optima restore-product presentation - welcome to … free year accumulating upto 100% of basic sum...

31/12/2011

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OPTIMA RESTOREOPTIMA RESTOREOPTIMA RESTOREOPTIMA RESTOREInInInIn----Patient Health Insurance Policy with Restore BenefitPatient Health Insurance Policy with Restore BenefitPatient Health Insurance Policy with Restore BenefitPatient Health Insurance Policy with Restore Benefit

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Jaiho Marketing & Share Broking EnterprisesC-33, Sanjay Nagar, Sector - 23, Ghaziabad - 201002, Ph - 0120 - 2788215, 09310851534, 09278793144,

Call – 09310851534 / 09278793144

Product Advantage

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- First Health Insurance Product providing Restore Benefit- Automatic Reinstatement option if Sum Insured is exhausted in the

policy year.

- First Health Insurance Product providing Multiplier Benefit- Bonus of 50% for every claim free year accumulating upto 100% of

basic sum insured.


Call – 09310851534 / 09278793144

31/12/2011

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USP’s of Optima Restore

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Restore Benefit

Multiplier Benefit

Pre-& Post Hospitalisation Limit-

60/180 Days

High Sum Insured Options


Call – 09310851534 / 09278793144

Why Optima Restore Scores better?

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1-Jan-2011

• Family A purchased Optima Restore Product with 3 Lacs SI

5-June-2011

• Husband underwent Angioplasty

• Claim Paid- 3Lacs

5-June-2011

• Optima Restore Benefit triggered. SI reinstated for another 3 Lacs

5-July-2011

• Wife suffered an accident .

• Claim Paid-3 Lacs

Family A purchases Optima Restore Family Floater Product 3 Lacs Sum InsuredFamily B purchases Traditional Health Family Floater Product 3 Lacs Sum Insured

1-Jan-2011

• Family B purchased Traditional Health Product with 3 Lacs SI

5-June-2011

• Husband underwent Angioplasty

• Claim Paid- 3Lacs

5-June-2011

• Sum Insured exhausted.

• No further claims to be paid

5-July-2011

• Wife suffered an accident

• No Claim Paid


Call – 09310851534 / 09278793144

31/12/2011

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• Available for every claimfree year

• Sum Insured increasedby 50% accumulatedmaximum up to 100% ofSI

• In the event of Claim,CB reduced by 50% ofbasic Sum Insured atthe time of renewal.

Multiplier Benefit

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Sum Insured Options

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15 Lacs

10 Lacs10 Lacs10 Lacs10 Lacs




Call – 09310851534 / 09278793144

31/12/2011

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� Self, Spouse, Dependent Children and Dependent Parents

� Maximum 6 members can be insured under one Individual and Familyfloater plan

� Maximum 2 adults can be insured in one family floater plan Entry Age

Cover Ceasing Age

� There is no maximum cover ceasing age in this policy

Policy Period - 1 yr or 2 yr (s)

Who can be insured

Minimum Maximum

Self 18 years 65 years

Adult Dependent 18 years 65 years

Child Dependent 5 years

(can be covered from 91st day

onwards if both parents are

covered under this policy)

21 years

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Call – 09310851534 / 09278793144

Types of Plans

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Jaiho Marketing & Share Broking EnterprisesC-33, Sanjay Nagar, Sector - 23, Ghaziabad - 201002,

Ph - 0120 - 2788215, 09310851534, 09278793144,

Call – 09310851534 / 09278793144

31/12/2011

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Individual Health Insurance :purchased on an indivi dual basis .

Family Floater Health Insurance: one single policy takes ca re of the

hospitalization expenses of your entire family under one Su m Insured .

