Care Advantage
CARE ADVANTAGE
Option to choose 25 Lacs/50 Lacs & 100 Lacs
All Category Rooms allowed Affordable
Price
No Claim Bonus Automatic Recharge
Income Tax Benefit under Section 80D
In
Patient & Day Care Treatment Expenses (Up to Sum Insured)
•
In-patient Care:
Covers hospitalization
expenses if the admission for injury/illness
in a hospital exceeds 24
consecutivehours.
•
Day Care Treatment:
Covers treatment
expenses where hospitalization duration is less than 24 hours. We cover 541 Day
care procedures
Room Rent
Customer is eligible
for All Room Category available in a Hospital
ICU Charges (No Sub Limit)
Pre Hospitalisation (30 Days)
Post Hospitalisation (60 Days)
Ambulance Cover
(Up to Sum Insured)
We cover expenses
incurred for the
transportation of the Insured person on
a Licensed Ambulance on the
written advice of treating
medical Practioner.
Ambulance
can be used for transporting insured member from
– Place of occurrence
to Nearest Hospital or
– One Hospital to another hospital for providing better medical care
Organ Donor Expenses
(Up to Sum Insured)
We will cover the cost of surgery performed on the Donor for the
extraction of organ Claim is payable
if it meets the following
conditions
– The Organ donor is an eligible donor
in accordance with The Transplantation of Human
Organs Act, 1994 (amended) and
other applicable laws and rules.
– The Insured Person is the recipient of the Organ so donated by the
Organ Donor.
– Pre-Hospitalization & Post Hospitalization
expenses incurred on the Donor are not covered
– Any other Medical Expenses in respect of the Donor
consequent to the harvesting are not covered
No Claim Bonus
|
Sum
Insured |
25 Lacs |
50
Lacs |
100
Lacs |
|
No Claim Bonus |
Up to 150%
Increase in Sum Insured |
Up to 50%
Increase in Sum Insured |
Up to 50%
Increase in Sum Insured |
No Claim Bonus – (NCB)
Base Policy SI is
increased by 10% on Renewal if there is no claim during the previous
policy period subject to following conditions
–
NCB benefit will not exceed 50% of Base Policy SI.
–
In case of a claim in any policy year,
the SI is reduced by 10%
–
In case of claims in
consecutive years the policy
SI will not be reduced below
base Sum Insure of the Policy.
 |
 |
 |
 |
 |
 |
||||||||||||||||
 |
 |
 |
|
 |
|||||||||||||||||
Automatic
Recharge
•
Once in a Policy Year
• Recharge amount can be utilized from the Second Claim in the Policy Year
• Claim from Recharge
will be even payable
if Same Person is admitted for treatment of an earlier claimed illness/injury in the policy year.
• Second Hospitalisation
should occur after 45 Days of discharge of the last hospitalisation
Automatic
Recharge Illustration
|
|
SCENARIO 1 |
SCENARIO 2 |
SCENARIO 3 |
|
Policy Sum Insured |
50,00,000 |
50,00,000 |
50,00,000 |
|
Claim 1
Filled |
50,00,000 |
59,00,000 |
40,00,000 |
|
Claim 1
Eligible |
50,00,000 |
50,00,000 |
40,00,000 |
|
Balance Sum
Insure |
- |
- |
10,00,000 |
|
Recharge |
50,00,000 |
50,00,000 |
50,00,000 |
|
Claim 2
Filled |
50,00,000 |
30,00,000 |
60,00,000 |
|
Claim 2
Eligible |
50,00,000 |
30,00,000 |
50,00,000 |
|
Balance Sum Insured for next claim in a Years |
- |
20,00,000 |
- |
Advanced Technology Methods
In case treatment
is taken using advanced technologies
while admitted in a hospital
under In-Patient Treatment or Day Care Treatment.
