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Ensure your familys health with

my:health Medisure Plus

Good health has always been one of the most basic and important
human needs. Even today, in spite of our busy schedules and hectic
lives, we strive to keep healthy in our own way. Each of us is unique in
the way we think about our health and look after ourselves. And
insuring all these unique aspects of our health is no easy task. At L&T
Insurance, it is our constant endeavor to not just cover all your health
needs, but also to provide you with an insurance plan that can be
customized to suit your exact requirements. Introducing my:health
Medisure Plus Insurance, a thoughtfully designed, insurance solution
that is tailor-made to your unique health needs. From the basics of good health to the tiniest detail in critical
situations, our Policy covers every possible aspect when it comes to protecting your health. Be it a guaranteed
response time, a cumulative bonus or just a health check up, we go that extra mile to make sure our Policy
meets your exact needs and also exceeds your expectations. Additionally, we also offer you the option of
choosing and paying only for the covers you want. So you don't waste money on covers that you don't need in
your insurance plan. Making this a truly custom-made insurance offering. At L&T Insurance, we understand that
the key to good health is the personal touch of thoughtfulness and care.

Covers under my:health Medisure Plus Insurance?


Standard

Thats why we provide you with the 9 essential standard covers that are built into your Policy. These ensure that your health is broadly protected
in a variety of situations, so that you always have a safety net to count on. The following covers form the bedrock of the Policy are:
In-patient Hospitalisation Expenses
If the treatment of a disease, illness or injury is taken we will pay the medical expenses incurred by you towards;

Room Rent/Boarding & Nursing: Actuals limited to 1% of Sum Insured (excluding cumulative bonus) per day subject to a maximum of
`4,000/- per day;

ICU Rent/Boarding & Nursing: Actuals limited to 2% of Sum Insured (excluding cumulative bonus) per day subject to a maximum of
`6,000/- per day;

Fees of Surgeon, Anesthetist, Nurses and Specialists: Actuals

Cost of Operation Theatre, diagnostic tests, medicines, blood, oxygen and cost of prosthetic and other devices or equipment if
implanted internally like pacemaker during a Surgical Procedure: Actuals

my:health Medisure Plus Insurance UIN No. IRDA/NL-HLT/L&TGI/P-H/V.II/34/14-15

We believe there are certain standard covers that are necessary in every health insurance policy.

This also covers any relapse within 45 days from the date of last hospitalisation at the hospital/nursing home where treatment was taken.
Occurrence of the same illness after 45 days would be a fresh instance of illness.
Medical expenses will be reimbursed subject to the following:

If you are hospitalised as an in-patient for a minimum period of 24 hours.

If the expenses on account of room rent/boarding and nursing and ICU rent/ boarding and nursing are higher than the limits
mentioned, the additional amount shall be reduced in the same proportion as such actual costs bears to the eligible limits. These limits
shall not apply in case you have selected the optional cover for waiver of room rent sub-limits.

Pre-hospitalisation
This covers the relevant medical expenses you incur within a period of 30 days before you are admitted to a Hospital/Nursing Home
provided that;
i. such medical expenses are incurred for the same condition for which Your
hospitalisation was required and
ii. the in-patient Hospitalisation claim for such hospitalisation is admissible by Us
Post-hospitalisation
This covers the relevant medical expenses, up to a period of 60 days, after you are
discharged from the Hospital/Nursing Home provided that;
i. such medical expenses are incurred for the same condition for which your
hospitalisation was required and
ii. the In-patient Hospitalisation claim for such Hospitalisation is admissible by us.

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Day Care Treatment


This covers the medical expenses for a day care procedure or surgery incurred by you for treatment or procedures that requires less than
24 hours of hospitalisation undertaken under general or local aneasthesia. There is no static list for day care procedures in the Policy as
advances in medical science leads to many more being added continuously. So, whether its recommended by a medical practitioner or
even if it is a new procedure, you can be rest assured that, we will cover it. However, this cover excludes diagnostic procedures and
treatments taken on an outpatient basis. For indicative list of Day Care Procedures, please refer Policy wordings or our website
www.ltinsurance.com
Treatment at Home or Domiciliary Hospitalisation
This covers the medical expenses you incur for treatment at home, in case you are not shifted to a Hospital/Nursing home based on the
advice of the attending medical practitioner or due to the unavailability of a hospital bed. This is applicable provided the medical
condition continues for at least 3 days. In such cases we will not cover your post-hospitalisation expenses; however pre-hospitalisation
expenses for up to 30 days will be covered.

my:health Medisure Plus Insurance UIN No. IRDA/NL-HLT/L&TGI/P-H/V.II/34/14-15

Thus, ensuring that you dont have to worry about expenses post-hospitalisation.

Pre-existing Diseases
Medical expenses arising out of your pre-existing diseases are covered from the 4th year of your Policy, after you have been continuously
insured with us for 36 months.
Health Check-Up
On completion of every 2 consecutive years of your Policy, we will provide a health check up coupon worth `1000 towards the cost of a
medical check up for the insured above age 50 years. This limit is available per individual in case of an individual policy/individual Sum
Insured basis and for all members put together in case of a floater policy.
Ambulance Charges
This covers your ambulance charges to the hospital/nursing home for treatment which requires you to be admitted to a hospital/nursing
home. The maximum cover will be actuals or upto `1,500 per hospitalisation whichever is less.
Advantage - Custom Covers
Since you have completely unique needs, we have created a health plan that can be tailor-made to suit your exact requirements. While all
our health plans offer you a basic set of covers, our range of optional covers give you the freedom to customize your own health insurance
policy. You can select from 9 optional covers, out of which 7 are available on the payment of an additional premium and 2 are available on
reduction of Premium. Please note that Reinstatement of Sum Insured and Critical Illness covers cannot be opted together. Hence you can
opt for maximum 8 optional covers. Just pick the ones that you need and we will ensure that every detail is taken care of, so that you can
enjoy absolute peace of mind.
Without payment of additional premium
1. Deletion of Pre/Post-Hospitalisation option

2. Deductibles
By choosing this option, the premium youll have to pay shall reduce. In this case, a part of the claim shall be paid by you as per the
deductible option chosen. The deductible options are:
no deductibles

`30000

`5000

`35000

`10000

`40000

`15000

`50000

`20000

`75000

`25000

`100000

my:health Medisure Plus Insurance UIN No. IRDA/NL-HLT/L&TGI/P-H/V.II/34/14-15

This gives you a choice to delete the pre/post-hospitalisation coverage and reduce the premium payable under the Policy. No claim will
be paid for any expenses incurred pre/post-hospitalisation once you choose this option.

What are deductibles?


A deductible is a cost-sharing requirement under this Policy that provides that we will not be liable for a specified rupee amount of the covered
expenses, which will apply before any benefits are payable. A deductible does not reduce the Sum Insured. Deductible is applicable per Insured
per claim.
On payment of additional premium
3. Critical Illness Cover (Indemnity Basis)
This cover provides you with an additional amount equivalent to the Sum Insured (excluding cumulative bonus) for treatment of the
below listed Critical Illnesses. This means you get double the Sum Insured under this cover.
This includes:
-

Cancer (of specific severity)

Major Organ Transplant

Coronary Artery Bypass Surgery

Stroke (resulting in permanent symptoms)

First Heart Attack (of specific severity)

Aorta Graft Surgery

Kidney Failure (requiring regular dialysis)

Primary Pulmonary Arterial Hypertension

Multiple Sclerosis

Permanent Paralysis of Limbs

Coma (of specific severity)

- Motor Neurone Diseases with permanent symptoms

For definitions of the above mentioned Critical Illness please refer to the Policy wordings or contact your insurance partner.
Conditions for opting Critical Illness cover
This cover can be availed by Individuals up to 65 years of age and shall be available during subsequent renewals for life time.
All those opting Sum Insured above `1,000,000/-, coverage under Critical Illness will be restricted to 1,000,000/- only.

