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December, 2008
Presenting a new health plan.
Trust us,
your customer will thank
youfor it!
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V1 2
Life Expectancy in India
64
2005
75*48Age
(in Years)
20251955Year
*Source: The OASIS (Old Age Social and Income Security committee
report)
The customer will live longer
..but not necessarily healthier
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Working42 yrs
Age 18 to 60
Retirement7 yrs
Age 60 to 67
Working30 years
Age 25 to 55
Retirement20 years
Age 55 to 75
Life stage of average individual
Previous
generation
Today
The customer will live longer
but not necessarily work longer
Is our customer prepared to meet health expenses during this
phase?
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Source : Outlook Money,31st May,2007`
The customer will make more money
but not necessarily meet the rising cost of healthcare
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26% of the consumers investing in tax saving
instruments in the last two years invested in
health insurance.
23% of the consumers who are planning to
invest in tax saving instruments in the next oneyear want to
invest in health insurance.
Findings from a consumer research conducted by ICICI
Prudential in Sep 08 across Mumbai, Chennai and Delhi
The customer will buy insurance to save tax
but not necessarily onlyfor Section 80 C
91% of the consumers are aware of health
insurance as a tax saving instrument.
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A plan which:
Provides guaranteed reimbursement
hospitalization cover till age 75
Builds up a health fund and allowsclaims for health expenses
not
covered in the hospitalization cover
Flexibility in premium payment
Gives complete tax benefit under
Section 80D
Yes,the customer will need a health plan
but not necessarily the oneYouhave in mind
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Rise to the health cover challenge
If this is the
customer s present
state
How will you balance?
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Presenting
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Complete Tax Benefit
under Section 80D
Cover with a dual benefit
Allows claim against
out-patient treatment,
diagnostics, dental
care etcReimbursement
based
hospitalization
coverage Builds a health
fund to cope with
rising cost ofhealth care
Hospitalisation
Insurance
Benefit
Health
Savings
Benefit
Comprehensive whole life health offering
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How does the plan work?
Health Savings
Benefit
Hospitalisation Insurance
Benefit
To cover you against
hospitalization expenses
To cover you against all other
health expenses
Select the annual limit for the hospitalization cover
Select a suitable premium
*Invested premiums mean premiums post deduction ofapplicable
charges
Basis age and annual limit chosen, part of premium will go
towards the health cover and remaining invested to build a
health fund*
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CoverageScope
Comprehensive
Cover
(Including OPD &
Daily costs)
Hospitalization
CI/Disability / Major
surgery
Comprehensive health offering
Specific cover
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The features in detail
Hospitalisation
Insurance Benefit
Health Savings
Benefit
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The features in detail
Hospitalisation
Insurance Benefit
Health Savings
Benefit
Covers actual expenses
incurred during
hospitalization
Room, boarding and nursing charges, ICU charges
Maximum room rent payable to be 1% of selected
annual limit only for single A/C rooms
Fees for doctor, surgeon, specialist, etc
Anesthesia, blood, oxygen, operation theatre,
surgical appliances, medicines, etc
Pre & Post hospitalization expenses for 30 & 60
days
125 listed day care procedures
Ambulance charges upto Rs 1000 per year
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The features in detail
Hospitalisation
Insurance Benefit
Health Savings
Benefit
Guaranteed coverage
till age 75No re-evaluation of health status or refusal of
cover
during term
No addition of exclusions or increase in premiums
due to claims made
No claims Bonus A bonus of 5% on annual limit added for every
claimfree year
Bonus amount up to 25% can be added
Family floaterCover yourself, spouse and upto 3 dependant
children
under same plan
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The features in detail
Hospitalisation
Insurance Benefit
Health Savings
Benefit
Free Health CheckupA free health check-up once every 2 policy
years after
the first year
Reimbursement of amount up to 1% of annual limit or
Rs 5000 whichever
Pre-Existing illnesses
CoverPre-existing illnesses covered after 2 years
The disease to be declared at inception & accepted
by the company
Cashless
HospitalizationCashless claims settlement in over 5000
network
hospitals
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The features in detail
Hospitalisation
Insurance Benefit
Health Savings
Benefit
Wide network access
with preferred benefits
Access to a network of over 5000 hospitals
A Co Pay of 20% applicable for room upgrade over
prescribed limit in single A/c room or for claims in
outside network hospitals
In Emergency, co-pays does not apply in cardiac or
trauma cases at a outside network hospital
Click here for co-pay illustration
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The features in detail
Hospitalisation
Insurance Benefit
Health Savings
Benefit
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The features in detail
Hospitalisation
Insurance Benefit
Health Savings
Benefit
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The features in detail
Hospitalisation
Insurance Benefit
Health Savings
Benefit
Build a Health Fund for
the future
Choose from two portfolio strategies :
Lifecycle strategywherein allocation is basedon customers age
with rebalancing on a quarterly
basis
As age progresses, allocation changed to suit Life
stage.Click here to know more.
Fixed strategywherein a customer can do hisown asset
allocation.
