A STUDY ON

HEALTH INSURANCE SCHEMES OF LIC VERSUS

ICICI PRUDENTIAL HEALTH INSURANCE
SCHEMES&BAJAJ ALLIANZ HEALTH INSURANCE
SCHEMES

SUBMITTED BY

D.DEEPTHI

Under the guidance of Dr. G.V.RAO

THE INDIAN INSTITUTE OF PLANING AND MANAGEMENT

6-3-252/2, ERRAMANZIL, BANJARA HILLS,HYDERABAD-500082

ACKNOWLEDGEMENT
My sincerest thanks are due to all who have helped me in various ways in
the course of the project.

I am deeply grateful to Dr. G.V.RAO, faculty guide for his help and support.

I am thankful to my parents and friends for all the direct and indirect help
they have given me throughout my work.

( D.DEEPTHI )
 DECLARATION

I here by declare that this project entitled a study on “HEALTH

INSURANCE SCHEMES OF LIC VERSUS ICICI PRUDENTIAL
HEALTH INSURANCE SCHEMES& BAJAJ ALLIANZ

” with special reference to LIC &ICICI PRUDENTIAL &BAJAJ ALLIANZ

submitted here is genuine and original work of mine.

This project report is submitted in partial fulfillment of the requirement for

the award of Master of Business Administration degree from IIPM
,HYDERABAD.

I also declare that this project is a result of my own efforts and has not been
submitted to any other University for any other degree or diploma.

DATE :

PLACE : ( D.DEEPTHI)
 CONTENTS

INTRODUCTION

OVERVIEW OF LIC

OVERVIEW OF BAJAJ ALLIANZ

OVERVIEW OF ICICI

WHAT IS HEALTH INSURANCE

HEALTH INSURANCE IN INDIA

LIC PRODUCTS

ICICI PRODUCTS

BAJAJ ALLIANZ PRODUCTS

QUESTIONARE

OUR FINDINGS

ARTICLES

SUGGESTIONS

BIBILOGRAPHY
ABSTRACT

With over a billion people, India is fast becoming a global economic power.
With a relatively youthful population, India will become an attractive
insurance market over the next decades. this paper examines the Indian
insurance industry. It starts by examining the details of the regulatory regime
that existed before independence .this is important because the culmination
of the insurance act of 1938 became the backbone of the current legislation
in place. It highlights the importance of the rural sector –where the majority
of the Indians still live. It shows how the recent privatization is playing out
in the market .the health infrastructure in India is facing daunting challenge
of meet in the health goals and complexities emerging from the changing
diseases pattern .the proliferation of various health care technologies and
increase in cost of care as unassociated the exploration of health financing
options to manage problems arising out of increasing health care costs.
Health insurance is emerging fast as an important mechanism to finance the
health care needs of the people .further, the uncertainty of disease or illness
is accentuating the need for insurance system that works on the basic
principle of pooling of risks of unexpected costs of persons falling ill and
needing hospitalization by charging premium from a wider population base
of the same community. However, the complexity of health insurance
industry has being much talked about but less understood, especially in
Indian scenario based on recent economic estimates, the paper provides
projections of segments of the market for 2025.
Introduction

What is insurance

Insurance, in law and economics, is a form of risk management primarily

used to hedge against the risk of a contingent loss. Insurance is defined as
the equitable transfer of the risk of a loss, from one entity to another, in
exchange for a premium, and can be thought of a guaranteed small loss to
prevent a large, possibly devastating loss. An insurer is a company selling
the insurance. The insurance rate is a factor used to determine the amount,
called the premium, to be charged for a certain amount of insurance
coverage. Risk management, the practice of appraising and controlling risk,
has evolved as a discrete field of study and practice.

Principles of insurance

Commercially insurable risks typically share seven common characteristics.

[1]

A large number of homogeneous exposure units. The vast majority of

insurance policies are provided for individual members of very large classes.
Automobile insurance, for example, covered about 175 million automobiles
in the United States in 2004.[2] The existence of a large number of
homogeneous exposure units allows insurers to benefit from the so-called
“law of large numbers,” which in effect states that as the number of
exposure units increases, the actual results are increasingly likely to become
close to expected results. There are exceptions to this criterion. Lloyd's of
London is famous for insuring the life or health of actors, actresses and
sports figures. Satellite Launch insurance covers events that are infrequent.
Large commercial property policies may insure exceptional properties for
which there are no ‘homogeneous’ exposure units. Despite failing on this
criterion, many exposures like these are generally considered to be insurable.
Definite Loss. The event that gives rise to the loss that is subject to
insurance should, at least in principle, take place at a known time, in a
known place, and from a known cause. The classic example is death of an
insured person on a life insurance policy. Fire, automobile accidents, and
worker injuries may all easily meet this criterion. Other types of losses may
only be definite in theory. Occupational disease, for instance, may involve
prolonged exposure to injurious conditions where no specific time, place or
cause is identifiable. Ideally, the time, place and cause of a loss should be
clear enough that a reasonable person, with sufficient information, could
objectively verify all three elements.

Accidental Loss. The event that constitutes the trigger of a claim should be
fortuitous, or at least outside the control of the beneficiary of the insurance.
The loss should be ‘pure,’ in the sense that it results from an event for which
there is only the opportunity for cost. Events that contain speculative
elements, such as ordinary business risks, are generally not considered
insurable.

Large Loss. The size of the loss must be meaningful from the perspective of
the insured. Insurance premiums need to cover both the expected cost of
losses, plus the cost of issuing and administering the policy, adjusting losses,
and supplying the capital needed to reasonably assure that the insurer will be
able to pay claims. For small losses these latter costs may be several times
the size of the expected cost of losses. There is little point in paying such
costs unless the protection offered has real value to a buyer.

Affordable Premium. If the likelihood of an insured event is so high, or the

cost of the event so large, that the resulting premium is large relative to the
amount of protection offered, it is not likely that anyone will buy insurance,
even if on offer. Further, as the accounting profession formally recognizes in
financial accounting standards, the premium cannot be so large that there is
not a reasonable chance of a significant loss to the insurer. If there is no such
chance of loss, the transaction may have the form of insurance, but not the
substance. (See the U.S. Financial Accounting Standards Board standard
number 113)

Calculable Loss. There are two elements that must be at least estimable, if
not formally calculable: the probability of loss, and the attendant cost.
Probability of loss is generally an empirical exercise, while cost has more to
do with the ability of a reasonable person in possession of a copy of the
insurance policy and a proof of loss associated with a claim presented under
that policy to make a reasonably definite and objective evaluation of the
amount of the loss recoverable as a result of the claim.

Limited risk of catastrophically large losses. The essential risk is often

aggregation. If the same event can cause losses to numerous policyholders of
the same insurer, the ability of that insurer to issue policies becomes
constrained, not by factors surrounding the individual characteristics of a
given policyholder, but by the factors surrounding the sum of all
policyholders so exposed. Typically, insurers prefer to limit their exposure
to a loss from a single event to some small portion of their capital base, on
the order of 5 percent. Where the loss can be aggregated, or an individual
policy could produce exceptionally large claims, the capital constraint will
restrict an insurer's appetite for additional policyholders. The classic
example is earthquake insurance, where the ability of an underwriter to issue
a new policy depends on the number and size of the policies that it has
already underwritten. Wind insurance in hurricane zones, particularly along
coast lines, is another example of this phenomenon. In extreme cases, the
aggregation can affect the entire industry, since the combined capital of
insurers and reinsurers can be small compared to the needs of potential
policyholders in areas exposed to aggregation risk. In commercial fire
insurance it is possible to find single properties whose total exposed value is
well in excess of any individual insurer’s capital constraint. Such properties
are generally shared among several insurers, or are insured by a single
insurer who syndicates the risk into the reinsurance market.

Indemnification

The technical definition of "indemnity" means to make whole again. There

are two types of insurance contracts; 1) an "indemnity" policy and 2) a "pay
on behalf" or "on behalf of"[3] policy. The difference is significant on paper,
but rarely material in practice.

An "indemnity" policy will never pay claims until the insured has paid out of
pocket to some third party; for example, a visitor to your home slips on a
floor that you left wet and sues you for $10,000 and wins. Under an
"indemnity" policy the homeowner would have to come up with the $10,000
to pay for the visitor's fall and then would be "indemnified" by the insurance
carrier for the out of pocket costs (the $10,000)[4].

Under the same situation, a "pay on behalf" policy, the insurance carrier
would pay the claim and the insured (the homeowner) would not be out of
pocket for anything. Most modern liability insurance is written on the basis
of "pay on behalf" language[5].

An entity seeking to transfer risk (an individual, corporation, or association

of any type, etc.) becomes the 'insured' party once risk is assumed by an
'insurer', the insuring party, by means of a contract, called an insurance
'policy'. Generally, an insurance contract includes, at a minimum, the
following elements: the parties (the insurer, the insured, the beneficiaries),
the premium, the period of coverage, the particular loss event covered, the
amount of coverage (i.e., the amount to be paid to the insured or beneficiary
in the event of a loss), and exclusions (events not covered). An insured is
thus said to be "indemnified" against the loss events covered in the policy.

When insured parties experience a loss for a specified peril, the coverage
entitles the policyholder to make a 'claim' against the insurer for the covered
amount of loss as specified by the policy. The fee paid by the insured to the
insurer for assuming the risk is called the 'premium'. Insurance premiums
from many insureds are used to fund accounts reserved for later payment of
claims—in theory for a relatively few claimants—and for overhead costs. So
long as an insurer maintains adequate funds set aside for anticipated losses
(i.e., reserves), the remaining margin is an insurer's profit.

Insurers' business model

Profit = earned premium + investment income - incurred loss - underwriting

expenses.

Insurers make money in two ways: (1) through underwriting, the process by
which insurers select the risks to insure and decide how much in premiums
to charge for accepting those risks and (2) by investing the premiums they
collect from insured parties.

The most complicated aspect of the insurance business is the underwriting of

policies. Using a wide assortment of data, insurers predict the likelihood that
a claim will be made against their policies and price products accordingly.
To this end, insurers use actuarial science to quantify the risks they are
willing to assume and the premium they will charge to assume them. Data is
analyzed to fairly accurately project the rate of future claims based on a
given risk. Actuarial science uses statistics and probability to analyze the
risks associated with the range of perils covered, and these scientific
principles are used to determine an insurer's overall exposure. Upon
termination of a given policy, the amount of premium collected and the
investment gains thereon minus the amount paid out in claims is the insurer's
underwriting profit on that policy. Of course, from the insurer's perspective,
some policies are winners (i.e., the insurer pays out less in claims and
expenses than it receives in premiums and investment income) and some are
losers (i.e., the insurer pays out more in claims and expenses than it receives
in premiums and investment income).

An insurer's underwriting performance is measured in its combined ratio.

The loss ratio (incurred losses and loss-adjustment expenses divided by net
earned premium) is added to the expense ratio (underwriting expenses
divided by net premium written) to determine the company's combined ratio.
The combined ratio is a reflection of the company's overall underwriting
profitability. A combined ratio of less than 100 percent indicates
underwriting profitability, while anything over 100 indicates an underwriting
loss.

Insurance companies also earn investment profits on “float”. “Float” or

available reserve is the amount of money, at hand at any given moment, that
an insurer has collected in insurance premiums but has not been paid out in
claims. Insurers start investing insurance premiums as soon as they are
collected and continue to earn interest on them until claims are paid out.

In the United States, the underwriting loss of property and casualty

insurance companies was $142.3 billion in the five years ending 2003. But
overall profit for the same period was $68.4 billion, as the result of float.
Some insurance industry insiders, most notably Hank Greenberg, do not
believe that it is forever possible to sustain a profit from float without an
underwriting profit as well, but this opinion is not universally held.
Naturally, the “float” method is difficult to carry out in an economically
depressed period. Bear markets do cause insurers to shift away from
investments and to toughen up their underwriting standards. So a poor
economy generally means high insurance premiums. This tendency to swing
between profitable and unprofitable periods over time is commonly known
as the "underwriting" or insurance cycle. [6]
Property and casualty insurers currently make the most money from their
auto insurance line of business. Generally better statistics are available on
auto losses and underwriting on this line of business has benefited greatly
from advances in computing. Additionally, property losses in the United
States, due to natural catastrophes, have exacerbated this trend.

Finally, claims and loss handling is the materialized utility of insurance. In

managing the claims-handling function, insurers seek to balance the
elements of customer satisfaction, administrative handling expenses, and
claims overpayment leakages. As part of this balancing act, fraudulent
insurance practices are a major business risk that must be managed and
overcome.

Origin of Insurance
Whenever there is uncertainty there is risk. We do not have any control over
uncertainties
which involves financial losses. The risk may be certain events like death,
pension,
retirement or uncertain events like theft, fire, accident, etc.

Insurance is a financial service for collecting the savings of the public and
providing
them with risk coverage. It comes under service sector and while marketing
this service
due care is taken in quality product and customer satisfaction. The main
function of the
Insurance is to provide protection against the possible chances of generating
losses.
The insurance sector in India has come a full circle from being an open
competitive
market to nationalization and back to a liberalized market again. Tracing the
developments in the Indian insurance sector reveals the 360-degree turn
witnessed over a
period of almost two centuries.
Brief History of the Insurance Sector

The business of life insurance in India in its existing form started in India in
the year
1818 with the establishment of the Oriental Life Insurance Company in
Calcutta. Some of
the important milestones in the life insurance business in India are:

1912: The Indian Life Assurance Companies Act enacted as the first statute
to regulate
the life insurance business.

1928: The Indian Insurance Companies Act enacted to enable the

government to collect
statistical information about both life and non-life insurance businesses.

1938: Earlier legislation consolidated and amended to by the Insurance Act

with the
objective of protecting the interests of the insuring public.

1956: 245 Indian and foreign insurers and provident societies taken over by
the central
government and nationalized. LIC formed by an Act of Parliament, viz. LIC
Act, 1956,
with a capital contribution of Rs. 5 crore from the Government of India. The
General
insurance business in India, on the other hand, can trace its roots to the
Triton Insurance
Company Ltd., the first general insurance company established in the year
1850 in
Calcutta by the British.
Some of the important milestones in the general insurance business in India
are:

1907: The Indian Mercantile Insurance Ltd. set up, the first company to
transact all
classes of general insurance business.
1957: General Insurance Council, a wing of the Insurance Association of
India, frames a
code of conduct for ensuring fair conduct and sound business practices.
2
1968: The Insurance Act amended to regulate investments and set minimum
solvency
margins and the Tariff Advisory Committee set up.
1972: The General Insurance Business (Nationalization) Act, 1972
nationalized the
general insurance business in India with effect from 1st January 1973. 107
insurers
amalgamated and grouped into four companies’ viz. the National Insurance
Company
Ltd., the New India Assurance Company Ltd., the Oriental Insurance
Company Ltd. and
the United India Insurance Company Ltd. GIC incorporated as a company.
INSURANCE SECTOR

The opening up of Insurance sector was a part of the on going liberalization

in the
financial sector of India. The changing face of the financial sector and the
entry of
several companies in the field of life and non life Insurance segment are one
of the key
results of these liberalization efforts. Insurance business by way of
generating premium
income adds significantly to be the GDP.

Over the past three years, more than thirty companies have expressed
interest in doing
business in India. The IRDA (Insurance Regulatory Development Authority)
is the
regulatory authority, which looks over all related aspects of the insurance
business. The
provisions of the IRDA bill acknowledge many issues related to insurance
sector.

The IRDA bill provides guidance for three levels of players - Insurance
Company,
Insurance brokers and Insurance agent. Life Insurance sector is one of the
key areas
where enormous business potential exists. In India currently the life
insurance premium
as a percentage of GDP is 1.3 % against, 5.2 per cent in the US.
General Insurance is another segment, which has been growing at a faster
pace. But as
per the current comparative statistics, the general insurance premium has
been lower
than life insurance. General Insurance premium as a percentage of GDP was
a mere 0.5
'per cent in 1996. In the General Insurance Business, General Insurance
Corporation
(GIC) and its four subsidiaries viz. New India Insurance, Oriental Insurance,
National
Insurance and United India Insurance, are doing major business. The
General Insurance
Industry has been growing at a rate of 19 percent per year.

The entry of several private insurance companies, particularly international

insurance
companies, through joint ventures, will speed up the process of insurance
mobilization.
The competition will unleash new schemes and benefits, which will give
consumers a
better Chance to save as well as insure. The regulatory system in India is
relatively new
and takes some more time to make the Insurance sector a perfectly
competitive one.
Insurance Regulatory Authority of India issued regulations on 15 subjects
which
included appointed. Actuary, actuarial report, Insurance agents, Solvency
margins, reinsurance,

registration of Insurers, and obligation of insurers to rural and social sector,

investment and accounting procedure. The reform in Insurance in India is
guided by
factors like availability of a variety of products at a competitive price,
improvement in
the quality of customer services etc. Also the employment opportunities in
the Insurance
sector wil1 increase as major players set their business plans in India. The
policy of the
government to open up the financial sector and the Insurance sector is
expected to bring
greater FDI inflow into the country. The increase in the investment limit in
this vital
sector has generated considerable business interests among the foreign
Insurance
companies" Their entry wil1 certainly change the Insurance sector
considerably.

Insurance Sector Reforms:

In 1993, Malhotra Committee, headed by former Finance Secretary and RBI

Governor
R.N. Malhotra was formed to evaluate the Indian insurance industry and
recommend its
future, direction. The Malhotra committee was set up with the objective of
complementing the reforms initiated in the financial sector.
In 1994, the committee submitted the report and some of the key
recommendations
included:
Structure:
1. Government stake in the insurance Companies to be brought down to
50%. 2.
Government should take over the holdings of GlC and its subsidiaries so that
these
subsidiaries can act as independent corporations.
3. All the insurance companies should be given greater freedom to operate.
Competition:
I. Private Companies with a minimum paid up capital of Rs. 1 bn should be
allowed to
enter the industry.
2. No Company should deal in both Life and General Insurance through a
single entity.
3. Foreign companies may be allowed to enter the industry in collaboration
with the
domestic companies.
4. Postal Life Insurance should be allowed to operate in the rural market.
5. Only one State Level Life Insurance Company should be allowed to
operate in each
state.

Regulatory Body:
1. The Insurance Act should be changed.

2. An Insurance Regulatory body should be set up.

Controller of Insurance (Currently a part from the Finance Ministry) should
be made
independent.
Investment:

1. Mandatory Investments of LIC Life Fund in government securities to be

reduced from
75% to 50%.

2. GIC and its subsidiaries are not to hold more than 5% in any company
(There current
holdings to be brought down to this level over a period of time.)
Customer Service:

1. LIC should pay interest on delays in payments beyond 30 days.

2. Insurance companies must be encouraged to set up unit linked pension

plans.
3. Computerization of operations and updating of technology to be carried
out in the
insurance industry.

The committee emphasized that in order to improve the customer

Services and increase the coverage of the insurance industry should open up
to
competition. But at the same time, the committee felt the need to exercise
caution as any
failure on the part of new players could ruin the public confidence in the
industry. Hence,
it was decided to allow competition in a limited way by stipulating the
minimum capital
requirement of Rs. 100 crores. The committee felt the need to provide
greater autonomy
to insurance companies in order to improve.

Insurance Regulatory Authority

On the recommendations of the Malhotra Committee, government has set up
an interim
Insurance Regulatory Authority (IRA), with a view to activate an insurance
regulatory
apparatus essential for proper monitoring and control of the insurance
industry. The IRA
is headed by a chairman who is also Controller o0f insurance and chairman
of TBC. The
other members of the IRA, not exceeding seven in number of whom not
more than three
shall serve full time, shall be nominated by the central government.
INSURERS:

Insurance industry, as on 1.4.2000, comprised mainly two players: the state

insurers:

Life Insures:
• Life Insurance Corporation of India (LIC)
General Insurers
• General Insurance Corporation of India (GIC) (with effect from Dec ‘2000,
a
national reinsurer)

4 I’s of Insurance Service

The 4 I’s refers to the different dimensions/ characteristics of any service.

Unlike
pure product, services have its own characteristics and its related problems.
So the
service provider needs to deal with these problems accordingly. The service
provider has to design different strategies according the varying feature of
the
service. These 4 I’s not only represent the characteristics of different
services but
also the problems and advantages attached to it.
These 4 I’s can be broadly classified as:
• Intangibility
• Inconsistency
• Inseparability
• Inventory

• Intangibility:
Insurance is a guarantee against risk and neither the risk nor the guarantee is
tangible. Hence, insurance rightly come under services, which are intangible.
Efforts have been made by the insurance companies to make insurance
tangible to
some extent by including letters and forms

• Inconsistency
Service quality is often inconsistent. This is because service personnel have
different capabilities, which vary in performance from day to day. This
problem of
inconsistency in service quality can be reduced through standardization,
training
and mechanization.

• Inseparability
Services are produced and consumed simultaneously. Consumers cannot and
do
not separate the deliverer of the service from the service itself. Interaction
between
consumer and the service provider varies based on whether consumer must
be
physically present to receive the service.

• Inventory
No inventory can be maintained for services. Inventory carrying costs are
more
subjective and lead to idle production capacity. When the service is available
but
there is no demand, cost rises as, cost of paying the people and overhead
remains
constant even though the people are not required to provide services due to
lack of
demand.
In the insurance sector however, commission is paid to the agents on each
policy
that they sell. Hence, not much inventory cost is wasted on idle inventory.
As the
cost of agents is directly proportionate to the policy sold.

HEALTH INSURANCE IN INDIA

1. Introduction

Over the last 50 years India has achieved a lot in terms of health
improvement. But still India is way behind many fast developing countries
such as China, Vietnam and Sri Lanka in health indicators (Satia et al 1999).
In case of government funded health care system, the quality and access of
services has always remained major concern. A very rapidly growing private
health market has developed in India. This private sector bridges most of the
gaps between what government offers and what people need. However, with
proliferation of various health care technologies and general price rise, the
cost of care has also become very expensive and unaffordable to large
segment of population. The government and people have started exploring
various health financing options to manage problems arising out of growing
set of complexities of private sector growth, increasing cost of care and
changing epidemiological pattern of diseases.
The new economic policy and liberalization process followed by the
Government of India since 1991 paved the way for privatization of insurance
sector in the country. Health insurance, which remained highly
underdeveloped and a less significant segment of the product portfolios of
the nationalized insurance companies in India, is now poised for a
fundamental change in its approach and management. The Insurance
Regulatory and Development Authority (IRDA) Bill, recently passed in the
Indian Parliament, is important beginning of changes having significant
implications for the health sector.
The privatization of insurance and constitution IRDA envisage to improve
the performance of the state insurance sector in the country by increasing
benefits from competition in terms of lowered costs and increased level of
consumer satisfaction. However, the implications of the entry of private
insurance companies in health sector are not very clear. The recent policy
changes will have been far reaching and would have major implications for
the growth and development of the health sector. There are several
contentious issues pertaining to development in this sector and these need
critical examination. These also highlight the critical need for policy
formulation and assessment. Unless privatization and development of health
insurance is managed well it may have negative impact of health care
especially to a large segment of population in the country. If it is well
managed then it can improve access to care and health status in the country
very rapidly.

