JS SehatSarmaya

JS SehatSarmaya is a comprehensive healthcare package that provides financial protection in case of an illness or accident that leads to hospitalization. The plan is underwritten by Allianz EFU, Pakistan’s first specialized health insurance company. Health-care cost is raising everyday. If you or someone in your family falls sick, it will not only lead to mental distress for the whole family but could also adversely affect your financial situation. The implications become even more severe if the illness results in prolonged hospitalization.

Scope of Cover

JS SehatSarmaya is a simple, valuable and affordable plan that provides credit based hospitalization coverage to you and your family members (including parents), up to the selected benefit limit in a network of pre-approved hospitals across the country.

Coverage of JS SehatSarmaya

JS SehatSarmaya offers coverage in case of:

  • In-patient Hospitalization
  • Day Care Treatment
  • Emergency Accidental Out-patient Treatment
  • Specialized Investigations
  • Pre-Hospitalization Benefit
  • Post-Hospitalization Benefit
  • Miscellaneous Expenses

Reasons to choose JS SehatSarmaya

  • 24 hours/52 weeks/365 days round the clock medical coverage
  • Accessible in all major hospitals across Pakistan
  • Also facilitates non-network hospitals (on re-imbursement basis)
  • Health Card that entitles you to the Credit Facility at network hospitals only
  • Excellent service when you need it the most

JS SehatSarmaya Coverage of Family Members

The customer can include children (above 90 days old), spouse (up to age 60) & parents (up to age 64) in the policy. Each family member is entitled to an independent coverage at the same benefit level as the main applicant. Once enrolled, the coverage can be continued up to the age of 65 years. This plan is issued for 1 year and can be renewed on an annual basis.

Unique Product Advantage

Condition to cover Pre-existing Medical

Pre-existing Medical Conditions mean any sickness disease or bodily injury or any symptom linked to such sickness, disease or bodily injury for which medical advice or treatment has been sought in the past. This includes such conditions which you or your dependant(s) know about even if no medical advice or treatment or diagnosis was sought or made before the effective date of this insurance.JS SehatSarmaya offers coverage for treatment related to pre-existing medical conditions after four (04) policy years. This is one of the unique advantages of this product. Pre-existing conditions, if any, must be disclosed by the insured member at the time of enrollment.

Exclusion

Expenses arising from or related to pre-existing conditions (during the first 4 years), pregnancy and childbirth, outpatient treatment, congenital Birth defects, war, invasion, civil unrest, infertility, cosmetic treatment, routine medical checkup etc. are not covered.

In-admissible Conditions

The policy is not available to people suffering from (pre-existing) Diabetes, Cancer or HIV/AIDS.

No Claim Bonus

JS SehatSarmaya offers a No Claim Bonus in case there is no claim under the Policy for two (02) consecutive Policy Years. The basic annual limit will be enhanced by 10% with effect from the following Policy Year, free of charge. The limit enhancement; however, will not apply to individuals aged 55 years and above.

Discounts on multiple enrollments

In case three or more family members are enrolled under the same policy, JS SehatSarmaya offers a 10% discount in premium for 3rd and subsequent members. The two eldest members will however, be required to pay the full premium.

Benefit Limits

The following chart gives you the Benefit Limits:

Description of Benefits Bronze Silver Gold Platinum
Room Entitlement General Semi Private Private Private
Basic Annual Limit Rs.100,000 Rs.200,000 Rs.350,000 Rs.500,000
Additional Annual Limit for Accidental Hospitalization Rs.25,000 Rs.50,000 Rs.100,000 Rs.100,000
Intensive Care Unit Actual Actual Actual Actual
Pre/ Post Hospitalization Investigations 30 days 30 days 30 days 30 days
Pre/ Post Hospitalization Consultations 30 days 30 days 30 days 30 days
Pre/ Post Hospitalization Medicines 30 days 30 days 30 days 30 days
Emergency Evacuation Sub Limit Rs. 25,000 Rs. 35,000 Rs.50,000 Rs.50,000

*The maximum Lifetime Benefit is PKR.1, 000,000 per insured member

Premium Rates (Rupees)

The Policy is available at very affordable rates. The premium depends upon age of the individuals being enrolled under the policy and the plan type selected.

The age bands and applicable premiums are given below:

Age (Next Birthday)

Bronze

Silver

Gold

Platinum

90 Days to 18 Years

3,950

6,100

8,600

10,050

19 to 29 Years

4,900

7,400

9,700

11,700

30 to 34 Years

6,250

8,850

11,350

14,200

35 to 39 Years

7,200

11,100

15,150

18,150

40 to 44 years

8,500

14,000

18,650

21,600

45 to 49 Years

9,800

16,000

20,900

24,500

50o 54 Years

11,250

18,050

22,950

27,100

55 to 59 Years

13,850

20,650

25,050

31,300

60 to 64 Year

16,350

22,350

26,600

34,750

Note:

• The above rates are inclusive of Government Taxes.

• Please add Rs.750 as Policy Admin Fee & Stamp Duty.

• The above rates are subject to change without prior notice.

Disclaimer:

  • JS Bank Limited is acting as a distributor of the Insurance Policy on behalf of Allianz EFU Health Insurance Limited. This product is underwritten by Allianz EFU.
  • For exact Terms and Conditions, please refer to the Policy Document.

FAQs for JS SehatSarmaya

What is JS SehatSarmaya?

JS SehatSarmaya is a comprehensive healthcare package that provides financial protection in case of an illness or accident that leads to hospitalization. The plan is underwritten by Allianz EFU, Pakistan’s first specialized health insurance company.

What Does JS SehatSarmaya Offer?

JS SehatSarmaya offers coverage in case of:

  • In-patient Hospitalization
  • Day Care Treatment
  • Emergency Accidental Out-patient Treatment
  • Specialized Investigations
  • Pre-Hospitalization Benefit
  • Post-Hospitalization Benefit
  • Miscellaneous Expenses

What are the applicable premiums under different age bands?

The age bands and applicable premiums are given below:

Age (Next Birthday)

Bronze

Silver

Gold

Platinum

90 Days to 18 Years

3,950

6,100

8,600

10,050

19 to 29 Years

4,900

7,400

9,700

11,700

30 to 34 Years

6,250

8,850

11,350

14,200

35 to 39 Years

7,200

11,100

15,150

18,150

40 to 44 years

8,500

14,000

18,650

21,600

45 to 49 Years

9,800

16,000

20,900

24,500

50o 54 Years

11,250

18,050

22,950

27,100

55 to 59 Years

13,850

20,650

25,050

31,300

60 to 64 Year

16,350

22,350

26,600

34,750

Note:

  • The above rates are inclusive of Government Taxes.
  • Please add Rs.750 as Policy Admin Fee & Stamp Duty.
  • The above rates are subject to change without prior notice.

What is meant by network hospitals & discount centers?

Allianz EFU has developed a network of over 160 carefully selected hospitals spread across the country. In case of hospitalization, one can avail the credit facility arranged by Allianz EFU through a simple pre-authorization procedure and Allianz EFU will settle your bills directly with the hospital, as per your entitlement. Moreover, to add greater value to our services, Allianz EFU has chosen discount centers in major cities whereby the insured members can avail discounts on outpatient consultations and investigations just by presenting their Health Cards. In addition to this, credit shall be extended for specialized investigations like CT scan, MRI and thallium scan (where available) provided prior approval has been obtained from Allianz EFU.