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Features of Hospitalization Insurance Scheme

(Comprehensive Plan)

Group Hospitalization Insurance Scheme is a comprehensive scheme designed for coverage of hospitalization treatment expenses of an insured due to illness or injury sustained during the period of coverage.

Salient Features:

  • Direct payment of treatment expense by the Company at designated hospitals.
  • Reimbursement of expenses for treatment at non-designated hospitals.
  • Treatment at any renowned hospital of the country by consultant of own choice.
  • Membership Card for each insured to facilitate preferential service.
  • Scope for inclusion of spouse & children under the Plan.
  • Scope forOverseas Treatment.
  • Scope to enjoyMaternity Benefit.
  • Coverage of Pre & Post Hospitalization expenses.

 

Scope: The scheme shall cover reasonable and necessary treatment expenses of an insured member within his entitlement as per benefit schedule, at any Govt. Hospital as well as renowned private hospital/clinic registered as such with the legitimate authority of the country.  

Eligibility for coverage under the Scheme: Any employee aged between 18 and 60 years & is in good health shall be eligible for coverage under the scheme. Similarly a new employee shall also be eligible to join the scheme during their good health upon intimation to the company and payment of premium. Besides, spouses up to the age of 60 years, dependent children from day 01 (one) up to the age of 25 (twenty five) years residing with the employee & is in good health may also be included under the scheme. Inclusion of dependant family members (Either spouse or spouse with children) should be on full participation basis (group concept).

Duration of the Contract: One or Three years from the date of commencement. A contract shall be signed initially which may be renewed on mutual agreement.  

Medical Requirement: No medical examination is required. A “Membership Form” to be filled in by each employee containing a declaration of health status for him-self & dependants to be covered under the scheme shall suffice.
General features of the scheme:

  • Coverage round the clock inclusive of Accidents and Emergencies (including holidays)
  • Option for treatment at any renowned Hospital, by consultants of own choice.
  • Preferential services& Direct Paymentof treatment expenses by Protective Islami Life at designated hospitals.
  • Reimbursement of expenses to the insured for treatment at non-designated hospitals.
  • Waiver of preliminary Medical Examination during enrolment.
  • Scope for inclusionof new member under the Scheme at any time.
  • Scope for inclusion of Spouse & Children under the plan.
  • Scope to enjoyMaternity Benefit

Special features of the scheme:

  • Overseas Treatment coverage: Inpatient treatment at any renowned hospital or clinic in India, Bangkok or elsewhere except Israel shall be covered, if satisfactory local treatment is not available and a local consultant advises such treatment. But, before going for such treatment a member should notify the company except for emergency treatment required by a member while on tour abroad. The claim shall be reimbursed for treatment expenses only, in a hospital/clinic as an inpatient, at standard rate, as may apply for such treatment at “Designated Hospitals” of the company in Bangladesh, within the benefit limit as per schedule and payable in Bangladeshi currency at exchange rate prevailing at that time.
  • Pre-Hospitalization:Coverage shall include expenses for the investigations done up to seven (07) days pre-confinement as per doctor’s advice at the time of referring a patient for Hospitalization.
  • Post Hospitalization:  Coverage shall include a post discharge consultation within 07 days of release from hospital.

Coverage of treatment expenses shall include:

  • Hospital accommodation (Room & Board)
  • Surgical Operation                                    
  • Consultation fee
  • Medicines & Accessories                          
  • Medical investigation
  • Ancillary service

* Ancillary services comprises of  : Registration or Admission, Labour Room Service, Blood Transfusion, Post Operative Care, Local ambulance Services to Hospital, Physiotherapy, Chemotherapy, Radiotherapy, Dialysis,  procedural charge, Dressing, Nebulization, Oxygen inhalation, ventilator charge etc.

Non-Reimbursable Expenses shall include:

Food, Food Supplement & Energy Builders eg. Milk, Horlics, Non Medicine Item like Diapers, Sanitary Pad etc, Extra corporeal durable medical appliances – e.g., Hot water bag,  BP Machine, Telephonic bill,  expenses not incurred for patient, any non specific (miscellaneous) expense, VAT, Service Charge,  Rent-a-Car, Herbal/ Ayurvedic / Homeopathic/Alternative-care Medicine, Cosmetic Cream, Oil, Water Purifier, Expenses incurred for/by Donor 

Major Exclusions from Coverage:

Hospitalization Treatment Expenses related to:- Congenital infirmity (anomaly), Existing permanent disability or Deformity, Surgical treatment of any pre-existing condition within 3  months of coverage, ongoing or follow up treatment of any  existing medical conditions, Self inflicted injury, Psychiatric disorder, Un-lawful activity, Alcoholism & Drug Addiction, Attempted suicide, Contraceptive Measures, Outpatient treatment expenses & procedures, AIDS & HIV disease, Dental & Ophthalmic Treatment, Cosmetic Treatment (except required for injury or burn sustained during contract period), Treatment for Family Planning purpose (including Sterility, D&C), in-fertility or sub-fertility, any treatment related to pregnancy or childbirth (if maternity option is not taken), rest, convalescence, rejuvenation cure, slimming beautification, Health checkup, prophylactic and immunization procedures, acupuncture, Circumcision or other religious or social rituals.  

Claim Settlement Procedure:
(A) Direct Payment (For Treatment at Designated Hospitals):
(B) Reimbursement (For Treatment at Non-Designated Hospitals):

Hospitalization Insurance Scheme
Benefit Schedule with Premium Rates (minimum employee 150)

Max. Benefit Per Insured
Per Hospitalization 

Tk. 50,000/=

Tk. 75,000/=

Tk.1, 00,000/=

Tk. 1, 50,000/=

Tk. 2, 00,000/=

A) Accommodation Limit per Hospitalization

Tk. 20,000/=

Tk. 30,000/=

Tk.40,000/=

Tk. 60,000/=

Tk. 80,000/=

Daily Hospital Room Rent
(At actual up to a Maximum)

Tk. 1000/=

Tk. 1500/=

Tk. 2000/=

Tk. 3000/=

Tk. 4000/=

ICU Limit maximum per Hospitalization

10 days

10days

12 days

15 days

15 days

B) All other In-patient treatment expenses. Includes surgical expenses, consultation fees, medicines, relevant investigation and other ancillary services (excluding Room and ICU charges) (At actual up to a maximum per Hospitalization.)

 

 

Tk. 30,000/=

 

 

Tk. 45,000/=

 

 

Tk.60,000/=

 

 

Tk. 90 ,000/=

 

 

Tk. 1,20,000/=



Maternity Benefit (For one Pregnancy in a contract year at actual as per Benefit Schedule above up to a maximum.)


Caesarian Delivery

Tk. 30,000/=

Tk. 40,000/=

Normal Delivery

Tk. 15,000/=

Tk. 20,000/=

Legal  Abortion or Miscarriage

Tk. 10,000/=

Tk. 15,000/=

Premium Rates are exclusive of VAT

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