Health insurance as it is different from other segments of insurance business

is more complex because of serious conflicts arising out of adverse
selection, moral hazard, and information gap problems. For example,
experiences from other countries suggest that the entry of private firms into
the health insurance sector, if not properly regulated, does have adverse
consequences for the costs of care, equity, consumer satisfaction, fraud and
ethical standards. The IRDA would have a significant role in the regulation
of this sector and responsibility to minimise the unintended consequences of
this change.
Health sector policy formulation, assessment and implementation is an
extremely complex task especially in a changing epidemiological,
institutional, technological, and political scenario. Further, given the
institutional complexity of our health sector programmes and the pluralistic
character of health care providers, health sector reform strategies in the
context of health insurance that have evolved elsewhere may have very little
suitability to our country situation. Proper understanding of the Indian health
situation and application of the principles of insurance keeping in view the
social realities and national objective are important.
This paper presents review of health insurance situation in India - the
opportunities it provides, the challenges it faces and the concerns it raises. A
discussion of the implications of privatization of insurance on health sector
from various perspectives and how it will shape the character of our health
care system is also attempted. The paper following areas:

• Economic policy context

• Health financing in India

• Health insurance scenario in India

• Health insurance for the poor

• Consumer perspective on health insurance

• Models of health insurance in other countries

This paper is partly based on a deliberations of a one day workshop (IIMA

1999) and a conference held at 11M Ahmedabad (IIMA 2000) in 1999-2000
on health insurance involving practicing doctors, representatives from
government insurance companies, medical associations, training institutes,
member-based organizations and health policy researchers. Workshop and
conference were part of the activities of Health Policy Development
Network (HELPONET) and is supported by the International Health Policy
Program. The paper also draws on several published and unpublished papers
and documents in the area of health insurance

.
2. Economic policy context and imperatives of liberalization of
insurance sector
There are several imperatives for opening of the insurance and health
insurance sector in India for private investment. Here we review some of
these imperatives.
Economic policy reforms started during late eighties and speeded up in
nineties are the context in which liberalization of insurance sector happened
in India. It was very obvious that the liberalization of the real (productive)
and financial sector of the economy has to go hand in hand. It is imperative
that these sectors are consistent with policies of each other and unless both
function efficiently and are in equilibrium, it would be difficult to ensure
appropriate economic growth. Given these facts liberalization of both sectors
has to proceed simultaneously.
Indian economic system has been developed on paradigm of mixed economy
in which public and private enterprises co-exist. The past strategies of
development based on socialistic thinking were focusing on the premise of
restrictions, regulations and control and less on incentives and market driven
forces. This affected the development process in the country in serious way.
After the economic liberalization the paradigm changed from central
planning, command and control to market driven development.
Deregulation, decontrol, privatization, delicensing, globalization became the
key strategies to implement the new framework and encourage competition.
The social sectors did not remain unaffected by this change. The control of
government expenditure, which became a key tool to manage fiscal deficits
in early 1990s, affected the social sector spending in major way. The
unintended consequences of controlling the fiscal deficits have been
reduction in capital expenditure and non-salary component of many social
sector programmes. This has led to severe resource constraints in the health
sector in respect of non-salary expenditure and this has affected the capacity
and credibility of the government health care system to deliver good quality
care over the years. Given the increasing salaries, lack of effective
monitoring and lack of incentives to provide good quality services the
provides in the government sector became indifferent to the clients. Clients
also did not demand good quality and better access, as government services
were free of cost.
Under this situation more and more clients turned to the private sector health
providers and thus the private sector healthcare has expanded. Given the
socialistic political thinking and populist policy it has been generally
difficult for any government to introduce cost recovery in public health
sector. Given that government is unable to provide more resources for health
care, and institute cost recovery, one of the ways to reduce the under-
funding and augment the resources in the health sector was to encourage the
development health insurance.

Another imperative for liberalization of the insurance sector was the need for
long-term financial resources on sustainable basis for the development of
infrastructure sector such as roads, transports etc. It was realized that during
the course of economic liberalization, the funds to development the
infrastructure also became a major constraint. Country certainly needed
infrastructure development. For this the finances are major constraint. In
these investments the benefits are more social than private. The major
concern was how these finances can be made available at low costs. In past
the development of social sector were financed using government channeled
funds through various semi-government financial institutions. Under the
liberalized economy this may not be possible. One hope is that if the
insurance sector develops rapidly under privatization then it can provide
long-term finance to the infrastructure sector.

The financial sector, which consists of banks, financial institutions,

insurance companies, provident funds schemes, mutual funds were all under
government control. There was less competition across these units. As a
result these institutions remained significantly less developed in their
approach and management. Insurance sector has been most affected by the
government controls. Government had significant control on the policies
these insurance companies could offer and utilization of the resources
mobilized by insurance companies. One can see that most of the insurance
products (e.g., life insurance products) were promoted as mechanisms to
improve the savings and tax shelters rather as risk coverage instruments.
Other segments of the insurance products grew because of the statutory
obligations (e.g., Motor Vehicle, Marine and Fire) under various acts. The
management and organization of insurance sector companies remained less
developed and they neglected new product development and marketing.
Thus one of the hopes in opening of the insurance sector was that the private
and foreign companies would rapidly develop the sector and improve
coverage of the population with insurance using new products and better
management.
Last imperative for opening of the insurance sector was signing the WTO
India. After this there was little choice but to open the entire financial sector
- including insurance sector to private and foreign investors. (Dholakia
1999).

3. Health sector and its financing: present scene and issues for the
future
During the last 50 years India has developed a large government health
infrastructure with more than 150 medical colleges, 450 district hospitals,
3000 Community Health Centers, 20,000 Primary Health Care centers and
130,000 Sub-Health Centers. On top of this there are large number of private
and NGO health facilities and practitioners scatters though out the country.
Over the past 50 ears India has made considerable progress in improving its
health status. Death rate has reduced from 40 to 9 per thousand, infant
mortality rate reduced from 161 to 71 per thousand live births and life
expectancy increased from 31 to 63 years. However, many challenges
remain and these are: life expectancy 4 years below world average, high
incidence of communicable diseases, increasing incidence of non-
communicable diseases, neglect of women's health, considerable regional
variation and threat from environment degradation. It is estimated that at any
given point of time 40 to 50 million people are on medication for major
sickness in India. About 200 million workdays are lost annually due to
sickness. Survey data indicate that about 60% people use private health
providers for outpatient treatment while 60 % use government providers for
in-door treatment. The average expenditure for care is 2-5 times more in
private sector than in public sector.
India spends about 6% of GDP on health expenditure. Private health care
expenditure is 75% or 4.25% of GDP and most of the rest (1.75%) is
government funding. At present, the insurance coverage is negligible. Most
of the public funding is for preventive, promotive and primary care
programmes while private expenditure is largely for curative care. Over the
period the private health care expenditure has grown at the rate of 12.84%
per annum and for each one percent increase in per capital income the
private health care expenditure has increased by 1.47%. Number of private
doctors and private clinical facilities are also expanding exponentially.
Indian health financing scene raises number of challenges, which are:

• increasing health care costs,

• high financial burden on poor eroding their incomes,

• increasing burden of new diseases and health risks and

• neglect of preventive and primary care and public health functions due to
under funding of the government health care.

Given the above scenario exploring health-financing options becomes

critical. Health Insurance is considered one of the financing mechanisms to
over come some of the problems of our system.

4. Health Insurance scene in India

Health insurance can be defined in very narrow sense where individual or
group purchases in advance health coverage by paying a fee called
"premium". But it can be also defined broadly by including all financing
arrangements where consumers can avoid or reduce their expenditures at
time of use of services. The health insurance existing in India covers a very
wide spectrum of arrangements and hence the latter- broader interpretation
of health Insurance is more appropriate.

Objectives of LIC

• Spread Life Insurance widely and in particular to the rural areas and to
the socially and economically backward classes with a view to
reaching all insurable persons in the country and providing them
adequate financial cover against death at a reasonable cost.

• Maximize mobilization of people's savings by making insurance-

linked savings adequately attractive.

• Bear in mind, in the investment of funds, the primary obligation to its

policyholders, whose money it holds in trust, without losing sight of
the interest of the community as a whole; the funds to be deployed to
the best advantage of the investors as well as the community as a
whole, keeping in view national priorities and obligations of attractive
return.

• Conduct business with utmost economy and with the full realization
that the moneys belong to the policyholders.

• Act as trustees of the insured public in their individual and collective

capacities.

• Meet the various life insurance needs of the community that would
arise in the changing social and economic environment.
 • Involve all people working in the Corporation to the best of their
capability in furthering the interests of the insured public by providing
efficient service with courtesy.

• Promote amongst all agents and employees of the Corporation a sense

of participation, pride and job satisfaction through discharge of their
duties with dedication towards achievement of Corporate Objective.

Mission
"Explore and enhance the quality of life of people through financial security
by providing products and services of aspired attributes with competitive
returns, and by rendering resources for economic development."

Vision
"A trans-nationally competitive financial conglomerate of significance to
societies and Pride of India."

Board of directors

Shri. T.S. Vijayan (Chairman)

Shri. D.K. Mehrotra (Managing Director - LIC)

Shri. Thomas Mathew T (Managing Director - LIC)

Shri A K Dasgupta (Managing Director - LIC )

Shri Arun Ramanathan, Secretary, Financial Services, Department of

Financial Services, Ministry of Finance, Govt of India.

Smt. Sindhushree Khullar, Special Secretary, Department of Economic

Affairs, Govt. of India Ministry of Finance .

Shri Yogesh Lohiya (Chairman cum Managing Director, GIC of India)

Shri T.C. Venkat Subramanian, Chairman & Managing Director. Export

Import Bank of India.
Contract Of Insurance:
A contract of insurance is a contract of utmost good faith technically known
as uberrima fides. The doctrine of disclosing all material facts is embodied
in this important principle, which applies to all forms of insurance.

At the time of taking a policy, policyholder should ensure that all questions
in the proposal form are correctly answered. Any misrepresentation, non-
disclosure or fraud in any document leading to the acceptance of the risk
would render the insurance contract null and void.

Protection:
Savings through life insurance guarantee full protection against risk of death
of the saver. Also, in case of demise, life insurance assures payment of the
entire amount assured (with bonuses wherever applicable) whereas in other
savings schemes, only the amount saved (with interest) is payable.

Aid To Thrift:
Life insurance encourages 'thrift'. It allows long-term savings since
payments can be made effortlessly because of the 'easy instalment' facility
built into the scheme. (Premium payment for insurance is either monthly,
quarterly, half yearly or yearly).
For example: The Salary Saving Scheme popularly known as SSS, provides
a convenient method of paying premium each month by deduction from
one's salary.
In this case the employer directly pays the deducted premium to LIC. The
Salary Saving Scheme is ideal for any institution or establishment subject to
specified terms and conditions.

Liquidity:
In case of insurance, it is easy to acquire loans on the sole security of any
policy that has acquired loan value. Besides, a life insurance policy is also
generally accepted as security, even for a commercial loan.

Tax Relief:
Life Insurance is the best way to enjoy tax deductions on income tax and
wealth tax. This is available for amounts paid by way of premium for life
insurance subject to income tax rates in force.
Assessees can also avail of provisions in the law for tax relief. In such cases
the assured in effect pays a lower premium for insurance than otherwise.
Money When You Need It:
A policy that has a suitable insurance plan or a combination of different
plans can be effectively used to meet certain monetary needs that may arise
from time-to-time.
Children's education, start-in-life or marriage provision or even periodical
needs for cash over a stretch of time can be less stressful with the help of
these policies.
Alternatively, policy money can be made available at the time of one's
retirement from service and used for any specific purpose, such as, purchase
of a house or for other investments. Also, loans are granted to policyholders
for house building or for purchase of flats (subject to certain conditions).

Who Can Buy A Policy?

Any person who has attained majority and is eligible to enter into a valid
contract can insure himself/herself and those in whom he/she has insurable
interest.

Policies can also be taken, subject to certain conditions, on the life of one's
spouse or children. While underwriting proposals, certain factors such as the
policyholder’s state of health, the proponent's income and other relevant
factors are considered by the Corporation.

Insurance For Women

Prior to nationalisation (1956), many private insurance companies would

offer insurance to female lives with some extra premium or on restrictive
conditions. However, after nationalisation of life insurance, the terms under
which life insurance is granted to female lives have been reviewed from
time-to-time.

At present, women who work and earn an income are treated at par with
men. In other cases, a restrictive clause is imposed, only if the age of the
female is up to 30 years and if she does not have an income attracting
Income Tax.

Medical And Non-Medical Schemes

Life insurance is normally offered after a medical examination of the life to

be assured. However, to facilitate greater spread of insurance and also to
avoid inconvenience, LIC has been extending insurance cover without any
medical examination, subject to certain conditions.

With Profit And Without Profit Plans

An insurance policy can be 'with' or 'without' profit. In the former, bonuses

disclosed, if any, after periodical valuations are allotted to the policy and are
payable along with the contracted amount.

In 'without' profit plan the contracted amount is paid without any addition.
The premium rate charged for a 'with' profit policy is therefore higher than
for a 'without' profit policy.

Keyman Insurance

Keyman insurance is taken by a business firm on the life of key employee(s)

to protect the firm against financial losses, which may occur due to the
premature demise of the Keyman.

1. Bajaj Allianz General Insurance Company:

Allianz AG:
Allianz group was founded in 1890 and is one of the world's leading insurance
companies with over 100 year's experience in insurance and related services. It is also the
largest insurer in Europe. Allianz group has multi-local structure and presence in over 70
countries. The key business areas of Allianz group include General Insurance (property,
engineering, marine, motor, casualty and miscellaneous), Reinsurance, Risk
Management, Life & health insurance, Asset Management and Pension Funds
Management.

Bajaj Auto Ltd.

Bajaj Auto Ltd the flagship company of Bajaj Group was incorporated in 1945 as
Bachraj Trading Corporation. Initially it started by assembling two and three wheelers in
collaboration with Piaggio of Italy. After the expiry of the Agreement in 1971 the two
and three wheelers acquired the brand name of Bajaj. The strength of the company lies in
its strong brand image and ability to offer value for money products leveraging on its
large-scale operations.
The Joint Venture
Bajaj Allianz General Insurance a joint venture non-life company promoted
jointly by Bajaj Auto and German insurer- Allianz. Indian auto major holds 74% while
Allianz holds 26% in the Joint Venture, and has an authorized and paid up capital of Rs.
ll0 crores. Mr. Graham Norris is the CEO of the company. Bajaj Allianz General
Insurance will leverage the customer base and expertise of Bajaj Auto Ltd and Allianz.

Vision

• To be the first choice insurer for customers

• To be the preferred employer for staff in the insurance industry.
• To be the number one insurer for creating shareholder value

Mission
As a responsible, customer focused market leader, we will strive to understand the
insurance needs of the consumers and translate it into affordable products that deliver
value for money.

A Partnership Based on Synergy

Bajaj Allianz General Insurance offers technical excellence in all areas of General and
Health Insurance as well as Risk Management. This partnership successfully combines
Bajaj Finserv's in-depth understanding of the local market and extensive distribution
network with the global experience and technical expertise of the Allianz Group. As a
registered Indian Insurance Company and a capital base of Rs. 110 crores, the company is
fully licensed to underwrite all lines of general insurance business including health
insurance.

Our Achievements
Bajaj Allianz has received "iAAA rating, from ICRA Limited, an associate of Moody's
Investors Services, for Claims Paying Ability.This rating indicates highest claims paying
ability and a fundamentally strong position

• Access to over 7000 physicians employed by the renowned hospitals of the

WorldCare Consortium.
Introduction

ICICI Prudential Life Insurance Company Limited was incorporated on July

20, 2000. The authorized capital of the company is Rs.2300 Million and the
paid up capital is Rs. 1500 Million. The Company is a joint venture of ICICI
(74%) and Prudential plc UK (26%).

The Company was granted Certificate of Registration for carrying out Life
Insurance business, by the Insurance Regulatory and Development Authority
on November 24, 2000. It commenced commercial operations on December
19, 2000, becoming one of the first few private sector players to enter the
liberalized arena.

The Company is now operational in Mumbai, New Delhi, Pune, Chennai,

Kolkata, Bangalore, Chandigarh, Ahmedabad, Hyderabad, Lucknow, Nasik,
Jaipur, Cochin, Meerut, Mangalore and Ludhiana.

Till March 31,2002 the Company has issued 100,000 polices translating into
a Premium Income of around Rs. 1,200 Million and a sum assured of over
Rs.15,000 Million.

The Company recognizes that the driving force for gaining sustainable
competitive advantage in this business is superior customer experience and
investment behind the brand. The Company aims to achieve this by striving
to provide world class service levels through constant innovation in
products, distribution channels and technology based delivery. The
Company has already taken significant steps to achieve this goal..

Vision and Mission

Their vision is to make ICICI Prudential Life Insurance Company the

dominant new insurer in the life insurance industry. This they hope to
achieve through their commitment to excellence, focus on service, speed and
innovation, and leveraging our technological expertise.

The success of the organisation will be founded on its strong focus on values
and clarity of purpose. These include:
 Understanding the needs of customers and offering them superior products
and service

Building long lasting relationships with their partners

Providing an enabling environment to foster growth and learning for their

employees

And above all building transparency in all our dealings.

They believe that they can play a significant role in redefining and reshaping
the sector. Given the quality of their parentage and the commitment of their
team, they feel that tere will be no limits to their growth.

Sponsors

ICICI Ltd was established in 1955 by the World Bank, the Government of
India and the Indian Industry, to promote industrial development of India by
providing project and corporate finance to Indian industry.

Since inception, ICICI has grown from a development bank to a financial

conglomerate and has become one of the largest public financial institutions
in India. ICICI has financed all major sectors of the economy, covering
6,848 companies and 16,851 projects. In the fiscal year 2000-2001, ICICI
had disbursed a total of Rs 319.65 billion.

ICICI has now developed a whole range of activities to become a Universal

Bank. Some of ICICI's spectrum of activities include:
* Commercial Banking - ICICI Bank, India's first internet bank.
* Information Technology - ICICI Infotech, transaction processing, software
development
* Investment Banking - ICICI Securities, one of the key players in the Indian
Capital Markets
* Mutual Fund - Prudential ICICI AMC, leading private sector mutual fund
player in India
* Venture Capital - ICICI Venture, leading private equity investor with
focus on IT and HealthCare
* Retail Services - ICICI PFS, Marketing and Distribution of Retail Asset
Products
* Distribution - ICICI Capital, Distribution and Servicing of Retail Liability
Products
ICICI is listed on the Indian Stock Exchanges and on the New York Stock
Exchange (NYSE). On September 22, 1999, it became the first Indian
company to be listed on the NYSE (symbol: IC and IC.D). This has been
followed by the listing of ICICI Bank on NYSE (symbol: IBN) on March
28, 2000.

Prudentialplc:

Prudential plc was founded in 1848. Since then it has grown to become one
of the largest providers of a wide range of savings products for the
individual including life insurance, pensions, annuities, unit trusts and
personal banking. It has a presence in over 15 countries, and caters to the
financial needs of over 10 million customers. It manages assets of over US$
259 billion (Rupees 11,39,600 crores approx.) as of December 31, 1999.
Prudential plc. has had its presence in Asia for the past 75 years catering to
over 1 million customers across 11 Asian countries.

Prudential is the largest life insurance company in the United Kingdom

(Source : S&P's UK Life Financial Digest, 1998). Asia has always been an
important region for Prudential and it has had a presence in Asia for over 75
years. In fact Prudential's first overseas operation was in India, way back in
1923 to establish Life and General Branch agencies.

In the US, Prudential owns Jackson National Life, one of the leading life
insurance companies. Prudential controls approximately 4% of all the listed
shares on the second largest stock exchange in the world, the London Stock
Exchange, making it one of the largest institutional investors in the UK.
Prudential is focused on the internet generation and is one of the first
financial service organisations to use the internet on a fully integrated basis.

In October 1998, Prudential launched a "branchless" bank based on the

internet. Unusually titled as " egg:|". The bank has in a short span of its
existence become a leading banking service provider in the UK. Infect in the
first six months of its existence it garnered over 5 billion (US$ 8 billion) in
deposits from over 500,000 customers.

Development of superior products and services that offer value for money
and security while producing superior financial returns, enables Prudential to
maximise the value of its shareholder's investment and to establish lasting
relationships with customers and policy holders.

ICICI and Prudential came together in 1993 to provide mutual fund products
in India and today are the largest private sector mutual fund company in
India. The two companies bring together two of the strongest financial
service brands in Asia known for their professionalism, excellent quality of
service and long term commitment to YOU.

Board of Directors

The ICICI Prudential Life Insurance Company Limited Board comprises reputed people
from the finance industry both from India and abroad.

Mr. K.V. Kamath, Chairman

Ms. Chanda Kochhar, Director
Mr. Barry Stowe, Director
Mr. H.T. Phong, Director
Prof. Marti G. Subrahmanyam, Director
Mr. Mahesh Prasad Modi, Director
Ms. Rama Bijapurkar, Director
Mr. Keki Dadiseth, Director
Ms. Shikha Sharma, Managing Director
Mr. N.S. Kannan, Executive Director
Mr. Bhargav Dasgupta, Executive Director

HEALTH INSURANCE

Health insurance policies insure you against several illnesses and guarantee you stay
financially secure should you ever require treatment. They safeguard your peace of mind,
eliminate all worries about treatment expenses, and allow you to focus your energy on
more important things, like getting better. Let's learn more about the various types of
health insurance available, and what the best policy for you might be.

