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 Entry Age up to 65 yrs and lifelong

guaranteed renewals. Optional benefits under Hospital Cash and

Patient Care. Coverage for HIV+ persons

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FEATURES EXPLAINED First time entry: First time entry:

For children from 5 Months For children from 5 Months For seniors up to 65 Yrs. For seniors up to 65 Yrs.

Guaranteed life long renewalsGuaranteed life long renewals Policy term options - 1 Year & 2 Years.Policy term options - 1 Year & 2 Years. Cover (with restrictions) can be offered to HIV+ Cover (with restrictions) can be offered to HIV+

persons also subject to the condition that CD 4 persons also subject to the condition that CD 4 count at the point of entry is not less than 350.count at the point of entry is not less than 350.

Co Pay 10% on every claim beyond 60 Years at Co Pay 10% on every claim beyond 60 Years at entry level and their renewals thereafter.entry level and their renewals thereafter.

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FEATURES EXPLAINED

Coverage:Hospitalisation Expenses as an in patient for treating

Illness/Sickness/Diseases

Accidental Injuries.

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FEATURES EXPLAINED

Room Rent, Nursing & Boarding Charges

2% of S I (A max of Rs.5,000/- per day)

Emergency Ambulance Rs.750/- per hospitalization withOverall limit of Rs.1500/-

Pre Hospitalisation 30 days

Post Hospitalisation 60 days from the date of discharge (7% of the hospitalization expenses with a max of Rs.5000/- per event)

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FEATURES EXPLAINED

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FEATURES EXPLAINED

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

Sum Insured Limit

Rs. 2L Rs.12,000/- for the policy period

> 2L up to 5L Rs.20,000/- for one eye and Rs.30,000/- for policy period

> 5L Rs.30,000/- for one eye and Rs.40,000/- for policy period

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FEATURES EXPLAINED

Automatic Restoration of Sum Insured

IF…….the sum insured is fully exhausted -

A One-time Restoration benefitA One-time Restoration benefit

2-times the basic sum insured2-times the basic sum insured

CAN ONLY BE utilized for illness/diseases CAN ONLY BE utilized for illness/diseases

unrelated to illness/diseases for which claim/s unrelated to illness/diseases for which claim/s

was/were made.was/were made.8

FEATURES EXPLAINED

Optional Riders

Hospital Cash

Rs.1000/- for each completed day subject to a Rs.1000/- for each completed day subject to a

maximum of 7 days per hospitalisation and 14 maximum of 7 days per hospitalisation and 14

days per policy perioddays per policy period

There should be a valid hospitalization claim.There should be a valid hospitalization claim.

No need to submit billsNo need to submit bills

Premium Rs.350/- + Service Tax 9

FEATURES EXPLAINED Optional Riders

Patient Care – Patient Care – Cost of engaging an attendant at residence immediately Cost of engaging an attendant at residence immediately

after discharge from hospital.after discharge from hospital.

Conditions:Conditions: Should be recommended by the attending physicianShould be recommended by the attending physician

Only for persons above 60 yrs of ageOnly for persons above 60 yrs of age

Benefit of Rs.400/- for each completed day up to 5 days per Benefit of Rs.400/- for each completed day up to 5 days per

occurrence and 14 days per policy periodoccurrence and 14 days per policy period

Only consequent to a valid hospitalizationOnly consequent to a valid hospitalization

No payment will be made for the first dayNo payment will be made for the first day

Bills to be submittedBills to be submitted

Premium Rs.580/- + Service Tax 10

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/- Rs.15,00,000/- (newly introduced)(newly introduced)

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FAMILY PACKAGE OPTION

Sum Insured EQUALLY DIVIDED among Insured family members

Coverage for self, spouse and maximum 2 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

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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 eligible for

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.

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FAMILY PACKAGE – PREMIUM CHART

Sum Insured Rs.2,00,000/- Sum Insured Rs.3,00,000/-

Age/Family Size

5m-25yrs26yrs-30yrs

31yrs-35yrs

36yrs-40yrs

41yrs-45yrs

5m-25yrs

26yrs-30yrs

31yrs-35yrs

36yrs-40yrs

41yrs-45yrs

2A 4460 4635 4635 4965 5095 4745 5045 5230 5555 5915

2A+ 1C 5149 5280 5280 5400 5595 5945 6195 6275 6365 6500

2A+2C 5200 5400 5600 6200 6500 7145 7345 7483 7700 7805

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FAMILY PACKAGE VERSUS FHO RESTORE

