Health Insurance


Health Insurance at a glance.
Thumb Rule No. 1: You must allocate 1% to 1.5% of your family income for medical insurance .
Thumb Rule No. 2. You must begin medical coverage at earliest & all your family member must be covered.

Shocking Truths about Indians:

  • 18% of the urban population suffers from hypertension, which leads to renal failure, stroke and cardio-vascular diseases.
  • 30% of the population suffers heart attacks before age 40.
  • 66% of deaths today are due to cardio-vascular diseases.
  • Almost 3.5 million Indians suffer from diabetes.
  • Cardio-vascular diseases (CVDs) like heart disease and stroke are the main causes of death and disability.

5 reasons why health insurance is a must:

  • Reason 1: Lifestyles have changed.
  • Reason 2: Rare non-communicable diseases are now common.
  • Reason 3: Medical care is unbelievably expensive.
  • Reason 4: Indirect costs add to the financial burden.
  • Reason 5: Incomplete financial planning.

It is a human right to secure good health by acquiring adequate coverage against the financial risks and medical emergencies. Mediclaim serves the purpose of protecting your valuable health. Healthcare involves the services developed to safeguard health, including medical facilities, professional and financial services such as medical insurance. We are exposed to various hazards that can damage not just our physical health, but also our finances. Thus, Mediclaim or Health Insurance becomes significant as it provides monetary protection in case of such unforeseen situations.


Following are some unique & special medical insurance policies available:

1. ICICI LOMBARD FAMILY FLOATER HEALTH INSURANCE

2. ICICI LOMBARD HEALTH ADVANTAGE PLUS

3. ICICI PRUDENTIAL HEALTH SAVER PLAN

4. RELIANCE INDIVIDUAL MEDICLAIM POLICY

5. ORIENTAL INDIVIDUAL MEDICLAIM POLICY





1. ICICI LOMBARD FAMILY FLOATER HEALTH INSURANCE

Benefits:

  • Avail Cashless Claim facility at 3,500+ hospital network across India.
  • No health check-up up to the age of 55 years (age as on last birthday).
  • Cover your family under a single policy.
  • Now get additional Sum Insured for every claim free year.
  • Avail tax benefits under Section 80D of the Indian Income Tax Act 1961.
  • Secure your family against terrorist activities.
  • Free health check-up coupon for any one insured family member
  • ICICI Lombard Family Floater health insurance policy has no sub-limits on room rent, doctor fees, and hospital charges or for any disease except Cataract (INR 20,000 per eye applicable)
  • ICICI Lombard Family Floater health insurance policy has no co-payments for any disease or any Hospital usage.
  • Options for one or two year covers available.

Coverage:

  • The Family Floater health plan covers the following medical expenses:
  • Incurred as an inpatient during hospitalization for more than 24 hours, including room charges, doctor/ surgeon’s fee, medicines bills, etc.
  • Medical expenses incurred 30 days prior to hospitalization
  • Medical expenses incurred 60 days post hospitalization
  • Day Care expenses incurred on named advanced technological surgeries and procedures requiring less than 24 hours of hospitalization. (Including Dialysis, Radiotherapy, and Chemotherapy)
  • Pre-existing diseases can be covered after 4 continuous years## of coverage with the Company
  • This policy also covers you for hospitalization# in case of Swine Flu / H1N1 influenza

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2. ICICI LOMBARD HEALTH ADVANTAGE PLUS

Benefits:

  • Covers Outpatient Department (OPD) expenses, such as diagnostics tests, dental treatment, medical bills, ambulance charges etc.
  • Avail Cashless Claim facility at 3,500 network hospitals across India.
  • A maximum of 2 adults can be covered under a single policy.
  • Now get additional Sum Insured for every claim free year.
  • Avail tax benefit under Section 80 D of the Indian Income Tax Act, 1961.
  • Pre-existing illness covered after two years, subject to continuous renewal of the policy.
  • Maternity expenses can be covered under OPD expenses of this plan up to the OPD sum insured.
  • ICICI Lombard Health Advantage Plus insurance policy has no sub-limits on room rent, doctor fees, and hospital charges or for any disease except Cataract (INR 20,000 per eye applicable).
  • ICICI Lombard Health Advantage Plus insurance policy has no co-payments for any disease or any Hospital usage.
  • Insurance against Terrorist activities.

Coverage:

  • Basic Hospitalisation Cover.
  • Covers medical expenses incurred, as an inpatient during hospitalisation for more than 24 hours, including room charges, doctor’s / surgeon’s fee, medicines, diagnostic tests, etc.
  • 30 days prior to hospitalisation.
  • 60 days post hospitalisation.
  • Pre-existing diseases shall be covered after 2 years.
  • This policy also covers you for hospitalization# in case of Swine Flu / H1N1 influenza.
  • Following technologically advanced treatments do not need 24-hour hospitalisation but are covered under this policy are:-
    1. Cataract (limited to Rs. 20,000 per eye)
    2. Lithotripsy (Kidney Stone Removal)
    3. Tonsillectomy
    4. Eye Surgery
    5. Dialysis
    6. Dilatation & Curettage
    7. Chemotherapy
    8. Radiotherapy
    9. Coronary Angiography
    10. Cardiac Catheterization
  • The following Outpatient Department (OPD) expenses are covered:
    1. Room, Boarding Expenses as charged by the Hospital
    2. Nursing Expenses
    3. Expenses related to Dental Treatment
    4. Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialist Fees
    5. Anaesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Consumables, Medicines and Drugs, Diagnostic Materials and X-ray, Dialysis, Chemotherapy, Radiotherapy, Cost of Pacemaker, Cost of Artificial Limbs External Medical Aids, Dental treatment charges, Ambulance charges
    6. Note: The OPD claims can be made only on a reimbursement basis. You can lodge a claim only once during the Period of Insurance, i.e. 90 days after commencement of policy and 30 days after expiry of the Period of Insurance.