Health Insurance policies in India - An Overview

There are several health insurance or medical insurance plans in India. These can be
divided into the following categories based on the coverage offered:

Hospitalization Plans: These health insurance plans cover your expenses in case you
need to be hospitalized. Within this category, products may have different payout
structures and limits for various heads of expenditure. The hospitalisation coverage may
be reimbursement based plans or fixed benefit plans. These plans aim to cover the more
frequent medical expenses. Click to know about our hospitalisation insurance plan
(Hospital Care)

Critical Illness Plans: These health insurance plans provide you coverage against critical
illnesses such as heart attack, organ transplants, stroke, and kidney failure among others.
These plans aim to cover infrequent and higher ticket size medical expenses. Click to
know about our critical illness plans (Crisis Cover, Health Assure Plus)

Specific Conditions Coverage: These plans are designed specifically to offer health
insurance against certain complications due to diabetes or cancer. They may also include
features such as disease management programs which are specific to the condition
covered. Click to know more about our diabetes (Diabetes Care, Diabetes Care
Plus, Diabetes Assure) and cancer (Cancer Care, Cancer Care Plus) suite of products.

HEALTH INSURANCE

Health insurance policies insure you against several illnesses and guarantee
you stay financially secure should you ever require treatment. They
safeguard your peace of mind, eliminate all worries about treatment
expenses, and allow you to focus your energy on more important things, like
getting better. Let's learn more about the various types of health insurance
available, and what the best policy for you might be.

Health Insurance policies in India - An Overview

There are several health insurance or medical insurance plans in India. These
can be divided into the following categories based on the coverage offered:
Hospitalization Plans: These health insurance plans cover your expenses in
case you need to be hospitalized. Within this category, products may have
different payout structures and limits for various heads of expenditure. The
hospitalisation coverage may be reimbursement based plans or fixed benefit
plans. These plans aim to cover the more frequent medical expenses. Click
to know about our hospitalisation insurance plan (Hospital Care)

Critical Illness Plans: These health insurance plans provide you coverage
against critical illnesses such as heart attack, organ transplants, stroke, and
kidney failure among others. These plans aim to cover infrequent and higher
ticket size medical expenses. Click to know about our critical illness plans
(Crisis Cover, Health Assure Plus)

Specific Conditions Coverage: These plans are designed specifically to offer

health insurance against certain complications due to diabetes or cancer.
They may also include features such as disease management programs
which are specific to the condition covered. Click to know more about our
diabetes (Diabetes Care, Diabetes Care Plus, Diabetes Assure) and cancer
(Cancer Care, Cancer Care Plus) suite of products.

5 reasons why health insurance is a must

Indians at greater risk

Reason 1: Lifestyles have changed. Indians today suffer from high levels of
stress. Long hours at work, little exercise, disregard for a healthy balanced
diet and a consequent dependence on junk food have weakened our immune
systems and put us at an increased risk of contracting illnesses.

Reason 2: Rare non-communicable diseases are now common. Obesity, high

blood pressure, strokes, and heart attacks, which were earlier considered
rare, now affect an increasing number of urban Indians.
Shocking Truths

18% of the urban population suffers from hypertension, which leads to renal
failure, stroke and cardio-vascular diseases

30% of the population suffers heart attacks before age 40

66% of deaths today are due to cardio-vascular diseases

Almost 3.5 million Indians suffer from diabetes

Cardio-vascular diseases (CVDs) like heart disease and stroke are the main
causes of death and disability

The Cost Factor

Reason 3: Medical care is unbelievably expensive: Medical breakthroughs

have resulted in cures for dreaded diseases. These cures, however, are
available only to a select few. High operating expenses—therapy for breast
cancer costs as much as Rs. 2 lakhs for 3 days—have restricted treatment to
the richest. In fact, even among the affluent groups, 20% need to sell their
valuable assets so they can accumulate the required amount to meet
healthcare costs.

Reason 4: Indirect costs add to the financial burden: Indirect sources of

expense—travel, boarding and lodging, and even temporary loss of income
—account for as much as 35% of the overall cost of treatment. Most often,
we overlook this fact when planning for medical expenses.
Reason 5: Incomplete financial planning: Most of us have insured our home,
vehicle, child’s education, and even our retirement years. Ironically
however, we have not insured our health. We ignore the fact that illnesses
strike without warning—and seriously impact our finances and eat into our
savings in the absence of a good health insurance or medical insurance plan.
Over two thirds of all Indians sell assets or dip into existing savings to meet
healthcare costs.

Selecting the Right Plan

Sound health cover planning ensures you receive both, direct medical
expenses and indirect expenses, as soon as any medical emergency or
hospitalisation event occurs.

When investing, choose a health insurance solution that:

Covers a wide spectrum of medical conditions from the most basic to the
most critical health complication

Includes a combination of reimbursement and fixed benefit plans, which

enable you to meet health expenses that include direct and indirect costs

An ideal health insurance solution must help cover for both the frequent and
low cost medical expenses while also enabling adequate coverage to meet
less frequent high cost critical complications as described in the diagram
below
Point to Remember: Select a health solution by taking into consideration
factors such as income, age, number of dependants, quality of care desired,
current coverage etc.

Quick tip

When choosing a health insurance plan, ensure that the plan:

Ensures long-term coverage

Has very clear and transparent norms

Provides a hassle free claims process

ICICI PRUDENTIAL LIFE INSURANCE COMPANY

HEALTH INSURANCE PRODUCTS

ICICI Prudential offers health insurance plans under the following major
need categories:

Hospitalisation Plans

MediAssure

Hospital Care

Critical Illness Plans

Crisis Cover

HealthAssure Plus

Cancer Products

Cancer Care

Cancer Care Plus

Diabetes Products

Diabetes Care Active

Diabetes Care
Diabetes Care Plus

Diabetes Assure

Why ICICI Pru MediAssure?

Health problems, in most cases, strike us unexpectedly, resulting in a sudden

financial burden. Despite this, only around one in every fifty Indians, is
covered through some form of individual medical insurance. Further, it has
been observed that 2 out of every 5 individuals hospitalised in India end up
either borrowing money or selling assets to cover healthcare costs. This
situation is set to escalate further as private health care spends in India are
estimated to increase by 2 to 3 times over the next 12 years.

Hence you need a solution that gives you peace of mind by providing
financial cover to both you and your family against unforeseen
hospitalisation events.

So what should you look for when buying a medical/hospitalisation cover:

Does the plan guarantee you insurability at renewal irrespective of your

health status?

Does the plan ensure that no new exclusions are added or no increase in
premiums occurs just because a claim is made?

Does the plan clearly state exclusions at the time of taking the policy and
also offer you cover against pre-existing conditions?

ICICI Prudential Life Insurance presents MediAssure, a health insurance

plan with a AAA guarantee for the family
Assured cover till age 75 years

Assured coverage for accepted pre-existing illnesses after 2 years

Assured price for 3 years

Moreover, this policy covers all your hospitalisation needs with the
flexibility to choose your location and quality of treatment.

At a glance

Term 3 years

18 - 65 years for individual policies

Min/ Max age at 90 days–65 years for dependents in a family
entry floater
Maximum cover ceasing age for children is 25
years under the family floater
Rs 2 lacs, Rs 3 lacs, Rs 5 lacs, Rs 7 lacs, Rs 10
Annual Limits
lacs
Premium Modes Monthly, Half yearly, Yearly
Guaranteed Renewablity
Renewability
(subject to a cover ceasing age of 75 yrs)
30 Days
Waiting Period (No waiting period applies for claims due to
accident)
Premium Plan
Plan Types
Classic Plan
Yearly
Premiums (Male/
Female) Premiums shown below are for an Annual Limit
of Rs 5 lacs
(in Rs.)
 Age Classic Premium
25 5,602 7,770
30 5,762 8,008
35 6,417 8,991
40 7,851 11,142
45 9,903 13,953
50 12,124 17,284
55 15,153 21,827

Premiums are shown for an individual option

with an annual payment mode and are exclusive
of service tax and education cess.

Features & benefits

Key Benefits of the MediAssure policy

Hospitalisation coverage for your family under a single policy

Pre-existing illnesses & conditions covered subject to underwriting

Guaranteed insurability up to 75 years of age

Coverage for Pre & Post-Hospitalisation expenses

Over 125 day care procedures covered

No claim bonus of 5% of annual limit for every claim free policy year

Cashless Hospitalisation in over 4000 network hospitals

Flexibility in upgrading hospital room facilities with additional co-pay

Avail tax benefits on premium paid u/s section 80D of IT Act, 1961
Benefits in detail

1.Family Floater
With the family floater option, you can additionally cover your spouse and
up to the first three dependent children to the same annual aggregate limit.

2.Guaranteed insurability up to 75 years of age

You can renew the policy once and within 30 days from the termination date
with the same terms and conditions. You can further renew the cover under
the then offered ICICI Pru MediAssure product or its nearest substitute
within 30 days from the policy termination date. The outstanding waiting
period from the current policy will be applied on continuation of cover. Your
premium payable on renewal and on subsequent continuation of cover shall
be reviewed subject to IRDA approval.

3.Pre exiting illnesses covered

Pre existing illnesses and conditions which are declared at inception and
specifically accepted by the company would be covered under this policy.
For conditions of diabetes or hypertension which are disclosed at inception
and which are accepted for cover, any complications arising from these
conditions will be covered after the first two consecutive policy years.

4.Pre-Hospitalisation and Post Hospitalisation Cover

Pre-Hospitalisation expenses up to 30 days prior to hospitalisation and post-

hospitalisation expenses up to 60 days from the date of discharge are also
covered. The Pre and Post Hospitalisation expenses would be covered only
in case the expenses incurred are due to the main hospitalisation event.

5.Day Care Treatment Cover

In addition to hospitalisation, you are also covered for procedures which

require less than 24 hours of hospitalisation. These include over 125 listed
day care surgeries, Parenteral Chemotherapy, Radiotherapy, Intervention
Cardiology, Intervention Radiology, Radio frequency Ablation Treatment,
Lithotripsy and Dialysis.

6.No Claim Bonus

You are entitled to a 5% increase in your annual limit for every claim free
year subject to a maximum of 25% increase in the annual limit. Incase a
claim is made during a policy year; the bonus amount would revert to 0% in
the following year.

ICICI Pru MediAssure - How does

MediAssure work?

W
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HOW DOES MY PLAN WORK?
WHAT HAPPENS WHEN I ACCESS OUT OF NETWORK
FACILITIES?
WHAT HAPPENS IN AN EMERGENCY?
What does MediAssure cover?

The policy provides you cover against inpatient hospitalisation, procedures

and surgical expenses that require a minimum of 24 hours hospitalisation. In
addition, over 125 day-care procedures are also covered.

The following expenses incurred during hospitalisation are covered, subject

to your annual limit:

a. Room, Boarding and Nursing Expenses as charged by the hospital where

the Insured availed medical treatment
b. Intensive Care Unit (ICU) charges
c. Fees for Doctor, Surgeon, Anaesthetist, Medical Practitioner, Consultant
and Specialist
d. Anaesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical
Consumables, Medicines and Drugs, Diagnostic Materials and X-ray,
Dialysis, Chemotherapy, Radiotherapy, Cost of Pacemaker, Cost of
Artificial Limbs
e. Pre and Post hospitalisation expenses related to the hospitalisation

Please note:
Payout for Doctors’ fees (including surgeon, anaesthetist) will be limited to 30% of
eligible claim amount for inpatient claims.
Payout for artificial limbs would be limited to lower of Rs 25,000 or 10% of the Annual
Limit.

How does your plan work?

Choosing your plan is very simple

Step 1: Set your Annual Limit

The Annual Limit is the maximum benefit payable under the policy towards
all the eligible medical expenses described above and incurred during a
policy year. You can select between various Annual Limit options i.e. Rs 2
Lacs, Rs 3 Lacs, Rs 5 Lacs, Rs 7 Lacs or Rs 10 Lacs.

Step 2: Select your Network

You can choose between the Premium and Classic plans. The Premium plan
gives you access to all List A and List B hospitals across India. The Classic
plan gives you access to all List A hospitals across India along with limited
access to List B hospitals as shown in the table below.

Plan Type
Eligible
Premium Classic
Room Type
Upto Single List A hospitals
List A hospitals all over India
A/C room all over India
All List B hospitals all over
All List B
Upto Twin India except districts of
hospitals all
A/C room Mumbai, Navi Mumbai and
over India
Thane

What happens when you access out of network facilities?

A co-pay of 20% on the eligible medical expenses will be applicable in case

you either

• Upgrade to a higher room type in the network hospitals, eg, a single A/C
room at List B hospital, or,
• Access facilities at hospitals not listed in the chosen network, eg, if you
have chosen the Classic plan and access care at a List B Mumbai hospital,
or, if you access care at a hospital not given in List A or B.

Please Note: Co-pay is that percentage of the total eligible medical expenses that is borne
by you while the balance is settled by the Company

What happens in an emergency?

In case of emergency hospitalisation related to cardiac or trauma cases, co-

pay will not be levied even when the hospital is outside your chosen
network. However your room eligibility in such a case will be to the extent
of twin-share A/C room only.

Claims Process

With ICICI Prudential’s MediAssure policy, you can now plan ahead, be in
control in any medical eventuality and focus on getting better without
having to worry about the money. ICICI Prudential provides a seamless and
hassle-free claims experience with MediAssure.

The claims can be under two scenarios:

Planned Hospitalisation

Emergency Hospitalisation
 Claims can either be in a ‘Network Hospital’ or in ‘Non-Network Hospital’
depending on the need and location of the claim.

On issuance of the policy, as part of the Welcome Kit, you will receive the
following:

• Health Card - a card with your unique policy number and 24 hours Claims
Helpline Toll Free number. This card can be utilized only in Network
Hospitals)
• List of Network Hospitals (An updated list would be available at
www.iciciprulife.com)
• Claims and Pre-Authorization Forms

When there is a need for hospitalization (includes day care procedures), you
can inform ICICI Prudential about hospitalisation by calling on the contact
number provided on the health card. You need to provide following
information when you call ICICI Prudential about the claim

• Name of insured person

• The Policy Number (as mentioned on the health card)
• Nature & Details (location, date of accident or commencement of sickness,
etc.)
• Name & Address of Hospital for treatment

All the above information can be provided to ICICI Prudential immediately

or prior to availing treatment and in any case within 4 days of hospitalization
in case of a network hospital.

The below mentioned documents would need to be submitted to the

company inorder to process the claim.
1. Duly filled & signed original claimant application form.
2. Photocopy of the policy certificate.
3. Duly attested original claim file documents from hospital authority.
4. All original investigation reports validating the diagnosis for which the
LA has been hospitalized.
5. Original discharge summary for the patient detailing the onset, duration &
progression of clinical symptoms & diagnosis .
6. Original detailed bill breakup for the expenses incurred with all invoices .
7. Copy of MLC/FIR as applicable.
8. Letter from Competent authority detailing history of circumstances
surrounding injury or clearly mentioned in discharge summary.
9. Photocopy of health card
10. Photocopy of additional photo ID proof

All the documents need to be attested by self as well as competent medical

authority from the provider where the treatment was sought.

From time to time in select circumstances further document requirements

may be triggered by way of –

First OPD consultation papers

Indoor case papers for hospitalization

Certificate from competent medical authority validating medical facts

Please note additional documents may be warranted / asked for at the time of
claims adjudication in exceptional circumstances.
Pre & Post Hospitalisation treatment

In case of Pre Hospitalisation treatment all supporting claim papers /

documents as listed above should be submitted within 7 days after discharge
from the hospital.

In case of post Hospitalisation treatment, all supporting claim papers /

documents as listed above should also be submitted within 7 days after
completion of such treatment (up to 60 days or actual period which ever is
less) to the Company. All documents must be duly attested by the insured
person.

Points to remember for a smooth claim settlement:

To ensure faster processing and settlement of claims, please adhere to the

following.

Complete disclosure:
Make sure that all the information related to your health is given to the
company as this would ensure faster settlement of claims and avoid
disappointments later. Please refer to the copy of your application form in
the welcome kit to check the disclosure made by you.

Claims intimation and processing:

You have to provide complete and accurate information asked by the
company at the earliest to ensure faster claim settlement. Please refer to the
policy document for details

Why Hospital Care?

Today, when you are young and healthy, planning for a contingency is not
always a priority but the cost of treating even the smallest of ailments is on
the rise. You realize it only when you or your loved ones has to undergo
some medical emergency and you are faced with the challenge of organizing
funds to meet the hospitalisation related expenses. Hence a medical
emergency comes not only with emotional turmoil but also with a huge
expense attached to it.

During such an unexpected situation, your only concern should be that the
best doctors and medical facilities are available and cost should not be a
constraint so that you can take care of things without compromise but to
ensure that best in class treatment is provided, the key to that is to be
financially prepared for it.

To help you manage this unexpected emergency, ICICI Prudential, India's

No. 1 private life insurer presents Hospital Care - a comprehensive insurance
policy that has:

Facility of cashless hospitalisation in more than 3000 network hospitals.

Benefit amount will be paid in addition to payment received by you from

other medical insurance plans.

You will receive lump-sum benefit amount, irrespective of the actual billing.

Long term guaranteed coverage up to 20 years.

Tax benefits on premium paid up to Rs.15,000 under Section 80D.

Hospital Care at-a-glance

Minimum / Maximum Age of 1 year - 60 years (age nearest

Entry birthday)
Minimum / Maximum Policy
10 years - 20 years
Term
Maximum Cover Ceasing Age 80 years
Premium Payment Frequency Yearly, half-yearly & monthly
No maturity / death benefit is
Maturity / Death Benefit
payable

The premiums are valid for one year from the date of commencement of the
policy. Thereafter, the company reserves the right to change the premium.
Any change in the above premiums will take place subject to approval from
IRDA and after giving notice to the policyholder. These premiums are
exclusive of any service tax and education cess.

Premium rates for Male and Female lives for term 10 - 20 years excluding
service tax and Education cess.

Age Band Plan A Plan B Plan C Plan D

1-5 2,876 4,685 6,494 8,304

2,631 4,174 5,717 7,263

6-10

11-15 3,415 5,742 8,068 10,394

16-20 3,905 6,720 9,535 12,351

21-25 4,062 7,034 10,005 12,977

26-30 4,330 7,570 10,810 14,050

31-35 4,861 8,631 12,402 16,172

36-40 5,542 9,991 14,439 18,888

41-45 6,532 11,967 17,402 22,837

7,883 14,662 21,440 28,218

 46-50

A summary of the benefits payable on the insured events is given in the table
below

How and when Size of such benefits/

Event
benefits are payable policy monies

1.Hospitalisation for
1.Hospitalisation more than 24 hrs. 1. 1.Plan's DHCB will be
for more than 24 The patient is paid for each day of
hrs. charged for at least 2 hospitalisation.
full days room &
board.

2.An additional 50%

2.Admission to 2.If admitted to an
of plan's DHCB for
ICU ICU
each day of admission

3.If hospitalised for 3.An amount equal to

3.Convalescence more than 5 days 3 times the plan's
continuously. DHCB.

4.If any surgery is 4.Based on the

performed severity of the surgery
4.Surgery a multiple of the plan's
DHCB is paid.
 5.Death during the 5.No benefit is
5.On death
term of the policy payable

6.At the end of the 6.No benefit is

6.Expiry of policy
term of the policy payable

7.No benefit is
7.On stopping of
7.Surrender/Lapse payable on
premiums
Surrenders/Lapses.

Features & Benefits of Hospital Care.

Features of Hospital Care

1. Hospitalisation Benefits (DHCB)

Get a benefit amount if you are hospitalized for more than 24 hours i.e. at
least 2 consecutive nights and must be charged for 2 days room expenses.

The benefit amount is fixed and will be paid irrespective of actual

hospitalisation expenses

DHCB is payable for hospitalisation up to 90 days per policy year, which

includes any days spent in Intensive Care Unit.
2. Intensive Care Unit (ICU) benefit

An additional 50% of DHCB amount per day is paid to you if you get
admitted to an Intensive Care Unit (ICU), and this amount is paid depending
on the plan chosen.

The ICU benefit is payable for hospitalisation up to 30 days per policy year,
and is paid in addition to DHCB.

3. Recuperating benefit

A post-hospitalisation benefit amount in addition to all other amounts will

be paid out to ensure that follow-up tests, medicines and consultations go
ahead as planned .

You are eligible for recuperating benefit only on being hospitalized

continuously for 5 or more days DHCB.

4. Surgery benefit

Over and above the hospitalisation expenses, a fixed lump-sum amount is

also paid for more than 900 surgical procedures. These surgeries have been
classified into four grades, depending on the type and severity. A sample list
of surgeries is given below:

Grades Surgeries
1 Tennis elbow release, bladder stone
 removal
2 Hernia, Removal of uterus
Removal of kidney, removal of thyroid
3
gland
Open heart surgery, removal of brain
4
tunour

Claims Process

THE GUIDE TO EASY CLAIMS WITH HOSPITAL CARE

The claims can be under two scenarios:

- Planned Hospitalisation
- Emergency Hospitalisation

It can either be in a 'Network Hospital' or in 'Non-Network Hospital'

depending on the need and location of the claim.

THE CLAIMS PROCESS

On issuance of the policy, as part of the Welcome Kit, you will receive the
following:

Health Card (a card which has your policy number and contact information
of ICICI Prudential and it can be utilized only in Network Hospitals)

Network Hospital List

Claims and Pre-Authorization Forms

When there is a need for hospitalization, you can inform ICICI Prudential
about hospitalisation by calling on the contact number provided on the
health card. You need to provide following information when you call ICICI
Prudential about the claim

Your Policy Number (as mentioned on the health card)

Name of insured person who is hospitalized.

Nature & Details (location, date of accident or commencement of

sickness)

Name & Address of Hospital, where life insured is admitted

All the above information can be provided to ICICI Prudential immediately

or prior to availing treatment and in any case within 4 days of hospitalization
in case of a network hospital.

Photocopies or duplicates of the following documents will be needed to

process the claim:

Copy of policy certificate

Claimant's Statement form

Duly filled claim form (provided along with the welcome kit or available on
our website)

Treating Doctor's Certificate

Copy of Indoor Case Papers

Hospital Discharge Card/Summary

Medical evidence in form of diagnostic reports, prescriptions, bills with

breakup, any other document to support hospitalization / surgery.
Besides the above, if required, ICICI Prudential may request for additional
documents / information, if any, for processing the claim.

