Critical Illness Insurance Policy

1

Smart Health Critical Illness Insurance Policy

Agenda

Need for Critical Illness Insurance?

Scope of Cover

Section I - Hospitalisation expenses payment/

reimbursement

Section 2 – Payment of Compensation

Add-on Covers

Policy Features

Exclusions

Key Features

For more detail about our products please visit us at www.bharti-axagi.co.in or call us at 080-49010200

http://www.bharti-axagi.co.in/



Need for Critical Illness

Threat of facing a major ailment is always present Increased probability due to modern life-style factors

- Long working hours

- Stress at work

- Lack of physical exercise

- Irregular meal patterns

- Junk foods habits

- Alcohol consumption

- Smoking habits

40s is the new 50s

- The average age of people facing such major illnesses have been falling over

the years

- Critical illnesses can occur to young people as well

- Often comes in an unexpected manner

- Rising occurrences of diabetes, blood pressure etc in people in the 30’s and

40’s





Potential Financial Impacts

1. Increasing treatment costs

to deal with - Advanced technology,

specialised experts etc

2. Savings that one has

worked very hard to build

can be wiped out

3. Potential Loss of Income - in case a critical illness

occurs to the breadwinner of

the family

4. Ad-hoc expenses





Why Critical Illness Insurance?

Specialized product only for critical illnesses Product can be taken as a “stand-alone” cover It can also act as a supplement to one’s existing health

insurance cover Illustration: Mr .X has taken a health insurance cover of Rs. 2 Lakh for his family. He, unfortunately, needs to undergo bypass surgery This Sum Insured can be fully consumed or prove to be insufficient for treatment

costs. Plus, the family’s health insurance cover would also be exhausted. In case Mr.X’s

son meets with an accident, there will not be any Sum Insured left

Solution: He can either take a critical illness policy to cover hospitalisation expenses – in

which case he can claim from this Policy and keep his health insurance policy intact

Or he can take a critical illness policy on benefit basis – in which case he can claim from his health insurance policy for hospitalisation expenses and then claim under the critical illness policy for compensation





Agenda

Need for Critical Illness Insurance

Scope of Cover


reimbursement


Add-on Covers

Policy Features

Exclusions

Plan Options

Product Comparison with Competitors

Key Features





Scope of Cover

This Policy provides for comprehensive coverage in case

the Insured Person is diagnosed with any of the covered

critical illnesses.

The coverage is available in two options:

Section I: Payment/Reimbursement of Hospitalisation

Expenses for treatment of critical illness

(Or)

Section II : Payment of Compensation





Critical Illnesses

1. Cancer2. First Heart Attack3. Coronary Artery Disease4. Coronary Artery Bypass

surgery 5. Heart Valve Surgery 6. Surgery to Aorta 7. Stroke8. Kidney Failure 9. Aplastic Anaemia 10. End Stage Lung Disease

11. End Stage Liver Failure12. Coma13. Major Burns14. Major Organ/Bone Marrow

Transplantation 15. Multiple Sclerosis16. Fulminant Hepatitis 17. Motor Neurone Disease 18. Primary Pulmonary

Hypertension 19. Terminal Illness 20. Bacterial Meningitis

The list of critical illnesses covered under the Policy are:

First product

in India to cover

20 critical illnesses





Agenda


Scope of Cover


reimbursement


Add-on Covers

Policy Features

Exclusions

Plan Options


Key Features





Section I - Hospitalisation expenses

Payment/ Reimbursement

This Section provides for payment or reimbursement of

hospitalisation expenses incurred by the Insured for

treatment of defined Critical Illnesses at any Hospital/

Nursing Home in India as an inpatient

This is available upto the Sum Insured opted by the

Insured.





Section I - Hospitalisation expenses

Payment/ Reimbursement

This Section offers the following benefits:

Hospitalisation Benefit

Pre Hospitalisation Expenses

Post Hospitalisation Expenses

Dread Disease Recuperation

Transplantation of Organs





Hospitalisation Expenses

This benefit provides cover for payment or reimbursement

of hospitalisation expenses that are reasonably and

necessarily incurred for treatment of Critical Illness in a

Hospital in India.

