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Baroda Health

"Baroda Health" (Mediclaim Insurance Policy) for Banks Account holders.


With a view to offer value added services to our customers, we have developed a co-branded insurance product called as "BarodaHealth" (Mediclaim Insurance Policy) for Bank's Account
holders w.e.f. 23rd February 2006 available at all our branches across the country.

What is Baroda Health Policy?


It is a Medical Insurance Scheme, available only to account holders of our Bank, which takes care of the hospitalization expenses incurred by the customer up to the amount of sum
insured, in respect of the following eventualities.

Any illness / disease

Accidental injury and/ or any ailment.

Any surgery that is required in respect of any disease or accident that has arisen during the policy period

The minimum hospitalization should be for 24 hours

Key Benefits :

Very low premium

In this co-branded product, single premium (generally payable for a single person) is payable and Medical Health insurance cover is available to family of -4- (self, spouse and 2
dependent children) up to the amount insured without any additional premium.

A member or all the members in insured family can avail hospitalization benefits during the policy period, to the extent of aggregate sum not exceeding the sum insured.

Premium paid is eligible for Income Tax exemption under Section 80 D as per Income Tax Rules.

Salient features:

No medical examination required for commencement of health cover.

Pre-existing diseases also get coverage after 3 continuous claim-free policy years.

Coverage options available: 8 slabs ranging from Rs. 50,000/- to Rs. 5,00,000/- per family of 1+3.

Upper age limit of primary member (first named person) is allowed upto 80 years, if a person obtains the insurance cover before completion of 65 years and continue to renew the
policy upto the age he wishes to or 80 years, whichever is earlier.

The scheme is administered through Third Party Administrators (TPAs) for settlement of Hospitalization Claims under the insurance cover.

The insured individuals get cashless hospitalization facility also in the selected hospitals through TPAs. The whole process is hassle-free and treatment upto the limit of insurance is
available without any payment at the time of admission or discharge. Payment of hospital bill up to the sum insured will be taken care of by the TPA directly.

Scope of cover:

Room, Boarding expenses as provided by the Hospital / Nursing Home.

Nursing expenses.

Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees.

Anaesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical appliances, Medicines & Drugs, Diagnostic Materials and X-Ray, Dialysis, Chemotherapy, Radiotherapy, Cost of
pacemaker, Artificial Limbs and cost of organs and similar expenses.

Additional Covers

Terms and Conditions:

This policy is available only to account holders of our Bank.

Period of insurance cover is one year. The policy needs renewal on or before the expiry date for continuity.

The Premium Payable (currently in force).

The family for this purpose means self, spouse and two dependent children.

Non-earning son / daughter is considered dependent (scholarship amount is not considered as income). However, Married daughters are not considered dependent.

There are certain diseases / expenses which are not covered in the scheme. Kindly check the details of these Major Exclusions

The insured will receive the following documents directly from the insurance co. and TPA

Original Receipt (can be used as proof for claiming IT rebates U/s 80D of Income Tax Act.)

Policy

TPA guide book

Identity Card issued by TPA

The scheme is administered through Third Party Administrators (TPAs) for settlement of Hospitalization Claims under the insurance cover. Please check details for Claim Procedure

The detailed Terms and Conditions as per the insuring company, which policy holder will receive along with the policy documents.

How to Apply:
The process is simple. Banks customers can download the proposal form, fill up and submit along with the cheque for premium amount to our nearest branch. The cheque should be drawn
in favour of National Insurance Co. Ltd. For any further details or assistance, please visit our nearest branch.

Disclaimer:
Insurance is the subject matter of solicitation. Bank of Baroda is the Certified Corporate Agent for National Insurance Co. Ltd. and nothing contained on the Website shall constitute or be deemed to constitute an
advice, an offer to purchase or an invitation or solicitation to undertake any activity or enter into any transaction relating to the Gen. Insurance Products. Participation by Bank of Baroda customers shall be purely on
voluntary basis. The contract of Insurance is between National Insurance Company Ltd. and the insured, and not between Bank of Baroda and the insured.

