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December, 2008

Presenting a new health plan.

Trust us,
your customer will thank
you for it!


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Life Expectancy in India
64
2005
75* 48
Age
(in Years)
2025 1955 Year
*Source: The OASIS (Old Age Social and Income Security committee report)
The customer will live longer
..but not necessarily healthier
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Working – 42 yrs
Age 18 to 60
Retirement – 7 yrs
Age 60 to 67
Working – 30 years
Age 25 to 55
Retirement – 20 years
Age 55 to 75
Life stage of average individual
Previous
generation
Today
The customer will live longer
…but not necessarily work longer
Is our customer prepared to meet health expenses during this phase?
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Source : Outlook Money,31st May,2007`
The customer will make more money
…but not necessarily meet the rising cost of healthcare
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26% of the consumers investing in tax saving
instruments in the last two years invested in
health insurance.
23% of the consumers who are planning to
invest in tax saving instruments in the next one
year want to invest in health insurance.
Findings from a consumer research conducted by ICICI
Prudential in Sep 08 across Mumbai, Chennai and Delhi
The customer will buy insurance to save tax
…but not necessarily only for Section 80 C
91% of the consumers are aware of health
insurance as a tax saving instrument.
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A plan which:

Provides guaranteed reimbursement
hospitalization cover till age 75

Builds up a health fund and allows
claims for health expenses not
covered in the hospitalization cover

Flexibility in premium payment

Gives complete tax benefit under
Section 80D
Yes, the customer will need a health plan
…but not necessarily the one You have in mind
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Rise to the health cover challenge
If this is the
customer „s present
state…



How will you balance?
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Presenting
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Complete Tax Benefit
under Section 80D
Cover with a dual benefit
Allows claim against
out-patient treatment,
diagnostics, dental
care etc
Reimbursement
based
hospitalization
coverage
Builds a health
fund to cope with
rising cost of
health care
Hospitalisation
Insurance
Benefit
Health
Savings
Benefit
Comprehensive whole life health offering
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How does the plan work?
Health Savings
Benefit
Hospitalisation Insurance
Benefit
To cover you against
hospitalization expenses
To cover you against all other
health expenses
Select the annual limit for the hospitalization cover
Select a suitable premium
*Invested premiums mean premiums post deduction of
applicable charges
Basis age and annual limit chosen, part of premium will go
towards the health cover and remaining invested to build a
health fund*
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Coverage
Scope
Comprehensive
Cover
(Including OPD &
Daily costs)
Hospitalization
CI/
Disability / Major
surgery

Comprehensive health offering
Specific cover
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The features in detail
Hospitalisation
Insurance Benefit
Health Savings
Benefit
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The features in detail
Hospitalisation
Insurance Benefit
Health Savings
Benefit
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The features in detail
Hospitalisation
Insurance Benefit
Health Savings
Benefit
Covers actual expenses
incurred during
hospitalization
Room, boarding and nursing charges, ICU charges
Maximum room rent payable to be 1% of selected
annual limit only for single A/C rooms

Fees for doctor, surgeon, specialist, etc

Anesthesia, blood, oxygen, operation theatre,
surgical appliances, medicines, etc

Pre & Post hospitalization expenses for 30 & 60
days

125 listed day care procedures

Ambulance charges upto Rs 1000 per year
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The features in detail
Hospitalisation
Insurance Benefit
Health Savings
Benefit
Guaranteed coverage
till age 75

No re-evaluation of health status or refusal of cover
during term

No addition of exclusions or increase in premiums
due to claims made
No claims Bonus
A bonus of 5% on annual limit added for every claim
free year

Bonus amount up to 25% can be added
Family floater
Cover yourself, spouse and upto 3 dependant children
under same plan
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The features in detail
Hospitalisation
Insurance Benefit
Health Savings
Benefit
Free Health Checkup
A free health check-up once every 2 policy years after
the first year

Reimbursement of amount up to 1% of annual limit or
Rs 5000 whichever
Pre-Existing illnesses
Cover
Pre-existing illnesses covered after 2 years

The disease to be declared at inception & accepted
by the company
Cashless
Hospitalization
Cashless claims settlement in over 5000 network
hospitals
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The features in detail
Hospitalisation
Insurance Benefit
Health Savings
Benefit
Wide network access
with preferred benefits


Access to a network of over 5000 hospitals

A Co Pay of 20% applicable for room upgrade over
prescribed limit in single A/c room or for claims in
outside network hospitals

In Emergency, co-pays does not apply in cardiac or
trauma cases at a outside network hospital

Click here for co-pay illustration

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The features in detail
Hospitalisation
Insurance Benefit
Health Savings
Benefit
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The features in detail
Hospitalisation
Insurance Benefit
Health Savings
Benefit
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The features in detail
Hospitalisation
Insurance Benefit
Health Savings
Benefit
Build a Health Fund for
the future
Choose from two portfolio strategies :
Lifecycle strategy wherein allocation is based
on customer’s age with rebalancing on a quarterly
basis
As age progresses, allocation changed to suit Life
stage.
Click here to know more.


