Вы находитесь на странице: 1из 24

Tamilnad Mercantile Bank Ltd., Head Office, Business Development, Thoothukudi Welcomes u all.

TMB UNI Family Health Care Policy.


1

TMB UNI Family Health Care Policy.

Brief Description Mediclaim Insurance is a Health cover, which takes care of medical expenses following Hospitalisation of the Insured. Also covers pre & post hospitalisation expenses. This policy covers all the insured person (self) and their family members under a single sum insured.
2

TMB UNI Family Health Care Policy.

Salient features A proposer can take the policy for self and family members. The premium under this policy is eligible for Income Tax benefit under section 80D. This health policy covers citizens aged from 3 months to 80 years. Pre-existing diseases are covered from the fifth year policy provided the renewals are done without break in insurance.
3

TMB UNI Family Health Care Policy.

Salient features Cashless facility for claim settlement available in network hospitals (as on today approximately 4500 hospitals) through Third Party Administrators (TPA). Hospitalisation expenses in India due to disease / accident for admission beyond 24 hours. ID Card issued to the Insured Person. Claims will be serviced by TPAs.
4

TMB UNI Family Health Care Policy.

Salient features The policy covers the age group from 3 months to 80 years. Floater Sum Insured where any one of the entire family can avail the sum insured offered.
5

TMB UNI Family Health Care Policy.

Scope of Cover This Mediclaim Insurance policy is exclusively designed for the benefit of the TMB Clients / Insured Persons only.

TMB UNI Family Health Care Policy.

Room charges and Boarding expenses as provided by the Hospital / Nursing Home is eligible for reimbursement. Nursing expenses can be repayable. Surgeon, Consultants, Specialists fees, Operation theatre expenses, Surgical appliances etc., are covered. Ambulance Facility can be availed subject to the maximum of Rs. 2,500/- per policy
7

TMB UNI Family Health Care Policy.

Hospital Daily Cash Benefit: The Policy will pay to the insured person a Daily Cash Allowance of Rs.250/- per day Subject to a maximum of Rs.2,500/- per policy period. Reimbursement of funeral expenses: Reimburse actual funeral expenses subject to a maximum of Rs.1,000/- during the policy period.
8

TMB UNI Family Health Care Policy.

PERIOD OF POLICY:
This insurance policy is issued for a period of one year.

TMB UNI Family Health Care Policy.

Additional Features Definition of Family: Family comprising of Self (account holder), his legal Spouse and Dependent Children.
10

TMB UNI Family Health Care Policy.

Dependent Children: Dependent children between the age of 3 completed months and 26 years provided either or both parents are covered concurrently. For unmarried and unemployed girls, disabled children without income dependent upon Proposer, the age limit of 26 will not apply.
11

TMB UNI Family Health Care Policy.

Dependent Children:
However, children will cease to be covered if they are employed / self-employed or married.

12

TMB UNI Family Health Care Policy.

Age at entry: Proposer age should be between 18 and 80 years. Renewal age: Up to 80 years of age subject to continuous renewal without break.
13

TMB UNI Family Health Care Policy.

Sum Insured: Beginning from Rs. 1,00,000/and in multiples of Rs. 1,00,000/- up to Rs. 5,00,000/-. Pre-Acceptance Health Checkup: Pre-acceptance medical examination is not required if the beneficiaries are below 45 years of age.
14

TMB UNI Family Health Care Policy.

EXCLUSIONS:
The most important exclusion relates to pre-existing illness. If the insuring person had a health condition, existing prior to taking the policy, which required medical treatment, the same gets automatically excluded in the policy. To ensure that in subsequent renewals medical conditions incepting since the policy was taken do not get excluded, the insuring person must renew the policy without break. Pre-existing disease coverage will not be available for an insured person during the first four years since inception of his / her first policy with the Company. Any disease contracted by the Insured person during the first 30 days from the commencement date of the policy is not covered. But accident claim is available. 15

TMB UNI Family Health Care Policy.