Benefit Family Package FHO Restore

Sum Insured Equally Apportioned Floating

Rating Age, Family Size & Sum Insured

Age, Family Size , Sum Insured & Zone

Restoration of Sum Insured Not Available Available

Sum Insured Options Only 2 options More than 2 options

Health Checkup Available Not Available

Bonus Not Available Available15

KEY CHANGES IN EXCLUSIONS

First Two-years: Listed initial two-year exclusions (No separate 1st year Xclusions):

Eye related1: Cataract, Glaucoma, Retinal detachment/ Macular

degenerationEye 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 Suppurative Otitis Media and related disorders, Stapedectomy.Treatment/removal of Stones: Hepato-biliary/ Gall bladder/ Pancreatic/

Genitourinary calculiDiseases 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. 16

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 policies17

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. 18

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 19

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.20

BENEFIT COMPARISONBenefits Existing Mediclassic Revised Mediclassic

Room Rent

2% of SI, Maximum Rs.5000/- per day

No Change

Nursing Expenses

Not included in the room rent

Included in the Room Rent

No. of Day Care Procedures 11 101

Cataract Limit

Rs 20000/- per eye; Rs30000/- entire policy period

Up to Rs 2L SI , Rs 12000/- entire policy periodAbove Rs 2L and up to Rs 5L, Rs 20000 (one eye) and Rs 30000 (Entire policy period)Above Rs 5L, Rs 30000 (one eye), Rs40000 (entire policy period)

Co-PayVoluntary Co-pay & discount Compulsory Co-Pay of 10% on every

claim for persons above 60 Years

Automatic-restore facility

Not Available Available, 2-times the basic sum insured21

BENEFIT COMPARISON (CONT’D…)

Benefits Existing Mediclassic Revised Mediclassic

Claims Loading Applicable NIL

First & First 2 year Exclusion First and First 2 year exclusions

Only First 2 year exclusions

Cover for HIV No cover available

Available is CD4 count is not less than 350 at the commencement of insurance under this policy

No Claim Discount Available Not available

Voluntary Deductible Available Not Available

Policy Term Only one year term

Option of one year and two years. 5% discount for 2 year policy where the premium is paid for the entire 2 year period upfront 22

PREMIUM CHART

Medi-Classic Insurance (Individual) Policy

ZoneAge in yrs

/Sum Insured Rs.

5mnths-35yrs

36-45 46-50 51-55 56-60 61-65 66-70 71-75 76-80 Above 80

Zone 1150000

2510 2510 3770 4495 6200 7900 11800 13300 16800 21840Zone 2 2510 2510 3770 4495 6200 7900 11800 13300 16800 21840Zone 1

2000003030 3260 5120 6110 7750 9850 14005 17330 22300 28990

Zone 2 2880 3175 4775 5900 7350 9550 13500 16950 22000 28600Zone 1

3000004400 4650 7665 11365 13750 14350 20000 24350 32270 41950

Zone 2 4000 4535 7200 11115 13200 14000 19600 23800 31900 41470Zone 1

4000004915 5550 8950 12690 15535 20000 26800 31525 42420 55140

Zone 2 4515 5210 8700 12335 15000 19600 26200 31000 41900 54470Zone 1

5000005450 6145 10700 14000 16775 24430 34755 38700 52540 68300

Zone 2 5080 5870 10700 13555 15875 24000 34200 38100 51900 67470Zone 1

10000007800 8200 13600 18384 22910 28900 34680 41615 58250 75725

Zone 2 7465 7965 13265 17875 21440 28200 33840 40800 57600 74880Zone 1

15000009545 9910 15310 22510 29160 39555 47125 52525 67825 88170

Zone 2 9165 9595 14710 21710 28810 38365 46395 50675 66700 86710Service Tax ExtraThe above premium is for a period of 1 year only. 23

PREMIUM CHART

FAMILY PACKAGE PLAN

Sum Insured (Rs) 200000

Age/Family Size 5m-25yrs 26yrs-30yrs 31yrs-35yrs 36yrs-40yrs 41yrs-45yrs

2A 4460 4635 4635 4965 5095

2A+ 1C 5149 5280 5280 5400 5595

2A+2C 5200 5400 5600 6200 6500

Sum Insured (Rs) 300000

Age/Family Size 5m-25yrs 26yrs-30yrs 31yrs-35yrs 36yrs-40yrs 41yrs-45yrs

2A 4745 5045 5230 5555 5915

2A+ 1C 5945 6195 6275 6365 6500

2A+2C 7145 7345 7483 7700 7805

 Service Tax Extra A - Adult C - Child  

This plan is not offered for other sum insured options as the current plan provides for these two sum insured options only

RATING SHEET (SERVICE TAX EXTRA)

ADD-ON COVERS

Hospital Cash 350

Patient Care 580

The above add-on covers are not available for Family Package PlanService Tax Extra

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ANY QUESTIONS, PLS?

Thank You

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