V1 2 Life Expectancy in India 64 2005 75* 48 Age (in Years) 2025 1955 Year *Source: The OASIS (Old Age Social and Income Security committee report) The customer will live longer ..but not necessarily healthier V1 3 Working 42 yrs Age 18 to 60 Retirement 7 yrs Age 60 to 67 Working 30 years Age 25 to 55 Retirement 20 years Age 55 to 75 Life stage of average individual Previous generation Today The customer will live longer but not necessarily work longer Is our customer prepared to meet health expenses during this phase? V1 4 Source : Outlook Money,31st May,2007` The customer will make more money but not necessarily meet the rising cost of healthcare V1 5 26% of the consumers investing in tax saving instruments in the last two years invested in health insurance. 23% of the consumers who are planning to invest in tax saving instruments in the next one year want to invest in health insurance. Findings from a consumer research conducted by ICICI Prudential in Sep 08 across Mumbai, Chennai and Delhi The customer will buy insurance to save tax but not necessarily only for Section 80 C 91% of the consumers are aware of health insurance as a tax saving instrument. V1 6
A plan which:
Provides guaranteed reimbursement hospitalization cover till age 75
Builds up a health fund and allows claims for health expenses not covered in the hospitalization cover
Flexibility in premium payment
Gives complete tax benefit under Section 80D Yes, the customer will need a health plan but not necessarily the one You have in mind V1 7 Rise to the health cover challenge If this is the customer s present state
How will you balance? V1 8 Presenting V1 9 Complete Tax Benefit under Section 80D Cover with a dual benefit Allows claim against out-patient treatment, diagnostics, dental care etc Reimbursement based hospitalization coverage Builds a health fund to cope with rising cost of health care Hospitalisation Insurance Benefit Health Savings Benefit Comprehensive whole life health offering V1 10 How does the plan work? Health Savings Benefit Hospitalisation Insurance Benefit To cover you against hospitalization expenses To cover you against all other health expenses Select the annual limit for the hospitalization cover Select a suitable premium *Invested premiums mean premiums post deduction of applicable charges Basis age and annual limit chosen, part of premium will go towards the health cover and remaining invested to build a health fund* V1 11 Coverage Scope Comprehensive Cover (Including OPD & Daily costs) Hospitalization CI/ Disability / Major surgery
Comprehensive health offering Specific cover V1 12 The features in detail Hospitalisation Insurance Benefit Health Savings Benefit V1 13 The features in detail Hospitalisation Insurance Benefit Health Savings Benefit V1 14 The features in detail Hospitalisation Insurance Benefit Health Savings Benefit Covers actual expenses incurred during hospitalization Room, boarding and nursing charges, ICU charges Maximum room rent payable to be 1% of selected annual limit only for single A/C rooms
Pre & Post hospitalization expenses for 30 & 60 days
125 listed day care procedures
Ambulance charges upto Rs 1000 per year V1 15 The features in detail Hospitalisation Insurance Benefit Health Savings Benefit Guaranteed coverage till age 75
No re-evaluation of health status or refusal of cover during term
No addition of exclusions or increase in premiums due to claims made No claims Bonus A bonus of 5% on annual limit added for every claim free year
Bonus amount up to 25% can be added Family floater Cover yourself, spouse and upto 3 dependant children under same plan V1 16 The features in detail Hospitalisation Insurance Benefit Health Savings Benefit Free Health Checkup A free health check-up once every 2 policy years after the first year
Reimbursement of amount up to 1% of annual limit or Rs 5000 whichever Pre-Existing illnesses Cover Pre-existing illnesses covered after 2 years
The disease to be declared at inception & accepted by the company Cashless Hospitalization Cashless claims settlement in over 5000 network hospitals V1 17 The features in detail Hospitalisation Insurance Benefit Health Savings Benefit Wide network access with preferred benefits
Access to a network of over 5000 hospitals
A Co Pay of 20% applicable for room upgrade over prescribed limit in single A/c room or for claims in outside network hospitals
In Emergency, co-pays does not apply in cardiac or trauma cases at a outside network hospital
Click here for co-pay illustration
V1 18 The features in detail Hospitalisation Insurance Benefit Health Savings Benefit V1 19 The features in detail Hospitalisation Insurance Benefit Health Savings Benefit V1 20 The features in detail Hospitalisation Insurance Benefit Health Savings Benefit Build a Health Fund for the future Choose from two portfolio strategies : Lifecycle strategy wherein allocation is based on customers age with rebalancing on a quarterly basis As age progresses, allocation changed to suit Life stage. Click here to know more.
