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8/13/2019 Iffoc Iah Ppt

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Comprehensive AccidentalHospitalization Cover Policy

ITGI


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Salient features of the Product

There are 2 Sections under the Policy.

Section 1(family floater cover)Covers Hospitalization Expensesdue to Accidental injury which includes the following:

Room, Boarding and Nursing Expense as provided in the Hospital/NursingHome.

Medical Practitioner/ Anesthetist, Consultant fees.

Expenses on Anesthesia, Blood, Oxygen, Operation Theatre, Surgical

Appliances, Medicines and Drugs, Diagnostic Materials and X-ray, Artificial

Limbs, Cost of Organs and reconstructive surgery and similar expenses.


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Scope of Benefits under Section 1:

Accidental Hospitalization benefit- The cover pays theactual cost incurred as a result of hospitalization due to an accidentOn

Cashless basis.

Outpatient Managed Fracture benefit-Coversthe actualcost of treatment of confirmed Fractures which do not result inHospitalization,

subject to a maximum limit of Rs. 10,000 per episode.-On cash basis Supplementary benefits-reimbursement basis

(i) Hospital Cash

(ii) Post Hospitalization medical benefit

Ancillary service-Ambulance charges upto max of Rs 1000 perevent , max 3 events in a year


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Scope of Benefits under Section 2:

Education Fund: In the event of death, Permanent Total Disablement of theProposer only triggering a claim under Item 1 to 4 of Table of Benefits above

compensation towards Education Fund for dependent children as below:

For one child upto the age of 21 yrs. -10% of the CSI of proposer subject to

max Rs 5000

For 2 children upto the age of 21 yrs-. 10% of the CSI of proposer subject to Rs

5000 each child and a max of Rs 10,000


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Scale of Benefit

Plan Gold : INR 300,000 per annum

Plan A: INR 300,000 per annum

Plan B: INR 200,000 per annum

Plan C: INR 100,000 per annum

Plan D: INR 50,000 per annum

Plan E: INR 50,000 per annum

Family Cover:

Self

Self + spouse Self + spouse + two dependent children up to age of 21 years.

Age Limit :

3 months to 60 years.


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Exclusions under Section 1:

Pre-existing Condition including congenital defects and anamolies.

Dental treatment or surgery of any kind.

Fractures arising from pathological conditions of bone like pagets Disease /Osteogenesis imperfectia.

Any expense on treatment of any disease or medical condition unless thesame is directly caused by an accident.

Expenses on treatment arising from or traceable to pregnancy, childbirth,Miscarriage, abortion or complications of any of these.

Any expense on treatment of Insured Person as outpatient in a Hospitalexcept as covered under Outpatient Managed Fracture benefit.


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EMERGENCY ASSISTANCE SERVICES

provides a value added Emergency Medical Assistance and Emergency

Services.

by Assist America Emergency Medical Services (India) Private Ltd. (AAEMSIL).

Emergency Services are available under all Plans except Plan E.

Specific Exclusions applicable to Emergency Assistance Services Benefit

Travel by Insureds spouse when it is for the benefit of the spouses employer

(spouse business travel)

Trips exceeding 90 days from declared residence without prior notification to

AAEMSIL. Students at home/school campus address (as they are not considered to be in

travel status)


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Services provided by Assist AmericaService Provider

Medical Consultation, Evaluation and Referral

Emergency Medical Evacuation

Medical Repatriation

Transportation to Join Patient

Care and/or Transportation of Minor Children Emergency Message Transmission

Return of Mortal Remains

Emergency Cash Coordination


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Target Market

This product is targeted at the budget buyers.

Budget buyers means the younger customers who are constrained byaffordability and driven by the cost.

Who do not see a probability of falling sick and hospitalised but areconcerned of accidents

Target distribution channel Agency force

franchisees

other partners and cooperative sector partners Bima kendras and bancassurance partners.

Among the distribution partners franchisees, partners like Bajaj capital,Mahindra Finance will cater to A and B category locations.

Cooperative sector partners and partners like Peerless will cater to customersin C and D category locations


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Segmentation

The Product is segmented for urban and rural segment and isbeing designed with Six Plans Gold ,A,B,C , D and E variants.

Plans Gold A,B and C can be sold in Urban location

Plan C , D and E can be sold in Rural locations due to itssimplicity and affordability.

D&E can also be explored as a Value add on to products andwith tieups


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Target Sales Channel

Direct sales

Agency selling

OTC selling.

Five locations are to designed where A&B variants and C&Dvariants are to be sold exclusively. So the product designed forthe C&D category locations should ideally not be sold in A&Bcategory locations.


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Premium chart Gold and Plan A

Gold Plan

Age Bracket Single Band

Principal Life

and Spouse

Principal Life

and Spouse

and children

0-29 1675 2125 2625

30-54 1175 1600 2125

55-59 1300 1900 2500

60-65 1400 2050 2600

Note: Gold Plan is similar to Plan A in all aspects except for the Gold Plan offers double Death benefit

under the Section 2 -Personal Accident Cover for the Proposer only

Plan A


Principal Life

and Spouse

Principal Life

and Spouse

and children

0-29 1500 2000 2450

30-54 1025 1450 1975

55-59 1150 1750 2350


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Plan B &C

Plan B


Principal Life and

Spouse

Principal Life and

Spouse and children

0-29 1200 1525 1925

30-54 800 1100 1500

55-59 900 1350 1800

60-69 975 1500 1900

Plan C


Principal Life and

Spouse

Principal Life and

Spouse and children

0-29 950 1200 1500

30-54 600 825 1125

55-59 700 1025 1400

60-69 775 1150 1475


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Plan d&ePlan D


Principal Life

and Spouse

Principal Life

and Spouse

and children

0-29 600 750 925

30-54 375 525 700

55-59 425 625 850

60-69 475 700 900

Plan E

Age Single Band

Principal Life

and Spouse

Principal Lifeand Spouse

and children

0-29 500 575 675

30-54 260 350 460

55-59 325 450 600

60-69 350 550 650


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