LIC’s Health Plus and

Mediclaim policy of others

Concepts

Mediclaim – Reimbursement

Health Plus - Hospital Cash

Benefit

Health Insurance Division CO Hyderabad 1

Medi Claim
Payment depends on the actual medical
expenses incurred.

There are caps, exclusions and restrictions.

Health Insurance Division CO Hyderabad 2

Medi Claim - Example
‘A’ takes a Medi Claim policy. What is
the benefit paid if he incurs medical
expense of Rs.5000 per day ?

‘A’ gets a reimbursement of the actual

expense incurred (Up to a maximum of
Rs.5000.00) subject to the caps placed as
per the scheme.

Health Insurance Division CO Hyderabad 3

Facts about Medi claim
Chances of Medi Claim insurance premium
increase by 30 % to100% based on claims
experience

It appears that Detariffication has reduced the

cross-subsidy on health premium.

Mediclaim premium may increase further.

Health Insurance Division CO Hyderabad 4

What is Hospital Cash benefit ?

Provides lump sum payments per each day of

hospitalisation after first 48 hours

Amount is paid irrespective of the

hospitalization expenses actually incurred.

Payment depends on the premium and size of

the policy

Health Insurance Division CO Hyderabad 5

Facts about Hospital Cash Scheme

Features and benefits of products vary

Such plans may also provide an

enhanced per diem payment in case of
ICU treatment

Lump sum benefit in case the insured

undergoes a listed surgical procedure is
also a common add on
Health Insurance Division CO Hyderabad 6
Facts about Hospital Cash Scheme

As there is no co-sharing of benefits,

originals of hospital bills, prescriptions and
discharge form is usually not insisted upon

Certified / Xerox copies will be sufficient for

settlement of claims

Health Insurance Division CO Hyderabad 7

Hospital Cash Benefit
Payment depends on the per day benefit
opted and the no. of days of
hospitalization incurred subject to the
ceilings applicable.

PAYMENT OF BENEFIT IS NOT

RELATED TO THE ACTUAL EXPENSES
INCURRED BY THE INSURED.

Health Insurance Division CO Hyderabad 8

A Question

A person gets hernia operation at a

religious trust hospital ‘free of cost’.
He spends 5 days in the hospital.

What does he get under a LIC’s

Health Plus policy?
What does he get under a mediclaim
policy?
Health Insurance Division CO Hyderabad 9
LIC’s Health Plus Vis-vis Mediclaim

Under Health Plus policy he is entitled

to the payment subject to caps,
exclusions and ceilings applicable

Under Mediclaim he gets nothing

because he was treated free.

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Why LIC’s Health Plus?
When disease / illness strikes, it affects the
family in several ways. Expenses are incurred
towards

Treatment
Hospital room rent
Boarding
Hospitality to Relatives & their needs like
transport, food etc.,
Loss of Earnings due to stay away from
work

Health Insurance Divison CO Hyderabad 11

Why LIC’s Health Plus ?
In LIC’s Health Plus, there is no co-
sharing of benefits

In other words, the customer can get

the benefit from any other Mediclaim,
and claim HCB under LIC’s Health Plus
too.

Health Plus payment is in addition to

any other payment he receives from
other health insurance scheme
Health Insurance Division CO Hyderabad 12
 MEDI CLAIM vis-a-vis
LIC’s Health Plus

Hospital Fixed daily Hospital

Reimbursement Cash benefit
benefit Major Surgical
Separate Major Benefit
Surgical Benefit is
not available  Cover to be used for
Money to be used for change of life
treatment only situation

Usually there is co- No deductible or co-

insurance or insurance
deductible
Health Insurance Division CO Hyderabad 13
 Analyse and propagate
LIC’s Health Plus
Potential is abundant

No limitations or caps for selling

Product is a super rich product

All the best

Health Insurance Division CO Hyderabad

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