Name Relationship D . O . B Sum Insured

Mr. Raghav Sharma Self 18 . 7 . 1973 5 Lac

Mrs. Aruna Sharma Spouse 17 . 6 . 1974 5 Lac

Seher Sharma Son 16 . 5 . 2000 5 Lac

Meher Sharma Daughter 15 . 4 . 2007 5 Lac

Name Relationship D . O . B Sum Insured

Mr. Raghav Sharma Self 18 . 7 . 1973

5 LacMrs. Aruna Sharma Spouse 17 . 6 . 1974

Seher Sharma Son 16 . 5 . 2000

Meher Sharma Daughter 15 . 4 . 2007

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How to insure your-self / Family Call – 09310851534 / 09278793144

Benefits Overview

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In-patient Treatment

Pre-Hospitalisation

Post-Hospitalisation

Day care Procedures

Organ Donor

Emergency Ambulance

Domiciliary Treatment

Restore Benefit

The Policy pays for the benefits mentioned below:


Call – 09310851534 / 09278793144

31/12/2011

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In-patient Treatment

The Medical Expenses for:• Room rent, boarding expenses,• Nursing,• Intensive care unit,• Medical Practitioner(s),• Anaesthesia, blood, oxygen, operation theatre

charges, surgical appliances,• Medicines, drugs and consumables,• Diagnostic procedures,• The Cost of prosthetic and other devices or

equipment if implanted internally during a SurgicalProcedure.

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Call – 09310851534 / 09278793144

Pre-Hospitalisation

• The Medical Expenses incurred in the 60 days immediately beforethe Insured Person was Hospitalised, provided that:

i) Such Medical Expenses were in fact incurred for the samecondition for which the Insured Person’s subsequentHospitalisation was required, and

ii)We have accepted an in-patient Hospitalisation claim underBenefit 1a) In-patient treatment.

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PostPostPostPost----Hospitalisation Hospitalisation Hospitalisation Hospitalisation

• The Medical Expenses incurred in the 180 days immediately afterthe Insured Person was discharged post Hospitalisation providedthat:

i) Such costs are incurred in respect of the same condition forwhich the Insured Person’s earlier Hospitalisation wasrequired, and

ii)We have accepted an in-patient Hospitalisation claim underBenefit 1a) In-patient treatment.


Call – 09310851534 / 09278793144

31/12/2011

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Day care Procedures

The Medical Expenses for 140 listed day care procedure mentioned in the listof Day Care Procedures (Refer Annexure 1) where the procedure or surgery istaken by the Insured Person as an in-patient for less than 24 hours in aHospital or standalone day care centre but not the out-patient department of aHospital or standalone day care centre.Examples of Day Care Procedures:• Cataract• Chemosurgery to the skin• Operations on the tonsils and adenoids• Surgical treatment of fistulas• Hemorrhoids• Lithotripsy• Coronary angiography• Haemodialysis• Radiotherapy for Cancer• Cancer Chemotherapy etc.

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Call – 09310851534 / 09278793144

Organ Donor

• The Medical Expenses for an organ donor’s treatmentfor the harvesting of the organ donated, provided that:

i) The organ donor is any person whose organ hasbeen made available in accordance andcompliance with “The Transplantation of HumanOrgans Act, 1994 (amended)” and

ii)The organ donated is for the use of the InsuredPerson, and

iii)We will not pay the donor’s pre and post-MedicalExpenses or any other medical treatment for thedonor consequent on the harvesting, and

iv)We have accepted an in-patient Hospitalisationclaim under Benefit 1a) In-patient treatment.

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Call – 09310851534 / 09278793144

31/12/2011

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Emergency Ambulance

• Expenses incurred on an ambulance offered by a healthcare or ambulanceservice provider used to transfer the Insured Person to the nearestHospital with adequate Emergency facilities for the provision of healthservices following an Emergency, provided that:

i) Our maximum liability shall be restricted upto Rs 2,000 perhospitalisation, and

ii) We have accepted an in-patient Hospitalisation claim under Benefit1a) In-patient treatment.

iii)Coverage includes the cost of the transportation of the InsuredPerson from a Hospital to the nearest Hospital provided suchmedical services cannot satisfactorily be provided at a Hospitalwhere the Insured Person is situated and transportation has beenprescribed by a Medical Practitioner and is medically necessary.

Emergency or Emergency Care means management for a severe illness orinjury which results in symptoms which occur suddenly and unexpectedly, andrequires immediate care by a Medical Practitioner to prevent death or seriouslong term impairment of the Insured Person's health.