Baroda Health - Additional Covers

1.

Ambulance charges not exceeding Rs.1000/- (Rupees one thousand only) per Policy period.

2.

In case of Hospitalisation of children below 12 years, a lump sum amount of Rs.1000/- (Rupees one thousand only) per policy period towards the out-of-pocket expenses. The
payment will be made on the basis of a declaration from the parent without insisting on any supporting bill/cash memo.

3.

Cost of health check-up: It is allowed at the rate of 1% of the sum insured after completion of three continuous claim free years of policy/policies issued by National Insurance
Company Ltd. only.

4.

Pre & Post Hospitalisation Expenses for first 30 days and 60 days respectively.

5.

Pre existing Diseases Cover :


Benefits for pre existing diseases will be available only after the completion of 36 months of continuous coverage since issue of the first policy.
(Pre-existing diseases shall mean any condition, ailment or injury or related condition(s) for which the insured had signs or symptoms and / or were diagnosed and / or received
medical advice / treatment within 48 months prior to first policy.)

Baroda Health -Premium Payable


(Currently in force including the service tax @ 14.00%)
Floater Sum Insured (INR)
50,000
1,00,000
1,50,000
2,00,000
2,50,000
3,00,000
4,00,000
5,00,000

Premium up to 65 years (INR)


945
1774
2677
3443
4122
4803
5992
7182

Premium above 65 years & upto 80 years


1181
2217
3346
4304
5153
6003
7490
8978

Baroda Health - Major Exclusions

1.

Benefits for pre existing diseases will not be available for any condition(s) as defined in the policy until 36 months of continuous Coverage has elapsed since issue of the first policy.

2.

Any hospitalization expenses incurred in the first 30 days from the first commencement date of Insurance cover except in case of Injury arising out of accident.

3.

During the 1st year of operation of insurance cover the expenses on treatment of diseases such as Cataract, Benign, Prostatic Hypertrophy, and Hysterectomy for Hemorrhagic, or
Fibromyoma, Hernia, Hydrocele, congenital internal disease, Fistula in anus, Piles, Sinusitis and related disorders are not payable.These diseases, if pre-existing, will be covered
only as per provisions mentioned as above.

4.

Circumcision, vaccination or inoculation or change of life or cosmetic or aesthetic treatment of any description, plastic surgery other than as may be necessitated due to an accident

or as apart of any illness.


5.

Cost of spectacles and contact lenses, hearing aids.

6.

Dental treatment or surgery of any kind unless requiring hospitalisation.

7.

Convalescence, general debility, run-down condition or rest cure, congenital external disease or defects or anomalies, Sterility, Infertility, Venereal disease, intentional self injury and
use of intoxication drugs/alcohol, AIDS.

8.

Charges incurred at Hospital or Nursing Home primarily for diagnosis purpose.

9.

Expenses on vitamins and tonics unless forming part of treatment for injury or diseases as certified by the attending physician.

10. Treatment arising from or traceable to pregnancy (including voluntary termination of pregnancy) and child birth (including Caesarean Section) and allied maternity benefits.
11. Naturopathy Treatment.
12. The benefits like Cumulative Bonus, health check up including continuity accrued under the previous Policy / Policies, issued by any other Insurance Company shall not be
available under this Policy.

Baroda Health - Claim Procedure

Hospital Claims will be settled by the TPA (Third Party Administrators). The details of the claim procedure for emergency / planned hospitalization and the contact phone nos. of TPAs
will be given in the TPA guidebook which the insured will receive directly. The guidebook provides all the details and procedure with regard to lodgment of insurance claim.
Insured person as well as his family is eligible either for the cashless treatment and / or reimbursement of claims. Cashless hospitalization service is available through the networked
Hospitals / Nursing Homes and is subject to pre admission authorization. The TPA shall, upon getting the related medical information from the insured persons / network hospital,
verify that the person is eligible to claim under the policy and after satisfying itself will issue a pre-authorization letter/ guarantee of payment letter to the Hospital / Nursing Home
mentioning the sum guaranteed as payable, also the ailment for which the person is seeking to be admitted as a patient.
The TPA reserves the right to deny pre-authorization in case the insured person is unable to provide the relevant medical details as required by the TPA. The TPA will also inform to
the insured person that denial of Cashless Access is in no way construed to be denial of treatment. The insured person may obtain the treatment as per his/her treating doctors
advice and later on submit the full claim papers to the TPA for reimbursement.
In the event of any claim to be lodged under the policy, the customer should submit the claim papers as under be directly to the TPA Third Party Administrators in accordance with
the guidelines incorporated in the guide book.
1.

