INTRODUCTION

• Pure Health Insurance, hence no

mortality cover
• A unit-linked product
– Premium paid will be subject to
allocation charge
– Balance credited to Policy Fund
Account
 POLICY FUND – A UNIT-
LINKED ACCOUNT
• Policy Fund Account will be subject to
– Health cover charge plus service tax
– Policy charge
• These charges shall be deducted on
monthly basis
 POLICY FUND – A UNIT-
LINKED ACCOUNT (Contd)
• Policy fund will be invested as per below
– Not less than 50% in Govt. securities/Govt.
guaranteed securities & Corporate debt
– Not less than 10% & not more than 50% -
Equity
– Balance Money Market instruments
– Single fund - no choice of funds, no switching
– NAV declared daily
 ELIGIBILITY CONDITIONS
• Premium :
– Max. Premium – No limit
– Min. Premium (p.a) - Rs.5,000 for single life
- Rs.7,500 for 2 lives
- Rs.10,000 for more than 2
- Minimum will also depend
on level of cover
- In multiples of Rs.500/-
 ELIGIBILITY CONDITIONS
• Age :
– Min. entry age : 18 for PI & Spouse (lbd)
3 months for children
– Max. entry age : 55 for PI & Spouse
17 years for children
– Max. cover ceasing age : 65 for PI & Spouse
25 for children
– Max. premium ceasing age: 65 for PI
 BENEFITS
• Following health covers shall be provided
– Hospital Cash Benefit (HCB)
– Major Surgical Procedures (MSP)
• Policy fund shall also provide
– Domiciliary Treatment benefit (DTB)
– Any excess spent on treatment than what is
available on hospitalisation/surgical procedure
 BENEFITS (Contd)
• Covers can be taken for
– self (Principal Insured (PI))
– spouse
– dependent children (no ceiling of number)
• Any eligible existing spouse/children if not
covered cannot be covered in future
• Any subsequent spouse (on marriage/
remarriage) or children (on birth/adoption) can
be covered within one year from policy
anniversary
 BENEFITS (Contd)
• On death of PI : - Premium stops
- If other lives are there
cover continues if at least,
3 years’ premiums have
been paid otherwise
balance in policy fund
paid
• On death of
other members : No change except
charges for them stop
 BENEFITS (Contd)
• Benefits :
– Hospital Cash Benefit
(HCB) - Min. Rs.250/-
Max. Rs.2,500 for PI & Rs.1,500
for others (in multiples of Rs.50)
- For others benefit cannot be
more than that of PI
- In case of ICU – double
 BENEFITS (Contd)
HSB (Contd)

Inflation/Increase : 5% p.a. subject to

max.
150% of initial benefit
1st year maximum : 18 days which may
include 9 days’ ICU
Subsequent year max.: 60 days which
may
 BENEFITS (Contd)
• Maximum life time : 365 days
• Waiting period : 180 days except
accident
• Exclusions : Usual
• Qualified per day : After 2 days every
day or part (4 hrs
or more)
 BENEFITS (Contd)
– Major Surgical Benefit
(MSB) : S.A = 200 times of per
day HSB
Minimum age for
benefit eligibility : 18
: 40%, 60% and 100% for
different procedures
: Each surgery covered
once only
Per year maximum : 100% of SA
 BENEFITS (Contd)

Max. life time : 3 times of S.A

Waiting period : 180 days
Exclusions : Usual
 BENEFITS (Contd)
– Domiciliary Treatment Benefit (DTB)
• Benefit can be claimed after payment of 3rd
year premium (i.e. after 2 years)
• Not more than twice in a year
• Equal to actual expenses subject to
minimum of Rs.2,500/- at a time
• Not more than 50% of policy fund at a time
• Leaving at least one annualized premium in
policy fund after payment
OTHER SALIENT FEATURES
• Surrender equal to policy fund after
completion of 3 years
• Partial withdrawals not allowed
• Loan not allowed
• Revival within 2 years of first unpaid
premium
• Alteration not allowed
OTHER SALIENT FEATURES
• Increase in premium permitted
without increase in benefits
• Reduction in premium permitted
without reduction in benefits (within
conditions of minima/maxima)
• Premium holidays permitted subject
to conditions
 CHARGES
• Allocation charge - 30% in F.Y
6% in SYs
• Policy Charge - Rs.75/- p.m in FY
Rs.25/- p.m in SYs
• HCB & MSB charges - Competitive rates
• Service Tax - Actual (12.36%
presently)
• Fund Mgt. charges - 1.25% p.a. of unit fund
 TARGET GROUP
• Policy provides complete health solution for the
family with/without mediclaim
• Along with mediclaim, one may opt for lower
HCB/HSB so that maximum amount goes in
policy fund from which expenses for DTB may
be claimed as and when needed.
• If one is already covered under mediclaim, then
also the policy shall provide Benefit which will
take care of additional expenses incurred by the
family for which no bills might be available
 TAX OPINION
• Premium paid under the policy shall
qualify for 80D
• Benefits received under HCB, MSB and
DTB not taxable
• Surrender value, if received at any time
will be taxable
• Amount received from policy fund either
on termination or on death will be taxable