Swasthya Kavach (Family Health) Policy

1. SwasthyaKavach (Family Health) Policy

2. What is Swasthya Kavach? The Policy offers a protection cover for you and your family for any injury or disease related contingencies like hospitalization, medical expenses, surgical expenses, Organ transplantation etc. The Policy covers the members of the Family consisting of you, your spouse and dependent children up to the age of 23 years on a floater basis. Coverage is under a single Sum Insured and no separate Sum Insured is required for each member of the Family. Thus each member of Family draws claim from the single Limit of Indemnity.

3. Unique Selling Proposition • Critical illness gives you an option of differential pricing on differential treatment-you can take a low basic Sum Insured for the general ailments and the high critical illness sum insured protects you against more expensive treatments. • The critical Illness Cover is a indemnification cover and not a benefit policy- Hence even after the critical illness is detected you continue to get renewals . • First Time critical Illness Family Floater cover in India • When compared to IMI with the little more extra than one is required to pay for his own cover, he can cover the entire family • Emergency Assistance service (No competitor is offering this feature) • It is one of the most inexpensive covers you can buy in the target segment of below 45 years

4. WHO CAN OPT FOR SUCH COVERS? Family The fresh proposal up to the age of 55 shall only be accepted and can be renewed up to the age of 65 Premium chart based Oldest Member Maximum of three dependent children From 91 days and up to the age of 23 can be covered Parents are not covered. Proposal only for self or for single member will not be accepted

5. Swasthya Kavach is offered under two Plans Base Plan Wider Plan Target Audience Families who are located in rural areas, small towns Middle class families located in metros who are looking for Health care financing at reasonable prices Families who are looking for Health care financing at reasonable prices Families who would like to cover the family against unforeseen disease or accident in an affordable Plan. I) Basic Cover only II) Basic Cover with Critical Illness

6. Common Coverage under Base Plan and Wider Plan (with varying limits of Coverage) # Room and ICU Charges # Pre-Hospitalization and Post Hospitalization expenses including authorized home nursing # Ambulance service expenses # Daily Allowance for bearing miscellaneous expenses for the duration of Hospitalization

7. Common Coverage under Base Plan and Wider Plan # Doctor’s fees, Cost of Medicines, Pathological Tests, etc. # Vitamin and tonics consistent with illness # Pre-existing disease after 4 continuous Policy years with us. # Prosthetic Devices like Pacemaker, Artificial Limbs etc. # Transplants including Donor’s treatment and organs transplantation cost # Dental surgery and treatment following an accident # Defined Day Care Surgeries

8. Common Exclusions under Base Plan and Wider Plan • Naturopathy, use of Ayurvedic treatment experimental or alternative medicine, procedure and treatment including acupressure, acupuncture, magnetic treatment and such other therapies. • Any diseases or injuries related to hazardous sports like bungee jumping, parasailing, ballooning, parachuting, skydiving, paragliding, hang gliding or rock climbing etc. • Any Genetic disorders. • External medical equipment of any kind used at home as Post Hospitalization care, like wheelchairs, crutches etc. • Treatment of obesity or condition arising there from (including morbid obesity) and any other weight control programe. • First 10% of any admissible claim if he is suffering from either Diabetes or Hypertension and First 25% of the admissible claim amount in case he is suffering from both diabetes and hypertension. • The above provision is applicable only for claims arising out of Diabetes and/or Hypertension.

9. Common Exclusions under Base Plan and Wider Plan Contd.. • Diseases which are Pre-existing at inception of the first Policy. • Diseases contracted during the first 30 days of Policy • During the first year of the Policy, the expenses on treatment of diseases such as Tonsillitis/ Adenoids, Gastric or Duodenal Ulcer, Any type of Cyst/ Nodules/ Polyps, Any type of Breast lumps. • During the first two continuous years of the insurance with ITGI, the expenses on treatment of diseases such as Cataract, Benign Prostatic Hypertrophy, Hysterectomy for Menorrhagia or Fibromyoma, Hernia, Hydrocele, Fistula in anus, Piles, Sinusitis, Choletithiasis and Cholecystectomy, Inter- vertebral Disc Prolapse (other than caused by an accident), Osteoarthritis, Varicose Veins / Varicose Ulcers etc. • Cosmetic or aesthetic treatment, general debility, use of intoxicating drugs, intentional self injury. • AIDS related expenses, venereal disease, congenital disease • Additional Exclusions under the Base Plan • During the first two continuous years of the Policy, the expenses on treatment of diseases such as Renal Failure, Heart Diseases, any type of Carcinoma/Sarcoma/Blood Cancer.

