Adamjee Insurance The Largest Insurance Company in Pakistan (2025)

Health insurance is a sort of insurance that aids individuals and families in controlling the price of medical and healthcare services. By paying all or a portion of the costs associated with hospital stays, prescription drugs, and other healthcare services, it offers financial protection.
Unexpected medical costs can be financially stressful, which is why health insurance exists. If you don't have insurance, the expense of healthcare may be too expensive, which could put you in a difficult financial situation or prevent you from getting the essential medical care.

* Above mentioned financial limits are Annual Family Limits for members enrolled under the policy

Hospitalization expenses (other than pregnancy) due to sickness or accident will be covered.

• Insurance Coverage will be effective for a period of one (1) year from the date the participant opts for Insurance Coverage.
• In the first policy year, the coverage would be effective after thirty (30) days once the policy has been issued, except for Accidental Emergencies which will be covered which shall commence when premium is deducted from customer account.
• Maximum age for coverage is 60 years. No requirement of health declaration or medical examination.
• Specialized Investigations are not covered.

This insurance policy does not cover claims arising directly or indirectly from or consequent upon the following:

• Pre-existing Conditions are not covered under the policy.
• Any treatment received in “Non Approved Hospital”
• Birth / congenital defects or illness of any nature whatsoever.
• Costs resulting from self–inflicted injury, attempted suicide, abuse of alcohol or drug addiction.
• Treatment or investigation of fertility, infertility, sterilization or contraception and any complication relating thereto or hormone treatment and investigations.
• Injuries as a result of an illegal act other than a minor misdemeanour or minor delinquency by the insured person.

Injury or treatment resulting from war, riots, invasion, act of foreign enemies, hostilities or warlike operations (whether war be declared or not), civil war, mutiny, civil commotion assuming the proportions of or amounting to a popular uprising, military uprising, insurrection, rebellion, military or usurped power or any act of any person acting on or on behalf of or in connection with any organization actively directed towards the overthrow or to the influencing of any government or ruling body by force, terrorism or violence.

• Services or Treatment in any spa, hydro clinic, sanatorium, nursing home or long term-care facility that is not a Hospital.
• Acquired immune deficiency syndrome (AIDS), AIDS related complex syndrome (ARCS) and all diseases caused by and or related to HIV virus or any other sexually transmitted disease.
• Experimental or unproven treatment.
• All dental Treatments or oral surgery apart from Emergency Accidental Dental Treatment
• Cost of correction of refractive errors of the eye and procedures such as Radial Keratotomy and Excimer Laser.
• Routine medical examinations or check-ups including charges arising out of any hospital confinement or admission primarily for diagnostic purposes, unless specifically authorized by the Company, routine eye or ear examinations, vaccinations, medical certificates, examination for employment or travel, spectacles, contact lenses, hearing aids and any treatment that is not considered medically necessary.
• Cosmetic or plastic surgery, unless it is re-constructive surgery necessitated by an Injury that occurred during the period whilst the insured person was covered under this policy and subject to the limits and sub-limits stated in the structure of benefits.
• Any increase in the expenses incurred for treatment on account of the insured person being admitted to a more expensive room than allowed by his daily room and board limit.
• Pregnancy and complications thereof, childbirth (including surgical delivery), miscarriage, abortion and/or any related prenatal or postnatal care. Any Out-patient Treatment, except that arising out of an Accident.
• Any charges in respect of the donor for organ transplant claims.
• Prostheses, corrective devices and medical appliances.
• Aviation other than as a fare-paying passenger of a recognized airline or charter service.
• Personal comfort items such as, charges for telephone, meals for other than the patient or other items not medically necessary.
• Natural catastrophes including, but not limited to, flood, earthquake, avalanche and cyclone.
• Hospitalization for pain management only without any surgical or disease modifying treatment given for the underlying medical condition
• Specialized Investigations are not covered.