Ensure your family’s health with my:health Medisure Plus Insurance · 2017-03-08 · health...

Ensure your family’s health withmy:health Medisure Plus Insurance

Covers under my:health Medisure Plus Insurance?

Standard

We believe there are certain standard covers that are necessary in every health insurance policy.

That’s why we provide you with the 9 essential standard covers that are built into your Policy. These ensure that your health is broadly protected in a variety of situations, so that you always have a safety net to count on. The following covers form the bedrock of the Policy are:

• In-patient Hospitalisation Expenses

If the treatment of a disease, illness or injury is taken we will pay the medical expenses incurred by you towards;

– Room Rent/Boarding & Nursing: Actuals limited to 1% of Sum Insured (excluding cumulative bonus) per day subject to a maximum of `4,000/- per day;

– ICU Rent/Boarding & Nursing: Actuals limited to 2% of Sum Insured (excluding cumulative bonus) per day subject to a maximum of `6,000/- per day;

– Fees of Surgeon, Anesthetist, Nurses and Specialists: Actuals

– Cost of Operation Theatre, diagnostic tests, medicines, blood, oxygen and cost of prosthetic and other devices or equipment if implanted internally like pacemaker during a Surgical Procedure: Actuals

Good health has always been one of the most basic and important human needs. Even today, in spite of our busy schedules and hectic lives, we strive to keep healthy in our own way. Each of us is unique in the way we think about our health and look after ourselves. And insuring all these unique aspects of our health is no easy task. At HDFC General Insurance, it is our constant endeavor to not just cover all your health needs, but also to provide you with an insurance plan that can be customized to suit your exact requirements. Introducing my:healthMedisure Plus Insurance, a thoughtfully designed, insurance solution that is tailor-made to your unique health needs. From the basics of good health to the tiniest detail in critical situations, our Policy covers every possible aspect when it comes to protecting your health. Be it a guaranteed response time, a cumulative bonus or just a health check up, we go that extra mile to make sure our Policy meets your exact needs and also exceeds your expectations. Additionally, we also offer you the option of choosing and paying only for the covers you want. So you don't waste money on covers that you don't need in your insurance plan. Making this a truly custom-made insurance offering. At HDFC General Insurance, we understand that the key to good health is the personal touch of thoughtfulness and care.

RENEWAL

This also covers any relapse within 45 days from the date of last hospitalisation at the hospital/nursing home where treatment was taken. Occurrence of the same illness after 45 days would be a fresh instance of illness.

Medical expenses will be reimbursed subject to the following:

– If you are hospitalised as an in-patient for a minimum period of 24 hours.

– If the expenses on account of room rent/boarding and nursing and ICU rent/ boarding and nursing are higher than the limits mentioned, the additional amount shall be reduced in the same proportion as such actual costs bears to the eligible limits. These limits shall not apply in case you have selected the optional cover for waiver of room rent sub-limits.

• Pre-hospitalisation

This covers the relevant medical expenses you incur within a period of 30 days before you are admitted to a Hospital/Nursing Home provided that;

i. such medical expenses are incurred for the same condition for which Your hospitalisation was required and

ii. the in-patient Hospitalisation claim for such hospitalisation is admissible by Us

• Post-hospitalisation

This covers the relevant medical expenses, up to a period of 60 days, after you are discharged from the Hospital/Nursing Home provided that;

i. such medical expenses are incurred for the same condition for which your hospitalisation was required and

ii. the In-patient Hospitalisation claim for such Hospitalisation is admissible by us.

Thus, ensuring that you don’t have to worry about expenses post-hospitalisation.

• Day Care Treatment

This covers the medical expenses for a day care procedure or surgery incurred by you for treatment or procedures that requires less than 24 hours of hospitalisation undertaken under general or local aneasthesia. There is no static list for day care procedures in the Policy as advances in medical science leads to many more being added continuously. So, whether it’s recommended by a medical practitioner or even if it is a new procedure, you can be rest assured that, we will cover it. However, this cover excludes diagnostic procedures and treatments taken on an outpatient basis. For indicative list of Day Care Procedures, please refer Policy wordings or our website www.hdfcgi.com

• Treatment at Home or Domiciliary Hospitalisation

This covers the medical expenses you incur for treatment at home, in case you are not shifted to a Hospital/Nursing home based on the advice of the attending medical practitioner or due to the unavailability of a hospital bed. This is applicable provided the medical condition continues for at least 3 days. In such cases we will not cover your post-hospitalisation expenses; however pre-hospitalisation expenses for up to 30 days will be covered.

• Pre-existing Diseases

Medical expenses arising out of your pre-existing diseases are covered from the 4th year of your Policy, after you have been continuously insured with us for 36 months.

• Health Check-Up

On completion of every 2 consecutive years of your Policy, we will provide a health check up coupon worth `1000 towards the cost of a medical check up for the insured above age 50 years. This limit is available per individual in case of an individual policy/individual Sum Insured basis and for all members put together in case of a floater policy.

