Leading Life and Health Insurer and Family Takaful Operator in Pakistan

Your Guide to Health Claims

Follow these easy steps to submit, track, and settle your claim.

Cashless Claim (Pre-authorization)

Submit Your Request
• Show your health card + CNIC at the hospital reception.
• Hospital verifies details (Policy number, Cert ID, admission date/time, diagnosis/procedure, treating doctor, estimated cost if available).
• Hospital sends pre-authorization request to EFU Life.
Review & Approval
• EFU Life’s medical team reviews the request and coordinates directly with the hospital.
• If approved, a cashless facility will be provided, and eligible expenses will be settled directly with the hospital.
Hospital Admission
• Admission continues as per approval.
• Status updates sent via SMS/Email.

Reimbursement Claim

For OPD, maternity, hospitalization, or critical illness expenses you’ve paid for, follow these steps to submit a reimbursement claim:

1. Submit Claim
• Online: Upload your claim through the Health Claims Portal. (hyperlink to health claims portal)
• Hard Copy: Download the claim form, fill it out completely (with your doctor’s signature where required), attach supporting documents, and submit them at the EFU Life Head Office.

2. Claim Review
• EFU Life reviews your submission within 15 working days.
• If any documents are missing, a requirement letter will be issued.

3. Settlement
• If approved, reimbursement will be made to your bank account or via cheque within 15 working days.
• If not approved, a regret letter will be issued.

All Claims Documents

FAQs

Health insurance is a plan that covers medical and hospital expenses. It protects you from high medical costs during illness or accidents, ensuring financial security and peace of mind.

Coverage typically includes hospital stays, surgeries, medical treatments, and diagnostic services. Both minor procedures and major illnesses, including critical conditions, can be covered depending on the plan.

Health insurance covers your medical expenses when you are sick or injured, while life insurance provides financial protection to your beneficiaries in the event of your death.

It means the insurance company directly settles eligible hospital bills with a network hospital, so you don’t have to pay first.

These are partner labs and facilities that provide outpatient medical services to insured members at discounted rates.

You can access the Discount Centres list through our locator or through the MyHealth app.

Network Hospitals are EFU Life’s partner hospitals where insured members can receive treatment without paying upfront, subject to coverage and hospital limits. Eligible expenses are settled directly by EFU Life.

You can access the Network Hospital list through our locator or through the MyHealth app.

It enables timely treatment at quality hospitals without the burden of high medical costs, making healthcare more accessible and affordable.

Key factors include the extent of coverage, hospital network, affordability and the needs of your family.

It is a comprehensive health insurance solution that gives you and your family access to quality care without the stress of medical bills. This plan offers flexible options:

Individual Limit Plan: Separate coverage for each family member.
Shared Family Limit Plan: A cost-effective option with one pooled limit shared across family members.

Individuals between the ages of 3 months and 65 years are eligible to enroll by completing an application form and paying the required premium. No medical examination is needed. Once enrolled, the policy can be renewed annually up to the age of 80, ensuring long-term health protection.

Yes. You can extend coverage to your spouse, children (above 90 days old), and parents (up to 65 years). Each family member will receive independent coverage equal to the benefit level chosen by the main applicant. Once enrolled, coverage can be renewed annually up to the age of 80.

Yes. Pre-existing medical conditions are covered. These include any illness, injury, symptom, or health issue (diagnosed or not) that existed before applying for insurance.

By choosing an EFU Life-approved network hospital, you can receive quality treatment without paying upfront. Through a straightforward pre-authorization process, EFU Life directly settles your eligible medical bills with the hospital as per your coverage. This cashless facility removes financial stress, allowing you to focus on recovery.

Yes, you may seek treatment at a non-network hospital, but the expenses must be paid by you first. EFU Life will reimburse the costs upon submission of bills, subject to the reasonable and customary charges that would apply at a comparable network hospital. However, since network hospitals are vetted for quality care and offer cashless treatment, we strongly recommend using them whenever possible.

Your HR focal person will need to submit the addition request using the applicable form (Family Health Questionnaire Form or Family Enrolment Form). Once received, the request will be processed, and a health card will be issued within 10 working days.

Your HR representative can submit a deletion request using the Change in Insured Status Form. Once processed, the member will be removed from the policy and their health card will be deactivated.

Any plan change (upgrade or downgrade) must be requested through your HR contact. Once approved and updated in the system, a revised health card will be issued reflecting the new benefits.

The standard turnaround time is 10 working days from the date the request is submitted.

Yes, physical health cards are issued. In addition, e-health cards are available on our mobile app and can be accessed immediately after approval.

Yes, members can log in to the MyHealth mobile app to view the real-time status of their requests and access their e-health cards.

Yes, employees can initiate family member additions directly through the mobile app. The request will be processed after HR approval and verification of the required documents.

The required documents usually include a CNIC, birth certificate, or marriage certificate, depending on the relationship. Specific requirements will be displayed in the mobile app or communicated by our team during processings

Please report any errors immediately through your HR representative or the mobile app. We will correct the details and issue an updated health card.

For urgent queries, your HR focal person can contact our dedicated support team by emailing us at customerrelations@efulife.com or by calling us at 111-338-338.

You will receive a confirmation email or SMS once your enrolment has been successfully processed.

For any enrolment-related issues, please reach out to your HR department or our dedicated enrolment support team via phone or email.

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Your Guide to Health Claims

Follow these easy steps to submit, track, and settle your claim.

Your Guide to Health Claims

Follow these easy steps to submit, track, and settle your claim.

Cashless Claim (Pre-authorization)

Reimbursement Claim

All Claims Documents

FAQs

What is health insurance and why do I need it?

What does health insurance cover?

What is the difference between health insurance and life insurance?

What is cashless hospitalization?

What are Discount Centres?

What are Network Hospitals?

How does health insurance improve access to healthcare?

What should I consider before choosing a health insurance plan?

What is EFU Life Health Plan?

Who is eligible to enroll in Retail Health?

Can I include my family members in the policy?

Are pre-existing conditions covered under this plan?

What are the benefits of using a network hospital?

Can I receive treatment at a non-network hospital?

How can a new employee be added to the health insurance policy?

How can we request the deletion or removal of an insured member?

What is the process for upgrading or changing a member’s benefit plan?

How long does it take to process an addition, deletion, or revision?

Will new or updated health cards be physically delivered?

Can employees track the status of their health card or policy update?

Can employees request the addition of a family member themselves?

What documents are required for adding a family member?

What should I do if there is an error in my health card details?

Who should we contact for urgent support or clarifications?

How do I confirm if my enrolment has been completed?

Who should I contact for enrolment-related issues?

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