Wellness Plus

8/6/2019 Wellness Plus

1/16

e c o m e n d e d f o rm

Rg o o d h e a l t h .

TMLi f e Li n e - W e l l n e s s P l u s P l a n

A N o n Li n k ed -N o n Pa r t i c i pa t i n g

H e a l t h I n s u r a n c e P l a n

U I N 1 0 4 N 0 4 2 V 0 1


2/16


3/16

H EALTH IS WEALTH .PREVEN TION IS BETTER THAN CURE.

We have all read and heard that. We should all be following this as well. But even so the fact remains that you still don't get time to exercise, you stillst

cannot always eat a health diet, you cannot choose how the hereditary disease affect you, you cannot tell how pollution and 21 century 24*7 life styleaffect your health. What you do know is that medical science is progressing and can help you cope with all of above. But that costs money.

A lot of money.

So while your wellness plans should have correct eating, correct exercising and correct lifestyle as its basis, please have a plan to fall back on

when emergency strikes. As they always do.

TMMax New York Life Insurance Co. introduces LifeLine - Wellness Plus . A health plan, which gives you a 360-degree benefit in terms of long

tenure of coverage, coverage for 38 critical illness, permissible tax benefit under Income Tax Act, and protection against a wide variety of

diseases and conditions.

TAX Benefit under Sec80Dup to Rs.15,000

5-Year Prem ium Guarantee

Coverage Tenure of Up to 20Years

The scale of benefits are denominated as 'Units 1 to 10' and any one unit can be proposed at

the stage of proposal. The company may, in its absolute discretion and subject to underwriting

rules, assign the most appropriate unit representing the scale of benefit to the policyholder. The

policyholder cannot propose for a different unit/ scale of benefit once the policy is effected.

TMCoverage Choice Life Line - Wellness P lus Plan

Number of Units 1 2 3 4 5 6 7 8 9 10Sum Assured (in lacs) 2 4 6 8 10 12 14 16 18 20

TMExample: If you take 5 units of wellness plus , you have bought yourself a sum assured of 10 lacs as per the table above.

S c a l e o f B e n e f i t / U n i t s

Li f e Li n e -

W el l n e s s

P l u s


4/16

What is the List of Covered Critical Illness Conditions under Wellness Plus Plan?

The List of Conditions Covered under Wellness Plus Plan is divided into 3 groups, depending on the severity of the disease and the benefit

payable under such group. Once a Claim is put forth for a particular Critical Illness, the cover will continue for the Balance Sum Assured.

The detailed listing of diseases and conditions under the three groups are captured in the table below. For details please refer to appendix A.

The list of covered conditions are divided into 3 groups

Group 1 Group 2 Group 3

Claim - 25% of Sum Assured. Claim - 50% of Sum Assured. Claim - 100% of Sum

Policy Continues with Policy Continues with the Assured.

the Balance Sum Assured Balance Sum Assured Policy discontinued

Alzheimer's Disease Angioplasty and other Invasive Apallic Syndrome

Blindness Treatment for Coronary Aplastic Anaemia Deafness Artery Disease Brain Surgery

Loss of Speech Benign Brain Tumor Cancer

Medullary Cystic Disease Cardiomyopathy Coma

Motor Neuron Disease End Stage Lung Disease Coronary Artery By-pass Surgery

Muscular Dystrophy Heart Attack Kidney Failure

Heart Valve Surgery End- Stage Liver Disease

Major Burns Loss of Independent Existence

Multiple Sclerosis Loss of Limbs

Multiple Trunk Avulsions of Major Head trauma

the Brachial Plexus Major Organ Transplant

Necrotizing Fascitiis Stroke

Paralysis or Paraplegia Surgery of Aorta

Parkinson's Disease Terminal Illness

Primary Pulmonary Hypertension Total Permanent Disability(to Age 65)

Poliomyelitis

Systemic Lupus Erythematosus

Be n e f i t s

On the happening of any of the above events and the following conditions:

Confirmed by a registered medical practitioner, including a relevant specialist acceptable to the company (the cost of which shall be borne

by the policyholder) and

provided the life insured has survived for at least 28 (Twenty eight) days after the happening of the insured event,

the life insured filing with the company all the required claim documents within 60 days of the date of the happening of the insuredevent.

