PROJECT

ON

MDICLEAIM
SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTSFOR THE AWARD OF THE DEGREE OF BACHELOR OF THE COMMERCE BANKING & INSURANCE AFFILIATED TO THE UNIVERSITY OF MUMBAI SUBMITTED BY:

MAMTA ASHOK GUPTA

RESEARCH GUIDE

Prof. KOMAL MANSUKHANI

SEVA SADANS
ARTS, SCIENCE AND COMMERCE, CENTRE FOR MANAGEMENT COURSES, ULHASNAGAR 421003.

2012 - 2013

OBJECTIVES

I have taken this topic because of following objectives :

To learn about the importance of Mediclaim. To learn its various types in insurance companies. To know how it is beneficial to investors, family, senior citizens. To know about various conditions for investing in Mediclaim.

ACKNOWLEDGEMENT

Men ought to know that in the theatre of human affairs, It is only for gods and angels to be spectator.

W e too are supernatural .Hence ,we can't afford to be a mere spectator .Hence at the Slightest of a provocation/inspiration we also have to jump on a stage to perform our roles on the stages of the world. There are many people behind creation of this project relating to

Mediclaim Insurance, without their help and

encouragement ;this creation would never have been made possible .I pay my sincere thanks to the company and its Members for trusting me possible without help ,co-operation and support of staff and executives of this company .Every has played their role well and helped me completed this project successfully . This is a result of joint effort of people of this company who have participated and provided me with the needed information .I acknowledge each one of them individually as the inputs by them forms the base of my study.

I cover my sincere thanks with the deepest gratitude to my Respected Principal Dr. Mrs. Lalithambal Natarajan and Prof. Komal Mansukhani Banking & Insurance Coordinator , I am deeply indebted to her
whose help, time, support, inspiration, stimulating suggestion and encouragement helped me in all the times of research and writing of this report. To end with , I thank the people who helped me indirectly but without their assistance this project was not possible . I thank all my friends and dear ones for their kind support .

Methodology

The methodology, which has been used for collection of data regarding MEDICLAIM INSURANCE, is classified under primary research and secondary research.

The secondary research includes visits to Insurance company, which was visited in RELIANCE LIFE INSURANCE COMPANY located shop no. 2, Bharti complex 1st Floor, Near LCC computers,Kalyan Ambernath , Ulhasnagar 421003. The primary research has been completed with the face to- face interview with the branch manager by using questionnaire as a tool of research.

EXECUTIVE SUMMARY

Mediclaim insurance provides cover for you and your family in case of sudden medical contingency. Having health care protection is important in your life because it provides monetory protection in case of unforeseen condition.

The medical cost is continuously going to rise up in the current situation . Due to this medical insurance cost is higher than other individual insurance. A Mediclaim policy basically provides a health cover of a certain amount of money and hence in the insurance it is a case of incurring any medical expenses, the expenses to a certain limit are borne by the particular insurance or the Mediclaim policy.

Mediclaim insurance under the brand name Mediclaim , these companies offer Mediclaim policies to their customer. Thus whether it is a Tata AIG, Bajaj Allianz , ICICI Lombard, Reliance, SBI , HDFC health insurance policy, cholamandalam, varishta that best suits your need or the need of your family.-

INDEX
SR. NO.

CHAPTER NAME Introduction To Insurance

INTRODUCTION TO INSURANCE
`Insurance is a form of risk management in which the insured transfers the cost of potential loss to another entity in exchange for monetary compensation known as the premium. Insurance allows individuals, businesses and other entities to protect themselves against significant potential losses and financial hardship at a reasonably affordable rate. We say "significant" because if the potential loss is small, then it doesn't make sense to pay a premium to protect against the loss. After all, you would not pay a monthly premium to protect against a $50 loss because this would not be considered a financial hardship for most. Insurance is appropriate when you want to protect against a significant monetary loss. Take life insurance as an example. If you are the primary breadwinner in your home, the loss of income that your family would experience as a result of our premature death is considered a significant lo red amount. The same principle applies to many other forms of insurance. If the potential loss will have a detrimental effect on the person or entity, insurance makes sense. Everyone that wants to protect themselves or someone else against financial hardship should consider insurance. This may include:

Protecting family after one's death from loss of income Ensuring debt repayment after death Covering contingent liabilities Protecting against the death of a key employee or person in your business Buying out a partner or co-shareholder after his or her death Protecting your business from business interruption and loss of income Protecting yourself against unforeseeable health expenses Protecting your home against theft, fire, flood and other hazards Protecting yourself against lawsuits Protecting yourself in the event of disability Protecting your car against theft or losses incurred because of accidents

And many more

INSURANCE DEFINITION
According to the encyclopedia Britannica, Insurance is a contract for reducing losses from accident incurred by an individual party through a distribution of the risk of losses among a number of parties. Insurance is a contract between two parties whereby one party agrees to undertake the risk of another in exchange for consideration known as premium and promises to pay a fixed sum of money to the other party on happening of an uncertain event (death) or after the expiry of a certain period in case of life insurance or to indemnify the other party on happening of an uncertain event in case of general insurance. The party bearing the risk is known as the 'insurer' or 'assurer' and the party whose risk is covered is known as the 'insured' or 'assured'. Concept of Insurance / How Insurance Works The concept behind insurance is that a group of people exposed to similar risk come together and make contributions towards formation of a pool of funds. In case a person actually suffers a loss on account of such risk, he is compensated out of the same pool of funds. Contribution to the pool is made by a group of people sharing common risks and collected by the insurance companies in the form of premiums.