This, among other things, includes: Hospital (Room & Boarding and Operation theatre) charges, admission and

registration charges in the Hospital

Fees of Surgeon, Anaesthetist, Nurses, Specialists,

Cost of diagnostic tests, medicines, blood, oxygen, appliances like pacemaker,

artificial limbs, organs etc.

A minimum period of 24 hours of hospitalisation is required

for this benefit to be payable.

This cover is available up to the limit of Sum Insured opted

by the Insured





Pre and Post Hospitalisation

Expenses

Pre-Hospitalisation Expenses

This benefit provides for payment or reimbursement of pre

hospitalisation expenses incurred for a period of 30 days

prior to hospitalisation

Post-Hospitalisation Expenses

This benefit provides for payment or reimbursement of pre

hospitalisation expenses incurred for a period of 60 days after

discharge from hospital





Dread Disease Recuperation

Payment of an allowance towards Recuperation

expenses incurred by the Insured Person post discharge from the Hospital, where he/she undertakes treatment for

any of the covered critical illnesses, as an in-patient.

This benefit is payable for 60 days subject to medical

requirement as certified by the attending Medical

Practitioner.





Transplantation of Organs

Payment or reimbursement of hospitalisation expenses

incurred towards donor for a major organ transplant in case the Insured Person contracts any of the covered critical illnesses

requiring major Organ Transplantation surgery and

the Insured Person undergoes surgery and treatment in a Hospital as an in-

patient.





Agenda


Scope of Cover


reimbursement


Add-on Covers

Policy Features

Exclusions

Plan Options


Key Features





Section II- Payment of Compensation

In case the Insured has contracted any of the defined critical

illnesses, this Section provides the entire Sum Insured as a

lump sum compensation benefit.

This Section operates as a benefit cover

Compensation shall be payable if the Insured is surviving for more than 30 days

post diagnosis of any Critical Illness.

This benefit is available after a waiting period of 30 days

from the date of inception of the Policy in the first year of

cover.





Agenda


Scope of Cover


reimbursement


Additional Benefits

Policy Features

Exclusions

Plan Options


Key Features





Additional Benefits (Under Section I)

Section-I provides for the following additional benefits: Hospital cash allowance

Home nursing

Ambulance charges

In-patient physiotherapy charges

Recovery grant

Accompanying person's expenses

Children education fund

Mortal remains





Hospital Cash Allowance

Payment of a daily hospitalisation expenses up to the

applicable limits In case the Insured is hospitalized for treatment of any of the defined critical

illness for which a valid claim is admissible under the Policy and

if the hospitalisation exceeds the applicable number of days

This benefit is applicable irrespective of the number of

occurrences during the Policy period subject to overall Sum

Insured.





Home Nursing

Payment of an allowance for medical care services of a

nurse at the residence of the Insured following discharge from Hospital after a treatment for any of the covered critical

illnesses for which a valid claim under this Policy is admissible

provided such medical care services are confirmed as being necessary by the

attending Medical Practitioner and

the treatment relates directly to the critical illness for which the Insured has

undertaken treatment during the hospitalisation,


occurrences during the Policy period subject to the overall

Sum Insured.





Ambulance Charges

Reimbursement of expenses incurred for the

transportation of the Insured Person by ambulance to

and from the Hospital for treatment of critical illness in a Hospital as an in-patient for which a valid

claim under this Policy is admissible.


occurrences during the Policy period and is subject to

the applicable limits.





In-patient Physiotherapy Charges

Reimbursement of charges incurred towards physiotherapy

in the Hospital as an in-patient that is confirmed as being necessary by the attending Medical Practitioner and

the same relates directly to the critical illness for which the Insured Person has

undertaken treatment in the Hospital for which a valid claim is admissible under

this Policy.


occurrences during the Policy period and is subject to the

applicable limits.