Fixed strategy wherein a customer can do his
own asset allocation.
The customer can chose from 7 funds
Click here to know more

Includes Health
Return
Guarantee Fund
With
Automatic
Transfer
Strategy
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The features in detail
Hospitalisation
Insurance Benefit
Health Savings
Benefit
Claim for any health
expenses after 3 years
Claim are allowed from 4
th
year onwards against
medical bills. Claims can be made for:

Daily medicines and drugs
Diagnostic expenses
Doctor bills and other OPD expenses
Co-pays /deductibles of other medical insurance cover
Miscellaneous medical expense over and above that
covered by Hospitalization Insurance

Claim schedule:




Claims can be made once every year, with minimum claim amount of
Rs 1000
100% 50% 20%
Maximum claim
(% of fund value)
From 11
th
Yr 6
th
-10
th
Yr 4
th
& 5
th
Yr Policy Years
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The features in detail
Hospitalisation
Insurance Benefit
Health Savings
Benefit
Cover Continuance
option after 5 years


Option of premium holiday after completion of 5
policy years

Hospitalization Insurance and Health Savings
benefit continues by deduction of charges from
accumulated fund

Once the fund value drops to <110%of annual
premium, the customer can still claim from it for the
next 5 years ( max 50% every year)


Tax benefit under
Section 80D

Complete tax benefit under Section 80 D even for this
component of the premium

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Features summarized
No Claim Bonus
Guaranteed
Coverage till age 75
Family Floater
Over 125 Daycare
coverage
Pre-existing Illness
Cover after 2 yrs
Build a health fund
for the future
Cover Continuance
option after 5 years
Allows you to claim
for any health
expenses after 3
years
Hospitalisation
Insurance Benefit
Health Savings
Benefit
Tax Benefits of upto
Rs 15000 u/s 80D
Click here
Free Health Checkup
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Therefore the product positioning





A dual benefit
health plan
Flexibility in
premium payment
Comprehensive
guaranteed
reimbursement
coverage
Builds a
health fund
and allows
Claims for all
health expenses
Complete tax
benefit
under
Section 80 D
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Illustration 1
Customer insured with annual limit of 3 Lakhs for the hospitalization cover at age
32. He has chosen to pay a premium of Rs. 15000 annually.
He made a claim for hospitalization due to a road accident at age 38; during the
treatment he incurred total hospitalisation expenses of Rs.84,000. He also had to
pay additional charges for follow-up tests, crutches, belts, collars totaling
Rs.16,000. What can the policyholder claim?

Claim payable under the plan:

Hospitalization insurance benefit
All eligible expenses during hospitalization are payable to the customer i.e. Rs. 84,000

Heath savings benefit
Since the claim is in 5
th
Policy year, he can make a partial withdrawal up to 50%of fund
value. The remaining expenses which are not covered under Hospitalization insurance
benefit can be reimbursed up to the actual expense i.e. Rs.16,000

Total benefit payable : Rs.1,00,000
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Illustration 2
Customer insured with annual limit of 2 Lakhs for the hospitalization cover at age
35. He has chosen to pay a premium of Rs. 25000 annually.

At age 39, the customer had accumulated medical bills for the past 2 years ranging
from bills for daily medicines, doctor visits and even dental treatment up to Rs.
22,000. He however has not undergone any hospitalization. What can he claim?

Claim payable under the plan:

Hospitalization insurance benefit
No instance of hospitalization

Heath savings benefit
Since the claim is in 4
th
Policy year, he can make a partial withdrawal up to 20%of fund
value. In this case the entire amount can be claimed from the health fund i.e. Rs.22,000

Total benefit payable : Rs.22,000
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Illustration 3
Customer insured with annual limit of 3 Lakhs for the hospitalization cover at age
41. He has chosen to pay a premium of Rs. 20000 annually.

At age 50, the customer decides to take a premium holiday and exercises CCO
option. At age 52 he is hospitalized for CABG and incurs expenses of Rs.2 lakhs.
He also has bills for follow-up medication of Rs. 20000. How much can be claim?

Claim payable under the plan:

Hospitalization insurance benefit
Since he opted for CCO, he continued to remain covered and the entire amount of Rs. 2
lakhs is payable.

Heath savings benefit
Since the claim is in 11th Policy year, he can make a 100% withdrawal from the fund
value. In this case the entire amount can be claimed from the health fund i.e. Rs.20,000

Total benefit payable : Rs.2,22,000
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Boundary conditions at-a-glance
30 Days
 No waiting period applies for claims due to accident
 Waiting period of two years will apply to some conditions
Waiting period
25 - 55 years for individual policies
18 - 55 years for spouse in a family floater
Dependent children (90 days - 25 years of age)
Min/Max Age at Entry
2 lacs / 3 lacs / 5 lacs / 7 lacs / 10 lacs Annual Limit Options
(Rs.)
Whole Life Plan
(Hospitalisation Insurance guaranteed upto age 75 years)
Term
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Yearly, Half Yearly, Monthly Premium Paying
Modes
Premiums would be subject to the minimum premium grid
given below based on the age and number of members
selected





Minimum Premium
CIPS allowed once in every 2 years Change in portfolio
strategy
4 Free switches in a year.
Additional switches chargeable at Rs.100 per switch
Switch
Annual Limit
> 5 lacs
Annual Limit
upto 5 lacs
All Annual Limits
30000 25000 15000 40-55
20000 15000 10000 <40
Family Individual
Age
Boundary conditions at-a-glance
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Health Saver charges
 Allocation Charge



 Policy Admin Charges
 For Monthly : Rs 90 per month
 For Yearly and Half yearly mode: Rs 60 per month