INTRODUCTION TO MEDICLAIM

Health insurance may be the most important type of insurance you can own. Without proper health insurance, an illness or accident can wipe you out financially and put you and your family in debt for years. So what is health insurance and how does it work? Health insurance is a type of insurance that pays for medical expenses in exchange for premiums. The way it works is that you pay your monthly or annual premium and the insurance policy contracts healthcare providers and hospitals to provide benefits to its members at a discounted rate. This is how hospitals and healthcare providers get listed in your insurance provider booklet. They have agreed to provide you with healthcare at the specified cost. These costs include medical exams, drugs and treatments referred to as "covered services" in your insurance policy. As with any type of insurance, there are exclusions and limitations. To know what these are, you have to read your policy to find out what is covered and what is not. If you elect to have a medical procedure done that is not covered by your insurance, you will have to pay for that service out of pocket. The range of coverage for expenses varies depending on the type of plan, as will the restrictions. You can purchase the insurance directly from the insurance company through an agent or through an independent broker but most people get their insurance coverage through employer-sponsored programs.

ADDITIONAL COSTS
Aside from premiums, there are other costs associated with your health insurance coverage. Let's explore what these are and how you would calculate them.

Premiums: This is the amount that you pay for coverage. Deductible: The amount that you pay out of pocket. Like any other type of
insurance, the deductiblecan range in amount depending on how much you would like to pay out of pocket. Generally, the higher the deductible, the lower the premiums.

Co-insurance: The percentage of covered expenses paid by the medical plan.

The co-insuranceamount is per family per calendar year. For example, in a coinsurance arrangement, there can be an 80/20 split between the insured and the insurance carrier in which the insured pays 20% of the cost of care up to the deductible, but below the out-of-pocket limit set forth by the policy. This is typically associated with coverage provided by a PPO.

Co-payment: Sometimes referred to "co-pay", this is a set cap amount that

you will pay each time you receive medical services. This is typically associated with coverage through an HMO (which will also be discussed a little later). For example, every time you visit your doctor, you may have to pay $20 as a copayment. These payments usually do not contribute toward out-of-pocket policy maximums. The co-payment and the coinsurance are not one in the same.

Stop-Loss Limit: The cumulative dollar amount of covered expenses in

excess of the deductible after which the coinsurance payment stops and the insurer pays 100% of covered expenses. The purpose of to the stop-loss limit is to limit the out-of-pocket costs for the insured individual. The "out-of-pocket max" is the maximum out-of-pocket expense you will incur before your insurance carrier pays 100% of covered services. At this point, all you will have to pay is your premiums.

What's important to remember for out-of-pocket expenses is that not all expenses go toward meeting the out-of-pocket max. Co-payments and premiums do not apply to the out-of-pocket expense maximum. Your deductible and coinsurance do apply toward this amount. It's worth noting that this may not be a standard feature with every policy. Let's say your health insurance plan has the following features:

Deductible: $500 Coinsurance: 80/20 (you pay the 20%) Out of Pocket Max: $5,000

Now, let's say that you go to the hospital and incur $7,500 worth of medical expenses. How much do you have to pay? Let's do the math. Let's start by subtracting your deductible from the total expense amount:

$7,500 - $500 = $7,000 Remember that you have to pay the deductible before the insurance kicks in. Now you have to pay 20% of the $7,000, which would be: $7,000 x 0.20 = $1,400 All in all, you will have to pay $1,900 out of pocket ($500 deductible + $1,400 of coinsurance). You will have to continue paying out of pocket until your total out-of-pocket expenses reach the $5,000 max set in your policy. At that point, you will no longer pay the coinsurance or deductible. With out-of-pocket expenses, co-payments, coinsurance and premiums why get insurance at all? The answer is simple: while these costs certainly do put a pinch in your wallet, their costs are not nearly as painful as those from a longterm illness or emergency.

TYPES OF PLANS
Indemnity Plan
An indemnity plan, sometimes called a fee-for-service plan, is a type of insurance that reimburses you according to a schedule for medical expenses, regardless of who provides the service. These plans cover things such as: Hospital stays Surgical expenses Major medical coverage Under these plans, the insurer pays a specific amount per day for a specific number of days. The amount paid can be calculated either as a percentage (80/20) or for actual expenses.

