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2015 Edelweiss Insurance Brokers Limited (EIBL) Super Top Up Policy
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Today’s Healthcare Cost Concern 2 Increased Healthcare Cost Advent of new Lifestyle diseases Corporatisation of Healthcare Advancement of Medical Technology Increasing Awareness General Inflation
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Current Solutions to the Healthcare Cost Concern 3 Group Mediclaim Policy Advancement of Loan Any other option???
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Current Solutions to the Healthcare Cost Concern 4 Confusion of abundance Restricted Benefits Pre-policy check up High Premium Any other Solution??? Personal Mediclaim Policy
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Alternative Solution 5 Confusion of abundance Restricted Benefits Pre-policy checkup High Premium Super Top Up Policy for Publicis Employees, specially designed by EIBL with Oriental Insurance Co. Ltd.
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6 1.This policy has coverage for employees and dependants which include spouse, children, parents or parent in laws. The identical family covered under Group Mediclaim will be covered for Super Top Up Policy. 2.No Medical check up / pre policy checkups. 3.The policy can be issued on family floater sum insured basis i.e. Single sum insured would be applicable for entire family and the same can be utilised by any of the insured family member. 4.Single documentation required for processing claims and hence employee need not to arrange any other documents for Super Top Up policy. 5.Paramount Health Services (TPA) Pvt. Ltd., will service the cashless and reimbursement claims under Super Top Up policy. 6.This policy will trigger only when the aggregate of covered hospitalisation expenses exceeds the Sum Insured under Group Mediclaim policy. 7.Employee has option to select sum insured from the choice of the sum insured from Rs.1 lakh to 20 Lakh. 8.This policy will be governed by Terms, conditions, exclusions and warranties of the Basic Group Mediclaim Policy. Highlights of the Policy
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Benefits 7 Claims under this Policy shall be payable only if the aggregate of covered Medical Expenses in respect to Hospitalisation(s) of Insured Person exceeds the Sum Insured under the Group Mediclaim Policy availed by Publicis The benefits covered are as below: 1.All the coverage's available under Publicis Group Mediclaim will be carried forward. 2.In-patient Treatment -Medical expenses for room rent, boarding expenses, nursing, ICU, medical practitioner, anesthesia, blood, oxygen, operation theatre charges, surgical appliances, medicines, drugs and consumables, diagnostic procedures, cost of prosthetic and other devices or equipment if implanted internally during a Surgical Procedure. 3.Waiver of Pre Existing diseases ; 1st year, 2nd year exclusion ;first 30 days exclusion. 4.Pre-Post hospitalization 5.Day Care Expenses 6.Claims paid under basic policy in which claim amount exceeds the sum insured of basic policy, super top up policy will pay the balance claim amount.
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Exclusions under Super Top Up Policy 8 The following expenses will not be covered under the policy: 1.Maternity Expenses, Pre & Post Natal Expenses, Baby Day 1 cover expenses. 2.Co-pay, Capped Diseases and Non admissible expenses deducted under Basic GMC policy of Publicis 3.All Exclusions of Basic GMC Policy like Cosmetic Surgery, Dental and cost of Spectacle, treatment of Obesity. 4.Domiciliary Hospitalization, Naturopathy, Stem Cell Surgery. Please note that all the terms and conditions applied in the Group Base Mediclaim policy will be applicable in the Top-up Policy
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Special Features 9 1.TPA : Same TPA (i.e) Paramount Health Services (TPA) Pvt. Ltd. for basic and Top-Up policy. Employee need not to prepare two set of documents. 2. Financial Saving: Financial saving by avoiding dent to your saving when hospitalisation cost exceeds the sum insured of your basic Group Mediclaim.
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Premium (Excluding Service Tax) 10 Premium Rates applicable Top Up Sum InsuredPremiumService Tax Total Payable 1 Lakhs 3500 5084007 2 Lakhs 4000 5804580 3 Lakhs 4500 6535153 5 Lakhs 5000 7255725 10 Lakhs 8000 11609160 15 Lakhs 11000 159512595 20 Lakhs 12500 181214313
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Insurance Broking services offered by Edelweiss Insurance Brokers Limited a Direct Broker (General) registered under IRDA License No.: 295 valid for a period from March 24, 2014 till March 23, 2017. Registered Office: Edelweiss House, Off CST Road, Kalina, Mumbai – 400098; Tel. (022) 4009 4400 Corporate Office: Unit No. 102, 10 th Floor, Sakhar Bhavan, 230, Nariman Point, Mumbai – 400021; Tel. (022) 6624 2600 Disclaimer This Information Package is distributed by Edelweiss Insurance Brokers Limited (hereinafter “Edelweiss”) on a strictly private and confidential and on a need to know basis. This Information Package and the information and projections contained herein may not be disclosed, reproduced or used in whole or in part for any purpose or furnished to any other person or persons. The Persons who are in possession of this Information package or may come in possession at a later day, hereby undertakes to observe the restrictions contained herein. The information contained herein is of a general nature and is not intended to address the facts and figures of any particular individual or entity. The information contained herein is from publicly available data or other sources believed to be reliable, but we do not represent that it is accurate or complete and it should not be relied on as such. The content provided here treats the subjects covered here in condensed form. It is intended to provide a general guide to the subject matter and should not be relied on as a basis for business decisions. No one should act upon such information without making appropriate additional professional advice after a thorough examination of the particular situation. This Information Package is distributed by Edelweiss upon the express understanding that no information herein contained has been independently verified. Further, no representation or warranty expressed or implied is made nor is any responsibility of any kind accepted with respect to the completeness or accuracy of any information as may be contained herein. Also no representation or warranty expressed or implied is made that such information remains unchanged in any respect as of any date or dates after those stated herein with respect to any matter concerning any statement made in this Information Package. Edelweiss or any of its affiliates/ group companies/ directors/ employees/ agents/consultants shall not be in any way responsible for any loss or damage that may arise to any person from any inadvertent error in the information and shall have no liability (including liability to any person by reason of negligence or negligent misstatement) for any statements, opinions, information or matters (express or implied) arising out of, contained in or derived from, or for any omissions from the Information Package and any liability whatsoever for any direct, indirect, consequential or other loss arising from any use of this information package and/or further communication in relation to this information package. All recipients of the Information Package should make their own independent evaluations and should conduct their own investigation and analysis and should check the accuracy, reliability and completeness of the Information and obtain independent and specific advice from appropriate professional advisers, as they deem necessary. Where this Information Package summarizes the provisions of any other document, that summary should not be relied upon and the relevant. The information contained in this document is confidential in nature and the recipient is receiving all such information on the express condition of confidentiality unless expressly authorized in writing by Edelweiss. If you are not the intended recipient, you must not disclose or use the information in this document in any way whatsoever. If you received it in error, please inform us immediately by return e-mail and delete the document with no intention of its being retrieved by you. We do not guarantee the integrity of any e-mails or attached files and are not responsible for any changes made to them by any other person. The data contained in this presentation is only indicative / illustrative. This information is subject to change without any prior notice. Edelweiss reserves the right to make modifications and alterations to this statement as may be required from time to time. However, Edelweiss is under no obligation to update or keep the information current. This presentation and its respective contents do not constitute an offer or solicitation of any Insurance Broking services. Insurance is the subject matter of solicitation. Disclaimer
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