Fixed strategy wherein a customer can do his own asset allocation. The customer can chose from 7 funds Click here to know more
Includes Health Return Guarantee Fund With Automatic Transfer Strategy V1 21 The features in detail Hospitalisation Insurance Benefit Health Savings Benefit Claim for any health expenses after 3 years Claim are allowed from 4 th year onwards against medical bills. Claims can be made for:
Daily medicines and drugs Diagnostic expenses Doctor bills and other OPD expenses Co-pays /deductibles of other medical insurance cover Miscellaneous medical expense over and above that covered by Hospitalization Insurance
Claim schedule:
Claims can be made once every year, with minimum claim amount of Rs 1000 100% 50% 20% Maximum claim (% of fund value) From 11 th Yr 6 th -10 th Yr 4 th & 5 th Yr Policy Years V1 22 The features in detail Hospitalisation Insurance Benefit Health Savings Benefit Cover Continuance option after 5 years
Option of premium holiday after completion of 5 policy years
Hospitalization Insurance and Health Savings benefit continues by deduction of charges from accumulated fund
Once the fund value drops to <110%of annual premium, the customer can still claim from it for the next 5 years ( max 50% every year)
Tax benefit under Section 80D
Complete tax benefit under Section 80 D even for this component of the premium
V1 23 Features summarized No Claim Bonus Guaranteed Coverage till age 75 Family Floater Over 125 Daycare coverage Pre-existing Illness Cover after 2 yrs Build a health fund for the future Cover Continuance option after 5 years Allows you to claim for any health expenses after 3 years Hospitalisation Insurance Benefit Health Savings Benefit Tax Benefits of upto Rs 15000 u/s 80D Click here Free Health Checkup V1 Therefore the product positioning
A dual benefit health plan Flexibility in premium payment Comprehensive guaranteed reimbursement coverage Builds a health fund and allows Claims for all health expenses Complete tax benefit under Section 80 D V1 25 Illustration 1 Customer insured with annual limit of 3 Lakhs for the hospitalization cover at age 32. He has chosen to pay a premium of Rs. 15000 annually. He made a claim for hospitalization due to a road accident at age 38; during the treatment he incurred total hospitalisation expenses of Rs.84,000. He also had to pay additional charges for follow-up tests, crutches, belts, collars totaling Rs.16,000. What can the policyholder claim?
Claim payable under the plan:
Hospitalization insurance benefit All eligible expenses during hospitalization are payable to the customer i.e. Rs. 84,000
Heath savings benefit Since the claim is in 5 th Policy year, he can make a partial withdrawal up to 50%of fund value. The remaining expenses which are not covered under Hospitalization insurance benefit can be reimbursed up to the actual expense i.e. Rs.16,000
Total benefit payable : Rs.1,00,000 V1 26 Illustration 2 Customer insured with annual limit of 2 Lakhs for the hospitalization cover at age 35. He has chosen to pay a premium of Rs. 25000 annually.
At age 39, the customer had accumulated medical bills for the past 2 years ranging from bills for daily medicines, doctor visits and even dental treatment up to Rs. 22,000. He however has not undergone any hospitalization. What can he claim?
Claim payable under the plan:
Hospitalization insurance benefit No instance of hospitalization
Heath savings benefit Since the claim is in 4 th Policy year, he can make a partial withdrawal up to 20%of fund value. In this case the entire amount can be claimed from the health fund i.e. Rs.22,000
Total benefit payable : Rs.22,000 V1 27 Illustration 3 Customer insured with annual limit of 3 Lakhs for the hospitalization cover at age 41. He has chosen to pay a premium of Rs. 20000 annually.
At age 50, the customer decides to take a premium holiday and exercises CCO option. At age 52 he is hospitalized for CABG and incurs expenses of Rs.2 lakhs. He also has bills for follow-up medication of Rs. 20000. How much can be claim?
Claim payable under the plan:
Hospitalization insurance benefit Since he opted for CCO, he continued to remain covered and the entire amount of Rs. 2 lakhs is payable.
Heath savings benefit Since the claim is in 11th Policy year, he can make a 100% withdrawal from the fund value. In this case the entire amount can be claimed from the health fund i.e. Rs.20,000
Total benefit payable : Rs.2,22,000 V1 28 Boundary conditions at-a-glance 30 Days No waiting period applies for claims due to accident Waiting period of two years will apply to some conditions Waiting period 25 - 55 years for individual policies 18 - 55 years for spouse in a family floater Dependent children (90 days - 25 years of age) Min/Max Age at Entry 2 lacs / 3 lacs / 5 lacs / 7 lacs / 10 lacs Annual Limit Options (Rs.) Whole Life Plan (Hospitalisation Insurance guaranteed upto age 75 years) Term V1 29 Yearly, Half Yearly, Monthly Premium Paying Modes Premiums would be subject to the minimum premium grid given below based on the age and number of members selected
Minimum Premium CIPS allowed once in every 2 years Change in portfolio strategy 4 Free switches in a year. Additional switches chargeable at Rs.100 per switch Switch Annual Limit > 5 lacs Annual Limit upto 5 lacs All Annual Limits 30000 25000 15000 40-55 20000 15000 10000 <40 Family Individual Age Boundary conditions at-a-glance V1 30 Health Saver charges Allocation Charge
Policy Admin Charges For Monthly : Rs 90 per month For Yearly and Half yearly mode: Rs 60 per month
Fund Management Charge 1.5% for Health Flexi Growth , Health Multiplier, Health RGF 1.0% for Health Flexi Balanced, Health Balancer 0.75% for Health Protector, Health Preserver 2% 4-10 0 9% 20% % of Annual Premium Thereafter 2-3 1 Year All charges deducted in the form of units from fund V1 31 Health Insurance Charges:
Inclusive of ST & Education Cess The health insurance charges are valid from 1 year of policy commencement date and are subject to change post IRDA approval Health Saver charges 2 Lacs 3 lacs 5 lacs 7 lacs 10 lacs 3283 25 yrs 35 yrs 45 yrs 55 yrs Annual Limit 2337 2756 3564 7052 2693 3179 3928 7836 2881 3402 4203 8384 3069 3624 4476 8929 3878 4790 9554 V1 32 Health Saver insurance charges versus competition For an annual limit of 2 Lakhs Most competitive insurance charges
Product
After product
Age 25 30 40 50 Health Saver 2337 2547 3045 5737 ICICI Lombard 2690 2690 3370 6000 Lombard over HS 115% 105% 110% 104% Age 25 30 40 50 Health Saver 2337 2547 3045 5737 Bajaj HG 2627 3074 3074 6267 Bajaj over HS 112% 121% 101% 109% Age 25 30 40 50 Health Saver 2337 2547 3045 5737 New India 2775 2775 3196 5517 New India/ HS 119% 109% 105% 96% After product
Charges inclusive of Service tax and Edu Cess. Charges for all competing products sourced from the respective company websites as on Dec 2008. V1 33 Health Saver insurance charges versus competition For an annual limit of 2 Lakhs Most competitive insurance charges
Even with a family floater.
Age 25 30 40 50 Health Saver 5887 6215 6954 11532 ICICI Lombard 6423 6423 7443 11988 Lombard over HS 109% 103% 107% 104% Charges for a family of four - 2 adults and 2 children Charges inclusive of Service tax and Edu Cess. Charges for all competing products sourced from the respective company websites as on Dec 2008. V1 34 Health Saver the real Health ULIP plan 2x after 5 days x x Pre/ Post Hospitalisation 80 D only on health charges 80 D only on health charges 80 D only on health charges 80 D on full premium Tax benefits
(From Fund)
(From Fund)
(From Fund)
(From Fund) Misc Health Expenses Reimbursed (OPD) x Only 33 MSB & 25 CI (Rider) NA Fixed Benefit Reliance Health+Wealth x Only 900 20x, 12x, 8x, 4x, 2x Fixed Benefit TATA AIG InvestAssure Health x Only 49 200x, 120x, 80x Fixed Benefit LIC Health Plus Surgery Scope Non-surgical benefit Surgery Benefit
Complete reimbursement cover for surgeries and medical expenses incurred at hospital
ICICI Prudential New Health Saver Daily Hospitalisation Benefit (DHCB) / ICU Core Coverage Benefits V1 35 Health Saver the real Health ULIP plan Tax benefit under 80 C Reimbursement Hospitalization plan Tax benefit under 80 D Fixed benefit Hospitalization plan
Health Saver Reliance Health + Wealth LIC Health Plus TATA AIG invest assure The only insurance plan to have the complete 80D tax advantage
The only insurance plan to have a reimbursement based floater hospitalization cover
Most comprehensive coverage with maximum tax advantage V1 36 Maternity expenses Medical equipment expenses Day to day medicines & drugs expenditure Dental treatment OPD expenses Daycare Procedures Hospitalisation Coverage Benefits
Traditional Mediclaim Health Saver The Health Saver advantage: The most comprehensive coverage Comprehensive coverage against both inpatient and outpatient medical instances
Pays for any kind of medical expense incurred during the policy term
V1 37
*For 25 year old with highest income tax slab of 33.66% with maximum Tax advantage under section 80 D ** fund value net of all charges and insurance charges for a 5 lakh annual limit The Health Saver advantage: Aapke health ka savings account Pay Rs 15,000 annual premium for Health Saver for 10 years Total premium paid for 10 years 1,50,000 Earn back your premium: Avail complete Tax advantage on the entire premium paid for 10 years* (A) Total tax saved during 10 years 50,990 Total fund value available for health claim after 10 years ( assuming a modest growth at 10%) (B) Total fund value after 10 years 1,60,228 Total return advantage after 10 years (A)+(B) 2,11,218 Total return after 10 years Plus Health Cover of 5 Lakhs during the 10 years Plus Free medical worth Rs. 5000 every 2 yrs V1 38 Retirement The Health Saver advantage: Takes care of you today and invests your money for tomorrow Age 25 Retirement Phase Working Phase Premium paying term 20 years Age 55 Regular premium Cover continuation phase Whole life Pay premiums during working years Get a health cover + build a health fund Opt for CCO on retirement and remain protected Continue claiming from health fund for whole life Relax! Age 75 Hospitalisation Cover Relax! V1 39 What makes Health Saver a winner Tax Benefits on entire premiums u/s 80D Build a health fund which allows you to claim for any other health expenses Long Term Coverage against Hospitalisation Expenses Flexible premium payment options continue cover even after stopping premiums V1 40 An easy sale with high jet limits Jet Limits
Only Standard Age proof allowed No Backdation allowed Health Saver would be rated with only MediAssure Employer-Employee scheme subject to immediate assignment to the employee Age/ Annual Limit 1-35 Yrs 36-45 Yrs 46-55 Yrs Upto 3 lacs No Medicals No Medicals Medicals Upto 10 lacs No Medicals Medicals Medicals V1 41 Imp: Please use Form Id: 02 A convenient sale with new 4 pager application form Only a 4 pager form and valid for all health products V1 42 Premium payment frequency & mode Premium payment frequency: Yearly/ Semi-annually/ Monthly ECS/Monthly Non-ECS
To ensure all health policy customers derive 80 D tax benefits CASH will not be accepted as a mode of First Premium Deposit. Amount & Modalities will be subject to company rules & relevant legislation/regulations. V1 43 Underwriting guidelines Previous life and health policies (other than MediAssure and Health Saver) and riders will not be taken into consideration for either triggering medicals, financial eligibility or rated up SA. The total Annual Limit in case the insured person buys more than one policy will be Rs. 2,500,000 (Health Saver + MediAssure) Only Standard Age proof allowed (PAN card allowed for rated up AL of 15 L) Underwriting would be done on individual lives under family floater options. Financial Eligibility Table
Income documents are compulsory for total rated up SA of LA above 15L for all members. Policy twisting norms of 2 years will apply for a HC , MA and HS policy Risk commencement date will be the final underwriting date.