The customer can chose from 7 fundsClick here to know more
Includes Health
Return
Guarantee Fund
With
Automatic
Transfer
Strategy
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The features in detail
Hospitalisation
Insurance Benefit
Health Savings
Benefit
Claim for any health
expenses after 3 years
Claim are allowed from 4thyear onwards against
medical bills. Claims can be made for:
Daily medicines and drugs
Diagnostic expensesDoctor bills and other OPD expenses
Co-pays /deductibles of other medical insurance cover
Miscellaneous medical expense over and above that
covered by Hospitalization Insurance
Claim schedule:
Claims can be made once every year, with minimum claim amount
of
Rs 1000
100%50%20%Maximum claim
(% of fund value)
From 11thYr6th-10thYr4th& 5thYrPolicy Years
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The features in detail
Hospitalisation
Insurance Benefit
Health Savings
Benefit
Cover Continuance
option after 5 years
Option of premium holiday after completion of 5
policy years
Hospitalization Insurance and Health Savingsbenefit continues by
deduction of charges from
accumulated fund
Once the fund value drops to
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Features summarized
No Claim Bonus
Guaranteed
Coverage till age 75
Family Floater
Over 125 Daycare
coverage
Pre-existing Illness
Cover after 2 yrs
Build a health fund
for the future
Cover Continuance
option after 5 years
Allows you to claim
for any health
expenses after 3
years
Hospitalisation
Insurance Benefit
Health Savings
Benefit
Tax Benefits of upto
Rs 15000 u/s 80D
Click here
Free Health Checkup
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Therefore the product positioning
A dual benefithealth plan
Flexibility in
premium payment
Comprehensiveguaranteed
reimbursement
coverage
Builds ahealth fund
and allows
Claims for all
health expenses
Complete tax
benefit
under
Section 80 D
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Illustration 1
Customer insured with annual limit of 3 Lakhs for the
hospitalization cover at age
32. He has chosen to pay a premium of Rs. 15000 annually.He made
a claim for hospitalization due to a road accident at age 38;
during the
treatment he incurred total hospitalisation expenses of
Rs.84,000. He also had to
pay additional charges for follow-up tests, crutches, belts,
collars totaling
Rs.16,000. What can the policyholder claim?
Claim payable under the plan:
Hospitalization insurance benefit
All eligible expenses during hospitalization are payable to the
customeri.e. Rs. 84,000
Heath savings benefitSince the claim is in 5thPolicy year, he
can make a partial withdrawal up to 50%of fund
value. The remaining expenses which are not covered under
Hospitalization insurance
benefit can be reimbursed up to the actual expense
i.e.Rs.16,000
Total benefit payable : Rs.1,00,000
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Illustration 2
Customer insured with annual limit of 2 Lakhs for the
hospitalization cover at age
35. He has chosen to pay a premium of Rs. 25000 annually.
At age 39, the customer had accumulated medical bills for the
past 2 years ranging
from bills for daily medicines, doctor visits and even dental
treatment up to Rs.
22,000. He however has not undergone any hospitalization. What
can he claim?
Claim payable under the plan:
Hospitalization insurance benefit
No instance of hospitalization
Heath savings benefit
Since the claim is in 4thPolicy year, he can make a partial
withdrawal up to 20%of fund
value. In this case the entire amount can be claimed from the
health fund i.e.Rs.22,000
Total benefit payable : Rs.22,000
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Illustration 3
Customer insured with annual limit of 3 Lakhs for the
hospitalization cover at age
41. He has chosen to pay a premium of Rs. 20000 annually.
At age 50, the customer decides to take a premium holiday and
exercises CCO
option. At age 52 he is hospitalized for CABG and incurs
expenses of Rs.2 lakhs.
He also has bills for follow-up medication of Rs. 20000. How
much can be claim?
Claim payable under the plan:
Hospitalization insurance benefit
Since he opted for CCO, he continued to remain covered and the
entire amount of Rs. 2
lakhs is payable.
Heath savings benefit
Since the claim is in 11th Policy year, he can make a 100%
withdrawal from the fund
value. In this case the entire amount can be claimed from the
health fund i.e.Rs.20,000
Total benefit payable : Rs.2,22,000
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Boundary conditions at-a-glance
30 Days
No waiting period applies for claims due to accident
Waiting period of two years will apply to some conditions
Waiting period
25 - 55 years for individual policies
18 - 55 years for spouse in a family floater
Dependent children (90 days - 25 years of age)
Min/Max Age at Entry
2 lacs / 3 lacs / 5 lacs / 7 lacs / 10 lacsAnnual Limit
Options
(Rs.)
Whole Life Plan
(Hospitalisation Insurance guaranteed upto age 75 years)
Term
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Yearly, Half Yearly, MonthlyPremium Paying
ModesPremiums would be subject to the minimum premium grid
given below based on the age and number of members
selected
Minimum Premium
CIPS allowed once in every 2 yearsChange in portfolio
strategy
4 Free switches in a year.
Additional switches chargeable at Rs.100 per switch
Switch
Annual Limit
> 5 lacs
Annual Limit
upto 5 lacs
All Annual Limits
30000250001500040-55
200001500010000
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Health Saver charges
Allocation Charge
Policy Admin Charges
For Monthly : Rs 90 per month For Yearly and Half yearly mode:
Rs 60 per month
Fund Management Charge
1.5% for Health Flexi Growth , Health Multiplier, Health RGF
1.0% for Health Flexi Balanced, Health Balancer 0.75% for Health
Protector, Health Preserver
2%
4-10
09%20%% of Annual Premium
Thereafter2-31Year
All charges deducted in the form of units from fund
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Health Insurance Charges:
Inclusive of ST & Education Cess
The health insurance charges are valid from 1 year of policy
commencement date and are subject to change post IRDA
approval
Health Saver charges
2 Lacs
3 lacs
5 lacs
7 lacs
10 lacs 3283
25 yrs 35 yrs 45 yrs 55 yrsAnnual Limit
2337 2756 3564 7052
2693 3179 3928 7836
2881
3402
4203 8384
3069 3624 4476 8929
3878 4790 9554
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Health Saver insurance charges versus
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Health Saver insurance charges versus
competition
For an annual limit of 2 Lakhs
Most competitive
insurance charges
Even with a family
floater.
