filing procedure and some Frequently Asked Questions (FAQs).
- Pre-authorization Form – is the Company’s standard form required to obtain Credit Facility at Network Hospital in case of hospitalization.
- Claim Form – is the Company’s standard form required for filing a Claim for reimbursement when the treatment is obtained without the credit facility and you have settled the hospital bill out of pocket.
Pre-authorization and Claim Forms can also be downloaded from our website https://www.efulife.com/health/ or can be obtained from our Individual Health Department. Photocopies of these forms are also acceptable.
We would request you to go through all the documents in detail so that you have a clear understanding of all aspects of your policy. These documents are of high importance and should be kept in a safe place.
4) What is the term of insurance contract?
The policy will be issued for a term of one year and can be renewed each year subject to the terms and conditions of the policy.
5) How can I pay for the renewal of my policy?
You will be sent a renewal letter, which includes the premium for the next policy year, thirty (30) days before expiry of the current policy year. You may pay directly to us through cheque, pay order, credit card etc. or may contact your Bank to deduct renewal premium from your account.
6) Can I request for change in my benefit plan during the policy period?
You can not request for change in your benefit plan during the policy period. However, the same can be requested at the time of renewal of the policy. The Company reserves the right to deny such request or to accept them subject to some special conditions.
7) I am already covered under my Company’s group health policy. Can I still buy Individual Health Policy through Bank?
Yes, you can still buy Individual Health Policy to augment the group health coverage. Your Company’s group health policy limits may not be enough to cover your medical expenses. In case a claim is not payable under your group contract due to a lower limit, you can apply for its reimbursement under the individual policy. Moreover, your company may not be covering your dependants. You can also buy health policy for them so that your whole family can enjoy peace of mind.
8) What is the purpose of Health Card?
Your Health Card contains the basic information about your coverage. You will need to show your Health Card each time you seek Treatment at a Network Hospital. It identifies you to the Network Hospitals and supplies them with key information about your Coverage. While making telephone enquiries with us we will also ask for the information on Health Card to identify you.
9) What is a Network Hospital?
EFU Life has developed close business relationships with a network of medical service providers. Today, the company enjoys strong professional association with a network of over 170 carefully selected hospitals spread throughout the country. 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 for covered treatment, we reimburse hospitals directly.
- No claims form and no waiting time for reimbursement cheques.
- Less administrative work.
10) How to avail Credit Facility at the Network Hospital?
Credit Facility means that when you go to a Network Hospital for a covered treatment you are not required to pay for the treatment (up to available limit) to the hospital and EFU Life will directly settle the bill to the Network Hospital on your behalf.
The credit facility can be availed through a simple procedure of Pre-authorization. However, in case of a life-threatening Medical Emergency, Pre-authorization is not required.
In case you need to be hospitalized for a planned treatment or surgery you should fill in the Pre-Authorization Form and send it to us three working days in advance of the Treatment. The pre-authorization form will be sent to you with the welcome package, at the time of the policy issuance. In addition, these forms are also available at the admission offices of all network hospitals. The form should also be signed by your Treating Physician. We will evaluate your form in light of your policy’s terms of coverage and confirm approval of the credit facility through phone/fax/email/letter. We will also inform the Network Hospital about the credit facility. On the day of admission you can simply go to the Network Hospital, show your Health Card at the admission office and obtain the necessary medical Treatment without having to pay out of pocket. You may however, be asked to pay for your personal convenience items like phone calls, attendant’s meal, tissue paper etc. Some Hospitals might also ask you to make a small initial deposit which will be refundable at the time of discharge after deducting your personal convenience items.
11) Whom do I contact if I have a problem with a Network Hospital?
In case you have a problem with any of the Network hospitals, please do not hesitate to immediately contact our 24hours Medical Hotline which is managed by our staff doctors for your assistance.
12) Can I obtain treatment from a Non-Network Hospital?
We have carefully selected our network hospitals to ensure geographical dispersion and we strongly recommend our insured members to visit the nearest network hospital. Still if you are unable to find a network hospital you can visit a non network hospital in case of emergency but you will have to settle the entire bill yourself, complete all claims procedure and documents and wait to receive reimbursement cheque. EFU Life reserves the right to evaluate these claims for coverage and reimburse the claim up to reasonable & customary charges that would have incurred at a comparable Network Hospital for similar treatment.
13) I have a query. How do I contact EFU Life?
We love to hear from our valued customers! We consider your feedback crucial in our continuous effort to improve our services.
Please feel free to contact us at any time for your queries, complaints, suggestions, or general feedback. You could write to us at our Head Office on:
Bancassurance Operations Department
In addition, a Call Centre has also been designated especially for you. The number is 111-HELP-00 (111-4357-00). You could call us during office hours for all sorts of queries, feedback, information etc. Our efficient and friendly Call Centre Officer will be glad to respond to your queries.
Below are some important 24 Hours Hotline Numbers:
In case of a medical emergency, our team of doctors is accessible 24 hours a day through our below Medical Emergency Hotlines. These doctors will guide and help you in seeking treatment and admission if needed in a network facility.
Karachi: 0300-8207000, Lahore: 0300-8483818, Islamabad: 0300-8508550.
For any other query, help or understanding, you may contact our Customer Services Hotline, available after office hours: Karachi: 0300-8208555.