Managed Care Plan
What is the IGI Life managed health plan?
IGI LIFE’s Managed Health plan is a system to finance and deliver healthcare while improving customer service and ensuring the highest level of care required to treat any particular medical condition. We believe that such a plan is of great benefit to you as its user, because it enables you to receive care from some of the best providers in the country, with only a low payment per visit, and without the hassles of filing claims and waiting for reimbursements. We have eliminated as much of the paperwork for you as we can.
The Preferred Provider Organization (also called the Managed Health Network) is a group of highly qualified, well-equipped medical providers with whom IGI LIFE has contracted to provide you with a superlative care.
What are the advantages of using IGI Life’s managed health plan?
There are several advantages of using IGI LIFE’s Managed Health Plan. Some of these are:
No claims submission.
All eligible medical expenses incurred at the provider network will be paid for directly by IGI LIFE.
Emphasis is laid on making it easier for you, our customer, to receive the proper care.
What are the procedures of admission?
Admission procedure is divided into two i.e. emergency admissions & non-emergency admission.
Emergency Admission: In cases of emergency no prior approval is required.
In case of emergency just go to one of the panel hospitals and if the attending physician advises you admission present your IGI LIFE Identification card to the admission office and get admitted, inform IGI LIFE or your HR Manager within 24 working hours.
However if you choose to go to a non-panel hospital you are allowed to do so but in that case you have to inform your HR Manager & IGI LIFE within 24 working hours and after getting discharged from the hospital you have to file a claim.
if you are going to a panel hospital the bill will be settled directly between IGI LIFE & the provider.
Non-emergency Admissions: in case of non-emergency you have to get a prior approval in the form of Benefits Predetermination review.
What is an emergency?
A serious medical condition or symptom (including severe pain) resulting from injury, sickness or mental illness which arises suddenly and requires immediate care and treatment, generally received within 24 hours of onset, to avoid jeopardy to the life or health of a covered person.
Who is going to define the condition?
Your attending physician is going to define whether it’s an emergency or non-emergency.
What is benefits predetermination review?
Benefits Pre-determination Review is a process whereby a designated officer of the insurance company reviews proposed Inpatient Hospital Confinement, Outpatient Surgery, MRI/CT Scan, Physiotherapy, Echocardiography, Echo to make sure that the insured’s medical needs are being met and that the most cost-effective solution is being utilized. BPR is done in conjunction with the insured, his attending physician, and the medical facility.
How to obtain a Benefits Pre-Determination Review,
- Have the treating physician fill out the Benefits Pre-Determination Review form completely. The sample form can be found with your Personnel or at IGI LIFE website igi.com.pk
- Fax/E-mail this form to IGI LIFE at (021) 35290042 & 35290043 and email@example.com
- IGI LIFE will review this form and respond soon.
- If, for any reason IGI LIFE feels that the treatment is not heading in the right direction we may ask for a second medical opinion the expenses of which will be beard by IGI LIFE i.e. for consultation & for any additional tests done, however no expenses will be borne by IGI LIFE for any treatment given in terms of second medical opinion.However if the insured does not agrees with the decision of second medical opinion you may ask for a third medical opinion, the physician will be agreed mutually and the charges will be beard by the insured himself.