Reliance

HealthWise Policy
December 2006

December 2006
Agenda

1. Introduction - Clinical Indian Health Industry and Health Insurance

2. Product Offering – Reliance HealthWise Policy

December 2006
Introduction
ƒ Health Risks could arise from various factors such as
ƒ Physical Condition
ƒ Psychological Conditions
ƒ Occupation
ƒ Lifestyle Related Factors
ƒ Growing concern over prevalence of chronic illnesses in India
ƒ obesity
ƒ heart-illnesses
ƒ diabetes and hypertension among others

These factors will have significant impact on the health-care cost.

December 2006
Our Life Style.. A Ticking Time Bomb

Tremendous change in our life style

ƒ More nuclear families…more responsibilities
ƒ Late working
ƒ Extreme work pressures
ƒ No time for self
ƒ Not eating on time…eating out
ƒ Eating unhealthy….junk food
ƒ High inflation….everything getting expensive

December 2006
Our Life Style.. A Ticking Time Bomb

Alarming Symptoms
ƒ Increased risk of falling sick
ƒ More and more younger people fall sick
ƒ One has to pay heavily for medical treatments
ƒ Medical costs directly affect one’s hard earned
savings
ƒ Savings which were meant for important needs
is drained on medical expenses

December 2006
Our Daily Solemn Promise – what we should do

ƒ Every day I promise to myself

• I will get up early and go for a walk
• I will come home early after office
• I will eat on time
• I stop drinking..Ok ..Only a little bit
• I will eat healthy, absolute NO to junk food
• Go to a gym..Take care of my health
• I will sleep early

As Promises are meant to be broken..so I break them every day!!

December 2006
The Next Best Alternative….

It’s never too

early to
plan for future…..

Health Insurance…

December 2006
Need for Health Insurance

ƒ Urban Lifestyle and Rural Infrastructure support

ƒ Inadequate Facilities in Government Hospitals
ƒ Privately run hospitals are expensive
ƒ Increased cost of medication
ƒ Diagnostic Expenses have spiraled
ƒ Specialist Doctors come expensive
ƒ Increasing Population with income disparity
ƒ More nucleus family means less savings and less disposable income
ƒ Changing disease profile and lack of Medical Information

December 2006
Current Market Scenario
ƒ Only 85m people in India are covered under Health Insurance
ƒ Among them, only 10.8m are covered by Insurance Companies
ƒ The rest are covered under government and company schemes
ƒ Contributes to 9.6% of the general insurance market
ƒ Intense competition among the public and private players
ƒ Historically perceived as a loss making portfolio
• Lack of spread of risk
• Lack of adequate Underwriting guidelines
• Inadequate claims control
• High perceived fears of fraud and abuse
ƒ Very little variation in product and price among the insurance providers
ƒ Inadequate distribution
ƒ Coverage of Pre-existing diseased - still a question

December 2006
Healthcare Opportunity in India - Mckinsey report

ƒ Healthcare spending in the next 10 years will Double

ƒ Healthcare spending will increase to 2,00,000 crores by 2012 (Rs.86,000
crores in 2000-01)
ƒ Health care insurance sector is to become a
ƒ Rs 25,000 crore industry by 2009 (Rs.1200 crores- in 2001-02)
ƒ Rs 75,000 crore by 2020

December 2006
The Way Forward….

ƒ Increased customer awareness for more spread of insurance

ƒ Higher standards of customer service
ƒ Popularisation of Floater Concept
ƒ Reduction of Claim Ratio through efficient underwriting guidelines/ control /
product offerings / spread of risk
ƒ Value Adds and Increased Features which further sweetens the product
ƒ Affordable pricing – cross subsidize across age categories
ƒ Increased Marketing Communication
ƒ Increased Cashless Coverage through TPA
ƒ Ensure Hassle-Free Policy Issuance and Claim Procedures
ƒ Inclusion of Preventive elements

December 2006
Agenda

1. Introduction - Clinical Indian Health Industry and Health Insurance

2. Product Offering – Reliance HealthWise Policy

December 2006
What is Reliance HealthWise Policy?

