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Financial Assistance for you and your family against Hospitalisation Expenses incurred towards disease / illness / injury in India along with other additional benefits.
• • •
Basic Features Value Added Features Policy Features
Plan Details Our Advantage
Pre and Post Hospitalisation Coverage of Pre-Existing Diseases
Policy covers hospitalisation expenses incurred as an in-patient in a Hospital which will include
Room, Boarding and Operation Theatre charges Fees of Surgeon, Anesthetist, Nurses, Specialists The cost of diagnostic tests, medicines, blood, oxygen, appliances like pacemaker, prosthesis/internal implants and any medical expenses incurred which is integral part
of the operation
Hospitalisation for a minimum period of 24 hours is a must except the day care procedures
defined under the policy.
hospitalisation expenses for certain treatments / diseases like the following are also covered.(B) Day Care Treatment Hospitalisation less than 24 hrs Due to advancement of technology. please refer to policy wordings . even though the hospitalisation is for less than 24 hours Cardiac Catheterization Dilation & Curettage Eye Surgery Hernia Repair Surgery Hydrocele Surgery Lithotripsy (Kidney stone removal) Radiotherapy Tonsillectomy Cataract Chemotherapy Coronary Angiography Coronary Angioplasty Dialysis For more Day Care Procedures (Total 100 defined).
(C) Pre and Post Hospitalisation Policy also covers relevant medical expenses incurred during a specified period. before & after hospitalization (for which a claim is payable) Policy Cover Pre-Hospitalisation upto 60 days. For Limits. Policy Cover Post-Hospitalisation upto 90 days. please check the Plan Slide .
and / or were diagnosed and / or received medical advice/ treatment. .(D) Coverage of Pre-Existing Diseases Definition: Means any condition. ailment or injury or related condition(s) for which You had signs or symptoms. within 48 months prior to inception of your first policy with Us Hospitalisation expenses incurred on treatment towards Pre-existing diseases / condition can be covered: After completition of 4 years of Consecutive years of policy with FG.
• • • • • • Local Road Ambulance Services Free Medical Health Check up Patient Care Hospital Cash Expenses on accompanying person at the Hospital Accidental Hospitalisation.2. Additional Benefits Additional benefits are payable up to the limits specified . These features become applicable once a valid claim is admitted under the basic hospitalisation expenses cover of the Policy .
(A) Local Road Ambulance Services Reimbursement of Expenses incurred for necessary transportation of the insured to the Hospital in an ambulance for hospital admission and requiring immediate treatment. Benefit under this extension is limited to 1% of the Sum Insured per policy period subject to maximum of INR 1500/- .
500/.Family Floater Plan: For 2 People : 1% of the sum insured subject to maximum of INR 4.Individual Plan: 1% of the sum Insured subject to maximum of INR 2. Applicable once at the end of a block of 4 claim free years.(B) Cost of Health Check up This benefit provides for reimbursement of cost / charges incurred for medical check up.000/- . Reimbursement is as follows: .
per day or actuals whichever is lower . . This is applicable for people above 60 years advised nursing at Home after discharged from hospital. Maximum Day allowance is 30 days during the policy period.(C) Patient Care Allowance Payment of Nursing Allowance for expenses towards employment of registered nurse at the residence of Insured such services are: Confirmed as being necessary by the treating Physician Relate directly to a disease / illness / injury for which the Insured has been hospitalised. Allowance is payable for 10 days for any single Hospitalization @ Rs 350/.
The allowance of Rs. . concurrently.per day is allowed for each completed day of Hospitalization subject to Maximum 60 days during a policy period. It is irrespective of the number of occurrences If case two people of the same floater are hospitalized. each one of them will be eligible for hospital daily allowance separately subject to max allowable policy limit.(D) Hospital Cash Allowance The Extension is only applicable for Platinum Plan Holder.500/.
(E) Expenses on Accompanying Person For Hospitalisation of Child less than 10 Years. . father. grandmother.500/.for each completed day of Hospitalisation subject to maximum of 30 days during the Policy period Accompanying person means and includes mother. grandfather or any immediate family member. Company will pay additional Rs.
(F) Accidental Hospitalization Increase Limit of Sum Insured available if Hospitalization is due to an accident. Enhancement of Limits by 25% of Available Sum Insured at the Time of Hospitalization due to an accident subject to 1 Lakh. .
Policy Features Income Tax Benefit Individual Plan & Family Floater Plan Sum Insured Pre-insurance Health Check up Option in Policy Duration Renewal Discount Cashless Facility (Through Third Party Administrators .3.TPA) Age Slabs .