• Ambulance Charges

This covers your ambulance charges to the hospital/nursing home for treatment which requires you to be admitted to a hospital/nursing home. The maximum cover will be actuals or upto `1,500 per hospitalisation whichever is less.

Advantage - Custom Covers

Since you have completely unique needs, we have created a health plan that can be tailor-made to suit your exact requirements. While all our health plans offer you a basic set of covers, our range of optional covers give you the freedom to customize your own health insurance policy. You can select from 9 optional covers, out of which 7 are available on the payment of an additional premium and 2 are available on reduction of Premium. Please note that Reinstatement of Sum Insured and Critical Illness covers cannot be opted together. Hence you can opt for maximum 8 optional covers. Just pick the ones that you need and we will ensure that every detail is taken care of, so that you can enjoy absolute peace of mind.

• Without payment of additional premium

1. Deletion of Pre/Post-Hospitalisation option

This gives you a choice to delete the pre/post-hospitalisation coverage and reduce the premium payable under the Policy. No claim will be paid for any expenses incurred pre/post-hospitalisation once you choose this option.

2. Deductibles

By choosing this option, the premium you’ll have to pay shall reduce. In this case, a part of the claim shall be paid by you as per the deductible option chosen. The deductible options are:

• no deductibles • `30000

• `5000 • `35000

• `10000 • `40000

• `15000 • `50000

• `20000 • `75000

• `25000 • `100000

What are deductibles?

A deductible is a cost-sharing requirement under this Policy that provides that we will not be liable for a specified rupee amount of the covered expenses, which will apply before any benefits are payable. A deductible does not reduce the Sum Insured. Deductible is applicable per Insured per claim.

On payment of additional premium

3. Critical Illness Cover (Indemnity Basis)

This cover provides you with an additional amount equivalent to the Sum Insured (excluding cumulative bonus) for treatment of the below listed Critical Illnesses. This means you get double the Sum Insured under this cover.

This includes:

- Cancer (of specific severity) - Major Organ Transplant

- Coronary Artery Bypass Surgery - Stroke (resulting in permanent symptoms)

- First Heart Attack (of specific severity) - Aorta Graft Surgery

- Kidney Failure (requiring regular dialysis) - Primary Pulmonary Arterial Hypertension

- Multiple Sclerosis - Permanent Paralysis of Limbs

- Motor Neurone Diseases with permanent symptoms - Coma (of specific severity)

For definitions of the above mentioned Critical Illness please refer to the Policy wordings or contact your insurance partner.

Conditions for opting Critical Illness cover

• This cover can be availed by Individuals up to 65 years of age and shall be available during subsequent renewals for life time.

• All those opting Sum Insured above `1,000,000/-, coverage under Critical Illness will be restricted to 1,000,000/- only.

4. Reinstatement of Sum Insured

We understand that medical emergencies like accidents and illnesses are unpredictable. That's why if your Sum Insured including cumulative bonus is exhausted due to claims paid and/or payable and is not enough to cover your expenses incurred towards hospitalisation, we offer an additional amount as reinstatement. This additional amount is equivalent to Sum Insured and is available only once during the 12-month policy period.

This cover is applicable only for new illnesses/diseases and will not be applicable to illnesses/diseases (including its complications) for which claims are already paid/payable. The cumulative bonus benefit is also not applicable to the reinstated Sum Insured. This cover is available only for those opting for Sum Insured of `3 Lacs to 5 lacs. Those opting for Sum Insured above `500,000/-, coverage under Restatement of Sum Insured will be restricted to `500,000/- only.

Note: Only one of the above covers i.e. Critical Illness or Reinstatement of Sum Insured can be opted under the Policy. Both the covers cannot be availed of together.

5. Waiver of Room Rent and ICU Sub-limits

If you have opted for this cover, we shall waive the sub-limits under room rent/boarding and nursing and ICU rent/boarding and nursing. We shall pay expenses incurred on room rent and/or ICU as per the actuals.

6. Extended Pre/Post-Hospitalisation Cover

This lets you extend the pre/post-hospitalisation coverage available under the standard cover. Limits for the expenses incurred against pre and post hospitalisation are extended to 60 days and 90 days respectively.

7. Hospital Cash

This cover helps you avail daily hospital cash allowance of `500 per day for a maximum of 7 days, starting from day 4 to day 10, provided your hospitalisation exceeds 3 continuous days. For example, if you are hospitalised for 12 days, we will reimburse you `500 each day from the 4th day onwards for 7 days. So the maximum reimbursement under this cover cannot exceed `3500 (`500 x 7 days).

8. Recovery Benefit

This cover entitles you to a recovery benefit where we will pay you a lump-sum amount of `10,000 in the event that your hospitalisation for a disease/illness/injury extends - more than 10 days.