Reliance HealthWise Policy provides for …………….

Financial Assistance for you and your family against Hospitalisation

Expenses towards disease / illness / injury in India along with host of
value additions / options

December 2006
Reliance HealthWise Policy
1. Basic Features
2. Value Added Features
3. Policy Features
4. Exclusions
5. Plan Details
6. Our Advantage

December 2006
1. Basic Features

a. Hospitalisation Expenses
b. Daycare Treatment
c. Domiciliary Hospitalisation
d. Pre and Post Hospitalisation
e. Coverage of Pre-Existing Diseases
f. Critical Illness Cover
g. Donor Expenses

December 2006
1.a. Hospitalisation
Covers hospitalisation expenses incurred as an in-patient in a Hospital which
will include

• Room, Boarding and Operation Theatre charges

• Fees of Surgeon, Anesthetist, Nurses, Specialists
• The cost of diagnostic tests, medicines, blood, oxygen, appliances
like pacemaker, artificial limbs and organs etc

Hospitalisation for a minimum period of 24 hours is a must

The cover provided is to a maximum of the Sum Insured

as selected by the Customer

December 2006
1.b. Day Care Treatment
Hospitalisation less than 24 hrs

Due to advancement of technology, hospitalisation expenses for certain

treatments / diseases like the following are also covered, even though the
hospitalisation is for less than 24 hours
• Cardiac Catheterization • Dilation & Curettage
• Cataract • Eye Surgery
• Chemotherapy • Hernia Repair Surgery
• Coronary Angiography • Hydrocele Surgery
• Coronary Angioplasty • Lithotripsy (Kidney stone removal)
• Dialysis • Radiotherapy
• Tonsillectomy

December 2006
1.c. Domiciliary Hospitalisation
Medical Treatment at your Home
Medical Treatment for a period exceeding three days, which in the normal
course, would require hospitalisation, but treatment is actually taken at home,
under any of the following circumstances: -
ƒ the condition of the patient does not permit him/her to be removed to
Hospital or
ƒ the patient cannot be admitted to Hospital for lack of accommodation
therein
This benefit also covers expenses on employment of a qualified nurse, as
recommended by the attending Doctor.

The cover provided is to a maximum of 10% of the Sum Insured

as selected by the customer
December 2006
1.d. Pre and Post Hospitalisation
Extended Pre and Post Hospitalisation
Policy also covers relevant medical expenses incurred during a specified
period, before & after hospitalisation (for which a claim is payable)

December 2006
1.e. Coverage of Pre-Existing Diseases

Pre-Existing Diseases Coverage

Hospitalisation expenses incurred on treatment towards Pre-existing diseases /
condition can be covered:
ƒ Gold Plan: after completion of 2 consecutive years of the policy period
ƒ Silver Plan: after completion of 2 consecutive years of the policy period
ƒ Standard Plan: after completion of 4 consecutive years of the policy period

December 2006
1.f. Critical Illness Cover
Double Sum Insured Benefit
If Insured contracts any of the following nine Critical Illnesses, the Sum
Insured under the Policy (chosen by the Insured), is doubled towards
hospitalisation expenses incurred for treatment of such Critical illness.
ƒ Cancer
ƒ Coronary Artery Bypass Surgery
ƒ First Heart Attack
ƒ Kidney Failure
ƒ Multiple Sclerosis
ƒ Major Organ Transplant
ƒ Stroke
ƒ Aorta Graft Surgery
ƒ Paralysis
ƒ Primary Pulmonary Arterial Hypertension

This feature is available only in Gold Plan

December 2006
1.g. Donor Expenses

Major Organ Transplant

Covers hospitalisation expenses towards donor in case of major organ

transplant.