CASHLESS Hospitalisation in a NETWORK HOSPITALS

a. PLANNED HOSPITALISATION

Step 1: Call and inform ICICI Prudential (on the help line number provided
on the reverse of the health card) about the planned hospitalization 4 days
prior to the treatment, before admitting into the hospital.
Step 2: Download the pre-authorization form from our website
(www.iciciprulife.com) or you could even visit any of our branches.
Step 3: To gain access to the network hospitals, just show your health card
and also submit a duly filled pre-authorization form at the treating hospital.
Step 4: The forms shall be scrutinized and further processed and the cashless
facility will be activated. We will inform you about the cashless facility
being activated through SMS. Also the status of the case will be updated on
the website.
Step 5: On discharge, you need to sign the required documents at the
hospital.
Step 6: ICICI Prudential will pay the amount to hospital.

b. EMERGENCY HOSPITALISATION

Step 1: In case of emergency, first admit the patient in the Hospital and then
inform ICICI Prudential, within 24 hours. You can call up on the number
provided on the reverse of the health card.
Step 2: As it's an emergency, you have the facility of collecting the pre-
authorization form from the treating hospital or you could even download
the pdf format from the website.
Step 3: Show your health card to the network hospital and also submit the
pre-authorization form to the treating hospital.
Step 4: The forms shall be scrutinized and further processed and the cashless
facility will be activated.
Step 5: On discharge, you need to sign the required documents.
Step 6: ICICI Prudential will pay the hospital.
The Cashless Settlement Scenario:

Hospital bill amount is more than your eligible amount: ICICI prudential
settles the eligible amount with the hospital and balance bill amount is
payable by you.

Hospital bill is less than eligible amount: ICICI Prudential settles the claim
with the hospital and the balance eligible amount is paid to you

2. HOW TO CLAIM IN CASE OF HOSPITALISATION IN NON-

NETWORK HOSPITALS

While it's suggested that you choose a network hospital, you are at liberty to
choose a Non-network hospital also. In case you avail treatment in a non-
network hospital, ICICI Prudential will pay you the eligible amount as per
the plan opted by you.
Step 1: Get admitted to the hospital and take the complete treatment.

Step 2: Settle the relevant bills in full, on discharge.

Step 3: Collect all the treatment papers along with the doctor's prescriptions,
investigation reports, Hospital Discharge card, photocopies or duplicates of
medical bills and receipt of hospital Bills and copy of FIR (if any, in case of
an accident).
Step 4: Lodge your claim by filling in the claim form (you can collect the
claims forms your nearest ICICI Prudential branch or the website.) and
attach all the required documents, within 60 days from the date of discharge.

The claim will be processed within 7 working days from the date of
receiving all the required documents.
PROCESS AT A GLANCE:

Why Crisis Cover?

Life is hectic in today's fast paced world. Along with the rapid pace and
progress comes the bane of modern life such as increased stress, poor diet
and lack of exercise. The alarming aspect is that, owing to these factors,
more and more Indians are becoming vulnerable to critical illnesses every
year. These illnesses, coupled with increasing costs of treatment, have made
recovery a long and expensive process.

It goes without saying that securing your family's financial future is a part of
prudent financial planning. However, no less important is your health and
well-being, for which you need a comprehensive health coverage. And,
given our lifestyles, it should ideally be a plan that provides complete
protection against Disease, Disability and Death.
Keeping this need in mind, ICICI Prudential Life Insurance presents Crisis
Cover. This all-inclusive long term insurance policy provides coverage
against 35 critical illnesses, total and permanent disability, and also death.

So, get the right protection tailored to suit your lifestyle, with this plan
which is
• Comprehensive
• Affordable
• Long Term

Crisis Cover at-a-glance

Eligible Age 18 years to 60 years

Coverage term 10 years to 50 years

Maximum Coverage
75 years
Ceasing Age

Rs. 300,000 to Rs. 2,000,000

Sum Assured
 Premium payment
Monthly, Half-yearly, Annual
frequency

As per prevailing tax laws under

Tax Benefit
Section 80C & 80D

Modes of Premium Payment:

Premiums are payable through any of the following modes:

Cash*

Cheques

Demand Drafts

Pay Orders

Bankers Cheque

Internet facility as approved by the Company from time to time.

Electronic Clearing System

Credit Cards (Only standing instruction)

*Amount and Modalities will be subject to company Rules and relevant
legislation/regulations

Premium Payment frequency:

Your Premium will fall due in every policy year based on the periodicity of
payment of premiums, i.e.

Yearly,

Half-Yearly or

Monthly

How much does the coverage cost?

The most comprehensive coverage is also affordable. Below are the annual
premium rates for a Sum Assured of Rs. 500,000 for various policy terms
and entry ages for Males.

Age(Years) Policy Term

15 years 20 years 25 years
25 Rs. 2435 Rs. 2474 Rs. 2734
30 Rs. 2896 Rs. 3204 Rs. 3738
35 Rs. 4106 Rs. 4724 Rs. 5576
 40 Rs. 6282 Rs. 7281 Rs. 8442
45 Rs. 9804 Rs. 11,182 Rs. 12,554

Premium in Rupees

The premiums are guaranteed for first five years from the date of
commencement of the policy. Thereafter, the premiums are annually
reviewable. Any change in premium will only be effected with approval
from IRDA.

Above premiums are inclusive of modal rebate and Large SA discount &
exclusive of any service tax and education cess.

Waiting Period:

No benefit in respect of Critical Illness Benefit (CIB) or Total & Permanent

Disability Benefit (TPDB) will be payable if it has occurred due to sickness
within the first 6 months of the policy or first 3 months of the policy
reinstatement date where the policy has lapsed for more than 3 months.

Crisis Cover Benefit, Critical Illness Benefit, Crisis Cover India

K
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HOW DOES CRISIS COVER WORK?
FLEXIBLE PAYOUTS FOR THE 35 CRITICAL ILLNESSES
COVERED
CLAIMS PROCESS MADE SIMPLE
DEFINITION OF CRITICAL ILLNESSES COVERED
LIST OF EXCLUSIONS

Key benefits of Crisis Cover

Benefit amount paid on diagnosis of any of the 35 diseases (critical

Illnesses), disability or death

Receive lump-sum benefit amount irrespective of actual billing

Benefit amount will be paid in addition to payment received by you from

other medical insurance plan

Long term coverage upto 75 years of age

Coverage continues even after claiming benefit on select critical illness

Premium paid is eligible for deduction under section 80C & section 80D*
* The overall limit of deduction for investment u/s 80C & u/s 80D of the Income Tax
Act, 1961 are Rs. 1,00,000 & Rs. 15,000 respectively, subject to conditions mentioned
therein.

How does Crisis Cover work?

Choose a Sum Assured under Crisis Cover

Pay Premium based on your age and sum assured and term of cover chosen

Get the applicable sum assured in the event of being diagnosed with a
critical illness or on being rendered totally disabled or on death, whichever
occurs first.

Remain covered even after a claim on select Critical Illnesses

Get the Sum Assured on under the plan on first occurrence of Death or Total
Permanent Disability or on diagnosis of any one of the following 35 Critical illnesses.

Flexible Payouts for the 35 Critical Illnesses covered

Flexible payouts for 35 Critical Illnesses covered are as below:

CI with Full Payout CI with Coverage Continuation

Advantage Advantage
Apallic Syndrome Angioplasty*
Benign Brain Tumour
Alzheimer's Disease
Blindness
Aplastic Anaemia
Brain Surgery
Cardiomyopathy
Cancer
Deafness
Chronic Lung Disease
Loss of Speech
Coma
Medullary Cystic Disease
Coronary Artery Bypass
surgery Motor Neurone Disease
End stage liver disease Multiple Sclerosis
Heart Attack Muscular Dystrophy
Heart Valve Surgery Parkinson’s Disease
Kidney Failure Poliomyelitis
Loss of Independent Primary Pulmonary hypertension
existence
SLE with Lupus Nephritis
Loss of Limbs

Major Burns

Major Head Trauma

Major Organ Transplant

Paralysis

Stroke

Surgery to aorta

Terminal Illness
The Critical Illnesses with Full Payout Advantage : Get the full benefit
amount for Critical Illnesses covered under this category. The benefit
amount payable is equal to the full sum assured chosen under the policy.

The Critical Illnesses with Coverage Continuation Advantage : The

maximum benefit amount payable is Rs. 500,000* for Angioplasty and Rs.
1,000,000 for all other critical illnesses in this category and the cover
continues for all other remaining illnesses benefits for the remaining sum
assured chosen under the policy.The premium is also revised proportionately
on the following Policy anniversary for the reduced Sum Assured.

* 50% of sum assured with a max limit of Rs. 500,000

Death or Total & Permanent Disability

The Full Sum Assured as chosen under the plan is paid in the event of Death
or Total Permanent Disability of the Life Assured. This benefit is payable
even if death or disability occurs because of an accident.

Claims Process made simple

Our claims process is an easy 3-step process. This will ensure that you get a
hassle-free and convenient claims experience.

Submit a written notice along with the proof of diagnosis of the critical
illness / disability / death required for claim.

The company verifies the documents and admits the claim.

The company pays the entire benefit amount as applicable.

LIC PRODUCTS

LIC's Health Plus

New Features :

LIC's Health Plus (Plan 901) : Health Plus is a first ever UNIT LINKED
HEALTH INSURANCE PLAN launched by L.I.C. of India. Health Plus
Unit Plans policy guards against the trauma that you may face due to
increased financial burden during hospitalization.The worst nightmare that
anyone can have is the one when a family member is hospitalized. Today,
when everything is uncertain nobody can be sure what will happen. A
seemingly small ailment can turn into major one. And what happens when
the earning member of your family is hospitalized? The family goes through
the trauma of a loved one being hospitalized as well as an increased financial
burden. There are hospitalization expenses, doctors fees and various tests to
be carried out.. Meanwhile the patient loses out on his earning for being
away from work, and a dismayed and worried family begins to feel the
anxiety of the financial implications.But with a policy from LIC you and
your family can rest assured!

LIC's Health Plus is unit linked Health Insurance plan which provides for
insurance cover against following health risks:
Hospital Cash Benefit (HCB)
Major Surgical Benefit (MSB)

Provision for reimbursement of domiciliary treatment expenses

Eligible for a person (the Principle Insured (PI)) aged between 18 and 55
covering himself / herself. The spouse and/or dependent children may also
be covered under the policy

Premiums can be paid regularly either in yearly or half yearly or monthly

(through ECS only) installments

Provision to increase premiums in multiples of Rs. 500/-. under the plan if a

request is received from the PI in writing

Benefits payable on Hospitalization:

If PI or any of the Insured lives covered under the policy is hospitalized due
to Accidental Body Injury or Sickness, an amount equal to the daily Hospital
Cash Benefit, available under the policy during that policy year, shall be
payable subject to terms and conditions.
The amount of Daily Benefit will increase at each policy anniversary by 5%
of the Initial Daily Benefit till it reaches a maximum of 1.5 times the Initial
Daily Benefit

Major Surgical Benefit:

In the event of PI or any of the Insured lives covered under the policy, due
to medical necessity, undergoing any of the surgeries defined, the respective
benefit percentage of the Major Surgical benefit Sum Assured, as specified
against each of the eligible surgeries mentioned, shall be payable subject to
terms.This benefit will remain fixed and there shall not be any increases in
subsequent years.

Domiciliary Treatment Benefit :

If at least 3 years' premiums have been paid, an amount shall be payable out
of Policy Fund equal to the actual amount spent to meet any domiciliary
treatment expenses or any other medical expenses over and above those paid
through hospital cash/ surgical benefits incurred in respect of PI or any of
the other Insured lives at any time, subject to all the following conditions
being satisfied for each payment:
 claimed amount is atleast Rs. 2,500 ;
maximum amount that can be paid shall be 50% of the Policy Fund at
the date of payment;
minimum balance of one annualized premium left in the Policy Fund
after making the payment.

Premium amount paid upto Rs. 15000/- p.a .is eligible for tax exemption
under SEC 80-D of the Income Tax Act

Health Insurance Products

ICICI Prudential offers health insurance plans under the following major need categories:

Hospitalisation Plans

• MediAssure
• Hospital Care

Critical Illness Plans

Understand Critical Guard

1. What is Critical Guard?

Critical Care protects you or your spouse against loss of income on diagnosis of
any of the 9 major medical illnesses and procedures. The first of its kind, it offers
a lump sum benefit on diagnosis of Cancer, Bypass Surgery, Heart Attack,
 Kidney Failure, Major Organ Transplant, Stroke, Paralysis, Heart Valve
Replacement Surgery or Multiple Sclerosis. Critical Care Insurance also provides
cover against accidental death and permanent total disablement (PTD).
2. Choice of Coverage
Sum Insured Rs. 3, 6 or 12 Lakhs
Critical Care offers you a choice of coverage on both the sum insured and the
tenure of the policy. You can choose the sum insured of Rs 3, 6 or 12 Lakhs over
a period of 1, 3 or 5 years. The premium would be calculated accordingly: The
cover would include:
o Major Medical illness and procedures
o Accidental Death
o Permanent Total Disablement (PTD) on account of Accident leading to
inability to remain gainfully employed

Why HealthAssure Plus

Illnesses have a way of sneaking up on us, weakening our financial stability

and stealing our family's peace of mind. It is best to keep oneself insured at
all times against the most critical illnesses that are also the most common:
Cancer, Coronary Artery Bypass Graft or Surgery, Heart Attack, Kidney
Failure, Major Organ Transplant, and Stroke.

ICICI Prudential's HealthAssure Plus financially insures you against these

six critical illnesses. Should you ever be diagnosed with one or more of
these, HealthAssure Plus provides you with a fixed sum, irrespective of your
actual medical expenses. The health plan thus shoulders the heavy costs of
your treatment and ensures you stay financially stable, come what may.

This financial guarantee during illness is not all that HealthAssure Plus
delivers. HealthAssure Plus comes with an added benefit: it insures your
life, as well. So should an unexpected accident or disability claim your life,
your family will receive the entire Sum Assured-an amount large enough to
ensure they live securely, even in your absence.

Read more about the features and benefits of HeathAssure Plus.

HealthAssure Plus at a Glance

Life and Six Critical Illnesses: Cancer,

Coronary Artery Bypass Graft or Surgery,
Coverage Against
Heart Attack, Kidney Failure, Major
Organ Transplant, and Stroke
Minimum Sum Assured Rs. 1 lakh
Maximum Sum
Rs. 10 lakhs
Assured
Minimum/Maximum
18 years to 55 years
Entry Age
Maximum Age at
65 years
Policy Maturity
Minimum Policy Term 10 years
Maximum Policy Term 30 years
Yes, calculated on basis of no claims
Maturity Benefit
made
Surrender Value Payable after 3 years of plan
15 days from the date on which you
Freelook Period
receive your documents
Tax benefit under Sec. 80 (C) for
Tax Benefits premiums paid towards both, Life and
Critical Illness covers.

Features and Benefits of HealthAssure Plus

Long-term coverage against 6 critical illnesses: Choose a cover, for as long

as 30 years with a premium guarantee for 5 years, depending on your age.

Sum Assured of up to Rs. 10 lakhs: Receive the Sum Assured on diagnosis

of any of the 6 covered critical illnesses: Cancer, Coronary Artery Bypass
Graft/Surgery, Heart Attack, Kidney Failure, Major Organ Transplant, and
Stroke.
Life Insurance Sum Assured: This amount is paid to the nominee should
something happen to the policyholder.

Flexible withdrawal options: Choose to receive the benefit amount either in

a lump-sum amount or in installments over 5 years. These installments will
be payable as 25% in the first years and 20% each year for the next 4 years.

Waiver of premium: Enjoy a waiver of premiums towards your Life Cover

even after you receive the benefit amount on being diagnosed with a critical
illness.

Maturity benefit: Receive a 'No claim benefit' when the policy term ends,
provided you have made no claims during the tenure. The Maturity Benefit
is equal to the sum total of all the premiums paid.

Surrender Value: You can surrender your plan after 3 years of cover. The
Surrender Value will be paid immediately, provided you have paid all your
premiums in the first 3 years.

No medical/other bills: Receive your claim amount on diagnosis without

having to show any bills.

No medical examinations: Enjoy a waiver on medical examinations if you

choose a Sum Assured up to Rs. 5 lakhs.

Tax benefits: Enjoy tax benefits on the premiums you pay (under u/s 80 C)
for premiums paid for both Critical Illness and Life Cover.
Why Cancer Care

As someone who has seen family members and friends struggle to survive
Cancer, you have undoubtedly suffered yourself. You know the extent to
which the illness drains the family; that the loss is both emotional, and
financial.

You would have also read, time and again, articles where medical experts
unanimously agree that Cancer can attack anyone, anywhere, at any time.
But this truth is only one part of the whole picture. Doctors also verify that
those with a family history of Cancer are especially prone to being affected
by it.

Given all these important facts, have you stopped for a moment and asked
yourself, "Why have I not insured myself against Cancer?"

ICICI Prudential suggests you insure yourself, right away, with Cancer
Care-a comprehensive Cancer insurance policy, which enables you and your
family to stay financially and mentally secure should you be diagnosed with
early or advanced Cancer.

Read more about the features and benefits of this plan that provides you with
a Sum Assured of up to Rs. 25 lakhs.

Cancer Care at a Glance

Coverage Against Cancer

Minimum/Maximum Sum 10 units to 25 units (Cover of Rs. 10
Assured lakhs to Rs. 25 lakhs)
Minimum/Maximum Entry
20 years to 55 years
Age
 Maximum Age at Policy
70 years
Maturity
Minimum/Maximum Policy
10 years to 50 years
Term
Minimum Single Premium Rs. 1,200 per annum
15 days from the date on which you
Freelook Period
receive your documents
Tax benefit under Section 80 (D) for
Tax Benefit
premiums paid

Types of Cancer Covered by Cancer Care

Cancer Care covers most forms of early and advanced stages of cancer that
affects both men and women. Following are the most common cancers that
are covered under Cancer care:

Cancers that commonly affects women:

Breast Cancer

Cancer of Cervix

Ovary Cancer

Oesophagus Cancer

Lung Cancer

Cancers that commonly affects men:

Lung Cancer

Oesophagus Cancer
Larynx

Stomach Cancer

Hypolarynx Cancer

Prostrate Cancer

Early cancers that affect men and women:

Hodgkin’s Disease Chronic Lymphocitic Leukemia

Chronic Lymphocitic Leukemia

Cancer of Colon or Rectum

Cancer of Urinary Bladder

Cancer of the stomach, large bowel, bladder, head and neck, liver, pancreas,
gall bladder, brain, kidney, lymphoma, leukemia, thyroid, and skin. These
cancers also affect men and women at an advanced stage.

Features and Benefits of Cancer Care

Comprehensive cancer insurance plan: Get covered for most forms of

cancer. Unique design: Receive pay benefits at both early and advanced
stages.

Cash payouts: Meet your expenses at for diagnosis, treatment and surgery,
with cash payouts at various stages.
Sum Assured up to Rs. 10 lakhs: Receive this amount for a premium as low
as Rs. 250 a month.

Benefits accrued: The benefits accrued if you purchase 10 units (equivalent

to Rs. 10 lakhs) of Cancer Care are enumerated in the table below:

If an early Cancer If no early Cancer

claim has been claim has been
made made
Diagnosis of Early
Rs. 1 lakh NA
Cancer*
Oncological Treatment
Rs. 1 lakh NA
Benefit for Early Cancer
Diagnosis of Advanced
Rs. 5.5 lakh Rs. 6.5 lakh
Cancer
Oncological Treatment
Benefit for Advanced Rs. 1 lakh Rs. 1.5 lakh
Cancer
Surgery for Advanced
Rs. 1.5 lakh Rs. 2 lakh
Cancer
Maximum Cover Rs. 10 lakh Rs. 10 lakh

No medical bills required: Enjoy a hassle-free claim procedure. Receive the

benefit amount without showing any medical bills.

No medical examinations: Enjoy a waiver on medical examinations if you

purchase up to 15 units (equivalent to Rs. 15 lakhs).

Waiver of premium: Have your premiums waived if diagnosed with

advanced Cancer.
Tax benefits:Enjoy tax benefits on the premiums you pay (under u/s 80 D).

If you would like to know more about this plan, please click here for our
advisor to contact you!

Why Cancer Care Plus

This Plan goes a set beyond providing you comprehensive coverage against
Cancer by providing a wellness program to all the Cancer Care Plus policy
holders.

Cancer does not discriminate between the rich and poor, young and old,
educated and uneducated. But the good news is that if detected early, the
chances of surviving the illness increases substantially.

Keeping this in mind, ICICI Prudential introduces Cancer Care Plus - A

wellness plan that includes all the benefits of Cancer Care and also provides
an additional critical benefit: FREE periodical cancer screenings at a partner
diagnostic centre close to you.

These regular cancer screening tests empower you to proactively keep a

track of your health, detecting any early signs of cancer and taking
immediate treatment.

With Cancer Care Plus, you not only safeguard your well-being but also
your savings, which stays intact, for this comprehensive plan pays for
diagnosis, oncological treatment and surgery of early and advanced Cancer.
Cover yourself with Cancer Care Plus today. It is the surest way to keep
yourself well-armed against India's most rapidly growing illness.

Wellness Program

What sets apart Cancer Care Plus is its unique Wellness Program. This is a
screening package that enables you to undergo specific tests, free of cost.
The tests will be conducted once in 2 years, starting from the second year of
the policy. This program will help in diagnosing the possibility of cancer at
the earliest stage, thereby initiating early treatment and increasing the
chances of survival. The tests will be conducted by the Company's
empanelled medical centers.

Benefits of the Wellness Program are applicable only on policies whose

premiums have been paid till date. However, there is no alternative cash
benefit in lieu of these tests.

Cancer Care Plus at a Glance

Coverage Against Cancer

Minimum/Maximum Sum 5 units to 25 units (Cover of Rs. 5

Assured lakhs to Rs. 25 lakhs)

Minimum/Maximum
20 years to 60 years
Entry Age
 Maximum Age at Policy
70 years
Maturity

Minimum/Maximum
10 years to 50 years
Policy Term

Minimum Single Premium Rs. 1,200 per annum

15 days from the date on which you

Freelook Period
receive your documents

Tax benefit under Section 80 (D) for

Tax Benefit
premiums paid

Free Cancer Screen at predefined

Wellness Program frequency for the entire term of the
policy

Types of Cancer Covered by Cancer Care Plus

Cancer Care Plus covers most forms of early and advanced stages of cancer
that affects both men and women. Following are the most common cancers
that are covered under Cancer Care Plus:

Cancers that commonly affects women:

Breast Cancer

Cancer of Cervix

Ovary Cancer

Oesophagus Cancer

Lung Cancer

Cancers that commonly affects men:

Lung Cancer

Oesophagus Cancer

Larynx

Stomach Cancer

Hypolarynx Cancer

Prostrate Cancer
Early cancers that affect men and women:

Hodgkin’s Disease

Chronic Lymphocitic Leukemia

Cancer of Colon or Rectum

Cancer of Urinary Bladder

Cancer of the stomach, large bowel, bladder, head and neck, liver, pancreas,
gall bladder, brain, kidney, lymphoma, leukemia, thyroid, and skin. These
cancers also affect men and women at an advanced stage.

Features and Benefits of Cancer Care Plus

Comprehensive cancer insurance policy that covers most forms of cancer at

both early and advanced stages.

