prohealth insurance detailed ppt_17022014_v1 0

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CignaTTK ProHealth Insurance

Product Presentation

February, 2014

Confidential, unpublished property of CignaTTK, Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. Copyright 2014 (CignaTTK Health Insurance Company Limited)


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2

Overview

CignaTTKIts Mission & Strength

Introducing ProHealth

A Plan to Cover You Completely

ProHealth at a Glance

ProHealth Features, Waiting Period and Exclusions

Plan Options and Benefit Structure

ProHealth USP

Premium



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3

What is CignaTTK?

Mission Statement

Our Philosophy & Our Strength



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4

Introducing

CignaTTK

ProHealthInsurancePolicy

At Cigna TTK our aim is to encourage you to stay healthy



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5

ProHealthA Plan That Covers You Completely

Physical Well-Being

We care about our customers health. In our effort to innovateand grow we have assembled benefits that takes care of yourPhysical Well-Being.

Emotional Well-Being

We understand life is not always a easy ride. We are there atevery stage of your life with benefits ensuring your EmotionalWell-Being.

Financial Well-Being

We always strive to bring a smile on your face and what betterway then to celebrate with your Financial Well-Being.



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6

ProHealth at a Glance

Physical Well-Being

In-Patient Hospitalization Pre & Post Hospitalization Day Care Treatment Health Maintenance Benefit Healthy Rewards Health Check-up Domiciliary Treatment

Emotional Well-Being

Expert Opinion on CriticalIllness

Worldwide EmergencyCover

Ambulance Expenses Donor Expenses Maternity & New Born

Expenses Vaccination Cover

Financial Well-Being

Restoration of SumInsured

Cumulative Bonus Critical Illness Add-on

Cover Discounts on Premium Deductible Tax Benefit


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ProHealth: Basic Covers

In-Patient Hospitalization

Covers medical expenses for hospitalization of insured due to injury or illness for more than 24 hours

Up to a Shared Room / Single Private Room as per the Plan opted. All Associated Medical Expenses will be

payable in the same proportion as defined in the policy.

Pre & Post Hospitalization

We will reimburse medical expenses towards treatment of injury or illness before and after hospitalizationupto the period specified in plan.

Day Care Treatment

Medically necessary procedure requiring less than 24 hours hospitalization is covered under Day Care. OurDay Care List includes 170+ Ailment.

Domiciliary Treatment

If situation requires treatment to be taken at home & condition for treatment continues for 3 days, same iscovered under this benefit provided that the patient cannot be shifted to the hospital or there is no bedavailable in the hospital.

Ambulance Cover

If an Insured is required to be transported to the hospital for treatment during emergency, same will becovered under Ambulance Cover up to the amount eligible under the plan



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ProHealth: Basic Covers

Donor Expenses

If the insured is required to go for a major organ transplant, in-patient medical expenses towards the donor will becovered under the plan

Worldwide Emergency Cover

We will reimburse medical expenses towards any emergency hospitalization outside of India.

Restoration of Sum Insured

If the SI and CB is insufficient due to previous claims made during a policy year, we will restore the SI to 100%.Same can be used for all future claims for unrelated ailments for the same Insured Person and all ailments for otherInsured Members.

Health Maintenance Benefit

Under this benefit Out patient treatment expenses for diagnostic tests, dental treatments, non-allopathic medicinesetc. are covered on reimbursement basis

Maternity/New Born/First Year Vaccination

Maternity expenses for up to 2 child of an insured between 18-45years will be covered including in-patienthospitalization expenses for the new born. We will cover vaccination expenses of the new born as per NIC programin addition to the maternity benefit limit.



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ProHealth: Value Added Covers

Health Check Up

For all insured above 18 years we will provide with a Health Check-up facility irrespective of the claim status atour Network Hospitals. The eligibility and tests will be as per the plan selected.

Expert Opinion on Critical Illness

Insured can avail of a second opinion from our Network of Medical Practitioners if diagnosed with any of thecovered critical illnesses.

Cumulative Bonus

We will increase the SI by 5%/10% as per the plan opted in case of no claim in the expiring policy with us.Maximum of 50% CB can be accumulated. There will be no reduction in CB for subsequent claims.