We understand that medical emergencies like accidents and illnesses are unpredictable. That's why if your Sum Insured including
cumulative bonus is exhausted due to claims paid and/or payable and is not enough to cover your expenses incurred towards
hospitalisation, we offer an additional amount as reinstatement. This additional amount is equivalent to Sum Insured and is available
only once during the 12-month policy period.
This cover is applicable only for new illnesses/diseases and will not be applicable to illnesses/diseases (including its complications) for
which claims are already paid/payable. The cumulative bonus benefit is also not applicable to the reinstated Sum Insured. This cover is
available only for those opting for Sum Insured of `3 Lacs to 5 lacs. Those opting for Sum Insured above `500,000/-, coverage under
Restatement of Sum Insured will be restricted to `500,000/- only.
Note: Only one of the above covers i.e. Critical Illness or Reinstatement of Sum Insured can be opted
under the Policy. Both the covers cannot be availed of together.

my:health Medisure Plus Insurance UIN No. IRDA/NL-HLT/L&TGI/P-H/V.II/34/14-15

4. Reinstatement of Sum Insured

5. Waiver of Room Rent and ICU Sub-limits


If you have opted for this cover, we shall waive the sub-limits under room rent/boarding and nursing and ICU rent/boarding and
nursing. We shall pay expenses incurred on room rent and/or ICU as per the actuals.
6. Extended Pre/Post-Hospitalisation Cover
This lets you extend the pre/post-hospitalisation coverage available under the standard cover. Limits for the expenses incurred against
pre and post hospitalisation are extended to 60 days and 90 days respectively.
7. Hospital Cash
This cover helps you avail daily hospital cash allowance of `500 per day for a maximum of 7 days, starting from day 4 to day 10,
provided your hospitalisation exceeds 3 continuous days. For example, if you are hospitalised for 12 days, we will reimburse you `500
each day from the 4th day onwards for 7 days. So the maximum reimbursement under this cover cannot exceed `3500 (`500 x 7 days).
8. Recovery Benefit
This cover entitles you to a recovery benefit where we will pay you a lump-sum amount of `10,000 in the event that your
hospitalisation for a disease/illness/injury extends - more than 10 days.
9. Expenses of Accompanying Person
This cover provides you a reimbursement of up to `500 per day for the expenses incurred by the person who accompanies you to the
hospital/nursing home. This amount will be reimbursed for a maximum period of 7 days if your hospitalisation exceeds 3 days. For
example, if you are hospitalised for 10 days, we will reimburse you `500 each day from the 4th day onwards for 7 days. The maximum
reimbursement under this cover cannot exceed `3500 (`500 x 7 days).

With this policy you dont just protect your health in every way possible, but also enjoy a host of special benefits that we offer you. These 8
covers are assured to you, irrespective of the package you choose. So, no matter what your plan is the advantages we offer you will never
change.
At L&T Insurance, we strive to make every Policy and plan keeping your interests in mind.
1. Lifetime Renewal
You can renew your Policy throughout your lifetime, provided your application for renewal and the renewal premium in full has been
received 30 days from the due date. However, no claim will be payable for hospitalisation expenses incurred during the gap period. This
is also subject to the realization of your premium. This benefit is not available in case of fraud, misrepresentation, non-disclosure or
suppression of material facts on the Proposal Form.

my:health Medisure Plus Insurance UIN No. IRDA/NL-HLT/L&TGI/P-H/V.II/34/14-15

How you benefit with my:health Medisure Plus Insurance?

2. Cumulative Bonus (CB)


If you have made no claim under the Policy in a year and you renew the policy with us the next year, we will apply a cumulative bonus
by automatically increasing 10% of the Sum Insured for the next policy year. The maximum cumulative bonus shall not exceed 50%
of the Sum Insured in any policy year.
Example - If your Sum Insured for the first year is `3 lakhs, and you dont make a claim and renew it on time, to reward this, we will
give you additional 10% Sum Insured which makes the total Sum Insured of `3.3 lakhs.
If a claim is made, the cumulative bonus that has accrued will be reduced by 10% of the basic Sum Insured. Only accrued cumulative
bonus will get reduced by 10%. The basic Sum Insured will remain intact.
In case of 2 years Policy, CB for both the years (10% for year 1 and 10% for year 2) will be applied at the time of renewal however
increased limit of 10% will be available in case of any claim in 2nd year of the Policy.
Where the Policy is issued as a Family Floater, cumulative bonus will be considered with respect to the Sum Insured of such Family
Floater.
Cumulative Bonus is not applicable to Value added covers and is calculated on Basic Sum Insured under the Policy excluding Sum
Insured of Optional covers.
3. Policy Period Option
This gives you the convenience of opting and renewing your Policy for a single year or for two continuous years. If you renew your Policy
for two continuous years, we will give you a discount of 5% on the total premium of 2 years.

This gives you an option of cancelling the Policy within 15 days from the date of receipt of Policy documents, if you are not satisfied with
the coverage and terms of the Policy. We will refund the premium paid after adjusting the amounts spent on stamp duty charges, Medical
examination (wherever applicable) and proportionate premium (If Policy has already commenced). Refund will not be applicable if you
have made a claim against the Policy during that period.
5. Family Floater
This gives you an option of covering three other family members apart from yourself in one Policy. The three other family members can be
your lawful spouse and two dependent unmarried children up to the age of 23 years or 3 dependent unmarried children up to the age of
23 years, excluding your spouse.
6. Age Eligibility (age last birthday as at Policy inception date)
With our Policy, you can insure your children from the age of 3 months to the age of 23 years. Adults can be insured from the age of 18
years to 65 years. Maximum age at entry for adults is 65 years. But you can renew your Policy throughout your life.

my:health Medisure Plus Insurance UIN No. IRDA/NL-HLT/L&TGI/P-H/V.II/34/14-15

4. Free-look Period

7. Family Discount
If you seek to cover your family members including your lawful spouse, dependent children and yourself, in a single Policy, a Schedule will
be issued naming all such individuals along with the chosen individual Sum Insured. If you choose to avail insurance for equal to or more
than 3 members in the family you will receive a 10% discount on the premium payable.
8. Sum Insured Options
Plan Type

Basic Sum Insured

Critical Illness Sum Insured*

Reinstatement of Sum Insured**

Individual

Minimum: `2,00,000/-

Equal to basic Sum Insured subject


to following.

Equal to basic Sum Insured subject


to following.

