Scope

Security and Management Services (Pvt) Ltd, “FSMS”, is committed to make arrangements for provision of Hospitalization and Emergency health care to all employees of FSMS and their immediate family members i.e. spouse and children (parents excluded).

Eligibility

Following are covered under the ELENA CARE Health Insurance Scheme:-

a. All employees (after getting their first salary)
b. Immediate family members of employees i.e. spouse and children
c. Following are excluded:-
(1) Married children
(2) Male children over 25 years of age

Procedure/ Responsibilities

a. Issuance of Health Card
(1) Employees /his or her family data is collected by respective HR Office / Recruitment staff at the time of induction at the regional office.
(2) Collected data will be sent to designated HR officer in HR Head Office.
(3) HR Department (Headquarters Office) will send that data to respective Insurance Company for issuance of Health insurance cards and further dispatch to respective Regional HR departments on receipt from Insurance Company. In case of any addition or deletion of family member in the health required same process will be followed.
(4) Health Insurance policy, List of authorized Panel Hospitals is sent up to the Zonal Level for record or display at notice boards.
(5) Limits for room / maternity charges are also provided to all inductees.

b. Pre admission – Routine cases (Panel Hospital – hospitals where the
Insurance Company has made prior arrangments).Whenever an employee needs hospitalization he / she will proceed as follows:-
(1) Pre-authorization forms will be collected from HR.
(2) Filled forms duly endorsed by treating physician along with estimated limit of expenditures / breakdown/ length of stay will be submitted to HR Head Office 15 days prior to actual utilization of the facility.
(3) HR will forward the filled forms to the Insurance Company and obtain formal approvals. Insurance Company will coordinate with respective hospital for arrangement of hospitalization.
(4) HR will confirm the arrangements to the individual prior to his hospitalization and provide him / her copy of approval through Regional HR department.

c. Admission – Routine cases (Non Panel Hospital):
Whenever an employee needs hospitalization in non-panel Hospitals he / she will proceed as follow:
1) Pre-authorization forms will be collected from HR.
2) Filled forms duly endorsed by treating physician along with estimated limit of expenditures / breakdown/ length of stay will be submitted to HR Head Office 15 days prior to actual utilization of the facility.
3) HR will forward the filled forms to the Insurance Company and obtain formal approvals. HR will provide him / her copy of approval and reimbursement form through Regional HR department which will be attached with reimbursement claim
for reference.
4) The affected person / any family member will get admission. At the time of discharge, employee will get Original bills and get endorsed reimbursement claim form the treating physician.

d. Emergency Cases. Telephone numbers for contact in case of emergency are given on the health cards. All emergency treatments will be forwarded to the HR Head Office within 48 hours. The individual must show health insurance card in case of emergency at
panel hospital and inform Respective HR department for information and necessary coordination if required.

4. Revision of SOP. ELENA CARE policy and procedure are reviewed annually
in the month of January by a reviewing panel comprising COO, Group
Director HR, CFO and Director Contracts. During this meeting the
reviewing panel reviews the policy / procedure and its actual compliance
to bring in improvements if required.

5. FSMS provides this information to every new employee when they sign
their contracts with FSMS.

Revision of SOP

ELENA CARE policy and procedure are reviewed annually
in the month of January by a reviewing panel comprising COO, Group
Director HR, CFO and Director Contracts. During this meeting the
reviewing panel reviews the policy / procedure and its actual compliance
to bring in improvements if required.

5. FSMS provides this information to every new employee when they sign
their contracts with FSMS.