Healthy Rewards

You can earn reward points from the time you buy the policy- equal to 1% of premium paid. In addition, rewardpoints can be earned by opting for our Online Wellness programs. Maximum of 5 programs can be opted by aninsured in a policy year. Earned points can be redeemed for a discount in premium or as Health MaintenanceBenefits from year 3 onwards.


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ProHealth: Optional Covers & Add-on Covers

Deductible

Under Protect & Plus plan, insured can choose deductible of 1/2/3 Lacs depending on the sum insured

opted. Such Deductible will be applied on the aggregate of all claims in each policy year.

Reduction on Maternity Waiting

Insured can reduce the maternity waiting period from 48 months to 24 months by opting for this benefit. Ifopted waiting period for New born baby cover and First Year Vaccination Cover will be reduced accordingly.

Voluntary Co-Pay

Under Protect and Plus plan insured can choose co-pay option of 10%/20% whereby we will pay only90%/80% of the admissible claim amount.

Critical Illness Add on Cover

Insured between 18-65 years can opt for CI cover. Once opted a List of 11 Critical Illnesses will be covered.We will pay lump sum amount equal to SI on first diagnosis of covered Critical Illness.


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CignaTTK ProHealth Product Features

Protect

2.5L/3.5L/4.5L

Plus

4.5L/5.5L/7.5L/10L

Preferred

15L/30L/50L

Premier

1Cr

Plan Type & SI

20% for all

persons

above 65

years

Policy Term

Min Entry AgeAdult

18 years, Children 91

days

Max Entry Age

Lifetime, Children 23

years (under floater as

dependents)

Policy Type

Individual Policy

covering Self, Spouse,

Parents, Siblings, In-

laws and Grand

Parents/Grand ChildrenFloater Policywith Max

2 adults and 3 children

(self, spouse,

dependent children,

parents)

Eligibility

15 days from the

date of receipt of

policy kit insured can

place a request for

cancellation statingthe reason. Full

refund if no claims

reported.

Free look

30 days

from expiry

date

Grace Period

Cancellation can

be intimated to

company giving15 days notice.

Refund will be on

short period scale

Renewability

Allowed as

per IRDA

guidelines

Portability

Renewals

will be

availablefor life

time

Cancellation

1 & 2

Years

Mandatory Co-pay



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CignaTTK ProHealth Product Features

Ambulance

Cover

New BornBaby Cover

Health

Maintenance

Benefits

Worldwide

Emergency

CoverDomiciliary

Treatment

Pre-

hospitalization

Inpatient

Hospitalization

Critical

Illness

Cover

(add-on)

Post-hospitalization

Day Care

Treatment

ExpertOpinion on

CriticalIllness

Healthy

Rewards

HealthCheck

Up

Deductible

Donor

Expenses

Restoration Of

Sum Insured

Maternity

Expenses

First Year

Vaccination

Reduction

inMaternity

Waiting

Voluntary

Co-pay

Cumulative

Bonus



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Premium Zone Wise

The Premium charged on the Policy will depend on the Plan, Sum Insured, Policy Tenure, Age,Policy Type, Gender, Zone of Cover, Optional Covers and Add On Benefits opted.

To calculate premium, the country has been divided into Zone 1, Zone 2 and Zone 3.Zone I:Mumbai, Thane & Navi Mumbai and Delhi & NCRZone II:Bangalore, Hyderabad, Chennai, Chandigarh, Ludhiana, Kolkata, GujaratZone III:Rest of India excluding the locations mentioned under Zone I & Zone II

Identification of Zone will be based on the City of the proposed Insured Persons.

(a) Persons paying Zone I premium can avail treatment all over India without any sub limits.

(b) Persons paying Zone II premiumi) Can avail treatment in Zone II and Zone III without any Co-pay.ii) Availing treatment in Zone I will have to bear Co-pay of 10% of each and every claim.

(c) Person paying Zone III premiumi) Can avail treatment in Zone III, without any Co-pay.

ii) Availing treatment in Zone II will have to bear Co-pay of 10% of each and every claim.iii) Availing treatment in Zone I will have to bear Co-pay of 20% of each and every claim.