Age
25
30
40
50
Health
Saver
5887
6215
6954
11532
ICICI
Lombard
6423
6423
7443
11988
Lombard
over HS
109%
103%
107%
104%
Charges for a family of four - 2 adults and 2 children
Charges inclusive of Service tax and Edu Cess.
Charges for all competing products sourced from
the respective company websites as on Dec 2008.
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Health Saverthe real Health ULIP plan
2x after 5 daysxxPre/ Post
Hospitalisation
80 D only on
health charges
80 D only on
health charges
80 D only on
health charges
80 D on full premiumTax benefits
(From Fund)
(From Fund)
(From Fund)
(From Fund)
Misc Health Expenses
Reimbursed (OPD)
x
Only 33 MSB &25 CI (Rider)
NA
Fixed Benefit
Reliance
Health+Wealth
x
Only 900
20x, 12x, 8x,
4x, 2x
Fixed Benefit
TATA AIG
InvestAssure
Health
x
Only 49
200x, 120x, 80x
Fixed Benefit
LIC Health
Plus
Surgery Scope
Non-surgical benefit
Surgery Benefit
Complete
reimbursement cover
for surgeries and
medical expenses
incurred at hospital
ICICI Prudential
New Health Saver
Daily Hospitalisation
Benefit (DHCB) / ICU
Core Coverage
Benefits
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Health Saverthe real Health ULIP plan
Tax benefit under
80 C
Reimbursement
Hospitalization
plan
Tax benefit under
80 D
Fixed benefit
Hospitalization
plan
Health Saver
Reliance Health + Wealth
LIC Health Plus
TATA AIG invest assure
The only insurance plan to have the
complete 80D tax advantage
The only insurance plan to have a
reimbursement based floater
hospitalization cover
Most comprehensive coverage with maximum tax advantage
The Health Saver advantage: The most
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Maternity expenses
Medical equipment
expenses
Day to day medicines &
drugs expenditure
Dental treatment
OPD expenses
Daycare Procedures
Hospitalisation Coverage
Benefits
TraditionalMediclaim
HealthSaver
The Health Saver advantage: The most
comprehensive coverage
Comprehensive coverage againstboth inpatient and outpatient
medical
instances
Pays for any kind of medical
expense incurred during the policy
term
The Health Saver advantage: Aapke health ka
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*For 25 year old with highest income tax slab of 33.66% with
maximum
Tax advantage under section 80 D** fund value net of all charges
and insurance charges for a 5 lakh annual limit
The Health Saver advantage: Aapke health ka
savings account
Pay Rs 15,000 annual premium for Health
Saver for 10 years
Total premium paid
for 10 years
1,50,000
Earn back your premium:
Avail complete Tax advantage on the entire
premium paid for 10 years* (A)
Total tax saved
during 10 years
50,990
Total fund value available for health claim after
10 years ( assuming a modest growth at 10%) (B)
Total fund value
after 10 years
1,60,228
Total return advantage after 10 years (A)+(B) 2,11,218
Total return after
10 years
Plus Health Cover of 5 Lakhs during the 10
years
Plus Free medical worth Rs. 5000 every 2 yrs
The Health Saver advantage: Takes care of you today
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Retirement
The Health Saver advantage: Takes care of you today
and invests your money for tomorrow
Age 25
Retirement PhaseWorking Phase
Premium paying term 20 years
Age 55Regular premium
Cover continuation phase
Whole life
Pay premiumsduring
working years
Get a healthcover + build
a health fund
Opt for CCOon retirement
and remain
protected
Continueclaiming from
health fund
for whole life
Relax!
Age 75
Hospitalisation Cover
Relax!
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What makes Health Saver a winner
Tax Benefits onentire premiums u/s
80D
Build a health fund
which allows you to
claim for any other
health expenses
Long Term
Coverage against
Hospitalisation
Expenses
Flexible premium
payment optionscontinue cover even
after stopping
premiums
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An easy sale with high jet limits
Jet Limits
Only Standard Age proof allowed No Backdation allowed
Health Saver would be rated with only MediAssure
Employer-Employee scheme subject to immediate assignment to
the
employee
Age/ Annual Limit
1-35 Yrs
36-45 Yrs
46-55 Yrs
Upto 3 lacs
No Medicals
No Medicals
Medicals
Upto 10 lacs
No Medicals
Medicals
Medicals
A convenient sale with new 4 pager
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Imp: Please use Form Id: 02
A convenient sale with new 4 pager
application form
Only a 4 pager form and valid for all health products
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Premium payment frequency & mode
Premium payment frequency:
Yearly/ Semi-annually/
Monthly ECS/Monthly Non-ECS
Premium payment mode: Cheque/DD/PDC/Pay Orders/Bankers
Cheque/
Internet facility/Electronic Clearing System/Credit Card
To ensure all health policy customers derive 80 D tax benefits
CASH will not beaccepted as a mode of First Premium Deposit.