 Fund Management Charge
 1.5% for Health Flexi Growth , Health Multiplier, Health RGF
 1.0% for Health Flexi Balanced, Health Balancer
 0.75% for Health Protector, Health Preserver
2%
4-10
0 9% 20% % of Annual Premium
Thereafter 2-3 1 Year
All charges deducted in the form of units from fund
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 Health Insurance Charges:











Inclusive of ST & Education Cess
 The health insurance charges are valid from 1 year of policy
commencement date and are subject to change post IRDA approval
Health Saver charges
2 Lacs
3 lacs
5 lacs
7 lacs
10 lacs 3283
25 yrs 35 yrs 45 yrs 55 yrs
Annual Limit
2337
2756
3564
7052
2693
3179
3928
7836
2881
3402
4203
8384
3069
3624
4476
8929
3878
4790
9554
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Health Saver insurance charges versus
competition
For an annual limit of 2 Lakhs
Most competitive
insurance charges

Product…

After product…

Age
25
30
40
50
Health
Saver
2337
2547
3045
5737
ICICI
Lombard
2690
2690
3370
6000
Lombard
over HS
115%
105%
110%
104%
Age
25
30
40
50
Health
Saver
2337
2547
3045
5737
Bajaj HG
2627
3074
3074
6267
Bajaj
over HS
112%
121%
101%
109%
Age
25
30
40
50
Health
Saver
2337
2547
3045
5737
New
India
2775
2775
3196
5517
New
India/ HS
119%
109%
105%
96%
After product…

Charges inclusive of Service tax and Edu Cess.
Charges for all competing products sourced from
the respective company websites as on Dec 2008.
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Health Saver insurance charges versus
competition
For an annual limit of 2 Lakhs
Most competitive
insurance charges

Even with a family
floater.…

Age
25
30
40
50
Health
Saver
5887
6215
6954
11532
ICICI
Lombard
6423
6423
7443
11988
Lombard
over HS
109%
103%
107%
104%
Charges for a family of four - 2 adults and 2 children
Charges inclusive of Service tax and Edu Cess.
Charges for all competing products sourced from
the respective company websites as on Dec 2008.
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Health Saver – the real Health ULIP plan
2x after 5 days x x  Pre/ Post
Hospitalisation
80 D only on
health charges
80 D only on
health charges
80 D only on
health charges
80 D on full premium Tax benefits

(From Fund)

(From Fund)

(From Fund)

(From Fund)
Misc Health Expenses
Reimbursed (OPD)
x
Only 33 MSB &
25 CI (Rider)
NA
Fixed Benefit
Reliance
Health+Wealth
x
Only 900
20x, 12x, 8x,
4x, 2x
Fixed Benefit
TATA AIG
InvestAssure
Health
x
Only 49
200x, 120x, 80x
Fixed Benefit
LIC Health
Plus
Surgery Scope
Non-surgical benefit
Surgery Benefit


Complete
reimbursement cover
for surgeries and
medical expenses
incurred at hospital

ICICI Prudential
New Health Saver
Daily Hospitalisation
Benefit (DHCB) / ICU
Core Coverage
Benefits
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Health Saver – the real Health ULIP plan
Tax benefit under
80 C
Reimbursement
Hospitalization
plan
Tax benefit under
80 D
Fixed benefit
Hospitalization
plan


Health Saver
•Reliance Health + Wealth
•LIC Health Plus
•TATA AIG invest assure
The only insurance plan to have the
complete 80D tax advantage

The only insurance plan to have a
reimbursement based floater
hospitalization cover




Most comprehensive coverage with maximum tax advantage
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  Maternity expenses
  Medical equipment
expenses
Day to day medicines &
drugs expenditure
Dental treatment
OPD expenses
Daycare Procedures
Hospitalisation Coverage
Benefits
 
 
 
 
 
Traditional
Mediclaim
Health
Saver
The Health Saver advantage: The most
comprehensive coverage
Comprehensive coverage against
both inpatient and outpatient medical
instances

Pays for any kind of medical
expense incurred during the policy
term



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*For 25 year old with highest income tax slab of 33.66% with maximum
Tax advantage under section 80 D
** fund value net of all charges and insurance charges for a 5 lakh annual limit
The Health Saver advantage: Aapke health ka
savings account
Pay Rs 15,000 annual premium for Health
Saver for 10 years
Total premium paid
for 10 years
1,50,000
Earn back your premium:
Avail complete Tax advantage on the entire
premium paid for 10 years* (A)
Total tax saved
during 10 years
50,990
Total fund value available for health claim after
10 years ( assuming a modest growth at 10%) (B)
Total fund value
after 10 years
1,60,228
Total return advantage after 10 years (A)+(B) 2,11,218
Total return after
10 years
Plus Health Cover of 5 Lakhs during the 10
years
Plus Free medical worth Rs. 5000 every 2 yrs
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Retirement
The Health Saver advantage: Takes care of you today
and invests your money for tomorrow
Age 25
Retirement Phase Working Phase
Premium paying term 20 years
Age 55 Regular premium
Cover continuation phase
Whole life
Pay premiums
during
working years
Get a health
cover + build
a health fund
Opt for CCO
on retirement
and remain
protected
Continue
claiming from
health fund
for whole life
Relax!
Age 75
Hospitalisation Cover
Relax!
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What makes Health Saver a winner
Tax Benefits on
entire premiums u/s
80D
Build a health fund
which allows you to
claim for any other
health expenses
Long Term
Coverage against
Hospitalisation
Expenses
Flexible premium
payment options
continue cover even
after stopping
premiums
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An easy sale with high jet limits
Jet Limits