Health Maintenance Organizations (HMO)

The HMO is the most common type of insurance policy people own and the one most frequently provided by employers. HMOs provide a wide range of comprehensive healthcare services to a group of subscribers in return for a fixed periodic payment. With this type of coverage, you select a primary care physician that acts as the gatekeeper for you to receive virtually all the medical care required during a year. The gatekeeper concept is the health insurer's attempt to control the cost and quality of care by coordinating health services with other providers. Specifically, your primary care physician is responsible for determining what care is required and when a patient should be referred to a specialist. These policies tend to be the least expensive form of health insurance, but they do come with annoying restrictions. Aside from having a gatekeeper, you can only select doctors and hospitals approved in the insurance carrier's network. This becomes a problem if you already have a great relationship with a doctor who is not in the network. If you use a non-

network provider, your HMO will not cover the costs unless it's for an emergency. Other than this, most preventive care services are covered.

Preferred Provider Organization (PPO)

PPOs are a group of healthcare providers that contract with an insurance company, third-party administrators, or others (like employers) to provide medical care services at a reduced fee. There are two major differences between HMOs and PPOs in that:

1. The healthcare providers in the PPO are generally paid on a fee-forservice basis as their services are needed, much like a traditional doctor's visit. 2. You are not required to use the PPO's healthcare providers or facilities you can go outside the network. That said, going outside the network usually means paying a higher co-payment or deductible.

Point of Service (POS)

A point of service plan is a hybrid plan that combines aspects of an HMO, PPO and indemnity plan. This type of plan is more flexible in that it allows you to decide at the time you need services to elect to use the POS plan's physician to arrange in-network care (HMO feature), or to go outside the network or hospital and pay a higher portion of the cost.

Health Insurance in India

How many accident you need to realise that you need Health Cover? It takes just one visit to a hospital to make us realize how vulnerable we are, every passing second. For the rich as well as poor, male as well as female and young as well as old, being diagnosed with an illness and having the need to be hospitalized can be a tough ordeal. Heart problems, diabetes, stroke, renal failure, cancer the list of lifestyle diseases just seem to get longer and more common these days. Thankfully there are more speciality hospitals and specialist doctors but all that comes at a cost. The super rich can afford such costs, but what about an average middle class person. For an illness that requires hospitalization/ surgery, costs can easily run into five digit bills. A Health insurance policy can cover such expenses to a large extent.

Types of health insurance

Individual Mediclaim :
The simplest form of health insurance is the Individual Mediclaim policy. It covers the hospitalization expenses for an individual for up to the sum assured limit. The insurance premium is dependent on the sum assured value. Example : If you have 3 family members you can get an individual cover of Rs 2 lacs each . In this case each of you are covered for 2 lacs , if 3 members face a need for hospitalization , all 3 of them can get expenses recovered upto Rs 2 lacs . All the 3 policies are independent .

Family Floater policy

Family Floater Policies are enhanced version of the mediclaim policy. The sum assured value floats among the family members. i.e each opted family member comes under the policy, and it covers expenses for the entire family up to the sum assured limit. The premium for family floater plans is typically less than that for separate insurance cover for each family member. Example : In this case if suppose there are 3 family members , you can take a Family floater policy for Rs 6 lacs in total . Now anyone can claim upto 6 lacs in expenses , but then the cover will go down by that much amount for that year . So if one of the family member is hospitalised and the expenses are 4.5 lacs . It will be paid and then the cover will be reduced to 1.5 lacs for that particular year . Next year again it will start from fresh 6 lacs. Family floater makes sense for a family because that way each one in family gets a big cover and probability of more than 1 getting hospitalized in same year is too low untill and unless whole family is travelling together most of the times in a year .

Unit Linked Health Plans :

Taking the ULIP route, health insurance companies too have introduced Unit Linked Health Plans. Such plans combine health insurance with investment and pay back an amount at the end of the insurance term. The returns of course are dependent on market performance. These plans are very new and still in development phase . This is only recomended for people who can handle market linked products like ULIP and ULPP . Read who should buy ULIPs . For a number of reasons, it is advisable to steer clear of unit linked health plans. The best way is to treat insurance purely as an expense. So if you are single, opt for an Individual Mediclaim policy and if you have family, opt for a Family Floater policy. The amount paid (by cheque or debit/ credit card) for health insurance premium provide tax exemption under section 80D for a maximum of Rs.15,000.

What is the Ideal Cover for Health Insurance

As mentioned earlier, the cost of Health Insurance depends on the sum assured , age, current health condition and your previous medical history. Higher the sum assured, higher the premium. So what is the ideal health insurance cover requirement? There is no standard answer or thumb rule for this. If we agree that health insurance is important, one has to look at his/ her own lifestyle, health condition, age/ life stage, family history of illnesses and affordability. Keep in mind that most insurance companies limit the sum assured to a maximum of 5 lakhs. Also note that many health insurance policies provide additional benefits such as daily allowance, ambulance charges, etc. for hospitalization. Not only are such benefits superfluous, they tend to drive the premiums higher. So it is best to avoid such plans and stick to something basic and simple.