This feature is available to customers of Gold and Silver Plans

December 2006
2. Value Added Features

Value added benefits are payable up to the Sum Insured for the plan opted.

a. Expenses on accompanying person at the Hospital

b. Local Road Ambulance Services
c. Recovery Benefit
d. Cost of Health Check up
e. Nursing Allowance
f. Hospital Daily Allowance

These features become applicable once a valid claim is admitted under

the basic hospitalisation expenses cover of the Policy
December 2006
2.a. Expenses on Accompanying Person

Payment towards expenses incurred by an accompanying person at the

hospital while Insured is hospitalised for a minimum period of 5 days.

ƒ Gold Plan: Rs. 300/- per day for a maximum of 5 days

ƒ Silver Plan : Rs. 250/- per day for a maximum of 5 days
ƒ Standard Plan : Rs. 200/- per day for a maximum of 5 days

This is a common feature available to all Policyholders

December 2006
2.b. Local Road Ambulance Services

Reimbursement of Expenses incurred for necessary transportation of the

insured to the nearest Hospital in an ambulance for hospital admission and
requiring immediate treatment.
Maximum limit:
ƒ Gold Plan – Rs. 1000/-
ƒ Silver Plan – Rs. 750/-
ƒ Standard Plan – Rs. 500/-

This is a common feature available to all Policyholders

December 2006
2.c. Recovery Benefit
In an unfortunate event, if the Insured is hospitalised for more than 10
consecutive days, a lump sum benefit of Rs. 10,000 will be payable as Recovery
Benefit.
Basic Hospitalisation claim is enough. No need to provide for bills as this is a
benefit payment.
This benefit is applicable for
ƒ All the members of the floater separately
ƒ Irrespective of the number of occurrence during the policy period

This feature is available only to customers of Gold Plan

December 2006
2.d. Cost of Health Check up

This benefit provides for reimbursement of cost / charges incurred for medical
check up.

ƒ Applicable once in a block of 4 claim free years.

ƒ Reimbursement is limited to 1.25% of the average sum insured.

This is a common feature available to all Policyholders

December 2006
2.e. Nursing Allowance

Payment of Nursing Allowance for expenses towards employment of registered

nurse at the residence of Insured or at the Hospital provided such services are:
ƒ Confirmed as being necessary by the treating Physician
ƒ Relate directly to a disease / illness / injury for which the Insured has been
hospitalised.

This is applicable irrespective of the number of times of occurrence

Allowance is payable for 5 days. In case of Critical Illness under Gold Plan this
is payable for 10 days.
ƒ Gold Plan Rs 300/- per day
ƒ Silver Plan Rs. 250/- per day

This feature is available to customers of Gold and Silver Plans

December 2006
2.f. Hospital Daily Allowance

Daily Hospital Allowance of Rs. 250 per day up to 7 days will be paid to
Insured, provided he/she is hospitalised for more than 3 days.

ƒ It is irrespective of the number of occurrences

ƒ If case two people of the same floater are hospitalised, concurrently, each
one of them will be eligible for hospital daily allowance separately

This feature is available only for Gold Plan customers

December 2006
3. Policy Features
a. Income Tax Benefit
b. Family Floater
c. Sum Insured
d. Pre-insurance Health Check up
e. Option in Policy Duration
f. Renewal Discount
g. Cashless Facility (Through Third Party Administrators - TPA)
h. Age Slabs

December 2006
3.a. Income Tax Benefit

Premium paid for Reliance HealthWise Policy is eligible for tax deduction under
section 80 D of the Income Tax Act, subject to the condition that the
premium amount is paid by cheque/DD by the customer from his bank
account.