9. Expenses of Accompanying Person

This cover provides you a reimbursement of up to `500 per day for the expenses incurred by the person who accompanies you to the hospital/nursing home. This amount will be reimbursed for a maximum period of 7 days if your hospitalisation exceeds 3 days. For example, if you are hospitalised for 10 days, we will reimburse you `500 each day from the 4th day onwards for 7 days. The maximum reimbursement under this cover cannot exceed `3500 (`500 x 7 days).

How you benefit with my:health Medisure Plus Insurance?

With this policy you don’t just protect your health in every way possible, but also enjoy a host of special benefits that we offer you. These 8 covers are assured to you, irrespective of the package you choose. So, no matter what your plan is the advantages we offer you will never change.

At HDFC General Insurance, we strive to make every Policy and plan keeping your interests in mind.

1. Lifetime Renewal

You can renew your Policy throughout your lifetime, provided your application for renewal and the renewal premium in full has been received 30 days from the due date. However, no claim will be payable for hospitalisation expenses incurred during the gap period. This is also subject to the realization of your premium. This benefit is not available in case of fraud, misrepresentation, non-disclosure or suppression of material facts on the Proposal Form.

2. Cumulative Bonus (CB)

– If you have made no claim under the Policy in a year and you renew the policy with us the next year, we will apply a cumulative bonus by automatically increasing 10% of the Sum Insured for the next policy year. The maximum cumulative bonus shall not exceed 50% of the Sum Insured in any policy year.

Example - If your Sum Insured for the first year is `3 lakhs, and you don’t make a claim and renew it on time, to reward this, we will give you additional 10% Sum Insured which makes the total Sum Insured of `3.3 lakhs.

– If a claim is made, the cumulative bonus that has accrued will be reduced by 10% of the basic Sum Insured. Only accrued cumulative bonus will get reduced by 10%. The basic Sum Insured will remain intact.

In case of 2 years Policy, CB for both the years (10% for year 1 and 10% for year 2) will be applied at the time of renewal however increased limit of 10% will be available in case of any claim in 2nd year of the Policy.

Where the Policy is issued as a Family Floater, cumulative bonus will be considered with respect to the Sum Insured of such Family Floater.

Cumulative Bonus is not applicable to Value added covers and is calculated on Basic Sum Insured under the Policy excluding Sum Insured of Optional covers.

3. Policy Period Option

This gives you the convenience of opting and renewing your Policy for a single year or for two continuous years. If you renew your Policy for two continuous years, we will give you a discount of 5% on the total premium of 2 years.

4. Free-look Period

This gives you an option of cancelling the Policy within 15 days from the date of receipt of Policy documents, if you are not satisfied with the coverage and terms of the Policy. We will refund the premium paid after adjusting the amounts spent on stamp duty charges, Medical examination (wherever applicable) and proportionate premium (If Policy has already commenced). Refund will not be applicable if you have made a claim against the Policy during that period.

5. Family Floater

This gives you an option of covering three other family members apart from yourself in one Policy. The three other family members can be your lawful spouse and two dependent unmarried children up to the age of 23 years or 3 dependent unmarried children up to the age of 23 years, excluding your spouse.

6. Age Eligibility (age last birthday as at Policy inception date)

With our Policy, you can insure your children from the age of 3 months to the age of 23 years. Adults can be insured from the age of 18 years to 65 years. Maximum age at entry for adults is 65 years. But you can renew your Policy throughout your life.

7. Family Discount

If you seek to cover your family members including your lawful spouse, dependent children and yourself, in a single Policy, a Schedule will be issued naming all such individuals along with the chosen individual Sum Insured. If you choose to avail insurance for equal to or more than 3 members in the family you will receive a 10% discount on the premium payable.

8. Sum Insured Options

Sum Insured to be in multiples of lakhs only; however above 10 Lakhs, the options available are 15 Lakhs, 20 Lakhs and 25 Lakhs.

*Critical Illness: For those having Basic Sum Insured for `1,000,000/- and above, Coverage for Critical Illness will be restricted to ̀ 1,000,000/-

**Reinstatement of Sum Insured: For those having Basic Sum Insured for `500,000/- and above, Reinstatement of Sum Insured will be restricted to `500,000/-

9. Income Tax Benefit

The Policy gives you benefits under Income Tax laws prevailing from time to time. Currently, deduction is available up to `15,000 under Sec 80 D of the Income Tax Act, 1961.

10. Service Assurance

We make sure our services are robust and actionable, so that you find us whenever you need us the most.

In case of a Cashless Claim,

We assure a response within 6 hours for a cashless facility request, provided the intimation is received during working hours from 9 am to 9 pm on Monday to Saturday. If the intimation is received after working hours on a working day, or at any time during a holiday, we assure a response within 8 hours.

In case of a Reimbursement Claim,

We assure a response within 6 working days from the date of receipt of the complete set of documents.

In case we fail to meet the assurance as stated above for the cashless and reimbursement facility, we will pay you a fixed compensation of `1,000 for a single claim.

