F amily H ealth O ptima Insurance Plan (Revised)

1. Family Health Optima Insurance Plan (Revised)

2. Features Age at Entry: 5 months to 65 years Family size : 2A + 3C ( Maximum) Dependant children less than 25 years of age Renewability : Up to 65 years Coverage on Floater Basis : Single Sum Insured on Floater Basis covering all members of the family

3. Features For entry age between 61 and 65 years, only 2 Adults option is available for Sum Insured of Rs.3,00,000/- and above Co Pay 20% Co pay on each and every eligible claim amount for insured persons between 61- 65 years, at entry level

4. Features Two Tier rating of Premium according to Zone Zone 1 - Mumbai including Thane, Delhi ( Delhi city, Noida, Gurgoan, Ghaziabad & Faridabad) and the entire State of Gujarat Zone 2 - Rest of India Premium would be charged according to the residential address of the customer. When a policy is charged as per Zone 2 rate and a treatment is taken in one of the Zone 1 cities, the difference in the premium is recovered from the claim amount

5. Benefits Hospitalization Benefit Hospitalization expenses incurred owing to disease, illness, sickness or accidents as inpatient in a registered hospital for a minimum period of 24 hours is covered on Cashless or reimbursement basis. Pre Hospitalization Reasonable Expenses incurred upto 30 days prior to the date of admission. Post Hospitalization 7% of the Hospitalization expenses (excluding room rent) subject to a maximum of Rs.5000/-

6. Benefits Room Rent : Class A Cities 2% of Sum Insured subject to maximum of Rs.5000 per day Class B Cities 1% of Sum Insured subject to maximum of Rs.3000 per day Other Locations 1% of Sum Insured subject to maximum of Rs.1000 per day

7. Benefits • Nursing charges, Surgeons, Anesthetist, Consultants and Specialists fees, Operation Theatre Charges, Drugs and medicines diagnostic materials, cost of pace maker etc., • Ambulance Charges • Rs. 750/- per hospitalization subject to a maximum of Rs. 1500/- per policy period

8. Benefits Day Care Procedures - 101 treatments covered as day care. Limit for Cataract is based on the Sum Insured SI Option Limit for Cataract

9. Benefits Automatic Restoration of SI Where the sum insured is fully exhausted during the policy period, either under a single claim or multiple claims put together there is an automatic top up of Sum insured for the rest of the policy period

10. Benefits Automatic Restoration of SI – An Illustration Mr.A has a Rs.5,00,000 policy and a claim is made in full for treatment of an ailment by him. Rs.500,000 is again reinstated in the policy for the rest of the policy period. No extra Premium is charged. This is automatic restoration. This amount can now be availed by all members covered in the policy including Mr. A. However in the case of Mr. A, the restored Sum Insured will be available for diseases other than for which the claim was made.

11. Benefits Bonus Additions The policy holder is now bestowed with additional Sum Insured in case of a claim free year. Different % age of bonus additions for Different Sum Insured options. A maximum of 35% of Basic Sum Insured is accumulated as Bonus. Ex: A policy with Sum insured of Rs.10,00,000/- will now automatically provide cover upto Rs. 12,50,000/- in the second year (I Renewal),Rs.13,50,000/- in the third year without any extra premium

12. Benefits Bonus Additions

13. Benefits What happens to Bonus Additions when there is claim in the subsequent year ? The Bonus will be reduced by 50% following a claim under the policy. The Bonus becomes Zero when there is a claim in the successive year also Bonus additions would continue according to slab for the further claim free year

14. Revised FHO Rates Service Tax extra A-Adult Choose the age of the oldest member for calculating the premiumC- Child

15. Revised FHO Rates Service Tax extra A-Adult Choose the age of the oldest member for calculating the premiumC- Child

16. Revised FHO Rates Service Tax extra A-Adult Choose the age of the oldest member for calculating the premiumC- Child

17. Revised FHO Rates Service Tax extra A-Adult Choose the age of the oldest member for calculating the premiumC- Child

18. Revised FHO Rates Service Tax extra A-Adult Choose the age of the oldest member for calculating the premiumC- Child

19. Revised FHO Rates Service Tax extra A-Adult Choose the age of the oldest member for calculating the premiumC- Child

20. Revised FHO Rates Service Tax extra A-Adult Choose the age of the oldest member for calculating the premiumC- Child

21. Declined Risk Persons who are suffering from or have suffered from the following ailments cannot be issued policy – Heart Problem (CVD) Cancer Kidney Failure

22. Exclusions • All Pre Existing Diseases not covered. However covered after 48 months of continuous coverage with any of Indian Insurer. • Any Diseases contracted during the first 30 days of the first policy year.

23. Exclusions First year ExclusionsBenign prostate hypertrophy, Hernia Hydrocele Fissures, Fistula in Anus / Piles Sinusitis Congenital internal disease/defect Treatment for Gall stone and Treatment for Renal stone

24. Exclusions First 2 year’s ExclusionsCataract Hysterectomy following menorrhagia or fibromyoma, Treatment for Knee, Treatment for Joint Prolapse of intervertibral disc Varicose veins/ulcers

25. Portability This policy is portable Proposals from less than 45 years of age without any previous claim or PED, can be ported to this policy by the operating office. The requisition has to be received 7 days before the date of expiry. Beyond 45 years of age, portability acceptance routed through portability cell and applications will have to be received atleast 30 days prior to the date of Expiry.

26. Portability Continuity benefits of First 30 days, First year exclusions, First two years’ exclusions and PED allowed according to the previous policy. Cumulative Bonus of the previous insurer is not given credit. However the Insured can opt for Sum Insured including the cumulative Bonus and Premium will be charged on the total Sum Insured.

27. Pre Insurance Medical Pre Insurance medical examination as per latest underwriting guidelines. Tests to be taken as per the guidelines given. Acceptance based upon the medical officer’s opinion of the MER. Persons with adverse medical history may also be referred for medical examination.

28. IT Benefit Deductions under Sec 80 D of Income Tax Act is available for all modes of payment other than cash

29. Revision of Sum Insured on Renewal Please refer the latest underwriting guidelines. The No Claim Discount for a claim free year is withdrawn in view of introduction of Bonus. The policy will now attract Bonus Additions as per the conditions.

30. Renewal (contd.,) An illustration Rs.4,00,000 claim free FHO policy is now renewed for Rs.5,00,000 Sum insured. There will be a bonus addition of Rs.1,00,000. (25% of Basic Sum insured which is Rs.4,00,000) Total Sum insured is Rs.6,00,000 (Rs.5,00,000 + Rs.1,00,000) Premium is charged for Rs.5,00,000 Sum insured

31. Documents required • Proposal form duly filled in all respects and signed by the proposer. Care to be taken to observe the PED details, if any. • One Photograph of each person to be insured • Two photographs for those who have to undergo medical examination • Age proof in case of age above 45 years • Full and Correct Premium of the plan • Portability Form, wherever applicable

32. USP’s of Revised FHO • 101 day care procedures covered • Revised limits for Cataract • Inclusion of Goa, Rajkot, Allahabad in B Cities • Automatic Restoration of SI up to 100% of Sum insured • Bonus additions for claim free year • Bonus additions is reduced by only 50% in case of a claim • No decrease in Basic SI • No loading on claims • Two tier pricing

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