Minimum Basic Sum Insured should be :


`200,000/-

Minimum Basic Sum Insured should be :


`300,000/-

Maximum: `1,000,000/-

Maximum: `500,000/-

Minimum: `2,00,000/-

Minimum: `200,000/-

Minimum: `300,000/-

Maximum: `25,00,000/-

Maximum: `10,00,000/-

Maximum: `500,000/-

Maximum: `25,00,000/-

Floater

Sum Insured to be in multiples of lakhs only; however above 10 Lakhs, the options available are 15 Lakhs, 20 Lakhs and 25 Lakhs.
*Critical Illness: For those having Basic Sum Insured for `1,000,000/- and above, Coverage for Critical Illness will be restricted to `1,000,000/**Reinstatement of Sum Insured: For those having Basic Sum Insured for `500,000/- and above, Reinstatement of Sum Insured will be
restricted to `500,000/-

The Policy gives you benefits under Income Tax laws prevailing from time to time. Currently, deduction is available up to `15,000 under Sec
80 D of the Income Tax Act, 1961.
10. Service Assurance
We make sure our services are robust and actionable, so that you find us whenever you need us the most.
In case of a Cashless Claim,
We assure a response within 6 hours for a cashless facility request, provided the intimation is received during working hours from 9 am to
9 pm on Monday to Saturday. If the intimation is received after working hours on a working day, or at any time during a holiday, we assure
a response within 8 hours.
In case of a Reimbursement Claim,
We assure a response within 6 working days from the date of receipt of the complete set of documents.
In case we fail to meet the assurance as stated above for the cashless and reimbursement facility, we will pay you a fixed compensation
of `1,000 for a single claim.

my:health Medisure Plus Insurance UIN No. IRDA/NL-HLT/L&TGI/P-H/V.II/34/14-15

9. Income Tax Benefit

What are the Medical Test Requirements?


All Individuals up to 50 years (age as on last birthday as at Policy inception) have to fill a declaration on the Proposal Form. If any medical
adversity exists, only then will you be required to undergo appropriate medical tests.
The age group 51-65 years (age as on last birthday as at Policy inception) may be required to undergo the following pre-acceptance medical
tests :- Medical Examination Report, TMT, Lipid Profile, HBA1C, Serum Creatinine, Complete Blood Count and Urinalysis.
For the following category:
Scenarios

Medical Tests Requirement

Charges of Medical check up pre


agreed with the network provider

Age group 50 to 65 years

Medical Examination Report, ECG, Lipid Profile, HbA1C,


Serum Creatinine, Complete Blood Count, Urinalysis.

As agreed with network provider>

Age group 51 - 65 years with


Optional Cover for Double Sum
Insured for Critical Illness or
Optional cover of Reinstatement
of Sum Insured

Medical Examination Report, Electrocardiogram,


Complete Blood Count, Lipid Profile, HbA1C, Serum
Creatinine, Urinalysis, SGOT, SGPT and GGT.

Optional Cover for Double Sum


Insured for Critical Illness at
Renewal with or without Claim
irrespective of age

As agreed with network provider>

*Age as on last birthday as at Policy inception date to be considered.

Medical Underwriting
The Company reserves the right to Accept on standard terms/Decline/Accept will exclusion and/or premium loading (up to maximum of 100%
on Basic Premium).

my:health Medisure Plus Insurance UIN No. IRDA/NL-HLT/L&TGI/P-H/V.II/34/14-15

If Sum Insured of `1,000,000/or more is opted

Medical Examination Report, ECG, Complete Blood


Count, Lipid Profile, HBA1C, Serum Creatinine,
Urinalysis, SGOT, SGPT and GGT

Loading on the premium is arrived at on the basis of factors given below;


Health condition at the time of proposal
Pre existing disease/medical condition (Exiting or cured)
Test results
Other co-morbid factors
Indicative range of loadings for most common diseases based on above factors is given below. These loadings are for your reference purpose
only and are subject to change based on medical test results.
Illness

Premium loading % on
Basic Premium (For reference only)

Diabetes

10% - 40%

Blood Pressure/Hypertension

10% - 30%

Asthama

10% - 30%

Kidney Related disorders

10% - 30%

For those having following Health conditions, proposal may be accepted with premanent exclusion (for those specific condition only) however
acceptance is subject to submission of treatment reports and subsequent medical examination by us.
Policy mellitus (not on treatment)
Cancer (fully cured)
Hysterectomy (operated before 1 year from proposal date)

For those having multiple illnesses and for other health conditions, loading may be charged and/or exclusion may be applied or Proposal may
be declined on severity of the condition at the time of proposal. Loading will be subject to an amount ranging from 10% to 100% of Basic
Premium. Proposed loading/exclusion will be intimated to proposer and Policy will be issued with written consent from the proposer on
premium loading/exclusion.
The Health check up and subsequent Medical reports are valid upto 30 days from date of Health Check up.
On acceptance of proposals, we will reimburse 50% of the expenses (on our pre agreed rates with the network provider) incurred on the
pre-acceptance medical tests. Please refer our website www.ltinsurance.com for the list of DC in your area.
Final decision of acceptance and related criteria will lie with Company.

my:health Medisure Plus Insurance UIN No. IRDA/NL-HLT/L&TGI/P-H/V.II/34/14-15

Fracture with foreign objects inserted

How to make a Quick and Transparent Claim with L&T Insurance?


Claim Process

Cashless Hospitalisation

Reimbursement of Expenses

Contact L&T Insurance and


Submit a Cashless request
form with required documents

Collate original bills with other


documents as required and
submit it to L&T Insurance

Cashless decision made within


6 hours by L&T Insurance

Reimbursement Claims response


Made within 6 Working days

Third Party Administrator


E-Meditek is a TPA appointed by us for processing of Claims however ultimate responsibility of acceptance or rejection of a Claim lies with
Us only.

What the Policy Doesnt Cover?


We shall not be liable to make any payment for any claim directly or indirectly caused by, based on, arising out of or howsoever attributable to
any of the following:

2. Any disease contracted and/or medical expenses incurred by You in respect of any disease/illness during the first 30 days from the
commencement date of the Policy except in case of accidental injuries. This exclusion doesnt apply for those having any health insurance
indemnity policy in India at least for 1 year prior to taking this Policy as well as for subsequent renewals with Us without a break.

my:health Medisure Plus Insurance UIN No. IRDA/NL-HLT/L&TGI/P-H/V.II/34/14-15

1. All pre-existing diseases/illness/injury/conditions as defined in the Policy, until 36 months of continuous covers have elapsed since
inception of the first Policy with us.

3. All expenses towards following ailments/diseases along with their complications are excluded and will be covered after the first two years
(24 months) of continuous operation of this insurance cover:

Cataract

Hysterectomy other than for malignancy

Uterine prolapse including any condition requiring Hysterectomy

Polycystic Ovarian Diseases, Myomectomy for Fibroids

Knee Replacement Surgery (other than caused by an accident)

Osteoarthritis and Osteoporosis


Arthritis, Arthroscopic Surgery, Rheumatism, Joint Replacement Surgery (other than caused by accident), Prolapse of Intervertibral
discs(other than caused by accident)
Varicose Veins and Varicose Ulcers, Hernia, Stones in the urinary, uro-genital and biliary systems, Benign Prostate Hypertrophy,
Hydrocele
Congenital internal anomaly
Fistula in anus, Piles, Fissures
Fibroids, Dilatation & Curettage for treatment purposes, Pilonidal sinus, Chronic Suppurative Otitis Media (CSOM)
Deviated Nasal Septum, Sinusitis and related disorders
Surgery on tonsils/Adenoids