 Only Standard Age proof allowed
 No Backdation allowed
 Health Saver would be rated with only MediAssure
 Employer-Employee scheme subject to immediate assignment to the
employee
Age/ Annual Limit
1-35 Yrs
36-45 Yrs
46-55 Yrs
Upto 3 lacs
No Medicals
No Medicals
Medicals
Upto 10 lacs
No Medicals
Medicals
Medicals
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Imp: Please use Form Id: 02
A convenient sale with new 4 pager
application form
Only a 4 pager form and valid for all health products
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Premium payment frequency & mode
Premium payment frequency:
 Yearly/
 Semi-annually/
 Monthly ECS/Monthly Non-ECS

Premium payment mode:
 Cheque/DD/PDC/Pay Orders/Bankers Cheque/
 Internet facility/Electronic Clearing System/Credit Card

To ensure all health policy customers derive 80 D tax benefits CASH will not be
accepted as a mode of First Premium Deposit.
•Amount & Modalities will be subject to company rules &
relevant legislation/regulations.
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Underwriting guidelines
 Previous life and health policies (other than MediAssure and
Health Saver) and riders “will not be taken into consideration”
for either triggering medicals, financial eligibility or rated up SA.
 The total Annual Limit in case the insured person buys more
than one policy will be Rs. 2,500,000 (Health Saver +
MediAssure)
 Only Standard Age proof allowed (PAN card allowed for rated
up AL of 15 L)
 Underwriting would be done on individual lives under family
floater options.
 Financial Eligibility Table



 Income documents are compulsory for total rated up SA of LA
above 15L for all members.
 Policy twisting norms of 2 years will apply for a HC , MA and HS
policy
 Risk commencement date will be the final underwriting date.

10.1 -15 L Above 3.5 L
2-5 L Above 50 K
5.1 -10L Above 2 L
15.1-25 L Above 5 L
Annual Limit Income
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The Claims Process
The Health Card – to enable claims

A Health Card for every Policy Holder
•Dispatched along with the Welcome Kit
•Will carry customer and policy details

How does it work?

Card produced at the Network Hospital
to avail cashless benefit

Preprinted phone numbers for any kind of
claims or service assistance









The Health Card
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HOSPITALISATION
Network Hospital Non-Network Hospital
Post discharge,
submit claim form
Scrutiny
Cheque sent
to Customer
Planned Emergency
Submit Preauthorization Form
Cashless authorized
Customer settle bill with
Hospital
Cashless not
authorized
Scrutiny
Reject
ICICI pays Hospital
Customer signs
Documents on
Discharge
The claims process – hospitalization
insurance benefit
HOSPITALISATION
Network Hospital Non-Network Hospital
Post discharge,
submit claim form
Scrutiny
Cheque sent
to Customer
Planned Emergency
Submit Preauthorization Form
Cashless authorized
Customer settle bill with
Hospital
Cashless not
authorized
Scrutiny
Reject
ICICI pays Hospital
Customer signs
Documents on
Discharge
Pre(30)&Post(60)
Hospitalization*
•Reimbursed only in the Event of
acceptance of the Hospitalisation or Day
Care Procedures claim by the Company.
•TAT -3hrs

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HOSPITALISATION
Medicines/Drugs
Diagnostics
Dental
Co-pays/Deductibles
Miscellaneous medical expenses
The claims process – health savings benefit &
free health check-up
HEALTH SAVINGS BENEFIT*
Scrutiny
Cheque sent
to Customer
Reject
Submit original bills or proof
of expenses along with
withdrawal Form
**Subject to a limit of Rs. 5,000 or 1% of the
annual limit, whichever is lower.
Can be claimed once every two years after the
first year
One bill per insured member for given 2 yr
period






Submission of original bills or
proof of expense along
with claim form
MEDICAL CHECK-UP**
Scrutiny
Cheque sent
to Customer
Reject
*Allows policyholder to claim his funds for different health care
expenses, after the completion of three policy years.

Can be claimed once in every Policy year subject to a minimum limit
of Rs. 1000/-

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The Claims process –Hospital Cover
documentation
Documents to be submitted within 10 days of discharge from the
Hospital or Nursing Home
 Photocopy of Policy certificate
 Claimant statement form
 Photo Identification proof
 Attending Physician Certificate
 Original Discharge summary or card, test reports
 Original Hospital bill and payment receipts
 Original cash memo from the chemist(s) with prescription
 Photocopy of Admission notes
 FIR / MLC / Panchnama for accidental Claims
 Other relevant Documents related to the current hospitalization/
surgery so as to process the claim faster

*ECS mandate and copy of cancelled cheque
to be submitted for direct credit facility
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• SMS Service: To provide assistance & prompt resolution on claims
processing

• To access SMS service type-
ICLAIM <space> <8 Digit Policy Number> & send SMS to 56767

• Customers will receive call back from our certified claims expert
SMS service will prove to be a customer delight.
Claims initiatives : The I Claim
Service
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Claims initiatives


 Document Reckoner shared with Branches: Checklist of
essential documents
 Original Documents (Bills/Medical Reports) mandatory for
Medi Assure and now Health Saver



• ECS Mandate along with a copy of cancelled cheque to be
submitted for availing direct credit of claims payout


Health Claims Documentation
Direct Credit Facility
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healthclaims@iciciprulife.com
TAT for response – 1 working day
Critical Illness products claims enquiries –
1800222020 (9AM – 9PM) or approach Branches.