Claim form

2.

Discharge Summary

3.

Prescription with bills

4.

Test Reports

5.

Certificate in respect of date of admission and discharge, discharge card etc.

6.

Any other documents required by TPA / NICL.

The customer should send all claim papers in ORIGINAL


In case of any query raised by TPA, it may be responded immediately so that the claim may be settled within reasonable time.
The TPA may repudiate the claim, giving reasons, if not covered under the terms of the policy. The insured person shall have right of appeal to the insurance company if he/she feels
that the claim is payable. The insurance companys decision in this regard will be final and binding on TPA.

Baroda Health Insurance Policy From Bank Of Baroda


Salient Feature
Baroda Health policy is a unique Health cum Accident Policy designed especially for the a/c holders of Bank of Baroda. The entire family consisting of the
a/c holder, spouse and 2 dependent children can be covered under this policy.
This policy covers Hospitalization expenses for a/c. holder and family. In case of Hospitalization Expenses, the entire family is covered for the Floater Sum
Insured as opted for, i.e., either one or all members of the family can utilize the Sum Insured during the policy period.
Age: 3 months to 65 years.

Scope of Cover
1) Room, Boarding expenses as provided by the Hospital/Nursing Home.
2) Nursing expenses.
3) Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees.
4) Anaesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical appliances, Medicines & Drugs, Diagnostic Materials and X-Ray, Dialysis,
Chemotherapy, Radiotherapy, Cost of pacemaker, Artificial Limbs and cost of organs and similar expenses.

Additional Covers

1) Ambulance charges not exceeding Rs.1000/- (Rupees one thousand only) per Policy period.
2) In case of Hospitalisation of children below 12 years, a lump sum amount of Rs.1000/- (Rupees one thousand only) per policy period towards the out-ofpocket expenses. The payment will be made on the basis of a declaration from the parent without insisting on any supporting bill/cash memo.
3) Cost of health check-up : It is allowed at the rate of 1% of the sum insured after completion of three continuous claim free years of policy/policies issued
by National Insurance Company Ltd. only.
4) Pre & Post Hospitalisation Expenses for first 30 days and 60 days respectively.
5) Pre-existing diseases will be covered after three consecutive continuous claims free policy years in respect of all diseases provided, there was no
hospitalisation for pre-existing ailment during such three years of insurance.

Other Features
1. Floater Sum Insured where any one of the entire family can avail of the Sum Insured opted.
2. Tax benefit available under Section 80D of IT Act.
3. The premium will be deducted from Bank a/c. of the a/c. holder.
4. The claims will be serviced by TPAs.
5. Minimum hospitalisation for 24 hours.

Major Exclusions
1.All diseases/injuries, which are pre-existing when the cover incepts for the first time. This exclusion will be deleted after three consecutive continuous
claims free policy years in respect of all diseases provided, there was no hospitalisation for pre-existing ailment during such three years of insurance.
2.Any hospitalization expenses incurred in the first 30 days from the commencement date of Insurance cover except in case of Injury arising out of
accident.
3.During the 1st year of operation of insurance cover the expenses on treatment of diseases such as Cataract, Benign, Prostatic Hypertrophy, and
Hysterectomy for Hemorrhagic, or Fibromyoma, Hernia, Hydrocele, congenital internal disease, Fistula in anus, Piles, Sinusitis and related disorders are
not payable. If these diseases are pre existing it will be covered after three consecutive continuous claims free policy years.
4.Circumcision, vaccination or inoculation or change of life or cosmetic or aesthetic treatment of any description, plastic surgery other than as may be
necessitated due to an accident or as apart of any illness.
5.Cost of spectacles and contact lenses, hearing aids.

