Family health optima revised 18012012

Family Health OptimaInsurance Plan

(Revised)

Age at Entry : 5 months to 65 years

Family size : 2A + 3C ( Maximum)Dependant children less than 25years of age

Renewability : Up to 65 years

Coverage on Floater Basis : Single Sum Insured on Floater

Basis covering all members of the family

Features

FeaturesSum Insured Options

Rs. 1,00,000/- Rs. 2,00,000/- Rs. 3,00,000/- Rs. 4,00,000/- Rs. 5,00,000/-

Rs. 10,00,000/- Rs. 15,00,000/-

For entry age between 61 and 65 years, only 2 Adults option is available for Sum Insured of Rs.3,00,000/- and above

Co Pay20% Co pay on each and every eligible claim amount for insured persons between 61- 65 years, at entry level

Two Tier rating of Premium according to Zone

Zone 1 - Mumbai including Thane, Delhi ( Delhi city, Noida, Gurgoan, Ghaziabad & Faridabad) and the entire State of Gujarat

Zone 2 - Rest of India

Premium would be charged according to the residential address of the customer.When a policy is charged as per Zone 2 rate and a

treatment is taken in one of the Zone 1 cities, the difference in the premium is recovered from the claim amount

Features

Hospitalization Benefit Hospitalization expenses incurred owing to disease, illness, sickness or accidents as inpatient in a

registered hospital for a minimum period of 24 hours is covered on Cashless or reimbursement basis.

Pre HospitalizationReasonable Expenses incurred upto 30 days prior to the date of admission.

Post Hospitalization 7% of the Hospitalization expenses (excluding room rent) subject to a maximum of Rs.5000/-

Benefits

Room Rent : Class A Cities2% of Sum Insured subject to maximum of Rs.5000 per day

Class B Cities1% of Sum Insured subject to maximum of Rs.3000 per day

Other Locations1% of Sum Insured subject to maximum of Rs.1000 per day

Benefits

Nursing charges, Surgeons, Anesthetist, Consultants and Specialists fees, Operation Theatre Charges, Drugs and medicines diagnostic materials, cost of pace maker etc.,

Ambulance Charges

Rs. 750/- per hospitalization subject to a maximum of Rs. 1500/- per policy period

Benefits

Day Care Procedures - 101 treatments covered as day care.

Limit for Cataract is based on the Sum InsuredSI Option Limit for Cataract

Benefits

Rs. 100,000Rs. 200,000

Rs. 12,000 Per policy period

Rs. 300,000Rs. 400,000Rs. 500,000

Rs. 20,000 per eye subject to Rs. 30,000 per policy period

Rs. 10,00,000Rs. 15,00,000

Rs. 30,000 per eye subject to Rs. 40,000 per policy period

Automatic Restoration of SI

Where the sum insured is fully exhausted during the policy period, either under a single claim or multiple claims put together there is an automatic top up of Sum insured for the rest of the policy period

Benefits

SI option % of Restoration

Upto Rs. 2,00,000 NIL

Rs. 3,00,000 & Above 100% of Sum Insured

Automatic Restoration of SI – An Illustration

Mr. A has a Rs.5,00,000 policy and a claim is made in full for treatment of an ailment by him.

Rs.500,000 is again reinstated in the policy for the rest of the policy period. No extra Premium is charged. This is automatic restoration.This amount can now be availed by all members

covered in the policy including Mr. A. However in the case of Mr. A, the restored Sum Insured will be available for diseases other than for which the claim was made.

Benefits

Bonus Additions

The policy holder is now bestowed with additional Sum Insured in case of a claim free year.

Different % age of bonus additions for Different Sum Insured options.

A maximum of 35% of Basic Sum Insured is accumulated as Bonus.

