Our Promise: Quality Health Care at an Affordable Price

Why Is Health Insurance Important :

Health insurance has become a necessity today because it plays a major role in health care. This is because an unfortunate illness or injury may strike any time and in such cases medical expenses can be unaffordable. Health insurance can prove to be a source of support by taking care of the financial burden ones family may have to go through.

Increasing pollution levels especially in big cities, stress at workplace and in personal life , cut throat competition taking its toll are some of the harsh realities we confront today. Besides, accident on roads is a common feature. In such instances timely and affordable medical help is the need of the hour.

But this may be easier said than done. Treatment for illnesses or accidents can be unaffordable. It is specially worse when the patient needs to be hospitalized. Expenses are exorbitant and the situation leaves you mentally devastated also burning a deep hole in your pocket.

Health insurance takes care of you in such circumstances. It will help you tackle such situations with ease by providing you with timely and adequate medical care. The financial burden of footing huge medical bills is taken care of by health insurance.

‘Family Sehat Care’ -Choice, Convenience and Care- Our Caring Package!

NJI ‘Family Sehat Care’ policy offers health insurance plans that are designed for individuals who wish to provide financial protection to themselves and their dependents family members against medical expenses arising due to sickness and accidents. Now with NJI you can have a peace of mind that your most valuable asset–health is covered.

This package covers treatment through its panel of hospitals, where you and your family will receive appropriate treatment in case of an unfortunate ailment or accident. You can seek treatment at one of our panel hospital and pay the bills. We will reimburse your claim for the expenses in line with the policy terms and conditions.

In case you don’t want to spend money upfront, just inform us 5 days in advance about the treatment and the panel hospital whose services you wish to utilize and we will arrange for the treatment of covered expenses on credit basis. You will not be required to pay to the hospital, this way there will be NO:

• Cash to arrange for the admission.
• Claim to file.
• Documentation.
• Paper Work.
• Settlement cheques to wait for.

NJI Family Sehat Care offers choice and convenience. We can offer different levels of cover to suit your budget. There are 03 plans available and all of them provide cover for in-patient hospitalization expenses. Other benefits covered are as under:

• Day care surgeries.
• Pre & Post hospitalization out patient treatment is also covered, giving you peace of mind 30 days before and after the hospitalization.
• 04 expensive diagnostics tests-MRI, CT Scan, Thallium Scan and Endoscopy-to facilitate diagnosis with no condition of hospitalization.
• Accidental outpatient expenses within 48 hours of the accident.

Common Questions:

Who can apply?

If you are between age 21 years and 55 years and a resident of Karachi, Lahore or Islamabad /Rawalpindi, you can apply for the insurance cover for yourself and your spouse and all dependent children between the ages of 6 months to 24 years.

You need to fill out our application form and disclose health history of all the persons who are applying for cover.

You can cover yourself and your family through different options as under:

• Self only
• Self , spouse (wife/husband) without any children.
• Self, your spouse and all dependent children.
• Self and all dependent children.

Once enrolled, the cover can continue till the age of 60 years for yourself and your spouse and 25 years for dependent children.

Is there any medical check up required?

Yes, but only for persons who are over 40 years will require a pre-acceptance medical tests/check up. If the application is accepted for insurance coverage, then the cost of these expenses will be borne by NJI. Otherwise, NJI will refund the premium after adjusting the cost of the tests/check up. For further details, please contact NJI’s call centre at UAN 111-654-111- Ext. 322 & 323.

When will your coverage commence?

Your insurance cover will start from the date NJI accepts the cover in writing based on your application form and the premium payment.

Are pre-existing medical conditions covered?

No, existing ailments and injuries and their related complications will not be covered.

What would be the mode of premium payment?

Premium will be paid in advance for one year and you can pay through cross cheque,pay order or bank draft .

Other Features:

• No Claim Bonus:

If there are no claims for any of the family members insured for any 2 consecutive policy year, the amount of annual limit will be enhanced by 15%.

• Family Discounts:

In case 3 or more family members are covered, 5% discount will be applicable on overall premium.

• Medical Management:

At NJI we can help control medical costs without compromising the quality of medical care. Our case manager doctors ensure that the necessary medical care is given in the most appropriate settings, which results in more efficient utilization of your benefits.

Policy Exclusions:

In order to keep the cost of your cover at a reasonable level, certain exclusions and limitations are applicable; some important ones are as under:

• Treatment of pre-existing conditions and any disease, illness, medical condition or injury, which is a complication of a pre-existing condition.
• Charges for treatment of congenital disorders/ birth defects.
• Any expense during the first 60 days of the inception of cover, unless the expenses are due to an accident.
• Any expense arising from or traceable to pregnancy, childbirth, including caesarean.
• Cosmetic and aesthetic treatments
use of intoxicating drugs and alcohol.
• Treatment of psychiatric, mental or nervous disorders or insanity. Any increase in expenses due to insured being admitted in more expensive room than that allowed by the maximum room and board limit or better facility than the type of room entitlement given in the policy.
• Expense for self inflicted injuries.
• Hospitalization expenses in Aga Khan and Shifa International hospitals for Gold and Silver policyholders.

‘Pre-existing Conditions’ means any illness or injury or related condition for which treatment, or medication, or advice, or diagnosis was sought or received prior to applying for the policy OR which was known or reasonably should have been known to exist prior to applying for the policy whether or not treatment or medication or advice or diagnosis had been sought or received.

Note: The Family Sehat Care' Cover is subject to the terms, conditions and exclusions of the policy.

For exact detail of the cover, premium rates and how you can avail the benefits please contact us on the numbers below.
UAN: 111-NJI-111 Ext. 322, 323 & 285, Tel: 021-2416022-26 Fax: 021-2425774

Nearest Branches
COMMERCIAL UNIT-KARACHI
Fax no. (021) 2420940, 2426654
Tel no.  (021) 2420393, 2422012

BUSINESS & FINANCE CENTRE BRANCH
Fax no.  (021) 2471716
Tel no.   (021) 2472004-06 (3 Lines), 2461714
 
JODIA BAZAAR BRANCH
Fax no. (021) 2420451
Tel no.  (021) 2422215-16 (2 Lines)

SHAHRAH-E-FAISAL BRANCE  
Fax no.  (021) 4541548
Tel no.   (021) 4524147, 4391172, 4537040, 4537050

PLAZA BRANCH
Fax no.  (021) 2241731
Tel no.   (021) 2241703, 2241719

SADDER BRANCH
Fax no.  (021) 5650426
Tel no.   (021) 5650428-30 (3 Lines)

NEW UNIT BRANCH
Fax no.  (021) 2463010
Tel no.  (021) 2463006-15 (10 Lines)

TARIQ ROAD BRANCH
Fax no.  (021) 4302099
Tel no.  (021) 4302094-98 (5 Lines)

CLIFTON BRANCH
Fax no.  (021) 5862454
Tel no.  (021) 5862451-53 (3 Lines)

We’ve got you covered

Click on pdf icon to download form
Prior Approval Form
Inpatient Claim Form