Hypertension and Diabetes and related complications


4. Domiciliary hospitalisation expenses in respect of following:
a. Asthma, Bronchitis, Tonsillitis and Upper Respiratory Tract infection including Laryngitis and Pharyngitis, Cough and Cold, Influenza,
b. Arthritis, Gout and Rheumatism,
c. Chronic Nephritis and Nephritic Syndrome,
d. Diarrhoea and all type of Dysenteries including Gastroenteritis,
e. Diabetes Mellitus and Insipidus,

my:health Medisure Plus Insurance UIN No. IRDA/NL-HLT/L&TGI/P-H/V.II/34/14-15

Gastric and duodenal ulcer, any type of Cysts/Nodules/Polyps, and any type of Breast lumps, benign ear, Nose and Throat disorders and
surgeries Chronic Nephritis and Nephropathy (Kidney diseases)

f. Epilepsy,
g. Hypertension,
h. Psychiatric or Psychosomatic Disorders of all kinds,
i. Pyrexia of unknown Origin.
5. Co-payment: All person(s) named in the Schedule to this Policy above the age of 80 years (age last birthday) shall bear a co-pay of 10%
for each and every claim.
6. Deductible: Claims/Claim amount falling with in deductible limit as opted by you and mentioned in the Schedule.
7. Any treatment arising from or traceable to pregnancy, childbirth including caesarean section. However, this exclusion/waiting period will
not apply to Ectopic Pregnancy proved by diagnostic means.
8. Genetic disorder and stem cell implantation/surgery.
9. Dental treatment or surgery of any kind unless necessitated due to an accident and requiring minimum 24 hours Hospitalisation or
treatment of irreversible bone disease involving the jaw which cannot be treated in any other way, but not if it is related to gum disease
or tooth disease or damage.
10. Birth control procedures, hormone replacement therapy and voluntary termination of pregnancy during the first 12 weeks from the date of
conception.
11. Routine medical, eye and ear examinations, cost of spectacles, laser surgery for cosmetic purposes or corrective surgeries, contact lenses
or hearing aids, vaccinations except post-bite treatment, issue of medical certificates and examinations as to suitability for employment or
travel.

13. Vitamins and tonics unless forming part of treatment for disease, illness or injury and prescribed by a Medical Practitioner.
14. Instrument used in treatment of Sleep Apnoea Syndrome (C.P.A.P.) and Continuous Peritoneal Ambulatory Dialysis (C.P.A.D.) and Oxygen
Concentrator for Bronchial Asthmatic condition, Infusion pump or any other external devices used during or after treatment.
15. Artificial life maintenance, including life support machine use, where such treatment will not result in recovery or restoration of the
previous state of health.
16. Treatment for developmental problems including learning difficulties eg. Dyslexia, behavioural problems including attention deficit
hyperactivity disorder (ADHD).

my:health Medisure Plus Insurance UIN No. IRDA/NL-HLT/L&TGI/P-H/V.II/34/14-15

12. All expenses arising out of any condition directly or indirectly caused due to or associated with human T-call Lymph tropic virus type III
(HTLV-III) or Lymphadinopathy Associated Virus (LAV) or Acquired Immune Deficiency Syndrome (AIDS), AIDS related complex syndrome
(ARCS) and all diseases/illness/injury caused by and/or related to HIV and sexually transmitted diseases.

17. Treatment for general debility, ageing, convalescence, run-down condition or rest cure, Congenital external anomaly/ies or defects, sterility,
infertility including IVF, impotency, venereal disease, puberty or menopause.
18. Committing or attempting to commit a criminal or illegal act, or intentional self injury or attempted suicide while sane or insane.
19. Certification/Diagnosis/Treatment by a family member or from persons not registered as Medical Practitioners under the respective
Medical Councils, or any diagnosis or treatment that is not scientifically recognized or experimental or unproven.
20. Ailment requiring treatment due to use, abuse or a consequence of an abuse of any substance, intoxicant, drug, alcohol or hallucinogen
and treatment for de-addiction, or rehabilitation.
21. Any illness or hospitalisation arising or resulting from You or any of Your family members committing any breach of law with criminal
intent.
22. Any treatment received in convalescent homes, convalescent hospitals, health hydros, nature cure clinics or similar establishments.
23. Prostheses, corrective devices and medical appliances, which are not required intra-operatively for the disease/illness/injury for which You
were hospitalised.
24. Any stay in Hospital/Nursing Home without undertaking any treatment or where there is no active line of treatment by the Medical
Practitioner.
25. Treatment of any mental illness or sickness or disease including a psychiatric condition, disorganisation of personality or mind, or emotions
or behaviour, Parkinsons or Alzheimers disease even if caused or aggravated by or related to an Accident or Illness or general debility or
exhaustion (run-down condition).
26. Any cosmetic surgery unless forming part of treatment for cancer or burns, surgery for sex change or treatment of obesity/morbid obesity
or treatment/surgery /complications/illness arising as a consequence thereof.

28. Costs of donor screening and organ.


29. Costs incurred on all medical treatments other than Allopathy Treatments.
30. Whilst You are engaging in speed contest or racing of any kind (other than on foot), bungee jumping, parasailing, ballooning, parachuting,
skydiving, paragliding, hang gliding, mountain or rock climbing necessitating the use of guides or ropes, potholing, abseiling, deep sea
diving using hard helmet and breathing apparatus, polo, snow and ice sports or involving a naval military or air force operation.
31. Whilst You are flying or taking part in aerial activities (including cabin crew) except as a fare-paying passenger in a regular Scheduled
airline or air Charter Company.
32. All expenses caused by ionizing radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the
combustion of nuclear fuel.

my:health Medisure Plus Insurance UIN No. IRDA/NL-HLT/L&TGI/P-H/V.II/34/14-15

27. Charges incurred primarily for diagnostic, X-ray or laboratory examinations or other diagnostic studies not consistent with or incidental to
the diagnosis and treatment even if the same requires confinement at a Hospital/Nursing Home.

33. All expenses directly or indirectly, caused by or arising from or attributable to foreign invasion, act of foreign enemies, hostilities, warlike
operations (whether war be declared or not or while performing duties in the armed forces of any country), civil war, public defense,
rebellion, revolution, insurrection, military or usurped power.
34. All non-medical expenses as mentioned in the Policy wordings.
35. Any condition after the point at which it is certified by the attending Medical Practitioner to be of such a nature that further medical
treatment may serve to stabilise or maintain it but it is unlikely to result in a material improvement within a reasonable time.
36. Service charges or any other charges levied by the Hospital/Nursing Home, except registration/admission charges.
37. Expenses incurred on alternative treatments.

How to Renew your Policy?


You can renew your Policy by making a request to us before the expiry date. You can also renew policy within 30 days from expiry of your Policy
subject to the fact that the premium for the renewal is received within the same period. In such a situation, you will be eligible to continuity
benefits like the cumulative benefits and others. Please note that we shall not be liable for any claims arising out of ailments/hospitalisation
during the period between expiry and renewal.
If the renewal of the Policy is not done within 30 days of due date, it will be considered as a new policy.
We will not be liable to pay hospitalisation expenses incurred during break period. Any disease/condition contracted in the break in period will
not be covered and will be treated as Pre-existing condition.

I.

any fraud, misrepresentation or suppression of material facts as sought to be declared on the Proposal form by You or on Your behalf is
found either in obtaining insurance or subsequently in relation thereto or,

II.