6.Dental treatment or surgery of any kind unless requiring hospitalization.


7.Convalescence, general debility, run-down condition or rest cure, congenital external disease or defects or anomalies, Sterility, Infertility, Venereal
disease, intentional self injury and use of intoxication drugs/alcohol, AIDS.
8.Charges incurred at Hospital or Nursing Home primarily for diagnosis purpose.
9.Expenses on vitamins and tonics unless forming part of treatment for injury or diseases as certified by the attending physician.
10. Treatment arising from or traceable to pregnancy (including voluntary termination of pregnancy) and child birth (including Caesarean Section) and allied
maternity benefits.
11. Naturopathy Treatment.
12. The benefits including continuity, enjoyed under the previous Policy/Policies, issued by any other Insurance Company shall not be available under this
Policy.
(N.B. Companys Liability in respect of all claims admitted during the period of Insurance shall not exceed the Floater Sum Insured per FAMILY as
mentioned in the schedule).

Premium Payable
Floater Sum Insured (Rs.) Premium plus Service Tax (Rs.)
50,000 969/1 lac 1770/1.5 lacs 2577/2.0 lacs 3383/2.5 lacs 4041/3.0 lacs 4698/4.0 lacs 5840/5.0 lacs 6997/-

Claims Procedure

Hospilisation Claims will be settled by the Third Party Administrators (TPA). They will send details of the claims procedure for emergency/planned
hospitalisation

Documents to be submitted:
1.Claim form
2.Discharge Summary
3.Prescription with bills
4.Test Reports
5. Any other documents required by TPA.

Procedure for availing Cashless Access Services in Network Hospital/Nursing Home:


Claims in respect of Cashless Access Services will be through the list of the network of Hospitals/Nursing Homes and is subject to pre admission
authorization. The TPA shall, upon getting the related medical information from the insured persons/ network provider, verify that the person is eligible to
claim under the policy and after satisfying itself will issue a pre-authorisation letter/ guarantee of payment letter to the Hospital/Nursing Home mentioning
the sum guaranteed as payable, also the ailment for which the person is seeking to be admitted as a patient.
The TPA reserves the right to deny pre-authorisation in case the insured person is unable to provide the relevant medical details as required by the TPA.
The TPA will make it clear to the insured person that denial of Cashless Access is in no way construed to be denial of treatment. The insured person may
obtain the treatment as per his/her treating doctors advice and later on submit the full claim papers to the TPA for reimbursement.
The TPA may repudiate the claim, giving reasons, if not covered under the terms of the policy. The insured person shall have right of appeal to the
insurance company if he/she feels that the claim is payable. The insurance companys decision in this regard will be final and binding on TPA.

General Instructions

The proposal form attached to this Prospectus should be duly filled and submitted to the Bank of Baroda Branch, where the a/c. holder has an a/c.

2 stamp size photographs to be affixed in the Proposal form.

A receipt will be given by the Bank.

The Prospectus contains the details of the policy and no individual policy will be issued.

Details of the policy will be available with Bank of Baroda, National Insurance Company Ltd., Third Party Administrators.

IT Certificate will be issued by NICL and given to the bank. The a/c. holder can collect the same from the bank.

Premium for hospitalization cover is eligible for IT benefit.

The premium will be deducted from the a/c.by the bank and paid to National Insurance Co. Ltd.