10.1 -15 L Above 3.5 L 2-5 L Above 50 K 5.1 -10L Above 2 L 15.1-25 L Above 5 L Annual Limit Income V1 The Claims Process The Health Card to enable claims
A Health Card for every Policy Holder Dispatched along with the Welcome Kit Will carry customer and policy details
How does it work?
Card produced at the Network Hospital to avail cashless benefit
Preprinted phone numbers for any kind of claims or service assistance
The Health Card V1 45 HOSPITALISATION Network Hospital Non-Network Hospital Post discharge, submit claim form Scrutiny Cheque sent to Customer Planned Emergency Submit Preauthorization Form Cashless authorized Customer settle bill with Hospital Cashless not authorized Scrutiny Reject ICICI pays Hospital Customer signs Documents on Discharge The claims process hospitalization insurance benefit HOSPITALISATION Network Hospital Non-Network Hospital Post discharge, submit claim form Scrutiny Cheque sent to Customer Planned Emergency Submit Preauthorization Form Cashless authorized Customer settle bill with Hospital Cashless not authorized Scrutiny Reject ICICI pays Hospital Customer signs Documents on Discharge Pre(30)&Post(60) Hospitalization* Reimbursed only in the Event of acceptance of the Hospitalisation or Day Care Procedures claim by the Company. TAT -3hrs
V1 46 HOSPITALISATION Medicines/Drugs Diagnostics Dental Co-pays/Deductibles Miscellaneous medical expenses The claims process health savings benefit & free health check-up HEALTH SAVINGS BENEFIT* Scrutiny Cheque sent to Customer Reject Submit original bills or proof of expenses along with withdrawal Form **Subject to a limit of Rs. 5,000 or 1% of the annual limit, whichever is lower. Can be claimed once every two years after the first year One bill per insured member for given 2 yr period
Submission of original bills or proof of expense along with claim form MEDICAL CHECK-UP** Scrutiny Cheque sent to Customer Reject *Allows policyholder to claim his funds for different health care expenses, after the completion of three policy years.
Can be claimed once in every Policy year subject to a minimum limit of Rs. 1000/-
V1 47 The Claims process Hospital Cover documentation Documents to be submitted within 10 days of discharge from the Hospital or Nursing Home Photocopy of Policy certificate Claimant statement form Photo Identification proof Attending Physician Certificate Original Discharge summary or card, test reports Original Hospital bill and payment receipts Original cash memo from the chemist(s) with prescription Photocopy of Admission notes FIR / MLC / Panchnama for accidental Claims Other relevant Documents related to the current hospitalization/ surgery so as to process the claim faster
*ECS mandate and copy of cancelled cheque to be submitted for direct credit facility V1 48 SMS Service: To provide assistance & prompt resolution on claims processing
To access SMS service type- ICLAIM <space> <8 Digit Policy Number> & send SMS to 56767
Customers will receive call back from our certified claims expert SMS service will prove to be a customer delight. Claims initiatives : The I Claim Service V1 49 Claims initiatives
Document Reckoner shared with Branches: Checklist of essential documents Original Documents (Bills/Medical Reports) mandatory for Medi Assure and now Health Saver
ECS Mandate along with a copy of cancelled cheque to be submitted for availing direct credit of claims payout
Health Claims Documentation Direct Credit Facility V1 50 healthclaims@iciciprulife.com TAT for response 1 working day Critical Illness products claims enquiries 1800222020 (9AM 9PM) or approach Branches.