We have discontinued issuance of Policy under this Product, in which event You will have the option of renewal under any similar Policy
being issued by Us; provided however, benefits payable shall be subject to the terms contained in such other Policy. Such modification or
revision of the terms and conditions of the Product shall be intimated to you 3 months in advance along with reasons of modification and
revision.
A change in the Sum Insured is allowed on renewals, however it may be subject to Medical test and subsequent Underwriting approval.
Any enhanced Sum Insured during subsequent policy renewals will not be available for an illness, disease, injury already contracted under
the preceding policy periods. All Waiting periods as defined in the Policy shall apply for this enhanced limit from the effective date of
enhancement of such Sum Insured considering such Policy Period as the first Policy with Us. Sum Insured enhancement will be subject to
Underwriting approval.

my:health Medisure Plus Insurance UIN No. IRDA/NL-HLT/L&TGI/P-H/V.II/34/14-15

The Policy can be renewed for lifetime unless:

Based on the experience of the Product, Premium, terms and conditions may be revised subject to prior approval of Insurance Regulatory and
Development Authority. Such revision shall be intimated to you 3 months in advance with an option of renewal under any similar Policy being
issued by Us. However, benefits payable shall be subject to the terms contained in such other Policy. Individual Claims experience loading is not
applicable under the Policy.
If you are above the age of 80 years, there is a 10% co-payment obligation as there is no further premium increase.
For any changes desired at the time of Renewal, please communicate with us. Contact Details are provided here below.
The Company reserves its right to vary the premium from time to time subject to approval of IRDA (Insurance Regulatory and Development
Authority).
Portability Option: Portability will be provided on the Policy in accordance with IRDA guidelines issued on Portability from time to time. You
may approach us atleast 45 days before the expiry date to avoid any break in coverage. Portability benefits are not automatically applicable
under the Policy unless application for portability has been specifically made and subsequently accepted by the Company.
The acceptance criteria for portability proposals is same as applicable to new proposals.
How to Cancel your Policy?
In case you wish to cancel your Policy, you may intimate us by giving 15 days notice in writing and we will refund the premium.
We reserve the right and may at any time, cancel Your Policy, on grounds of misrepresentation, fraud, non disclosure or suppression of material
facts as sought to be declared on the Proposal form or non co-operation, by giving 15 days notice in writing by Registered Post
Acknowledgment Due to You at Your last known address in which case, We shall not be liable to repay the premium for the unexpired term.

Period On Risk

Rate of Premium Refunded

Up to 1 month

75% of annual Premium

Up to 3 months

50% of annual Premium

Up to 6 months

25% of annual Premium

Exceeding six months upto 365 days

NIL

In case of 2 year Policy;


If cancellation done before completion of 1 year: same grid as given above is applicable on first year Premium and second year Premium will
be completely refunded.
If cancellation is done after completion of 1 year: same grid as given above is applicable however retention Premium on second year premium
will be calculated on Annual Premium without long term Policy discount.

my:health Medisure Plus Insurance UIN No. IRDA/NL-HLT/L&TGI/P-H/V.II/34/14-15

You may also give 15 days notice in writing, to Us, for the cancellation of this Policy, in which case We shall from the date of receipt of notice
cancel the Policy and retain the premium for the period this Policy has been in force at Our short period scales as under

An individual policy with a single person named in the Schedule to this Policy shall automatically terminate in case of death of the Policyholder.
In case of an individual Policy with multiple persons named in the Schedule to this Policy and incase of a floater, the Policy shall continue to be
in force for the remaining members of the family upto the expiry of current Policy Period. The Policy may be renewed on an application by
another adult person named in the Schedule to this Policy, whenever such is due.
However, in case of a valid claim having been paid or reported under this Policy, there would be no refund of premium.
Minimum premium of `250 per Policy will be retained by Us towards administrative charges.

Special channel for Insured Persons who are Senior Citizens


Good things come with time and so for our customers who are above 60 years of age we have created special channels to address any health
insurance related query. At L&T Insurance, our senior citizen customers can reach us through the below dedicated channels to enable us to
service them promptly.

Dedicated prompt in our Toll Free Number 1800-209- 5846 (1800-209- LTIN )

SMS SENIOR to 5607058

Email us at senior@ltinsurance.com

Note:
Age, wherever mentioned shall be completed age last birthday as at Policy inception date.
Premium: Is payable in advance.
Premium As Annexure attached

For over 7 decades, across industries, the L&T Group has practiced and perfected incisive solutions and its precise delivery. We are a
state-of-the-art, technology-driven company that has the caliber and expertise to provide world-class customer service.
We combine innovative and unique product benefits with seamless customer support to make sure our approach to your life is a thoughtful
one. At L&T Insurance, you are our priority.
Contact Details
The information provided here includes only the salient features of my:health Medisure Plus Insurance Policy. For more details please call us on
TOLL FREE on 1800 209 5846 or call a branch in your city. Alternatively, to get a Quick-Quote you can log on to www.ltinsurance.com, or
leave your name and number if you want us to contact you. You can even SMS LTI <your name> to 5607058. IRDA Reg. No. 146 L&T General
Insurance Company Ltd. Address: 6th Floor, City 2, Plot No. 177, Near Bandra-Kurla Telephone Exchange, Kalina, Santacruz (East), Mumbai 400 098 I Phone: +91 22 6123 0000 I Fax: +91 22 6123 0030/0145
Insurance is the subject matter of solicitation. For detailed terms and conditions please refer the policy wordings, visit our website
www.ltinsurance.com or contact your insurance partner.

my:health Medisure Plus Insurance UIN No. IRDA/NL-HLT/L&TGI/P-H/V.II/34/14-15

Get the L&T Advantage

Reach us at the touch points below


Toll - free No.:
1800-209-5846 (1800-209-LTIN)
SMS:
LTI to 5607058 (56070LT). We will call you back.
Email:
help@ltinsurance.com
Write to us:
L&T General Insurance Company Limited
6th Floor, City 2, Plot no. 177, CST Road,
Near Bandra-Kurla Telephone Exchange, Kalina,
Santacruz East, Mumbai 400098

LTGICL/HL-01 / Oct-2014

Website:
www.ltinsurance.com

is the brand of L&T General Insurance Company Limited. Registered Office: L&T House, N.M. Marg, Ballard Estate, Mumbai - 400001.
Corporate Office: 6th Floor, City 2, Plot No. 177, CST Road, Near Bandra Kurla Telephone Exchange Kalina, Santacruz (East), Mumbai - 400098, India.
The information provided herein includes only the salient features of my:health Medisure Plus Insurance. For more details on coverage, exclusions, terms and
conditions, please refer to the Policy wordings before concluding a sale. Beware of spurious phone calls and fictitious/fraudulent offers. IRDA clarifies to public that
it / its officials do not involve in activities like sale of any kind of insurance. Public receiving such phone calls are requested to lodge a police complaint along with
details of phone call and number. IRDA Registration No. 146. Insurance is the subject matter of solicitation. Advt.no. LTGICL/FY14-15/007
UIN No. IRDA/NL-HLT/L&TGI/P-H/V.II/34/14-15 CIN No. U66030MH2007PLC177117

Premium Chart my:health Medisure Plus Insurance


Premium is payable in advance on or before inception of the policy
Medisure Plus - Simple Rate Card (No Sub Limits)
Plan A

