Presentation on theme: "A New Revolution In Health – Care. SyndArogya Mediclaim Insurance cum Personal Accident Scheme. Individual Policy with benefit of Group size of 2 lacs."— Presentation transcript:
SyndArogya Mediclaim Insurance cum Personal Accident Scheme. Individual Policy with benefit of Group size of 2 lacs policy holders Floater 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
SyndArogya Benefits to Policyholders Mediclaim Scheme meets 100 % of all types of Hospitalisation Expenses viz.: Room Rent Doctors/Surgeon Fees Medicine & Drugs Anesthesia, OT, Diagnostics Materials Blood, Oxygen, X-ray Chemotherapy, Radiotherapy Nursing expenses Cost of pacemaker & Artificial Limbs etc.
Cashless Facility at Networked Hospitals of TPA Treatment at any Hospital/Nursing Home in India Relevant medical expenses 30 days prior to and 60 days subsequent to hospitalisation covered Income Tax relief on Premium under S80D Benefits to Policyholders
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 Assured Max Sum Insured Increased to Rs 5 lacs in multiples of 50000 Cost of Health Check reimbursed up to 1% of Average Sum Insured after 3 claim free years
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
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 Insured Sum Insured Min Rs 50000/- Max Rs 5 lacs Uniform 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
Unique Benefits in SyndArogya No Medical Checkup even above 45 years Pre-existing diseases covered from 4 th year subject to certain conditions In Addition to hospitalisation charges, following death claim Payable in case of accident resulting into death within one year from the date of accident Accountholder 100% of Sum Insured selected Spouse 50% of SI Child above 5 years 20 % of SI Child below 5 years 10% of SI
SyndArogya TPA(Third Party Administrator ) Following Outsourced Third Party agency (TPAs) are empanelled by United India for servicing SyndArogya insurance policies 1) 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.
Role of TPA (Third Party Administrator ) Issues Photo identity card, Insurance Certificate, Members Guide Book with list of Network Hospitals, Certificate Arranges Cashless facility at Networked Hospitals Reimburses to Policyholders expenses incurred in Non networked hospitals Call centre facility with Toll free no. and Website
SyndArogya Claim Procedures For treatment at Non-networked hospitals: Intimation immediately after hospitalisation Claim for reimbursement within 15 days from discharge or completion of post hosp treatment Documents required: Copy of policy & Photo Identity card Original of discharged summary & consolidated bills with breakup Original reports and pharmacy bills with break up.
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 claim Notice to Nodal Office of Insurance Co.to get claim form Filled up claim form, FIR, Death Certificate, Postmortem report, legal heir certificate etc.
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
Premium Table (Amt in Rs.) Sum InsuredPlan-A(1+3) Plan-B(1+5) with Parents 50,000956 1597 1,00,0001848 3085 1,50,0002709 4519 2,00,0003488 5815 2,50,0004181 6967 3,00,0004875 8120 3,50,0005484 9131 4,00,0006094 10143 4,50,0006706 11156 5,00,0007316 12167 NB:Premium all inclusive of charges for TPA and Service Tax