ƒ Rs. 10,000/- for self, spouse, kids and parents

ƒ Rs. 15,000/- if the policy includes senior citizens whose ages is above 65
yrs

December 2006
3.b. Family Floater

Policy can be issued on a Floater basis covering the family members of the
Insured comprising the Insured, spouse and two dependant children (upto the
age limit of 21 years).
What is floater, how does it benefit?
ƒ All members of the family (Self, Spouse, 2 Kids)
can be covered under one single policy
ƒ Single premium payable for the entire family
ƒ The amount of Sum Insured “floats”
over the entire family
ƒ No need to insure individual members separately
ƒ No hassles of tracking renewals for different members

December 2006
3.b. Family Floater - Illustration

Family: Mr. Ashish Sethi, Mrs. Sethi & their kid Nikki
Scenario 1:
ƒ They take an insurance policy with a SI of Rs.1 Lakh each
ƒ Mr. Sethi unfortunately needs to undergo angioplasty
ƒ The total bill amount Rs. 1.4 lakhs
ƒ Insurance company pays only Rs. 1 Lakh as he is covered for only 1 Lakh.
He cannot adjust the rest in the unused coverage amount of his wife and
daughter
ƒ Mr. Sethi needs to bear the reminder of the cost – i.e. Rs, 40,000!!

December 2006
3.b. Family Floater - Illustration

Family: Mr. Ashish Sethi, Mrs. Sethi & their kid Nikki
Scenario 2:
ƒ They take a Reliance Healthwise Policy with a SI of Rs. 3 Lakh for the family
ƒ Mr. Sethi unfortunately needs to undergo angioplasty
ƒ The total bill amount Rs. 1.4 lakhs
ƒ The entire amount is paid for by Reliance HealthWise Policy
ƒ Mr. Sethi does not need shell out any money out of his own picket

December 2006
3.b. Your Choice!

OR

December 2006
3.b. Advantage Floater!

Chance of all in the Sethi family falling ill in one year is low as compared to
one member falling severely ill – Theory of probability

Individual
Single cover for each member
No flexibility to transfer the unutilized limit
for other members
Separate policy (separate document) for
family members
Premium payment annual in nature
Currently, all plans annual in nature
Floater
Common cover for all members
The limit can be used by any member of
the family & for any number of times
Single document, single premium, single
date to track
For the 2 year option, premium payment
once in 2 years (at the beginning)
Floater plan available for one/two
years..so assured zero hassle renewal
next year

December 2006
3.b. Fits all in the Family
ƒ Family covered under floater policy
ƒ Choice to cover
ƒ Individual
ƒ Couple
ƒ Couple & One kid
ƒ Couple & Two kids
ƒ Choice of cover amount
ƒ Rs. 1 to 5 Lakh per family depending on the plan selected

December 2006
3.c. Sum Insured

Wide range of Sum Insured option depending upon his medical requirement:

ƒ Gold Plan: 1 lac, 2 lac, 3 lac, 4 lac, 5 lac

ƒ Silver Plan: 1 lac, 2 lac, 3 lac, 4 lac, 5 lac

ƒ Standard Plan: 1 lac, 2 lac, 3 lac, 4 lac, 5 lac

December 2006
3.d. Two Year Policy Option

ƒ The Reliance HealthWise Policy offers to the Insured an option of

ƒ 1 year Policy

ƒ 2 years Policy

If two year policy option is taken……………….

ƒ No worries for the insured members regarding:

ƒ Any price increase

ƒ Remembering to renewing the policy again next year

ƒ Premium to be paid for 2 years at the beginning itself

December 2006
3.e. Pre-insurance health Check up

ƒ No medical tests required at enrollment stage for family members under the
age of 45 and the Policy is issued immediately based on proposal form and
declaration

ƒ Applicants above 45 yrs will be covered only after completion of medical

tests, submission of reports and the approval of Underwriting team

December 2006
3.f. Renewal Discounts

ƒ A renewal discount of 5 % on the renewal premium will be allowed, in case

no claim is made during the expiring policy period

ƒ This renewal discount can be accumulated upto a maximum of 50%

December 2006
3.g. Cashless Facility (Through TPA)

ƒ Each Policy holder will get a Health Card

ƒ Using Health Card the Insured can avail of Cashless Hospitalisation facility
through contacting the TPA

ƒ Cashless facility is available in over 3000 networked hospitals across the

country

ƒ TPA provides assistance in

ƒ Cashless hospitalisation

ƒ Information on Claims status

ƒ Information on Hospitals

ƒ 24 hour helpline
(TPA - Third Party Administrators)
December 2006
3.h. Age Slabs – Applicability
ƒ Anyone between the age of 3 months to 65 yrs can be covered under the
various plans