A claim with respect to any particular critical illness, if paid, shall not be payable again.


5/16

E xample Ailment Client Age Plan Opted Units Sum Benefit Paid PolicyPurchased Assured out Status

Example 1 Suffers 35years LifeLine - 2 Units 4 Lacs 100 % of 4 Policy will

Kidney Wellness Lacs = 4 Lacs cease sinceTMFailure in Plus 100% of year 2 SA is exhausted

Example 2 Suffers 47 years Wellness 5 Units 10 Lacs 25% of SA = Policy ContinuesDeafness Plus Plan Rs. 2.5 lacs gets for Balance SAin Year 3 paid of 7.5 lacsSuffers 25% of SA = PolicyLoss of Rs. 2.5 lacs Continues for 5speech which gets paid lacsin Year 4 from Balance

SA of 7.5 lacs

Example 3 Suffers 50 years Wellness 4 Units 8 Lacs 50% of SA = Policy ContinuesHeart Plus Plan Rs. 4 lacs gets for 4 lacsAttack in paid 100% of Policy will ceaseYear 3 SA= 8 lacs, after secondSuffers However claim since FullKidney Balance SA SA is exhaustedFailure in available afterYear 4 first Claim is

4 lacs only

Please note: - The payment of benefit in aggregate during the policy term

shall not exceed 100% of the sum assured.


6/16

ELIGIBILITY CRITERIA AT A GLANCE: -Through the below mentioned eligibility criteria, we aim to provide coverage to maximum years of your life.

Eligibility LifeLine - Wellness Plus

Age At entry 18 years to 60 years

Option for policy term 10, 15 or 20 years

Maximum age at maturity 75 years

*Premium Guarantee 5 Years i.e subject to the revision with IRDA approval Premium is renewed every 5 years throughthe term of your plan

Premium Limits Please select Units/ Scale of Benefits as per your choice subject to payment of a minimumYearly Premium of Rs. 2,500 and Minimum Half-Yearly premium of Rs. 1,300

Waiting Period 180 days from policy commencement

Reinstatement after Lapse Allowed only till 6 months basis declaration of good health

Waiting Period after 90 days from policy revival dateReinstatement

* Subject To prior Approval form IRDA ** This prem ium is exclusive of any taxes.

Premium Table (Sample)** 10 Year Term:

Units 5 (Sum Assured = 10 lacs) 10 (Sum Assured = 20 lacs)

Age (yrs) Male Female Male Female

20 3405 3245 6810 6490

30 4880 5085 9760 10170

40 10225 9950 20450 19900

50 25190 20555 50380 41110

15 year Term:



20 3450 3285 6900 6570

30 5135 5340 10270 1068040 11225 10535 22450 21070

50 27090 21550 54180 43100

20 year Term:



20 3495 3495 6990 6990

30 5635 5790 11270 11580

40 12470 11350 24940 2270050 28845 22515 57690 45030

* Premium rates are guaranteed for the first five years. At the end of five years, the premiums may be reviewed to take in to account the Company's experience.However premium will not be changed without the prior approval of the IRDA.


7/16

No benefit will be payable if the insured event occurs from, or is caused by, either directly or indirectly, voluntarily or involuntarily, by one of the following:

I. Any pre-existing condition*.

II. Any insured event happening within the first 180 days of the effective date and within 90 days of date of revival of the policy, except a critical illness

which occurs from or is caused as a result of an injury.III. Opportunistic diseases associated with AIDS or HIV infection.

