Swasthya Kavach Family Health What is Swasthya

Swasthya Kavach (Family Health)

What is Swasthya Kavach? The Policy offers a protection cover for you and your family for any injury or disease related contingencies like hospitalization, medical expenses, surgical expenses, Organ transplantation etc. The Policy covers the members of the Family consisting of you, your spouse and dependent children up to the age of 23 years on a floater basis. Coverage is under a single Sum Insured and no separate Sum Insured is required for each member of the Family. Thus each member of Family draws claim from the single Limit of Indemnity.

Unique Selling Proposition – Critical illness gives you an option of differential pricing on differential treatment-you can take a low basic Sum Insured for the general ailments and the high critical illness sum insured protects you against more expensive treatments. – The critical Illness Cover is a indemnification cover and not a benefit policy- Hence even after the critical illness is detected you continue to get renewals. – First Time critical Illness Family Floater cover in India – When compared to IMI with the little more extra than one is required to pay for his own cover, he can cover the entire family – Emergency Assistance service (No competitor is offering this feature) – It is one of the most inexpensive covers you can buy in the target segment of below 45 years

WHO CAN OPT FOR SUCH COVERS? Family The fresh proposal up to the age of 55 shall only be accepted and can be renewed up to the age of 65 Premium chart based Oldest Member aximum of three dependent children From 91 days and up to the age of 23 can be covered Parents are not covered. Proposal only for self or for single member will not be accepted

Swasthya Kavach is offered under two Base Plan Target Audience Families who are located in rural areas, small towns Wider Plan Middle class families located in metr are looking for Health care financing reasonable prices Families who are looking for Health financing at reasonable prices Families who would like to cover the family against unforeseen disease or accident in an affordable Plan. I) Basic Cover only II) Basic Cover with Critical Illness

ommon Coverage under Base Plan and Wider Pla (with varying limits of Coverage) # Room and ICU Charges # Pre-Hospitalization and Post Hospitalization including authorized home nursing # Ambulance service expenses # Daily Allowance for bearing miscellaneous expenses for the duration of Hospitalization

Common Coverage under Base Plan and Wider Plan # Doctor’s fees, Cost of Medicines, Pathological Tests, etc. # Pre-existing disease after 4 continuous Policy years with us. # Prosthetic Devices like Pacemaker, Artificial Limbs etc. ansplants including Donor’s treatment and organs transplantation co # Dental surgery and treatment following an accident # Defined Day Care Surgeries # Vitamin and tonics consistent with illness

Common Exclusions under Base Plan and Wider Plan §Naturopathy, use of Ayurvedic treatment experimental or alternative medicine, procedure and treatment including acupressure, acupuncture, magnetic treatment and such otherapies. §Any diseases or injuries related to hazardous sports like bungee jumping, parasailing, ballooning, parachuting, skydiving, paragliding, hang gliding or rock climbing etc. §Any Genetic disorders. §External medical equipment of any kind used at home as Post Hospitalization care, like wheelchairs, crutches etc. §Treatment of obesity or condition arising there from (including morbid obesity)

Common Exclusions under Base Plan and Wider Plan Contd. . § Diseases which are Pre-existing at inception of the first Policy. § Diseases contracted during the first 30 days of Policy § During the first year of the Policy, the expenses on treatment of diseases such as Tonsillitis/ Adenoids, Gastric or Duodenal Ulcer, Any type of Cyst/ Nodules/ Polyps, Any type of Breast lumps. § During the first two continuous years of the insurance with ITGI, the expenses on treatment of diseases such as Cataract, Benign Prostatic Hypertrophy, Hysterectomy for Menorrhagia or Fibromyoma, Hernia, Hydrocele, Fistula in anus, Piles, Sinusitis, Choletithiasis and Cholecystectomy, Inter- vertebral Disc Prolapse (other than caused by an accident), Osteoarthritis, Varicose Veins / Varicose Ulcers etc. § Cosmetic or aesthetic treatment, general debility, use of intoxicating drugs, intentional self injury. § AIDS related expenses, venereal disease, congenital disease Additional Exclusions under the Base Plan • During the first two continuous years of the Policy, the expenses on treatment of diseases such as Renal Failure, Heart Diseases, any type of Carcinoma/Sarcoma/Blood Cancer.

Plans are differentiated by the limits in claims cost for individual diseases, sub limits and exclusions applicable. These Differences are as under : - S. N o Benefits Base Plan Wider Plan 1. Cost of Health Check up Not Applicable The reimbursement shall not exceed the amount equal to 1% of the average Floater Sum Insured during the block of four claim free years of Insurance with Us. 2. Daily Allowance Rs 150 per day Rs 250 per day 3. Post – Hospitalizati on Medical expenses up to 7% of Hospitalization expenses incurred Relevant medical expenses incurred up to 60 days after Hospitalization on Disease/illness/ Injury

S. N o Benefits Base Plan Wider Plan 4. Restriction on other hospital expenses in accordance with the room rent. Applicable Not Applicable 5. Ambulance charges Rs. 750/-or actual whichever is less Rs. 1500/- or actual whichever is less. 6. 7. Sub limit per day for Normal Room Intensive Care Unit expenses: Additional Exclusions for first two continuous years of Policy 1. 0% of the Sum Insured 2. 0% of the Sum Insured 1. 5% Basic Sum 2. 5% of Basic Insured Sum Insured Chronic Renal failure or End Stage Renal Failure. Heart Disease. Any type of Carcinoma / Sarcoma/ Blood Cancer. Covered 8.