Amount & Modalities will be subject to company rules
&
relevant legislation/regulations.
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Underwriting guidelines
Previous life and health policies (other than MediAssure and
Health Saver)and riders will not be taken into considerationfor
either triggering medicals, financial eligibility or rated up
SA.
The total Annual Limit in case the insured person buys morethan
one policy will be Rs. 2,500,000 (Health Saver +MediAssure)
Only Standard Age proof allowed (PAN card allowed for rated
up AL of 15 L) Underwriting would be done on individual lives
under family
floater options.
Financial Eligibility Table
Income documents are compulsory for total rated up SA of LAabove
15L for all members.
Policy twisting norms of 2 years will apply for a HC , MA and
HSpolicy
Risk commencement date will be the final underwriting date.
10.1 -15 LAbove 3.5 L
2-5 LAbove 50 K
5.1 -10LAbove 2 L
15.1-25 LAbove 5 L
Annual LimitIncome
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The Claims Process
The Health Cardto enable claims
A Health Card for every Policy Holder
Dispatched along with the Welcome Kit
Will carry customer and policy details
How does it work?
Card produced at the Network Hospital
to avail cashless benefit
Preprinted phone numbers for any kind of
claims or service assistance
The Health Card
The claims process hospitalization
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HOSPITALISATION
Network Hospital Non-Network Hospital
Post discharge,
submit claim formScrutiny
Cheque sentto Customer
Planned Emergency
Submit Preauthorization Form
Cashless authorized
Customer settle bill with
Hospital
Cashless not
authorized
Scrutiny
Reject
ICICI pays Hospital
Customer signs
Documents on
Discharge
The claims process hospitalization
insurance benefit
HOSPITALISATION
Network Hospital Non-Network Hospital
Post discharge,
submit claim formScrutiny
Cheque sentto Customer
Planned Emergency
Submit Preauthorization Form
Cashless authorized
Customer settle bill with
Hospital
Cashless not
authorized
Scrutiny
Reject
ICICI pays Hospital
Customer signs
Documents on
Discharge
Pre(30)&Post(60)
Hospitalization*
Reimbursed only in the Event of
acceptance of the Hospitalisation or Day
Care Procedures claim by the Company.
TAT -3hrs
The claims process health savings benefit &
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HOSPITALISATION
Medicines/Drugs
Diagnostics
Dental
Co-pays/Deductibles
Miscellaneous medical expenses
The claims process health savings benefit &
free health check-up
HEALTH SAVINGS BENEFIT*
Scrutiny
Cheque sent
to CustomerReject
Submit original bills or proof
of expenses along with
withdrawal Form
**Subject to a limit of Rs. 5,000 or 1% of the
annual limit, whichever is lower.
Can be claimed once every two years after the
first year
One bill per insured member for given 2 yr
period
Submission of original bills or
proof of expense along
with claim form
MEDICAL CHECK-UP**
Scrutiny
Cheque sent
to CustomerReject
*Allows policyholder to claim his funds for different health
care
expenses, after the completion of three policy years.
Can be claimed once in every Policy year subject to a minimum
limitof Rs. 1000/-
The Claims process Hospital Cover
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The Claims processHospital Cover
documentation
Documents to be submitted within 10 days of discharge from
the
Hospital or Nursing Home Photocopy of Policy certificate
Claimant statement form
Photo Identification proof
Attending Physician Certificate
Original Discharge summary or card, test reports
Original Hospital bill and payment receipts
Original cash memo from the chemist(s) with prescription
Photocopy of Admission notes
FIR / MLC / Panchnama for accidental Claims
Other relevant Documents related to the current
hospitalization/
surgery so as to process the claim faster
*ECS mandate and copy of cancelled cheque
to be submitted for direct credit facility
Claims initiatives : The I Claim
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SMS Service: To provide assistance & prompt resolution on
claimsprocessing
To access SMS service type-ICLAIM & send SMS to 56767
Customers will receive call back from our certified claims
expert
SMS service will prove to be a customer delight.
Claims initiatives : The I Claim
Service
Cl i i iti ti
http://www.webmaster247.co.uk/Images/SMS%2Btext%2Bmarketing.jpg
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Claims initiatives
Document Reckoner shared with Branches: Checklist of
essential documents
Original Documents (Bills/Medical Reports) mandatory for
Medi Assure and now Health Saver
ECS Mandate along with a copy of cancelled cheque to be
submitted for availing direct credit of claims payout
Health Claims Documentation
Direct Credit Facility
B h S t f H lth Cl i C ll
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[email protected] for response1 working day
Critical Illness products claims enquiries
1800222020 (9AM9PM) or approach Branches.
Hospitalization products (Hospital Care & Medi Assure)
(Toll free 24*7) 1800221719 & 022 23000431
Grievance02240398147
GM Call logCall type Health claims Subtype complaint
Branch Support from Health Claims Cell
Document reckoner deployed for support at branches
C t l
mailto:[email protected]:[email protected]
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Category rules
ConditionHealth SaverCategory
Only as family floater. Plan starts from 90
days of age*(subj to policy anniversary)Minor
The minimum age at entry for children
under Family floater is 90 days and
maximum is 25 years
Students will only be offered family
floater. Maximum cover up to AL- 15 L
can be offered under a parents family
floater of Health Saver/ MediAssure.