IV. Suicide or attempted suicide or intentional self-inflicted injury, by the life insured, whether sane or not at the time;

V. Life insured being under the influence of drugs, alcohol, narcotics or psychotropic substance, not prescribed by a registered medical practitioner;

VI. War (declared or undeclared), invasion, civil war, riots, revolution or any warlike operations;

VII. Participation by the life insured in a criminal or unlawful act;

VIII. Service in the military/ para-military, naval, air forces or police organizations of any country in a state of war (declared or undeclared) or of armed

conflict;IX. Participation by the life insured in any flying activity other than as a bonafide passenger (whether paying or not), in a licensed aircraft provided that the

life insured does not, at that time, have any duty on board such aircraft;

X. Life insured engaging in or taking part in professional sport(s) or any hazardous pursuits, including but not limited to, diving or riding or any kind of

race; underwater activities involving the use of breathing apparatus or not; martial arts; hunting; mountaineering; parachuting; bungee-jumping;

XI. Exposure to the radioactive, explosive or hazardous nature of nuclear fuel materials or property contaminated by nuclear fuel materials or accident

arising from such nature.

XII. Failure to seek or follow medical advice;XIII. Any congenital condition;

XIV. Any pre-malignant tumors, polyps or carcinoma-in-situ of any organ; and

XV. Pregnancy or childbirth or complications arising there from. The company reserves the right to add to or delete any critical illness from the list of critical

illnesses covered under the policy and the categorization of the same depending upon the experience and advancement in medical treatment and

diagnostic techniques. The policyholder shall be notified in writing 30 days in advance about the same and the same shall be binding upon the

policyholder.

Premium Mode Factor Yearly 1.0000

Half-Yearly 0.5200

EXCLUSIONS UN DE R LifeLine - Wellness Plus

*Pre-existing condition shall mean a condition, prevailing at or prior to the effective date of this policy or the dateof revival of the policy, having symptoms of an illness or injury which would have caused any ordinary prudentperson to seek or receive treatment, diagnosis or care, or medical advice from a registered medical practitioner orundergo medical tests or investigations or hospitalization or surgery. Any treatment or hospitalization or surgery forany illness or injury arising out of or connected with a pre-existing condition shall be considered as part of the pre-existing condition.

Premium payment optionsYearly and Half Yearly modes are permitted in this plan and modal factor for the same are as under:


8/16

Lapse and Revival provisions

Premiums should be paid on the due date of premium, in case if premium is not paid on due date, you willget 30 days of grace period during which company will accept premium without interest and provideinsurance coverage. If premium is not received by the Company by the end of the grace period, the policy willlapse. All Insurance cover will end upon lapse of the policy. No benefit is payable in respect of an insuredevent which occurred during the period when the policy has lapsed even though the policy may subsequently

be revived.Within six months from the due date of the premium (period of revival) and before termination of the policy,the policyholder may apply in writing for revival of the policy.

The Company may upon receipt of a written request from the policyholder, and on production of evidenceof insurability acceptable to the Company (cost of which shall be borne by the policyholder) and at theabsolute discretion of the Company revive the policy on such terms and conditions as are applicable at thetime of revival of the policy.

All overdue premiums must be paid together with interest at such rates as may be intimated by the Companyfrom time to time. The revival of the policy shall take effect only after revival is approved by the Companyand communicated to the policyholder in writing. If at the end of the revival period, the policy is not revived,

the policy shall terminate, and no benefit shall be payable thereafter.TAX BEN EFIT

This health insurance plan may entitle you certain tax benefits on your premiums as well as on the benefitsreceived under this policy

U/ s 80D/ 80 C of the Income Tax act 1961 on your annual premium on your policy.

U/ s 10(10D) of the Income Tax act 1961 on your proceeds of the policy.