Above Co-pays will not apply for Hospitalizations due to Accidents.



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Policy Discounts

14


Family Discount10% for covering more than 2 members of the same family under a single policy

Long Term Discount7.5% for opting a 2 year policy

Copay Discount7.5% for opting a 10% Copay

15% for opting a 20% Copay


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ProHealth: Waiting Periods

Pre-existing disease: 24 for Preferred & Premier Plan36 months for Plus Plan &

48 months for Protect Plan

First 30 days WP:From policy inception date a period of 30 days will apply for hospitalizationclaims except for accidents.

Two Years WP: 24 months WP will apply on specific ailments like Cataract Knee Replacement surgery Urinary Stones All type of Hydrocele Sinusitis, Surgery on Tonsils Gastric, Cysts, Polyps, Internal/Skin tumors, Breast lumps

Maternity Waiting Period:48 months WP will apply unless Reduction of MWP opted in whichcase it will be 24 months.

Personal Waiting Period :A Maximum of 48 months of WP can apply as per UW decision forspecific ailments as declared at the time of proposal or subsequent diagnosis during MedicalTests.

CI Waiting Period:90 days WP will apply on CI add on cover



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ProHealth: Permanent Exclusions

We will not pay any claims arising out of or attributable to any of the following:

1. Genetic Disorder2. Dental treatment.3. Circumcision4. Birth control procedures, contraceptive supplies and services5. Routine medical check-up and diagnostic tests6. AIDS and all diseases/illnesses caused by or related to HIV

7. All sexually transmitted diseases8.Mental Illnesses9. Aliments arising out of alcohol and drug abuse10. Cosmetic surgery except reconstructive surgery for burns and accidents.11. Any form of non-allopathic treatment12.Any robotic or remote surgery13. Any amount which falls under the deductible or co-pay14. Non Medical Expenses Listed as per IRDA

Abov e List is only indicat ive and no t exhaust ive and do es NOT apply to Health

Maintenance Benefits



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Plan Options and Benefit Structure

In-patient

Hospitalization

Pre -

Hospitalization

Post

Hospitalization

Day Care

Treatment

Domiciliary

Treatment

Ambulance

Cover

Donor Expenses

Premier

Covered upto full Sum Insured

CignaTTK ProHealth Insurance Plan- Benefit Structure

Sum Insured

2.5 Lac,

3.5 Lac,

4.5 Lac

Preferred

15 Lac,

30 Lac,

50 Lac,

Covered up to 60 days before date of hospitalisation

100 Lac

Covered up to

Shared roomCovered up to Single Private room

Covered up to

Single Private room

Covered up to Single Private

room

4.5 Lac,

5.5 Lac,

7.5 Lac,

10 Lac

Covered up to 180 days post discharge from hospital

Covered up to full Sum Insured

Covered up to full Sum Insured

Up to 2000 per

hospitalization

event

Up to 3000 per hospital ization event Actual expenses paid per hospital ization event

Covered up to 90

days post discharge

from hospital

Protect Plus

Basic

Covers

1



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Plan Options and Benefit Structure2

Restoration Of

Sum Insured

Health

Maintenance

Benefits

New Born Baby

Expenses

First Year

Vaccinations

Premier

WorldwideEmergency

Cover

Covered upto full Sum Insured


Preferred

(once in a policy year)

Covered upto a maximum of 10 Lacs

Reimbursement of

500Reimbursement of 2000

Reimbursement upto maximum of 15000 per

policy year

Available once in a policy year for unrelated illnesses in addition to the Sum Insured opted Not Available

Maternity

ExpensesNot Available

Not Available Covered upto Limit under Maternity Expenses

Covered upto 15,000 for normal del ivery and

25,000 for C- Section per event

After a Waiting Period of 48 months

Covered upto 50,000 for normal del ivery and

100,000 for C-Section per event after a waiting

Period of 48 months

Not Available Covered as per national immunization programme over and above Maternity Expenses

Protect Plus

Basic

Covers



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Premier

Health Check-

Up

Expert Opinion

on Critical

illness

Cumulative

Bonus

Not

Available

Preferred

Available at each renewal, to all insured persons who have completed 18 years of

Age

Available once in 3 years for insured

aged 18 or above

5% Increase in Sum Insured, maximum

upto 50%.10% Increase in Sum Insured, maximum upto 50%

Value

addedcovers

Available once during the Policy Year

Healthy

Rewards

Reward Points to be earned for each year of premium paid & accumulated for 2 years. Points can also be earned for

enrolling & completing Our Online Wellness Programs. These earned Points can be used to get a discount in premium from

the 3rd Annual premium or can be redeemed aganist Health Maintanance Benefits.