Plan Type

Individual

Floater

Minimum: `2,00,000/-

Maximum: `25,00,000/-

Reinstatement of Sum Insured**Critical Illness Sum Insured*Basic Sum Insured

Equal to basic Sum Insured subjectto following.

Minimum Basic Sum Insured should be : `200,000/-

Maximum: `1,000,000/-

Equal to basic Sum Insured subjectto following.

Minimum Basic Sum Insured should be : `300,000/-

Maximum: `500,000/-

Minimum: `300,000/-

Maximum: `500,000/-

Minimum: `200,000/-

Maximum: `10,00,000/-

Minimum: `2,00,000/-

Maximum: `25,00,000/-

What are the Medical Test Requirements?

All Individuals up to 50 years (age as on last birthday as at Policy inception) have to fill a declaration on the Proposal Form. If any medical adversity exists, only then will you be required to undergo appropriate medical tests.

The age group 51-65 years (age as on last birthday as at Policy inception) may be required to undergo the following pre-acceptance medical tests :- Medical Examination Report, TMT, Lipid Profile, HBA1C, Serum Creatinine, Complete Blood Count and Urinalysis.

For the following category:

Medical Underwriting

The Company reserves the right to Accept on standard terms/Decline/Accept will exclusion and/or premium loading (up to maximum of 100% on Basic Premium).

Age group 50 to 65 years Medical Examination Report, ECG, Lipid Profile, HbA1C, Serum Creatinine, Complete Blood Count, Urinalysis.

As agreed with network provider>

As agreed with network provider>

Scenarios Medical Tests Requirement Charges of Medical check up pre agreed with the network provider

*Age as on last birthday as at Policy inception date to be considered.

Age group 51 - 65 years with Optional Cover for Double Sum Insured for Critical Illness or Optional cover of Reinstatement of Sum Insured

If Sum Insured of `1,000,000/- or more is opted

Optional Cover for Double Sum Insured for Critical Illness at Renewal with or without Claim irrespective of age

Medical Examination Report, Electrocardiogram, Complete Blood Count, Lipid Profile, HbA1C, Serum Creatinine, Urinalysis, SGOT, SGPT and GGT.

Medical Examination Report, ECG, Complete Blood Count, Lipid Profile, HBA1C, Serum Creatinine, Urinalysis, SGOT, SGPT and GGT

Loading on the premium is arrived at on the basis of factors given below;

• Health condition at the time of proposal

• Pre existing disease/medical condition (Exiting or cured)

• Test results

• Other co-morbid factors

Indicative range of loadings for most common diseases based on above factors is given below. These loadings are for your reference purpose only and are subject to change based on medical test results.

Illness Premium loading % on Basic Premium (For reference only)

Diabetes 10% - 40%

Blood Pressure/Hypertension 10% - 30%

Asthama 10% - 30%

Kidney Related disorders 10% - 30%

For those having following Health conditions, proposal may be accepted with premanent exclusion (for those specific condition only) however acceptance is subject to submission of treatment reports and subsequent medical examination by us.

• Policy mellitus (not on treatment)

• Cancer (fully cured)

• Hysterectomy (operated before 1 year from proposal date)

• Fracture with foreign objects inserted

For those having multiple illnesses and for other health conditions, loading may be charged and/or exclusion may be applied or Proposal may be declined on severity of the condition at the time of proposal. Loading will be subject to an amount ranging from 10% to 100% of Basic Premium. Proposed loading/exclusion will be intimated to proposer and Policy will be issued with written consent from the proposer on premium loading/exclusion.

The Health check up and subsequent Medical reports are valid upto 30 days from date of Health Check up.

On acceptance of proposals, we will reimburse 50% of the expenses (on our pre agreed rates with the network provider) incurred on the pre-acceptance medical tests. Please refer our website www.hdfcgi.com for the list of DC in your area.

Final decision of acceptance and related criteria will lie with Company.

Claim Process

How to make a Quick and Transparent Claim with HDFC General Insurance?

Third Party Administrator

E-Meditek is a TPA appointed by us for processing of Claims however ultimate responsibility of acceptance or rejection of a Claim lies with Us only.

What the Policy Doesn’t Cover?

We shall not be liable to make any payment for any claim directly or indirectly caused by, based on, arising out of or howsoever attributable to any of the following:

1. All pre-existing diseases/illness/injury/conditions as defined in the Policy, until 36 months of continuous covers have elapsed since inception of the first Policy with us.

2. Any disease contracted and/or medical expenses incurred by You in respect of any disease/illness during the first 30 days from the commencement date of the Policy except in case of accidental injuries. This exclusion doesn’t apply for those having any health insurance indemnity policy in India at least for 1 year prior to taking this Policy as well as for subsequent renewals with Us without a break.

