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2 Product Construct – Lifeline Lifeline – Base Cover Inpatient All Day Care Procedure Pre & Post Hospitalization Organ Donor Expenses Domiciliary Treatment Emergency Ambulance Re-load of Sum Insured Ayush Treatment No Claim Bonus Health Check-up ( once in 2 yrs) Vaccination for Animal Bite Health & Wellness PED – 4 years 2 nd Opinion for CI Emergency Domestic Evacuation Classic SI – 2,3,4 lacs Classic SI – 2,3,4 lacs Supreme SI – 5,10,15,20,50lacs Supreme SI – 5,10,15,20,50lacs Elite SI – 25, 30,50,100,150lacs Elite SI – 25, 30,50,100,150lacs International Treatment for 11 Critical Illness Worldwide Emergency Hospitalization PED – 3 years PED – 2 years ClassicSupreme Lifeline – Customer Level Options 1. Top up plan on annual deductible basis 2. Hospital cash Maternity Benefit 1. US/Canada option for worldwide emergency hospitalization & international treatment for 11 CI 2. Hospital Cash 1. Top up plan on annual deductible basis 2. Hospital cash Note - Geographic pricing – Entire country is divided into 2 Zones (Zone 1 - 7 metros and Gujarat State, Zone 2 – Rest of India). Premium in Zone 2 is lower than Zone 1 by 15% as cost of treatment is lower in non metros OPD Benefit 10% Higher NCB Annual Health check up
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3 Lifeline – Classic No room rent cap All day care procedures covered Ayush treatment Vaccination for animal bite Organ donor expenses covered upto SI 10% NCB every year upto max of 50% Pre & post covered upto SI Reload benefit – Incase SI including NCB is exhausted by insured and he is admitted for a different illness then the SI is automatically reloaded upto 100% of base SI. Reload in family floater is applicable to the entire family Key Features FeaturesBenefit Sum Insured2/3/4 Lacs Inpatient CareCovered upto SI Pre and post hospitalization expenses 30/60 days, Covered upto SI All Day care proceduresCovered upto SI Ambulance CoverUpto Rs.3000 Organ Donor ExpensesCovered upto SI Domiciliary HospitalizationCovered upto SI No Claim Bonus 10% of Base Sum Insured upto a max of 50% Re-load of Sum InsuredUpto base SI Ayush Treatment Government Hospitals - Covered upto SI; Other Hospitals – Covered upto Rs.20,000 Vaccination in case of Animal BiteUpto Rs.2500 Customer level options 1. Top-up plan on annual aggregate basis Deductible of Rs.1,2,3,4,5 and 10 lacs 2. Hosptial Cash (for 30 days in case of hospitalization beyond 2 days) Rs.1000/day
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4 Lifeline – Supreme No room rent cap All day care procedures covered Ayush treatment Vaccination for animal bite Organ donor expenses covered upto SI 20% NCB every year upto max of 100% Annual Health Check up Emergency domestic evacuation Pre & post covered upto SI Reload benefit Second opinion for 11 Critical illness PED waiting period – 3 years Key Features FeaturesBenefit Sum Insured5/10/15/20/50 Lacs Inpatient CareCovered upto SI Pre and post hospitalization expenses 60/90 days, Covered upto SI All Day care proceduresCovered upto SI Ambulance CoverUpto Rs.5000 Organ Donor ExpensesCovered upto SI Domiciliary HospitalizationCovered upto SI No Claim Bonus20% of Base Sum Insured upto a max of 100% Re-load of Sum InsuredUpto base SI Ayush Treatment Government Hospitals - Covered upto SI; Other Hospitals - Covered upto Rs.30,000 Vaccination in case of Animal Bite Upto Rs.5000 Emergency Domestic Evacuation (Bed to Bed on advise of treating doctor) Covered upto Rs.100,000 Customer level options 1. Top-up plan on annual aggregate basis Deductible of Rs.1,2,3,4,5 and 10 lacs 2. Hosptial Cash (for 30 days in case of hospitalization beyond 2 days) Rs.2000/day
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5 Lifeline – Elite No room rent cap All day care procedures covered Ayush treatment Vaccination for animal bite Organ donor expenses covered upto SI 20% NCB every year upto max of 100% Annual Health Check up Emergency domestic evacuation Pre & post covered upto SI Reload benefit Second opinion for 11 Critical illness Worldwide emergency hospitalization International treatment for 11 CI Maternity & OPD covered PED waiting – 2 years Key Features FeaturesBenefit Sum Insured25/30/50/100/150 Lacs Inpatient CareCovered upto SI Pre and post hospitalization expenses60/180 days, Covered upto SI All Day care proceduresCovered upto SI Ambulance CoverUpto Rs.10000 Organ Donor ExpensesCovered upto SI Domiciliary HospitalizationCovered upto SI No Claim Bonus20% of Base Sum Insured upto a max of 100% Re-load of Sum InsuredUpto base SI Ayush Treatment Government Hospitals - Covered upto Sum Insured; Other Hospitals - Covered upto Rs.50,000 Vaccination in case of Animal BiteUpto Rs.7500 Emergency Domestic Evacuation (Bed to Bed on advise of treating doctor) Covered upto Rs.300,000 Worldwide Emergency Hospitalization (excluding US and Canada) 50% of Base Sum Insured upto max of Rs.20lacs; Deductible of $1,000 per hospitalization International Treatment abroad for specified 11 CI(excluding US and Canada) Covered upto SI;Airfare covered upto Rs.3 lac OPDCovered upto Rs.10000 Maternity cover upto 2 deliveries Maternity covered upto Rs.2.5 Lacs; New born cover upto Rs.37.5 Lacs;1st year Vaccinations for new born- Rs.10000 Customer level options 1. Include US/Canada for worldwide emergency hospitalization & international treatment for 11 CI Available 2. Hosptial Cash (for 30 days in case of hospitalization beyond 2 days) Rs.5000/day