Below mentioned advanced technology
treatment are covered
|
Uterine
Artery Embolization and HIFU |
Balloon
Sinuplasty |
Deep
Brain stimulation |
 |
 |
 |
|||
Advanced Technology Methods
|
Oral
chemotherapy |
Immunotherapy-
Monoclonal Antibody to be given as injection |
Intra
vitreal injections |
|
Robotic
surgeries |
Stereotactic
radio surgeries |
Bronchical
Thermoplasty |
Advanced Technology Methods
|
Vaporisation of the
prostrate (Green laser treatment or holmium laser treatment) |
IONM
- (Intra Operative Neuro Monitoring) |
Stem cell
therapy: Hematopoietic stem cells
for bone marrow transplant for
haematological conditions to be
coveredIntra vitreal injections |
 |
 |
 |
|||
Optional Benefits
|
No
Claim Bonus SUPER |
50%
increase in SI per Policy Year in case of claim-free year; Max up to 100% of SI (50% decrease in SI per Policy Year in case a claim has been paid; Such decrease is only
in SI accrued as NCBS) |
|
Smart
Select |
•
No Co-payment for Treatment in SMART
SELECT Listed Hospitals •
Additional Co-payment of 20% on all treatment taken in a Non-
Smart Select Network Hospital |
|
Room Rent Modification |
Room Category will be restricted to
Most Economical Single Private AC Room of the Hospital |
OPTIONAL
BENEFITS :
Base Policy Sum insured is increased by 50% on Renewal
if there is no claim during the previous policy
period subject to following conditions
–
No Claim Bonus SUPER benefit will not exceed 100% of Base Policy
Sum Insured
–
In case of a claim in any policy year, the Sum Insured is reduced by 50%
of sum insured
–
In case of claims in consecutive years the policy sum Insure
will
not be
reduced below base policy sum Insure
 |
 |
 |
 |
 |
|||||
|
Policy Year |
Total Sum Insured (After RENEWAL) |
No Claim Bonus |
NO Claim Bonus
SUPER |
Claim Status |
|
0 |
50,00,000 |
|
- |
No |
|
1 |
80,00,00 |
5,00,000 |
25,00,000 |
No |
|
2 |
1,10,00,000 |
5,00,000 |
25,00,000 |
No |
|
3 |
1,15,00,000 |
5,00,000 |
- |
No |
|
4 |
1,20,00,000 |
5,00,000 |
- |
Yes |
|
5 |
90,00,000 |
-5,00,000 |
-25,00,000 |
Yes |
|
6 |
60,00,000 |
-5,00,000 |
-25,00,000 |
No |
|
7 |
90,00,000 |
5,00,000 |
25,00,000 |
|
Note :
•
In Year 5 & Year 6 , Policy Sum Insure is reduced
because of claim in Year 4 and Year 5
•
Amount reduced is from the No Claim /No Claim Bonus accrued in the policy
•
There is a
reduction of the NCB & NCB SUPER amount as there was a claim Year
•
In year 7, Policy
Sum Insure is increased
because there was NO Claim in Year 6
•
Policy Sum Insure
will not reduced
below Basic Policy Sum Insure i.e 50 Lacs in our example
•
Policy Sum Insure
will not go beyond 1.25 Cr ( in case NCB Super
is added) & 75 Lacs (in case NCB Super is not
added
•
Customer is eligible for a 10% discount on the Premium by opting
for this Optional Cover
•
By choosing this Optional
Cover the Room Rent/Room
Category shall be limited to “Single Private
Room”
– If the
Room Category opted or Room Rent incurred is higher than
the Single Private Room. Then the Insured Person shall bear the ratable
proportion of the total
Variable Medical Expenses (including
applicable surcharge and taxes thereon) in the proportion of the difference
between the Room Rent actually incurred
and the Room Rent of the entitled Room Category to the
Room Rent actually incurred
•
15% DISCOUNT on Premium
•
Points to Remembered
–
NIL co-payment if the
treatment is taken in a SMART SELECT Network hospital
– Have to bear 20% co-payment
if the treatment is taken in a