Free Cancer Screening through medical tests under the Wellness Program,
for the entire duration of the policy term.

Benefits in the form of cash payouts at various stages for diagnosis,

treatment and surgery, to help you meet expenses.

Payout is independent of any other medical insurance plan you may have.

Cover up to Rs.10 lakhs against cancer, for a premium as low as Rs 300 per
month#

Future premiums will be waived off if advanced cancer is detected.

Tax benefits under Section 80D on premium paid as per prevailing Income
Tax laws.
# The premium is for a 30 year old male with 10 year term.

Free Cancer Screening Tests: As a Cancer Care Plus Policy holder, you are
entitled for FREE regular Cancer check-ups during the entire duration of the
policy term.

The screening package for the most common cancers amongst men and
women can be availed once in every two years from our network of medical
centres starting from the second policy year depending on the attained age at
that time.

The various tests which will be conducted for different ages are indicated
below:

Age Cancer Screening Test

Clinical Examination, Complete Blood Count

20 to 50
(CBC), Chest X Ray
years

Males
51 years Clinical examination, Prostate specific
and antigen (PSA) test, Stool examination-occult
above blood, Complete blood count, Chest X Ray,
Ultrasound of Upper Abdomen
 20 to 40 Clinical examination, PAP smear, Complete
years Blood count, Chest X Ray

Females
Clinical examination, PAP smear,
41 years
Mammogram, Stool examination-occult
and
blood, Complete blood count, Ultrasound of
above
Pelvis, Chest X Ray

Cash payouts: Meet your expenses for diagnosis, treatment and surgery, with
cash payouts at various stages.

Benefits accrued: The benefits accrued if you purchase 10 units (equivalent

to Rs. 10 lakhs) of CancerCare Plus are enumerated in the table below:

Claim starts at
Claim at Early
advanced cancer
Cancer Stage
stage

Rs. 1 lakh
Diagnosis of Early Cancer* NA
(10% of units)

Rs. 1 lakh NA
(10% of units)
Oncological Treatment
 Benefit for Early Cancer

Diagnosis of Advanced Rs. 5.5 lakh Rs. 6.5 lakh (65% of

Cancer (55% of units) units)

Oncological Treatment
Rs. 1 lakh Rs. 1.5 lakh (15% of
Benefit for Advanced
(10% of units) units)
Cancer

Surgery for Advanced Rs. 1.5 lakh Rs. 2 lakh (20% of

Cancer (15% of units) units)

Rs. 10 lakh
Rs. 10 lakh (100%
Total Cover (100% of
of units)
units)

No medical bills required: Enjoy a hassle-free claim procedure. Receive the

benefit amount without showing any medical bills.

No medical examinations: Enjoy a waiver on medical examinations if you

purchase up to 15 units (equivalent to Rs. 15 lakhs).
Waiver of premium: Have your premiums waived if diagnosed with
advanced Cancer.

Tax benefits: Enjoy tax benefits on the premiums you pay (under u/s 80 D).

Why ICICI Pru Diabetes Care Active?

According to the WHO, India is the diabetes capital of the world, with more
than 20% of the diabetes cases. The main causes are our sedentary lifestyle,
poor eating habits and genetic pre disposition. India also has a high
prevalence of people with Impaired Glucose Tolerance (IGT) or Impaired
Fasting Glucose (IFG), pre-diabetic conditions, which lead to diabetes if not
managed early. Moreover, there is an increasing trend of onset of these
conditions at younger ages in India.

For the many diabetics, the above translates into an altered lifestyle
characterized by change in food habits, physical activity & medication. It
also brings along many serious health complications such as heart attack,
kidney failure & stroke, which may entail a huge financial burden.

On the other hand, regular monitoring, life style changes, medication and
diet control, can lead to a healthy life and postpone or possibly even avoid
the complications.

Keeping in mind the above, ICICI Prudential proudly presents ICICI Pru
Diabetes Care Active. This offering aims to provide you a comprehensive
diabetes management solution. While our Wellness Programme ensures that
you stay healthy, our insurance guarantees financial assistance in case a
critical illness does strikes. The plan aims to encourage, enable & offer you
incentives to manage your diabetes by reducing premiums for good diabetes
management.

Key Benefits of ICICI Pru Diabetes Care Active

Wellness Programme to help you manage diabetes avoid complications

Regular medical testing and annual doctor consultation

Diabetes Coach to facilitate diabetes management

Special offers from our healthcare partners

Support through online tools

Reduced premiums upto 20% on showing good control over your diabetes

Lump-sum amount paid on diagnosis of 7 critical illnesses including

Angioplasty

Long term coverage upto 65 years of age

Tax benefits under section 80D of the Income Tax Act, 1961

Wellness Programme

Managing your Diabetes is the key to staying healthy

To enable you to regularly monitor your health and take necessary care, the
policy provides for a wellness programme, under which, you have to
undergo checkups as per a defined protocol every six months. This protocol
is described below and would be applicable in each policy year.

6th month of every policy year: HbA1c test, blood pressure and pulse

12th month (except in the last policy year*): HbA1c, lipid profile, blood
pressure, pulse rate and a doctor consultation
* The annual check-up would however not be provided for in the last policy
year as it would coincide with the end of the policy term.

Managing diabetes, Reducing premiums

We also offer you an added incentive to maintain good health – by reducing

premiums the next year (shown below). We help you assess your progress
using the "Diabetes Control Index", which uses key factors from your
regular tests and is an overall indicator of your control.

Age at entry
25 - 35 36 - 50 51 - 65
years years years
Premium Reduction
7.50 % 10% 12.50%
Level 1
Premium Reduction
10% 15% 20%
Level 2
However, if your Diabetes Control Index increases, you may be required to
pay a higher premium on your base premium for the following year, as per
table below.

Age at entry
25 - 35 36 - 50
51 - 65 years
years years
Higher Premium Level
10% 15% 17.50%
1
Higher Premium Level
20% 30% 37.50%
2

Diabetes Coach

Aren’t there times when you have wished for someone who could help you
lead a healthy life? We present to you – Diabetes Coach!

What does a Diabetes Coach do?

You will be assigned a specially trained Diabetes Coach who will

collaborate with you in managing diabetes. Your Coach helps you through
following activities:

Diabetes education

Goal setting for diabetes management using DCI

Personalised guidance on diet planning & exercise to achieve goals

Progress tracking and reminders through periodic interactions

Analysis & interpretation of your Wellness Programme test results

 Diabetes Coach Program Structure
Module Frequency
Every 2 weeks for the first Every month
Diet & fitness
3 months thereafter
Goal setting Once in 6 months
Reminder for
Once in 6 months
testing
Test results
Once in 6 months
analysis

In addition, you will also receive support through information booklets and
goal trackers. That's not all. We also present to you our Diabetes Hotline, a
dedicated helpline for all your diabetes related queries. You can call us on
1800 - 419 - 1000 between 10:00 AM to 07:00 PM, Monday to Friday.

Diabetes Hotline and Diabetes Coach are value added initiatives by ICICI
Prudential Life Insurance Company Limited. These initiatives are purely
voluntary and free of charge. ICICI Prudential Life Insurance Company
Limited does not purport to provide advice of any nature. Only general
guidelines will be suggested in order to facilitate you to maintain good
health. We urge you to consult your family doctor for any medical needs as
these guidelines are not medical advice.

Financial Support

We know that when faced with a critical illness, money matters should be
the last thing on your mind. ICICI Pru Diabetes Care Active offers you
coverage till 65 years of age with 3 options of Sum Assured (SA) - Rs 3
lakh, Rs 5 lakh or Rs10 lakh.

ICICI Pru Diabetes Care Active will pay the full Sum Assured on diagnosis
of six critical illnesses and 50% of the sum assured on diagnosis of
Angioplasty, with the unused cover continuing for the remaining critical
illnesses.

The seven critical illnesses covered in the plan are:

Coronary Artery Bypass Graft / Surgery (CABG)

Cancer

End stage renal failure

Heart attack

Major organ transplant (as a recipient)

Stroke

Angioplasty*

Applicable Benefit Amount Payable

Time of diagnosis Benefit amount payable

First 6 months of Return of premiums paid till date and policy
the policy terminates
50% of the sum assured (25% of the sum
6 - 12 months
assured for Angioplasty)
100% of the sum assured (50% of the sum
After 1 year
assured for Angioplasty)
* The claim is payable only on survival for 10 days from the date of
diagnosis of the critical illness. After Angioplasty claim the cover will
continue for 50% of the sum assured for the remaining critical illnesses.

The benefit amount is paid irrespective of your expenses. What’s more, we

don’t ask for any original medical or other bills. This amount can be used for
meeting the cost of treatment and also to take care of additional expenses
arising on illness.

This policy provides additional protection through two optional riders -

Diabetes Enhanced Benefit Rider (DEBR) and Death Benefit Rider (DBR).

Rider Options

ICICI Pru Diabetes Care Active offers you two optional rider benefits which
provide you additional protection.

Diabetes Enhanced Benefit Rider (DEBR)

If you opt for this rider, you get an additional procedure based cover for

LASER Treatment for Diabetic Retinopathy

Limb Amputation

The benefit under this rider shall be payable only once and only upon the
first ever occurrence of either of the above conditions. The benefit payable
shall be 10% of the sum assured under this policy. After the payment of the
benefit, the rider shall terminate but the base plan shall continue.
 Time of diagnosis DEBR payout
First 6 months of the Return of the rider premiums paid till date
policy and policy terminates
50% of the rider sum assured, which is 5%
6 - 12 months of the base plan sum assured is payable and
rider shall terminate thereafter.
100% of the rider sum assured, which is
After 1 year 10% of the base plan sum assured is payable
and rider shall terminate thereafter.

Death Benefit Rider

To provide complete protection to your family, we offer you the optional

Death Benefit Rider (DBR) which pays out 100% of the applicable sum
assured on death of the life assured.

Good control of your health (as indicated by a reduction in DCI) would

entitle you to a reduction in your rider premiums as shown below.

Reduction in DBR Premium

Premium Reduction Level 1 20%
Premium Reduction Level 2 30%

However in case of poor control (as indicated by increase in DCI), you may
be charged an additional rider premium as below :

Increase in DBR Premium

Higher Premium Level 1 25%
Higher Premium Level 2 45%

Note:
Incase on Angioplasty claim under base Diabetes Care Active, the rider will
continue for the 50% of the sum assured for the death benefit and future
premiums will reduce proportionately from the next policy anniversary. The
policyholder will continue to be eligible for the complete wellness
programme and reduced premiums / higher premiums as applicable.
However, subsequent premium reductions/ increase will apply to this
reduced premium.

The Sum assured will be payable on death any time during the policy term
before of a Critical Illness payment.

There is no Waiting period for death.

The levels of premium reduction/ higher premium as explained above are

annually reviewable subject to IRDA approval. The company will give
notice in writing about the change to the policyholder. The policy shall lapse
if the policyholder does not accept such changes.

Health Support

Healthcare Partners

Some of our healthcare partners include;

Monitoring Instruments Manufacturers

Johnson & Johnson

Fitness Centres

Tie-ups with over 250 fitness centre outlets across the country

Web Support
With ICICI Pru Diabetes Care Active, you also get access to a customized
web-pages which have been designed exclusively to help you monitor your
diabetes more effectively by providing you:

Details on your medicals tests & DCI score

Information on effective diabetes management

Information on special offers that you are entitled to our customer

A dedicated helpline to solve all your diabetes related queries

Claims

Claims Process

Our claims process is an easy 3 step process. This will ensure that you get a
hassle-free and convenient claims experience.
Submit a written notive along with proof of diagnosis of criticall illness/
surgery, required for the claim.

The company verifies the documents and admits the claim.

The company pays the entire benefit amount as applicable.

What does ICICI Pru Diabetes What does ICICI Pru Diabetes
Care Active cover Care Active not cover
Financial Cover Financial Cover

Lumpsum paid on diagnosis of 7 The policyholder needs to

Critical Illnesses i.e. Heart survive beyond 10 days of
Attack, Stroke, Bypass Surgery, diagnosis of Critical Illness (CI)
Major Organ Transplant (as to be eligible for a claim payout
recipient), End Stage Renal
Failure, Cancer, and
Angioplasty. (Please refer
to finacial support section for
detailed description)

Diagnosis & Testing Diagnosis & Testing

Wellness Programme Test results from diagnostic

Regular free testing (HbA1c,
Blood Pressure, and pulse rate
test) on every 6th month/year
during the policy term.
centers or doctors who are not
from our empanelled network
will not be accepted / will not be
reimbursed.
Any additional consultation or
tests conducted will not be
covered or reimbursed under the
 An annual comprehensive
medical checkup will be
provided at the end of the each
policy year (except in last policy
year).
plan.
No payment / benefit will be
available against tests not done.

One free consultation with an

expert physician every year.

Test results will be available on

the diabetes care website

Why Diabetes Care?

Diabetes Care is a unique critical illness insurance policy for Type 2

diabetics and pre-diabetics. Diabetes Care not only provides financial
support but also helps you manage your condition more effectively.

Key Benefits of Diabetes Care

Lump-sum payment on diagnosis of any one of the six critical illnesses

Optional cover for eye & foot complications

Wellness program - 3 Free check-ups and a consultation with a doctor every

year

Reduced Premium on display of good control

Tie-ups with leading healthcare partners to help you Manage diabetes

Web support for better diabetes control

Tax benefit under Section 80D of the Income Tax Act

The lump-sum amount is paid on diagnosis, irrespective of your expenses.

We don't require any medical bills and you can use the benefit amount to
meet cost of treatment and any other concomitant expenses.
Improving Health, Reducing Premiums

We offer you an attractive incentive to keep in good health - a reduction in

your premiums (as indicated in the table below). This premium reduction
will be made after periodic check-ups to confirm your good health, for
which we have created a Diabetes Control Index. This index uses key factors
from your regular tests like HbA1c, blood pressure, lipids and weight and is
an overall indicator of your control.

Therefore, if you show good control, your Diabetes Control Index will go
down and your premium will be reduced for the next year by 5% to 30% of
your 1st year's base premium!

Age at Entry (years) 25-35 36-50 51-60

Premium Reduction
5% 10% 12.5%
Level 1
Premium Reduction
10% 15% 20%
Level 2
Premium Reduction
15% 20% 30%
Level 3

If your results worsen or you miss any of the tests, your Diabetes Control
Index will go up. If it rises beyond a scale, you will be required to pay a
higher premium for the following year, as indicated below:

Age at Entry (years) 25-35 36-50 51-60

Higher Premium (over
10% 15% 17.5%
1st year's Base Premium)
Coverage

What Diabetes Care covers/provides?

Financial Cover

Lump-sum amount paid on 1st diagnosis of any of the 6 critical

illnesses, i.e. Coronary Artery Bypass Graft (CABG), Cancer, End
stage renal failure, Heart Attack, Major organ transplant (as a
recipient) and Stroke. Please refer to critical illnesses covered for a
detailed description.

If Diabetes Enhanced Benefit Rider is taken, a lump-sum amount

(equivalent to 10% of the Base Sum Assured) is paid in the event of
limb amputation due to diabetic complications or LASER treatment
for diabetic retinopathy. Please refer to Diabetes Enhanced Benefit
Rider for details.

The payout is made only in case the critical illness occurs for the first
time.

Diagnosis & Testing

Regular free testing (HbA1c, Blood Pressure and Pulse rate check)
every 4th & 8th month, during the policy term.

A comprehensive medical check-up will be provided every year, till

the end of the first 4 policy years.

One free consultation every year with an expert physician, till the
end of the first 4 policy years.

Free home collection of blood samples for testing.

Test results will be available on the Diabetes Care website.

Partnerships

Concessions on products offered by our partners.

What Diabetes Care does not cover/not provide?

Financial Cover

If the policyholder does not survive beyond 28 days from the date of
diagnosis of a critical illness, the policyholder will not be eligible to
receive the critical illness payout.

After the lump-sum payout is made for the 1st critical illness, the
policy stands terminated.

Diagnosis & Testing

Tests from diagnostic centers or doctors who are not from our
empanelled network will not be accepted/will not be paid for.

Any additional consultations or tests conducted will not be covered

or reimbursed under the plan.

Partnerships

There will be no reimbursement offered against drug purchases,

insulin or insulin delivery mechanisms.
Why Diabetes Care Plus?

Diabetes Care Plus is a unique insurance policy that covers critical illnesses
and death for Type 2 diabetics and pre-diabetics. Diabetes Care Plus not
only provides financial support but also helps you manage your condition
more effectively.

Key Benefits of Diabetes Care Plus

Lump-sum payment on diagnosis of any one of the six critical illnesses or

death.

Optional cover for eye & foot complications.

Wellness program - 3 Free check-ups and a consultation with a doctor every

year.

Reduced Premium on display of good control.

Tie-ups with leading healthcare partners to help you Manage diabetes.

Web support for better diabetes control.

Tax benefit under Section 80C of the Income Tax Act.

The lump-sum amount is paid on diagnosis, irrespective of your expenses.

We don't require any medical bills and you can use the benefit amount to
meet cost of treatment and any other concomitant expenses.

Product Features

Eligibility
Type 2 Diabetics or Pre-Diabetics (IFG/IGT)

Impaired Fasting Glucose - IFG is a condition wherein, after overnight

fasting the blood glucose values are between 110 and 125 mg/dl.^

Impaired Glucose Tolerance - IGT is a condition wherein along with IFG,

blood glucose values after 2 hours of meals are between 140 and 199
mg/dl.^

Age (Nearer Birthday): 25-60 Years

Sum Assured

Base Sum Assured Options: Rs. 3 Lakhs, Rs 5 Lakhs, Rs 10 Lakhs

Benefit is payable on death or Critical Illness whichever is earlier

No maturity Benefit is payable

Diabetes Enhanced Benefit Rider: 10% of Base Sum Assured

The Sum Assured for CI/Rider will be paid as per the table below:

Rider Benefit
Time of Diagnosis CI Benefit Amount
Amount
Return of rider
First 6 months of the Return of premiums
premiums paid till
policy paid till date
date
50% of Sum 50% of Rider Sum
6-12 months
Assured * Assured
100% of Sum 100% of Rider Sum
After 1 year
Assured * Assured
Full death benefit is payable on death of the Life assured any time during the
entire policy term, including 1st policy year.

Premium

Premium payment frequency: Monthly, Half Yearly and Annual

Premiums payable for Sum Assured of 3 Lakhs for a male are g iven below:

Premium with maximum

Base
Age(Years) reduction after Year
Premium(Rs.)#
1(Rs.)#
35 12,754 10,841
40 15,263 11,447
45 18,957 14,218
50 26,341 19,756
55 36,179 23,516

Policy Term

There is a fixed policy term of 5 Years

^ As per Indian Council of Medical Research (ICMR) Guidelines

* The claim is payable only on survival for 28 days from the date of
diagnosis of the critical illness
# The premiums shown are exclusive of service tax and education cess

Wellness Program
Managing your diabetes is the key to staying healthy. As part of our
Wellness Program, we will sponsor you for three diagnostic tests and one
consultation every year, absolutely FREE.

In the 4th and 8th month every year after issue of the policy, you will need
to undergo HbA1c test and need to get your blood pressure and pulse rate
measured, which will help monitor your condition.

There will be a comprehensive and compulsory medical check-up every year

(except at the end of 5th policy year), which will include tests such as
sequential medical analysis of 12 tests (SMA 12 covering blood sugar,
lipids, S Creatinine etc), HbA1c, ECG, routine urine analysis and urine test
for Microalbuminuria.

We will also offer a free consultation every year with an empanelled doctor,
for advice and an appropriate health care plan.

To make sure you don't miss any of your tests, we will send you periodic
reminders also.

Improving Health, Reducing Premiums

We offer you an attractive incentive to keep in good health - a reduction in

your premiums (as indicated in the table below). This premium reduction
will be made after periodic check-ups to confirm your good health, for
which we have created a Diabetes Control Index. This index uses key factors
from your regular tests like HbA1c, blood pressure, lipids and weight and is
an overall indicator of your control.

Therefore, if you show good control, your Diabetes Control Index will go
down and your premium will be reduced for the next year by 5% to 35% of
your 1st year's base premium!
 Age at Entry (years) 25-35 36-50 51-60
Premium Reduction
5% 10% 15%
Level 1
Premium Reduction
10% 20% 30%
Level 2
Premium Reduction
15% 25% 35%
Level 3

If your results worsen or you miss any of the tests, your Diabetes Control
Index will go up. If it rises beyond a scale, you will be required to pay a
higher premium for the following year, as indicated below:

Age at Entry (years) 25-35 36-50 51-60

Higher Premium (over
10% 20% 25%
1st year's Base Premium)

Coverage

What Diabetes Care Plus covers/provides?

Financial Cover

Lump-sum amount paid on death or 1st diagnosis of any of the 6

critical illnesses, i.e. Coronary Artery Bypass Graft (CABG), Cancer,
End stage renal failure, Heart Attack, Major organ transplant (as a
recipient) and Stroke, whichever is earlier. Please refer to critical
illnesses covered for a detailed description.

If Diabetes Enhanced Benefit Rider is taken, a lump-sum amount

(equivalent to 10% of the Base Sum Assured) is paid in the event of
limb amputation due to diabetic complications or LASER treatment
for diabetic retinopathy. Please refer to Diabetes Enhanced Benefit
Rider for details.
The payout is made only in case the critical illness occurs for the first
time.
Diagnosis & Testing

Regular free testing (HbA1c, Blood Pressure and Pulse rate check)
every 4th & 8th month, during the policy term.

A comprehensive medical check-up will be provided every year, till

the end of the first 4 policy years.

One free consultation every year with an expert physician, till the
end of the first 4 policy years.

Free home collection of blood samples for testing.

Test results will be available on the Diabetes Care Plus website.

Partnerships

Concessions on products offered by our partners.

What Diabetes Care Plus does not cover/not provide?

Financial Cover

After the lump-sum payout is made for the 1st critical illness, the
policy stands terminated.
Diagnosis & Testing

Tests from diagnostic centers or doctors who are not from our
empanelled network will not be accepted/will not be paid for.

Any additional consultations or tests conducted will not be covered

or reimbursed under the plan.
Partnerships

There will be no reimbursement offered against drug purchases,

 insulin or insulin delivery mechanisms.

Diabetes Assure

ICICI Prudential proudly brings to you Diabetes Assure, a product created

for Type II diabetics and pre-diabetics which exclusively covers kidney, eye
and limb complications.

