Presentation on theme: "“A New Revolution In Health – Care”"— Presentation transcript:
1 “A New Revolution In Health – Care” SyndArogya“A New Revolution InHealth – Care”
2 SyndArogya Mediclaim Insurance cum Personal Accident Scheme. Individual Policy with benefit of Groupsize of 2 lacs policy holdersFloater Policy 1+3 (Husband, wife & two dependent children) with premium as per Plan A table and 1+5 (Husband, wife, two dependent children & dependent Parents) with premium as per Plan B table annexed
3 SyndArogya Benefits to Policyholders Mediclaim Scheme meets 100 % of all types of Hospitalisation Expenses viz.:Room RentDoctors’/Surgeon FeesMedicine & DrugsAnesthesia, OT, Diagnostics MaterialsBlood, Oxygen, X-rayChemotherapy, RadiotherapyNursing expensesCost of pacemaker & Artificial Limbs etc.
4 Benefits to Policyholders Cashless Facility at Networked Hospitals of TPATreatment at any Hospital/Nursing Home in IndiaRelevant medical expenses 30 days prior to and 60 days subsequent to hospitalisation coveredIncome Tax relief on Premium under S80D
5 Attractive Benefits Added to SyndArogya Cover Available to Dependent Parents also as per Plan B. Entry age for parents also 65 years renewable up to 80 years of age.Ambulance charge up to Rs 1000/-Maternity Benefits and Baby Care covered up to maximum 5% of Sum AssuredMax Sum Insured Increased to Rs 5 lacs in multiples of 50000Cost of Health Check reimbursed up to 1% of Average Sum Insured after 3 claim free years
6 Hospital cash up to Rs 1000 in case of hospitalisation of child below 12 years age Treatment anywhere in India, Nepal or Bhutan in Indian currency
7 Unique Benefits in SyndArogya Floater Policy i.e. any one or all dependant family members up to 4 (Plan A) or 6(Plan B) can take benefits to the maximum extent of Sum InsuredSum Insured Min Rs 50000/- Max Rs 5 lacsUniform Premium irrespective of age of main policyholder i.e. min 5 years maximum 65 years renewal up to 80 years Min Floater age 3 months baby if covered with parents
8 Unique Benefits in SyndArogya No Medical Checkup even above 45 yearsPre-existing diseases covered from 4th year subject to certain conditionsIn Addition to hospitalisation charges, following death claim Payable in case of accident resulting into death within one year from the date of accidentAccountholder 100% of Sum Insured selectedSpouse 50% of SIChild above 5 years 20 % of SIChild below 5 years 10% of SI
9 SyndArogya TPA(Third Party Administrator) Following Outsourced Third Party agency (TPAs) are empanelled by United India for servicing SyndArogya insurance policies1) Med Save Health Care Ltd. 2) Medicare TPA Services (I) Pvt.Ltd. 3)TTK Healthcare Services Pvt. Ltd. 4) GENINS India Ltd. 5) Heritage Health Services Pvt.Ltd. 6) M/s Vipul Medcorp Pvt Ltd. 7) E-Meditek Solutions Ltd.
10 Role of TPA (Third Party Administrator) Issues Photo identity card, Insurance Certificate, Members Guide Book with list of Network Hospitals, CertificateArranges Cashless facility at Networked HospitalsReimburses to Policyholders expenses incurred in Non networked hospitalsCall centre facility with Toll free no. and Website
11 SyndArogya Claim Procedures For treatment at Non-networked hospitals:Intimation immediately after hospitalisationClaim for reimbursement within 15 daysfrom discharge or completion of post hosp treatmentDocuments required:Copy of policy & Photo Identity cardOriginal of discharged summary & consolidated bills with breakupOriginal reports and pharmacy bills with break up.
12 SyndArogya Claim Procedures For Treatment at Networked Hosp. no claim as cashless facility. Prior Authorisation required from TPA before commencing treatment for cashless facility.For Personal Accident death claimNotice to Nodal Office of Insurance Co.to get claim formFilled up claim form , FIR, Death Certificate, Postmortem report, legal heir certificate etc.
13 Main Exclusions Domiciliary hospitalisation Pre-existing diseases (covered from 4th year onwards if without any break in cover)Waiting period of first 30 days - commencement of policy except those arising out of accident.Treatment for Cataract, benign, prostatihypertrophy, hysterectomy, hernia, hydrocele, piles, sinusitis, etc., during the first year of operation of insurance cover.Cost of spectacles, hearing aids, vitamins, tonics and expenses relating to dental treatment, convalescence, general debility, naturopathy, etc.Dental treatment unless requiring hospitalisation
14 Premium Table Sum Insured Plan-A(1+3) Plan-B(1+5) with “Parents” (Amt in Rs.)Sum Insured Plan-A(1+3) Plan-B(1+5)with “Parents”50,1,00,1,50,2,00,2,50,3,00,3,50,4,00,4,50,5,00,NB:Premium all inclusive of charges for TPA and Service Tax