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Presentation on MEDI PREMIER

Presentation on MEDI PREMIER. Policy Sections. Section I - Regular Hospitalisation Benefits Section II - Payment of lump-sum compensation for their continuation of treatment of specified Major Illnesses. Age Limits. 26 Years – 75 Years

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Presentation on MEDI PREMIER

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  1. Presentation on MEDI PREMIER

  2. Policy Sections • Section I - Regular Hospitalisation Benefits • Section II - Payment of lump-sum compensation for their continuation of treatment of specified Major Illnesses

  3. Age Limits • 26 Years – 75 Years • Acceptance subject to medical screening for persons above 50 years

  4. Section I

  5. Coverages Hospitalization Expenses incurred as an inpatient for • Sickness/Illness/Diseases • Accident

  6. What is a Hospital? • Hospital, Nursing Home means any institution in India established for indoor care and treatment of sickness and injuries • It has been registered with the local authorities and is under the supervision of a registered and qualified Medical Practitioner or • Should comply with minimum criteria as under • It should have at least 15 inpatient beds (10 in Class ‘C’ Towns). • Fully equipped operation theatre of its own wherever surgical operation is carried out. • Fully qualified nursing staff under its employment round the clock • Fully qualified Doctor(s) should be in charge round the clock.

  7. Allowable Expenses • Room rent & boarding charges @ 2% of the sum insured up-to a maximum of Rs. 4,000/- per day • Boarding and Nursing charges • Surgeons, Anesthetist, Consultants and Specialists fees • Operation Theatre charges, drugs and medicines diagnostic materials, cost of pace maker etc • Emergency Ambulance charges to go to Hospital for treatment @ Rs 750/- per hospitalisation upto maximum of Rs 1,500/- per policy period

  8. Allowable Expenses (Contd.) • Pre-hospitalization expenses incurred for a period of 30 days prior to the date of hospitalization • Post hospitalization expenses on a lump-sum basis @ 7% of the actual hospitalization expenses (excluding room rent and hospital registration charges), subject to a maximum of Rs 5,000/-

  9. Day Care Treatment Expenses on Hospitalization for minimum period of 24 hours are admissible. However, this time limit will not apply for • Dialysis, • Chemotherapy, • Radiotherapy, • Cataract surgery, • Dental Surgery, • Lithotripsy (Kidney stone removal), • Tonsillectomy, • Cutting and Draining of Abscess, • Liver Aspiration, • Pleural Effusion Aspiration, • Colonoscopy, • Sclerotheraphy, taken in the Hospital / Nursing Home and the Insured is discharged on the same day.

  10. Sub limits

  11. Section II

  12. Coverages Payment of Lump Sum compensation for the following Major Illnesses • Stroke • Renal Failure • Cancer

  13. Allowable Expenses • Lump Sum Compensation under Section II in addition to payment of hospitalization under Section I.

  14. Conditions • The Major Illness experienced should be the first incidence of that major illness. • Such hospitalisation expenses would be paid only till the date of diagnosis of the major illness. • On entitlement for payment of lump-sum under this section, all further benefits under the policy shall cease and policy automatically gets terminated.

  15. Conditions (contd.) • Only one lump sum payment will be made during the lifetime of the insured, irrespective of the number of major illness suffered by the insured/number of policies. • The signs or symptoms of the Major Illness experienced by the Insured Person after 90 days following the date of policy commencement. • The insured must survive beyond 30 successive days from such date of detection of major illness, to be eligible for a claim.

  16. Common Features Under both Sections

  17. Sum Insured • Minimum Sum Insured - Rs. 1,00,000/- • Maximum Sum Insured - Rs. 4,00,000/- • The following Sum Insured options are available • Rs. 1,00,000/- • Rs. 1,50,000/- • Rs. 2,00,000/- • Rs. 2,50,000/- • Rs. 3,00,000/- • Rs. 3,50,000/- • Rs. 4,00,000/-

  18. Rating Benefit Under Section II is restricted to 50% of the Sum Insured under Section I subject to a maximum of Rs. 2 lacs.

  19. Other Benefits • Benefits under Section 80-D of the IT Act • Cashless Service without intervention of TPA • Direct Tie up with hospitals on an All India Basis • 24 X 7 In-House Call center • Toll Free Telephone line assistance • Full knowledge based website to offer medical information, including Health Tips • Health Check-up benefits • Frequent health meets to disseminate info on the health related topics

  20. Exclusions • Pre Existing Diseases • Any Disease contracted during first 30 days under Section I and 90 days under Section II • First Year Exclusions • Benign prostate hypertrophy • Hernia, Hydrocele, Fistula in Anus, Piles • Sinusitis • congenital internal disease/defect • Renal stone and Gall stone removal • First Two Years Exclusions • Cataract • hysterectomy following menorrhia or fibromyoma • Knee Replacement Surgery • Joint Replacement Surgery • Prolapse of intervertibral • Vericose veins/ulcers

  21. Exclusions (Contd.) • Injury / Disease arising due to War, Invasion, Act of Foreign Enemy, Warlike operations • Circumcision unless necessary for treatment of a disease • Cost of spectacles and contact lens, hearing aids, walkers, crutches wheel chairs and such other aids • Dental treatment or surgery • Convalescence, general debility, Run-down condition or rest cure, congenital external disease or defects or anomalies, sterility, venereal disease, intentional self injury and use of intoxicating drugs/alcohol • Naturopathy Treatment • Expenses incurred on Lasik Laser or Refractive Error Correction treatment

  22. Exclusions (Contd.) • Hospital registration charges, record charges, telephone charges and such other similar charges. • Non Allopathic shall be restricted to 25% of the sum insured subject to a maximum of Rs. 25,000/- for the entire policy period.

  23. Options not available under Medi Premier As against Medi Classic the following optins are not available under Medi Premier • No Claim Discount • Hospital Cash • Patient Care • Family Package Cover • Group Policy • Age limits is restricted to 26 to 75 years as against 5 months to 80 years.

  24. Attractiveness of this policy • Lump Sum payment for critical illness in addition to hospitalization expenses • Policy will be in force even after exhausting the full Sum Insured under Section I till the expiry of the policy

  25. Claim Procedure In case of Network Hospitals • Immediate intimation to the Call Centre (1800 425 2255) • The insured has to send a request for ‘Pre Authorization Form’ signed by the Doctor in the Network Hospital • Based on the intimation a field visit will be done by the Star Doctor • Pre Authorization will be issued to the Hospital • Based on the Pre Authorization and the Report by the Star Doctor, Cash Less Treatment will be given by the Network Hospital

  26. Claim Procedure (Contd.) In case of Non Network Hospitals • Immediate intimation to the Call Centre (1800 425 2255) • Claim form will be sent to the Insured. • Based on the intimation a field visit will be done by the Star Doctor • Bills has to be settled by the Insured and will be reimbursed by Star on submitting the following documents • Original Discharge Summary • Main Hospital Bill with Break Up • Investigation Reports with X-Ray Film • Medical Bills with Prescriptions

  27. Thank You

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