Recovery Grant

Payment of a fixed allowance/grant in case the Insured Person is hospitalized for a period of 8 consecutive days or

more for treatment of any critical ilness for which a valid claim is admissible under

the Policy


occurrences during the Policy period.





Accompanying Person’s Expenses

Payment an allowance towards expenses incurred on the

accompanying person at the Hospital during hospitalisation treatment of the Insured Person for the critical illness for

which a valid claim is admissible under the Policy.


occurrences during the Policy period and is subject to the

applicable limits





Children Education Fund

Payment of a fixed amount per dependent child in the event of death of the Insured Person whilst under treatment in a Hospital as

an in-patient for any covered critical illness for which a valid claim is payable

under the Policy.

This is available for a maximum of two dependant children

who pursue studies and are below the age of 23 years





Mortal Remains

Reimbursement of expenses incurred for transportation of

the mortal remains of the deceased Insured Person from

Hospital to his/her place of residence in the event of death at the Hospital as an in-patient whilst under treatment of a

covered critical illness for which a valid claim is payable under the Policy





Agenda


Scope of Cover


reimbursement


Additional Benefits

Policy Features

Exclusions

Plan Options


Key Features





Family Floater Benefit

This policy can be issued on a Floater basis covering the

family members of the Insured comprising the Insured,

spouse and two dependant children (upto the age limit of 23

years).

All members of the family (Self,

Spouse, 2 Kids) can be covered

under one single policy

Single premium payable for the

entire family

The amount of Sum Insured

“floats” over the entire family

No need to insure individual

members separately

No hassles of tracking renewals

for different members





Renewal Discount

Discount equivalent to 5% of renewal premium every year on

a progressive scale will be given back to the Insured as

Renewal Discount at the time of renewal,

This is applicable where the Policy which is renewed is

claim free in the expiring year.

This renewal discount on a progressive scale will be allowed

upto a maxumum of 25%.

In case of renewal of a Policy where there is a loss, the

Insured will lose the entire Renewal Discount accumulated.

Discounts

5% to 25%





Income Tax Benefit

Premium paid under the Policy shall be eligible for

income tax deduction benefit under Sec 80 D as per the

Income tax Act.





Agenda


Scope of Cover


reimbursement


Additional Benefits

Policy Features

Exclusions

Plan Options


Key Features





Exclusions

Some of the major exclusions under the policy are:

Any disease / illnesses contracted during the first 60

days of the first year policy This will not apply for subsequent and regular renewals

Any pre-existing diseases / conditions / injuries at

the inception of the policy cover. However, the same will be covered after four continuous renewals

with us. Since the policy cover incepts for the first time.

Treatment traceable to pregnancy or childbirth

AIDS or HIV or ARCS-AIDS Related Complex

Syndrome

Treatment following use of drugs or liquor or in case

of intentional self-injury

Treatment received overseas

Treatment for any criminal act





Exclusions

Experimental and unproven treatment

Treatment by a family member / self-medication or any treatment, which

is not scientifically approved

Naturopathy / unani treatment

Aesthetics / cosmetic treatment, plastic surgery

Psychiatric, mental and psychological disorder and stress, Congenital

internal disease

Medical Treatment following use of intoxicating drugs and alcohol or

drug abuse, solvent abuse etc

Sex change or treatment related to, sex change.

Vaccination and inoculation of any kind.

Vitamins and tonics unless forming part of treatment for critical illness

as certified by the Medical Practitioner.

Any treatment received in convalescent homes, convalescent hospitals,

health hydros, nature cure clinics or similar establishments.