Cashless Hospitalisation

Contact HDFC General Insuranceand Submit a Cashless request form with required documents

Cashless decision made within6 hours by HDFC General Insurance

Reimbursement Claims responseMade within 6 Working days

Collate original bills with otherdocuments as required and submit

it to HDFC General Insurance

Reimbursement of Expenses

3. All expenses towards following ailments/diseases along with their complications are excluded and will be covered after the first two years (24 months) of continuous operation of this insurance cover:

• Cataract

• Hysterectomy other than for malignancy

• Uterine prolapse including any condition requiring Hysterectomy

• Polycystic Ovarian Diseases, Myomectomy for Fibroids

• Knee Replacement Surgery (other than caused by an accident)

• Osteoarthritis and Osteoporosis

• Arthritis, Arthroscopic Surgery, Rheumatism, Joint Replacement Surgery (other than caused by accident), Prolapse of Intervertibral discs(other than caused by accident)

• Varicose Veins and Varicose Ulcers, Hernia, Stones in the urinary, uro-genital and biliary systems, Benign Prostate Hypertrophy, Hydrocele

• Congenital internal anomaly

• Fistula in anus, Piles, Fissures

• Fibroids, Dilatation & Curettage for treatment purposes, Pilonidal sinus, Chronic Suppurative Otitis Media (CSOM)

• Deviated Nasal Septum, Sinusitis and related disorders

• Surgery on tonsils/Adenoids

• Gastric and duodenal ulcer, any type of Cysts/Nodules/Polyps, and any type of Breast lumps, benign ear, Nose and Throat disorders and surgeries Chronic Nephritis and Nephropathy (Kidney diseases)

• Hypertension and Diabetes and related complications

4. Domiciliary hospitalisation expenses in respect of following:

a. Asthma, Bronchitis, Tonsillitis and Upper Respiratory Tract infection including Laryngitis and Pharyngitis, Cough and Cold, Influenza,

b. Arthritis, Gout and Rheumatism,

c. Chronic Nephritis and Nephritic Syndrome,

d. Diarrhoea and all type of Dysenteries including Gastroenteritis,

e. Diabetes Mellitus and Insipidus,

f. Epilepsy,

g. Hypertension,

h. Psychiatric or Psychosomatic Disorders of all kinds,

i. Pyrexia of unknown Origin.

5. Co-payment: All person(s) named in the Schedule to this Policy above the age of 80 years (age last birthday) shall bear a co-pay of 10% for each and every claim.

6. Deductible: Claims/Claim amount falling with in deductible limit as opted by you and mentioned in the Schedule.

7. Any treatment arising from or traceable to pregnancy, childbirth including caesarean section. However, this exclusion/waiting period will not apply to Ectopic Pregnancy proved by diagnostic means.

8. Genetic disorder and stem cell implantation/surgery.

9. Dental treatment or surgery of any kind unless necessitated due to an accident and requiring minimum 24 hours Hospitalisation or treatment of irreversible bone disease involving the jaw which cannot be treated in any other way, but not if it is related to gum disease or tooth disease or damage.

10. Birth control procedures, hormone replacement therapy and voluntary termination of pregnancy during the first 12 weeks from the date of conception.

11. Routine medical, eye and ear examinations, cost of spectacles, laser surgery for cosmetic purposes or corrective surgeries, contact lenses or hearing aids, vaccinations except post-bite treatment, issue of medical certificates and examinations as to suitability for employment or travel.

12. All expenses arising out of any condition directly or indirectly caused due to or associated with human T-call Lymph tropic virus type III (HTLV-III) or Lymphadinopathy Associated Virus (LAV) or Acquired Immune Deficiency Syndrome (AIDS), AIDS related complex syndrome (ARCS) and all diseases/illness/injury caused by and/or related to HIV and sexually transmitted diseases.

13. Vitamins and tonics unless forming part of treatment for disease, illness or injury and prescribed by a Medical Practitioner.

14. Instrument used in treatment of Sleep Apnoea Syndrome (C.P.A.P.) and Continuous Peritoneal Ambulatory Dialysis (C.P.A.D.) and Oxygen Concentrator for Bronchial Asthmatic condition, Infusion pump or any other external devices used during or after treatment.

15. Artificial life maintenance, including life support machine use, where such treatment will not result in recovery or restoration of the previous state of health.

16. Treatment for developmental problems including learning difficulties eg. Dyslexia, behavioural problems including attention deficit hyperactivity disorder (ADHD).

17. Treatment for general debility, ageing, convalescence, run-down condition or rest cure, Congenital external anomaly/ies or defects, sterility, infertility including IVF, impotency, venereal disease, puberty or menopause.

18. Committing or attempting to commit a criminal or illegal act, or intentional self injury or attempted suicide while sane or insane.

19. Certification/Diagnosis/Treatment by a family member or from persons not registered as Medical Practitioners under the respective Medical Councils, or any diagnosis or treatment that is not scientifically recognized or experimental or unproven.

