N EW M EDI - CLASSIC I NSURANCE P OLICY
U NIQUE F EATURES Restoration of Sum Insured Health Check up every 4 years (SI >Rs2L) 101 Day Care Procedures Zone Based Two-Tier Rating No Sub-limits for day care procedures except for cataract. Option of 2 years policy period Entry Age up to 65 yrs and lifelong guaranteed renewals. Optional benefits under Hospital Cash and Patient Care. Coverage for HIV+ persons 2
F EATURES EXPLAINED First time entry: For children from 5 Months For seniors up to 65 Yrs. Guaranteed life long renewals Policy term options - 1 Year & 2 Years. Cover (with restrictions) can be offered to HIV+ persons also subject to the condition that CD 4 count at the point of entry is not less than 350. Co Pay 10% on every claim beyond 60 Years at entry level and their renewals thereafter. 3
F EATURES EXPLAINED Coverage: Hospitalisation Expenses as an in patient for treating Illness/Sickness/Diseases Accidental Injuries. 4
F EATURES EXPLAINED Room Rent, Nursing & Boarding Charges 2% of S I (A max of Rs.5,000/- per day) Emergency AmbulanceRs.750/- per hospitalization with Overall limit of Rs.1500/- Pre Hospitalisation30 days Post Hospitalisation60 days from the date of discharge (7% of the hospitalization expenses with a max of Rs.5000/- per event) 5
F EATURES E XPLAINED C OST OF H EALTH C HECKUP Available after every block of 4 claim-free years Available after every block of 4 claim-free years Up to 1% of the average sum insured subject to a maximum of Rs.5,000/- per block Up to 1% of the average sum insured subject to a maximum of Rs.5,000/- per block This BENEFIT NOT AVAILABLE for the basic product with Sum Insured of Rs.1.5L. This BENEFIT NOT AVAILABLE for the basic product with Sum Insured of Rs.1.5L. 6
F EATURES EXPLAINED Day Care Procedures 101 NAMED Procedures. No Sub-limits except for Cataract, which are: Sum InsuredLimit Rs. 2LRs.12,000/- for the policy period > 2L up to 5LRs.20,000/- for one eye and Rs.30,000/- for policy period > 5LRs.30,000/- for one eye and Rs.40,000/- for policy period 7
F EATURES EXPLAINED Automatic Restoration of Sum Insured IF…….the sum insured is fully exhausted - A One-time Restoration benefit A One-time Restoration benefit 2-times the basic sum insured 2-times the basic sum insured CAN ONLY BE utilized for illness/diseases unrelated to illness/diseases for which claim/s was/were made. CAN ONLY BE utilized for illness/diseases unrelated to illness/diseases for which claim/s was/were made. 8
F EATURES EXPLAINED Optional Riders Hospital Cash Rs.1000/- for each completed day subject to a maximum of 7 days per hospitalisation and 14 days per policy period Rs.1000/- for each completed day subject to a maximum of 7 days per hospitalisation and 14 days per policy period There should be a valid hospitalization claim. There should be a valid hospitalization claim. No need to submit bills No need to submit bills Premium Rs.350/- + Service Tax 9
F EATURES EXPLAINED Optional Riders Patient Care – Cost of engaging an attendant at residence immediately after discharge from hospital. Conditions: Should be recommended by the attending physician Should be recommended by the attending physician Only for persons above 60 yrs of age Only for persons above 60 yrs of age Benefit of Rs.400/- for each completed day up to 5 days per occurrence and 14 days per policy period Benefit of Rs.400/- for each completed day up to 5 days per occurrence and 14 days per policy period Only consequent to a valid hospitalization Only consequent to a valid hospitalization No payment will be made for the first day No payment will be made for the first day Bills to be submitted Bills to be submitted Premium Rs.580/- + Service Tax 10
F EATURES EXPLAINED Sum Insured Options Rs. 1,50,000/- Rs. 2,00,000/- Rs. 3,00,000/- Rs. 4,00,000/- Rs. 5,00,000/- Rs.10,00,000/- Rs.15,00,000/- (newly introduced) Rs.15,00,000/- (newly introduced) 11
F AMILY P ACKAGE OPTION Sum Insured EQUALLY DIVIDED among Insured family members Coverage for self, spouse and maximum 2 dependent children Entry Age: 5months for children; 45 years for Adults. After 45 yrs, migrate to Mediclassic Individual or Family Health Optima. Sum Insured Options Rs.2,00,000/- & Rs.3,00,000/- only 12
F AMILY P ACKAGE OPTION Restoration benefit – Not available Cost of Health check-up – Available. Equally apportioned among all the members Even if one person makes a claim, the rest will be eligible for their share of health check up benefit. An example: If sum insured under the 4 year period is Rs 3L, max eligible for health check-up is Rs3000/-. Eligibility per person is Rs.750 (3000/4). If one person has made a claim in the 4 year period, the remaining limit of Rs2250/- will be available for other non-claiming members. 13
F AMILY P ACKAGE – P REMIUM CHART Sum Insured Rs.2,00,000/-Sum Insured Rs.3,00,000/- Age/Family Size 5m-25yrs 26yrs- 30yrs 31yrs- 35yrs 36yrs- 40yrs 41yrs- 45yrs 5m- 25yrs 26yrs- 30yrs 31yrs- 35yrs 36yrs- 40yrs 41yrs- 45yrs 2A A+ 1C A+2C