Student
Cannot be offeredXForeign National / PIO
For treatment in India only and upto
Annual Limit of Rs 5 LakhNRI
C t l f l li
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Category rules - female lives
ConditionHealth SaverCategory
Up to Annual limit of Rs 5 L without documentation/
husbands insurance Higher cover subject to equivalent
husbands
MediAssure/HS cover up to maximum AL of Rs 10 L
Family floater: Maximum cover up to AL- 15L can be
offered under husbands family floater of Health
Saver/ MediAssure
**Housewives can be offered maximum Health Savercover
(Individual + Family floater) of 15 Lacs.
Single women: Can offer maximum AL - 3L subject to
approval from Health Team
Group III
Up to Annual limit of Rs 5 L without documentation
Higher cover subject to income documentsGroup II
At par with male lives
Group I
R i t t t
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Re-instatement norms
With Medicals / exclusions / Declaration of good health.
Reapplication of waiting periods
No claim payable within the lapsed period
Greater than 60 days
2 years
No revivals permitted post 2 years
Max Revival Period
Simple revival
(Payment of arrears premium with interest)
Upto 60 Days
NormTime interval
Under riting G idelines
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Underwriting Guidelines
Medical Examination Chart
MER, HbA1c, ECG, RUA, SMA124655 years
MER, FBSMER3645 years
MERMER 35 years
>3 Lacs 3 LacsAge / Option
Things to note
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Things to note
Eldest member is the primary life
Individual underwriting questions for each family
member
DOB proofs required for all members
Signature for all members
FAQ
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FAQs
Can I change my annual limit during the term of the plan?
You can increase or decrease your annual limit at every policy
anniversary withdeduction of appropriate insurance charges based on
change in annual limit. Any
increase in the annual limit will be subject to underwriting an
as per terms and
condition set by the company.
Can I change my premium during the term of the plan?
You can increase or decrease your premium at every policy
anniversary, any
decrease in premium will be subject to the minimum premium grid
based on
annual limit , age and number of members in the family.
What if I am unable to pay my premiums after the first 3
years?
If premium is discontinued in the first three policy years and
if the policy is notrevived within the period of two years from the
due date of the first unpaid
premium, then the policy will be terminated. During this period,
Hospitalisation
Insurance Benefit will cease and the policyholder will only have
the benefit of
investment in the respective unit funds.
FAQ
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FAQs
What if I am unable to pay my premiums after the first five
years?
On payment of at least first five years premium, you have the
option of opting for a
cover continuance option wherein your further charges would be
deducted fromyour fund until fund value falls below 110% after
which the policy would be
foreclosed.
What happens if my fund value falls below 110%?
If premiums have been paid for three full policy years and after
three policy years
have elapsed and fund value falls below 110% of one full years
premium, thepolicyholder will be given intimation and option to
reduce the Health Savings
Benefit claim amount so that the fund value does not fall below
110%. If the
policyholder does not opt to reduce the Health Savings Benefit
claim then, the
benefit shall be paid and the policy will be foreclosed.
What happens on foreclosure?
On the date of foreclosure, the fund value will be calculated as
per prevailing NAVon that date. The fund value so calculated can be
withdrawn by you within 5 years
for health expenses upon submission of original bills for
expenses incurred. This
withdrawal will be subject to a maximum of 50% per annum of the
fund value as on
date of foreclosure. This condition will also apply during the
cover continuance
stage, if opted for.
FAQ
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FAQs
How does the Health Checkup benefit function under the plan?
The free health checkup will be available to all insured members
after the first
year once every 2 years. Each member can submit only a single
bill in everyblock of 2 years after the first year. (i.e. once in
the 2nd -3rd yr , 4th -5th yr and
so on). We will not allow of aggregation of bills of any member
The cumulative
limit for all the members under the policy would be 1% of the
annual limit or Rs
5000 whichever is lower.
Can the family floater be issued in a case single parent and
children?Yes, the family floater in Health Saver allows for a
single parent to include
himself/herself and upto 3 dependant children under the
plan.
Can I add a family member to my plan at a later date?
Addition of family members to the policy shall be allowed only
in the event of
marriage or birth or legal adoption of a child. You should opt
for this within 90
days from the date of event or at the next policy anniversary.
The change shallbe effective for the purpose from the next premium
due date which would be the
risk commencement date for the new member added. You shall have
to pay
additional premium on addition of a family member as determined
by the
Company.
FAQ
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FAQs
What would happen to the fund value in case of death of the
primary insuredor
any other insured member during term of plan?In the unfortunate
event of death of the primary insured member during the term
of the policy, the nominee shall receive the total fund value
and the policy shall
be terminated. The fund value paid out on death of the primary
insured may be
taxable in the hands of the nominee as per the prevailing tax
regulations at that
time. The remaining insured members have the option of
continuing coverage
by availing a new policy.In the unfortunate event of death of
any other insured
members the policy Would continue for remaining insured members
with the
appropriate reduction in health insurance charges
Can I make a claim if I get treated outside India?
No, you are entitled to a claim for treatment undergone in India
only.
What is the duration within which a claim has to be reported to
ICICIPrudential?
If the claim is from a network hospital then 4 days prior to the
planned
hospitalization by forwarding the pre-authorization form. In
case of emergency,
within 24 hours of getting admitted. If the claim is from a
non-network hospital
then within 60 days of getting discharged from the hospital, the
claim request
should be given to the insurer. All claims will be settled in 7
working days after
receiving request.
