Who can apply?
- A baby from 15 days old and an adult not more than seventy (70) at the time of the application.
- Your principle country of residence must be Pakistan.
- A child age from 15 days to 6 years must enroll with at least one parent or legal guardian.
Can my family members take up different plans under the same policy?
No, all applicants must apply for the same plan.
Is there any waiting period under my plan?
Yes, there shall be no benefits for any medical treatment, except for those arising from an accident, received during the first 30 days.
There is also a specific 12-month waiting period for Cancer, Hepatitis B, Hepatitis C, Diabetes, Heart Disease, Kidney Failure, High Blood Pressure, Chronic Obstructive Pulmonary Disease, Liver Cirrhosis/Liver Failure, Stroke and their associated medical conditions.
Are there any policy exclusions
There are certain conditions, services and supplies under which no benefit will be payable. These are stated limitations and exclusions in your policy provisions/ you are advised to read the policy provision/handbook for the full list of policy limitations and exclusions.
Will I be covered when I am outside of my area of cover?
Yes, you will be covered up to the amount shown in your benefit table for emergency treatment only, which arises suddenly when you are outside your area of cover. You are not covered if you have specifically travelled outside your area of cover to get treatment, if it was not for an emergency or in respect of pregnancy or childbirth.
Can I maintain my policy when I reside outside Pakistan for more than one-hundred and eighty-five days
Whenever you change your principal country of residence, you must notify us of such changes within thirty (30) days. If you are not a Pakistan national and you are returning to your home country to live, you will not be able to keep this policy. If you are a Pakistani national, we will review your request, as in some cases we may not be able to cover you when you reside outside of Pakistan because of international law or domestic law of the country.
We are unable to cover you if you are an American or Canadian citizen whose principal country of residence is either the United States of America or Canada.
Can I change my plan?
Yes, you can change your plan level upon policy anniversary. Any change in plan is subject to our approval.
Will I be subject to revision of terms when I renew my policy after a claim?
We will not change the terms of your policy alone simply as a result of your personal claims. However, we will make changes only to reflect any past or foreseeable changes in medical practice or procedures and type of frequency of claims. The purpose of such changes, as far as possible, is to maintain substantially the same level and type of cover in place while ensuring that the plan remains affordable. Premium rates are not guaranteed and the premium payable at policy anniversary shall be determined at each renewal based on the attained age of each member and if there are changes due to increased cost, taxation, regulations or benefit changes.
Is there a free-look period when I can cancel my policy without charges?
The policyholder may cancel this policy by contacting us during the fourteen (14) day free-look period. The fourteen (14) day free-look period commences on the day that the contract is concluded or the day that full policy terms and conditions received, whichever is the later. If the policy is cancelled during the fourteen (14) free-look period, we will return any premium paid for the policy provided no claims have been made during this period.
Who can I call if I have questions on my enrollment or membership?
For all membership queries: +92 21 111-000-330
How do I make a claim?
Simply call +92 301-8215798 or +92 21 111-000-330 when outside Pakistan. We will help you process your claim as quickly as possible.
Will claims be settled through direct billing or on reimbursement basis?
We will settle the eligible in-patient treatment claims via direct billing to the hospitals on our panel in Pakistan and overseas with in your chosen area of cover. If the hospital with in your chosen area of cover is not on panel the reimbursement will be on an 80:20 ratio and based on reasonable and customary charges. Meaning 80 percent of the cost will be borne by TPL Life. For any reimbursement type claims you must present your treatment related invoices and reports and we will reimburse eligible expenses once we have assessed your claim.
Pre-notication for all eligible in-patient treatment or day-care treatment is required otherwise the insured person would have to pay 20% co-insurance on the eligible expenses.
Who should I contact in case of emergency?
In case of emergency, you can contact +92 301-8215798 or +92 21 111-000-330 from wherever you are.
Is long term treatment for cancer covered under my plan?
Yes. We will pay for active cancer treatment intended to treat, shrink, stabilize or shrink the spread of cancer and not given solely to relieve the symptoms, this is limited to radiotherapy and chemotherapy for all plans up to the benefit limits stated in the benefit table, for which first symptoms become apparent after the member was accepted by us for cover on a particular plan. If there were any symptoms prior to your application and inception of your policy, such conditions must be declared in good faith to us at the time of insurance application.
Can I choose the doctor/ country for my treatment?
Yes, you are free to choose any recognized doctor for your treatment in any country within your chosen area of cover, subject to reasonable and customary charges. We have contractual agreement through our partners with a list of medical centers where we have preferred rates and direct billing arrangements. Use of the applicable network to your plan will minimize delays in settling claims.
Do you have a list of panel hospitals at TPL Life?
Yes, please contact us for more information on the network, if required.
How can I make sure I am fully covered when I require in-patient treatment?
We recommend you contact the 24/7 claims customer service team:
For all claims related queries:
Claims in Pakistan: +92 21 111-000-330
Claims outside Pakistan: +92 301-8215798