Agenda


Scope of Cover


reimbursement


Additional Benefits

Policy Features

Exclusions

Plan Options


Key Features





Plan Options

200000 300000 500000

Hospitalisaiton Expenses: Indemnity

basis 100%of Sum Insured 100%of Sum Insured 100%of Sum Insured

Pre-Hospitalisation: Up to 100%of Sum Insured

under section 1A

Up to 100%of Sum Insured under

section 1A


section 1A

Post-Hospitalisation Up to 100%of Sum Insured

under section 1A


section 1A


section 1A

Dread disease Recouperation:Rs 500 per day for a max of 45

days

Rs 500 per day for a max of 45

daysRs 500 per day for a max of 45 days

Transplantation of Organs:15% of SI over and above the

Original SI

15% of SI over and above the

Original SI

15% of SI over and above the Original

SI

ADDITIONAL

BENEFITSHospital Cash Allowance

Rs 750 per day for 30 days after

the first 3 days


the first 3 days

Rs 1000 per day for 30 days after the

first 3 days

Home Nursing:Rs 350 per day for 10 days after

the first 3 days


the first 3 days

Rs 500 per day for 10 days after the

first 3 days

Ambulance Charges: Rs 2500 Rs 2500 Rs 2500

Inpatient Physiotherapy: 2% of SI 2% of SI 2% of SI

Recovery Grant Rs 12500 Rs 12500 Rs 12500

Accompanying Person ExpensesRs 250 for 10 days after first

three days

Rs 250 for 10 days after first three

daysRs 250 for 10 days after first three days

Chidren Education Benefit 5000 5000 5000

Carriage of mortal remains 1000 2000 2000

II

Payment of

Compensation

Payment of Compensation 100%of Sum Insured 100%of Sum Insured 100%of Sum Insured

Sum Insured Rs.

ParticularsSection

I Hospitalisation

Expenses

Reimbursement





Plan options

Option1.Critical Illness Reimbursement Plan-

Section I + Additional Benefits

Option 2.Critical Illness Lump Sum Benefit Plan-

Section II





Agenda


Scope of Cover


reimbursement


Additional Benefits

Policy Features

Exclusions

Plan Options


Key Features





Product Comparison with

Competitors

Features Bharti Axa ICICI Lombard Tata AIG Reliance Bajaj Allianz

No of Critical illness covered 20 9 9 10 10

Sum Insured Options upto 5

lacs

Accompanying person's

expenses

Dread disease Recuperation

Income Tax Benefits 80D

Family Floater option

Lumpsum Benefit Option

Ambulance Charges

Home Nursing

Carriage of mortal remains

Children education benefits

Pre-hospitalisation expenses

Post-hospitalisation expenses

In-patient physiotherapy

charges





Pricing Comparison with Competitors

Critical Illness Pricing Comparison - 2 Lakhs Sum Insured

0

5000

10000

15000

20000

25000

30000

35000

Up to 2

5 years

30-35 y

ears

41-45 y

ears

51-55 y

ears

61-65 y

ears

Age Band

Pre

miu

m (

INR

)

Bharti AXA

Bajaj Allianz

Tata AIG


0

10000

20000

30000

40000

50000

60000

70000

80000

90000

Age Band

Pre

miu

m (

INR

)

Bharti AXA

Bajaj Allianz

TATA AIG


0

5000

10000

15000

20000

25000

30000

35000

40000

45000

50000

Up

to 2

5 ye

ars

25-2

9 ye

ars

30-3

5 ye

ars

36-4

0 ye

ars

41-4

5 ye

ars

46-5

0 ye

ars

51-5

5 ye

ars

56-6

0 ye

ars

61-6

5 ye

ars

Age Band

Pre

miu

m (

INR

)

Bharti AXA

Bajaj Allianz

TATA AIG





Agenda


Scope of Cover


reimbursement


Additional Benefits

Policy Features

Exclusions

Plan Options


Key Features





Key Features

Coverage for 20 major critical illnesses, against the usual

standard products in the market covering 10 to 12 diseases

Family Floater Option – Covers your family under one single

Policy

Can complement and suplement your existing Health

Insurance policy

Flexibility of Coverage under two options Payment or Reimbursement Hospitalisation expenses

Payment of Compensation

Innovative additional benefits on offer

Wide Range of Sum Insured Options to choose from

Benefits structured into pre-packaged plans for the

customer to pick and choose from

Cashless facility at over 4000 network hospitals





43

Thank you

For more detail about our products please visit

us at www.bharti-axagi.co.in or call us at

080-49010200




Economy & Finance

Critical Illness Insurance Policy