FAQ
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FAQs
Are the claims made through withdrawals from the Health Savings
Benefit tax
free?Yes all claims made from your health fund will not be taxed
as they would be
treated as a health claim on the policy.
Can I claim for non allopathic medical expenses under the
Health
Savings Benefit?
Yes the Health Saver allows you to claim for all health care
expenses under the
Health Savings Benefit which includes non allopathic
expenses.
Will any claims under the Health Savings Benefit reduce the
annual limit in the
hospitalisation insurance benefit?
No all claims from your Health Savings Benefit are settled by
withdrawals againstyour health savings kitty and will not effect
your annual limit offered in your
Hospitalisation Insurance benefit
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FAQs
What are the policy twisting norms for the Health Saver?
In case customer has lapsed any of the following policies i.e.
Hospital Care
,MediAssure & Health Saver within the last 1 year , he must
reinstate his lapsed
policy before being entitled to buy a new Health saver
policy.
Are the insurance charges deducted from my policy constant
throughout the
policy term?
No the insurance charges will be deducted every year based on
the new age of
the customer.
Can the Health Saver be sold as a combo plan?
The Health Saver application form allows you to buy a Health
Saver along with
any other health plan. However in case of a family floater only
the primary lifewill be able to buy the additional health plan.
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Thank You
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For any product related queries, please write into:
[email protected]
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LIFECYCLE BASED PORTFOLIO STRATEGY
How Does It Work
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How Does It Work
Initial allocation based on customers age
Rebalancing on a quarterly basis
As age progresses, allocation changed to suit Life
stage
65%35%6675
100%0%75+
55%45%5665
55%
65%
75%
85%
Health Flexi Growth
45%4655
35%3645
25%2635
15%025
Health Protector
AllocationAge Band
Flowchart for lifecycle based strategy
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NAV CHANGES
ALTER THE
EQUITY-DEBT
RATIO
WITH CHANGE IN
AGE,
ALLOCATION IS
ALTERED
Flowchart for lifecycle based strategy
Customer
Policy Inception
EQUITY
75%
DEBT
25%
ALLOCATIONS
BASED ON AGE
Every Quarter
PORTFOLIO
REBALANCING
75%
25%50% 50%75%
25%
Age = 30
Every shift in
age band
DEBTEQUITY
65%
35%
Age = 36
Asset Allocation
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Asset Allocation
What is it?
How can it be done?
Why should you do it?
It is the diversification of your portfolio
By distributing wealth amongst different asset
classes viz. equity, debt & money market
In order to optimize your risk-return balance
Why is Asset Allocation
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important?
Studies have shown that asset allocation is the single
most important factor in determining returns
Studies have shown that asset allocation is the single
most important factor in determining returns
Brinson Study on the Importance of Asset
Allocation
Security
Selection ,
5%
Market
timing, 2%Others, 1%
Long Term
Asset
Allocation ,
92%
Long Term Asset Allocation Security Selection Market timing
Others
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FIXED PORTFOLIO STRATEGY
Fixed Strategy : Choice of Funds
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Fixed Strategy : Choice of Funds
A customer may wish to do his allocations on his own
We have given him a flexibility of allocating his wealth
as per his choice
Health Flexi Growth
Health Multiplier
Health Flexi Balanced
Health Balancer
Health Protector
Health Preserver Health Return Guarantee Fund
Automatic Transfer Strategy (ATS)
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ATS ( Automatic Transfer Strategy ) is a mechanism that
eliminates the need to time ones investments in the market.
Through ATS you can regularly switch a fixed sum of
investment at a monthly frequency from Health Preserver to
Health Multiplier or Health Flexi Growth
Advantages
Reduce risk in overall investment
Bulk of investment in Health Preserver
A good strategy in a volatile market to average out cost of
acquisition
Automatic Transfer Strategy (ATS)
What is the Return Guarantee Fund?
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What is the Return Guarantee Fund?
Return Guarantee Fund ( RGF) is a close ended
debt fund
It offers a Minimum Guaranteed NAV at the end
of 5 years.