Plan B - Critical Illness

Plan C - Reinstate

Age Group

Plan Type

2 Lac

3 Lac

4 Lac

5 Lac

2 Lac

5 Lac

3 Lac

4 Lac

5 Lac

Upto 35 Years

Individual

3,386

4,217

5,257

6,088

3,641

4,430

5,399

6,202

4,488

5,401

6,149

36 to 40 Years

Individual

3,769

4,710

5,886

6,827

4,109

4,994

6,075

6,978

5,323

6,389

7,211

41 to 45 Years

Individual

4,212

5,280

6,614

7,682

4,638

5,634

6,851

7,871

5,893

7,117

8,066

46 to 50 Years

Individual

6,285

7,944

10,019

11,679

6,966

8,512

10,398

11,982

9,399

11,118

12,508

51 to 55 Years

Individual

7,247

9,106

11,431

13,290

9,461

10,951

12,661

14,274

10,561

12,530

14,119

56 to 60 Years

Individual

9,901

12,518

15,790

18,408

12,625

14,789

17,304

19,619

13,973

16,890

19,237

61 to 65 Years

Individual

11,528

14,609

18,461

21,542

14,594

17,164

20,164

22,904

19,650

22,447

24,550

Upto 35 Years

2 Adults

5,410

6,820

8,582

9,992

5,842

7,181

8,823

10,184

7,280

8,827

10,095

36 to 40 Years

2 Adults

6,052

7,650

9,644

11,240

6,628

8,130

9,965

11,496

8,692

10,500

11,893

41 to 45 Years

2 Adults

6,801

8,614

10,877

12,687

7,521

9,214

11,278

13,008

9,656

11,733

13,340

46 to 50 Years

2 Adults

10,053

12,799

16,227

18,970

11,174

13,735

16,851

19,469

15,200

18,041

20,337

51 to 55 Years

2 Adults

11,730

14,807

18,648

21,720

15,376

17,849

20,677

23,344

17,208

20,462

23,088

56 to 60 Years

2 Adults

16,001

20,351

25,766

30,104

20,459

24,079

28,256

32,097

22,752

27,580

31,471

61 to 65 Years

2 Adults

18,666

23,786

30,160

35,265

23,681

27,980

32,961

37,508

32,103

36,738

40,229

Upto 35 Years

2 Adults + 1 Child

7,139

9,043

11,422

13,326

7,826

9,616

11,804

13,631

9,774

11,810

13,489

36 to 40 Years

2 Adults + 1 Child

7,781

9,872

12,485

14,574

8,612

10,566

12,947

14,944

11,185

13,484

15,288

41 to 45 Years

2 Adults + 1 Child

8,530

10,837

13,717

16,021

9,505

11,650

14,259

16,455

12,149

14,717

16,735

46 to 50 Years

2 Adults + 1 Child

11,781

15,022

19,067

22,304

13,159

16,170

19,833

22,917

17,693

21,025

23,732

51 to 55 Years

2 Adults + 1 Child

13,459

17,030

21,488

25,054

17,361

20,284

23,659

26,791

19,701

23,446

26,482

56 to 60 Years

2 Adults + 1 Child

17,730

22,574

28,606

33,438

22,443

26,514

31,238

35,545

25,245

30,564

34,866

61 to 65 Years

2 Adults + 1 Child

20,395

26,009

33,000

38,599

25,666

30,416

35,943

40,956

34,597

39,722

43,624

Upto 35 Years

2 Adults + 2 Child

8,832

11,221

14,205

16,592

9,775

12,007

14,729

17,011

12,222

14,737

16,816

36 to 40 Years

2 Adults + 2 Child

9,474

12,050

15,267

17,841

10,561

12,956

15,871

18,324

13,634

16,410

18,615

41 to 45 Years

2 Adults + 2 Child

10,224

13,014

16,500

19,288

11,454

14,040

17,184

19,835

14,598

17,643

20,062

46 to 50 Years

2 Adults + 2 Child

13,475

17,199

21,850

25,570

15,108

18,561

22,758

26,297

20,141

23,951

27,059

51 to 55 Years

2 Adults + 2 Child

15,153

19,208

24,271

28,321

19,310

22,675

26,583

30,171

22,150

26,372

29,809

56 to 60 Years

2 Adults + 2 Child

19,424

24,751

31,389

36,704

24,392

28,905

34,162

38,925

27,693

33,490

38,193

61 to 65 Years

2 Adults + 2 Child

22,089

28,187

35,783

41,866

27,615

32,806

38,867

44,336

37,045

42,648

46,951

Upto 35 Years

1 Adult + 1 Child

5,115

6,440

8,097

9,422

5,626

6,866

8,381

9,649

6,981

8,384

9,543

36 to 40 Years

1 Adult + 1 Child

5,498

6,932

8,726

10,161

6,094

7,429

9,057

10,426

7,816

9,373

10,605

41 to 45 Years

1 Adult + 1 Child

5,941

7,502

9,454

11,016

6,622

8,070

9,832

11,318

8,386

10,101

11,460

46 to 50 Years

1 Adult + 1 Child

8,013

10,167

12,859

15,013

8,950

10,948

13,379

15,429

11,893

14,102

15,902

51 to 55 Years

1 Adult + 1 Child

8,976

11,329

14,271

16,624

11,445

13,387

15,643

17,721

13,055

15,514

17,513

56 to 60 Years

1 Adult + 1 Child

11,629

14,741

18,630

21,742

14,610

17,224

20,286

23,066

16,467

19,874

22,631

61 to 65 Years

1 Adult + 1 Child

13,257

16,832

21,301

24,876

16,578

19,599

23,146

26,351

22,143

25,431

27,945

*Premium inclusive of Service Tax of 14% & Swachh Bharat Cess of 0.5%

3 Lac

4 Lac

1/6

Plan A

Plan B - Critical Illness

Plan C - Reinstate

Age Group

Plan Type

2 Lac

3 Lac

4 Lac

5 Lac

2 Lac

4 Lac

5 Lac

3 Lac

4 Lac

5 Lac

Upto 35 Years

1 Adult + 2 Child

6,808

8,618

10,879

12,689

7,575

9,256

11,305

13,029

9,430

11,311

12,871

36 to 40 Years

1 Adult + 2 Child

7,191

9,110

11,509

13,427

8,043

9,820

11,982

13,806

10,264

12,300

13,933

41 to 45 Years

1 Adult + 2 Child

7,635

9,680

12,237

14,282

8,571

10,460

12,757

14,698

10,834

13,028

14,787

46 to 50 Years

1 Adult + 2 Child

9,707

12,345

15,642

18,279

10,899

13,338

16,304

18,809

14,341

17,029

19,229

51 to 55 Years

1 Adult + 2 Child

10,669

13,507

17,053

19,891

13,394

15,777

18,567

21,102

15,503

18,440

20,840

56 to 60 Years

1 Adult + 2 Child

13,323

16,919

21,413

25,009

16,559

19,615

23,211

26,447

18,915

22,800

25,958

61 to 65 Years

1 Adult + 2 Child

14,951

19,010

24,083

28,142

18,527

21,990

26,070

29,732

24,592

28,358

31,272

Upto 35 Years

1 Adult + 3 Child

8,520

10,818

13,691

15,989

9,541

11,669

14,258

16,443

11,900

14,266

16,231

36 to 40 Years

1 Adult + 3 Child

8,903

11,310

14,320

16,728

10,010

12,233

14,935

17,220

12,735

15,255

17,293

41 to 45 Years

1 Adult + 3 Child

9,346

11,880

15,048

17,582

10,538

12,874

15,710

18,112

13,305

15,983

18,148

46 to 50 Years

1 Adult + 3 Child

11,418

14,545

18,453

21,580

12,866

15,751

19,257

22,223

16,812

19,984

22,590

51 to 55 Years

1 Adult + 3 Child

12,381

15,707

19,865

23,191

15,361

18,190

21,520

24,515

17,974

21,395

24,201

56 to 60 Years

1 Adult + 3 Child

15,034

19,119

24,224

28,309

18,525

22,028

26,164

29,860

21,386

25,755

29,319

61 to 65 Years

1 Adult + 3 Child

16,662

21,210

26,895

31,442

20,494

24,403

29,023

33,145

27,062

31,313

34,633

3 Lac

*Premium inclusive of Service Tax of 14% & Swachh Bharat Cess of 0.5%
Note:
Plan A