(A) Income Tax Benefit Premium paid for Health Suraksha Policy is eligible for tax deduction under section 80 D of the Income Tax Act.for self.000/. spouse & Dependent Children.if the policy includes senior citizens whose ages is above 65 yrs . subject to the condition that the premium amount is paid by any mode.15. 15. 20. Rs. Rs. other than cash Rs.towards the Health premium for parents.000/.000/.
Renewal Discount & Cumulative Bonus: • • Would be applicable to the members in the policy who have a claims free year of policy for first 5 years. each member would get entitled of Cumulative Bonus of 10% on the basic sum insured upto maximum of 50% of the sum insured for every claim free year. 10% Family Discount is applicable in the policy if the insureds are more than one. 10 Lakh – Subject to Medical approval based on age and Sum Insured. . Claims Experience Loading • At renewal claims experience loading is charged only on the individual who has made the claim and not on other members covered under the policy.to Rs. Has an option to start with a sum insured as low as 100000 /.Options Available Policy can be Opted for Individual Plan & Family Floater Plan Individual Plan – Health Suraksha (Individual): • • • • Each member has a liberty to chose their own limits and has advantage to utilize it to 100% during the policy period. Sum insured of 50000 can be taken for children only Parents can be also covered in same plan upto the age of 70 years subject to medical and maximum Sum Insured of 5 Lakh. Each claim free year would have an entitlement of 5% discount on the renewal premium. From 6th Year.
Ahmedabad. Hyderabad & Bangalore) Zone C – ( All other cities in the country except defined in Zone A & B) Zone C will have lower premium than Zone B and Zone B would have lower premium than Zone A for similar benefits. Kolkata.Thane and Panvel & Delhi & NCR) Zone B – (Chennai. where the cost of treatment is higher as compared to Bhopal? Geographical Classification. – Why a person living in Bhopal should pay premium equivalent to Delhi/Mumbai. . Geographical Classification is based on differential Medical Treatment cost in various city. Zone A – (Mumbai .Plan Available under Health Suraksha (Individual) Structuring of Plans based on Geographical classification.
Silver Plan: Available for Zone B. . Company would deduct the %tage from the approved claim amount. The Next Slide will reflect these deductions in claim amount when there is a difference in Plan opted and Zone of Treatment. I have paid Lower premium for Zone C and I decide to take a treatment at high Medical Treatment Zone A.Plan Details Basic Plan: Available for Zone C. What if I opt for Basic Plan (Applicable for Zone C) and take treatment in Zone A. Gold Plan: Available for Zone A Platinum Plan: Across India.
Deduction in Claims (When Plan opted and Treatment Zones are different) Benefit Plan Platinum Plan Gold Plan Silver Plan Basic Plan Zone A 100%* 100%* 80%* 70%* Zone B 100%* 100%* 100%* 80%* Zone C 100%* 100%* 100%* 100%* *The percentage of claim amount shown in the above table is with respect to the eligible claim amount. treatment taken irrespective of location (Zone). Eg. If a person opts for Platinum or Gold plan. is paid only 70% of the approved claim amount. 100% of Approved claim amount is paid • If a person opts for Silver and takes treatment in Zone A geography is paid only 80% of the approved claim amount. . • If Person opts for Basic and takes treatment in Zone A or Zone B.
