Providing protection organist financial foll-out of illness

Sep 15 - 21, 1997

Health policy consists of various types of insurance plans. some of which cover a specific kind of medical expenses, such as hospitalisation expenses, and others are broader in scope. This cover is being provided through the mechanism of either group insurance or individual insurance.

Health insurance has its roots in the early 20th century, but the earliest crude form of it came in 1885, when an Edinburgh based insurer started issuing policies that provided the compensation payments in the event of certain specified sicknesses. Until about 1950, group health insurance was largely occupied with benefits related to expenses for hospital confinement and surgery. Since about 1951, quite significant advancements have been made to develop much broader plans.

Group health policies insure groups of persons. The most common type of groups are the employees of a single employer or an association of employers. This insurance may be provided to employees alone or employees along with their dependents, spouse and children. In some cases, coverage might be extended to a broader classification of dependents. The costs of group health cover maybe paid by the contributions of employees alone or by their employers alone, or can be shared by both in various proportions.

Group policies are mainly taken out by employers in the United States and are also more popular than individual cover in France, Switzerland and Canada. There are different brand names of health insurance, like health-care, clini-care, hospitalisation plan, prime-care, health-watch and most simple health cover etc.

From small, mature markets like Spain and the Netherlands to the vast populations of China and Barazil, people throughout the world are taking a very serious look at the potential benefits of health insurance. The market has already grown substantially in recent years, and is now set for further continued expansion in the coming century as all the industrial countries already find it hard to contain the medical costs.

Joseph M. Juran, says about future, "The 20th Century has been the century of Productivity. The 21st Century will be the century of Quality". In Pakistan, group health cover is developing rapidly and it is a good sign that two leading Pakistan insurers, i.e. EFU General and New Jubilee, have come forward with quality products and services to meet the challenges of the 21st Century. The health cover offered by these companies not only comprehensive, economical and flexible but can also be tailored according to the needs, requirements and the budgetary position of an organisation. As a matter of fact, both the insurance companies are not only introduces of new health-products, but also innovators of quality.

EFU is working with a vision "to be the best". This company has a network of offices. Its branches are situated in almost each and every business center of the country to provide a " total quality service". The aim of EFU is to create the finest issuance products and the purpose is not only to please, but leading, professionally managed and the fastest growing organisations of the country.

Some salient features of EFU's health cover are:


This is a core benefit that covers almost all the medical expenses against sickness, surgery of accidental injuries, such as:

Room rent charges. Services and supplies (ancillaries) during confinement, i.e. laboratory and X-ray tests, prescription drugs, doctors'/dislocations, therapeutic endoscopic procedures, radium therapy etc. Intensive care unit (ICU) charges. permission diagnostic testing expenses. Surgical benefits, like surgeons fees for any cutting operation including day care surgeries and related operation theater charges, anaesthetist's fees and post-surgical consultations charges.

If required, the scope of this plan can be extended to cover the following risks too:

1. Maternity Expense Rider:

Covers almost all pregnancy-related hospitalisation. The benefits, included in this rider, are:

pre-natal expenses (out-patient expenses before delivery).

Delivery fee for the gynecologist/doctor/ licensed midwife and for visits, during confinement. Room charges. Labour room and operation theater charges. Miscellaneous hospital services and supplies. Enhanced limits in cases of multiple births and caesarean sections. Nursery bill for the bady, while the mother is confined to the hospital. Circumcision for bady boys.

2. Outpatient Expense Rider:

This is to meet the diagnostic and treatment expenses that incuned without the insured person being hospitalised. The insurer is offering this benefit on reimbursement basis, covering:

Charges paid to a general practitioner or specialist in allopathic, homeopathic or herbal medicine. Prescribed medicines. Dental treatment. Physiotherapy/ acupuncture.

Diagnostic test, X-ray ECGs, scans, etc. Post -natal consultations and treatment expenses. Eyesight testing fee.

Osteopathy (setting of fractures).

3. Critical Illness Expense Rider:

Critical illness cover is available as an additional rider. This rider increases the limits under the core hospitalisation policy for the following eight potentially lethal diseases.

Myocardial infarction(heart attack); Coronary artery surgery (bypass); Stroke; Renal failure (kidney failure); major Organ transplant; Multiple sclerosis; major burns;

Some Other Features of the Product:

The insurer has arranged a panel of hospitals, throughout Pakistan, to provide the best services to the insured persons. Thus, round-the-clock, around the country, the hospital's services are available, without the botheration of depositing initial amount/payment of bills by the insured person to hospital, as the bills are to be paid directly by the insurer to the hospitals.

Policy may be extended to include eligible dependents, i.e. a wife or husband, unmarried children and parents up to a specified age.

Insurer is providing medical advice and counselling, absolutely free.

Newborn babies are automatically included in the plan

No waiting period for maternity benefits

Special converges like major medical, pre and post hospitalisation,

Profit commission for larger groups, and

Cost containment features to reduce the cost of scheme are also available.

This insurer has the finest facilities to discuss the policy in detail and in person through visual aid, at the premises of the interested companies/groups.

The author of this article is vice president of EFU General Insurance Limited, Southern Zonal Office, Karachi