1. DAILY LEARNING AUGUST 2018

2. Accident Care Individual Question : What is Table A, Table B and Table C under PA Policy? Answer : Table A - Only Death Cover. Table B - Death Cover + Permanent Partial Disability (PPD) + Permanent Total Disability (PTD) Table C - Death Cover + Permanent Partial Disability (PPD) + Permanent Total Disability + Temporary Total Disability (PTD-Weekly Compensation)

3. No Pre Medical-Health Policies Question : What are the Health policies are available without Pre Medical screening even the Age above 50? Answer : 1.Family Health Optima (FHO) 4L and above SI irrespective of Age. 2.Star Comprehensive irrespective of Age and SI. 3.Senior Citizens Red Carpet irrespective of Age and SI. 4.Star Cardiac Care irrespective of Age and SI. 5.Star Diabetes Safe irrespective of Age and SI (Only for Plan B). 6.Star Cancer Care irrespective of Age and SI. 7.Star Special Care (Autism) irrespective of Age. 8.Star Health Gain irrespective of Age and SI. 9.Star Super Surplus irrespective of Age and SI. 10.Star Care irrespective of Age.

4. COMPREHENSIVE INSURANCE PLAN WHY CHI IS SPECIAL?  Single Standard A/C Room  Pre & Post Hospitalization  Domiciliary Hospitalization  Auto Restoration 100% of SI  Delivery Expenses & New Born Baby Cover  OP Medical Consultation benefits  Both Road & Air Ambulance Benefits  Free Health Checkup  Hospital Cash Benefit  Free Personal Accident Cover  Up to 405 Day Care Procedures  No Sub Limit for Cataract Surgery  Second Medical Opinion  Bariatric Surgery  Adults entry age 61 to 65 yrs - Co pay 10%  Pre Medical Screening not necessary for persons above 50 yrs  No Claim Bonus up to 100% &Life Long Renewal

5. RECHARGE BENEFIT  Additional indemnity support @ free of cost  Recharge is REAL PROTECTION whenever SI is exhausted  Available for your existing claims A) 75,000/- for 3L SI B)1,00,000/- for 4L SI C)1,50,000/- for 5L & Above SI  Triggered when limit of coverage (Basic SI & NCB) not sufficient  Benefit available only in FHO

6. RTA - Road Traffic Accident Additional Sum Insured RTA - Road Traffic Accident  To avail this benefit wearing helmet is Must while traveling in Two Wheeler  Benefit avl. for all SI  25% of Basic SI up to max of Rs.5,00,000/- Ex: For SI 5 L increased SI is 1.25 L Additional SI avl. only once during the policy period Benefit available only in FHO

7. Emergency Domestic Medical Evacuation (Ambulance) Benefit available only in FHO The company will reimburse reasonable and necessary expenses incurred towards transportation of the insured person from one hospital (where the insured person is currently undergoing treatment) to another hospital (for further treatment) provided: a) The medical condition of the Insured Person is a life threatening emergency b) Further treatment facilities are not available in the current hospital c) The Medical Evacuation is recommended by the treating Medical Practitioner d) Claim for hospitalization is admissible under the policy Limit per hospitalization: up to 4L SI = up to Rs. 5000/- 5 L - 15 L SI = up to Rs. 7,500/- 20L & 25 L SI = up to Rs. 10,000/- Payment under this benefit does not form part of the SI. This benefit is an excellent USP for rural areas (Unique Selling Point)

8. HOSPITAL CASH  Cash benefit which takes care of uncovered sundry expenses  Benefit avl. when there is an admissible claim  No need to submit bills ▪ CHI - Benefit inbuilt  Does not reduce SI in primary cover  The day of admission is excluded in all claims Max. 7 days per hospitalization Max. 120 days per policy period  Per day Cash limit is min. 500/- to max. 1500/- ▪ MCI - Rider Benefit (optional)  Rider Premium Rs. 413/- (incl. Tax)  The day of admission & the day of discharge are excluded in all claims Max. 7 days per hospitalization Max 14 days per policy period  Per day cash limit is Rs. 1000/-

