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New Medi -classic Insurance Policy

New Medi -classic Insurance Policy. Unique Features. Restoration of Sum Insured Health Check up every 4 years (SI >Rs2L) 101 Day Care Procedures Zone Based Two-Tier Rating No Sub-limits for day care procedures except for cataract. Option of 2 years policy period

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New Medi -classic Insurance Policy

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  1. NewMedi-classic Insurance Policy

  2. Unique Features • Restoration of Sum Insured • Health Check up every 4 years (SI >Rs2L) • 101 Day Care Procedures • Zone Based Two-Tier Rating • No Sub-limits for day care procedures except for cataract. • Option of 2 years policy period • Entry Age up to 65 yrs and lifelong guaranteed renewals. • Optional benefits under Hospital Cash and Patient Care. • Coverage for HIV+ persons

  3. Features explained • First time entry: • For children from 5 Months • For seniors up to 65 Yrs. • Guaranteed life long renewals • Policy term options - 1 Year & 2 Years. • Cover (with restrictions) can be offered to HIV+ persons also subject to the condition that CD 4 count at the point of entry is not less than 350. • Co Pay 10% on every claim beyond 60 Years at entry level and their renewals thereafter.

  4. Features explained Coverage: Hospitalisation Expenses as an in patient for treating • Illness/Sickness/Diseases • Accidental Injuries.

  5. Features explained

  6. Features Explained • Cost of Health Checkup • Available after every block of 4 claim-free years • Up to 1% of the average sum insured subject to a maximum of Rs.5,000/- per block • This BENEFITNOT AVAILABLE for the basic product with Sum Insured of Rs.1.5L.

  7. Features EXPLAINED • Day Care Procedures • 101 NAMED Procedures. • No Sub-limits except for Cataract, which are:

  8. Features explained • Automatic Restoration of Sum Insured IF…….the sum insured is fully exhausted - • A One-time Restoration benefit • 2-times the basic sum insured • CAN ONLY BE utilized for illness/diseases unrelated to illness/diseases for which claim/s was/were made.

  9. Features explained • Optional Riders • Hospital Cash • Rs.1000/- for each completed day subject to a maximum of 7 days per hospitalisation and 14 days per policy period • There should be a valid hospitalization claim. • No need to submit bills • Premium Rs.350/- + Service Tax

  10. Features explained • Optional Riders • Patient Care – Cost of engaging an attendant at residence immediately after discharge from hospital. Conditions: • Should be recommended by the attending physician • Only for persons above 60 yrs of age • Benefit of Rs.400/- for each completed day up to 5 days per occurrence and 14 days per policy period • Only consequent to a valid hospitalization • No payment will be made for the first day • Bills to be submitted • Premium Rs.580/- + Service Tax

  11. Features explained • Sum Insured Options • Rs. 1,50,000/- • Rs. 2,00,000/- • Rs. 3,00,000/- • Rs. 4,00,000/- • Rs. 5,00,000/- • Rs.10,00,000/- • Rs.15,00,000/- (newly introduced)

  12. Family Package option • Sum Insured EQUALLY DIVIDED among Insured family members • Coverage for self, spouse and maximum2 dependent children • Entry Age: 5months for children; 45 years for Adults. • After 45 yrs, migrate to Mediclassic Individual or Family Health Optima. • Sum Insured Options Rs.2,00,000/- & Rs.3,00,000/- only

  13. Family Package option • Restoration benefit – Not available • Cost of Health check-up – Available. • Equally apportioned among all the members • Even if one person makes a claim, the rest will be eligiblefor their share of health check up benefit. • An example: If sum insured under the 4 year period is Rs 3L, max eligible for health check-up is Rs3000/-. Eligibility per person is Rs.750 (3000/4). If one person has made a claim in the 4 year period, the remaining limit of Rs2250/- will be available for other non-claiming members.

  14. Family Package – Premium chart

  15. Family Package versus FHO Restore

  16. Key changes in Exclusions First Two-years: Listed initial two-year exclusions (No separate 1st year Xclusions): • Eye related1: Cataract, Glaucoma, Retinal detachment/ Macular degeneration • Eye related2: Lasik/ Laser treatment/ Refractive Error Correction, treatment of eye disorders requiring intra-vitreal injections. • E N T related: Deviated nasal septum, Sinusitis, Tonsillitis, Nasal polyps, Chronic SuppurativeOtitis Media and related disorders, Stapedectomy. • Treatment/removal of Stones: Hepato-biliary/ Gall bladder/ Pancreatic/ Genitourinary calculi • Diseases of Female reproductive organs: Uterine -prolapse/ Dysfunctional Uterine Bleeding/ Fibroids/ Pelvic Inflammatory Diseases, Diseases of fallopian tubes and ovaries • Preventive/ Cosmetic Treatment: All vaccinations/inoculations (Except Anti-Rabies Injection), Circumcision, Plastic/Bariatric surgery / Weight control treatment etc.

  17. Key changes in Exclusions First Two-years – cont’d: Listed initial two-year exclusions (No separate 1st year Xclusions): • Joints/Musculo-skeletal: Degenerative diseases of joints/ vertebral disc/ Joint replacement/ IVDP (other than by fresh accident) • Certain named procedures: Stem Cell Implantation Therapy/ Enhanced External Counter Pulsation (EECP) therapy and related therapies and Rotational Field Quantum Magnetic Resonance Therapy and such other similar therapies. • Non-Allopathic: 25% of SI or Max of Rs.25000 • Over 60 years Co-pay: 10% co-pay for all claims in fresh/renewal policies

  18. Key changes in Exclusions First Two-years – cont’d: Listed initial two-year exclusions (No separate 1st year Xclusions): • Congenital Internal defects for first two years. • Cost of Medical support/Aids: Spectacles /contact lens, Hearing aids including Cochlear implants, Walkers/ Crutches/ Wheel chairs, Support like CPAP, CAPD, Infusion pump and such other similar aids.

  19. Regular exclusions • Any disease contracted in First 30 days • Dental treatment or surgery unless necessitated due to an accident • HIV treatment (opportunistic infections of insured HIV patients covered) • Pregnancy/Child-birth related treatment • Infertility related treatment • Naturopathy/ Unconventional/ Unproven therapies • Non-medical like registration charges etc

  20. Regular exclusions – cont’d • Varicose veins and varicose ulcers, Benign prostatic hypertrophy • Hernia, Hydrocele, Fistula / fissure-in-ano and Hemorrhoids • Charges incurred primarily for diagnostic purpose/ Vitamins/Nutritional supplements etc • Naturopathy/ Unconventional/ Unproven therapies • Non-medical like registration charges etc • War, Invasion, Act of Foreign Enemy, Warlike operations/Nuclear perils etc.

  21. Benefit comparison

  22. Benefit Comparison(cont’d…)

  23. Premium Chart

  24. Premium Chart

  25. Any questions, pls? Thank You

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