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Call – 09310851534 / 09278793144

Domiciliary Treatment

• The Medical Expenses incurred by an Insured Person for medicaltreatment taken at his home which would otherwise have requiredHospitalisation, provided that:

i) On the advice of the attending Medical Practitioner, the InsuredPerson could not be transferred to a Hospital or a Hospital bed wasunavailable,

ii) The condition continues for at least 3 days, andiii)We will not make any payment for Post-Hospitalisation expenses

but We will pay Pre-hospitalisation expenses upto 60 days inaccordance with pre-hospitalisation benefit, and

iv)No payment will be made if the condition for which the InsuredPerson requires medical treatment is: Asthma, Bronchitis, Tonsillitisand Upper Respiratory Tract infection including Laryngitis andPharyngitis, Cough and Cold, Influenza, Arthritis, Gout andRheumatism, Chronic Nephritis and Nephritic Syndrome, Diarrhoeaand all type of Dysenteries including Gastroenteritis, DiabetesMellitus and Insipidus, Epilepsy, Hypertension, Psychiatric orPsychosomatic Disorders of all kinds, Pyrexia of unknown Origin.

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Call – 09310851534 / 09278793144

31/12/2011

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Restore Benefit

• Restoration of Sum Insured by automatically re-instatingthe basic sum insured, if the basic sum insured andmultiplier benefit has been exhausted during the policyyear.

• Basic sum insured will be re-instated only once in apolicy year.

• Restore Sum Insured can be used for only future claimsmade by the Insured Person and not against any claimfor an illness/disease (including its complications) forwhich a claim has been paid in the current policy year.

• If the restore sum insured is not utilized in a policy year,it will not be carried forward to any subsequent policyyear.

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Call – 09310851534 / 09278793144

Free Look Cancellation

•Free Look period of 15 days is offered from the date ofreceipt of the Policy document to review the terms andconditions of this Policy.•Refund of premium after adjusting amount spent on anymedical check-up, stamp duty charges and proportionaterisk premium..•Free look cancellation is allowed only if no claim has beenmade under the Policy.•Free look provision is not applicable and available at thetime of renewal of the Policy

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Call – 09310851534 / 09278793144

31/12/2011

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Portability

If proposed insured is insured continuously and withoutinterruption under any other Indian insurer’s individualhealth insurance policy for the reimbursement of medicalcosts for in-patient treatment in a Hospital and proposedinsured want to shift to Us on renewal, Optima RestorePolicy make due allowances for:• 30 days waiting periods• 2 years waiting period for specific illness and treatments• Waiting period for coverage of Pre-Existing Conditions.

If the proposed insured transfers from any other insurerand increases the Sum Insured, then the portability benefitswill be offered only in respect to the previous Sum Insuredonly.

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Call – 09310851534 / 09278793144

Key Definitions

Pre-existing Condition means any condition, ailment orinjury or related condition(s) for which insured person hadsigns or symptoms, and/or were diagnosed, and/orreceived medical advice/treatment, within 36 months priorto the commencement of his first being covered under anOptima Restore policy issued by us.

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Call – 09310851534 / 09278793144

31/12/2011

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Premium Payment

Optima Restore provides an option to buy a plan for 2 years with a discount of 7.5%applied on the combined premiums of the 1st & 2nd year.

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Call – 09310851534 / 09278793144

As per Section 80D –•An assessee is entitled to a deduction of Rs. 15,000 in respect of medical premia paid on the health of himself, his spouse and children. If any of them is a senior citizen, then he shall be entitled to a maximum deduction of Rs. 20,000/- as a whole.

•In addition thereto, if he pays insurance premia on the health of his parents, whether dependant or not, he will be entitled to additional deduction of Rs. 15,000/- (senior citizen -Rs. 20,000/-)

Section 80 D

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Call – 09310851534 / 09278793144