20. Ailment requiring treatment due to use, abuse or a consequence of an abuse of any substance, intoxicant, drug, alcohol or hallucinogen and treatment for de-addiction, or rehabilitation.

21. Any illness or hospitalisation arising or resulting from You or any of Your family members committing any breach of law with criminal intent.

22. Any treatment received in convalescent homes, convalescent hospitals, health hydros, nature cure clinics or similar establishments.

23. Prostheses, corrective devices and medical appliances, which are not required intra-operatively for the disease/illness/injury for which You were hospitalised.

24. Any stay in Hospital/Nursing Home without undertaking any treatment or where there is no active line of treatment by the Medical Practitioner.

25. Treatment of any mental illness or sickness or disease including a psychiatric condition, disorganisation of personality or mind, or emotions or behaviour, Parkinson’s or Alzheimer’s disease even if caused or aggravated by or related to an Accident or Illness or general debility or exhaustion (“run-down condition”).

26. Any cosmetic surgery unless forming part of treatment for cancer or burns, surgery for sex change or treatment of obesity/morbid obesity or treatment/surgery /complications/illness arising as a consequence thereof.

27. Charges incurred primarily for diagnostic, X-ray or laboratory examinations or other diagnostic studies not consistent with or incidental to the diagnosis and treatment even if the same requires confinement at a Hospital/Nursing Home.

28. Costs of donor screening and organ.

29. Costs incurred on all medical treatments other than Allopathy Treatments.

30. Whilst You are engaging in speed contest or racing of any kind (other than on foot), bungee jumping, parasailing, ballooning, parachuting, skydiving, paragliding, hang gliding, mountain or rock climbing necessitating the use of guides or ropes, potholing, abseiling, deep sea diving using hard helmet and breathing apparatus, polo, snow and ice sports or involving a naval military or air force operation.

31. Whilst You are flying or taking part in aerial activities (including cabin crew) except as a fare-paying passenger in a regular Scheduled airline or air Charter Company.

32. All expenses caused by ionizing radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel.

33. All expenses directly or indirectly, caused by or arising from or attributable to foreign invasion, act of foreign enemies, hostilities, warlike operations (whether war be declared or not or while performing duties in the armed forces of any country), civil war, public defense, rebellion, revolution, insurrection, military or usurped power.

34. All non-medical expenses as mentioned in the Policy wordings.

35. Any condition after the point at which it is certified by the attending Medical Practitioner to be of such a nature that further medical treatment may serve to stabilise or maintain it but it is unlikely to result in a material improvement within a reasonable time.

36. Service charges or any other charges levied by the Hospital/Nursing Home, except registration/admission charges.

37. Expenses incurred on alternative treatments.

How to Renew your Policy?

You can renew your Policy by making a request to us before the expiry date. You can also renew policy within 30 days from expiry of your Policy subject to the fact that the premium for the renewal is received within the same period. In such a situation, you will be eligible to ‘continuity benefits’ like the cumulative benefits and others. Please note that we shall not be liable for any claims arising out of ailments/hospitalisation during the period between expiry and renewal.

If the renewal of the Policy is not done within 30 days of due date, it will be considered as a new policy.

We will not be liable to pay hospitalisation expenses incurred during break period. Any disease/condition contracted in the break in period will not be covered and will be treated as Pre-existing condition.

The Policy can be renewed for lifetime unless:

I. any fraud, misrepresentation or suppression of material facts as sought to be declared on the Proposal form by You or on Your behalf is found either in obtaining insurance or subsequently in relation thereto or,

II. We have discontinued issuance of Policy under this Product, in which event You will have the option of renewal under any similar Policy being issued by Us; provided however, benefits payable shall be subject to the terms contained in such other Policy. Such modification or revision of the terms and conditions of the Product shall be intimated to you 3 months in advance along with reasons of modification and revision.

A change in the Sum Insured is allowed on renewals, however it may be subject to Medical test and subsequent Underwriting approval. Any enhanced Sum Insured during subsequent policy renewals will not be available for an illness, disease, injury already contracted under the preceding policy periods. All Waiting periods as defined in the Policy shall apply for this enhanced limit from the effective date of enhancement of such Sum Insured considering such Policy Period as the first Policy with Us. Sum Insured enhancement will be subject to Underwriting approval.

Based on the experience of the Product, Premium, terms and conditions may be revised subject to prior approval of Insurance Regulatory and Development Authority. Such revision shall be intimated to you 3 months in advance with an option of renewal under any similar Policy being issued by Us. However, benefits payable shall be subject to the terms contained in such other Policy. Individual Claims experience loading is not applicable under the Policy.

If you are above the age of 80 years, there is a 10% co-payment obligation as there is no further premium increase.

For any changes desired at the time of Renewal, please communicate with us. Contact Details are provided here below.

The Company reserves its right to vary the premium from time to time subject to approval of IRDA (Insurance Regulatory and Development Authority).