Ex: A policy with Sum insured of Rs.10,00,000/- will now automatically provide cover upto Rs. 12,50,000/- in the second year (I Renewal),Rs.13,50,000/- in the third year

without any extra premium

Benefits

Bonus Additions

Benefits

Basic Sum Insured

% age of Bonus in 1st year of Policy

% age of Bonus in 2nd year (First Renewal)

% age of Bonus in 3rd year (Second Renewal)

Maximum % age of Bonus

100,000 Nil 10 5 15

200,000 Nil 10 5 15

300,000 Nil 25 10 35

400,000 Nil 25 10 35

500,000 Nil 25 10 35

10,00,000 Nil 25 10 35

15,00,000 Nil 25 10 35

What happens to Bonus Additions when there is claim in the subsequent year ?

The Bonus will be reduced by 50% following a claim under the policy.

The Bonus becomes Zero when there is a claim in the successive year also

Bonus additions would continue according to slab for the further claim free year

Benefits

Revised FHO Rates

SumZONE 1

MUMBAI, DELHI & GUJARAT

ZONE 2

REST OF INDIA

Insured

Age in yrs 5m-35 36-45 46-50 51-55 56-60

61-65yrs

Age in yrs 5m-35 36-45 46-50 51-55 56-60

61-65yrs

(Rs) 2A 3890 3890 NA NA NA NA 2A 3600 3600 NA NA NA NA 2A+1C NA NA NA NA NA NA 2A+1C NA NA NA NA NA NA1 lac 2A+2C NA NA NA NA NA NA 2A+2C NA NA NA NA NA NA 2A+3C NA NA NA NA NA NA 2A+3C NA NA NA NA NA NA 1A+1C 3250 3875 NA NA NA NA 1A+1C 3250 3700 NA NA NA NA 1A+2C 4150 4700 NA NA NA NA 1A+2C 3850 4300 NA NA NA NA

1A+3C NA NA NA NA NA NA 1A+3C NA NA NA NA NA NA

Service Tax extra A-Adult Choose the age of the oldest member for calculating the premium C- Child

Revised FHO Rates

SumZONE 1


ZONE 2

REST OF INDIA

Insured

Age in yrs 5m-35 36-45 46-50 51-55 56-60

61-65yrs

Age in yrs 5m-35 36-45 46-50 51-55 56-60

61-65yrs

(Rs) 2A 3950 4675 7870 8145 9400 NA 2A 3850 4465 7515 7775 8515 NA 2A+1C 4620 5170 8580 8855 9635 NA 2A+1C 4255 4935 8190 8455 9195 NA2 lacs 2A+2C 6110 6875 9425 9800 10840 NA 2A+2C 5450 6565 8995 9260 9870 NA 2A+3C 6510 7975 10625 11200 11840 NA 2A+3C 6300 7415 9845 10110 10720 NA 1A+1C 3500 3950 5800 6225 7225 NA 1A+1C 3500 3875 5300 6000 7005 NA 1A+2C 4310 4905 7400 7575 8200 NA 1A+2C 4100 4830 7210 7300 8200 NA

1A+3C 5200 5960 8975 9735 11000 NA 1A+3C 5200 5410 8530 8790 9030 NA


Revised FHO Rates


ZONE 1


ZONE 2

REST OF INDIA

Age in yrs 5m-35 36-45 46-50 51-55 56-60

61-65yrs

Age in yrs 5m-35 36-45 46-50 51-55 56-60

61-65yrs

Sum 2A 4300 5320 9515 9790 12675 20500 2A 4200 5170 9085 9345 12090 18750

Insured 2A+1C 5400 5900 11070 11350 13440 NA 2A+1C 5300 5555 10565 10830 12830 NA(Rs) 2A+2C 6875 7245 11880 12155 14030 NA 2A+2C 6565 6775 11340 11605 13390 NA3 lacs 2A+3C 7975 8195 12980 13255 15130 NA 2A+3C 7465 7675 12240 12505 14290 NA 1A+1C 3875 4275 7010 7335 8995 NA 1A+1C 3875 4275 7010 7335 8645 NA 1A+2C 4910 5365 7980 8910 9995 NA 1A+2C 4910 5100 7810 8770 9510 NA