31/12/2011

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Key Exclusions• Any treatment within first 30 days of cover except any accidental injury.• 2 years waiting period for specific diseases.• Pre-existing Conditions will not be covered until 36 months of continuous coverage have

elapsed, since inception of the first Optima Restore Policy with Us.• War or any act of war, nuclear weapons/materials, chemical and biological weapons, radiation

of any kind.• Insured Person committing or attempting to commit a breach of law with criminal intent, or

intentional self injury or attempted suicide while sane or insane.• Insured Person’s participation or involvement in naval, military or air force operation, racing,

diving, aviation, scuba diving, parachuting, hang-gliding, rock or mountain climbing.• Abuse or the consequences of the abuse of intoxicants or hallucinogenic substances such as

intoxicating drugs and alcohol.• Treatment of Obesity and any weight control program.• Psychiatric, mental disorders; congenital internal or external diseases, stem cell implantation

or surgery; sleep-apnoea.• Conditions related to or arising out of HIV/AIDS.• Pregnancy, miscarriage (except as a result of an Accident or Illness), maternity or birth

(including caesarean section) except in the case of ectopic pregnancy.• Dental treatment and surgery of any kind, unless requiring Hospitalisation.• Plastic surgery or cosmetic surgery unless necessary as a part of medically necessary

treatment.• Any non allopathic treatment.

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This is only a summary of the exclusions, for the

complete list of exclusions please refer policy

wording.

Call – 09310851534 / 09278793144

PPC Grid

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Age Group/Basic Sum Insured (Rs.)

300,000; 500,000 1,000,000; 1,500,000

91 Days – 17 Years Nil Cat 11

18-45 Years Nil Cat - 12

46-55 Years Cat - 13 Cat - 14

56 – 60 Years Cat - 15 Cat - 16

61 – 65 Years Cat - 16 Cat - 16

Category Tests Category Tests

Cat 11 ME, RUA Cat - 14 ME, RUA, FBS, CBC, Lipid Profile, PSA(Males), TMT, USG Abd (Males & Females), HbA1c, X-Ray Chest, LFT,

RFT, HBsAgCat - 12 ME, RUA, FBS, CBC, Sr Creat, Lipid

Profile, PSA(Males), TMT, SGOT, USG Abd(females), HbA1c, X-Ray Chest,

SGPT, GGT, HBsAg

Cat - 15 ME, RUA, FBS, CBC, Lipid Profile, PSA(Males), TMT, USG Abd (Males &

Females), HbA1c, LFT, RFT

Cat - 13 ME, RUA, FBS, CBC, Sr Creat, Lipid Profile, TMT, SGOT, USG Abd (Males &

Females), HbA1c, SGPT, GGT

Cat - 16 ME, RUA, FBS, CBC, Lipid Profile, PSA(Males), TMT, USG Abd (Males & Females), HbA1c, X-Ray Chest, LFT,

RFT, HBsAg, PAP smear

Call – 09310851534 / 09278793144

31/12/2011

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Product Advantage

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ME = Medical Examination Report; RUA = Routine Urine Examination; CBC = Complete Blood Count; FBS = Fasting Blood Sugar; Lipids = Lipid Profile; Sr

Creatinine = Serum Creatinine; PSA = Prostate Specific antigen; TMT = Treadmill Test; USG = Ultrasonogram; SGOT – Serum Glutamic Oxaloacetic Transaminase; HbA1c – Glycoslated Hb; SGPT = Serum Glutamic Pyruvic Transaminase; GGT = Gamma-Glutamyl Transpeptidase; X-Ray Chest; LFT = Liver Function Test; RFT =

Renal Function Test; HBsAg = Hepatitis B Surface Antigen; PAP smear.We will reimburse 50% of the expenses incurred per Insured Person on the

acceptance of the proposal. The medical reports are valid for a period of 90 days from the date of Pre-Policy Checkup.


Call – 09310851534 / 09278793144

WHY APOLLO………?

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No Capping / Sub Limit on Room Rent / ICU

No Loading on Claim / Renewal

No Co-payment

No Claim Bonus every year 50% upto 100% of Sum Asured

Health Line Toll Free No. for day to day problems

* * * * * 5 Stars rating for Services & Claim Settlement.

Automatic Re-instatment of Amount equal to Sum Assured option if Sum Assured is Exhausted in policy year


Call – 09310851534 / 09278793144

If Apollo No…….then what else……?Pl go through the policy features before taking Med iclaim

optima restore-product presentation - welcome to … free year accumulating upto 100% of basic sum...

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