Health Insurance

Key Definitions
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. Accidental Bodily Injury Age Disease / Illness Domiciliary Hospitalisation Family Hospital/Nursing Home Hospitalisation Medical Expenses Medical Practitioner Pre-existing Condition Post - Hospitalisation Expenses Pre - Hospitalisation Expenses Qualified Nurse Waiting Period
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Health Insurance Policy- Retail

Scope of Cover
Hospitalisation, Domiciliary Hospitalisation expenses arising accident , sickness. Minimum 24 hours hospitalisation. Examples Room, Board & Nursing Charges Surgeon, Anaesthetist, Consultants, and Specialists Fees Anaesthesia, Blood, Oxygen, OT Expenses Pre and Post Hospitalisation expenses Ambulance Expenses Convalescence Benefit Day care treatments Parental Care Child Care Limits and sub limits as applicable out of

Eligibility Limits
Permanent Resident of India Age at entry for dependent children - Minimum 3 months & maximum 18 years (23 year for studying students & only on exception basis). Age at entry for Adults - Minimum 18 years & maximum 65years. Individual sum Insured or Floater basis Sum Insured 50,000 to 5,00,000 in multiples of 100,000. Sum Insured for dependents cannot be more than Primary Insured. Maximum Rs.200,000/- for Insureds aged above 60 yrs in case of fresh cover. Compulsory health examination above 45 yrs through a nominated service provider and 50% cost paid if proposal acceptable.

Health Insurance Retail Product Plan Types

Benefit Plan Plan A Plan B Location A 100% 80% Location B 100% 100% Location C 100% 100%

Plan C

70%

80%

100%

Treatment Location A or ( Plan A ) Mumbai, Delhi Treatment Location B or ( plan B ) Chennai, Kolkata, Bangalore, Ahmedabad, Hyderabad Treatment Location- C or ( Plan C ) Rest of India

Plan Options
Policy Options: 1. Individual (Self Only) 2. Family Individual (Self + Spouse + 2 Dependent Children + 2 Dependent Parents) 3. Family Floater (Self + Spouse + 2 Dependent Children). Minimum and Maximum Sum Insured: 1. Options available for Sum Insured are 50,000, 1 lac, 2 lacs, 3 lacs, 4 lacs, 5 lacs under plans B & C for Individual Plan. For plan A options available are 1 lac, 2 lacs, 3 lacs, 4 lacs, 5 lacs for Individual Plan 2. Options available for Sum Insured are 50,000, 1 lac, 2 lacs, 3 lacs, 4 lacs, 5 lacs under plans B & C for Family Individual Plan. For plan A options available are 1 lac, 2 lacs, 3 lacs, 4 lacs, 5 lacs for Family Individual Plan 3. Options available for Sum Insured are 2 lacs, 3 lacs, 4 lacs, 5 lacs under all the 3 plans for Family Floater Plan

No Claim Bonus (NBS)

A no claim bonus in the form of increase in Sum Insured by 5% of the Sum Insured offered if no claim has been made during the policy year and the policy is renewed with us without any break or within the grace period of 15 days. The maximum increase shall not exceed 25 % of the base sum insured in any policy year. In case of any claim, the no claim bonus shall stand reduced to nil at the time of renewal for that policy year. Family Floater Policy: In case of any claim, the no claim bonus shall stand reduced to nil at policy level (for all the lives insured in the plan) regardless of whichever life insured makes a claim. Family individual / Individual Policy: In case of any claim, the no claim bonus shall stand reduced to nil at the time of renewal for that policy year for the Insured person making the claim. The benefit of No Claim shall continue for the remaining Insureds who have not made any claim Roll-Over Policies: Subject to provision of policy certificate and renewal notice from any previous Indian General Insurer, indicating the % of No Claim Bonus, the same would be applicable as below
% of previous NCB 25% < 25% 0 NCB offered by SBIGIC 20% 5% reduction from the previous NCB amount NCB as applicable for fresh policy

Increase in Sum Insured at renewal of policy: NCB starts getting applicable to the increased SI only from the subsequent year subject to no claims. The NCB on the increased SI would start from 5%. The percentage of NCB on the base SI would however continue its normal increase (by 5% each year). The total NCB (on the base as well as increased SI) shall not exceed 25% of Base SI .

Other Features

Lifetime renewal.
Portability for continuity of benefits offered. 15 days Grace period ( deemed renewal but no cover) Reimbursement policy Claims will be administered by Best TPAs in the country. More than 3000 hospital network PAN India.

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Roll over's & Portability

If the Insured is covered continuously and without interruption for at least 4 years under any Other Insurers individual health insurance policy for the reimbursement of medical costs for inpatient treatment in a Hospital, then the first 30 days, Pre-Existing condition , 1st Year exclusion, 2nd Year exclusions & 3rd Year exclusions stands waived. If the Insured is covered continuously and without interruption for at least 3 years under any other Insurers individual health insurance policy for the reimbursement of medical costs for inpatient treatment in a Hospital, then the first 30 days, 1st Year exclusion, 2nd Year exclusions & 3rd Year exclusions stands waived. But Pre-Existing condition stands waived after a waiting period of 1 year from commencement of Policy. If the Insured is covered continuously and without interruption for at least 2 years under any other Insurers individual health insurance policy for the reimbursement of medical costs for inpatient treatment in a Hospital, then the first 30 days, 1st Year exclusion & 2nd Year exclusion stands waived. But the pre-existing condition stands waived after a waiting period of 2 years from commencement of Policy and & 3rd Year exclusions stands waived after a waiting period of 1 year from commencement of Policy. If the Insured is covered continuously and without interruption for at least 1 year under any other Insurers individual health insurance policy for the reimbursement of medical costs for inpatient treatment in a Hospital, then the then the first 30 days & 1st Year exclusion stands waived. But pre-existing condition stands waived after a waiting period of 3 year from commencement of Policy, 3rd Year exclusions stands waived after a waiting period of 2 years from commencement of Policy & 2nd Year exclusion stands waived after a waiting period of 1 year from commencement of Policy .
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Pricing Logic
Premium is based on Floater or non floater Basis and available (adult + Child ) combinations Other factors of premium Plan Age of the Insured Sum Insured Geographical location Smoking status Medical acceptance terms vary with certain diseases For family floater plans premium will be calculated basis the age of the oldest member of the family to be insured. For floater plans, primary insured should be the oldest member of the family to be insured.

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UW Authority Matrix
Authority Matrix SI Band 4 SI Band 3 SI Band SI Band 2 1 RG 1 4 3 2 1 RG 2 4 3 2 1 RG 3 4 4 4 3 D 4 4 4 4

RG 1 - Age & Sum Insured RG 2 - (Proposal Without Medical UW) RG 3 - (Proposal With Medical UW) D - ( Decline )

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Major Exclusions
Pre-existing disease ( 4 yrs period) Waiting period ( 30 days) exclusion First year exclusion Three years Exclusion Treatment outside India Epidemics Cosmetic aesthetic treatment Medical equipments Alternate treatments War and like perils Intentional self injury

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Important Checklists
Completely filled and signed Proposal form Adverse health history if any, then the same to be filled and declared in the Proposal form. Previous policy if any, details to be filled in Proposal form and expiring Policy copy, renewal certificates to be provided. Previous Claim history if any, details to be filled in Proposal form. Age proof for children. Education proof for dependent children.

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Thanks

Together we will make SBIGIC a leading Insurer

4/21/2014