Hospitalization products (Hospital Care & Medi Assure) (Toll free 24*7) 1800221719 & 022 23000431 Grievance 022 40398147 GM Call log Call type Health claims Subtype complaint Branch Support from Health Claims Cell Document reckoner deployed for support at branches V1 51 Category rules Condition Health Saver Category Only as family floater. Plan starts from 90 days of age*(subj to policy anniversary) Minor The minimum age at entry for children under Family floater is 90 days and maximum is 25 years Students will only be offered family floater. Maximum cover up to AL- 15 L can be offered under a parents family floater of Health Saver/ MediAssure. Student Cannot be offered X Foreign National / PIO For treatment in India only and upto Annual Limit of Rs 5 Lakh NRI V1 52 Category rules - female lives Condition Health Saver Category Up to Annual limit of Rs 5 L without documentation/ husbands insurance Higher cover subject to equivalent husbands MediAssure/HS cover up to maximum AL of Rs 10 L Family floater: Maximum cover up to AL- 15L can be offered under husbands family floater of Health Saver/ MediAssure **Housewives can be offered maximum Health Saver cover (Individual + Family floater) of 15 Lacs. Single women: Can offer maximum AL - 3L subject to approval from Health Team Group III Up to Annual limit of Rs 5 L without documentation Higher cover subject to income documents Group II At par with male lives Group I V1 53 Re-instatement norms With Medicals / exclusions / Declaration of good health. Reapplication of waiting periods No claim payable within the lapsed period Greater than 60 days 2 years No revivals permitted post 2 years Max Revival Period Simple revival (Payment of arrears premium with interest) Upto 60 Days Norm Time interval V1 54 Underwriting Guidelines Medical Examination Chart MER, HbA1c, ECG, RUA, SMA12 46 55 years MER, FBS MER 36 45 years MER MER 35 years >3 Lacs 3 Lacs Age / Option V1 55 Things to note Eldest member is the primary life Individual underwriting questions for each family member DOB proofs required for all members Signature for all members V1 56 FAQs Can I change my annual limit during the term of the plan? You can increase or decrease your annual limit at every policy anniversary with deduction of appropriate insurance charges based on change in annual limit. Any increase in the annual limit will be subject to underwriting an as per terms and condition set by the company.
Can I change my premium during the term of the plan? You can increase or decrease your premium at every policy anniversary, any decrease in premium will be subject to the minimum premium grid based on annual limit , age and number of members in the family.
What if I am unable to pay my premiums after the first 3 years? If premium is discontinued in the first three policy years and if the policy is not revived within the period of two years from the due date of the first unpaid premium, then the policy will be terminated. During this period, Hospitalisation Insurance Benefit will cease and the policyholder will only have the benefit of investment in the respective unit funds. V1 57 FAQs What if I am unable to pay my premiums after the first five years? On payment of at least first five years premium, you have the option of opting for a cover continuance option wherein your further charges would be deducted from your fund until fund value falls below 110% after which the policy would be foreclosed.
What happens if my fund value falls below 110%? If premiums have been paid for three full policy years and after three policy years have elapsed and fund value falls below 110% of one full years premium, the policyholder will be given intimation and option to reduce the Health Savings Benefit claim amount so that the fund value does not fall below 110%. If the policyholder does not opt to reduce the Health Savings Benefit claim then, the benefit shall be paid and the policy will be foreclosed.
What happens on foreclosure? On the date of foreclosure, the fund value will be calculated as per prevailing NAV on that date. The fund value so calculated can be withdrawn by you within 5 years for health expenses upon submission of original bills for expenses incurred. This withdrawal will be subject to a maximum of 50% per annum of the fund value as on date of foreclosure. This condition will also apply during the cover continuance stage, if opted for. V1 58 FAQs How does the Health Checkup benefit function under the plan? The free health checkup will be available to all insured members after the first year once every 2 years. Each member can submit only a single bill in every block of 2 years after the first year. (i.e. once in the 2nd -3rd yr , 4th -5th yr and so on). We will not allow of aggregation of bills of any member The cumulative limit for all the members under the policy would be 1% of the annual limit or Rs 5000 whichever is lower.
Can the family floater be issued in a case single parent and children? Yes, the family floater in Health Saver allows for a single parent to include himself/herself and upto 3 dependant children under the plan.
Can I add a family member to my plan at a later date? Addition of family members to the policy shall be allowed only in the event of marriage or birth or legal adoption of a child. You should opt for this within 90 days from the date of event or at the next policy anniversary. The change shall be effective for the purpose from the next premium due date which would be the risk commencement date for the new member added. You shall have to pay additional premium on addition of a family member as determined by the Company. V1 59 FAQs What would happen to the fund value in case of death of the primary insured or any other insured member during term of plan? 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. The remaining insured members have the option of continuing coverage by availing a new policy.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
Can I make a claim if I get treated outside India? No, you are entitled to a claim for treatment undergone in India only.