for each completed day of hospitalisation in case of a child up to age of 10 years subject to max of 30 days. OT Charges. As per Actuals As per Actuals Upto 8% of the eligible per hospitalisation expenses. Specialists Fees Anaesthesia.Benefit under various Plans S r # 1 Room. grand mother.(b) during the . Surgical Appliances Pre-hospitalisation expenses.per day or actuals whichever is lower up to a max 10 days -subject to max of 30 days during the policy period. 2500. Charges Etc a If admitted into Intensive Care Unit .free medical check-up . 4000.1% of SI up to a max of Rs.for each completed day of hospitalisation subject to max of 60 days. policy period c Surgeon. Anaesthetist.60 days Scope BASIC. 8. For FF(2-people) . 1500 For every 4 claim free years. b All admissible claims under 1. 2500.SILVER & GOLD Upto 1% of the SI per day As per Actuals Payment PLATINUM 1 Upto 2% of the SI per day As per Actuals 1 Upto 35% of the Sum Insured per claim As per Actuals 2.1% of SI up to a max of Rs. Accompanying person means and includes mother. Post –hospitalisation expenses-90 days Day Care Expenses Ambulance charges Free medical check-up Upto 10% of the eligible per hospitalisation expenses. Oxygen. father. Patient Care 1 Accidental Hospitalisation 0 Hospital Cash 1 Accompanying Person 2 1 1 .(a) & 1. grand father. 6. 4000.1 Lacs NA Rs 500/. 3 4.for each completed day of hospitalisation in case of a child up to age of 10 years subject to max of 30 days. Above 60 years-attendant nursing charges after discharge from the hospital @ Rs 350/. Upto 1% of SI per policy period up to a max of Rs. 9. 7. Upto 10% of the eligible per hospitalisation expenses.per day or actuals whichever is lower up to a max 10 days -subject to max of 30 days during the policy period. Blood. Above 60 years-attendant nursing charges after discharge from the hospital @ Rs 350/. For FF(2-people) . Board & Nursing Expenses & Service . father. 1500 For every 4 claim free years. 5.1% of SI up to a max of Rs.Consultants.1% of SI up to a max of Rs. Limits under the policy shall increase by 25% of the balance sum insured available subject to max of Rs. grand mother. any immediate family member. Accompanying person means and includes mother.1 Lacs Rs 500/.free medical check-up . Around 100 day care procedures. grand father. Upto 1% of SI per policy period up to a max of Rs. Limits under the policy shall increase by 25% of the balance sum insured available subject to max of Rs. Rs 500/. any immediate family member. Upto 35% of the Sum Insured per claim Upto 40% of the Sum Insured per claim Upto 8% of the eligible per hospitalisation expenses. Around 100 day care procedures.
To Rs.000/ Sum Insured under Platinum Plan: Rs.00.Eligibility Age Eligibility Age from 5 Years to 70 Years. Silver & Basic plan: Rs.00.00.00. Sum Insured Eligibility Sum Inured under Gold.000/. if the parents are also covered at the same time with Future Generali. 10. 5.000/- . Children above 90 days of age can be covered under the policy.To Rs.000/.1. 6.
Children above age of 90 days eligible if the parents are concurrently insured with Future Generali Minimum SI limit for Individual cover to be 100.SI of 50000 can be availed by children .000.Underwriting guidelines Acceptance Limit Age at entry is restricted to 70 years Family floater policy – the eldest age will be considered for premium calculation. Family floater policy age entry (age for the eldest family member) is restricted to 45 years.
ROLL OVER CASES For person who already have an ongoing policy with the any Insurance Company Up to 45years -no claim in the previous policy year accept and allow them the NCB One year policy with any insurer and no claim Accept with eligible CB and 1st year exclusion is waived. 2 year policy with any insurer and no claim Accept with eligible CB and 1st year & 2nd year exclusion is waived 3 year policy with any insurer and no claim Accept with eligible CB and 1st year & 2nd year & 3rd year exclusion is waived But in any case pre-existing exclusion waiver applicable only after completion of 4 years with FGI Above 45 years –accept as fresh case with out no claim bonus .
Incase of a claim in the Policy the Renewal premium discount will be nil and the Cumulative Bonus will get reduced by 20% for each claim year. . Transfer of CB from previous floater policy to the new floater policy or to an individual policy is not possible. At 6th year in case of no claims the maximum discount availed would be 25% on the renewal premium and 10% cumulative bonus on the expiring sum insured. The discount of 25% on renewal premium will be applicable for succeeding year provided there are nil claims.ROLL OVER CASES Renewal Discount and Renewal No Claim bonus The maximum cumulative bonus shall be 50% for those policies where there is no CB at the time of inception of this policy with FG.For Policies which have CB at the time of inception of the first policy with FG the Cumulative bonus shall be restricted to max 70%.
(d) Any positive history of any other ailment For sum insured up to 5 lacs can be decided by the underwriting office after obtaining medical opinion from the Zonal Underwriter. Above this please consult HO. .MEDICAL UNDERWRITING GUIDELINES Taking into account the proposal form and /or the medical reports following restrictions & loadings are applicable.The final acceptance of the proposal will be decided by the underwriter. ECG. Lab1 & X-ray Chest Asthma Combination of any 2 or more of (b). 0-35 years 36-45 years Smoker Hypertension Diabetes 10% loading on the standard rates Decline 20% loading on premium accept with Diabetes and related conditions exclusion 10% loading on standard premium accept with exclusion Decline Ask for FMR. (c).