Diabetes Assure offers you the following benefits:

Payment of lump-sum benefit in case of Kidney Failure (End Stage Renal

Failure)

Procedure based cover for multiple occurences of

Limb Amputation due to Diabetic complications

LASER Treatment for Diabetic Retinopathy

Tax benefit on premiums paid under Section 80D of the Income Tax Act

This product is currently available in the following cities only: Chennai,

Delhi, Hyderabad, Kolkata and Mumbai.

Diabetes Assure at a Glance

How does the Diabetes Assure plan work for me?

This is a 5 year term regular premium paying product

You can choose from sum assured options of Rs.2 lakhs, Rs.3 lakhs, Rs.4
lakhs or Rs.5 lakhs
In the unfortunate event of kidney failure, diabetic retinopathy or limb
amputation due to diabetic complications, the policy will pay you the sum
assured as defined in the financial benefits section

Your premium is based on your age and the sum assured chosen by you

Premiums can be paid monthly, half-yearly or yearly

Diabetes Assure at a Glance

Type II Diabetes and Pre-diabetics

(IGT - Impaired Glucose Tolerance and IFG

Eligibility - Impaired Fasting Glucose) having blood
Conditions glucose values between 110 and 125 mg/dl
after overnight fasting and between 140 & 199
mg/dl after 2 hours of meals*
Min age at
25 years
entry
Max age at
60 years
entry
Policy term 5 years
SA options 2 Lakhs, 3 Lakhs, 4 Lakhs, 5 Lakhs
Premium
Payment Monthly, Half Yearly, Yearly
Modes
Maturity
No maturity benefit at the end of the term
Benefit

(*as per ICMR guidelines)

Premium Rates

SA/ 2L 3L 4L 5L
 Age
30 2070 2418 2767 3115
40 2286 2738 3199 3644
50 2936 3705 4472 5239
60 3517 4548 5580 6611

The premiums shown include 2% rebate for annual payment mode and are
exclusive of service tax and education cess.

Financial Support

We know that when faced with a critical illness, money matters should be
the last thing on your mind. Diabetes Assure plan offers a cover for a period
of 5 years with four Sum Assured options - Rs.2 lakh, Rs.3 lakh, Rs.4 lakh
or Rs.5 lakh.

Under this plan, coverage is provided for the following conditions:

End Stage Renal Failure (Kidney Failure)

Procedure based cover for Eye and Limb disorders

Tax Benefits

The premiums paid by you under this plan will be eligible for tax benefits
under Sec 80D, as a premium paid towards a health insurance product.

Health insurane products IN BAJAJ ALLAINZ

The worst nightmare that anyone can have is the one when a family member is
hospitalized. Today, when everything is uncertain nobody can be sure what will happen.
A seemingly small ailment can turn into major one. And what happens when the earning
member of your family is hospitalized? But with a policy from Bajaj Allianz you and
your family can rest assured!

It is rightly said ‘Health is Wealth’. We are all aware that health care costs are high and
getting higher. At times, unfortunately we fall prey to unanticipated accidents & illness.
Bajaj Allianz promises to stand by you during those difficult times of physical and mental
stress. Our Health Guard policy takes care of your hospitalization expenses & also offers
a wide coverage of pre & post hospitalization expenses. We are the first company to
provide the higher coverage of SI 10 lacs

Features

• The member has cashless facility at over 2400 hospitals across India
• The member can opt for hospitals besides the empanelled ones, in which the
expenses incurred by him shall be reimbursed within 14 working days from
submission of all documents.
• Pre and post - hospitalization expenses covers relevant medical expenses incurred
60 days prior to and 90 days after hospitalization.
• Cumulative bonus of 5 % is added to your sum assured for every claim free year.
• Family discount of 10 % is applicable.
• Covers ambulance charges in an emergency subject to limit of Rs. 1000 /-
• No tests required up to 45 years up to SI 10 lacs*
• 10% co- payment applicable if treatment taken in non-network hospitals. Waiver
of co-payment is available on payment of additional premium
• Pre-existing diseases covered after 4 years continuous renewal with Bajaj Allianz

Benefits
• In house Health Administration Team for hospitalisation claims to lower turn
around time
• Access to over 2400 hospitals all over India for cashless facility.
• No Sub-limits applicable on room rent and other expenses.
• Hassle-free claim settlement due to In-house claim administration.
• Income tax benefit on the premium paid as per section 80-D of Income Tax Act as
per existing IT law.
• Health Check up for maximum amount of Rs. 1000 /- at the end of continuous
four claim free years
• Family discount of 10% is applicable
Coverage

• 10 lacs coverage available from 3 months up to 55 years*

• Policy can be renewed up to 70 years*
• In built E-opinion cover for SI 5 lacs & above.

With a Hospital Cash policy from Bajaj Allianz you and your family can now breathe a
sigh of relief! As this is a benefit policy which covers the incidental expenses incurred
during the Hospitalization period. In the event of hospitalization this policy provides a
cash allowance of Rs 500-2500 for each day of hospitalization.

Features

 The policy pays a daily allowance as a fixed benefit on hospitalisation

 The Policy can be taken along with any other health insurance policies.
 The allowance is doubled in case of ICU admission (for maximum 7 days)
 Photocopy of discharge card, along with copies of reports, bills and prescriptions
required for claims processing. (do we include this in the feature?)
 The policy can be taken along with any other health insurance policies

 It is a unique policy covering incidentals or miscellaneous expenses incase of

hospitalization

Benefits
• . Covers miscellaneous expenses incurred during hospitalization.

• Comprehensive coverage with nominal premium.

• Premium amount upto Rs.15000/- p.a. is eligible for tax exemption under section
80-D of Income Tax Act as per existing IT law.
• Dependent spouse and children can be also covered under this policy.
• 5% family discount is applicable if cover taken for family

Coverage
 • SI available from 500-2500.
• Cover available for 30days & 60 days.

Critical illness policy provides protection from the life threatening illness, which can
hamper your routine life style. With a critical illness cover you can secure yourself from
such contingencies. This is a benefit policy which pays the SI as lump sum amount once
you are diagnosed with one of the listed critical illness*

• Cancer
• Multiple Sclerosis
• Paralysis
• Coronary Artery Bypass Surgery
• Major Organ Transplant
• Primary Pulmonary Arterial Hypertension.
• First Heart Attack
• Stroke
• Kidney Failure
• Arota Graft Surgery

Features

 Covers 10major illnesses like cancer, heart attack, paralysis, etc.

 The benefit amount is payable once the disease is diagnosed meeting specific criteria
and the insured survives 30 days after the diagnosis*

 Medical examination may be required in some cases based on the age and the benefit
amount opted by the propose

Benefits / Advantages

• Very competitive premium rates

• The insured receives the amount as lump sum so that he can plan the treatment
accordingly
• Expenses like donor expenses in a transplant surgery, which are not covered
under normal health insurance policy, can be paid out of the amount received
under this cover
• Premium paid is exempt under the section 80 D of Income Tax Act as per existing
IT laws.
 • Hassle-free in house claim settlement.

Coverage

• SI available from 1,00,000 to Rs. 50,00,000

• Age band – 6 yrs – 59 Years.

Life is full of uncertainties and unexpected events. Accidents can happen at home, at
work, even at play. The death or injury of a breadwinner can create serious financial
problems for any family. It is in situation like these, that you need to be prepared. To help
you soften the blow Bajaj Allianz offers the Personal Guard cover. Our Personal Guard
Policy offers these additional benefits.

Features

 Covers Death, Permanent Total Disability, Permanent Partial Disability, and

Temporary Total Disability
 Children's Educational Bonus benefit.
 Daily hospital confinement allowance payable in case of hospitalization due to
accident*

 Medical expenses reimbursement in case of hospitalization due to accidents*

Benefits

• Highest compensation of 125% of the SI in case of Permanent Total Disability.

• Children's education is not hampered due to your accidental death or injury
• Hassle free in house claim settlement.
• Cumulative bonus @ 5% per claim free year to a maximum of 50%.
• Family discount of 10%

Coverage

• Covers Death, Permanent Partiality Disability, Permanent Total Disability, &

Temporary Total disability.
• In case of Temporary Total Disability 1% of SI or Rs 5000 / week (whichever is
lesser) will be payable up to max 100 weeks.
In the times of rising medical costs Bajaj Allianz’s Health EnSure policy is the perfect
health protection for you and your family. It takes care of the medical treatment costs
incurred during hospitalization due to serious accident or illness.

Features

• Pre-existing diseases covered after 2 yrs continuous renewals with us.

• A flat benefit of 2% of admissible hospitalization expenses are paid towards pre
& post hospitalization expenses.
• Access to 2400 hospitals for Cashless facility
• In case of admission in non network hospitals the expenses incurred would be
reimbursed within 14 days from the date of submission of all documents

Advantages

• No tests required up to the age of 55 yrs*

• Health Check up at the end of continuous four claim free year
• 130 day care procedures covered
• In case of emergency ambulance charges covered subject to a maximum of Rs.
1000 /- per policy period.
• Hassle free claim settlement due to in house claims administration team
• Family discount of 5 % is applicable
• Income tax benefit on the premium paid as per section 80-D of the income Tax
Act.

Coverage

• Policy can be taken from 3 months to 55 yrs *

• Renewal up to 75 yrs*
• SI - 50,000, 75000, and 1 lac.

In the times of rising medical costs Bajaj Allianz's Insta Insure Family Health Policy is
the perfect health protection for you and your family. It takes care of the medical
treatment costs incurred during hospitalization due to serious accident or illness. The
policy also pays an amount equivalent of 2 % of admissible hospitalization expenses
towards pre and post hospitalization medical expenses and ambulance charges in case of
emergency (subject to a maximum of Rs1000). The proposer (self insured) under the
policy is also covered for a sum insured of Rs1lac against death due to accident

3 easy steps -
Select your desired insurance plan
Pick the Kit to fill the proposal form
Pay your Premium by Cheque/Card/Cash and get insured

Features

• A single family floater policy to cover hospitalization expenses & personal

accident benefit
• Hassle free policy, Health & PA cover for Healthy individuals without any history
of pre-existing diseases.
• The cover starts once the KIT is activated by generating the authentication
number
• Entry age restricted upto 45 yrs and no medical underwriting( Subject to clean
proposal)
• Policy can be renewed till proposer attaining an age of 70 yrs
• Access to over 2400 hospitals for cashless facility

Benefits

• Complete protection to the family for hospitalization expenses

• All the family members can be covered under a single SI for a single premium
( Floater Cover)
• Death cover for the proposer.
• Hassle free policy issuance without medical tests
• Income tax benefit on the premium paid as per section 80D
• Covers emergency ambulance charges

Coverage

• 1 lac family floater cover towards Hospitalization expenses & 1 lac death cover
for the proposer
• The policy covers ambulance charges in case of emergency subject to a maximum
of Rs 1000
• 130 day care procedures subject to terms and conditions
• Pre-existing diseases covered after 4 years’ continuous renewals with us
• A flat benefit of 2% of admissible hospitalization expenses towards pre and post
hospitalization medical expenses
Eligibility

 Age of proposer 18 years to 45 years

 Age of entry 3 months to 45 years
 Policy renewed continuously upto age 70 years

 No pre existing ailment

Premium

Self
Rs.1,550
Self + Spouse Rs.2,050
Self + Spouse + 1 Child Rs.2,300
Self + Spouse + 2 Children Rs.2,550

Star Package policy is a unique family floater policy which protects your family against
various risks and contingencies. It provides a gamut of covers for various health risks,
household contents, education grant, travel baggage and public liability all under a single
policy. It has 8 sections and you would have to opt for a minimum 3 sections to avail for
this policy.

Features

• Covers Hospital Cash, Health Guard, Critical Illness, Personal accident,

Education Grant, Householders contents, Traveling Baggage & Public liability.
• Family floater can be opted by paying 50% & 25% of self premium for spouse &
children respectively.
• Add on covers can be opted under Health Guard.
• 12 Dreaded diseases are covered under Critical illness.
• The policy can be taken for maximum 3 years to avoid yearly renewal.
• 10-15% section discount can be availed if 4 or more sections are opted.
• 10-15% Long term discount can be availed if the policy is taken for 2 or more
years.
Benefits

• Wide coverage from Health to Home.

• Access to over 2400 hospitals all over India for cashless facility.
• No Sub-limits applicable on room rent and other expenses.
• Hassle-free claim settlement due to In-house claim administration
• Income tax benefit on the premium paid as per section 80-D of Income Tax Act*
as per existing IT law

Coverage

• Age – 3 Months – 55 years.

• Wide range of Sum Insured is available under different cover

Products Sum Insured

Hospital cash
Health Guard
Critical illness
Personal Accident
Education Grant
House Holder Content
Traveling Baggage
Public Liability
500 to 2500
100000 to 500000
100000 to 300000
200000 to 500000
200000 to 500000
100000 to 400000
10000 to 40000
200000 to 500000

As the age of an individual increases the health care costs increase & become a burden on
the individual. The senior citizens have to pay out the hard earned savings to meet the
expenses. Bajaj Allianz’s Silver Health plan is exclusively designed for the senior
citizens, which covers medical expenses incurred during hospitalization period.

Features

• Pre-existing diseases covered from the second year of the policy.

• A flat benefit of 3% of admissible hospitalization expenses are paid towards pre
& post hospitalization expenses.
 • Cashless facility : With Silver Health plan, the member has access to cashless
facility at various network of over 2400 hospitals across India (subject to
exclusions and conditions)
• If admission in non-network hospitals the expenses incurred would be reimbursed
within 14 days from the submission of all documents.
• 20% of co-payment of the admissible claim to be paid by the member if treatment
is taken in a hospital other than a network hospital.
• Waiver of co-payment is available on payment of additional premium.

Advantages

 Cumulative bonus of 5 % added to your sum assured for every claim free year.
 Health Check up at the end of continuous four claim free years.
 Family discount of 5 % is applicable.
 Income tax benefit on the premium paid as per section 80-D of the Income Tax Act as
per existing IT law

Coverage

• Policy can be taken form 46-70yrs *

• Renewal up to 75 yrs*
• SI can be opted form 50,000 – 5, 00,000.

Bajaj Allianz launches e-opinion rider, which will cover the expenses of 2nd opinion e-
consultation services for serious illness in India. The policy offers unprecedented access
to over 7000 physicians employed by the renowned hospitals of the WorldCare
Consortium. This innovative e-opinion rider gives you an opportunity to obtain best of
international expertise at a fraction of the cost.

Features

• Anyone taking this plan is entitled to take a second opinion should there be any
illness and an expert consultation is required.
• This rider entitles you to have a 2nd opinion from renowned hospitals of the
WorldCare consortium of hospitals like Clevland Clinic, Duke University,
Massachusetts General Hospital, Brigam and Women's Hospital.
• Qualified physicians from these renowned hospitals will render a written report
which includes a diagnosis and treatment plan within 7 working days .
Benefits

• Simple process of sending medical reports in digitized form to WorldCare

consortium.
• This product provides independent, world class opinions which will enable the
attending doctor and the patient to take informed decisions on the diagnosis and
the further course of action.
• Three opinions are available per year of coverage and 6 opinions in case it is
renewed continuously.

Advantages

• Valuable 2nd opinion at nominal cost without physically visiting these renowned
hospitals.
• Opinions for major critical illnesses

QUESTIONNAIRE

How do you come to know about this particular plan in this company?

a) Advertisements b) Hoardings

c) News Papers d) Others

Does the company informs you about the premium renewal for every period

a) Yes b) No

Do you think that the premium paid in this company is less compared to
another company?

a) Yes b) No

Are you satisfied by taking the policy in this company?

a) Yes b) No
What is the policy term? How much return are you getting?

a) 10 years b) 15 years c) 20 years d)25 years

How many times you have the chance of getting switched.

a) 3 b) 24 c) 10

Is the service provided by the company.

a) Excellent b) Very Good c) Good d) Poor

Do you have the chance of partial withdrawals per policy

a) Yes b) NO

What is premium allocation charge

a) 10% b) 25% c) 30% d) No Idea

How much is the Additional Allocation of units?

a) 0.1% b) 0.5% c) No Idea

Can you rate the performance of this company?

a) Excellent b) Very Good c) Good d) Not bad.

Overall rating for this company.

a) Excellent b) Very Good c) Good d) Need to be improved.

DATA ANALYSIS

How do you come to know about this particulars plan in this company ?

a) Advertisement b) Hoardings

c) News Papers d) Others

Advertisement Hording Newspaper others

LIC 0 0 7 2
ICICI 3 1 4 2
BAJAJ 4 2 5 2
 7

4 LIC
3 ICICI
BAJAJ
2

0
1st Qtr 2nd Qtr 3rd Qtr 4th Qtr

OBSERVATION:

In insurance sectors all the private companies are trying to promote their
insurance plans through media. but LIC is still bringing its plans through
newspapers, hoardings and through LIC agents.

Even private sector companies are recruiting more and more agents to sell
more policies.
Dos the company informs you about the premium renewal for every period?

a) Yes b) No

YES NO
LIC 9 1
ICICI 10 0
BAJAJ 11 0

12
10
8
LIC
6
ICICI
4
BAJAJ
2
0
YES NO

OBSERVATION:

As it is a competitive industry every company is following the same

guidelines and assisting their customers and making them aware of the
information about premium renewal.

As the technology is growing day by day there will be no problem in

communicating in private as well as public sector companies.
Do you think that the premium paid in this company is less compared to
another?

a) Yes b) No

YES NO
LIC 6 3
ICIC 4 6
BAJAJ 2 7

7
6
5
4 LIC
3 ICICI
2 BAJAJ
1
0
YES NO

OBSERVATION:

In private insurance companies the annual premium is fixed to some amount

for every different plan ex: Hdfc –Minimum Annual Premium is 12000
Bajaj Allianz Annual Premium is 10000. But in LIC its not like that the
annual premium varies from age to age and dependent on term.

Are you satisfied by taking the policy in this company?

a) Yes b) No
 YES NO
LIC 6 3
ICICI 9 1
BAJAJ 9 0

10

6 LIC

4 ICICI
BAJAJ
2

0
YES NO

OBSERVATION:

Both private and public sector companies investors are satisfied by taking
the policy.

But there are some investors who are not satisfied by taking polices its
because the companies did not reached to their expectations.
What is the policy term? How much return are you getting?

a) 10 years b) 15 years c) 20 years

10years 15 years 20 years

LIC 0 2,25800 3,59,400
ICICI 8,52,693 5,20,984 9,52,886
BAJAJ 7,05,444 3,20,884 2,00,000

400000
350000
300000
250000 LIC
200000
ICICI
150000
100000 BAJAJ
50000
0
10YEARS 20YEARS

OBSERVATION:

On an average ICICI is performing well in giving good returns next to LIC,

but Kotak and Bajaj allianz are still need to be improved in acquiring more
investors.

Infect HDFC is also given good returns in long term but its not happening in
the period of short term.

How many times you have the chance of getting switched.

a) 3 Times b) 24 Times c) 4 Times

d) 6times e) Never

3 24 4 6 NO
LIC 0 0 0 9 0
ICICI 0 0 0 5 5
BAJAJ 0 0 0 5 4

10

6 LIC

4 ICICI
BAJAJ
2

0
3 24 4 6 NO

OBSERVATION:

The switching option is available only in unit linked plans as LIC is

concentrating more on traditional plans the customer can’t switch from fund
to fund.

The switching option is offered more flexibly by HDFC company.

Is the service provided by the company.

a) Excellent b) Very Good c) Good d) Poor

EXCELLENT VERY GOOD POOR

GOOD
LIC 1 3 5 0
ICICI 2 8 0 0
BAJAJ 2 10 0 0

10

8
6
LIC
4 ICICI
2 BAJAJ
0
EXCELLENT GOOD

OBSERVATION:

The service provided by both private and public sector companies are on
average.As the ICICI health insurance is providing more and more service to
investors it is rated as excellent.EX: SWITCHING OPTION -6 TIMES
FLEXIBLE ALLOCATION OF FUNDS
Do you have the chance of partial withdrawals per policy.

a) Yes b) No

YES NO
LIC 0 9
ICICI 6 4
BAJAJ 7 5

10

6 LIC

4 ICICI
BAJAJ
2

0
YES NO

OBSERVATION:Both the private and public sector companies are having

partial withdrawals option. but the customer can with draw only after three
policy years.

These companies are not allowing to take total fund value.

But investors can take loans against these plans. EX: HDFC-
MINIMUM AMOUNT 5000/-

BAJAJ ALLIANZ- 2000/-

What is premium allocation charge ?

a) 25% b) 30% c) 10% to 60% d) 98%

e) No Idea

25% 30% 10%TO60% 98% NO IDEA

LIC 0 9 0 0 0
ICICI 0 2 6 2 0
BAJAJ 0 3 7 3 0

10

6 LIC

4 ICICI
BAJAJ
2

0
25% 10%TO60% NO IDEA

OBSERVATION:

The premium allocation charges are done in every company in order to

cover the risk.

For every year these premium allocation charges varies from company to
company.
How much is the additional allocation of units ?

a) 0.1% b) 0.5% c) No Idea

0.1% 0.5% NO IDEA

LIC 1 3 5
ICICI 2 8 0
BAJAJ 3 7 0

8
7
6
5
4 LIC
3 ICICI
2
BAJAJ
1
0
0.10% 0.50% NO
IDEA

OBSERVATION:

ICICI prudential health Insurance is performing well in additional allocation

of units. Rest of the companies are also doing the same but up to level of
ICICI prudential health insurance.
Can you rate the performance of this company?

a) Excellent b) Very Good c) Good d) Not bad

EXCELLENT VERY GOOD NOT BAD

GOOD
LIC 1 1 2 5
ICICI 5 2 1 2
BAJAJ 4 3 1 1

90
80
70
60
50 LIC
40
30 ICICI
20 BAJAJ
10
0
EXCELLENT VERY GOOD NOT BAD
GOOD

OBSERVATION:

The performance rated by the customers for both public and private sectors
on are average they still need to be improved in both services as well as in
returns.

As feed back given by the LIC investors what we found is the development
officers are not giving proper service to them.

Overall rating for this company?

a) Excellent b) Very Good c) Good d) Not to be

improved
 EXCELLENT VERY GOOD NOT BAD
GOOD

LIC 1 1 2 5
ICICI 5 2 1 2
BAJAJ 6 3 1 2

3
LIC
2 ICICI
BAJAJ
1

0
EXCELLENT GOOD

OBSERVATION:

In overall rating ICICI is the company which are giving returns and going to
launch more and more plans.

Even LIC is performing well in giving returns but the infrastructure and
delightment given to the customers are not up to the mark of private
companies.
YOUNG STAR TERM PREMIUM RETURNS
LIC 20 15094 69000
ICICI 20 15000 602737
BAJAJ 20 15000 600000

600000

500000

400000
LIC
300000
ICICI
200000 BAJAJ
100000

0
TERM RETURNS

OBSERVATION:

Both private and public sector companies are giving more retunes. But in
LIC the amount for premium is very less it depends on age of policy holder.