100100Debt, Money market & Cash
Min (%)Max (%)Indicative Portfolio Allocation
Fund Management Charge: 1.50%
Upside Potential
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Upside Potential
On Dec 20, 2013 you get Min Guaranteed NAV ofRs 15.03 or the NAV
on that day; whichever is
higher
The falling interest rate regime is expected to boostthe returns
given by debt funds- as seen in the past
GET THE ADVANTAGE OF HIGHER RETURNSWITH THE PROMISE OF A MINIMUM
GUARANTEE
Health RGF Snapshot
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Health RGF Snapshot
It will open with an NAV of Rs.10 on Dec 22, 2008
Subscription to this fund is open for a limited period
The fund can be closed by giving a notice of 5 workingdays
notice
The fund will terminate (mature) on Dec 20, 2013
Health RGF Snapshot
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Health RGFSnapshot
Only your First Premium Deposit is invested in the RGF
Subsequent Premiums:
Allocation must be chosen at inception ( in app form); and can
be allocated
into any of the fund / strategy available with the product
Switch out of Return Guarantee fund at the prevailing NAV at any
point of time
and re-invest in any of our other funds
Subscription to this fund is open for a limited period
The fund can be closed by giving a notice of 5 working days
notice
Co-pay illustration
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Co-pay illustration
Plan : Annual limit of Rs 5L
Following expenses incurred during treatment
01000Telephone
01500Food bill forattending person
Total Eligible Bill (Rs)Total Bill (Rs)Eligible for
coverExpenses
3000030000Room & ICU
4900051500Grand Total (Rs)
1000010000Opn Procedure
40004000Medicines
50005000Doctors Fees
Co-pay illustration 2
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Appropriate choice of hospital will avoid any co-
pay for the customer
8200
(20% Co Pay for outside
network claims)
0
(0% Co Pay for within
network claims)
Amount to be paid
by customer (Rs)
39200
(80% of eligible bill)
49000
(100% of eligible bill)
Amount covered
by policy (Rs)
Non Network HospitalNetwork HospitalNetwork
Co-pay illustration 2
Increase in premiums after claims
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Mr Rakesh K (age 72) with a 10 year old
mediclaim policy of Rs 3 lacs
8000
12000
60000
Pre
mium(
Rs)
Year 1 Year 2
No Claim
Claim
Source: Mediclaim p remium hike capp ed at 75%,1 Dec2007,
IST,Prabh akar Sin ha,TOI,
Increase in premiums after claims
Reason for this huge rise in premium: Customer had
claimed Rs 1,50,000 for an angioplasty after developing
a heart ailment
Adding exclusions after claims
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Mr Joshi (age 67) had purchased a mediclaim
policy in 1992
Policy Issued
1992
Disease/ConditionOccurs
1999 2002
New Exclusion
added at renewal
Current Status
Premium DoubledNew Exclusion added
Source: Two mo re PILs fi led in Mediclaim c ases.14 Apr 2003,
TOI
Adding exclusions after claims
For the first 10 years of taking the policy, there was no
claim and now that the time has come to encash on the
policy, they are asking me to discontinue, - Joshi
Pre existing illnesses not covered
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Pre existing illnesses not covered
Mr Vasant Rao underwent by-pass1986
Bought Mediclaim with disclosure of by-pass
and renewed regularly sinceMar 95
Apr 99
Underwent surgical procedure for the same
Underwent Angioplasty and diagnosed with
Ischemic Heart Disease (IHD)
Jul 99
(Source:Honou r Mediclaim polic y: National panel
Friday July 7 2006 ,www.newindp ress.com )
Claim was not honoured by the company citing exclusion
clause on pre-existing disease
Comparisons with other players
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Comparisons with other players
Not coveredStar Allied & Health
Upto 5 years*Bajaj Life Care First
Not coveredBajaj Gen Health Guard
4 yearsNew India Assurance
4 yearsNational Insurance2 yearsICICI LombardHealth Advantage
Plus
4 yearsICICI Lombard- Family floater
2 (gold) / 4
(silver/standard) years
Reliance Healthwise
Pre-existing disease
waiting period
Company/Product
* Some ailments
Day Care Comparison
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Day Care Comparison
NoneNew India
NoneStar Allied & Health (Premier
Plan)
7 Listed ProceduresReliance Healthwise
9 Listed ProceduresICICI Lombard Family Floater
Over 125 listed Day care
proceduresICICI Pru Medi Assure
Day Care procedures/
Specified treatmentsCompany/Product
No Claim Bonus
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No Claim Bonus
625,000
600,000
575,000
550,000
600,000
575,000
5,50,000
5,25,000
Annual Limit
with bonus
6 lacs(10%X
5lacs)
Working
600,00008
575,00007
550,00006
Claim
Amount
Year
600,000
575,000
550,000
525,000
500,000
Available
Annual Limit
400000
0
0
0
0
5
4
3
2
1
Amounts in Rs
Income Tax Norms
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Income Tax Norms
Tax Benefits U/S 80D for premia paid towards Health Insurance
*
Tax deduction benefit available on IncomeInsured members
Upto Rs 15000 (Additional to benefit on
premiums towards policy for self, spouse
and children)
For Parents
Upto Rs 20000For Senior Citizens (Over 65 yrs old)
Upto 15000For Self , Spouse and dependant
children
*No Benefit available if premiums towards Health
Insurance are paid in cash
10%1.5L2.99 lacs
20%3 lacs4.99 lacs
30%5lacs and more
0%Less than 1.5 L
Rate of Tax for an IndividualTotal Income (Rs)
Exclusions
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Exclusions
Please refer to policy document for detailed exclusions
Permanent exclusions & Pre existing illness or conditions
unless specificallyaccepted by the Company
Pre and Post Hospitalization benefits are payable only when the
ailments or illnessesare directly related to the covered
hospitalization event/Day care Procedure.
Any expenses more than 30 days prior to hospitalization/Day care
Procedure & 60days beyond discharge are not payable
Diagnosis and treatment or any expenses incurred outside
India.
Treatment & investigations for conditions arising due to
Diabetes & Hypertension ifdisclosed at inception are excluded
for first 2 policy years from risk commencementdate or 2 years from
the reinstatement date in case reinstatement done after 60 daysfrom
last unpaid premium.
Any treatment directly or indirectly consequent to war, civil
war, terrorism, activemilitary or police duties ,military aircraft
or vessels
Circumcision, Sex change surgery ,cosmetic surgery & plastic
surgery not due toaccident or treatment of disease etc
Vaccinations, inoculations & expenses on vitamins &
tonics until medically necessary
Refractive error correction, Hearing impairment correction,
Corrective & cosmetic
Dental surgeries apart from for any treatment arising due to
systemic disease orinjury.
