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Family Health Optima Insurance Plan (revised)

Revision. Family Health Optima Insurance Plan (revised). Room rent revised Class A and Class B cities redefined Cataract limits revised Portability brought in 101 day-care procedures included Cumulative bonus in lieu of discount Claims Loading removed

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Family Health Optima Insurance Plan (revised)

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  1. Revision Family Health Optima Insurance Plan (revised)

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

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

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

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

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

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

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

  9. Benefits Existing Benefits Revised • Room Rent • A Class City Rs1500/ • B Class City Rs 750/ • Other s Rs 500/ • Room Rent • A Class City Rs 5000/ • B Class City Rs3000/ • Others Rs1000/ Benefits------- room rent

  10. Benefits Existing Benefits Revised • Less than 24 Hrs treatment at Hospital “Day Care Procedure” • Specific named procedures Now 101 Procedures allowed Benefits –Day Care Procedure

  11. Limits for Cataract SurgeryExistingRs 12000/Per policy PeriodRevised

  12. Existing Revised • NO CLAIMS LOADING Claims Loading

  13. Existing Revised • A discount of 10% is allowed on renewal of the policy if there is no claim in the immediately preceding year of the policy. This discount is not cumulative No discount NO Claim Discount- substituted by cumulative bonus

  14. Automatic Restoration of Sum Insured WHERE THE SUM INSURED IS EXHAUSTED DURING THE POLICY PERIOD IT IS AUTOMATICALLY TOPPED UP BY 50% FOR SUM INSURED OF RS 3 LACS AND BY 100% FOR SUM INSURED ABOVE RS 4 LACS AND ABOVE New Feature (1)

  15. Automatic Restoration of Sum Insured SUCH REPLENISHED AMOUNT SHALL NOT BE UTILISED FOR ANY AILMENT FOR WHICH CLAIM HAS BEEN MADE

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

  17. Bonus For every claim free year Bonus upto the scales is allowed. The bonus ranges from 10% to 25% in the first renewal and additional 5% to 10% for the second renewal. New Feature (2)

  18. Bonus

  19. BENEFIT ILLUSTRATION….

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

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

  22. SUM INSURED OPTION-WISE 2 LACS – MAX DIFF RS 2600 IN AGE BAND-51 TO 55 YRS 3 LACS – RS 2560 4 LACS- RS 2000 5 LACS – RS 3800 ALL FOR ZONE 1 How does it compare with the other policies in the market???

  23. EXAMPLE – INSURED 52YRS FAMILY SIZE 2A+ 2C SUM INSURED RS 5 LACS ZONE 2 2 CLAIM FREE YEARS. THE SAVINGS CAN BE USED FOR BUYING A SURPLUS POLICY COMPAR……

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

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

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

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