ECG. X ray Chest. ECG.Age Of the Person to be Insured Sum Insured Medical Examination Tests Required Under 45 years Up to 5 lacs Not required. ECG. Lab1. lipid profile FMR. Lab1. Required Not required Required Required FMR. Lab1. Lipid profile FMR. X ray Chest. X ray Chest Under 45 years Between 46-55 years Between 46-55 years Above 55 years Over 5 lacs Up to 3 lacs More than 3 lacs for all sum insured Max Sum Insured available for the Person above 55 years will Be Rs 5 Lacs . Subject to the proposal forms being clean of any previous illness/diseases/surgeries.
.Ray Chest. Complete Blood Count (incl Diff). post prandial blood sugar. Serum Creatinine.FMR: Full Medical Report by a MD Physician ECG: Electrocardiogram conducted by the MD Lipid Profile Lab 1: includes Fasting Blood Glucose. Serum Cholesterol. Urinalysis (chemical & microscopic) X .
. Sum Insured and Age. Age to be taken as Completed Age.Premium for Health Suraksha (individual) Premium is calculated on the basis of Plan.
after 50 Years of age – The Life Time Indemnity Limit is 3 Times of Sum Insured specified in earliest Health Suraksha Plan. Life Time Indemnity Insured subscribing to FG Health Suraksha for 1st Time.Renewal Terms Renewal Premium would be based on Age Band and claim experience. if policy is renewed continuously. . Loading based on Claim Frequency and Claim amount.
Floater Plan Health Suraksha Family Floater Family Floater Policy can be issued on a Floater basis covering the family members of the Insured comprising the Insured. Spouse. What is floater. how does it benefit? All members of the family (Self. spouse and two dependant children (upto the age limit of 21 years). 2 Kids) can be covered under one single policy Single premium payable for the entire family The amount of Sum Insured “floats” over the entire family No need to insure individual members separately No hassles of tracking renewals for different members .
He cannot adjust the rest in the unused coverage amount of his wife and daughter Mr. Smith & their kid Dooby Scenario 1: They take an insurance policy with a SI of Rs.00. Mrs.e. 1 Lakh as he is covered for only 1 Lakh.Family Floater . John Smith.000/- .Illustration Family: Mr.1 Lakh each Mr. Smith unfortunately needs to undergo Heart Bypass The total bill amount Rs. Smith needs to bear the reminder of the cost – i. 2 lakhs Insurance company pays only Rs. Rs. 1.
Mrs.Family Floater .Illustration Family: Mr. Smith does not need shell out any money out of his own pocket Still 1 lakh is Left Unutilized for the policy period for the family. Simth unfortunately undergoes Heart Bypass The total bill amount Rs. 2 lakhs The entire amount is paid by Future Generali Mr. Smith & their kid Dooby Scenario 2: They take a Health Suraksha Family Floater with a SI of Rs. John Smith. 3 Lakh for the family Mr. .
Your Choice! OR .
single date to track . single premium.Simth family falling ill in one year is low as compared to one member falling severely ill – Theory of probability Individual Single cover for each member No flexibility to transfer the unutilized limit for other members Separate policy (separate document) for family members Floater Common cover for all members The limit can be used by any member of the family & for any number of times Single document.Advantage Floater! Chance of all in Mr.
Fits all in the Family Family covered under floater policy Choice of cover Couple Couple & One kid Couple & Two kids Individual & One Kid Individual & Two Kids Choice of cover amount Rs. 2 to 10 Lakh per family depending on the plan selected .
Company would deduct the %tage from the approved claim amount. . What if I opt for Basic Plan (Applicable for Zone C) and take treatment in Zone A. I have paid Lower premium for Zone C and I decide to take a treatment at high Medical Treatment Zone A.Plan Details Basic Plan: Available for Zone C. Gold Plan: Available for Zone A Platinum Plan: Across India. The Next Slide will reflect these deductions in claim amount when there is a difference in Plan opted and Zone of Treatment. Silver Plan: Available for Zone B. The other terms and conditions are same as that of Individual Health Suraksha.
Sum Insured Eligibility Sum Inured under Gold.To Rs.000/. 5.000/. 10.To Rs. Children above 90 days of age can be covered under the policy. if the parents are also covered at the same time with Future Generali.Eligibility Age Eligibility Age from 5 Years to 45 Years.00.000/- .00.00.2.00. 6. Silver & Basic plan: Rs.000/ Sum Insured under Platinum Plan: Rs.
tumors shall be covered after a waiting period of 2 years. hernia . Any condition. Any disease contacted during the first 30 days of inception of policy – accidents excluded and roll over cases excluded Non-allopathic treatment Pregnancy & childbirth related diseases . Certain diseases/surgeries like gallstones. after the date of inception of the first policy with Future Generali. prior to inception of your first policy. had signs and / or symptoms. renal stones shall be covered after a waiting period of 1 year. until 48 consecutive months have elapsed. ailment or injury or related conditions for which you have been diagnosed.Exclusions Certain diseases like cataract. received medical treatment. Joint replacement surgery shall be covered after a waiting period of 3 years except done due to an accident.