What is the duration within which a claim has to be reported to ICICI Prudential? If the claim is from a network hospital then 4 days prior to the planned hospitalization by forwarding the pre-authorization form. In case of emergency, within 24 hours of getting admitted. If the claim is from a non-network hospital then within 60 days of getting discharged from the hospital, the claim request should be given to the insurer. All claims will be settled in 7 working days after receiving request. V1 60 FAQs Are the claims made through withdrawals from the Health Savings Benefit tax free? Yes all claims made from your health fund will not be taxed as they would be treated as a health claim on the policy.
Can I claim for non allopathic medical expenses under the Health Savings Benefit? Yes the Health Saver allows you to claim for all health care expenses under the Health Savings Benefit which includes non allopathic expenses.
Will any claims under the Health Savings Benefit reduce the annual limit in the hospitalisation insurance benefit? No all claims from your Health Savings Benefit are settled by withdrawals against your health savings kitty and will not effect your annual limit offered in your Hospitalisation Insurance benefit
V1 61 FAQs What are the policy twisting norms for the Health Saver? In case customer has lapsed any of the following policies i.e. Hospital Care ,MediAssure & Health Saver within the last 1 year , he must reinstate his lapsed policy before being entitled to buy a new Health saver policy.
Are the insurance charges deducted from my policy constant throughout the policy term? No the insurance charges will be deducted every year based on the new age of the customer.
Can the Health Saver be sold as a combo plan? The Health Saver application form allows you to buy a Health Saver along with any other health plan. However in case of a family floater only the primary life will be able to buy the additional health plan.
V1 62 Thank You
V1 63 For any product related queries, please write into:
healthinfo@iciciprulife.com V1 64 LIFECYCLE BASED PORTFOLIO STRATEGY V1 65 How Does It Work Initial allocation based on customers age Rebalancing on a quarterly basis As age progresses, allocation changed to suit Life stage 65% 35% 66 75 100% 0% 75+ 55% 45% 56 65 55% 65% 75% 85% Health Flexi Growth 45% 46 55 35% 36 45 25% 26 35 15% 0 25 Health Protector Allocation Age Band V1 66 NAV CHANGES ALTER THE EQUITY-DEBT RATIO WITH CHANGE IN AGE, ALLOCATION IS ALTERED Flowchart for lifecycle based strategy Customer Policy Inception EQUITY 75% DEBT 25% ALLOCATIONS BASED ON AGE Every Quarter PORTFOLIO REBALANCING 75% 25% 50% 50% 75% 25% Age = 30 Every shift in age band DEBT EQUITY 65% 35% Age = 36 V1 67 Asset Allocation What is it? How can it be done? Why should you do it? It is the diversification of your portfolio By distributing wealth amongst different asset classes viz. equity, debt & money market In order to optimize your risk-return balance V1 68 68 Why is Asset Allocation important? Studies have shown that asset allocation is the single most important factor in determining returns Studies have shown that asset allocation is the single most important factor in determining returns Brinson Study on the Importance of Asset Allocation Security Selection , 5% Market timing, 2% Others, 1% Long Term Asset Allocation , 92% Long Term Asset Allocation Security Selection Market timing Others V1 69 FIXED PORTFOLIO STRATEGY V1 70 70 Fixed Strategy : Choice of Funds A customer may wish to do his allocations on his own We have given him a flexibility of allocating his wealth as per his choice Health Flexi Growth Health Multiplier Health Flexi Balanced Health Balancer Health Protector Health Preserver Health Return Guarantee Fund V1 71 ATS ( Automatic Transfer Strategy ) is a mechanism that eliminates the need to time ones investments in the market.
Through ATS you can regularly switch a fixed sum of investment at a monthly frequency from Health Preserver to Health Multiplier or Health Flexi Growth
Advantages Reduce risk in overall investment Bulk of investment in Health Preserver A good strategy in a volatile market to average out cost of acquisition Automatic Transfer Strategy (ATS) V1 73 What is the Return Guarantee Fund? Return Guarantee Fund ( RGF) is a close ended debt fund
It offers a Minimum Guaranteed NAV at the end of 5 years. 100 100 Debt, Money market & Cash Min (%) Max (%) Indicative Portfolio Allocation Fund Management Charge: 1.50% V1 74 Upside Potential
On Dec 20, 2013 you get Min Guaranteed NAV of Rs 15.03 or the NAV on that day; whichever is higher
The falling interest rate regime is expected to boost the returns given by debt funds- as seen in the past
GET THE ADVANTAGE OF HIGHER RETURNS WITH THE PROMISE OF A MINIMUM GUARANTEE V1 75 Health RGF Snapshot It will open with an NAV of Rs.10 on Dec 22, 2008
Subscription to this fund is open for a limited period
The fund can be closed by giving a notice of 5 working days notice
The fund will terminate (mature) on Dec 20, 2013
V1 76 Health RGF Snapshot Only your First Premium Deposit is invested in the RGF