Portability Option: Portability will be provided on the Policy in accordance with IRDA guidelines issued on Portability from time to time. You may approach us atleast 45 days before the expiry date to avoid any break in coverage. Portability benefits are not automatically applicable under the Policy unless application for portability has been specifically made and subsequently accepted by the Company.

The acceptance criteria for portability proposals is same as applicable to new proposals.

How to Cancel your Policy?

In case you wish to cancel your Policy, you may intimate us by giving 15 days notice in writing and we will refund the premium.

We reserve the right and may at any time, cancel Your Policy, on grounds of misrepresentation, fraud, non disclosure or suppression of material facts as sought to be declared on the Proposal form or non co-operation, by giving 15 days notice in writing by Registered Post Acknowledgment Due to You at Your last known address in which case, We shall not be liable to repay the premium for the unexpired term.

You may also give 15 days notice in writing, to Us, for the cancellation of this Policy, in which case We shall from the date of receipt of notice cancel the Policy and retain the premium for the period this Policy has been in force at Our short period scales as under

In case of 2 year Policy;

If cancellation done before completion of 1 year: same grid as given above is applicable on first year Premium and second year Premium will be completely refunded.

If cancellation is done after completion of 1 year: same grid as given above is applicable however retention Premium on second year premium will be calculated on Annual Premium without long term Policy discount.

Period On Risk Rate of Premium Refunded

Up to 1 month 75% of annual Premium

Up to 3 months 50% of annual Premium

Up to 6 months 25% of annual Premium

Exceeding six months upto 365 days NIL

An individual policy with a single person named in the Schedule to this Policy shall automatically terminate in case of death of the Policyholder. In case of an individual Policy with multiple persons named in the Schedule to this Policy and incase of a floater, the Policy shall continue to be in force for the remaining members of the family upto the expiry of current Policy Period. The Policy may be renewed on an application by another adult person named in the Schedule to this Policy, whenever such is due.

However, in case of a valid claim having been paid or reported under this Policy, there would be no refund of premium.

Minimum premium of `250 per Policy will be retained by Us towards administrative charges.

Note:

Age, wherever mentioned shall be completed age last birthday as at Policy inception date.

Premium: Is payable in advance.

Premium As Annexure attached

Contact Details

The information provided here includes only the salient features of my:health Medisure Plus Insurance Policy. For more details please call us on TOLL FREE on 1800 2 092 020 or call a branch in your city. Alternatively, to get a ‘Quick-Quote’ you can log on to www.hdfcgi.com, or leave your name and number if you want us to contact you. Address: HDFC General Insurance Limited, Registered & Corporate Office: 1st Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai - 400 020.

For detailed terms and conditions please refer the policy wordings, visit our website: www.hdfcgi.com or contact your insurance partner.

Reach us at the touch points below

Toll - free No.:1800 2 092 020

Email:care@ hdfcgi.com

Write to us:HDFC General Insurance Limited,Registered & Corporate Office: 1st Floor,HDFC House, 165-166 Backbay Reclamation,H. T. Parekh Marg, Churchgate,Mumbai - 400 020.

Website:www.hdfcgi.com

HDFC General Insurance Limited. CIN : U66030MH2007PLC177117. IRDAI Reg No.146Registered & Corporate Office:1st Floor, HDFC House, 165 - 166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai - 400 020.Toll free: 1800 2 092 020 | Tel.: +91 22 6638 3600 | Fax: 91 22 6638 3699 | www.hdfcgi.com | [email protected]. For more details on the risk factors, terms and conditions, please read the sales brochure before concluding the sale. Trade logo displayed above belongs to HDFC Limited and ERGO International AG and used by the Company, being a wholly owned subsidiary of HDFC ERGO General Insurance Company Limited, which is the license holder. ARN: HDFCGI/FY16-17/012.

Age Group Plan TypePlan A

2 Lac 3 Lac 4 Lac 5 Lac 2 Lac 3 Lac 4 Lac 5 Lac 3 Lac 4 Lac 5 Lac

Plan B - Critical Illness Plan C - Reinstate

Upto 35 Years Individual 3401 4236 5280 6115 3657 4450 5422 6229 4508 5424 6176

36 to 40 Years Individual 3785 4730 5912 6857 4127 5015 6102 7009 5346 6417 7242






Upto 35 Years 2 Adults 5433 6850 8620 10035 5868 7212 8861 10228 7312 8865 10139

36 to 40 Years 2 Adults 6078 7683 9687 11289 6657 8166 10008 11547 8730 10546 11945

41 to 45 Years 2 Adults 6831 8652 10925 12743 7553 9255 11327 13065 9698 11784 13399

46 to 50 Years 2 Adults 10096 12855 16298 19053 11223 13795 16925 19554 15266 18120 20426

51 to 55 Years 2 Adults 11782 14872 18729 21815 15444 17927 20767 23446 17283 20551 23189

