The benefits covered under Adamjee Health Insurance care are briefed as follows:
Hospitalization Benefit
This benefit covers the eligible hospitalization treatment (other than pregnancy & childbirth) due to illness, surgeries and accidents. Hospitalization expenses payment up to the "Per Annum Limit" in case of different diseases and prolonged illnesses.
Major Medical Care Benefit (Optional)
This benefit enhances the hospitalization limit of in-patient expenses (except maternity related expense) for each insured person for all eligible hospitalization expenses covered under specified benefits structure.
Critical Illness Benefit (Optional)
These benefits cover the hospitalization for the following critical illnesses
- Myocardial infection
- Coronary artery disease requiring surgery
- Stroke
- Cancer
- Aids
- Renal failure
- Major organ transplant
- Multiple sclerosis
This benefit pays for medical expenses related to pregnancy and child birth up to the annual maternity limit. It includes:
- Daily room rent
- Labour Room charges
- Operation theatre charges
- Anesthetics fee
- Pre & postnatal expenses coverage
- Circumcision
Adamjee also provides the option of out-patient benefits to its clients which pays for the coverage of expenses incurred on medical treatment where a person does not need to be hospitalized. The following expenses are covered under this rider.
- General practionar / specialist consultation charges
- Prescribed medicine and treatment
- Prescribed Laboratory investigations.
Terrorist cover: The policy also covers hospitalization and surgical expenses of any innocent insured person (not taking part in terrorist activities) who is injured due to an act of terrorism.
International cover: The policy covers emergency hospitalization during overseas travel of insured persons. However, the hospitalization expenses will be reimbursed in Pakistan in Pak-Rupees on the basis of what it will cost for a similar procedure to be carried out in Pakistan.
Complimentary cover for accidental injury: The hospitalization annual available limit is automatically increased by 25-50 per cent in case of hospitalization due to an accidental injury.
Exclusions
The items, conditions, treatments pertaining to the following and the related expenses are excluded from the policy for which the company will not be liable.
- Cosmetic treatment or plastic surgery
- Treatment of infertility / sterilization and contraception
- Psychiatric treatment
- Personal expenses like, telephone, guest meals & non medical items
- Self inflicted injury
- Eye glasses, contact lenses, hearing aids, artificial limbs etc
- Dental treatments
- Epidural Anesthesia (for painless delivery) • Hospital admission not medically necessary or undertaken specifically to conduct diagnostic or other tests or workup
- Congenital birth defects
- General Health checkups and preventive vaccinations
- Psychiatric treatment , mental or nervous disorder
- Charges for visiting consultant
- Relationship Management functions for constant facilitation of our valued insured members.
- 24/7 Call Center facilities.
- 24 hr Medical Hotline to facilitate all your queries regarding hospitalizations.
- Adamjee supports you as you make healthy choices every day gives you access to special savings on selected pharmacies and diagnostic services all over Pakistan
- Adamjee’s ‘Medzine’ provides useful information regarding common medical issues keeping you in touch with the current developments in health and helps you manage your illness in a better way.
- Adamjee’s wellness programs aimed to focus on improving awareness and lifestyle choices for you to improve your health.
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