Subsequent Premiums: Allocation must be chosen at inception ( in app form); and can be allocated into any of the fund / strategy available with the product
Switch out of Return Guarantee fund at the prevailing NAV at any point of time and re-invest in any of our other funds
Subscription to this fund is open for a limited period
The fund can be closed by giving a notice of 5 working days notice V1 77 Co-pay illustration Plan : Annual limit of Rs 5L Following expenses incurred during treatment 0 1000
Telephone 0 1500
Food bill for attending person Total Eligible Bill (Rs) Total Bill (Rs) Eligible for cover Expenses 30000 30000
Room & ICU 49000 51500 Grand Total (Rs) 10000 10000
Opn Procedure 4000 4000
Medicines 5000 5000
Doctors Fees V1 78 Appropriate choice of hospital will avoid any co- pay for the customer 8200 (20% Co Pay for outside network claims) 0 (0% Co Pay for within network claims) Amount to be paid by customer (Rs) 39200 (80% of eligible bill) 49000 (100% of eligible bill) Amount covered by policy (Rs) Non Network Hospital Network Hospital Network Co-pay illustration 2 V1 79 Mr Rakesh K (age 72) with a 10 year old mediclaim policy of Rs 3 lacs 8000 12000 60000 P r e m i u m
( R s )
Year 1 Year 2 No Claim Claim Source: Mediclaim premium hike capped at 75%,1 Dec 2007, IST,Prabhakar Sinha,TOI, Increase in premiums after claims Reason for this huge rise in premium: Customer had claimed Rs 1,50,000 for an angioplasty after developing a heart ailment V1 80 Mr Joshi (age 67) had purchased a mediclaim policy in 1992 Policy Issued 1992 Disease/Condition Occurs 1999 2002 New Exclusion added at renewal Current Status Premium Doubled New Exclusion added Source: Two more PILs filed in Mediclaim cases.14 Apr 2003, TOI Adding exclusions after claims For the first 10 years of taking the policy, there was no claim and now that the time has come to encash on the policy, they are asking me to discontinue, - Joshi V1 81 Pre existing illnesses not covered Mr Vasant Rao underwent by-pass 1986 Bought Mediclaim with disclosure of by-pass and renewed regularly since Mar 95 Apr 99 Underwent surgical procedure for the same Underwent Angioplasty and diagnosed with Ischemic Heart Disease (IHD) Jul 99 (Source:Honour Mediclaim policy: National panel Friday J uly 7 2006 ,www.newindpress.com) Claim was not honoured by the company citing exclusion clause on pre-existing disease V1 82 Comparisons with other players Not covered Star Allied & Health Upto 5 years* Bajaj Life Care First Not covered Bajaj Gen Health Guard 4 years New India Assurance 4 years National Insurance 2 years ICICI Lombard Health Advantage Plus 4 years ICICI Lombard- Family floater 2 (gold) / 4 (silver/standard) years Reliance Healthwise Pre-existing disease waiting period Company/Product * Some ailments V1 83 Day Care Comparison None New India None Star Allied & Health (Premier Plan) 7 Listed Procedures Reliance Healthwise 9 Listed Procedures ICICI Lombard Family Floater Over 125 listed Day care procedures ICICI Pru Medi Assure Day Care procedures/ Specified treatments Company/Product V1 84 No Claim Bonus 625,000 600,000 575,000 550,000 600,000 575,000 5,50,000 5,25,000 Annual Limit with bonus 6 lacs (10%X 5lacs) Working 600,000 0 8 575,000 0 7 550,000 0 6 Claim Amount Year 600,000 575,000 550,000 525,000 500,000 Available Annual Limit 400000 0 0 0 0 5 4 3 2 1 Amounts in Rs V1 85 Income Tax Norms Tax Benefits U/S 80D for premia paid towards Health Insurance * Tax deduction benefit available on Income Insured members Upto Rs 15000 (Additional to benefit on premiums towards policy for self, spouse and children) For Parents Upto Rs 20000 For Senior Citizens (Over 65 yrs old) Upto 15000 For Self , Spouse and dependant children *No Benefit available if premiums towards Health Insurance are paid in cash 10% 1.5L 2.99 lacs 20% 3 lacs 4.99 lacs 30% 5lacs and more 0% Less than 1.5 L Rate of Tax for an Individual Total Income (Rs) V1 86 Exclusions Please refer to policy document for detailed exclusions
Permanent exclusions & Pre existing illness or conditions unless specifically accepted by the Company Pre and Post Hospitalization benefits are payable only when the ailments or illnesses are directly related to the covered hospitalization event/Day care Procedure. Any expenses more than 30 days prior to hospitalization/Day care Procedure & 60 days beyond discharge are not payable Diagnosis and treatment or any expenses incurred outside India. Treatment & investigations for conditions arising due to Diabetes & Hypertension if disclosed at inception are excluded for first 2 policy years from risk commencement date or 2 years from the reinstatement date in case reinstatement done after 60 days from last unpaid premium. Any treatment directly or indirectly consequent to war, civil war, terrorism, active military or police duties ,military aircraft or vessels Circumcision, Sex change surgery ,cosmetic surgery & plastic surgery not due to accident or treatment of disease etc Vaccinations, inoculations & expenses on vitamins & tonics until medically necessary Refractive error correction, Hearing impairment correction, Corrective & cosmetic Dental surgeries apart from for any treatment arising due to systemic disease or injury. Any hospitalization for tests or diagnosis wherein such investigations are possible as out patient procedures / weight loss / weight gain / Preventive / recuperation purposes/ routine check-ups & issue of any medical certificate or examination for employment or travel. Any treatment / expenses incurred by a Donor of an Organ