F AMILY P ACKAGE VERSUS FHO R ESTORE BenefitFamily PackageFHO Restore Sum InsuredEqually ApportionedFloating RatingAge, Family Size & Sum Insured Age, Family Size, Sum Insured & Zone Restoration of Sum InsuredNot AvailableAvailable Sum Insured OptionsOnly 2 optionsMore than 2 options Health CheckupAvailableNot Available BonusNot AvailableAvailable 15
K EY CHANGES IN E XCLUSIONS First Two-years: Listed initial two-year exclusions (No separate 1st year Xclusions): Eye related1: Cataract, Glaucoma, Retinal detachment/ Macular degeneration Eye related2: Lasik/ Laser treatment/ Refractive Error Correction, treatment of eye disorders requiring intra-vitreal injections. E N T related: Deviated nasal septum, Sinusitis, Tonsillitis, Nasal polyps, Chronic Suppurative Otitis Media and related disorders, Stapedectomy. Treatment/removal of Stones: Hepato-biliary/ Gall bladder/ Pancreatic/ Genitourinary calculi Diseases of Female reproductive organs: Uterine -prolapse/ Dysfunctional Uterine Bleeding/ Fibroids/ Pelvic Inflammatory Diseases, Diseases of fallopian tubes and ovaries Preventive/ Cosmetic Treatment: All vaccinations/inoculations (Except Anti-Rabies Injection), Circumcision, Plastic/Bariatric surgery / Weight control treatment etc. 16
K EY CHANGES IN E XCLUSIONS First Two-years – cont’d: Listed initial two-year exclusions (No separate 1st year Xclusions): Joints/Musculo-skeletal: Degenerative diseases of joints/ vertebral disc/ Joint replacement/ IVDP (other than by fresh accident) Certain named procedures: Stem Cell Implantation Therapy/ Enhanced External Counter Pulsation (EECP) therapy and related therapies and Rotational Field Quantum Magnetic Resonance Therapy and such other similar therapies. Non-Allopathic: 25% of SI or Max of Rs Over 60 years Co-pay: 10% co-pay for all claims in fresh/renewal policies 17
K EY CHANGES IN E XCLUSIONS First Two-years – cont’d: Listed initial two-year exclusions (No separate 1st year Xclusions): Congenital Internal defects for first two years. Cost of Medical support/Aids: Spectacles /contact lens, Hearing aids including Cochlear implants, Walkers/ Crutches/ Wheel chairs, Support like CPAP, CAPD, Infusion pump and such other similar aids. 18
R EGULAR EXCLUSIONS Any disease contracted in First 30 days Dental treatment or surgery unless necessitated due to an accident HIV treatment (opportunistic infections of insured HIV patients covered) Pregnancy/Child-birth related treatment Infertility related treatment Naturopathy/ Unconventional/ Unproven therapies Non-medical like registration charges etc 19
R EGULAR EXCLUSIONS – CONT ’ D Varicose veins and varicose ulcers, Benign prostatic hypertrophy Hernia, Hydrocele, Fistula / fissure-in-ano and Hemorrhoids Charges incurred primarily for diagnostic purpose/ Vitamins/Nutritional supplements etc Naturopathy/ Unconventional/ Unproven therapies Non-medical like registration charges etc War, Invasion, Act of Foreign Enemy, Warlike operations/Nuclear perils etc. 20
B ENEFIT COMPARISON Benefits Existing MediclassicRevised Mediclassic Room Rent 2% of SI, Maximum Rs.5000/- per day No Change Nursing Expenses Not included in the room rent Included in the Room Rent No. of Day Care Procedures Cataract Limit Rs 20000/- per eye; Rs30000/- entire policy period Up to Rs 2L SI, Rs 12000/- entire policy period Above Rs 2L and up to Rs 5L, Rs (one eye) and Rs (Entire policy period) Above Rs 5L, Rs (one eye), Rs40000 (entire policy period) Co-Pay Voluntary Co-pay & discount Compulsory Co-Pay of 10% on every claim for persons above 60 Years Automatic-restore facility Not AvailableAvailable, 2-times the basic sum insured 21
B ENEFIT C OMPARISON ( CONT ’ D …) Benefits Existing MediclassicRevised Mediclassic Claims Loading ApplicableNIL First & First 2 year Exclusion First and First 2 year exclusions Only First 2 year exclusions Cover for HIVNo cover available Available is CD4 count is not less than 350 at the commencement of insurance under this policy No Claim DiscountAvailable Not available Voluntary DeductibleAvailable Not Available Policy TermOnly one year term Option of one year and two years. 5% discount for 2 year policy where the premium is paid for the entire 2 year period upfront 22
P REMIUM C HART Medi-Classic Insurance (Individual) Policy Zone Age in yrs /Sum Insured Rs. 5mnths -35yrs Above 80 Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Service Tax Extra The above premium is for a period of 1 year only. 23
P REMIUM C HART FAMILY PACKAGE PLAN Sum Insured (Rs) Age/Family Size 5m-25yrs26yrs-30yrs31yrs-35yrs36yrs-40yrs41yrs-45yrs 2A A+ 1C A+2C Sum Insured (Rs) Age/Family Size 5m-25yrs26yrs-30yrs31yrs-35yrs36yrs-40yrs41yrs-45yrs 2A A+ 1C A+2C Service Tax ExtraA - AdultC - Child This plan is not offered for other sum insured options as the current plan provides for these two sum insured options only RATING SHEET (SERVICE TAX EXTRA) ADD-ON COVERS Hospital Cash350 Patient Care580 The above add-on covers are not available for Family Package Plan Service Tax Extra 24
A NY QUESTIONS, PLS ? Thank You 25