56 to 60 Years 2 Adults 16071 20440 25879 30235 20548 24184 28379 32238 22851 27700 31608

61 to 65 Years 2 Adults 18748 23890 30292 35419 23785 28102 33105 37672 32244 36898 40405

Upto 35 Years 2 Adults + 1 Child 7170 9082 11472 13384 7860 9658 11856 13691 9816 11862 13548

36 to 40 Years 2 Adults + 1 Child 7815 9916 12539 14638 8649 10612 13003 15009 11234 13543 15354













Upto 35 Years 1 Adult + 1 Child 5137 6468 8132 9463 5650 6896 8417 9691 7012 8421 9585

36 to 40 Years 1 Adult + 1 Child 5522 6963 8764 10205 6120 7462 9097 10471 7850 9414 10652






Medisure Plus - Simple Rate Card (No Sub Limits Applicable)

All Premium inclusive of 14% Service Tax, 0.5% Swachh Bharat Cess & 0.5% Krishi Kalyan Cess

01

Premium Chart – my:health Medisure Plus InsurancePremium is payable in advance on or before inception of the policy

HDFC General Insurance Limited

An HDFC ERGO Company

(Formerly L&T General Insurance Company Limited)

GENERAL INSURANCE



















Note:

Plan A Base Cover + Waiver of Room Rent Sub Limits

Plan B Plan A + Critical Illness cover

Plan C Plan A + Reinstatement cover

02




GENERAL INSURANCE




Upto 35 Years Individual 2566 3213 3944 4653 2822 3427 4086 4767 3485 4088 4714







Upto 35 Years 2 Adults 4020 5118 6357 7560 4454 5480 6598 7753 5580 6602 7663

36 to 40 Years 2 Adults 4481 5724 7127 8489 5059 6207 7449 8746 6771 7986 9145

41 to 45 Years 2 Adults 5018 6429 8020 9566 5741 7032 8423 9887 7476 8880 10221

46 to 50 Years 2 Adults 7351 9488 11899 14239 8478 10428 12526 14741 11900 13720 15613

51 to 55 Years 2 Adults 8706 11100 13801 16423 12368 14155 15838 18053 13512 15622 17796

56 to 60 Years 2 Adults 11770 15152 18960 22660 16247 18896 21461 24662 17564 20782 24033

61 to 65 Years 2 Adults 13685 17667 22149 26503 18722 21879 24962 28756 26020 28756 31489






















Medisure Plus - Simple Rate Card (Sub Limits)


03




GENERAL INSURANCE



















Note:

Plan A Base Cover ONLY with 1% or Rs. 4000 for Room / 2% or Rs. 6000 for ICU

Plan B Plan A + Critical Illness cover

Plan C Plan A + Reinstatement cover

04




GENERAL INSURANCE

Age Group Plan TypeHospital Cash Accompanying Person Expenses Recovery Benefit

Add Ons

Upto 35 Years Individual 39 39 17

36 to 40 Years Individual 45 45 29






Upto 35 Years 2 Adults 67 67 29

36 to 40 Years 2 Adults 76 76 49

41 to 45 Years 2 Adults 87 87 62

46 to 50 Years 2 Adults 101 101 85

51 to 55 Years 2 Adults 113 113 110

56 to 60 Years 2 Adults 149 149 142

61 to 65 Years 2 Adults 178 178 213

Upto 35 Years 2 Adults + 1 Child 107 107 47

36 to 40 Years 2 Adults + 1 Child 115 115 67






Upto 35 Years 2 Adults + 2 Child 146 146 64







Upto 35 Years 1 Adult + 1 Child 79 79 35

36 to 40 Years 1 Adult + 1 Child 84 84 46






Medisure Plus - Add On Rate Card


05




GENERAL INSURANCE

Age Group Plan TypeHospital Cash Accompanying Person Expenses Recovery Benefit

Add Ons
















DISCLAIMER

1. This rate card is a tool for Ease of Business with limited options as stated under the plans.

2. For complete set of Custom Covers and their Premium; refer to the Master Rate Card.

3. The Master Rate Card Premium is Final & Binding




GENERAL INSURANCE

my:health Medisure Plus Insurance UIN No. IRDA/NL-HLT/L&TGI/P-H/V.II/34/14-15HDFC General Insurance Limited. CIN : U66030MH2007PLC177117. IRDAI Reg No.146Registered & Corporate Office:1st Floor, HDFC House, 165 - 166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai - 400 020. Trade logo displayed above belongs to HDFC Limited and ERGO International AG and used by the Company, being a wholly owned subsidiary of HDFC ERGO General Insurance Company Limited, which is the license holder. ARN: HDFCGI/FY16-17/012.

Toll - free No.:1800 2 092 020

Email:[email protected]

Website:www.hdfcgi.com

Reach us at the touch points below

Ensure your family’s health with my:health Medisure Plus Insurance · 2017-03-08 · health...

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