V1 87 Exclusions (Continued) Any Treatment for Congenital Conditions / Physical defects/genetic disorders etc Any stream or type of medicines other than Allopathy ( Western medicine) Any Treatment related to Contraception / Pregnancy / Child birth and infertility or assisted conception procedures except for life threatening ectopic pregnancy. Any treatment directly or indirectly arising from alcoholism/drug abuse, self-inflicted injuries or attempted suicide or intoxication of drugs, psychiatry ailments. Any treatment due to and as a result of HIV / AIDS / Sexually Transmitted Disease (STD) Any treatment related to sleep disorders & Sleep Apnoea syndrome. Durable medical/Non medical equipments including all non medical expenses including personal comfort expenses, domiciliary treatment. More than one coronary angiography in a policy year. Any treatment arising out of professional / hazardous sports or activities etc. or deliberate exposure to exceptional danger. Any kind of service charge, surcharge, admission fees, registration fees. Extension of duration of hospital stay without any medical requirement as per the specialist or expenses incurred for investigations/treatment not relevant to the reason for hospitalization. Disease or ailment other for one where hospitalisation was necessary & Hospitalization or treatment not actually performed Back V1 88 Terms & Conditions Free Look Period: A period of 15 days is available to review the policy from the date of receipt of the policy document by the policyholder. Revival Norms:
Foreclosure Norms Incase fund value falls below 110% post 3 years of policy Fund value can be withdrawn by policy holder for health expenses post 5 years of termination. No other benefits will be applicable 2 years Uw/g, Waiting periods and exclusions to reapply T+60 (No claim payable in lapsed period) T+15 (Monthly) T+30 (Yearly & H.Y) Max revival Revival Post 60 Simple Revival Grace Period Back V1 89 Procedures covered after 2 years Lithotripsy / Basketing for Renal Calculus 12 Lap / Open Chole cystectomy for Cholecystitis / Gall stones 11 Myomectomy for Fibroids and menorrhagia 10 Hysterectomy for Fibroids, menorrhagia, Dysfunctional Uterine Bleeding , Prolapse 9 Dilation & Curettage for menstrual irregularities 8 Trans Urtheral Resection of Prostrate / Open Prostatectomy for Benign Enlargement of Prostrate 7 Piles / Fissure / Fistula / Rectal prolapse 6 Hydrocoel / Varicocoel / Spermatocoel surgery 5 Hernia (Inguinal / Ventral / Umbilical / Incisional) 4 Thyroidectomy for Nodule / Multi Nodular Goitre 3 Surgery for Tonsillitis / Adenoiditis 2 Functional Endoscopic Sinus Surgery / Septoplasty for Deviated Nasal Septum / Sinusitis 1 V1 90 Procedures covered after 2 years Osteoarthrosis leading to Total Knee Replacement or Total Hip Replacement (After two years from Risk Commencement Date or revival date, where the revival occurred more than 60 days after the first unpaid premium, whichever is later, claims for up to one knee or hip treatment will be covered in any policy year ) 19 Cataract (After two years from Risk Commencement Date or revival date, where the revival occurred more than 60 days after the first unpaid premium, whichever is later, only claims up to Rs. 20,000 will be covered in any policy year) 18 Osteoporosis leading to Fracture Neck of Femur 17 Renal failure due to diabetes 16 Amputation due to diabetes 15 Vitrectomy and Retinal Detachment surgery for Retinopathy 14 Traction / Discectomy / Laminectomy for Prolapsed Inter Vertebral Disc 13 V1 91 Claims initiatives To access this service, our customers will simply have to type: ICLAIM <space> <8 Digit Policy Number> and send to 56767 The customer would receive a quick call back from our certified claims expert.
Document Reckoner shared with Branches: Checklist of essential documents Original Documents (Bills/Medical Reports) mandatory for Medi Assure and now Health Saver
ECS Mandate along with a copy of cancelled cheque to be submitted for availing direct credit of claims payout
Introduction of ICLAIM SMS service
Health Claims Documentation Direct Credit Facility V1 92 Underwriting Guidelines Crisis cover Comprehensive Critical illness products 5 Hospital Care Mediassure Health Saver Hospitalization & Surgery products 4 Diabetes Care Diabetes Care Plus Diabetes Assure Diabetes Care Active Diabetes specific products 3 Cancer Care Cancer Care Plus Cancer specific products 2 Health Assure Health Assure Plus Critical Illness benefit products 1 Plans covered Product Category Sr. No Policy Twisting Norms: If a customer wants to buy a new policy, but his earlier policy within the same category (refer the grid below for different categories) has lapsed within the last 12 months. Then the lapsed policy needs to be revived prior to taking a new policy. Thus Health saver, Mediassure and Hospital Care fall under the same category.