PlusProtect



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Protect Plus Preferred Premier

Optional

covers

Deductible*

Deductible Options for Protect Plan Deductible Options for Plus Plan

Not AvailableNot

available

2.5

LacNA

4.5 Lac

1 Lac

3.5

Lac1 Lac 2 Lac

4.5

Lac

1 Lac5.5

Lac

2 Lac

3 Lac

2 Lac

7.5

Lac

2 Lac

3 Lac

10 Lac 3 Lac

* Voluntary Co-pay and Deductible cannot be taken under a single plan

Reduction in

Maternity

Waiting

Not Available Maternity waiting period Reduced to 24 months

Voluntary Co-

Payment*

10% or 20% voluntary co-payment for each and every claim as opted on

the PolicyNot Available

Not

Available

Add on cover Critical Illness Lump sum payment of 100% of Basic Sum Insured OptedNot

Available



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What is Unique about ProHealth?



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Unique about ProHealth

Restorati

on

Cumulative Bonus

Deductible

Maternity NewBorn &

Vaccination Cover

Worldwide Cover

CriticalIllnessCover

HealthMaintena

nceBenefit

HealthyRewards



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Restoration

When the basic SI is insufficient due to claims paid or accepted as payable,the same will be restored to 100% of basic SI. This does not require the

Basic SI + CB to be exhausted completely.

Example 1:Mr. Ram has taken an individual Protect plan for 2.5 L. Policy term 1 year.He has already received a claim for 2.4 lac under hospitalization due toaccident. In the same policy year he is admitted to hospital for Jaundicewhere the claim amount is Rs 50,000 and claim is accepted.

Under Restoration, the Basic SI will be restored to 100% to honor theclaim.

Restoration benefit available with competitors only restores once the SumInsured + earned CB is fully exhausted. However at CignaTTK we willrestore even when the balance Sum Insured is insufficient.

CignaTTK ProHealth

RestorationMarket Practice



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CumulativeBonus

For any claim free year, the expiring SI will be increased by 5 % (Protect plan) /10 % (Plus & Preferred plans). The CB can accrue upto a Max of 50%.CB will not accrue in the year in case of a claim.

Example 1:Ms. Sheena has taken an individual Plus plan for 10 L. Policy term 2 year.No claim is registered in the 1stPolicy year. Accordingly in the 2ndYear she willbe eligible for 10% CB on Basic SI of 10L. CB accrued will be Rs.1L.If she renews policy after expiry of 2nd year and there is no claim in the 2ndyearalso. She further receives a CB of 10 % on Basic SI. So Total CB is 20% ofBasic SI (2L).In this fashion, she will be eligible for a maximum of 50% CB.However if there is a claim in the 2ndyear, the CB bonus will remain as 10%. Wewill not reduce the earned CB which is her reward. No CB will be given for 2ndyear as there is a claim.CB will start accruing again from the year in which no claim has been made.

The CB benefit as available with the competitors has a reward and penalty methodology.In case of a claim the CB is reduced in the same proportion that it is earned.

At CignaTTK we ensure that the rewards are kept intact.

CignaTTK ProHealth

Cumulative Bonus Market Practice



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Deductible

A Deductible Plan offers the customer to bear the expenses on any claim up

to the amount of opted Deductible.Deductible Plans will be best suited for persons with existing cover or personswho can share part of the expenses. It enables you to top up your existingcover with much lower premium outgo as compared to a fresh cover.

In the market, for plans with deductible option the deductible limit is applied on each and every claimadmitted in the policy year.However for ProHealth deductible amount will be applied on aggregate of all admissible claims in thatpolicy year.Deductible plans available in the market are not feature rich however at CignaTTK our best plans comewith a deductible option.