Premium chart For Family Floater .
CLAIMS PROCESS .
Where the customer is aware of the hospitalisation atleast 72 hours in advance Emergency .Where the customer meets with an accident or suffers from bout of illness that requires immediate admission to the hospital Claims are serviced at both network as well as non-network hospitals Network hospitals – Hospitals which are on the tied up list (more than 3000 hospitals covered) Where our service provider has a relationship Non-network hospitals – which do not form part of the list .Types of claims Hospitalisation Claims can be broadly of two types: Reimbursement claims Cashless claims – Through our TPA – Dedicated Health Services Limited This further can be broken into: Planned .
documents and reports. Take admission into the hospital. As soon as possible. Lodge the claim with TPA for processing and reimbursement by duly filling in the claim form & enclosing all original bills/vouchers/receipts . At the time of discharge. Step 2. Step 2. Lodge the claim with TPA for processing and reimbursement by duly filling in the claim form & enclosing all original bills/vouchers/receipts B) Planned hospitalisation Step 1. documents and reports. Get admitted into the hospital as planned.Reimbursement Steps to follow during hospitalisation A) Emergency hospitalisation Step 1. Step 4. to settle the hospital bills in full and collect all the original bills. Step 3. At the time of discharge. Step 4. Step 3. Inform TPA about the planned hospitalisation. to settle the hospital bills in full and collect all the bills. inform TPA about the hospitalisation.
commencement date of symptom of disease in case of sickness Location of accident • .Reimbursement Claims Claim procedure As soon as hospitalised. to intimate the TPA (Help line/Toll free number mentioned in the Health Card) Following information needs to be furnished while intimating a claim: • • • • • Contact Numbers Policy Number (as reflecting on the Health Card) Name of Insured person who is Sick or Injured Nature of Sickness/Accident Date & Time in case of accident.
it may be required by the Hospital. The Hospital will coordinate for this. This authorisation along with a copy of the Health Card has to be given to the Network Provider at the time of admission Please also keep a copy of any photo ID card. • This facility is available only at our Network Hospitals “Cashless Request Form” available in network hospital is to be filled up and sent to TPA for getting authorisation from TPA. To avail the “Cashless Service” • • • TPA will authorize “Cashless Service” at the Network Hospitals for all cases which are covered under the policy. .Cashless Claims Procedure (Approval) Cashless Service is the service wherein the Insured need not pay any money at the time of admission or discharge.
Cashless Claims Procedures (Denial) “Cashless Service” may be denied in following situations: In case of any doubt in the coverage of treatment of present ailment under the Policy If the information sent to TPA is insufficient to confirm coverage The ailment/condition etc. not being covered under the policy If the request for pre-authorisation is not received by TPA in time Denial of “Cashless Service” is not denial of treatment. The Insured can continue with the treatment. pay for the treatment to the hospital and after discharge send the claim to TPA for processing. .
Cashless Claims Procedures for emergency hospitalisation Rush to hospital and get admitted. . Obtain the Pre-Authorisation Form from the hospital (if it network). The Hospital will coordinate for this. Get the same filled in & signed by the attending doctor with required details. Fax the pre-authorization form along with necessary medical details to TPA at the number mentioned in health card.
• Verify the bills and sign on all the bills at the Hospital.Cashless Claims Procedures for emergency hospitalisation If pre-authorisation is received from the TPA for “Cashless Service” At the time of discharge…………. Leave the original discharge summary & other investigations reports with the hospital. • Pay only for those items that are not reimbursable under the Policy (Hospital / TPA will guide in this). • . Retain a Xerox copy for records.
cost estimates etc. At the time of discharge a. to TPA. c. Pay only for those items that are not reimbursable under the Policy. Retain a Xerox copy for records. If “Cashless Service” is authorised by TPA • At the time of admission. b. handover in the authorisation letter of TPA for cashless service & a photocopy of ID card to the hospital. • .Cashless Claims Procedures for Planned hospitalisation Coordinate with hospital & send in all the details along with the Pre-Authorisation Form at least 2 days prior to the hospitalisation including the plan of treatment. other reports with the hospital. Verify the bills and sign on all the bills. Leave the original discharge summary.
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