S. N o Benefits 9. Base Plan Wider Plan Add on features: Cumulative Not Bonus Applicable Critical Illness 10. Increased by 5% of the Basic Sum Insured at each renewal in respect of each claim free year of insurance, subject to maximum of 50% of the Basic Sum Insured Not Applicable Optional cover Limit of Liability Basic Sum Insured under option I : Limit of Liability is the Sum Insured + Cumulative Bonus if earned for claim free year under option II : the total Sum Insured of the Basic Cover and Optional

S. No Benefits 11 Base Plan Specified List of Applicable treatments have Expenses limit per treatment per claim or actual whichever is less for example Cataract, Piles, Fistula, Tonsillitis , Sinusitis, Hernia , Knee/ Hip Joint Replacement, etc. Wider Plan Not Applicable

List of Treatments Under Base Plan Treatment List Expense Limit per Claim 1) Cataract 7. 5% of the Sum Insured subject to maximum of Rs. 15000/ 2) Piles, Fistula, 10 % of the Sum Insured subject to Fissure, Tonsillitis, maximum of Rs. 30000/ Sinusitis 3) Benign Prostatic 20% of the Sum Insured subject to Hypertrophy, Hernia maximum of Rs. 50000/- 4) Knee/ Hip Joint 50% of the Sum Insured subject to

Benefits available Sum Insured options are Rs. 200000/-, Rs. 300000/- , Rs. 400000/- and Rs. 5000 three, four and five member family. Policy is not portable which means that benefits enjoyed in other policies of ITGI or policies with other insurer (other than similar floater cover) are not transferable. ( Transfer Only to the Wider Plan) Emergency Assistance Services are available with all the plan options and rem the same in scope of cover as in IMI and IAH policy. Third Party Administrator is Raksha. TPA. It has to be kept in mind that the above Emergency Services will be provided as direct service to the Insured by Emergency Assistance Service Provider free of cost. There will be no facility of any cash payment under these heads or reimbursement of expenses incurred

Emergency Assistance Services Provider Medical Consultation, Evaluation and Referral Emergency Medical Evacuation Medical Repatriation Transportation to Join Patient Care and/or Transportation of Minor Children Emergency Message Transmission Return of Mortal Remains Emergency Cash Coordination

Premium Table The cover is provided under two Plans 1. Base Plan 2. Wider Plan with two options viz. Highest Age a) Basic Cover b) Basic Cover + Critical illness Age limit: Proposer 18 years to 60 years Children 91 days to 23 years ITGI provides for the Policy with the premium based on Age, the Plan and Family size as applicable from time to time. Dependent parents are not covered.

Premium Table is provided with following options 1) Proposer + Spouse 2) Proposer+ Spouse + 1 child 3) Proposer + Spouse + 2 children 4) Proposer + Spouse + 3 children 5) Proposer + one child 6) Proposer + two children 7) Proposer + three children Premium is provided without Service Tax and therefore needs to be loaded accordingly. Individual and self alone proposal with parents are not covered. The

Premium comparison for Sum Insured of Rs. 200000/- for a family of 2 adults + 2 children 36 -45 12000 10000 8000 6000 4000 2000 0 STAR RELIANCE HDFC BAJAJ RSA UNITED CHOLA LOMBARD ITGI(Wider) Apolo

Underwriting Process The Policies shall be accepted and written by all the o offices up to the age of 45. The proposal with Pre-exis disease and/or with the age of 45 years shall require from Corporate office. The premium is based on the highest age in the family, the size of the family , the sum insured and the type of Plan Raksha TPA shall be issuing the member cards and the Beneficiary Guide, which will also carry the contact numbers of Emergency Assistance Service Provider for availing the aforesaid special services.

Documents required for settlement of claims § Claim Form § Discharge Summary, Bills and Receipt of Hospital/Nursing, Home Attending Doctor’s Report and Bills as well as cash memos of medicines and pathological tests duly supported by proper prescription. § F. I. R, Post Mortem Report, Final Investigation Report etc. in case of an accident.

Claim Process The claims process for the cashless claim settlement shall remain the same as at present under IMI Policies but for the change in TP Emergency Assistance Service Provider shall only respond to emergency situations out side the home town of the insured person (during travel beyond 150 kms. within India) and the TPA takes Dedicated center of Raksha. TPA at Faridabad shall act as the over from the time the insured person is actually admitted centralized as an processing unit for all claims under this Policy whether on inpatient in a hospital. Cashless or Reimbursement basis or for claims under Personal Accident Benefit. This exclusive center will be in constant coordination with

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