1A+3C 5940 6005 9725 10100 11445 NA 1A+3C 5670 5670 9555 9800 11225 NA

Revised FHO Rates

SumZONE 1


ZONE 2

REST OF INDIA

Insured

Age in yrs 5m-35 36-45 46-50 51-55 56-60

61-65yrs

Age in yrs 5m-35 36-45 46-50 51-55 56-60

61-65yrs

(Rs) 2A 5300 6510 12000 13200 16000 28500 2A 5300 6350 12000 13000 15500 23200 2A+1C 6825 7730 13900 14925 18075 NA 2A+1C 6610 7375 13200 14250 17255 NA4 lacs 2A+2C 8300 8915 15270 16100 18835 NA 2A+2C 7920 8525 14665 15185 17980 NA 2A+3C 9500 9715 16570 16890 20035 NA 2A+3C 8820 9425 15565 15885 18880 NA 1A+1C 4640 5165 8570 9090 10135 NA 1A+1C 4640 5005 8375 8685 9865 NA 1A+2C 5865 6235 9565 11110 12665 NA 1A+2C 5640 6000 9345 10875 12440 NA

1A+3C 7385 7590 11960 12985 14420 NA 1A+3C 7050 7245 11730 12650 14100 NA


Revised FHO Rates

SumZONE 1


ZONE 2

REST OF INDIA

Insured

Age in yrs 5m-35 36-45 46-50 51-55 56-60

61-65yrs

Age in yrs 5m-35 36-45 46-50 51-55 56-60

61-65yrs

(Rs) 2A 6885 8000 14970 15300 20050 30315 2A 6885 7640 14290 14600 19145 25750

2A+1C 8080 9125 16080 16400 21180 NA 2A+1C 7710 8710 15350 15665 20225 NA

5 lacs 2A+2C 9655 10090 16510 16840 22075 NA 2A+2C 9210 9635 15760 16075 21070 NA

2A+3C 10955 11390 17810 18140 23375 NA 2A+3C 10210 10635 16760 17075 22070 NA

1A+1C 6510 7225 9995 12100 14885 NA 1A+1C 6510 7225 9565 11850 14500 NA

1A+2C 7785 8010 14240 14700 16900 NA 1A+2C 7435 7650 14000 14450 16335 NA

1A+3C 8800 9000 15610 15930 20590 NA 1A+3C 8560 8630 14895 15215 19650 NA


Revised FHO Rates


ZONE 1 MUMBAI, DELHI & GUJARAT

ZONE 2 REST OF INDIA

Age in yrs 5m-35 36-45 46-50 51-55 56-60

61-65yrs

Age in yrs 5m-35 36-45 46-50 51-55 56-60

61-65yrs

Sum 2A 9110 11350 20500 22100 30300 40500 2A 8900 11000 18750 21000 28800 38500

Insured 2A+1C 11665 13450 21800 24800 32340 NA 2A+1C 11000 12875 20990 22700 30325 NA

(Rs) 2A+2C 13445 16200 23555 27900 36210 NA 2A+2C 12800 15380 22800 26440 35080 NA

10 lacs 2A+3C 16405 19505 26780 32665 39500 NA 2A+3C 15900 18100 25710 28850 37500 NA

1A+1C 8700 9900 16330 17680 24000 NA 1A+1C 8500 9700 15000 16810 23000 NA

1A+2C 10775 11995 17750 22875 26970 NA 1A+2C 10100 11000 16900 21000 26090 NA

1A+3C 13575 15010 22100 26860 30010 NA 1A+3C 12575 13895 20100 25660 27775 NA

Revised FHO Rates


ZONE 1


ZONE 2

REST OF INDIA

Age in yrs 5m-35 36-45 46-50 51-55 56-60

61-65yrs

Age in yrs 5m-35 36-45 46-50 51-55 56-60

61-65yrs

Sum 2A 10885 13865 25650 31125 39500 50500 2A 10100 12500 24400 29895 36500 41135