10. Plans are differentiated by the limits in claims cost for individual diseases, sub limits and exclusions applicable. These Differences are as under :-  

14. List of Treatments Under Base Plan Treatment ListExpense Limit per Claim 1) Cataract 7.5% of the Sum Insured subject to maximum of Rs. 15000/- 2) Piles, Fistula, 10 % of the Sum Insured subject to Fissure, Tonsillitis, maximum of Rs. 30000/- Sinusitis 3) Benign Prostatic 20% of the Sum Insured subject to Hypertrophy, Hernia maximum of Rs.50000/- 4) Knee/ Hip Joint 50% of the Sum Insured subject to Replacement, All Cancer, maximum of Rs 200000/- Renal Failure 5) Appendicitis, Gall 15% of the Sum Insured subject to Bladder stones and maximum of Rs 40000/- Hysterectomy

15. Benefits available Sum Insured options are Rs. 200000/-, Rs. 300000/- , Rs.400000/- and Rs. 500000/-  for two, three, four and five member family.  It has to be kept in mind that the above Emergency Services will be provided as direct service to the Insured by Emergency Assistance Service Provider free of cost. There will be no facility of any cash payment under these heads or reimbursement of expenses incurred directly by the Insured or through any other service/ agency. Policy is not portable which means that benefits enjoyed in other policies of ITGI or policies with other insurer (other than similar floater cover) are not transferable. ( Transfer Only to the Wider Plan) Emergency Assistance Services are available with all the plan options and remains the same in scope of cover as in IMI and IAH policy. Third Party Administrator is RakshaTPA.

16. Emergency Assistance ServicesProvider Medical Consultation, Evaluation and Referral Emergency Medical Evacuation Medical Repatriation Transportation to Join Patient Care and/or Transportation of Minor Children Emergency Message Transmission Return of Mortal Remains Emergency Cash Coordination

17. Premium Table The cover is provided under two Plans 1. Base Plan 2. Wider Plan ITGI provides for the Policy with the premium based on Age, the Plan and Family size as applicable from time to time. Dependent parents are not covered. with two options viz. a) Basic Cover b) Basic Cover + Critical illness Highest Age Age limit: Proposer 18 years to 60 years Children 91 days to 23 years

18. PremiumTable 1) Proposer + Spouse Premium Table is provided with following options 2) Proposer+ Spouse + 1 child 3) Proposer + Spouse + 2 children 4) Proposer + Spouse + 3 children 5) Proposer + one child 6) Proposer + two children 7) Proposer + three children Premium  is provided  without Service Tax and therefore needs to be loaded accordingly. Individual and self alone proposal with parents are not covered . The parents can take separate proposal and cover themselves..

19. Premium comparison for Sum Insured ofRs. 200000/- for a family of 2 adults + 2 children

20. Underwriting Process The Policies shall be accepted and written by all the operating offices up to the age of 45.The proposal with Pre-existing disease and/or with the age of 45 years shall require approval from Corporate office. Raksha TPA shall be issuing the member cards and the Beneficiary Guide, which will also carry the contact numbers of Emergency Assistance Service Provider for availing the aforesaid special services. The premium  is based on the highest age in the family, the size of the family , the  sum insured and the type of Plan

21. Documents required for settlement of claims • Claim Form • Discharge Summary, Bills and Receipt of Hospital/Nursing, Home Attending Doctor’s Report and Bills as well as cash memos of medicines and pathological tests duly supported by proper prescription. • F.I.R, Post Mortem Report, Final Investigation Report etc. in case of an accident.

22. Claim Process The claims process for the cashless claim settlement shall remain the same as at present under IMI Policies but for the change in TPA. Emergency Assistance Service Provider shall only respond to emergency situations out side the home town of the insured person (during travel beyond 150 kms. within India) and the TPA takes over from the time the insured person is  actually admitted as an inpatient in a hospital. Dedicated center of RakshaTPA at Faridabad shall act as the centralized processing unit for all claimsunderthis Policy whether on Cashless or Reimbursement basis or for claims under Personal Accident Benefit. This exclusive center will be in constant coordination with AAMESIL and our Health Claims Unit at CCU to ensure that best possible service level are maintained.

23. Thank You