ƒ No fresh policy to be issued after 55 yrs in case of Gold Plan; 60 yrs incase
of Silver Plan; 65 yrs incase of Standard Plan

ƒ 3 months - 45 yrs can be covered without Pre-insurance medical tests

ƒ 46 yrs & above Mandatory medical test & necessary approval from the UW

Age band Coverage

Covered only along with either of the parents without any medical
3 months to 5 yrs
examination
6 years to 45 yrs Covered without any medical examination.
46-65 yrs Covered subject to satisfactory medical examination

December 2006
4. Exclusions
First year Exclusions
There are certain ailments which are not covered for the First year of inception of
health insurance cover, but are covered subsequently –
ƒ Cataract
ƒ Benign Prostatic Hypertrophy
ƒ Myomectomy, Hysterectomy or menorrhagia or fibromyoma unless because
of malignancy
ƒ Dilation and curettage
ƒ Hernia, hydrocele, congenital internal disease, fistula in anus, sinusitis
ƒ Skin and all internal tumors/ cysts/nodules/ polyps of any kind including breast
lumps unless malignant /adenoids and hemorrhoids
ƒ Dialysis required for chronic renal failure
ƒ Gastric and Duodenal ulcers
December 2006 This exclusion will not apply for roll over cases
4. Exclusions
Permanent Exclusion

ƒ Disease/ Injury existing before inception of health insurance policy being pre-
existing disease (however, these will be covered after 2nd year, depending
on the choice of plan)

ƒ Any disease contacted during the first 30 days of inception of policy –

accidents excluded and roll over cases excluded

ƒ Naturopathy or other forms of local medication

ƒ Pregnancy & childbirth related diseases

ƒ Intentional self-injury / injury under influence of alcohol, drugs

ƒ Diseases such as HIV or AIDS

ƒ Diseases existing from the time of birth (Congenital diseases)

December 2006
4. Exclusions contd……..
ƒ Cost of spectacles, contact lenses and hearing aids

ƒ Dental treatment or surgery of any kind unless requiring hospitalization

ƒ Charges incurred at Hospital or Nursing Home primarily for diagnostic

without any treatment

ƒ Expenses on vitamins and tonics unless forming part of treatment for disease
or injury as certified by the medical practitioner

ƒ Cosmetic, aesthetic, treatment unless arising out of accident

ƒ Treatment related to obesity

ƒ War, riot, strike, terrorism, nuclear weapons induced hospitalisation

ƒ Routine medical, eye and ear examinations

ƒ Treatment of mental illness

December 2006
5. Plan Details

Plan Comparison – Basic Features

December 2006
5. Plan Details

Plan Comparison – Value added Benefits

December 2006
5. Plan Details
Plan Comparison – Policy Features

December 2006
6. Our 17 points Advantage!
1. Family Floater Option
2. Coverage of Pre-Existing Diseases after 2nd year of renewal
3. Automatic Double Sum Insured under Critical Illness cover
4. Policy duration for 2 years
5. Extended Pre and Post-hospitalisation
6. Wider Sum Insured options
7. Hospital Daily Allowance
8. Nursing Allowance
9. Recovery Benefit
10. Reimbursement of Cost of Health Check up after 4 years
11. Local Road Ambulance Services
12. Expenses on Accompanying Person
13. Cashless Facility
14. Policy without Medical test till 45 yrs
And you tell me the Last
15. Renewal Reward - No Claim Bonus
Advantage…. The 17 advantage
16. Income Tax Benefits
December 2006
6. Our 17 points Advantage!

17. Instant Policy Issuance

December 2006
6. Reliance Healthwise Vs. Other Cos.

December 2006
6. Reliance Healthwise Vs. Other Cos.

December 2006
6. Reliance Healthwise Vs. Other Cos.

December 2006
fast forward
better living

December 2006
Thank you
December 2006

December 2006