CignaTTK ProHealth

DeductibleMarket Practice



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Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. 2013 Cigna 26

Maternity &

New Born

Cover

Maternity benefit available for max of 2 deliveries/lawful terminations forinsured aged between 18-45 years.

New born baby cover provides for:

1.Medical expenses on the new born baby while the insured person ishospitalized as in-patient for delivery2. In-patient hospitalization expenses on the new born upto a max of 90 daysfrom DOB

First Year Vaccination:Vaccination expenses as per NIC will be covered till the baby completes 12months

Most retail plans in the market do not offer Maternity & New Born Cover. Where the plans are offered

they have a waiting period of 48 months and Vaccination costs are not payable. The Vaccination expenses

(if available in plan) is included within the maternity benefit SI.

With ProHealth we provide an option to reduce this waiting period to 24 months and cover Vaccination

expenses over and above the Maternity Sum Insured

CignaTTK ProHealth

Market Practice


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Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. 2013 Cigna 27

Worldwide

EmergencyCover

In Worldwide Emergency Cover we will reimburse Inpatient hospitalizationexpenses for illness and injury outside India.

The cover will be limited to the SI of the plan and sub limit specified. Insuredcan avail this benefit once in policy year.

Example: Mr. Rajan has a Plus plan with SI Rs.10 L. On his trip to Malaysiahe meets with an accident and incurs $25000 (Malaysian) as Hospitalizationexpenses.He registers a claim for reimbursement of the expenses.RBI exchange rate on the date of payment of expenses: $1 (Malaysian)=

INR. 20.The inpatient expenses = $20000.Total claim amount: Rs.400000SI under the plan Rs.10LThe admissible claim amount under WWEC is Rs.4L.

All health policies cover only admission within India. Even where offered thesame is available for specified Critical Illnesses.Under ProHealth the benefit is available for all kinds of emergencytreatments .

CignaTTK ProHealth

Market Practice


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Critical IllnessCover

CI benefit is available as an Add on cover under Protect/Plus and Preferredplan.

The benefit will lapse for the insured once claim is paid against a covered CI.All other insured in the policy can avail of this benefit in current or insubsequent renewals.Example 1:Mr. Raj has taken a Plus plan (floater-self & spouse) for 4.5 L with CI benefitas an Add-on Cover. Policy term 2 years.He claims for First Heart Attack and his claim is settled.

Mr. Raj will not be able to claim for any CI in current or subsequent years.However he will be covered for all other benefits in the plan.His Spouse will continue to be eligible for a CI cover of 4.5L once during thepolicy period.

Floater Policies in the marker offer Critical Illness on Floater basis, henceonce a claim is made by any one Insured Person the coverage under CriticalIllness section will cease.

At CignaTTK we will Reinstate the Sum Insured for Critical Illness for floaterpolicies for the 2ndAdult Insured.

CignaTTK ProHealth

CI benefit as in Market



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HealthMaintenance

Benefit

Benefit can be used to cover costs for Diagnostic tests, drugs, prosthetics,medical aids, prescribed by a doctor as per limit under the plan.

They can also be used for Dental Treatments and Alternative Forms ofMedicines.

We will connect with you to ensure that you use the benefit.

Most health policies do not offer any cover for such expenses. At Cigna TTKwe would like you to make sure you take care of your health even whenthey are minor ailments which do not require hospital admission.

CignaTTK ProHealth

Market Practice



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HealthyRewards

We motivate you to stay healthy

Reward points can be earned equivalent to 1% of premium paid for each

Policy. In addition to this reward points can be accumulated by opting foronline wellness programs available on the CignaTTK website, that will helpassess customers health status and aid in improving overall well-being.

Each earned reward point will be valued at 1 Rupee. Accumulated rewardpoints can be redeemed in the following ways -A discount in premium from the 3rd Annual Premium

-Equivalent value of Health Maintenance Benefits from 3rd Policy Year.

Currently no player offers a reward program of this nature which aims atmotivating customers to maintain a healthy lifestyle.