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Health Insurance provided by Employer

Many employers provide health cover for their employees. Isnt that sufficient? Three aspects need to be considered in such a case Is that cover sufficient? Is the insurer good enough? What happens if you change your job? Health insurance is provided as a perk to the employees. So it is important to understand the policy a bit more in detail and to check for coverage. The best way is to ask the HR Department for policy details. Get into details , what is covered , what is not covered ? Many times Employees just think that they have health Insurance and are just relaxed only to find later that it does not cover X and covers Y only upto a limit . That can be a painful situation . Health Insurance for the aged Till a few years back, health insurance companies were reluctant to provide cover for the aged. But nowadays there are a lot of insurance companies providing policies for the senior citizens. Insurance cover paid for a person of age 65 years and above, can provide additional tax exemption of up to Rs.20,000. But keep in mind that the premium rates are higher for senior citizens. For the employed, another option is to approach the employer to negotiate with the official insurer to provide an option for additional cover to parents. Since the volumes are high, the insurer can provide such added cover at attractive premium rates.

Tax Exemption from Health Insurance Premiums

Sec 80D covers Health Insurance . You can get exemptions of Upto Rs. 15,000 paid for self + spouse + cildren. Upto Rs 15,000 paid for Parents (Rs 20,000 if parents are senior citizens) So in total if you pay your health insuance and your parents health Insurance premium , you can save upto maximum of 35,000 . Note : If you take Health Insurance riders with Term Insurance like Critical Illness cover , the extra premium paid for that will be actually be covered under Sec 80D , not sec 80C . See Tax Rules

What is TPA (Third Party Administrators)

TPA stands for Third Party Administrator. TPA is a middlemen between Insurer and the Customer . Customer can directly deal with TPA at the time of claim and TPA will help with with all the process of claim settlement . A TPA is a specialized health service provider rendering variety of services like networking with hospitals, arranging for hospitalization and claim processing and settlement. The concept of TPA has been introduced by the IRDA (Insurance Regulatory and Development Authority of India) for the benefit of both the insured and the insurer. While the insured is benefited by quicker & better health service, insurers are benefited by reduction in their administrative costs, fraudulent claims and ultimately bringing down the claim ratios. An insurance company can have more than one TPA and a TPA can serve more than one insurance company. Some of the services TPA provides are Maintain database of policyholders Issue of identity card to all policyholders Provide ambulance service Provide information to policyholders about hospitals. Check various investigations Provide Cashless service Process claims Health Insurance Claims settlement process A bit on how health insurance claims processing works. In most cases, the Insurance companies appoint a third part administrator (TPA) for claims processing. That means once the health insurance policy is sold, the insurer passes on the baton to the TPA. In case of a claim, the insured has to get in touch with the TPA for all versification and formalities.

There are 2 ways by which health insurance claims are settled:

Cashless :

For availing cashless treatment (only at authorized network hospitals), the TPA has to be notified in advance (for planned hospitalization) or within the stipulated time limits (for emergencies). The insurance desk at hospitals usually helps with all paper work. The claim amount need to be approved by the TPA, and the hospital settles the amount with the TPA/ Insurer. Typically there will be exclusions and such amount will have to be settled directly at the hospital.

Reimbursement : Reimbursement facility can be availed at both the

network and non-network hospitals. Here the insured avails the treatment and settles the hospital bills directly at the hospital. The insured can claim reimbursement for hospitalization by submitting relevant bills/ documents for the claimed amount to the TPA. The TPA mode of claims settling has its own problems. The TPA is incentivized to limit insurance claims and they are not the ones who sells the policy. There are many cases where the insured had a tough time to claim for his hospital expenses. So before taking health insurance it would be useful to check who the TPA is and how good are they when it comes to claims processing. Internet search and a friendly chat with the hospital staff can give you good insight on the insurer/ TPA. There are also some health insurance providers who do not employ TPAs and does claims settlement directly (this is called Inhouse TPA) .

An Introduction To Cashless Mediclaim Insurance

India has made tremendous progress in medical sectors still a majority of population has not direct accessibility to such quality medical facilities as they are too expensive to afford. People really face a tough time at critical medical situation requiring a person subsequent hospitalisation. Sometimes the medical treatment drains out substantial money from the patient, making him almost broke. Had the patient insured with one of the medical insurance, he/she wouldnt have to bear all the medical expenses. Rather, they would have been compensated by the health plan itself. Considering the very importance of health insurance policy, people, representing different social backgrounds purchase one of the medical policies to ensure their well being from unforeseen medical emergency.