Any hospitalization for tests or diagnosis wherein such
investigations are possible asout patient procedures / weight loss
/ weight gain / Preventive / recuperationpurposes/ routine
check-ups & issue of any medical certificate or examination
foremployment or travel.
Any treatment / expenses incurred by a Donor of an Organ
Exclusions (Continued)
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Exclusions (Continued)
Any Treatment for Congenital Conditions / Physical
defects/geneticdisorders etc
Any stream or type of medicines other than Allopathy ( Western
medicine)
Any Treatment related to Contraception / Pregnancy / Child birth
andinfertility or assisted conception procedures except for life
threateningectopic pregnancy.
Any treatment directly or indirectly arising from
alcoholism/drug abuse,self-inflicted injuries or attempted suicide
or intoxication of drugs,psychiatry ailments.
Any treatment due to and as a result of HIV / AIDS / Sexually
TransmittedDisease (STD)
Any treatment related to sleep disorders & Sleep Apnoea
syndrome.
Durable medical/Non medical equipments including all non
medicalexpenses including personal comfort expenses, domiciliary
treatment.
More than one coronary angiography in a policy year.
Any treatment arising out of professional / hazardous sports or
activitiesetc. or deliberate exposure to exceptional danger.
Any kind of service charge, surcharge, admission fees,
registration fees. Extension of duration of hospital stay without
any medical requirement as
per the specialist or expenses incurred for
investigations/treatment notrelevant to the reason for
hospitalization.
Disease or ailment other for one where hospitalisation was
necessary &Hospitalization or treatment not actually
performed
Back
Terms & Conditions
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&
Free Look Period: A period of 15 days is available
to review the policy from the date of receipt of thepolicy
document by the policyholder.
Revival Norms:
Foreclosure Norms
Incase fund value falls below 110% post 3 years of
policy
Fund value can be withdrawn by policy holder for
health expenses post 5 years of termination.
No other benefits will be applicable
2 yearsUw/g, Waiting periodsand exclusions to
reapply
T+60 (No claimpayable in lapsed
period)
T+15 (Monthly)T+30 (Yearly & H.Y)
Max revivalRevival Post 60Simple RevivalGrace Period
Back
Procedures covered after 2 years
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y
Lithotripsy / Basketing for Renal Calculus12
Lap / Open Chole cystectomy for Cholecystitis / Gall
stones11
Myomectomy for Fibroids and menorrhagia10
Hysterectomy for Fibroids, menorrhagia, Dysfunctional Uterine
Bleeding ,Prolapse9
Dilation & Curettage for menstrual irregularities8
Trans Urtheral Resection of Prostrate / Open Prostatectomy for
Benign
Enlargement of Prostrate
7
Piles / Fissure / Fistula / Rectal prolapse6
Hydrocoel / Varicocoel / Spermatocoel surgery5
Hernia (Inguinal / Ventral / Umbilical / Incisional)4
Thyroidectomy for Nodule / Multi Nodular Goitre3
Surgery for Tonsillitis / Adenoiditis2
Functional Endoscopic Sinus Surgery / Septoplasty for Deviated
Nasal
Septum / Sinusitis
1
Procedures covered after 2 years
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y
Osteoarthrosis leading to Total Knee Replacement or Total
Hip
Replacement (After two years from Risk Commencement Date or
revivaldate, where the revival occurred more than 60 days after the
first unpaid
premium, whichever is later, claims for up to one knee or hip
treatment
will be covered in any policy year )
19
Cataract (After two years from Risk Commencement Date or
revival
date, where the revival occurred more than 60 days after the
first unpaid
premium, whichever is later, only claims up to Rs. 20,000 will
be covered
in any policy year)
18
Osteoporosis leading to Fracture Neck of Femur17
Renal failure due to diabetes16
Amputation due to diabetes15
Vitrectomy and Retinal Detachment surgery for
Retinopathy14Traction / Discectomy / Laminectomy for Prolapsed
Inter Vertebral Disc
13
Claims initiatives
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To access this service, our customers will simply have to
type:ICLAIM and send to 56767
The customer would receive a quick call back from our
certified
claims expert.
Document Reckoner shared with Branches: Checklist of
essential
documents
Original Documents (Bills/Medical Reports) mandatory for
Medi
Assure and now Health Saver
ECS Mandate along with a copy of cancelled cheque to be
submitted for availing direct credit of claims payout
Introduction of ICLAIMSMS service
Health Claims Documentation
Direct Credit Facility
Underwriting Guidelines
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g
Crisis coverComprehensive Critical illness products5
Hospital Care
MediassureHealth Saver
Hospitalization & Surgery products4
Diabetes Care
Diabetes Care Plus
Diabetes Assure
Diabetes Care Active
Diabetes specific products3
Cancer CareCancer Care Plus
Cancer specific products2
Health Assure
Health Assure Plus
Critical Illness benefit products1
Plans coveredProduct CategorySr. No
Policy Twisting Norms: If a customer wants to buy a new policy,
but his earlier policy withinthe same category (refer the grid
below for different categories) has lapsed within the last 12
months. Then the lapsed policy needs to be revived prior to
taking a new policy. Thus Healthsaver, Mediassure and Hospital Care
fall under the same category.