Hospitalization products (Hospital Care & Medi Assure)
(Toll free 24*7) 1800221719 & 022 23000431
Grievance
022 – 40398147
GM Call log – Call type Health claims Subtype complaint
Branch Support from Health Claims Cell
Document reckoner deployed for support at branches
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Category rules
Condition Health Saver Category
Only as family floater. Plan starts from 90
days of age*(subj to policy anniversary)
 Minor
The minimum age at entry for children
under Family floater is 90 days and
maximum is 25 years
Students will only be offered family
floater. Maximum cover up to AL- 15 L
can be offered under a parent‟s family
floater of Health Saver/ MediAssure.
 Student
Cannot be offered X Foreign National / PIO
For treatment in India only and upto
Annual Limit of Rs 5 Lakh
 NRI
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Category rules - female lives
Condition Health Saver Category
 Up to Annual limit of Rs 5 L without documentation/
husband‟s insurance
 Higher cover subject to equivalent husband‟s
MediAssure/HS cover up to maximum AL of Rs 10 L
 Family floater: Maximum cover up to AL- 15L can be
offered under husband‟s family floater of Health
Saver/ MediAssure
 **Housewives can be offered maximum Health Saver
cover (Individual + Family floater) of 15 Lacs.
 Single women: Can offer maximum AL - 3L subject to
approval from Health Team
 Group III
 Up to Annual limit of Rs 5 L without documentation
 Higher cover subject to income documents
 Group II
 At par with male lives  Group I
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Re-instatement norms
With Medicals / exclusions / Declaration of good health.
Reapplication of waiting periods
No claim payable within the lapsed period
Greater than 60 days
2 years
No revivals permitted post 2 years
Max Revival Period
Simple revival
(Payment of arrears premium with interest)
Upto 60 Days
Norm Time interval
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Underwriting Guidelines
Medical Examination Chart
MER, HbA1c, ECG, RUA, SMA12 46 – 55 years
MER, FBS MER 36 – 45 years
MER MER ≤ 35 years
>3 Lacs ≤ 3 Lacs Age / Option
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Things to note
 Eldest member is the “primary life”
 Individual underwriting questions for each family
member
 DOB proofs required for all members
 Signature for all members
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FAQ’s
Can I change my annual limit during the term of the plan?
You can increase or decrease your annual limit at every policy anniversary with
deduction of appropriate insurance charges based on change in annual limit. Any
increase in the annual limit will be subject to underwriting an as per terms and
condition set by the company.

Can I change my premium during the term of the plan?
You can increase or decrease your premium at every policy anniversary, any
decrease in premium will be subject to the minimum premium grid based on
annual limit , age and number of members in the family.

What if I am unable to pay my premiums after the first 3 years?
If premium is discontinued in the first three policy years and if the policy is not
revived within the period of two years from the due date of the first unpaid
premium, then the policy will be terminated. During this period, Hospitalisation
Insurance Benefit will cease and the policyholder will only have the benefit of
investment in the respective unit funds.
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FAQ’s
What if I am unable to pay my premiums after the first five years?
On payment of at least first five years‟ premium, you have the option of opting for a
cover continuance option wherein your further charges would be deducted from
your fund until fund value falls below 110% after which the policy would be
foreclosed.

What happens if my fund value falls below 110%?
If premiums have been paid for three full policy years and after three policy years
have elapsed and fund value falls below 110% of one full year‟s premium, the
policyholder will be given intimation and option to reduce the Health Savings
Benefit claim amount so that the fund value does not fall below 110%. If the
policyholder does not opt to reduce the Health Savings Benefit claim then, the
benefit shall be paid and the policy will be foreclosed.

What happens on foreclosure?
On the date of foreclosure, the fund value will be calculated as per prevailing NAV
on that date. The fund value so calculated can be withdrawn by you within 5 years
for health expenses upon submission of original bills for expenses incurred. This
withdrawal will be subject to a maximum of 50% per annum of the fund value as on
date of foreclosure. This condition will also apply during the cover continuance
stage, if opted for.
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FAQ’s
How does the Health Checkup benefit function under the plan?
The free health checkup will be available to all insured members after the first
year once every 2 years. Each member can submit only a single bill in every
block of 2 years after the first year. (i.e. once in the 2nd -3rd yr , 4th -5th yr and
so on). We will not allow of aggregation of bills of any member The cumulative
limit for all the members under the policy would be 1% of the annual limit or Rs
5000 whichever is lower.

Can the family floater be issued in a case single parent and children?
Yes, the family floater in Health Saver allows for a single parent to include
himself/herself and upto 3 dependant children under the plan.

Can I add a family member to my plan at a later date?
Addition of family members to the policy shall be allowed only in the event of
marriage or birth or legal adoption of a child. You should opt for this within 90
days from the date of event or at the next policy anniversary. The change shall
be effective for the purpose from the next premium due date which would be the
risk commencement date for the new member added. You shall have to pay
additional premium on addition of a family member as determined by the
Company.
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FAQ’s
What would happen to the fund value in case of death of the primary insured
or
any other insured member during term of plan?
In the unfortunate event of death of the primary insured member during the term
of the policy, the nominee shall receive the total fund value and the policy shall
be terminated. The fund value paid out on death of the primary insured may be
taxable in the hands of the nominee as per the prevailing tax regulations at that
time. The remaining insured members have the option of continuing coverage
by availing a new policy.In the unfortunate event of death of any other insured
members the policy Would continue for remaining insured members with the
appropriate reduction in health insurance charges

Can I make a claim if I get treated outside India?
No, you are entitled to a claim for treatment undergone in India only.