One of the most striking features of health insurance plan is facility of cashless treatment. So to say, this sort of medical policy covers medical expenses such as hospitalisation, surgery, room charge, and doctors fees as per the term of the policy. Since the insurance company is responsible to pay these expenses, the insured person doesnt have to pay anything in this regard. In addition, your cashless mediclaim remains effective provided that you are hospitalised at network hospital of your insurance service provider.

How cashless mediclaim work?

First of all, as mentioned above, the cashless mediclaim functions if the insured person is admitted to one of the network hospitals of insurance company. This will help you avail cashless treatment during hospitalisation thus helping you save a lot of money. The cashless treatment wont be effective if you get admitted at a non-network hospital of your company. In that case, whatever preliminary medical expenses you incur will be born by you and not the company; however, the company will reimburse those expenses later on.

TPA (third-party administrator) is a representative of your insurance company and during any pre-hospitalisation case; you are supposed to phone or inform the TPA in this regard. It functions as intermediary between your company and the assumed hospital where you will get medical treatment. Thus the TPA facilitates claims on your behalf without requiring you do anything. Hence better inform your TPA before any pre-hospitalisation case.

Adding further, like any insurance policy, the functionality of health plan is subject to certain conditions too. Before signing up the insurance documents, better study all the terms and conditions associated with your plan. This is very crucial thing to do as more often than not, people, owing to lack of knowledge end up availing substandard health plan. In the case of cashless insurance policy, the insured person doesnt need to pay anything to the concerned hospital regarding any medical expenses.

FAMILY FLOATER MEDICLAIM POLICY

We have designed a new Policy called as Family Floater Mediclaim Policy for covering the family members with one sum insured. All the terms and conditions of Individual Mediclaim Policy 2007 will be applicable for Family Floater Mediclaim Policy.

Who can take this Policy?

This insurance is available to persons between the age of 18 years to 60 years. The persons beyond 60 years can continue their insurance provided they are insured under Mediclaim policy with our Company without any break.

1. FLOATER BENEFIT means the Sum Insured as specified for the proposer under the policy, is available for any or all the members of his /her family for one or more claims during the tenure of the policy. 2. The Family Floater Mediclaim Policy can be issued to the persons up to 60 years of age covering the following family members: o Self o Spouse o Dependent children ? Maximum two
o

3. Parents/Parents-in law/ brothers and sisters are not covered under Family Floater Mediclaim Policy even if they are residing with the proposer. 4. Sum Insured: Minimum Sum Insured is Rs. 2 lacs and Maximum Sum Insured is Rs 5 lacs. 5. Premium: Premium is as per Individual Mediclaim Policy (2007). The basic premium will be as per highest age of the family member. Apply 50% loading for covering spouse, and 25% loading for covering each and every additional dependent child.

What does this Policy Cover?

The policy covers hospitalization expenses for the treatment of illness/injury provided hospitalization is more than 24 hours. Pre-

hospitalization expenses for 30 days and post hospitalization expenses for 60 days are also payable. Day-care treatment - The Medical expense towards specific technologically advanced day-care treatments / surgeries where 24 hour hospitalization is not required.

Ambulance Charges for shifting the insured from residence to hospital are covered up to the limits specified in the policy. Ayurvedic/Homeopathic and Unani system of medicine are covered to the extent of 25% of Sum Insured provided the treatment is taken in the Registered Hospital. Pre-existing diseases are covered only after 4 continuous and claim free renewals with our Company. Pre-existing conditions like Hypertension, Diabetes, and their complications are covered after two years of continuous insurance on payment of additional premium.

Exclusions

Diseases contracted within 30 days of insurance. Dental treatment except arising out of accident. Debility and General Run Down Conditions. Sexually transmitted diseases and HIV (AIDS).

Circumcision, Cosmetic surgery, Plastic surgery unless required to treat injury or illness. Vaccination and Inoculation. Pregnancy and child birth. War, Act of foreign enemy, ionizing radiation and nuclear weapon. Treatment outside India. Naturopathy. Domiciliary Treatment. Experimental or unproven treatment. All external equipments such as contact lenses, cochlear implants etc.

Premium
Premium is based on age of the proposer and geographical area of treatment. The following 3 zones have been made for rating: ZONE-I (MUMBAI), ZONE-II (DELHI & BANGALORE) AND ZONE-III (REST OF INDIA). Premium will be charged depending on the Zone in which the insured undertakes to seek hospitalization.

Special Features of the Policy

Loyalty Discount. Good Health Discount. Income Tax Benefit under Section 80D of IT Act.

How to Avail Claim?

Claims are administered through Third Party Administrators (TPA) whose contact particulars appear on the policy document. Insured can opt for cashless or reimbursement facility for their claims. For more details please contact our nearest Office.

RELIANCE Individual Mediclaim Policy

Salient Features Hospitalization Care for the Family Reliance Mediclaim Insurance Policy covers you and

your family for hospitalization and related expenses. Family members between the ages of 5 and 80 years can be covered. The policy also provides health insurance for children between the ages of 3 months and 5 years if one of the parents is covered concurrently. Claim-Free Bonus With a no-claim bonus of 5% on every claim-free renewal, the prospective policy holder can be rewarded. This can be accumulated up to a maximum of 50%. Tax Advantage With health insurance you not only protect your family but also can avail of tax benefits under Section 80D of the Income Tax Act.