Few Important terms (for other terms and conditions, please request your Agent Advisor, intermediaries for better understanding of the product beforeconcluding the sale)

Free Look period:

The policyholder has a period of 15 days from the date of receipt of the policy to review the terms and conditions of the policy and where thepolicyholder disagrees with any of those terms or conditions, he has the option to return the policy stating the reasons for his objections, upon which heshall be entitled to refund of the premium paid subject to deduction of the proportionate risk premium for the period of cover and the expenses incurredby the company on medical examination and on account of stamp duty.

Prohibition of Rebates: Section 41 of the Insurance act, 1938 states: no person shall allow or offer to allow, either directly or indirectly, as aninducement to any person to take or renew or continue an insurance in respect of any kind of risk relating to lives, or property, in India, any rebate ofwhole or part of the commission payable or any rebate of the premium shown on the policy, nor shall any person taking out or renewing or continuing apolicy accept any rebate, except such rebate as may be allowed in accordance with the published prospectuses or tables of insurer.

Non-Disclosure: Section 45 of the Insurance Act, 1938 states that under the provisions of Section 45 of the Insurance Act, 1938, the Company is

entitled to repudiate a policy on the ground that a statement made in the proposal or in any report of a medical officer or reference or friend of theinsured or any other document leading to issue of the policy was inaccurate or false, before expiry of 2 years from the effective date of the policy, andthereafter that if such false or inaccurate statement was on a material matter or suppressed facts were material to disclose and it was fraudulently madeand the policy holder knew that the statement was false or was material to disclose.

A professional pedigree that's second to none: Insurance solutions from Max New York Life bring proven expertise to the Indian life insurance arena.As your partner for life, we bring you innovative life insurance solutions based on New York Life's global experience of over 160 years and Max India'sdeep understanding of the Indian market.

Exper t Advice at Your Doorstep: Our Agent Advisors have been professionally trained to understand and evaluate your unique financial requirements,and recommend a policy which best meets your needs. With experienced agents, we are fully resourced to help you achieve your life's financial objectives.Please call us today. We would be delighted to meet you.

Important N otes: This is only sales literature. It does not purport to be a contract of insurance and does not in any way create any rights and/ or obligations. All the

benefits are payable subject to the terms and conditions of the Policy. Benefits are available provided all premiums are paid, when they are due.


9/16

Service Tax and Education Cess would be levied as per applicable laws and would be to the account of the policyholder.

Insurance is the subject matter of solicitation.

Max New York Life Insurance Company Ltd.

Registered Address:

Max New York Life Insurance Company Limited,Max House, 3rd Floor, 1 Dr. Jha Marg, Okhla,

New Delhi - 110020

Tel: (011) 6933610

Corporate Address:

Max New York Life Insurance Company Limited,

11th Floor, DLF Square Building,

Jacaranda Marg, Phase II,

Gurgaon - 122002

Tel: (0124) 2561717

Toll Free No./ Customer Care No.

Call us on our toll free number 1800 - 180 - 5577

Dispute Redressal Cell

All consumer grievances may be first addressed to the company's Customer Helpdesk at 90 A, Sector 18, Gurgaon, 122002, Haryana, India

or the servicing General Office and subsequently (if r equired) to the Insurance O mbudsman, whose address can be obtained from the

offices of the company or from the IRDA website address www.irdaindia.org or refer to list attached below.


10/16


11/16


12/16


13/16


14/16


15/16

Li t f O b d


16/16

MN YL/SALES LITERATURE/ EURO/ 05

Li st o f O m b u d s ma n

O FFICE OF TH E O MBUD SMAN N AME OF TH E O MBUD SMAN AN D CO NTACT DETAILS AREAS O F JURISD ICTIO NAHMEDABAD Shri B.C. Bose2nd Flr., Ambica House,Nr. C.U. Shah College, (O) 079-27546150, 27546139 Gujarat, UT of Dadra & Nagar Haveli, Daman and Diu5, Navyug Colony, 2, Ashram Road, Fax:079-27546142