Insured 2A+1C 13990 15800 29910 37750 43660 NA 2A+1C 12770 14500 27500 35000 41200 NA

(Rs) 2A+2C 17780 19700 32100 41780 49205 NA 2A+2C 16660 18300 31650 40700 47810 NA

15 lacs 2A+3C 20780 22700 35100 44780 52205 NA 2A+3C 19310 20950 34300 43350 50460 NA

1A+1C 10540 11995 19875 24000 30890 NA 1A+1C 10000 11240 19030 22875 28880 NA

1A+2C 13450 14400 21880 29020 32910 NA 1A+2C 12450 13750 21000 28050 32000 NA

1A+3C 16770 18000 27030 33770 37990 NA 1A+3C 15875 16550 25010 30080 34700 NA

Persons who are suffering from or have suffered

from the following ailments cannot be issued

policy –

Heart Problem (CVD)

Cancer

Kidney Failure

Declined Risk

All Pre Existing Diseases not covered. However covered

after 48 months of continuous coverage with any of

Indian Insurer.

Any Diseases contracted during the first

30 days of the first policy year.

Exclusions

First year Exclusions

Benign prostate hypertrophy,

Hernia

Hydrocele

Fissures, Fistula in Anus / Piles

Sinusitis

Congenital internal disease/defect

Treatment for Gall stone and

Treatment for Renal stone

Exclusions

First 2 year’s Exclusions

Cataract

Hysterectomy following menorrhagia or

fibromyoma,

Treatment for Knee,

Treatment for Joint

Prolapse of intervertibral disc

Varicose veins/ulcers

Exclusions

This policy is portableProposals from less than 45 years of age without any previous claim or PED, can be ported to this policy by the operating office.

The requisition has to be received 7 days before the date of expiry.

Beyond 45 years of age, portability acceptance routed through portability cell and applications will have to be received atleast 30 days prior to

the date of Expiry.

Portability

Continuity benefits of First 30 days, First year exclusions, First two years’ exclusions and PED allowed according to the previous policy.

Cumulative Bonus of the previous insurer is notgiven credit. However the Insured can opt for Sum Insured including the cumulative Bonus and Premium will be charged on the total Sum Insured.

Portability

Pre Insurance medical examination as per latest underwriting guidelines.

Tests to be taken as per the guidelines given.

Acceptance based upon the medical officer’s opinion of the MER.

Persons with adverse medical history may also be referred for medical examination.

Pre Insurance Medical

Deductions under Sec 80 D of Income Tax Act

is available for all modes of payment other

than cash

IT Benefit

Revision of Sum Insured on Renewal Please refer the latest underwriting guidelines.

The No Claim Discount for a claim free year is withdrawn in view of introduction of Bonus.

The policy will now attract Bonus Additions as per the conditions.

Renewal (contd.,)

An illustration

Rs.4,00,000 claim free FHO policy is now renewed for Rs.5,00,000 Sum insured.

There will be a bonus addition of Rs.1,00,000. (25% of Basic Sum insured which is Rs.4,00,000)

Total Sum insured is Rs.6,00,000 (Rs.5,00,000 + Rs.1,00,000)

Premium is charged for Rs.5,00,000 Sum insured

Documents required

Proposal form duly filled in all respects and signed by the proposer. Care to be taken to observe the PED details, if any.

One Photograph of each person to be insured

Two photographs for those who have to undergo medical examination

Age proof in case of age above 45 years

Full and Correct Premium of the plan

Portability Form, wherever applicable

USP’s of Revised FHO 101 day care procedures covered

Revised limits for Cataract

Inclusion of Goa, Rajkot, Allahabad in B Cities

Automatic Restoration of SI up to 100% of Sum insured

Bonus additions for claim free year

Bonus additions is reduced by only 50% in case of a claim

No decrease in Basic SI

No loading on claims

Two tier pricing

Happy Selling

Family health optima revised 18012012

Health & Medicine

Transcript of Family health optima revised 18012012