Policy Coverage

Reliance Mediclaim Insurance Policy will cover various hospitalization expenses.

 Hospitalization Expenses These include room charges and operation theatre charges, nursing expenses, fees of medical practitioner, anaesthetist and consultants. Medicine, Consumables and Diagnostic Expenses Cost of anaesthesia, blood, oxygen, surgical appliances, medicine and drugs, diagnostic material and X-rays, dialysis, chemotherapy, radiotherapy, pacemaker, artificial limbs and organs. Day Care Treatment The policy will cover expenses incurred towards technologically advanced treatment that does not require hospitalization for 24 hours or more. Domiciliary Hospitalization We also provide cover for treatment administered at home, subject to specified conditions. Pre- and Post-Hospitalization Reliance Mediclaim Insurance Policy covers medical expenses for treatment up to 30 days before and up to 60 days after the hospitalization. Value Added Benefits Reliance Mediclaim Insurance Policy offers value-added benefits to give an individual extra cushioning and added cover.

 The policy will cover pre-hospitalization expenses for 30 days and post-hospitalization expenses for 60 days. It also provides you with health cover for technologically advanced treatment that does not require 24-hour hospital stay. No medical check-up up to the age of 45. Free medical check-up after 4 claim-free renewals. Exclusions At Reliance General Insurance, we would like our policy to be as transparent as possible. To ensure that you do not face any unpleasant surprises when you make a claim, we would like you to know some of the major exclusions under the policy. This policy does not cover: Any pre-existing illness Specified illnesses for the first year. Specified illnesses in the case of domiciliary hospitalization. Any treatment for the first 30 days from the time of inception of policy, unless due to an accident. Treatment related to HIV / AIDS. Treatment due to abuse of alcohol or intoxicants.

 Vaccination and inoculation. Nuclear and war perils. Naturopathy treatment. Eligibility The policy can be issued to: Persons between 5 years and 80 years of age. Children between 3 months and 5 years if one or both parents are covered concurrently.

Benefit

Coverage by Gold Plan

Coverage by Silver Plan

Room, Not more than 1 percent of sum assured Same as nursing, and on a daily basis Gold Plan boarding costs as provided by the nursing home or

hospital Intensive care Not more than 2 percent of sum assured Same as unit costs on a daily basis Gold Plan Fees of According to previously specified limits surgeons, consultants, anesthetists, specialists, and medical practitioners Cost of According to previously specified limits anesthesia, diagnostic material and x-rays, blood, dialysis, oxygen, chemotherapy sessions, operation theatre fees, radiotherapy sessions, surgical appliances, pacemaker expenses, medicines and drugs, and artificial limbs Ambulance service fees Same as Gold Plan

Same as Gold Plan

INR 2 thousand for each illness and INR 1 restricted to a maximum of 1 percent of thousand sum insured or INR 6000 - the lesser for each illness and

amount throughout the policy term

restricted to a maximum of 1 percent of sum insured or INR 3000 the lesser amount throughout the policy term

Hospital cash 0.1% of sum insured per day for each None allowance on illness - restricted to a maximum of 10 a daily basis days - overall expenses will be limited to 1.5% of sum insured. Allowance for INR 500 per day per illness - the None attendants maximum limit is 10 days for each illness; the total upper limit is 15 days

In case of domiciliary hospitalization the following benefits shall be provided: Benefit Coverage Gold Plan by Coverage Silver Plan by

Fees of surgeons, consultants, medical practitioners, specialists, and blood, diagnostic material and dialysis, oxygen, chemotherapy session, surgical appliances, nursing, medicines and drugs expenses

INR 50,000 throughout the policy period

10 percent of sum insured maximum amount is INR 25,000

Treatment for dog bites or of other INR 5000 rabid animals like cats or monkeys

INR 5000

Family CareFirst - A health insurance plan for the entire family

The health of your family is very important to you. When faced with hospitalization or one or more family members, the medical bills can severely dent your savings. The cost associated with hospitalization might be very high and you need to be better prepared for such an emergency. Buying Medical Insurance for each individual family member can be cumbersome and expensive. What if there is a solution that gives you a single tool to cover your entire family - all in one? Bajaj Allianz Family CareFirst presents an innovative yet practical health care plan for everyone in your family including children and parents. This unique hospitalization plan gives you a 3year health cover for your entire family and allows you to renew the policy after every 3 years to keep your family covered till the age of 74 years. So no separate accounts, repetitive paperwork or payment adjustments for each member. Secure your entire family in one shot.