Base Cover + Waiver of Room Rent Sub Limits

Plan B

Plan A + Critical Illness cover

Plan C

Plan A + Reinstatement cover

DISCLAIMER
1. This rate card is a tool for Ease of Business with limited options as stated under the plans.
2. For complete set of Custom Covers and their Premium; refer to the Master Rate Card.
3. The Master Rate Card Premium is Final & Binding

2/6

Medisure Plus - Simple Rate Card (Sub Limits Applicable)


Plan A

Plan B - Critical Illness

Plan C - Reinstate

Age Group

Plan Type

2 Lac

3 Lac

4 Lac

5 Lac

2 Lac

5 Lac

3 Lac

4 Lac

5 Lac

Upto 35 Years

Individual

2,554

3,199

3,926

4,633

2,810

3,412

4,068

4,747

3,469

4,070

4,694

36 to 40 Years

Individual

2,828

3,557

4,380

5,180

3,169

3,841

4,570

5,332

4,170

4,884

5,564

41 to 45 Years

Individual

3,144

3,972

4,906

5,813

3,570

4,327

5,142

6,003

4,585

5,409

6,197

46 to 50 Years

Individual

4,625

5,911

7,364

8,774

5,306

6,479

7,742

9,077

7,366

8,463

9,603

51 to 55 Years

Individual

5,388

6,829

8,456

10,036

7,601

8,673

9,685

11,020

8,284

9,555

10,865

56 to 60 Years

Individual

7,283

9,312

11,602

13,827

10,008

11,582

13,116

15,038

10,767

12,702

14,656

61 to 65 Years

Individual

8,447

10,835

13,531

16,150

11,513

13,390

15,234

17,512

15,876

17,518

19,158

Upto 35 Years

2 Adults

4,003

5,096

6,329

7,527

4,435

5,456

6,569

7,719

5,556

6,574

7,630

36 to 40 Years

2 Adults

4,461

5,700

7,096

8,452

5,037

6,180

7,416

8,708

6,742

7,952

9,105

41 to 45 Years

2 Adults

4,997

6,401

7,986

9,524

5,716

7,002

8,386

9,844

7,443

8,841

10,177

46 to 50 Years

2 Adults

7,319

9,447

11,847

14,177

8,441

10,383

12,471

14,677

11,848

13,661

15,545

51 to 55 Years

2 Adults

8,668

11,052

13,741

16,352

12,314

14,094

15,769

17,975

13,453

15,555

17,719

56 to 60 Years

2 Adults

11,719

15,087

18,878

22,561

16,176

18,814

21,368

24,555

17,487

20,692

23,929

61 to 65 Years

2 Adults

13,626

17,590

22,053

26,388

18,641

21,784

24,853

28,631

25,907

28,631

31,352

Upto 35 Years

2 Adults + 1 Child

5,238

6,713

8,379

9,997

5,925

7,287

8,761

10,302

7,444

8,767

10,160

36 to 40 Years

2 Adults + 1 Child

5,696

7,317

9,146

10,921

6,527

8,010

9,608

11,291

8,630

10,145

11,635

41 to 45 Years

2 Adults + 1 Child

6,231

8,019

10,035

11,994

7,206

8,832

10,578

12,428

9,332

11,035

12,707

46 to 50 Years

2 Adults + 1 Child

8,554

11,065

13,897

16,647

9,931

12,213

14,663

17,260

13,736

15,854

18,075

51 to 55 Years

2 Adults + 1 Child

9,903

12,670

15,790

18,821

13,804

15,924

17,961

20,558

15,341

17,748

20,249

56 to 60 Years

2 Adults + 1 Child

12,953

16,704

20,928

25,031

17,667

20,645

23,559

27,138

19,376

22,886

26,459

61 to 65 Years

2 Adults + 1 Child

14,861

19,208

24,102

28,857

20,131

23,614

27,045

31,214

27,795

30,824

33,882

Upto 35 Years

2 Adults + 2 Child

6,447

8,298

10,387

12,416

7,391

9,084

10,911

12,836

9,299

10,919

12,640

36 to 40 Years

2 Adults + 2 Child

6,906

8,902

11,154

13,341

7,993

9,808

11,758

13,825

10,485

12,297

14,115

41 to 45 Years

2 Adults + 2 Child

7,441

9,604

12,044

14,413

8,672

10,630

12,728

14,961

11,187

13,187

15,187

46 to 50 Years

2 Adults + 2 Child

9,764

12,649

15,905

19,067

11,397

14,011

16,813

19,793

15,591

18,007

20,555

51 to 55 Years

2 Adults + 2 Child

11,113

14,254

17,799

21,241

15,270

17,722

20,111

23,091

17,196

19,900

22,729

56 to 60 Years

2 Adults + 2 Child

14,163

18,289

22,936

27,451

19,132

22,443

25,710

29,672

21,231

25,038

28,939

61 to 65 Years

2 Adults + 2 Child

16,070

20,792

26,111

31,277

21,596

25,412

29,195

33,747

29,651

32,976

36,362

Upto 35 Years

1 Adult + 1 Child

3,789

4,816

5,976

7,103

4,300

5,242

6,260

7,330

5,358

6,264

7,224

36 to 40 Years

1 Adult + 1 Child

4,063

5,175

6,430

7,650

4,659

5,671

6,761

7,915

6,058

7,077

8,094

41 to 45 Years

1 Adult + 1 Child

4,379

5,589

6,956

8,283

5,060

6,157

7,334

8,586

6,473

7,603

8,728

46 to 50 Years

1 Adult + 1 Child

5,860

7,529

9,413

11,244

6,796

8,309

9,934

11,660

9,254

10,656

12,133

51 to 55 Years

1 Adult + 1 Child

6,622

8,446

10,505

12,506

9,092

10,504

11,877

13,603

10,172

11,749

13,395

56 to 60 Years

1 Adult + 1 Child

8,518

10,929

13,652

16,297

11,498

13,413

15,308

17,621

12,655

14,895

17,186

61 to 65 Years

1 Adult + 1 Child

9,682

12,453

15,581

18,620

13,003

15,220

17,426

20,095

17,764

19,711

21,689

*Premium inclusive of Service Tax of 14% & Swachh Bharat Cess of 0.5%

3 Lac

4 Lac

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Age Group

Plan Type

Upto 35 Years

Plan A

Plan B - Critical Illness

2 Lac

3 Lac

4 Lac

5 Lac

2 Lac

3 Lac

1 Adult + 2 Child

4,999

6,401

7,984

9,522

5,765

7,040

36 to 40 Years

1 Adult + 2 Child

5,273

6,760

8,439

10,070

6,124

41 to 45 Years

1 Adult + 2 Child

5,589

7,174

8,964

10,703

46 to 50 Years

1 Adult + 2 Child

7,070

9,114

11,422

51 to 55 Years

1 Adult + 2 Child

7,832

10,031

56 to 60 Years

1 Adult + 2 Child

9,728

61 to 65 Years

1 Adult + 2 Child

Upto 35 Years

4 Lac

Plan C - Reinstate
5 Lac

3 Lac

4 Lac

5 Lac

8,410

9,863

7,213

8,416

9,704

7,469

8,912

10,448

7,914

9,229

10,575

6,526

7,955

9,484

11,119

8,329

9,755

11,208

13,664

8,262

10,107

12,084

14,193

11,110

12,809

14,613

12,514

14,925

10,557

12,302

14,027

16,136

12,027

13,901

15,875

12,514

15,660

18,716

12,963

15,211

17,458

20,154

14,510

17,047

19,666

