Medical Services
UMT provides various benefits to its employees after regularization; one of these benefits is Medical Coverage for employee and his/her dependants.
Medical coverage is of two types:
1. Indoor Health Facility
Indoor Health Facility is utilized when confinement in the hospital is necessary for treatment. Currently, we have coverage through Adamjee Insurance Company. All full-time permanent employees upto 65 years of age are eligible for medical insurance coverage under the Group Health Insurance Scheme. Only the employee, his/her spouse and children are covered under this scheme. Son of employees are covered till the age of 25 while daughters are covered till they get married. Parents are not covered under this scheme.
How it works:
University bears the expense of premium of the insurance provided by Adamjee Insurance Company. All medical facilities under this scheme have to be pre-approved except in case of emergency. For pre-authorization, kindly visit Office of Human Resources.
In case of emergency, kindly contact Office of Human Resources immediately after hospitalization and in cases of planned treatment please inform OHR a week before hospitalization to avoid any inconvenience. Medical expenses incurred 30 days prior and 30 days post hospitalization are covered whether treatment is from the panel hospital or otherwise.
i. Treatment in Panel Hospital:
In case the employee visits any hospital on the panel of Adamjee Insurance Company, he/she will not have to bear any expense as long as the cost of treatment remains within the limit of coverage provided by the insurance company. Any amount over and above the limit will have to be borne by the employee.
If a covered person avails treatment from a panel hospital but from a visiting consultant, initially the charges shall be borne by the employee that can be claimed afterwards from the Insurance Company through OHR.
If a covered person prefers treatment by a consultant of his/her own choice rather than the panel consultant, then the expenses shall be covered as per the agreed rates of the Insurance Company with the same hospital.
List of Adamjee panel hospitals can be viewed through the following link:
https://admin.umt.edu.pk/Media/Site/UMT/SubSites/OHR/FileManager/Adamjee Panel Hospitals List.pdf
ii. Treatment in Non-Panel Hospital
Treatment in any non-panel hospital can also be availed. However, the employee has to pay the cost of treatment and can claim the same afterwards from the insurance company through OHR. All non-panel expenses can be claimed through the claim form available on the following link:
https://admin.umt.edu.pk/Media/Site/UMT/SubSites/OHR/FileManager/Indoor Claim Form - Adamjee Takaful.pdf
Document checklist for Reimbursement cases:
The following documents are required to claim reimbursement of any non-panel hospitalization expense:
i. Claim form – Duly Filled by the employee, signed and stamped by the physician
ii. Original hospital itemized bill (i.e. with payment breakup)
iii. Advance payment receipt(s)
iv. Final payment receipt
v. Copy of Discharge Summary/Discharge Card
vi. Laboratory or Radiology reports along with doctor’s advice
vii. Original itemized medicine receipts supported by the physician’s prescription
viii. Copy of birth certificate (for Maternity case only)
ix. Any other bills related to hospitalization
x. Copy of Health Card
The Insurance Company reserves the right to limit the reimbursement for the medically necessary treatment to only reasonable and customary charges – reasonable and customary charges mean charges for medical care shall be considered by Adamjee Insurance Company so as to be reasonable and customary to the extent that they do not exceed the general level of charges being made by others of similar standing in the locality where the charges are incurred while giving the same or comparable treatment, services or supplies to individual of same sex and of age for a similar disease or injury.
What is not covered:
a) Any treatment related to infertility/sterility
b) Dental surgery, examination, extraction or filling
c) Mental illness due to any cause/drug addiction
d) Radial keratotomy and excimer laser procedures
e) Supply of eye glasses or contact lenses, dentures and hearing aids
f) Expenses directly or indirectly resulting from congenital defects and deformities
g) All non-medical expenses, vaccines are not covered
Standard Specialized Investigations and Day Care procedures covered under Health Insurance:
Medically necessary specialized investigations recommended by the physician and Day Care procedures are covered by the insurance company (list attached in the following link):
https://admin.umt.edu.pk/Media/Site/UMT/SubSites/OHR/FileManager/Specialized Investigations Daycare Procedure List.pdf
How to avail Indoor Medical Facility:
Please fill the “Form for Indoor Enrollment” along with the details of the dependents for insurance cover purposes. The form is available on the following link:
https://admin.umt.edu.pk/Media/Site/UMT/SubSites/OHR/FileManager/Request form for Indoor Medical Coverage.pdf
The addition request must be generated by the employee in accordance with the following timelines:
a) New addition of the employee (within 10 days of confirmation)
b) Spouse addition (within 30 days of marriage)
c) New Born dependent addition (within 30 days of birth)
*Please note that Indoor and Outdoor Panel Hospitals are different and all expenses over and above the prescribed limit will be borne by the employee.
2. Outdoor Health Facility (OPD):
Visits to doctors and diagnostics (ultra-sound, ECG, Lab Tests, etc), not requiring hospitalization, are covered under out-door health facility. To avail these facilities please fill in the “Request Form for OPD Cards” available at the following link:
https://admin.umt.edu.pk/Media/Site/UMT/SubSites/OHR/FileManager/Downloads/HealthForms/Request form for Outdoor Medical Coverage.pdf
Please attach 1’x1’ photographs of yourself and your dependants with the form so that OPD cards can be issued to you.
Who is covered:
All regular fulltime employees, their spouse, children (Sons of employees are covered till the age of 25 while daughters are covered till they get married) and parents are covered under this facility.
How it works:
UMT has entered into agreements with several renowned hospitals and labs to provide outdoor health facility. The list of those hospitals and labs is available at:
List of Hospitals and Labs at UMT Panel
List of Doctors @ Fatima Memorial Hospital
List of Doctors @ Iqraa Hospital
List of Doctors @ Niazi Hospital
List of Doctors @ Mansoorah Hospital
List of Doctors @ Masood Hospital
List of Doctors @ Farooq Hospital
The employee just has to show the OPD card issued by OHR in the panel hospitals or labs. Please present copy of the card and prescription to the Chughtais Lahore Labs to avail this facility. Kindly bring copy of the card to the hospital. 15 % of the cost incurred on all diagnostics will be charged to the employees’ salary while the rest is paid by UMT.
Treatment in non-panel hospitals can also be availed however the employee has to first pay the cost of treatment and claim the same from the Office of Human Resources – only the rates of panel hospital are reimbursed. In case of non-panel OPD visits and diagnostics, only the agreed rates with the panel hospital are reimbursed after deduction of 15%. If the cost of a single diagnostic test is above Rs. 5000 then 50 % of the total cost will be reimbursed.
How to claim:
All non-panel consultation and diagnostics expenses can be claimed on the “Expense Claim Voucher/Outdoor Claim Form” (available online/in OHR and OTR) after attaching original receipts of payments made.
Expense Claim Voucher /Outdoor Claim Form
What is not covered:
All types of
a. Medicines and vaccinations are not covered.
b. Dental treatment is not covered.
Note: Please note that Outdoor and Indoor hospitals are different.