What is the duration within which a claim has to be reported to ICICI
Prudential?
If the claim is from a network hospital then 4 days prior to the planned
hospitalization by forwarding the pre-authorization form. In case of emergency,
within 24 hours of getting admitted. If the claim is from a non-network hospital
then within 60 days of getting discharged from the hospital, the claim request
should be given to the insurer. All claims will be settled in 7 working days after
receiving request.
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FAQ’s
Are the claims made through withdrawals from the Health Savings Benefit tax
free?
Yes all claims made from your health fund will not be taxed as they would be
treated as a health claim on the policy.

Can I claim for non allopathic medical expenses under the Health
Savings Benefit?
Yes the Health Saver allows you to claim for all health care expenses under the
Health Savings Benefit which includes non allopathic expenses.

Will any claims under the Health Savings Benefit reduce the annual limit in the
hospitalisation insurance benefit?
No all claims from your Health Savings Benefit are settled by withdrawals against
your health savings kitty and will not effect your annual limit offered in your
Hospitalisation Insurance benefit



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FAQ’s
What are the policy twisting norms for the Health Saver?
In case customer has lapsed any of the following policies i.e. Hospital Care
,MediAssure & Health Saver within the last 1 year , he must reinstate his lapsed
policy before being entitled to buy a new Health saver policy.

Are the insurance charges deducted from my policy constant throughout the
policy term?
No the insurance charges will be deducted every year based on the new age of
the customer.

Can the Health Saver be sold as a combo plan?
The Health Saver application form allows you to buy a Health Saver along with
any other health plan. However in case of a family floater only the primary life
will be able to buy the additional health plan.

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Thank You


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63
For any product related queries, please write into:

healthinfo@iciciprulife.com
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LIFECYCLE BASED PORTFOLIO STRATEGY
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How Does It Work
 Initial allocation based on customer’s age
 Rebalancing on a quarterly basis
 As age progresses, allocation changed to suit Life
stage
65% 35% 66 – 75
100% 0% 75+
55% 45% 56 – 65
55%
65%
75%
85%
Health Flexi Growth
45% 46 – 55
35% 36 – 45
25% 26 – 35
15% 0 – 25
Health Protector
Allocation Age Band
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NAV CHANGES
ALTER THE
EQUITY-DEBT
RATIO
WITH CHANGE IN
AGE,
ALLOCATION IS
ALTERED
Flowchart for lifecycle based strategy
Customer
Policy Inception
EQUITY
75%
DEBT
25%
ALLOCATIONS
BASED ON AGE
Every Quarter
PORTFOLIO
REBALANCING
75%
25%
50% 50%
75%
25%
Age = 30
Every shift in
age band
DEBT EQUITY
65%
35%
Age = 36
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Asset Allocation
What is it?
How can it be done?
Why should you do it?
It is the diversification of your portfolio
By distributing wealth amongst different asset
classes viz. equity, debt & money market
In order to optimize your risk-return balance
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Why is Asset Allocation
important?
Studies have shown that asset allocation is the single
most important factor in determining returns
Studies have shown that asset allocation is the single
most important factor in determining returns
Brinson Study on the Importance of Asset
Allocation
Security
Selection ,
5%
Market
timing, 2%
Others, 1%
Long Term
Asset
Allocation ,
92%
Long Term Asset Allocation Security Selection Market timing Others
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FIXED PORTFOLIO STRATEGY
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Fixed Strategy : Choice of Funds
A customer may wish to do his allocations on his own
We have given him a flexibility of allocating his wealth
as per his choice
 Health Flexi Growth
 Health Multiplier
 Health Flexi Balanced
 Health Balancer
 Health Protector
 Health Preserver
 Health Return Guarantee Fund
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ATS ( Automatic Transfer Strategy ) is a mechanism that
eliminates the need to time one‟s investments in the market.

Through ATS you can regularly switch a fixed sum of
investment at a monthly frequency from Health Preserver to
Health Multiplier or Health Flexi Growth

Advantages
Reduce risk in overall investment
Bulk of investment in Health Preserver
A good strategy in a volatile market to average out cost of acquisition
Automatic Transfer Strategy (ATS)
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What is the Return Guarantee Fund?
 Return Guarantee Fund ( RGF) is a close ended
debt fund

 It offers a Minimum Guaranteed NAV at the end
of 5 years.
100 100 Debt, Money market & Cash
Min (%) Max (%) Indicative Portfolio Allocation
Fund Management Charge: 1.50%
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Upside Potential

 On Dec 20, 2013 you get Min Guaranteed NAV of
Rs 15.03 or the NAV on that day; whichever is
higher

 The falling interest rate regime is expected to boost
the returns given by debt funds- as seen in the past


GET THE ADVANTAGE OF HIGHER RETURNS
WITH THE PROMISE OF A MINIMUM GUARANTEE
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Health RGF – Snapshot
 It will open with an NAV of Rs.10 on Dec 22, 2008

 Subscription to this fund is open for a limited period

 The fund can be closed by giving a notice of 5 working
days notice

 The fund will terminate (mature) on Dec 20, 2013


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Health RGF – Snapshot
 Only your First Premium Deposit is invested in the RGF