CignaTTK ProHealth

Reward Programs



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ProHealth Premium for Milestone Ages


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ProHealth Premium for Milestone Ages for Base Plan

Sum Insured 2.5Lac 3.5 Lac 4.5 Lac

1 Adult(Male/Female)

3610/3170 4030/3510 4410/3810

2 Adult 5210 5850 6440

2A + 1 Kid

6800 7710 8540

2A + 2 Kid 8200 9320 10360

4.5 Lac 5.5 Lac 7.5 Lac 10 Lac

6160/6600 6390/6780 7300/7520 7940/8040

9630 9980 11370 12320

12180 12670 14590 15910

14320 14920 17250 18870

Protect Plan Plus Plan

SumInsured

15 Lac 30 Lac 50 Lac

1 Adult(M/F) 21370/24050 26110/27910 28960/30230

2 Adult 31740 41150 46810

2 A+1K 39180 51440 58810

2A+2K 45830 60340 69070

Preferred Plan

100 Lac

34640/34840

58080

73620

86730

Premier Plan

Age 25 yrs.

Term 1 yr.



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4210/3740 4700/4140 5130/4490

2 Adult 5930 6660 7290

2A + 1 Kid

7510 8490 9370

2A + 2 Kid 8950 10150 11240


7370/7970 7640/8180 8890/9620 9680/9920

11360 11750 13350 14440

14030 14560 16680 18140

16370 17020 19570 21340


SumInsured


1 Adult(M/F) 25830/29180 31510/33900 34920/36730

2 Adult 40990 54450 62530

2 A+1K 49110 65300 75030

2A+2K 56880 75530 86740

Preferred Plan

100 Lac

41710/42380

78640

94770

109790

Premier Plan

35 yrs.

Term 1 yr.



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6540/5790 7610/6700 8660/7600

2 Adult 8600 9990 11400

2A + 1 Kid

10230 11860 13490

2A + 2 Kid 11880 13750 15590


13100/12360 13630/12800 16050/14870 18000/16550

16060 16680 19340 21200

19020 19780 22970 25200

21890 22780 26450 29040


SumInsured


1 Adult(M/F) 36350/35860 46860/44810 53170/50180

2 Adult 50250 67740 78250

2 A+1K 59040 79160 91260

2A+2K 67940 90720 104410

Preferred Plan

100 Lac

65770/60900

99210

115930

132860

Premier Plan

45 yrs.

Term 1 yr.



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ProHealth Premium for Milestone Ages



11400/11090 13710/12130 15770/13920

2 Adult 14570 17570 20220

2A + 1 Kid

16000 19140 21940

2A + 2 Kid 17660 21050 24070


22710/20420 23760/21320 28430/25390 33140/29520

25350 26520 31720 35440

28520 29790 35380 39360

32380 33780 39900 44230


SumInsured


1 Adult(M/F) 50200/46700 69440/63450 80980/73500

2 Adult 68190 95540 111950

2 A+1K 76780 106140 123780

2A+2K 86430 118550 137840

Preferred Plan

100 Lac

104050/93580

144730

159650

177690

Premier Plan

55 yrs.

Term 1 yr.



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C fid ti l bli h d t f Ci TTK D t d li t di t ib t U d di t ib ti li it d l l t th i d l

Offered by: Connecticut General Life Insurance Company or Cigna Health and Life Insurance Company.

Cigna,the Treeof Lifelogo and GOYOUare registered service marks of Cigna Intellectual Property, Inc., licensed for

use by Cigna Corporation and its operating subsidiaries. All products and services are provided by or through such

operating subsidiaries and not by Cigna Corporation. Such operating subsidiaries include Connecticut General Life

Insurance Company, Cigna Health and Life Insurance Company, and HMO or service company subsidiaries of Cigna Health

Corporation and Cigna Dental Health, Inc. All models are used for illustrative purposes only.

000000 00/13 2013 Cigna. Some content provided under license.

This material is not a public document and it is meant solely for internal use of CignaTTK Health Insurance Company Limited

(CignaTTK). This material shall be used solely for the training, recruitment, and education of personnel, intermediaries,

counselors, and solicitors of CignaTTK and the same shall not be used to induce the public to purchase, increase, modify, orretain a policy of insurance.

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