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6 Key Differentiating Features 1.No Room rent capping – No deduction in claim because of room rent 2.No Disease specific sub-limits – for eg, no sub-limits on cataract treatment, etc 3.Reload of Sum Insured – Doubling the sum insured (in case of different illness for same insured or different insured person) at no extra cost 4.Accelerated No Claim Bonus – Doubling the Sum Insured in 5 claim free year in Supreme & Elite Plan and 1.5 times in case of Classic Plan. No Reduction of No Claim Bonus earned in case of claim in any particular year 5.Vaccination in case of Animal Bite 6.Geography based Pricing – Zone 2 customers are charged 15% less compared to Zone 1 7.Health & Wellness Benefit including Free Health Check-up (Annually in Supreme & Elite, Once in 2 years in Classic Plan) 8.International Coverage including return Air Fare (covered in Elite Plan) 9.Maternity & OPD Treatment (covered in Elite Plan) 10.Comprehensive coverage like All Day Care Procedures, Organ Donor, Pre & Post Hospitalization, etc covered upto Sum Insured
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7 Key Policy Criteria Entry Age: Child – 91days to 25 years Adult – 18 years onward Policy Type Individual Family Floater (relationship between insured should be Self, Spouse and upto 4 children) Policy Tenure – 1 year, 2 years and 3 years. Get discount of 7.5% and 12% in case of 2 years or 3 years respectively Lifetime Renewability Geographic pricing – Entire country is divided into 2 Zones and premium varies as per customer Zone. Zone 2 customers get 15% discount in premium Zone 1 – Delhi/NCR, Mumbai (including Thane, Vashi, etc), Bengaluru, Hyderabad, Chennia, Pune, Kolkata and Gujarat State Zone 2 – Rest of India)
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8 We will not cover any treatment taken during the first 30 days since the commencement of the Policy, unless the treatment needed is a result of an Accident. This waiting period does not apply for any subsequent and continuous renewals of Your Policy. For Cirtical Illness Benefit (in Supreme & Elite), the initial waiting period is of 90 days Waiting periods and exclusions (1/2) Initial Waiting Period 17 specified conditions not covered for first 2 Years 1.Stones in biliary and urinary systems 2.Lumps / cysts / nodules / polyps / internal tumours 3.Gastric and Duodenal Ulcers 4.Surgery on tonsils / adenoids 5.Osteoarthrosis / Arthritis / Gout / Rheumatism / Spondylosis / Spondylitis / Intervertebral Disc Prolapse 6.Cataract 7.Fissure / Fistula / Haemorrhoids 8.Hernia / Hydrocele 9.Chronic Renal Failure or end stage Renal Failure 10.Sinusitis / Deviated Nasal Septum / Tympanoplasty / Chronic Suppurative Otitis Media 11.Benign Prostatic Hypertrophy 12.Knee/Hip Joint replacement 13.Dilatation and Curettage 14.Varicose veins 15.Dysfunctional Uterine Bleeding / Fibroids / Prolapse Uterus / Endometriosis 16.Diabetes and related complications 17.Hysterectomy for any benign disorder
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9 Addictive conditions and disorders; Adventurous or Hazardous Sports; Ageing and puberty; Alternative Treatment; Ancillary Hospital Charges; Artificial life maintenance; Charges for Medical Papers; Circumcision; Conflict and Disaster; Congenital conditions; Convalescence and Rehabilitation; Cosmetic surgery; Dental/oral treatment; Drugs and dressings for OPD Treatment or take-home use; Eyesight; Health hydros, nature cure, wellness clinics etc.; HIV and AIDS; Hereditary conditions (specified); Hospitalization undertaken for observation or for investigations only; Items of personal comfort and convenience; Psychiatric and Psychosomatic Conditions; Obesity; OPD Treatment; Preventive care; Reproductive Medicine; Self-inflicted injuries; Sexual problems and gender issues; Sexually transmitted diseases; Sleep disorders; Speech disorders; Stem Cell Implantation; Treatment for Alopecia; Treatment for developmental problems; Treatment received outside India; Unproven/Experimental Treatment; Unrecognized physician or Hospital; Unrelated diagnostic, X-ray or laboratory examinations; Unlawful Activity; Any costs or expenses specified in the List of Expenses Generally Excluded as Annexure II in Policy Wording Waiting periods and exclusions (2/2) Classic – 4 years Supreme – 3 years Elite – 2 years Pre-Existing ConditionsPermanent Exclusions