 Subsequent Premiums:
 Allocation must be chosen at inception ( in app form); and can be allocated
into any of the fund / strategy available with the product

 Switch out of Return Guarantee fund at the prevailing NAV at any point of time
and re-invest in any of our other funds

 Subscription to this fund is open for a limited period

 The fund can be closed by giving a notice of 5 working days notice
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Co-pay illustration
 Plan : Annual limit of Rs 5L
 Following expenses incurred during treatment
0 1000

Telephone
0 1500

Food bill for
attending person
Total Eligible Bill (Rs) Total Bill (Rs) Eligible for cover Expenses
30000 30000

Room & ICU
49000 51500 Grand Total (Rs)
10000 10000

Opn Procedure
4000 4000

Medicines
5000 5000

Doctors Fees
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 Appropriate choice of hospital will avoid any co-
pay for the customer
8200
(20% Co Pay for outside
network claims)
0
(0% Co Pay for within
network claims)
Amount to be paid
by customer (Rs)
39200
(80% of eligible bill)
49000
(100% of eligible bill)
Amount covered
by policy (Rs)
Non Network Hospital Network Hospital Network
Co-pay illustration … 2
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 Mr Rakesh K (age 72) with a 10 year old
mediclaim policy of Rs 3 lacs
8000
12000
60000
P
r
e
m
i
u
m

(
R
s
)

Year 1 Year 2
No Claim
Claim
Source: Mediclaim premium hike capped at 75%,1 Dec
2007, IST,Prabhakar Sinha,TOI,
Increase in premiums after claims
Reason for this huge rise in premium: Customer had
claimed Rs 1,50,000 for an angioplasty after developing
a heart ailment
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80
 Mr Joshi (age 67) had purchased a mediclaim
policy in 1992
Policy Issued
1992
Disease/Condition
Occurs
1999 2002
New Exclusion
added at renewal
Current Status
Premium Doubled
New Exclusion added
Source: Two more PILs filed in Mediclaim cases.14 Apr 2003, TOI
Adding exclusions after claims
“For the first 10 years of taking the policy, there was no
claim and now that the time has come to encash on the
policy, they are asking me to discontinue”, - Joshi
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Pre existing illnesses not covered
Mr Vasant Rao underwent by-pass 1986
Bought Mediclaim with disclosure of by-pass
and renewed regularly since
Mar 95
Apr 99
Underwent surgical procedure for the same
Underwent Angioplasty and diagnosed with
Ischemic Heart Disease (IHD)
Jul 99
(Source:Honour Mediclaim policy: National panel
Friday J uly 7 2006 ,www.newindpress.com)
Claim was not honoured by the company citing exclusion
clause on pre-existing disease
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Comparisons with other players
Not covered Star Allied & Health
Upto 5 years* Bajaj Life Care First
Not covered Bajaj Gen Health Guard
4 years New India Assurance
4 years National Insurance
2 years ICICI Lombard – Health Advantage Plus
4 years ICICI Lombard- Family floater
2 (gold) / 4
(silver/standard) years
Reliance Healthwise
Pre-existing disease
waiting period
Company/Product
* Some ailments
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Day Care Comparison
None New India
None
Star Allied & Health (Premier
Plan)
7 Listed Procedures Reliance Healthwise
9 Listed Procedures ICICI Lombard Family Floater
Over 125 listed Day care
procedures
ICICI Pru Medi Assure
Day Care procedures/
“Specified treatments”
Company/Product
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No Claim Bonus
625,000
600,000
575,000
550,000
600,000
575,000
5,50,000
5,25,000
Annual Limit
with bonus
6 lacs – (10%X
5lacs)
Working
600,000 0 8
575,000 0 7
550,000 0 6
Claim
Amount
Year
600,000
575,000
550,000
525,000
500,000
Available
Annual Limit
400000
0
0
0
0
5
4
3
2
1
Amounts in Rs
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85
Income Tax Norms
Tax Benefits U/S 80D for premia paid towards Health Insurance *
Tax deduction benefit available on Income Insured members
Upto Rs 15000 (Additional to benefit on
premiums towards policy for self, spouse
and children)
For Parents
Upto Rs 20000 For Senior Citizens (Over 65 yrs old)
Upto 15000 For Self , Spouse and dependant
children
*No Benefit available if premiums towards Health
Insurance are paid in cash
10% 1.5L – 2.99 lacs
20% 3 lacs – 4.99 lacs
30% 5lacs and more
0% Less than 1.5 L
Rate of Tax for an Individual Total Income (Rs)
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Exclusions
Please refer to policy document for detailed exclusions

 Permanent exclusions & Pre existing illness or conditions unless specifically
accepted by the Company
 Pre and Post Hospitalization benefits are payable only when the ailments or illnesses
are directly related to the covered hospitalization event/Day care Procedure.
 Any expenses more than 30 days prior to hospitalization/Day care Procedure & 60
days beyond discharge are not payable
 Diagnosis and treatment or any expenses incurred outside India.
 Treatment & investigations for conditions arising due to Diabetes & Hypertension if
disclosed at inception are excluded for first 2 policy years from risk commencement
date or 2 years from the reinstatement date in case reinstatement done after 60 days
from last unpaid premium.
 Any treatment directly or indirectly consequent to war, civil war, terrorism, active
military or police duties ,military aircraft or vessels
 Circumcision, Sex change surgery ,cosmetic surgery & plastic surgery not due to
accident or treatment of disease etc
 Vaccinations, inoculations & expenses on vitamins & tonics until medically necessary
 Refractive error correction, Hearing impairment correction, Corrective & cosmetic
Dental surgeries apart from for any treatment arising due to systemic disease or
injury.
 Any hospitalization for tests or diagnosis wherein such investigations are possible as
out patient procedures / weight loss / weight gain / Preventive / recuperation
purposes/ routine check-ups & issue of any medical certificate or examination for
employment or travel.
 Any treatment / expenses incurred by a Donor of an Organ