Key Benefits

Coverage from 3 months to age 74 with guaranteed renewals

3 year premium guarantee for each policy term Hospitalization Cover in leading hospitals across the country 15% discount on prevailing premium on every renewal No claim bonus in the form of increase in sum assured @5% every year Day Care Treatment for 140 day care procedures Pre-Hospitalization and Post-Hospitalization Benefit Reimbursement of Ambulance expenses Choice to select Health Critical Illness rider Choice to include Your spouse, children and parents Cash Less Service Facility in leading hospitals across the country

Critical Illness
A health insurance plan that covers critical illness means you can insure yourself against the risk of serious illness in much the same way as you insure your car and your house. It will give you the same security of knowing that a guaranteed cash amount will be paid if the unexpected happens and you are diagnosed with a critical illness. Advantages of Critical Illness health insurance plan Illness Covered Exclusions Claim Procedure Premium Table FAQ 1. Advantages of Critical Illness Health Insurance Plan The Critical Illness health insurance plan has the following advantages: The benefit amount is payable once the disease is diagnosed meeting specific criteria and the insured survives 30 days after the diagnosis. The insured receives the amount as lumpsum so that he can plan the treatment accordingly. Expenses like donor expenses in a transplant surgery, which are not covered under normal health insurance policy, can be paid out of the amount received under this cover both in India & abroad.

Key Features The product is offered from 6 to 59 years. Medical examination may be required in some cases based on the

age and the benefit amount opted by the proposer. Very competitive premium rates. Insured can opt for Sum Assured from 1,00,000 to Rs. 50,00,000.

2. Illness Covered 1) Cancer:A claim can be made if the assured is diagnosed as suffering from a malignant tumour, which has invaded surrounding tissue. A microscopic examination of the cells will be required to confirm the claim. 2) Coronary Artery Bypass Surgery:When coronary arteries become narrowed or blocked they cannot supply enough blood to the heart muscle. To correct this and prevent risk of death, a coronary artery bypass surgery is performed in which two sections of artery on either side of the blockage are connected together. With our health insurance plan - Critical Illness, you can insure yourself against this serious illness in much the same way as you insure your car and your house. You will be able to claim if you undergo this surgery for blockage of 2 or more coronary arteries. 3) First Heart Attack:- (Myocardial Infarction) First heart attack, also known as myocardial infarction, occurs when part of the heart muscle dies from lack of oxygenated blood. Chest pain is usually felt at the time of the attack, ECG (electrocardiogram) changes will confirm the diagnosis. A damaged heart also releases enzymes into the bloodstream and a blood test will show that the heart attack is recent. 4) Kidney Failure:The kidneys act as filters and remove waste from the blood. When the kidneys fail to do this, waste builds up in the blood and leads to severe complications. Although it is possible to manage with one kidney; if both kidneys fail completely, one will need long-term dialysis or a transplant. 5) Major Organ Transplant:Sometimes a major internal organ is so seriously diseased or damaged that the only effective treatment is replacement with a healthy one.

Kidney transplants are covered under a separate section. 6) Multiple Sclerosis:This is a progressive disease of the central nervous system where the protective covering (myelin) of the nerve fibers in the brain and spinal cord is destroyed. The severity of the disease and symptoms will depend on the areas of the brain or spinal cord affected. Periods of remission which may last many years between acute phases are characteristic of the disease. 7) Stroke:A stroke is an incident, which affects the supply of blood to the brain causing permanent neurological damage such as paralysis or disturbance of speech or vision. Transient ischaemic attacks are excluded as they do not cause permanent damage and the symptoms do not last for more than few days. 8) Aorta Graft Surgery:The aorta is the main artery that supplies oxygenated blood to all other parts of the body. Sometimes, part of the aorta becomes blocked or weak and may need replacement. You will be able to claim if you need surgery to remove and replace part or the entire aorta. 9) Paralysis:Paralysis is usually caused by damage to the brain or spinal cord, affecting the transmission of messages through the nervous system or by physical injury to the limbs in question.

10) Primary Pulmonary Arterial Hypertension:Primary pulmonary hypertension a progressive disorder recommended

or which was first manifested or contracted before characterized by high blood pressure (hypertension) of the main artery of the lungs (pulmonary artery). The pulmonary artery is the blood vessel that carries blood from the heart through the lungs. Symptoms of primary pulmonary hypertension include shortness of breath (dyspnoea) especially during exercise, chest pain, and fainting episodes. The exact cause of primary pulmonary hypertension is unknown. 3. Exclusions Any critical illness for which care, treatment, or advice was recommended or which was first manifested or contracted before Any critical illness diagnosed within the first 90 days Death with in 30 days following the diagnosis of the critical illness Presence of HIV/AIDS infection Treatment arising from or traceable to pregnancy or childbirth, including caesarean section and birth defects War, invasion, act of foreign enemy, terrorism, hostilities (whether war be declared or not), civil war, rebellion, revolution Naval or military operations of the armed forces or air force and participation in operations requiring the use of arms or which are ordered by military authorities for combating terrorists, rebels and the like, any natural peril Consequential losses of any kind, be they by way of loss of profit, loss of opportunity, loss of gain, business interruption etc. The details furnished above do not constitute the entire terms and conditions. For more details on the policy, please visit our office nearest to you. Our executives will be pleased to furnish further details. Coverage SI available from 1,00,000 to Rs. 50,00,000 Age band - 6 yrs - 59 Years.