10,892

14,038

17,589

21,039

14,468

17,018

19,576

22,629

19,620

21,864

24,169

1 Adult + 3 Child

6,221

8,003

10,014

11,967

7,243

8,854

10,581

12,421

9,085

10,589

12,209

36 to 40 Years

1 Adult + 3 Child

6,495

8,361

10,468

12,514

7,602

9,283

11,083

13,006

9,786

11,402

13,080

41 to 45 Years

1 Adult + 3 Child

6,811

8,776

10,993

13,147

8,004

9,769

11,655

13,677

10,200

11,928

13,713

46 to 50 Years

1 Adult + 3 Child

8,292

10,715

13,451

16,108

9,739

11,921

14,255

16,752

12,982

14,981

17,119

51 to 55 Years

1 Adult + 3 Child

9,055

11,632

14,543

17,370

12,035

14,116

16,198

18,695

13,899

16,074

18,380

56 to 60 Years

1 Adult + 3 Child

10,950

14,115

17,689

21,161

14,441

17,025

19,629

22,713

16,382

19,220

22,171

61 to 65 Years

1 Adult + 3 Child

12,114

15,639

19,618

23,484

15,946

18,832

21,747

25,187

21,491

24,036

26,674

*Premium inclusive of Service Tax of 14% & Swachh Bharat Cess of 0.5%
Note:
Plan A

Base Cover ONLY with 1% or Rs. 4000 for Room / 2% or Rs. 6000 for ICU

Plan B

Plan A + Critical Illness cover

Plan C

Plan A + Reinstatement cover

DISCLAIMER
1. This rate card is a tool for Ease of Business with limited options as stated under the plans.
2. For complete set of Custom Covers and their Premium; refer to the Master Rate Card.
3. The Master Rate Card Premium is Final & Binding

4/6

Medisure Plus - Add On Rate Card


Add Ons

Age Group

Plan Type

Upto 35 Years

Individual

39

39

17

36 to 40 Years

Individual

44

44

29

41 to 45 Years

Individual

51

51

36

46 to 50 Years

Individual

61

61

51

51 to 55 Years

Individual

68

68

67

56 to 60 Years

Individual

90

90

85

61 to 65 Years

Individual

108

108

128

Upto 35 Years

2 Adults

67

67

29

36 to 40 Years

2 Adults

76

76

49

41 to 45 Years

2 Adults

86

86

61

46 to 50 Years

2 Adults

101

101

84

51 to 55 Years

2 Adults

112

112

110

56 to 60 Years

2 Adults

149

149

141

61 to 65 Years

2 Adults

177

177

212

Upto 35 Years

2 Adults + 1 Child

106

106

47

36 to 40 Years

2 Adults + 1 Child

115

115

66

41 to 45 Years

2 Adults + 1 Child

126

126

79

46 to 50 Years

2 Adults + 1 Child

140

140

101

51 to 55 Years

2 Adults + 1 Child

152

152

127

56 to 60 Years

2 Adults + 1 Child

188

188

158

61 to 65 Years

2 Adults + 1 Child

217

217

229

Upto 35 Years

2 Adults + 2 Child

145

145

64

36 to 40 Years

2 Adults + 2 Child

154

154

83

41 to 45 Years

2 Adults + 2 Child

165

165

96

46 to 50 Years

2 Adults + 2 Child

179

179

119

51 to 55 Years

2 Adults + 2 Child

191

191

144

56 to 60 Years

2 Adults + 2 Child

227

227

176

61 to 65 Years

2 Adults + 2 Child

256

256

246

Upto 35 Years

1 Adult + 1 Child

79

79

35

36 to 40 Years

1 Adult + 1 Child

84

84

46

41 to 45 Years

1 Adult + 1 Child

90

90

53

46 to 50 Years

1 Adult + 1 Child

100

100

68

51 to 55 Years

1 Adult + 1 Child

107

107

84

56 to 60 Years

1 Adult + 1 Child

129

129

103

61 to 65 Years

1 Adult + 1 Child

147

147

146

Hospital Cash

Accompanying Person Expenses

*Premium inclusive of Service Tax of 14% & Swachh Bharat Cess of 0.5%

Recovery Benefit

5/6

Add Ons

Age Group

Plan Type

Upto 35 Years

1 Adult + 2 Child

118

118

52

36 to 40 Years

1 Adult + 2 Child

123

123

63

41 to 45 Years

1 Adult + 2 Child

130

130

71

46 to 50 Years

1 Adult + 2 Child

140

140

86

51 to 55 Years

1 Adult + 2 Child

147

147

101

56 to 60 Years

1 Adult + 2 Child

169

169

120

61 to 65 Years

1 Adult + 2 Child

186

186

163

Upto 35 Years

1 Adult + 3 Child

157

157

69

36 to 40 Years

1 Adult + 3 Child

162

162

81

41 to 45 Years

1 Adult + 3 Child

169

169

88

46 to 50 Years

1 Adult + 3 Child

179

179

103

51 to 55 Years

1 Adult + 3 Child

186

186

118

56 to 60 Years

1 Adult + 3 Child

208

208

137

61 to 65 Years

1 Adult + 3 Child

225

225

180

Hospital Cash

Accompanying Person Expenses

Recovery Benefit

*Premium inclusive of Service Tax of 14% & Swachh Bharat Cess of 0.5%
DISCLAIMER
1. This rate card is a tool for Ease of Business with limited options as stated under the plans.
2. For complete set of Custom Covers and their Premium; refer to the Master Rate Card.
3. The Master Rate Card Premium is Final & Binding

HLT/MPL/ 02.Dec.2015/Ver.2

call 1800 209 5846


www.ltinsurance.com
email help@ltinsurance.com

6/6

is the brand of L&T General Insurance Company Ltd. Trade Logo displayed above belongs to Larsen & Toubro Ltd. and is used by L&T General Insurance Company
Limited under license. IRDA Reg. No. 146. Insurance is the subject matter of solicitation. The information provided herein includes only the salient features of my:health Medisure Plus
Insurance. For more details on coverage, exclusions, terms and conditions, please refer to the product brochure or policy wordings before concluding a sale. Beware of spurious phone
calls and fictitious/fraudulent offers. IRDA clarifies to public that it / its officials do not involve in activities like sale of any kind of insurance. Public receiving such phone calls are
requested to lodge a police complaint along with details of phone call and number. The premium is calculated with Service Tax of 14% & Swachh Bharat Cess of 0.5%. CIN No.
U66030MH2007PLC177117, UIN-IRDA/NL-HLT/L&TGI/P-H/V.II/34/14-15, Advt. Ref No. LTGICL/FY15-16/ 012. Registered Office: L&T House, N. M. Marg, Ballard Estate, Mumbai 400001. Corporate Office: L&T General Insurance Company Limited, 6th Floor, City 2, Plot No. 177, CST Road, Near Bandra Kurla Telephone Exchange, Kalina, Santacruz (East),
Mumbai - 400098, India.