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Exclusions (Continued)
 Any Treatment for Congenital Conditions / Physical defects/genetic
disorders etc
 Any stream or type of medicines other than Allopathy ( Western medicine)
 Any Treatment related to Contraception / Pregnancy / Child birth and
infertility or assisted conception procedures except for life threatening
ectopic pregnancy.
 Any treatment directly or indirectly arising from alcoholism/drug abuse,
self-inflicted injuries or attempted suicide or intoxication of drugs,
psychiatry ailments.
 Any treatment due to and as a result of HIV / AIDS / Sexually Transmitted
Disease (STD)
 Any treatment related to sleep disorders & Sleep Apnoea syndrome.
 Durable medical/Non medical equipments including all non medical
expenses including personal comfort expenses, domiciliary treatment.
 More than one coronary angiography in a policy year.
 Any treatment arising out of professional / hazardous sports or activities
etc. or deliberate exposure to exceptional danger.
 Any kind of service charge, surcharge, admission fees, registration fees.
 Extension of duration of hospital stay without any medical requirement as
per the specialist or expenses incurred for investigations/treatment not
relevant to the reason for hospitalization.
 Disease or ailment other for one where hospitalisation was necessary &
Hospitalization or treatment not actually performed
Back
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Terms & Conditions
 Free Look Period: A period of 15 days is available
to review the policy from the date of receipt of the
policy document by the policyholder.
 Revival Norms:



 Foreclosure Norms
 Incase fund value falls below 110% post 3 years of
policy
 Fund value can be withdrawn by policy holder for
health expenses post 5 years of termination.
 No other benefits will be applicable
2 years Uw/g, Waiting periods
and exclusions to
reapply
T+60 (No claim
payable in lapsed
period)
T+15 (Monthly)
T+30 (Yearly & H.Y)
Max revival Revival Post 60 Simple Revival Grace Period
Back
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Procedures covered after 2 years
Lithotripsy / Basketing for Renal Calculus 12
Lap / Open Chole cystectomy for Cholecystitis / Gall stones 11
Myomectomy for Fibroids and menorrhagia 10
Hysterectomy for Fibroids, menorrhagia, Dysfunctional Uterine Bleeding ,
Prolapse
9
Dilation & Curettage for menstrual irregularities 8
Trans Urtheral Resection of Prostrate / Open Prostatectomy for Benign
Enlargement of Prostrate
7
Piles / Fissure / Fistula / Rectal prolapse 6
Hydrocoel / Varicocoel / Spermatocoel surgery 5
Hernia (Inguinal / Ventral / Umbilical / Incisional) 4
Thyroidectomy for Nodule / Multi Nodular Goitre 3
Surgery for Tonsillitis / Adenoiditis 2
Functional Endoscopic Sinus Surgery / Septoplasty for Deviated Nasal
Septum / Sinusitis
1
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Procedures covered after 2 years
Osteoarthrosis leading to Total Knee Replacement or Total Hip
Replacement (After two years from Risk Commencement Date or revival
date, where the revival occurred more than 60 days after the first unpaid
premium, whichever is later, claims for up to one knee or hip treatment
will be covered in any policy year )
19
Cataract (After two years from Risk Commencement Date or revival
date, where the revival occurred more than 60 days after the first unpaid
premium, whichever is later, only claims up to Rs. 20,000 will be covered
in any policy year)
18
Osteoporosis leading to Fracture Neck of Femur 17
Renal failure due to diabetes 16
Amputation due to diabetes 15
Vitrectomy and Retinal Detachment surgery for Retinopathy 14
Traction / Discectomy / Laminectomy for Prolapsed Inter Vertebral Disc
13
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Claims initiatives
 To access this service, our customers will simply have to type:
ICLAIM <space> <8 Digit Policy Number> and send to 56767
 The customer would receive a quick call back from our certified
claims expert.


 Document Reckoner shared with Branches: Checklist of essential
documents
 Original Documents (Bills/Medical Reports) mandatory for Medi
Assure and now Health Saver



• ECS Mandate along with a copy of cancelled cheque to be
submitted for availing direct credit of claims payout



Introduction of ICLAIM – SMS service

Health Claims Documentation
Direct Credit Facility
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Underwriting Guidelines
Crisis cover Comprehensive Critical illness products 5
Hospital Care
Mediassure
Health Saver
Hospitalization & Surgery products 4
Diabetes Care
Diabetes Care Plus
Diabetes Assure
Diabetes Care Active
Diabetes specific products 3
Cancer Care
Cancer Care Plus
Cancer specific products 2
Health Assure
Health Assure Plus
Critical Illness benefit products 1
Plans covered Product Category Sr. No
• Policy Twisting Norms: If a customer wants to buy a new policy, but his earlier policy within
the same category (refer the grid below for different categories) has lapsed within the last 12
months. Then the lapsed policy needs to be revived prior to taking a new policy. Thus Health
saver, Mediassure and Hospital Care fall under the same category.