The a/c. holder will be given:


1. Prospectus which broadly contains the details of the policy.
2. Receipt
3. IT Certificate
4. ID Card / Instructions from TPA
Source: http://www.nationalinsuranceindia.com/nicWeb/nic/PolicyServlet?id=9999&name=4865.htm

http://www.businesstoday.in/moneytoday/insurance/health-plans-offered-by-banks-beneficial-high-risk-portfolio/story/198911.html

Banking On Cover
Health plans offered by banks to their customers work well for individuals with high risk.
Chandralekha Mukerji

Edition:October 2013

Insurance from banks on offer for account holders might be the economic option for those who have to pay higher than
normal for a health plan. This includes those who have a pre-existing condition, fall in the higher age bracket or miss
having the benefits of an employer's group health plan.
Banks have tied up with insurers, usually public sector general insurers, to offer health insurance plans with low
premiums compared with indemnity plans (just like group health insurance plans).

For example, SyndArogya, a tieup between Syndicate Bank and United India Insurance, charges the same premium for a
30 year old and a 60 year old for the same cover. Or consider a mediclaim policy from National Insurance. It would cost
a 55 year old Rs 9,672 annually. But, the family floater Baroda Health Policy, a tie-up of Bank of Baroda with National
Insurance, for spouse and two children will cost only Rs 4,213.
"As the bank promises large business to insurers, they devise a product that is better than the retail product in their
own portfolio," says Sudhir Sarnobat, CEO, Medimanage Insurance Broking, a Mumbai-based health insurance
brokerage firm.
Further, there are usually no medical check-ups and the entry age is up to 65 years with no increase in cost. All this
makes it an attractive product for those with pre-existing conditions or fall in the higher age bracket.
The tie-up also ensures that the insurer will respond to your enquiry for a health plan. Often, high-risk individuals do
not get a reply from insurers. "Since the forms are submitted through the bank, a response has to be officially conveyed
and, so, even people with diabetes or hypertension might get approved," says Harsh Roongta, CEO, Apnapaisa.com.
Some such plans are even better than other retail products on offer. For instance, the Baroda Health Policy has no
sublimit (on room rent, doctor's fee and so on), no co-payment (high risk plans often have insurers and customers
sharing treatment costs), a fixed premium for up to 65 years and a 25% increase in premium after 65.
Some, such as SyndArogya, even cover parents at a lucrative rate. A Rs-5 lakh cover for a family of six-proposer, spouse,
two dependent children and parents-would cost Rs 12,167 annually. This is one-fourth of what a retail product with
similar benefits would cost.
There are add-on features available as well. Among others, the cost of health check-up (up to 1% of the sum insured) is
covered after three claim-free years. Pre-hospitalisation and post-hospitalisation expenses are covered for first 30 days
and 60 days, respectively. You also get ambulance charges cover up to Rs 1,000, while some cover maternity benefits (up

to 5% of sum insured) from the second year.


The claim settlement is carried out directly between the customer and the insurer. Rates, and more importantly terms,
are pre-negotiated and, so, normally excellent.
Since this is a direct contract between the policyholder and insurer, you get regular tax benefits under Section 80D of the
I-T Act. "These are bulk deals and not a group policy and, so, each account holder gets a policy document, not a policy
certificate," says Roongta.

THE DRAWBACKS
One major shortcoming is the age at which renewal stops, usually 80 years. In comparison, most indemnity plans offer
lifelong coverage. However, this might change as the new guidelines have made renewal mandatory for all heath plans.

Also, the maximum coverage you can get is Rs 5 lakh, which might be very low considering current medical costs. "It is
advisable not to buy any insurance plan that does not offer lifetime coverage and adequate cover," says Yashish Dahiya,
CEO, Policybazaar.com.
Apart from the regular exclusions and a 3-year claims-free waiting period on pre-existing illnesses, some plans also don't
cover primary diagnostic treatment charges.
Moreover, though the policy is approved through the bank, the claims settlement process will be done through a TPA or
the insurer.
There is also the risk of discontinuance of the partnership. Since the product is designed for the customers of a partner
bank, the plan will likely be withdrawn.
Sarnobat explains: "In such cases, the policies will continue till the date of expiry. On expiry, like group insurance plans,
the customer will be given the option to port to a similar plan being offered by the insurer."
While continuity benefits would be offered under standard portability guidelines, there will be no guarantee on pricing
and there may be changes in policy benefits.