ICICI is giving good returns on par with rest of the companies in young star
plan.

OUR FINDINGS

LIC comfortable: the public sector major life insurance corporation (LIC)
was comparatively in a much more comfortable situation ,reporting a
22%growth in profit at rs.774 crore .
The average break even period for life insurance companies was said to be
when the sector was opened upto private sector entry at the term of this
millennium. A few private players have been able to reduce their losses this
year or prevent from getting work.

GOOD PERFORMANCE:

Public sector general insurance companies produced a record performance in

2006-2007. profits for the state owned companies put together even up by
120% to a level of 2907/- crore in 2006-2007.

TOPPERS IN PRIVATE SECTOR:

Bajaj allianz-75 crore

ICICI- 68 crore

The general insurance markets grew at about 22%to reach a level just under
rs/-25000 crore in premium in 2006-2007 . the public sector companies head
a market share of 65% which eight companies head a market share of 35%s

Profit/loss 2006-2007(crores.) 2005-2006(crores)

LIC 774 632
HDFC -126 -129
BAJAJ ALLIANZ -72 -99
KOTAK -110 -44
ICICI -649 -188
COMPANIES %OF REPUDIATED %DECLINE CLAIMS
HDFC 17.15 23.85
BAJAJ ALLIANZ 14.35 15.73
ICICI 7.13 12.44
KOTAK 11.27 11.84
LIC 2.90 3.10

LIC Market Share 74.18%

Mumbai, September 4: Insurance giant LIC had a healthy market share of

74.18 per cent in the last financial year with a premium collection of Rs
55,934.6 crore while nearly a dozen private insurers accounted for the rest
25.82 per cent.

However, in terms of number of new policies, the state- owned company

enjoyed a much better market share of 82.83 per cent with 3.82 crore new
policies, LIC Chairman T S Vijayan said in his presentation of the financial
performance in 2006-07.

"In total LIC planned to invest around Rs 117 lakh crore this financial year
of which Rs 52,000 crore had been already invested," he said.

LIC's investment in the capital market as on March 31, 2007 stood at Rs

1,24,643 crore and it intended to invest between Rs 10,000 to 12,000 crore
in equities and preference shares in the current fiscal.
Till March 31, 2007 LIC's total investment was of Rs 6,13,266.58 crore of
which 2,72,497.82 crore was invested in Central Government securities, Rs
64,284.80 crore in State Government and other approved securities, Rs
73,746 crore in infrastructure and social investments and Rs 44,217 crore in
bond and debentures.

The popular unit-linked insurance plans (ULIP) contributed 80 per cent in

LIC's new business premium of Rs 39,541 crore as compared to the
traditional business products.

Compare Health Insurance Premiums

ICICI Bajaj- IFFCO- Royal TATA- Reliance

Features
Lombard Allianz Tokio Sundram AIG General
3 months to 3 months to 3 months to
6
65 70 60
3 months to months 3 months to
Age-Limit years(renew years(renew years(renew
70 years to 50 75 years
al upto 75 al upto 75 al upto
years
years) years) 70years)
30 days 60 days 60 days 30 days 60 days Prior
Pre & Post Prior & 60 Prior & 90 Prior & 60 Prior & 60 & 90 days
Hospitalizati days Post days Post days Post days Post No Post
on Expenses Hospitalizati Hospitalizati Hospitalizati Hospitalizati Hospitaliazati
on Expenses on Expenses on Expenses on Expenses on Expenses
Pre-existing
Covered Covered Covered Covered
diseases Not Covered after
After 2 After 4 After 3 after 5
(coverage covere 2 claim free
claim-free claim-free claim-free claim-free
after No of d years
years years years years
years)
Cashless
facility & Yes list of
Yes Yes Yes No Yes
Network Hospitals
Hospitals
Family Yes upto Rs.
10% 10% 10% 10% Yes
Discount 1000
No Claim 5% for No No No No 5% for Claim-
Discount Claim-free free year with
year with a a maximum of
 maximum of
50%
50%
5% for 5% for
Claim-free Claim-free
No Claim
No year with a No year with a 5% No
Bonus
maximum of maximum of
50% 50%
Maternity
No No No No No No
Benefits
Subject to a
Upto Rs. limit of Rs.
Ambulance Upto Rs. Covere
Covered 1000 only in 1000/- per No
Charges 1000 only d
emergency claim in
emergency
Subject to a
Room & limit of
Yes, No Yes, No Yes, No
Boarding 1.5% of Sum Yes Yes, No limit
limit limit limit
Expenses assured per
day
All
Specified disease
First two First two
diseases First year First year s are First two years
years years
excluded for covere
d
Income Tax
benefit
Yes Yes Yes Yes Yes Yes
under Sec
80D
Accidental
Yes Yes Yes Yes Yes Yes
Cover

No Claim Bonus: It is the amount by which your sum-assured increases in case of claim-
free year.
Family Discount: When the husband or wife and children or dependent parents are
covered under one policy, a ceratin percentage of discount is given on total premium
called Family discount.
No Claim Discount: It is the discount you get on premium amount in case of any claim-
free year.
ARTICLES

NEWS ON LIC’S NEW HEALTH INSURANCE PRODUCT

LIC’s maiden health insurance product soon

Mumbai, Oct. 5

Life Insurance Corporation of India will file its maiden health insurance
product with the insurance regulator by next month. The product will be a
long-term policy and have a savings element, said Mr D.D. Singh, Executive
Director (Health), LIC.

It will have a unit-linked component and be issued as a family floater policy.

There will also be sub-limits in place, and customers will be provided with
‘hospital cash’.

Munich Re will be the reinsurer for LIC on this product. The premium for
the product will increase progressively on an annual basis as the customer’s
age increases.

Mr Singh said that the objective was to keep costs low.

LIC has already chosen eight third party administrators for servicing claims
from this product. The payment of claims will, however, be made by banks,
selected by LIC. “We have selected Syndicate Bank, Axis Bank and Bank of
America for the payment of claims,” Mr Singh told reporters, on the
sidelines of a health seminar organised by CII.

LIC’s health insurance division is based in Hyderabad. It will have access to

a centralised data repository. The health insurance outfit will have a team of
20-30 employees but will use LIC’s actuaries for designing products. LIC’s
agency force, numbering over 10 lakh, will be leveraged to market the
product.

Mr Singh said the Government was inclined to have LIC’s health insurance
business as a separate subsidiary. But the Corporation had to take a call on
going ahead with this.

Among the other life insurance companies, Bajaj Allianz Life has a long
term health insurance product. ICICI Prudential Life and HDFC Standard
Life are also looking at health insurance products.

Standalone health insurance company Apollo DKV is also lining up health

insurance products to hit the market. The company will design products for
the urban and rural population as well as for corporates catering to specific
sectors. They will actively look at disease management and also introduce
niche products like a policy covering HIV patients.

LIC to launch health insurance products in February

Wednesday, 26 December , 2007, 18:15

New Delhi: Life Insurance Corporation of India has got the approval of
regulator IRDA for its health insurance product 'LIC Health Plus', which
would be launched by February.

"We have got Insurance Regulatory Development Authority's (IRDA) nod to

launch the health insurance products. The long term comprehensive health
insurance products would be launched in the second week of February next
year," LIC Executive Director (Health) D D Singh told PTI.

The product was originally supposed to be launched in last week of

December, but has been postponed partly due to the delay in regulatory
approval.

Unlike the cashless transaction model followed by competitors, LIC's

product would be based on the lines of floater plan, which would give the
policyholder the option to receive a lumpsum - which means claims could be
made for even treatment undergone at home.

"The additional feature would be domiciliary claim, where a patient taking

treatment at home will be reimbursed as and when he submits the complete
bills," he said.

LIC is targeting to provide health cover to close to one crore families in the
first year of the launch of the product and expects over Rs 5,000 crore of
revenues.

The company has claimed that the present cashless model is not in favour of
the customer as many hospitals were not accepting the facility. Moreover, in
many cases hospitals are charging more if a patient comes with an insurance
cover that offers cashless treatment.

LIC's product will also be a long-term product of over 10 years.

The sources said unlike the current mediclaim products offered by general
insurance companies that cover the insured's hospitalisation expenses and
are annual in nature, LIC would pay the insured a predetermined lumpsum
amount, depending on his premium payment.

The product is expected to be marketed in a big way through all distribution

channels of LIC, including its over 10 lakh agents.

LIC has set up its health department at Hyderabad, which will contain the
centralised data. It is also learnt that the product will not have a level
premium and will increase with the age of the insured and if more benefits
are opted for. The pre-existing diseases will be covered, but with some
clauses.

It will also have a health savings account and a unit-linked component

attached to it. The product will cover outdoor patient expenses, but there will
be limits to ensure overcharging by health care providers.

Earlier, LIC selected 83 third-party administrators (TPAs) in different

regions across the country. The TPAs will issue health cards and will be
used only for settling the claims. For claim payouts, the public sector insurer
has tied up with Axis Bank, Syndicate Bank and Bank of America.

The company's prospects in health insurance business may brighten once the
premium rates are liberalised by the IRDA early next year, as the group
health insurance premium rates would go up.

LIC targets Rs5,000 crore from health insurance news

Venkatachari Jagannathan
17 November 2007

Chennai: Asian life insurance giant, Life Insurance Corporation of India,

hopes to mop up around Rs5,000 crore selling its novel unit-linked health
insurance policy.

Interestingly, its three-months target is more than the Rs3,200 crore in

health insurance premium earned by the 13 Indian non life insurers - 12
general insurers and one specialised health insurer - during 2006-07.
Hoping to get Insurance Regulatory and Development Authority''''s (IRDA)
sanction for the product soon, LIC plans to launch its product some time in
December 2007 or January 2008.

The timing is also right as January-March are busy months for life insurers
as people buy policies to save on their taxes. With an army of around 10
lakh agents LIC plans to sell around 1 crore policies during this period.

To cope with the expected sales, the life insurer''''s technology team is
already getting the software ready to sell the product.

Declining to comment on the product features G N Agarwal, executive

director (actuarial), says, "We have filed the product with IRDA. They
have called us for a meeting on the subject. I am not in a position to detail
you anything more about the product."

It is learnt LIC''''s unit-linked health insurance policy will be a combination

of hospital cash (fixed sum paid to the policyholder daily when admitted
into a hospital) and surgical benefit (a lump sum towards list of surgeries
covered under the policy).

The proposed health insurance will be a long-term floater policy whereby

for a fixed sum insured the principal policyholder can cover himself,
spouse and two children.

It is also learnt the primary insurance cover will be hospital cash. The value
of surgical benefit would be arrived as a multiple of the hospital cash.

As in the case of unit-linked life insurance policy (ULIP), some portion of

the annual premium would go towards investments. The corpus thus built
could be withdrawn by the policyholder or be accumulated till death.

On the death of the principal policyholder, the spouse would become the
principal policyholder and could use the balance in the fund.

On the death of the spouse, the fund balance would be given to the
nominees or legal heirs.

Challenging target
While the concept of unit-linked health insurance is interesting, is this
target of earning Rs5,000 crore in three months from crore policies, an
ambitious one?

"No," says D D Singh, executive director. Citing the earlier success of

Asha Deep and Jeevan Asha policies that covered a list of critical illness,
he adds, "The future is in health insurance."

A 1977 batch officer cadre recruit, the 53-year old Singh is charting LIC''''s
entry in to health insurance foray sitting in Hyderabad. He has more than a
decade''''s experience in marketing at branch and divisional office levels,
apart from working in LIC''''s information technology, and training
divisions.

Singh is betting on LIC''''s army of ten lakh agents and an existing client
base of 17 crore policies. Moreover, the productivity of LIC''''s agents in
terms of number of policies sold in a year is high, averaging around 37,
compared to the agents of private life insurers.

"Would life insurance agents be really interested in selling a health

insurance policy where the ticket size is normally lower than a life policy?"
asks S S Gopalarathnam, president, operations, Cholamandalam MS
General Insurance Company Limited.

A life insurance agent gets around 40 per cent commission on the first year
premium when he sells a life policy. On the other hand the commission
paid by non-life insurer on its health insurance policy is not more than 15
per cent.

"The intensity of post sales service in the case of health insurance is high as
compared to a life insurance policy. Given the ticket size, the commission
rate and post sales service, it is doubtful whether a life insurance agent
would be enthused to sell what is primarily a non-life product," adds
Gopalarathnam.

What he says may hold true for private life insurers who pay their
individual agents around 40 per cent of the first year premium as
commission up to 70 per cent for bancassurance / corporate agents.

According to Singh, LIC has priced its health insurance product taking
everything into account.

Adds Agarwal, "Unlike other Indian life insurers, the commission paid to
our agents on selling life policies is low."

The average commission paid by LIC on traditional policies is around 25

per cent and in the case of ULIP it is around 15 per cent.

"The commission rate on our proposed health insurance will also be

comparable," he says.

The proposed health insurance policy is expected to increase the average

premium per policy of a LIC agent and in turn his income.

Remarks R Ramakrishnan, consulting actuary and former executive

director (Actuarial) LIC, "If the product catches the imagination of the
prospect no agent can say no to a product."

In addition the policy could also be sold through LIC''''s growing

bancassurance route. The corporation has 37 bancassurance partners and is
working on referral arrangements with other banks.

Perhaps LIC''''s health insurance policy may eat into the sales of normal
ULIP and that too of private life insurers.

Towards smoother claims settlement

In order to have a faster and smoother claims settlement - unlike the non-
life insurance industry - LIC has restricted the role of third party claims
administrators (TPA) to claims processing only.

The TPA would first advice LIC on the permissibility of the claim. "LIC
would in turn instruct a select group of bankers to issue the claim cheque to
its health insurance policyholders," explains Singh. LIC has tied up with
Syndicate Bank, Axis Bank (formerly called UTI Bank) and Bank of
America for issuance of claim cheques to health insurance policyholders.

"We have drawn strict level agreements with the TPAs whereby identity
cards and claims processing should be done within a stipulated time,"
explains Singh.
This way LIC avoids the problem of funding the TPA to settle the claims
as it happens in the non-life insurance sector.

It should be noted that in the case of non-life insurance sector, the

minimum time taken to process a claim by the TPAs is one month.

"Claims cheques will be issued within 24 hours of the claims approval,"

assures Singh.

Lack of data a challenge

For LIC''''s appointed actuary Agarwal, designing the product was bit of a
challenge in the absence of reliable morbidity data specific to India.

Agrees Ramakrishnan, "In India there is no data that tells the number of
times a person falls sick, in order to be able to design a long-term health
insurance policy. It is a great challenge for any actuary in India."

To overcome this crucial handicap, Agarwal and his team used the
morbidity experience of UK and South Africa.

With its event-based health insurance compensation policy, LIC has to

some extent has escaped the bane that the Indian non life insurers suffer,
which is the negative moral hazard of policyholders, hospitals, doctors and
others in the healthcare chain.

The non life insurers have to contend with fraudulent health insurance
claims as their policies deal with reimbursement of expenditure.

Is there a downside?
The downside of LIC''''s policy is that the policyholder is tied to a sum
insured chosen at the time of taking the policy for a long term.

"What LIC would offer is a long-term document. A policy that does not
factor inflationary trends in health care costs will not be of much help to a
policyholder in the long run," feels K N Bhandari, former chairman and
managing director, New India Assurance Company Limited, and secretary
general, General Insurance Council of India.

According to LIC''''s Singh, LIC''''s health insurance product need not be a

direct competition to the non-life insurers.

"The existing health insurance policyholders can also take our policy as it
is beneficial. If a policyholder suffers some life critical illness like cancer,
kidney failure, etc, then the entire family''''s wealth is wiped out during the
last six months of the patient''''s life. Our policy will help to meet such
contingencies."

LIC would pay the agreed fixed sum even if its policyholder holds a
separate mediclaim policy, while non-life insurers contribute
proportionately to the claim when a policyholder holds more than one
mediclaim policy

Singh says, "The Indian insurance market is also getting ready for co-
payment of expenditure where the insured is made to share part of the
claim amount. "In motor insurance the concept of co-payment has been in
vogue for the past several decades."

Today the non life insurers are making their policyholders share some part
of the hospital bill.

Meanwhile Singh and Agarwal are gearing themselves to meet IRDA

officials who have called a meeting some time this month to discuss the
health insurance product.

If all goes according to its plans, LIC seems to have a winning product on
its hands. Realising this, it plans to launch some more health insurance
products.
 ICICI PRU LIFE INSURANCE CROSSES 2 MN
POLICIES MILESTONE

ICICI Prudential Life Insurance, India’s No. 1 private life insurance

company, has become the first private life insurer to cross the two million
policy mark. The corresponding sum assured stands at Rs 43,000 crore and
new business received premium income at Rs 4,532 crore. This achievement
has come less than 18 months after crossing the one million policy mark in
September 2004, making it one of the most rapid expansions in such a short
timeframe.

Commenting on this latest achievement, Ms Shikha Sharma, Managing

Director and CEO, ICICI Prudential Life Insurance said, “A policy base of
two million in less than 6 years of operations is an indicator of the
robustness and scalability of our business processes – distribution,
underwriting, service, etc. We have been able to realise economies of scale
and bring down the expense ratio, an important parameter from the
profitability point of view. Last, but not least, since the pooled mortality and
investment risks are spread over a larger base, the overall risk for the
company, and hence policyholders, is reduced”.

ICICI Prudential’s other recent achievements include:

• First life insurer in India to receive a National Insurer Financial Strength
rating of AAA (Ind) by Fitch Ratings
• Rs. 7,000 crore funds under management (FUM) – largest for any private
sector life insurance company
• Prudence Customer Centricity Award for the second year in a row -
Prudential Corporation Asia
ICICI Prudential continuously researches to understand the emerging needs
of its consumer base. The company recently launched two health products –
Health Assure and Health Assure Plus. The products are designed to provide
the customers a guaranteed financial benefit at the time of a critical illness,
over and above the direct medical expenses that are incurred. The policy
aims to cover aspects like loss of income during the period of illness and
recovery, lodging for a family member, travel and stay, etc.

ICICI Prudential was one of the first private life insurance companies to
commence operations after the privatization of the sector in 2000. Over the
years, it has enhanced its understanding of various saving and investments
need of customers and launched a series of flexible products to meet the
same, spanning the segments of child plans, retirement solutions, health
plans, savings solution as well as pure protection plan. For the period April-
December 2005, the company’s retail market share stood at 31.8% amongst
all private companies and 11% of the total market.
PLAN
Private sector life insurance business jumps 90%
Mumbai, May 10 In a tough battle to expand market shares the private sector
life insurance industry consisting 14 life insurance Companies at 26% have
lost 3% of market share to the state owned Life Insurance Corporation(LIC)
in the domestic life insurance industry in 2006-07.

According to the figures released by Insurance Regulatory & Development

Authority the total premium these 14 Companies have shot up by 90% to Rs
19,471.83 crore in 2006-07 from Rs 10, 252 crore. LIC with a total premium
mobilization of Rs 55,934 crore has been able retain a market share of 74.26
% during the reporting period. In total the life insurance industry in first year
premium has grown by 110% to Rs 75, 406 crore during 2006-07. The 2006-
07 performance has thrown a few surprises in the ranking among the private
sector life insurance Companies. New entrants like Reliance Life and SBI
Life had shown a huge growth of over 381% and 210% respectively during
the year. Reliance Life which has become one of the top five Companies
ended the year with a premium of Rs 930 crore during the year.

Though ICICI Prudential Life Insurance remained as the No 1 private sector

life insurance company during the year Bajaj Allianz overtook ICICI
Prudential in terms of monthly market share in March, for the first time ever.
Bajaj’s market share among private players in non-single premium for
March stood at 29.1% vs. ICICI Prudential’s 23.8%. Bajaj gained 4.6
percentage point market share among private sector players for FY07.

Among other private players, SBI Life and Reliance Life continued to do
well, each gaining 4% market share in FY07. SBI Life’s growth was driven
by increasing contribution from ULIP premiums. Another notable
developments of the 2006-07 performance has been the expansion of retail
Markets by the life insurance comapnies. Bajaj Alliannz Life insurance has
added 20 lakh policies while ICICI Prudential has expanded over 19 lakh
policies during the year

Bajaj Allianz Care First – India’s first ‘Health+Life’ cover

A Medical policy that puts your health care first

1. 1st time in India a ‘Health+Life’ policy that provides health insurance benefits
coupled with life insurance.

2. Guaranteed renewals upto age 65 without medicals

3. Same premium for 3 years

4. Generous hospital cover upto 7Lacs

5. Tie-up with leading hospitals across 200 towns and growing to more towns

6. Cash Less Card facility across hospitals tie-ups

7. Finest services & support across India :

8. 24x7 Help-line Support across India.

9. All medical records available online and can be accessed by insured from
anywhere.

10. Referral services for Doctors, diagnostic centers, Ambulance providers

11. Multiple Claims and Tax Saving

Kolkata, June 11th , 2007: Bajaj Allianz Life Insurance has once again taken the lead
amongst pvt. sector life insurance cos. in providing superior products which suite
customer needs by launching India’s first ‘Health+Life’ cover plan.

First of its kind long term medical policy, already has access to finest hospital across 200
towns in India and speaking at this occasion Sam Ghosh Country Manager Allianz &
CEO Bajaj Allianz Life was very proud to say that “With the new & unique cashless
Bajaj Allianz Care First Plan the common man would also be able to get the finest
medical care incase of emergencies and hospitalisation without the worry of
arranging for paying heavy bills.” He also said “ we are the only company to offer a
long-term medical policy with guaranteed renewal upto age 65 without medicals

BAJAJ ALLIANZ
Bajaj Allianz Care First the finest medical policy.”
Some of the key highlights of this products are:
.

1. ‘Health+Life’ plan – 1st of it’s kind product -This plan provides

common sum assured, giving dual benefit which can be utilized incase of
hospitalization cover for treatment as well as a life cover benefit incase of
unfortunate death of the policy holder.

2. Cash Less Card: Bajaj Allianz Life Insurance in association with

Medicare TPA services will issue photo identity cards to all the insured
members, facilitating cashless hospitalization at empanelled hospitals all
over India.

3. Cashless Hospitalization facility: Tie –up in over 2000 finest

empanelled hospitals across 200 towns in India. In case of emergency or
planned hospitalization subject to pre authorization cashless facility will
be extended to the members at identified networked hospitals. Incase of
treatment is undertaken in hospitals other then empanelled hospitals we
provide speedy claim settlement within 7 days provided complete
documents are submitted.