CLAIM PROCEDURE: All claims will be processed and settled by specified Third Party Administrator (TPA) licensed by IRDA. The payment will be made either to Hospital / Nursing Home in case of Cashless treatment and to the Proposer / insured person in other cases. Intimation of Hospitalisation is to be made immediately to the TPA. To avail Cashless facility, Pre-authorisation request to be sent or faxed to TPA immediately on admission. In Reimbursement cases, Insured to intimate TPA about hospitalisation of insured persons immediately on admission or not later than 24 hours. Claim bills to be submitted to TPA within seven days of discharge. All claims under this policy shall be payable in Indian currency.
16

TMB UNI Family Health Care Policy.


Procedure for availing Cashless access service: Cashless facility means TPA may authorize upon the Insureds request for direct settlement of admissible claim as per agreed charges between Net work Hospitals & the TPA. In such cases the TPA will directly settle all eligible amounts with the Net work Hospitals and the Insured Person may not have to pay any bills after the end of the treatment at Hospital to the extent of the claim is covered under the policy. To avail Cashless facility, Pre-authorisation request to be sent or faxed to TPA immediately on admission. Claims in respect of Cashless access services will be through the agreed list of Network Hospitals which has agreed to participate for providing cashless health services to the insured persons. The list is maintained by and is available with the TPA and the same 17 is subject to amendment from time to time.

TMB UNI Family Health Care Policy.


Conditions:
Contract: The proposal form, declaration, Health Certificate, Policy and ID Card issued shall constitute the complete contract of insurance. Communication: Every notice or communication to be given or made under this Policy other than relating to claim shall be delivered in writing at the address of the policy issuing office as shown in the schedule. The claim shall be referred to the TPA appointed for providing claim services. Premium Payment: The premium payable under this policy shall be paid in advance.
18

TMB UNI Family Health Care Policy.


Physical Examination:
Any Medical Practioner authorized by the TPA / Company shall be allowed to examine the Insured Person in case of any alleged disease / illness / injury requiring Hospitalisation. Non-co-operation by the Insured Person will result in to rejection of claim. Fraud, Misrepresentation, Concealment: The policy shall be null and void and no benefits shall be payable in the event of misrepresentation, mis-description or non-disclosure of any medical 19 fact / particulars.

TMB UNI Family Health Care Policy.


Cancellation Clause: The Company may at any time cancel the Policy on grounds of misrepresentation, fraud, non-disclosure of material fact or noncooperation by the insured by sending seven days notice in writing by Registered A/D to the insured at his last known address in which case the Company shall return to the insured a proportion of the last premium corresponding to the unexpired period of insurance if no claim has been paid under the policy. The insured may at any time cancel this policy and in such event the Company shall allow refund of premium at Companys short period rate table.
20

TMB UNI Family Health Care Policy.

Disclaimer of Claim: If the TPA / Company shall disclaim liability to the Insured for any claim hereunder and if the insured shall not, within 12 calendar months from the date of receipt of the notice of such disclaimer notify the TPA / Company in writing that he does not accept such disclaimer and intends to recover his claim from the Company, then the claim shall for all purposes be deemed to have been abandoned and shall not thereafter be recoverable hereunder.

21

TMB UNI Family Health Care Policy.


Renewal of Policy: The Company shall renew this Policy if the Insured shall remit the requisite premium to the Company prior to expiry of the Period of Insurance. The Premium for renewal shall ordinarily be payable in advance to the Company. The Company shall if necessary, revise the rates of premium for such Policies, in which event the Insured shall be liable to pay the revised rates of premium prevailing at the time of renewal and / or load the Premium for the Insured, depending upon the claims experience under the Policy held by the Insured. The Company shall be entitled to decline renewal if, any fraud, misrepresentation or suppression by the Insured.
22

TMB UNI Family Health Care Policy.


Cumulative Bonus: The sum insured under policy shall be increased by 5% at each renewal in respect of each claim free year of insurance, subject to maximum of 30%. In case of a claim, the cumulative bonus earned shall be withdrawn on renewal of the policy. Cumulative Bonus will be lost if policy is not renewed on the date of expiry. Companys Liability: The Companys liability in respect of all claims admitted during the period of Insurance shall not exceed the sum 23 insured including Cumulative Bonus.

TMB UNI Family Health Care Policy.

Thank you.
24