Premium Table

Sum insured 100000 300000 500000

AGE ( in years) 21- 25 26 - 35 36 - 40 41 - 45 46 - 50 51 - 55 56 - 60 200 600 1000 300 900 1500 3000 550 1650 2750 5500 800 2400 4000 8000 1200 3600 6000 12000 1750 5250 8750 3000 9000 15000

1000000 2000

17500 30000

4. Claim Procedure 1. The illness / claim should be reported to Bajaj Allianz General Insurance Company Ltd. with an immediate notice by telephone or in Writing (email / letter). 2. On receipt of claim intimation, Bajaj Allianz General Insurance Company Ltd. will forward a claim form and check list for the documents to be submitted by the claimant. 3. After receiving the claim form the claimant should submit the completed claim form mentioning the following mandatory details:Insured details (Name / Address / Age / Sex / Contact No.) Hospitalization details (Date and time of admission and discharge). Details of the other hospital cash policies in force. Signature of the claimant.

4. The other relevant documents to be submitted along with the claim form are as follows:-

Discharge summary mentioning the diagnosis, date and time of admission and discharge, past medical and surgical history with duration. All supporting reports to prove diagnosis. First consultation paper. 5. The claims team would assess the claim for completeness of documentation and admissibility. A written communication would be sent to the insured regarding requirement of documents if any or if the claim is deemed to be inadmissible as per policy terms and conditions. 6. In case the claim is determined to be admissible a pay order and discharge voucher would be sent to the insured address as mentioned on the policy document.

Disclaimer: We take privacy seriously. Bajaj Allianz does not share your personal information with any third party. Please read ourPrivacy Policy here. Notwithstanding your registration as NDNC, fully/partially blocked and or your customer preference registration, by filling this form confirms that you agree to receive a sales or service call from our employees/telecallers based on information you have submitted here.

Health Care - A health insurance plan to help you fight medical costs
Health is Wealth... particularly when health care costs are getting higher every year. The emotional and financial burden of a serious accident, major illness or surgery often lasts beyond the immediate period of the trauma. Bajaj Allianz HealthCare protects you and your family from the high expenses associated with medical care and provides you with a comprehensive financial cushion against various health hazards. The benefits under this plan are payable in addition to the benefits under all other plans that you may have, including a Medi-claim policy.

Following Benefits are available in the Health Care Plan:Life Cover is payable on death of the life assured. Hospital Cash Benefit Post Hospitalization Benefit Surgical Benefit Critical Illness Benefit Accident Permanent Total/Partial Disability (APT/PD) Multiple Claims:- Hospital Cash, Post Hospitalization Benefit & Surgical Benefit can be claimed on multiple occasions as per the coverage selected (subject to the overall limits) provided the policy is in force at the time of claim.

Life Health Insurance for hospitalization

At Bajaj Allianz Life Insurance we offer unique hospitalisation-cum-insurance plan that takes care of your hospitalization bills and also provides crucial financial support to your dependents in case of your unfortunate death. Our health insurance plans offer a sound protection to safe guard your family from any medical emergencies and will make sure that financial problems are least of your worries in trying to get yourself treated. We offer cash less Mediclaim facility across 2000 hospitals in over 300 towns and provide best treatment in the finest hospitals with our health insurance products. Tax Gain Plan - Health Insurance Policy YES! You can save tax and gain OPD benefits also! Bajaj Allianz has designed a unique product - The Tax Gain plan, a Family floater health policy which covers out patient (OPD) expenses & hospitalization expenses under a single policy and helps you in your tax management also.

1. Features OPD & Hospitalisation expenses covered under a single policy on floater basis Access to over 2400 hospitals all over India for cashless facility. Covers ambulance charges in case of an emergency up to Rs 1000/ 130 day care procedures subject to terms & conditions 10% co-payment of the admissible claim amount applicable if treatment is taken in non-network hospital, waiver of co-payment is available on payment of additional premium. Provides benefit of Health check-up at the end of each four (Hospitalization) claim free policy periods. Tests as specified in the schedule. This benefit can be opted by any one insured member 2. Benefits A single policy or cover can be continued till a person reaches 75 yrs! The premium slabs remain same from 18 yrs -55 yrs & 56- 75 yrs No restrictions of waiting periods to claim under Out patient expenses You can claim for dental procedures & treatment under OPD section! Cost of Spectacles, dentures, crutches can also be claimed under OPD Section! Provides Tax benefit under section 80 D of Income Tax Act

In house claims settlement without hassles of going through a TPA.