hospital not on the SMART SELECT Network Hospital
Note
: Co-payment applicable on Policy due to Entry Age will be applicable in both
claim scenarios mentioned above
CARE SHIELD comes with Unique Benefits :
ü CLAIM SHIELD will protect CLAIMS made in the
policy from
NON-PAYABLEitems in Policy
ü NO CLAIM BONUS SHIELD will protect NO CLAIM BONUS/NO CLAIM BONUS SUPER eligibility from claims made a policy Year
ü INFLATION
SHIELD will make your policy INFLATION proof
by increasing Base Sum Insure as
per CPI INFLATION in the previous
year
List of Payable Items Under Claim Shield
|
#Internal Training
and Circulation only
CLAIM
SHIELD
Convert NON PAYABLE list of items in your policy to PAYABLE items
CLAIM SHIELD
ILLUSTRATION :
|
Details |
AMOUNT in Rs, |
REMARKS |
|
Total
Claim |
216350 |
|
|
Deductions |
69583 |
Diet
Charges/Food, Dietician, Mineral Water, Bed Bath, Bed Sheet, Face Shield,
Handrub,mask, Nasal Canula,o2 Mask, Tegagerm, Underpad, Pulse Oxymeter,
Registration /Mrd, Other Consumables |
|
Amount
Paid without CARE SHIELD |
146767 |
|
|
Total Amount Payable with CLAIM SHIELD |
216350 |
|
Note : The above
illustration is for a Non - Covid hospitalisation
#Internal
Training and Circulation only
NO
CLAIM BONUS SHIELD
You don’t loose your NCB/NCB SUPER if claimed amount is
Lessthan 25% of BASE Sum
Insured in a Policy Year
NO CLAIM BONUS SHIELD ILLUSTRATION :
|
|
Year
1 |
Year 2 |
Year
3 |
Year 4 |
|
Sum Insure |
10,00,000 |
11,00,000 |
10,00,000 |
10,00,000 |
|
Amount of Claim paid on Policy |
2,00,000 |
2,60,000 |
5,00,000 |
1,50,000 |
|
Claim Amount %age |
20% |
26% |
50% |
15% |
|
Is the Policy eligible for NCB on renewal |
Yes |
No |
No |
Yes |
#Internal Training and Circulation only
INFLATION SHIELD
BASE SUM INSURE will increase
every year to
keep pace
with CPI INFLATION
every year
INFLATION SHIELD ILLUSTRATION :
|
|
Year 1 |
Year 2 |
Year 3 |
Year 4 |
|
Total Sum Insured plus inflation amount |
10,00,000 |
11,00,000 |
12,00,000 |
13,00,000 |
|
CPI INFLATION |
10% |
10% |
10% |
10% |
|
Amount Added to Policy due to INFLATIONSHIELD |
1,00,000 |
1,00,000 |
1,00,000 |
1,00,000 |
Note :
ü CPI means Consumer Price Index
ü CPI Inflation increase will not be effected
by claims in the Policy
ü Amount
of Sum Insure to be increased will always be calculated on Base Policy Sum Insure
ü Increase of Sum Insure will be on cumulative basis
ü CPI Inflation Percentage is calculated on Policy Year
Basis
#Internal Training and Circulation only
|
Po |
licy Conditions |
|
Minimum Entry Age |
Individual
:5 Years Floater :91
days with atleast 1 person of 18 Years or above |
|
Maximum
Entry Age |
Child : 24
Years & Adult : No Age Limit |
|
Policy Term |
1/2/3 Years |
|
Co-payment |
20%
Mandatory in case entry Age >60 Years . |
|
Allowed
Relation ships |
1) Individual: Self, Legally married spouse,
son, daughter, father, mother, brother, sister, mother-in-law,
father-in law, grandmother, grandfather, grandson, granddaughter,
uncle, aunt, nephew, niece,
employee or any other relationship having an insurable interest. 2) Family Floater: Self, Legally married spouse, son, daughter,
father, mother, employee and his/her dependents
(Legally married Spouse, Children & Parents) or any other relationship having an insurable interest |
Waiting Period
|
Initial Wait
Period |
30 Days for Treatment related to diseases |
|
Named Ailment wait Period |
24 Months |
|
Pre-Existing Disease Wait Period |
48 Months |
Comments
Post a Comment