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10 Underwriting Criteria 1.Sum Insured >=10lacs 2.Age >= 46 years 3.Any ‘yes’ to 6 medical questions in proposal form 4.All Portability proposal (external as well as internal) 5.Body Mass Index >= 33 Policy Issuance Process TVS FOS submits proposal form, documents and payment at branch ops Is policy straight pass on following 5 criteria Operations team enters details in policy issuance system Policy dispatched to customer at T+7 Policy received by customer T+9-T+12 Yes Case flows to medical underwriting team who calls customer & asks 15-20 health questions PPMC Yes Policy dispatched to customer at T+12, T+25 Policy received by customer T+14-T+25 No Policy approved Yes Case rejected, customer informed No
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11 Example of Lifeline VS United India Age-45 years SI-3 Lacs Premium Rs. 10,406 (Zone 2 – Cochin, Calicut, etc) (for a family combination of 2 Adult + 2 Children) Lifeline Age-45 years SI-3 Lacs Premium Rs.11,149 (for a family combination of 2 Adult + 2 Children) United Family Medicare Customer admitted for Kidney Stone @ Aster Medicity with room rent of Rs.4000. No room rent capping under Lifeline Cost of treatment Rs.80,000 Claim paid by RS under Lifeline- Rs.80,000 Customer admitted for Kidney Stone @ Aster Medicity with room rent of Rs.4000. Room rent cap of 1%, ie.Rs.3000 Cost of treatment Rs.80,000 Claim paid by Star Health- Rs.60,000 The premium paid in Zone 2 is lower than United and due to no room rent cap, entire amount is paid in case of claim
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12 Lifeline Premiums IndividualClassicSupremeElite Age2L3L5L10L50L150L 30 3,567 3,984 4,911 6,726 43,959 62,082 35 3,923 4,303 5,549 7,638 47,789 68,543 40 4,391 4,818 6,289 8,551 53,622 75,677 45 5,567 6,122 7,724 10,092 59,772 83,554 50 7,263 8,129 10,082 12,816 72,226 88,726 55 9,654 11,577 15,497 19,217 83,557 1,02,035 60 12,654 15,557 21,176 27,452 98,437 1,18,629 65 17,072 21,331 27,793 35,330 1,22,160 1,46,778 2A+2CClassicSupremeElite Age2L3L5L10L50L150L 30 6,502 7,478 10,183 14,465 83,491 1,09,402 35 7,101 8,116 11,106 15,734 91,323 1,13,756 40 7,670 8,817 12,221 17,075 95,982 1,20,691 45 9,736 10,739 12,967 19,219 1,05,289 1,36,616 50 13,017 14,617 18,051 24,204 1,23,595 1,52,557 55 17,246 20,740 24,858 32,666 1,43,589 1,76,541 60 22,701 27,975 33,347 43,477 1,73,439 2,11,607 65 30,973 38,778 47,409 61,394 2,27,752 2,69,894
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13 Market positioning – Classic Plan Area Royal Sundaram – Lifeline Star Health – Medi Classic Baja Allianz Health Guard ICICI Lombard CHI United India No room rent capping All Day care procedures Pre/Post Hospitalization upto SI Ayush Treatment Reload benefit Vaccination in case of Animal Bite Health check-up irrespective of claim NCB benefit without penalty No Disease specific sub-limit Domiciliary Treatment Health & Wellness Organ donor expenses No Co-payment
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14 Market positioning – Supreme Plan Area Royal Sundaram – Lifeline Star Health – Medi Classic Baja Allianz Health Guard ICICI Lombard CHI United India No Room Rent capping No Entry Age Restriction Pre/Post Hospitalization upto SI Reload of Sum Insured NCB benefit without penalty Second opinion Annual Health Check-up Domestic Evacuation Ayush Treatment All Day Care Procedures No Disease Specific Capping Organ donor expenses Health & Wellness
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15 Market positioning – Elite Plan Area Royal Sundaram – Lifeline Star Health – Medi Classic Baja Allianz Health Guard ICICI Lombard CHI United India Sum Insured No Room Rent capping Pre/Post Hospitalization upto SI Reload of Sum Insured NCB benefit without penalty Second opinion Annual Health Check-up International Coverage Maternity benefit Domestic Evacuation Ayush Treatment All Day Care Procedures No Disease Specific Capping Organ donor expenses
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16 Premium Comparison – Individual (excluding service tax) (1/2)
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17 Premium Comparison – Individual (excluding service tax) (2/2)
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18 Premium Comparison – 2 Adults 2 Children (excl Service Tax) (1/2)
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19 Premium Comparison – 2 Adults 2 Children (excl Service Tax) (2/2)
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20 Thank You
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