4. Guaranteed renewals upto age 65 without medicals: anyone between

18 to 56 years of age is eligible to take this policy also Bajaj Allianz Care
First assures the continuity of the policy up to the age of 65 years
provided the premium is paid at the time of renewals without lapse, that
too without undergoing medicals again.

5. Generous hospital cover upto 7 Lacs : sum assured cover is available

from Rs 1 lac to Rs 7 lacs. Apart from medical covers, ‘Life Cover’
benefit is also paid incase of unfortunate death of the life assured.

6. Same premium for 3 years: this long term health care plan comes with
an assurance of 3 year same premium.

7. Day-Care Treatment: incase of illnesses or procedures like Eye

Surgery, Cataract, Hernia Repair surgery etc, where in one doesn’t need
to be hospitalised for at-least 24 continuous hours, it will be considered
as proper hospitailsation and the medical expense would be reimbursed.
8. Pre-Hospitalisation and Post-Hospitalisation Cover:
expenses associated with for both pre and post hospitalization treatment
are covered under this plan

9. All treatment pertaining to Critical Illness are covered under

this plan and also provides for valuable life cover

SUGGESTIONS:
1. Both public and private sector companies are to be improved in giving
services to their investors.

2. The premium amount should be reduced in all private sector companies so

that poor people can buy a policy which gives more respect to them in their
minds.

3. Even plans for students should be implemented so that they can have a
financial security in long term.

4. The switching option in LIC companies should be increased so that there

investors will have more option. They even have to educate about investing
in different type of funds.

5. The insurance agents have to explain them thoroughly about the policies and
their advantages. But most of the agents are just trying to sell their policies
for their benefit.

6. Tax benefits are to be increased so that investor will be tension free.

7. Even the branch manager should train their development officers in knowing
about the market share.

ex: in LIC most of the development officers are not aware about their market
share .that’s they failed in explaining to their investors.

8. Both the percentage of repudiation and declining claims are increased from
company to company in private sector. But in public sector its the only LIC
company going on an average.
9. In private sector insurance companies they are selling more number of unit
linked plans. They are not concentrating on traditional plans. So people are
diverting to LIC. Today it’s the only LIC which is having more number of
customers its all because of their long term policies.

10. Even the private sector insurance companies had to improvise in

implementing traditional plans.

11. As per the feedback given by the investor what we found is not even a single
investor is able to tell how much percentage of premium is allocated every
year.

So it is a duty of insurance companies to explain them detailed about the

premium allocation.

12. The Information about the allocation of funds i.e. how much amount of
premium is invested on different funds must be inform to the investors.
• By this investor also have an idea that how much return will they get
and even the fund value.

Problems faced by some of the customers. In motor insurance : most of the

investors are suffering a lot because of delay in this claim settlement. the investor
had to wait for more than 15 days to get the insured money.

In claim settlement most of the private insurance companies

are providing poor service to their investors. investors got fed up with this claim
settlement. So they are opting for LIC rather than private companies.

QUESTIONS RELATED TO HEALTH INSURANCE

Hospital Care FAQs

FAQs - General

Q1. If I have a mediclaim as well as a Health Protect policy, I will not be

able to give you the original documents of treatments, surgeries etc.
since these papers cannot be issued in duplicate. How will I manage to
get both claims in such a case?
Ans: For making a Health Protect claim, you will be required to show all
your original documents at our branch. The originals will immediately be
verified and attested and the original documents will be returned to you. You
can submit the originals to your mediclaim company.

Q2. When does the cover start? (What is the waiting period under
Hospital Care policy?)
Ans: There is a waiting period of 90 days except for accidental claims. Thus
your cover starts from 90 days of policy issue date.

Q3. If I already have a pre-existing illness, can I get covered under

Hospital Care? What are the exclusions for this?
Ans:To cover pre-existing illness ICICI Prudential may add extra premiums
or may exclude the illness and its related complications from the scope of
the policy depending upon the underwriting norms.

Q4. Can I switch from one plan A to some other plan during the tenure
of the policy?
Ans: No. You cannot switch from one plan to another. You can take a fresh
additional policy under any plan subject to a maximum Daily
Hospitalization Cash Benefit (cumulative of all policies) equal to plan D.

Q5. Can I buy this policy for my family? For whom all can I buy this
policy?
Ans:You can buy this policy for your family, which includes your spouse
and children.
Q6. Can a married woman take the policy for her parents?
Ans: No. A married woman cannot take the policy for her parents.

Q7. Do I have to undergo medical tests before enrolling under any Plan
type?
Ans: As per underwriting norms, if you choose plan A or plan B, and you
happen to be in the age group of 1 - 45 years, you would not required to
undergo medical tests.

Q8. Which medical tests does an adult above 46 years need to go

through?
Ans:An adult above 46 years of age has to go through the following medical
tests, depending on the plan chosen by him

As per the plan

Plan/Age Adult >46 yrs of age

A MER
MER, Lipid Profile, Fasting Blood Sugar, Glycosylated
B
Hemoglobin
C MER, Glycosylated Hemoglobin, SMA-12, TMT,
D MER, Glycosylated Hemoglobin, SMA-12, TMT

Our representative will call the proposed insured(s) for prior appointment for
the medical tests (mentioned above) within 2 days of receipt of full
premium.
This leaflet is indicative of terms, conditions, warranties and exceptions
contained in the insurance policy. For further details, please refer to the
policy document. In the event of conflict, if any, between the terms and
conditions contained in this leaflet and those contained in the policy
document, the terms and conditions contained in the policy document shall
prevail. Insurance is the subject matter of the solicitation © 2007, ICICI
Prudential Life insurance Company Limited. Hospital Care: Form No.: T12

FAQs - Claims

Q1. How many claims can be made during the policy term?
Ans:One can make multiple claims during the policy term subject to the
yearly limit and Policy Term limits available.

Q2. In case of taking claim from two insurers, will I need to furnish all
original documents to ICICI Prudential?
Ans:
- It is always preferred to submit all the documents in original only.
However, if you need to retain the originals (for claim to be raised with other
company) the photocopies can be provided (the same to be verified against
originals by ICICI Prudential official)
- Incase the hospital has submitted the original documents directly to your
insurance company; the hospital can issue duplicate copies of the same.
These will be accepted only if the hospital issues a certificate stating that the
originals are submitted to another insurance company. The certificate must
state name of the insurance company / TPA whom the documents are
submitted.

Q3. Is recuperation benefit dependent on any documents/prescription?

Ans:Recuperation benefit is payable when the Life assured is continuously
hospitalized for a period of 5 or more days and it is not dependent on any
documents/ prescription. The benefit shall be maximum 3 times Daily
Hospitalisation Cash Benefit (DHCB). This benefit is not payable, if the Life
Assured dies in the hospital.
Q4. If I want to claim money from two insurance companies, can my
other insurer deny me a payout incase I claim under Hospital Care as
well?
Ans:The benefits under Hospital Care policy are independent of any other
policy taken by you. However, the benefit whether payable by other
company, depends upon the other company's terms and conditions.

Q5. If I want to claim money from two insurance companies, will my

payout from Hospital Care policy become taxable?
Ans:The benefits received under Hospital Care policy are Non-Taxable.

Q6. Will a claim be entertained if it's not from the Network Hospital?
Ans:Yes, we will entertain the claim from Non Network Hospital provided
the terms and conditions under the policy are met. A Hospital Network is
created by the company in order to facilitate the cashless hospitalization and
convenience to customer.

Q7. Will I get a pre-authorization form at a network hospital?

Ans:Yes, you will get a pre-authorization form at our network hospitals.
However it will not be available at non-network hospitals.

Q8. Can I make a claim if I get treated out side India?

Ans:You are entitled to make claim for the treatment undergone out side
India, provided the diagnosis and treatment occurs in the countries which are
listed in the policy document.

Q9. What is grading of surgery and are the procedures according to any
standardised definition?
Ans:There are 4 surgery grades under this policy, the benefit are payable
based on the type of surgery undergone.
The surgical procedures are described as per the International Classification
of Diseases (ICD) prescribed by World Health Organization.

Q10. Can a surgery claim be made even if the procedure does not
require Hospitalisation?
Ans:Yes. The applicable surgery benefit will be paid as per the surgery
grade. As long as the surgery is in the list of covered procedures, the payout
is not dependent on Hospitalization. However other benefits (Daily
Hospitalisation Cash Benefit, Intensive Care Unit Benefit & Recuperating
Benefit) will not be paid.

Q11. If death occurs during the course of hospitalization, will the

benefit amount be paid to the nominee?
Ans:The benefit amount shall be payable as per the policy terms. However,
recuperating benefit shall not be payable upon the death of the Life Assured
in hospital.

Q12. If I make a claim, will my policy be renewed next year?

Ans: Hospital Care is a long term policy. The policy shall continue through
the term if the premiums are paid on the due date or within the grace period.
The policy gets terminated once the lifetime limit exhausted or upon death
of Life Assured or on maturity of the policy.

Q13. Do I have to undergo medical tests before enrolling under any

Plan type?
Ans:As per underwriting norms, generally, if you choose Plan A / Plan B
and you happen to be in the age group of 1-45, the medicals would be
waived off.

Q14. What is a health card and the benefit of carrying a health card?
Ans:A health card is a card that comes along with the policy. It sent to you
as part of the Welcome Kit and contains your name and policy number. This
card would entitle you to avail cashless hospitalisation facility at any of our
network hospitals.
BENEFITS:

It serves as a proof of Identity

Entitles you to avail cashless facility hospitalisation facility at the network

hospitals
Q15. Are all policyholders eligible for a health card?
Ans: Yes, all the policyholders are eligible for the health card as it is an
important component of the policy.

Q16. What should I do in case I lose my health card?

Ans:Please inform us. We will replace it immediately at additional cost.

Q17. What if I have to get admitted but my Health Card is lost and I am
waiting for the new card?
Ans:In case of a hospitalisation you need to quote the Policy number and
card number in the authorization form and get the authorization. Carry a
photo ID card with you at the time of admission.

Q18. What is the turn around time for receiving the re-imbursements in
case of non-network hospitals?
Ans: We will process the claim and dispatch the cheque in 7 working days

Q19. With which hospitals, is the cashless facility available and how can
I get the list?
Ans: The list of more than 3000 hospitals across India is available on our
website. This list will also be sent to you along with the policy certificate.
The claims procedure and the health card will also be sent along.

Crisis Cover Benefit, Critical Illness Benefit, Crisis Cover India

Q1. If I want to claim money from 2 insurance companies, including

mediclaim, will my payout from Crisis Cover become taxable?
Ans: Crisis Cover is a benefit based health insurance plan which qualifies
for the tax exemption under section 80D & section 80C and the payout is not
taxable since it is treated as a capital receipt.

Q2. Can I make a claim if I get treated overseas?

Ans: You are entitled for a claim made overseas, provided the diagnosis and
treatment occurs from the specified list of countries mentioned in policy
document. List of countries covered: Australia, Brunei, Canada, Dubai,
Hong Kong, Japan, Malaysia, New Zealand, Singapore, Switzerland, UAE,
USA, and countries of the European Union.

Q3. Can this policy be proposed to family? Which family members are
eligible?

Ans:This policy can be proposed to parents, spouse & dependent children

only and not to siblings or non blood relations.

Q4. What is the duration within which a claim for a CI has to be

reported to ICICI Prudential?

Ans: The claim needs to reported within 60 days from the date of
discharge/diagnosis All claims will be settled in 7 working days after
receiving request.

Q5. If I already have a pre-existing illness, can I get covered under

Crisis Cover? What are the exclusions for this?

Ans:If the customer is suffering from Pre-Existing disease (among 35

critical illnesses & TPD) the policy shall not be issued. For other illness the
company may add extra premiums and issue the policy.

Q6. Under what medical conditions can a policy be denied to a

customer?

Ans: Apart from the 35 conditions covered under the plan, a diabetic will be
denied the plan

Q7. In case of cover continuation, when will the revised premium be

applicable for the reduced sum assured?
Ans: The revised premium will be applicable from the next policy
anniversary.

Q8. Assuming a person has an existing CIBR (critical illness benefit

rider) as well as Crisis Cover, when he or she submits a claim; will both
the claims be entertained?

Ans:Yes. Both claims will be entertained since CIBR and CC are considered
as two separate policies. However, the total payout can not increase Rs. 20
Lakhs.

Q9. Can I buy another health or life policy from ICICI Prudential in
case my crisis cover plan is lapsed?

Ans:Yes, you can buy another life plan even if Crisis Cover is lapsed.
However, in case you are buying another health plan within 12 months of
lapsing Crisis Cover, all the arrear in premium will have to be cleared first.
There is no such condition if you buy another plan after 12 months

Q10. Can we give Crisis Cover as employer employee plan?

Ans:Yes Crisis Cover can be given as an employer-employee plan.

Q11. If somebody has both Health Assure and Crisis Cover plans, can
he claim them for two different CIs?

Ans:The CI plans cover the person for the first occurrence of the CI. Hence,
he would be paid all the benefit under various CI products/riders he has
taken from the company on the first occurrence of any of the CIs. It would
be very essential for a person to take all the money when a CI strikes him
first rather wait for a second CI to happen since the chances of the same
happening are very low.

Q12. How is reduced premium calculated?

Ans:The reduced premium is calculated based on the balance sum assured

and age of entry and not on the basis of the current age of the person insured.

Q13. Can Crisis Cover be sold as a Combo?

Ans:Yes, Crisis Cover can be sold as a Combo.

Q14. Can we choose between Group I CI & Group II CI?

Ans:No. Crisis Cover covers 35 critical illnesses along with death &
disability. The 35 critical illnesses are split under Group I & Group II, based
on their payout structure.

Q15. In a case where a critical illness leads to disability, what will be

payable, if the policy is in the waiting period?

Ans:If the policy is in the waiting period, the benefit will not be payable.
The Premiums paid till date would be returned (ROP) and the policy will
close.

Q16. Can the cover be increased during the policy term?

Ans:No, the cover cannot be increased. One can buy another crisis cover
plan, provided the total CI bucket does not exceed 20 lakhs.

Q17. Do we cover Partial Disability?

Ans:No, we do not cover Partial Disability.

Cancer Care FAQs, Benefits of Cancer Care, Cancer Cover, Cancer Care
Claims

Disease-related FAQs

Q1.Is Mouth Cancer covered in Cancer Care?

Ans: Yes, Mouth Cancer is covered under advanced cancer.

Q2. If an individual has a history of early cancer and has just developed
cancer in another part of the body, what financial benefit can he or she
avail of under the policy?

Ans: An individual who has suffered from early cancer (carcinoma-in-situ)

receive a payment of 10% each for diagnosis and treatment or surgery. In the
future, if he or she suffers from early cancer in another organ, he or she will
not receive any benefits. However, if the cancer is advanced, the individual
will receive 55% of the payment for diagnosis, 10% for treatment and 15%
for surgery.

Claims-related FAQs

Q1. If I have a mediclaim as well as a Cancer Care policy, I will not be

able to give you the original documents of treatments, surgeries etc.
since these papers cannot be issued in duplicate. How will I manage to
get both claims in such a case?

Ans: For making a Cancer Care claim, you will be required to show all your
original documents at our branch. The originals will immediately be verified
and attested and the original documents will be returned to you. You can
submit the originals to your mediclaim company.

Q2. Why is there a 6-month waiting period for receiving a claim benefit
under advanced cancer while there is a one-year waiting period for
early cancer?

Ans: Advanced cancer requires treatment within 6 months and so the

waiting period is 6 months to avoid anti-selection (please clarify what this
term means). In case of early cancer, the waiting period is 1 year since an
individual can wait for a longer period to avail of the benefit.

Q3. What benefits can I avail of for treatment of advanced cancer i.e.
chemotherapy, which is taken every 6 months or on a yearly basis for
more than 2 years?

Ans: In advanced cancer, the treatment benefit is a lump sum of 10% (if
early cancer benefit was claimed). The policy will continue to be in force
with cover for treatment and/or surgical benefits. This cover will be for a
maximum period of 2 years from the date of diagnosis of advanced cancer.

Q4. What benefits are given under Cancer Care if life assured is
diagnosed with cancer 3 months after the policy has been issued?

Ans: The individual will not be eligible for any claim if diagnosed after 3
months of policy issuance, as the waiting period in early cancer is 12 months
and advanced cancer is 6 months. He/she will be returned the premiums.
Q5. If I make a claim under advanced cancer in the 7th month, will you
settle the claim?

Ans: Yes, we will settle the claim for advanced cancer.

Q6. Once I make an advanced claim and my future premiums are

waived, will I be eligible for surgery benefits?

Ans: You will be eligible for treatment/surgical benefit for 2 years from the
date of diagnosis.

Miscellaneous FAQs

Q1. What is the list of exclusions under Cancer Care?

Ans: The following cancers are excluded under advanced cancer benefit:

1. All conditions included under early cancer benefits.

2. Leukaemia, where there is no generalised dissemination of leukaemia

cells in the blood-forming bone marrow.

3. Tumours showing the malignant changes of carcinoma-in-situ (including

cervical dysplasia CIN-1, CIN-2 and CIN-3) or which are histologically
described as pre-malignant.

4. All skin cancers, unless there is evidence of metastases or the tumour is a

malignant melanoma of greater than 1.5mm maximum thickness as
determined by histological examination using the Breslow method.
5. Non life-threatening cancers, such as prostate cancers which are
histologically described as T1 under TNM Classification, or are of another
equivalent or lesser classification.

6. Papillary micro-carcinoma of the thyroid. General exclusions (for both

early and advanced cancer benefits) No benefits will be payable under this
policy if a claim or event suffered by the Insured is directly or indirectly
caused or exacerbated as a result of any of the following:

Any pre-existing medical condition that can attribute to or increase the risk
of a particular cancer such as HIV/AIDS.

Unreasonable failure to seek or follow medical advice.

An intentional or self-inflicted act.

Drug-taking other than under the direction of a qualified medical

practitioner, abuse of alcohol or taking of poison.

Diagnosis and treatment for cancer outside India. The company will waive
this clause for anyone residing in the following countries: USA, Canada,
countries of the European Union, Switzerland, Japan, Hong Kong,
Singapore, Brunei, Australia, New Zealand, UAE, and Malaysia. ICICI
Prudential may at its discretion review the list of accepted foreign
residencies from time to time. Claims documents from outside India are only
acceptable in English language unless specifically agreed otherwise.

Alternative treatment other than typical treatment by Western medicine

standards (Allopathy) is not covered. This is applicable for the oncological
treatment and surgery benefits.

Q2. Which benefits are given to the life assured if he or she dies within
the survival period i.e. 28 days?

Ans: If the life assured dies within the survival period he or she will get
treatment benefits but not diagnosis benefits.

Q3. Can I change the term in due course of the policy?

 Ans: Unfortunately, you cannot change the term of the policy. But you can
increase the cover.

Q4. Will you accept the proposal form if the life assured has family
history of cancer?

Ans:Yes, we will accept the proposal form. You will be required to submit
a detailed description of the parent's cancer history.

Cancer Care Plus FAQs

FAQs - Illness

Q1. Is Mouth Cancer covered in Cancer Care Plus?

Ans: Yes, Mouth Cancer is covered under advanced cancer.

Q2. If an individual has a history of early cancer and has just developed
cancer in another part of the body, what financial benefit can he or she
avail of under the policy?

Ans: An individual who has suffered from early cancer (carcinoma-in-situ)

receive a payment of 10% each for diagnosis and treatment or surgery. In the
future, if he or she suffers from early cancer in another organ, he or she will
not receive any benefits. However, if the cancer is advanced, the individual
will receive 55% of the payment for diagnosis, 10% for treatment and 15%
for surgery.

FAQs - Claims

Q1. If I have a mediclaim as well as a Cancer Care Plus policy, I will not
be able to give you the original documents of treatments, surgeries etc.
since these papers cannot be issued in duplicate. How will I manage to
get both claims in such a case?

Ans: For making a Cancer Care Plus claim, you will be required to show all
your original documents at our branch. The originals will immediately be
verified and attested and the original documents will be returned to you. You
can submit the originals to your mediclaim company.
Q2. Why is there a 6-month waiting period for receiving a claim benefit
under advanced cancer while there is a one-year waiting period for
early cancer?

Ans:Advanced cancer requires treatment within 6 months and so the waiting

period is 6 months to avoid anti-selection (please clarify what this term
means). In case of early cancer, the waiting period is 1 year since an
individual can wait for a longer period to avail of the benefit.

Q3. What benefits can I avail of for treatment of advanced cancer i.e.
chemotherapy, which is taken every 6 months or on a yearly basis for
more than 2 years?

Ans: In advanced cancer, the treatment benefit is a lump sum of 10% (if
early cancer benefit was claimed). The policy will continue to be in force
with cover for treatment and/or surgical benefits. This cover will be for a
maximum period of 2 years from the date of diagnosis of advanced cancer.

Q4. What benefits are given under Cancer Care Plus if life assured is
diagnosed with cancer 3 months after the policy has been issued?

Ans: The individual will not be eligible for any claim if diagnosed after 3
months of policy issuance, as the waiting period in early cancer is 12 months
and advanced cancer is 6 months. He/she will be returned the premiums.

Q5. If I make a claim under advanced cancer in the 7th month, will you
settle the claim?

Ans: Yes, we will settle the claim for advanced cancer.

Q6. Once I make an advanced claim and my future premiums are

waived, will I be eligible for surgery benefits?

Ans: You will be eligible for treatment/surgical benefit for 2 years from the
date of diagnosis.
 BIBLIOGRAPHY
PRIMARY DATA:
IN LIC COMPANY WE GATHERED INFORMATION FROM:

1. Mr. KHAN-DEVELOPMENT OFFICER

2. Mr. DAMODAR –LIC AGENT

3. Mr. RAMULU.G-LIC AGENT

4. Mrs. YADAMMA-CLAIMS DEPARTMENT

IN ICICI INSURANCE COMPANY:

1. Mr.AKASH

2. Mr. PRAVEEN- AGENT

IN BAJAJ ALLAINZ
1.Mr.RAGHU-AGENT

SECONDARY DATA:

1 .LIC AGENT BOOK

2. INFORMATION FROM THE WEBSITES:

a. www.licgov.in
b. www.moneycontrol.com
c. www.kotakmahindra.in
d. www.hdfc.com
e. www.licindia.in
f. www.bajaallianz.com
g. www.icicprudential.com
h. www.wikipedia.com
i. www.google.com

INFORMATION FROM NEWSPAPERS:

1. BUSINESS LINE

2. NEWSPAPERS,PREVIOUS REPORTS