9. ACCIDENT CARE CLAIM DOCUMENTATION  1. Claim intimation  2. Reimbursement claim documents  ▪ For Death Claims Death certificate Post-mortem certificate, if conducted FIR (wherever req.) PIR (wherever req.) Viscera Sample Report (wherever req.) Forensic Science Lab Report (wherever req.) Legal Hair Certificate Succession Certificate (wherever req.) ▪ For Disability Claims Certificate from Govt. Doctor Certificate from the employer confirming leave of absence from duty

10. BARIATRIC SURGERY  Max payable limit is 2,50,000/- incl. pre & post hospitalization  Min. Age during surgery Above 18 yrs  Waiting Period 36 months  Claim processed only on cashless basis & obtain prior approval for cashless treatment.  The limit of cover forms part of SI.  To make a claim, NIH (National Institute of Health) criteria followed:  The BMI >40 or >35 with co-morbidities (like Diabetes, High Blood Pressure etc.)  Is unable to lose weight with traditional methods like diet & exercise  Benefit available only in Comprehensive plan

11. Question & Answer -Diabetes  Question : What is the waiting period for Diabetic and related treatment in Diabetes Safe Product under Plan B?  Answer :Earlier it was 15 Months. Now it has been reduced to 12 Months w.e.f. 03/08/2018.

12. STAR SPECIAL CARE A Special policy for Autistic Children What are the documents to be accompanied while receiving proposals? a)Birth D/S summary b) Prior Treatment & Investigation Reports c)Autism assessment Chart / Score Records will be examined by doctors for risk- acceptance

13. COMPASSIONATE TRAVEL  Air Travel expenses of one immediate family member  Insured person hospitalized for life threatening emergency  Away from his usual place of residence  Avl. for other than the travel companion  Avl. if the hospitalization is admissible  Reimbursed up to Rs. 5000/-  Benefit avl. from 10 L & Above SI  This benefit will not form part of SI  Benefit avl only in FHO

14. FAMILY HEALTH OPTIMA Zone Based Pricing  ZONE 1: Mumbai, Thane, Delhi incl. Faridabad, Gurgaon, Ghaziabad & Noida, Ahmedabad, Baroda, Surat.  ZONE 1a :Chennai, Bangalore, Pune, Nasik, Ernakulam, Trivandrum & Rest of Gujarat  ZONE 2 :Coimbatore, Indore City & Rest of Kerala  ZONE 3 :Rest of IndiaZone determines Premium based on Proposer's pin code

15. FHO- Cash Benefits  What are the two types of cash benefits available in FHO Policy? ▪ Shared Accommodation Limit per day is Rs. 800/- for 3L to 15L SI Rs. 1000/- for 20L & 25L SI ▪ Treatment @ Preferred Network Hospital- Lump sum Benefit 1% of SI with max. limit of Rs. 5000 per policy year

16. FHO- Top 10 Features  What are the Brand New TOP 10 Features in Revised FHO Policy?  Air Ambulance  Domestic Medical Evacuation  Compassionate Travel  Repatriation of Mortal Remains  Treatment @ Preferred Network Hospitals  Shared Accommodation  AYUSH Treatment  Second Medical Opinion  Assisted Reproduction Treatment  Additional SI for 2 wheeler RTA

17. FHO-Without Reducing the SI  Benefits that do not reduce the Sum Insured (separate limits) ▪ Treatment in Preferred Network Hospitals ▪ Shared Accommodation ▪ Cost of health Check-up after a claim free year ▪ Emergency Domestic Medical Evacuation ▪ Compassionate Travel ▪ Repatriation of Mortal Remains ▪ Road Traffic (Two-wheeler) Accident

18. FHO-With Reducing the SI  Benefits that reduces Sum Insured  ▪ In-Patient Treatment  ▪ Day Care Treatment  ▪ Emergency Ambulance  ▪ Air Ambulance  ▪ Pre-Hospitalization  ▪ Post-Hospitalization  ▪ Domiciliary Hospitalization  ▪ Organ Donor Expenses  ▪ Hospitalization expenses for Treatment of New Born Baby  ▪ AYUSH Treatment  ▪ Assisted Reproduction Treatment

