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Presentation on MEDI-CLASSIC

Presentation on MEDI-CLASSIC. Coverages. Hospitalization Expenses incurred as an inpatient for Sickness/Illness/Diseases Accidental injuries. What is a Hospital?.

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Presentation on MEDI-CLASSIC

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  1. Presentation on MEDI-CLASSIC

  2. Coverages Hospitalization Expenses incurred as an inpatient for • Sickness/Illness/Diseases • Accidental injuries

  3. What is a Hospital? • Hospital, Nursing Home means any institution in India established for indoor care and treatment of sickness and injuries and which Either • 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.

  4. Age Limits • Entry Age 5 Months – 60 Yrs • Renewal up to age 80 Yrs.

  5. Medical Examination For persons with adverse medical history and For all persons above 50 years, acceptance subject to Medical Examination at Company’s Cost.

  6. Sum Insured • Minimum Sum Insured - Rs. 50,000/- • Maximum Sum Insured - Rs. 10,00,000/- • The following Sum Insured options are available • Rs. 50,000/- • 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/- • Rs. 5,00,000/- • Rs.10,00,000/-

  7. Allowable Expenses • Room rent & boarding charges @ 2% of the sum insured up-to a maximum of Rs. 4,000/- per day • 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 a 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 Minimum of 24 hours Hospitalization is not necessary for the following • Dialysis, • Chemotherapy, • Radiotherapy, • Cataract surgery, • Dental Surgery, • Lithotripsy (Kidney stone removal), • Tonsillectomy, • Cutting and Draining of Abscess, • Liver Aspiration, • Pleural Effusion Aspiration, • Colonoscopy, • Sclerotheraphy, The above treatment shall be taken in the Hospital / Nursing Home and the Insured is discharged on the same day.

  10. Sub limits

  11. No Claim Discounts (NCD) in case of Renewal • 5% Discount on Basic Premium for every Claim Free Year • Maximum 25% • In the event of a Claim • One Step back in NCD for Age Group 5M – 35 Yrs • Two Steps back for Age Group 36 – 45 Yrs • Above 45 Yrs – No NCD

  12. Transfer of Policy • To obtain the following benefits there should be a continuous renewal of the expiring policy • (a) Renewal with Cumulative Bonus details • Cumulative Bonus as shown in the Renewal Notice is given • Additional 5% Discount on premium is also given • Sum Insured – Rs. 1 Lac • Premium – Rs. 1,200/- + S.Tax • CB shown in the expiring Policy – Rs. 10,000/- (10%) • CB eligible at the time of Renewal – Rs. 15,000/- (15%)

  13. Transfer of Policy – An Illustration (b)No Renewal Notice or Renewal Notice without Cumulative Bonus details • Cumulative Bonus as shown in the Previous Policy is given • Additional 5% Discount on premium is also given • A declaration stating No Claim under the expiring policy has to be obtained from the insured • In Case of (a) – CB of Rs. 15,000/- will be given and additional 5% discount on Rs. 1,200/- will also be given. • In Case of (b) – CB of Rs. 10,000/- as shown in the expiring policy will be given and additional 5% discount on Rs. 1,200/- will also be given.

  14. Exclusions • Pre Existing Diseases • Any Disease contracted during first 30 days • 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

  15. 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

  16. 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/- per occurrence for the entire policy period.

  17. Premium Rating

  18. Other Benefits • Benefits under Section 80-D of the IT Act • Cashless Service without involvement of TPA • Direct Tie up with hospitals on an All India Basis • 24 X 7 In-House Call center (044-2826 3300) • Toll Free Telephone line assistance (1800 425 2255) • Full knowledge based website to offer medical information, including Health Tips. • Health Check-up benefits in addition to NCD • Frequent health meets to disseminate information on health related topics

  19. Optional Benefits The following Optional benefits can be availed on payment of Additional Premium • Hospital Cash : • This insurance provides for Cash benefit of Rs. 500/- for and each and every completed day of Hospitalisation subject to a maximum of Rs. 1,500/- per hospitalisation and Rs. 3,000/- per policy period. • Insured persons aged less than 21 years and more than 60 years are not entitled for this benefit. • Premium

  20. Optional Benefits (contd.) • Patient Care : • Applicable for persons aged above 65 Years • This insurance is extended to provide for the cost incurred for engaging one attendant at residence after discharge from the hospital of the Insured Person following a covered occurrence under the policy up to Rs. 400 per day for a maximum of 5 days per occurrence. Subject to Time excess of 2 days. • Provided engagement of such an attendant is recommended by the attending physician and agreed to by the Company, in writing • Premium – Rs.300/- per person

  21. Family Package • Covers Insured Person, Spouse and 2 Dependant Children • Age Limit : 5 Months to 45 Years • Sum Insured Equally apportioned among Insured family members Rating • Provides cover to New Born from Birth up to expiry of policy period. • The Sum Insured is restricted to 10% of the Mother’s Sum Insured on Payment of 10% of the Policy Premium.

  22. Claim Procedure In case of Network Hospitals • Immediate intimation to the Call Centre (1800 425 2255/044-28263300) • 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

  23. Claim Procedure (Contd.) In case of Non Network Hospitals • Immediate intimation to the Call Centre (1800 425 2255 /044-28263300) • 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

  24. Thank You

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