1. Revision

2.  Room rent revised  Class A and Class B cities redefined  Cataract limits revised  Portability brought in  101 day-care procedures included  Cumulative bonus in lieu of discount  Claims Loading removed  Automatic replenishment of SI upon exhaustion of SI

3.  Two tier rating introduced  Zone 1 applicable for Mumbai, Delhi ( Delhi city, Noida, Gurgoan,Ghaziabad, Faridabad) and entire Gujarat State will carry a higher rate  Zone 2 applicable for the rest of India will carry a slightly lower rate  Premium variation between the zones is between 4% to 11%

4.  Premium chargeable will be based on the address of the customer  It is mandatory for the operating offices to get the correct and complete address.  Incomplete proposal forms NOT TO BE ACCEPTED

5.  Policy taken with Zone 2 rates and treatment in Zone 1 areas NO co-payment as is the case with other insurance companies  But the difference in premium between the Zones will be recovered (adjusted in the claims)  Medical screening as per the usual practice to continue  New Rs 15lacs option introduced

6.  Bonus eligibility-  Where the previous policy is claims free then the insurance will be renewed under New FHO with the first slab of Bonus as applicable for the expiring sum insured.

7.  Expiring policy FHO  2A+ 2C sum insured Rs 2 lacs  Renewed under New FHO  Same family Size but SI is Rs 4 lacs  No claim under the previous policy  Eligible Bonus will be 10% that is Rs20000/-

8.  This policy is portable.  The benefit of continuity will be given only for 30 Days, PED, FY and F2Yrs exclusion  The sum insured will be limited to the expiring policy sum insured only  BONUS EARNED WITH THE PREVIOUS INSURER WILL NOT BE GIVEN CREDIT

9. BENEFITS EXISTING BENEFITS REVISED  Room Rent  A Class City Rs1500/  B Class City Rs 750/  Other s Rs 500/  Room Rent  A Class City Rs 5000/  B Class City Rs3000/  Others Rs1000/

10. BENEFITS EXISTING BENEFITS REVISED  Less than 24 Hrs treatment at Hospital “Day Care Procedure”  Specific named proced ures Now 101 Procedures allowed

11. Sum InsuredAmount Per Eye Rs Amount Per Policy Period Rs Upto Rs200000/ 12000/ Rs 3/4/5 Lakhs Rs 20000/ 30000/ Rs 10 lakhs Rs 30000/ 40000/

12. EXISTING REVISED Average claims ratio of preceding two consecutive years Loading on Premium % >100%- 125% 30 >125%- 150% 50 > 150 %80  NO CLAIMS LOADING

13. EXISTING REVISED  A discount of 10% is allowed on renewal of the policy if there is no claim in the immediately preceding year of the policy. This discount is not cumulative No discount

14.  Automatic Restoration of Sum Insured WHERE THE SUM INSURED IS EXHAUSTED DURING THE POLICY PERIOD IT IS AUTOMATICALLY TOPPED UP BY 50% FOR SUM INSURED OF RS 3 LACS AND BY 100% FOR SUM INSURED ABOVE RS 4 LACS AND ABOVE

15. Sum Insured%of restoration on the Basic Sum Insured Up to Rs 2 Lakhs Nil Rs 3 Lakhs 50% Rs 4 and above 100% SUCH REPLENISHED AMOUNT SHALL NOT BE UTILISED FOR ANY AILMENT FOR WHICH CLAIM HAS BEEN MADE

16.  Let us assume a family of 2A + 1C has taken a policy for Rs 300000/-  1A is hospitalised for ailment (say for example Hernia) and the entire sum insured of Rs 300000/- is exhausted.  Now the restoration clause will operate and a sum of Rs 150000/- will now be available for the remaining policy period only and no additional premium is chargeable for this  This Rs 150000/- can be utilised by the same person 1A for any ailment unrelated to Hernia. Other persons under the policy can also utilise the sum insured until policy expiry date.

17.  Bonus For every claim free year Bonus upto the scales is allowed. The bonus ranges from 10% to 25% in the first renewal and additional 5% to 10% for the second renewal.

18. Basic Sum Insured Rs I YearIIYear % III Year % Maximum Cumlative Bonus % 100000Nil10515 200000Nil10515 300000Nil251035 400000Nil251035 500000Nil251035 1000000Nil251035 1500000Nil251035

19. YearBasic Sum Insured Rs Claims RsBonus in Rs First Year300000Nil Second Year300000Nil75000 Third Year300000Nil105000 Fourth Year300000Nil105000

20. In any case the maximum bonus shall not exceed 35% for sum insured of Rs 3 lacs and above and 15% for sum insured below Rs 3 lacs

21.  Bonus will be computed on the basic sum insured  If there is a claim the earned bonus will be reduced by 50%  If there is a claim in the successive year the bonus will become zero

22.  SUM INSURED OPTION-WISE 2 LACS – MAX DIFF RS 2600 IN AGE BAND-51 TO 55 YRS 3 LACS – RS 2560 4 LACS- RS 2000 5 LACS – RS 3800 ALL FOR ZONE 1

23.  EXAMPLE – INSURED 52YRS FAMILY SIZE 2A+ 2C SUM INSURED RS 5 LACS ZONE 2  2 CLAIM FREE YEARS. THE SAVINGS CAN BE USED FOR BUYING A SURPLUS POLICY SUM INSURED PREMIUM STAR MARKET PREM SAVINGTOTAL COVERAGE INCL BONUS 50000016075204744399500000 + 175000=675000 1000000*4300675000+1000000=1675000** *SUPER SURPLUS ** BUT MARKET POL SI WILL BE RS 500000 +BONUS RS500000= TOTAL RS 1000000 ONLY

24.  NO ONE YEAR WAITING PERIOD – MIN WAITING PERIOD IS 2 YRS UNDER POLICY  BONUS; IF THERE IS A CLAIM THE BONUS IS REDUCED BY 50% OF THE BASIC SI. THAT IS WHAT IS EARNED IS LOST

25.  FOR EG X TAKES A POLICY FOR RS 3 LACS  HAS ONE CLAIM FREE YR  IN YR 2 HIS COVERAGE AMNT IS RS450000/-  IN YR 3 HE LODGES A CLAIM AND IN YR 4 HIS COVERAGE WILL BE ONLY THE BASIC SI OF RS 3LACS  THE BONUS EARNED IS TOTALLY LOST – BUT HE CONTINUES TO PAY THE HIGHER PREMIUM

26.  NOW UNDER OUR POLICY  YR 1 POLICY FOR RS 3LACS- NO CLAIM  YR 2 HIS COVERAGE IS RS 300000+75000(B)  YR 3 THERE IS A CLAIM  YR 4 HIS COVERAGE WILL BE 300000+37500 HE CAN HAVE THE CAKE & EAT IT TOO !