19. Geographical Scope:  The Insurance Cover under these Sections Applies Worldwide  ▪ COMPREHENSIVE HEALTH INSURANCE Accidental Death & Permanent Total Disablement (Section 7)  ▪ DIABETES SAFE Personal Accident (Section 4)  ▪ CARDIAC CARE Personal Accident (Section 4)

20. MEDI CLASSIC INSURANCE (INDIVIDUAL) :  Q: What benefit the customer will get if he pays for 2 years policy period in MCI policy?  Ans: The customer can enjoy 5% Discount on Premium

21. MEDI CLASSIC INSURANCE (INDIVIDUAL) :  What are the two optional rider benefits available in MCI policy? ▪ Hospital Cash (Recover your uncovered sundry expenses) ▪ Patient Care (A special home care extension for 60+)

22. MEDI CLASSIC INSURANCE (INDIVIDUAL) : Patient Care - Optional rider benefit(cost of engaging an attendant at residence immediately after discharge from hospital) ▪ Should be recommended by the attending physician ▪ Only for persons above 60 yrs of age ▪ Benefit of Rs. 400/- for each completed day ▪ up to 5 days per hospitalization & 14 days per policy term ▪ Only consequent to a valid hospitalization ▪ No payment for the first day ▪ Bills to be submitted ▪ Premium Rs. 580/- (excl. Tax)

23. SENIOR CITIZEN RED CARPET : Do we have Pre & Post Hospitalization benefits in SCRC policy? ▪ No Pre Hospitalization benefit ▪ Post Hospitalization 7% of hospital expenses subject to maximum of Rs.5000/-

24. SENIOR CITIZEN RED CARPET : If the Senior submits Medical Reports ▪ Stress Thallium Report ▪ Blood Pressure Report ▪ Sugar (Blood & Urine) ▪ Blood Urea & Creatinine Medical reports within 45 days prior to date of Proposal. Cost borne by Proposer Every year can avail 10% Discount on Fresh & Renewal Premium

25. SENIOR CITIZEN RED CARPET : Unbelievable Features of SCRC ▪ Policy for the age group of 60 to 75 yrs ▪ Seven SI options ▪ No Medical Screening ▪ PED covered from 13th month onwards ▪ Premium will not increase with increase in Age ▪ Life Long Renewal Guarantee ▪ OP Consultation Benefit ▪ Emergency Ambulance service ▪ All Day Care covered ▪ 10% Discount on Fresh & Renewal Premium (submit specific medical records)

26. CHI: Free In-built PA Cover ▪ PA SI equivalent to SI in medical cover ▪ Accidental Death & Permanent Total Disability covered ▪ Disability covered 100%, if the disablement occurs within 12 calendar months from the date of the Accident ▪ The disablement is confirmed & claimed for, prior to the expiry of a period of 60 days since occurrence of the disablement ▪ Cover given for one nominated person ▪ Dependant Children & persons above 70 yrs cannot be nominated for cover ▪ Any claim under health portion will not affect the SI under this Section 7 ▪ The cover under this section applies Worldwide

27. ACCIDENT CARE -Additional Benefits : Additional Benefits: ▪ Purchase of Blood ▪ Transport costs of imported medicine ▪ Vehicle and/or Residence modification ▪ Ambulance/Transport of mortal remains ▪ Travel expenses to one relative - in case of Accidental death of insured ▪ Education grant to dependent children (max. of 2 children)

28. DAY CARE PROCEDURE : Day Care Treatment means Medical Treatment and/or Surgical Procedure which is: A.Undertaken under general or local anesthesia in a hospital/day care centre in less than 24 hrs because of technological advancement and B. Which would have otherwise required a hospitalization of more than 24 hrs. Treatment normally taken on an out-patient basis is not included in the scope of this definition. ▪ FHO, MCI, DIABETES SAFE & CARDIAC CARE - All Day Care Procedures Covered without any Sublimit except Cataract Surgery ▪ CHI - All Day Care Procedures covered without any sublimit ▪ SCRC - All Day Care Procedures covered with sublimit for listed treatments as per the Policy Clause