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3. ICICI PRUDENTIAL HEALTH SAVER PLAN

A comprehensive health insurance and savings solution that not only provides your family with immediate hospitalisation cover but also aims to create a fund to keep you prepared against any health related expenses especially allowing you to provide for rising health care costs.

  • A part of your premiums are allocated for investment designed specifically to build a health fund to meet for health related expenses
  • The health savings kitty is created by investment in a long term flexible savings plan with multiple fund options and portfolio investment strategies based on your preference.
  • Allows for health related claims from your savings kitty post 3 completed policy years.
  • Allows you to avail tax benefits u/s 80D for the entire amount invested.
Term Whole life plan
Coverage
  • Hospitalization Insurance Benefit
  • Health Savings Benefit
Min/Max age at entry
  • 25 years to 55 years for individual plans.
  • 90 days to 55 years for family floater.
  • (Maximum cover ceasing age for children is 25 years under the family-floater cover)
Max age at maturity
  • Hospitalisation Insurance Benefit ceases at 75 years of age.
  • Health Savings Benefit continues for whole life.
Min/ max Annual Limit Annual limits available under the plan are Rs. 2 lacs, Rs. 3 lacs , Rs. 5 lacs , Rs. 7 lacs and Rs. 10 lacs
Min / Max Premium Premiums would be subject to the minimum premium grid given below based on the age and number of members selected.

Individual Family floater Family floater
Age (Yrs) All Annual Limits Annual Limits upto Rs 5 lacs Annual Limits greater than Rs 5 lacs
< 40 10,000 15,000 20,000
40-55 15,000 25,000 30,000
Available premium paying frequency Monthly, Half Yearly, Yearly
Waiting period 30 days from policy commencement date.


Important Benefits

  • Cover Continuance Option
  • This option ensures that your policy continues subject to foreclosure in case you are unable to pay premiums, any time after payment of the first five years’ premium. All applicable charges will be automatically deducted from the units available in your fund. You will need to opt for cover continuance, if you wish to avail of this benefit.

  • Death Benefit
  • 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.
    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.

  • Increase or Decrease in Premium
  • You can increase or decrease the annual premium under the policy (subject to minimum premium grid), but such an increase or decrease would be allowed at next premium due date.

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4. RELIANCE INDIVIDUAL MEDICLAIM POLICY

Benefits:

  • Hospitalisation Care for the Family Reliance Mediclaim Insurance Policy covers you and your family for hospitalisation and related expenses. Family members between the ages of 5 and 80 years can be covered. The policy also provides health insurance for children between the ages of 3 months and 5 years if one of the parents is covered concurrently.
  • Claim-Free Bonus We reward you with a no-claim bonus of 5% on every claim-free renewal. This can be accumulated up to a maximum of 50%.
  • Tax Benefits: With health insurance you not only protect your family but also can avail of tax benefits under Section 80D of the Income Tax Act.

Coverage:

    Reliance Mediclaim Insurance Policy will cover various hospitalisation expenses.

  • Hospitalisation Expenses – These include room charges and operation theatre charges, nursing expenses, fees of medical practitioner, anaesthetist and consultants.
  • Medicine, Consumables and Diagnostic Expenses – Cost of anaesthesia, blood, oxygen, surgical appliances, medicine and drugs, diagnostic material and X-rays, dialysis, chemotherapy, radiotherapy, pacemaker, artificial limbs and organs.
  • Day Care Treatment – The policy will cover expenses incurred towards technologically advanced treatment that does not require hospitalisation for 24 hours or more.
  • Domiciliary Hospitalisation – We also provide cover for treatment administered at home, subject to specified conditions.
  • Pre- and Post-Hospitalisation – Reliance Mediclaim Insurance Policy covers medical expenses for treatment up to 30 days before and up to 60 days after the hospitalisation.

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5. ORIENTAL INDIVIDUAL MEDICLAIM POLICY

Brief Description :
Mediclaim Insurance is a cover which takes care of medical expenses following Hospitalisation/Domiciliary Hospitalisation of the Insured in respect of the following situations: (A) In case of a sudden illness (B) In case of an accident (C) In case of any surgery which is required in respect of any disease which has arisen during the policy period.
Covered Risks :
This cover is a hospitalisation cover and reimburse the medical expenses incurred in respect of covered disease /surgery while the insured was admitted in the hospital as an in patient. The cover also extends to pre- hospitalsation and post- hospitalisation for periods of 30 days and 60 days respectively.
Major Exclusions :
Any pre-existing disease,any expense incurred during first 30 days of cover except injury due to accident,all expenses incurred in respect of any treatment relating to pregnancy and child birth. Treatment for Cataracts,Benign prostatic hypertrophy,Hysterectomy, Menorrhagia or Fibromyoma, Hernia,Fitula of anus,Piles, Sinusitis, Asthma,Bronchitis, All Psychiatric or Psychosomatic disorders are excluded from the scope of the cover.

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