AHMEDABAD - 380 014 E-mail: [email protected]

BHOPAL Shri R.P. Dubey1st Floor, 117, Zone-II, (O) 0755-2769200, 2769202, 2769201, Madhya Pradesh & Chhattisgarh(Above D.M. Motors Pvt. Ltd.), . Fax:0755-2769203

Maharana Pratap Nagar, BHOPAL - 462 011 E-mail: [email protected]

BHUBANESWAR Shri M.N. Patnaik62, Forest Park, (O) 0674-2535220, 2533798 OrissaBHUBANESWAR - 751 009 Fax:0674-2531607

Email : [email protected]

CHANDIGARH Shri K.M. ChadhaS.C.O. No. 101,102 & 103, (O) 0172-2706196, 2705861 Punjab, Haryana, Himachal Pradesh, Jammu &2nd Floor, Batra Building,Sector 17-D, EPBX: 0172-2706468 Kashmir, UT of ChandigarhCHANDIGARH - 160 017 Fax: 0172-2708274

E-mail : [email protected]

CHENNAI Shri K. Sridhar

Fatima Akhtar Court, (O) 044-24333678, 24333668 Tamil Nadu, UTPondicherry Town and Karaikal4th Flr., 453(old 312 ), Fax: 044-24333664 (which are part of UT of Pondicherry)Anna Salai, Teynampet, E-mail : [email protected] -600 018

DELHI Shri R. Beri2/ 2 A, 1st Floor, (O) 011-23239611,23237539, 23237532 Delhi & RajashthanUniversal Insurance Bldg., Asaf Ali Road, Fax: 011-23230858NEW DELHI 110 002 E-mail : [email protected]

GUWAHATI Shri S.K. KarAquarius, (O) 0361-2413525 Assam, Meghalaya, Manipur, Mizoram,Bhaskar Nagar, EPBX: 0361-2415430 Arunachal Pradesh, Nagaland and TripuraR.G. Baruah Rd., Fax: 0361-2414051GUWAHATI - 781 021 E-mail : [email protected]

HYDERABAD Shri P.A. Chowdary6-2-46, 1st Floor, (o) 040-23325325, 23312122, 65504123, Andhra Pradesh, Karnataka and UT of YanamMoin Court, Lane Opp.Saleem Function Palace, Fax:040-23376599, a part of the UT of PondicherryA. C. Guards, Lakdi-Ka-pool, E-mail : [email protected]

HYDERABAD - 500 004.

KOCHI Smt. P.N. Santhakumari2nd Flr., CC 27/ 2603, Pulinat Building, (O) 0484-2358734, 2359338, 2358759, Kerala, UT of (a) Lakshadweep, (b) Mahe -Opp. Cochin Shipyard, M.G. Road, Fax:0484-2359336 a part of UT of PondicherryERNAKULAM - 682 015 E-mail: [email protected]

KOLKATA Shri K. RangabhashyamN orth British Bldg. (O ) 033-22134869, 22134867, 22134866, West Bengal, Bihar, Jharkhand and29, N. S. Road, 3rd Flr., Fax: 033-22134868, UT of Andeman & Nicobar Islands, SikkimKOLKATA -700 001. E-mail : [email protected]

LUCKNOW Shri K.S.K. KhareJeevan Bhawan, Phase 2, 6th Floor, (O ) 0522-2201188, 2231330, 2231331 Uttar Pradesh and UttaranchalNawal Kishore Rd., Hazartganj, Fax:0522-2231310,LUCKNOW - 226 001 E-mail: [email protected]

MUMBAI Shri R.K. Vashishtha3rd Flr., Jeevan Seva Annexe, S.V. Road, (O) 022-26106928, 26106360, Maharashtra, GoaSanta Cruz (W), EPBX: 022-6106889,MUMBAI - 400 054 Fax: 022-26106052

Email: [email protected]

Documents

Wellness Plus