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SUBMITTED BY
D.DEEPTHI
ACKNOWLEDGEMENT
My sincerest thanks are due to all who have helped me in various ways in
the course of the project.
I am deeply grateful to Dr. G.V.RAO, faculty guide for his help and support.
I am thankful to my parents and friends for all the direct and indirect help
they have given me throughout my work.
( D.DEEPTHI )
DECLARATION
I also declare that this project is a result of my own efforts and has not been
submitted to any other University for any other degree or diploma.
DATE :
PLACE : ( D.DEEPTHI)
CONTENTS
INTRODUCTION
OVERVIEW OF LIC
OVERVIEW OF ICICI
LIC PRODUCTS
ICICI PRODUCTS
QUESTIONARE
OUR FINDINGS
ARTICLES
SUGGESTIONS
BIBILOGRAPHY
ABSTRACT
With over a billion people, India is fast becoming a global economic power.
With a relatively youthful population, India will become an attractive
insurance market over the next decades. this paper examines the Indian
insurance industry. It starts by examining the details of the regulatory regime
that existed before independence .this is important because the culmination
of the insurance act of 1938 became the backbone of the current legislation
in place. It highlights the importance of the rural sector –where the majority
of the Indians still live. It shows how the recent privatization is playing out
in the market .the health infrastructure in India is facing daunting challenge
of meet in the health goals and complexities emerging from the changing
diseases pattern .the proliferation of various health care technologies and
increase in cost of care as unassociated the exploration of health financing
options to manage problems arising out of increasing health care costs.
Health insurance is emerging fast as an important mechanism to finance the
health care needs of the people .further, the uncertainty of disease or illness
is accentuating the need for insurance system that works on the basic
principle of pooling of risks of unexpected costs of persons falling ill and
needing hospitalization by charging premium from a wider population base
of the same community. However, the complexity of health insurance
industry has being much talked about but less understood, especially in
Indian scenario based on recent economic estimates, the paper provides
projections of segments of the market for 2025.
Introduction
What is insurance
Principles of insurance
Accidental Loss. The event that constitutes the trigger of a claim should be
fortuitous, or at least outside the control of the beneficiary of the insurance.
The loss should be ‘pure,’ in the sense that it results from an event for which
there is only the opportunity for cost. Events that contain speculative
elements, such as ordinary business risks, are generally not considered
insurable.
Large Loss. The size of the loss must be meaningful from the perspective of
the insured. Insurance premiums need to cover both the expected cost of
losses, plus the cost of issuing and administering the policy, adjusting losses,
and supplying the capital needed to reasonably assure that the insurer will be
able to pay claims. For small losses these latter costs may be several times
the size of the expected cost of losses. There is little point in paying such
costs unless the protection offered has real value to a buyer.
Calculable Loss. There are two elements that must be at least estimable, if
not formally calculable: the probability of loss, and the attendant cost.
Probability of loss is generally an empirical exercise, while cost has more to
do with the ability of a reasonable person in possession of a copy of the
insurance policy and a proof of loss associated with a claim presented under
that policy to make a reasonably definite and objective evaluation of the
amount of the loss recoverable as a result of the claim.
Indemnification
An "indemnity" policy will never pay claims until the insured has paid out of
pocket to some third party; for example, a visitor to your home slips on a
floor that you left wet and sues you for $10,000 and wins. Under an
"indemnity" policy the homeowner would have to come up with the $10,000
to pay for the visitor's fall and then would be "indemnified" by the insurance
carrier for the out of pocket costs (the $10,000)[4].
Under the same situation, a "pay on behalf" policy, the insurance carrier
would pay the claim and the insured (the homeowner) would not be out of
pocket for anything. Most modern liability insurance is written on the basis
of "pay on behalf" language[5].
When insured parties experience a loss for a specified peril, the coverage
entitles the policyholder to make a 'claim' against the insurer for the covered
amount of loss as specified by the policy. The fee paid by the insured to the
insurer for assuming the risk is called the 'premium'. Insurance premiums
from many insureds are used to fund accounts reserved for later payment of
claims—in theory for a relatively few claimants—and for overhead costs. So
long as an insurer maintains adequate funds set aside for anticipated losses
(i.e., reserves), the remaining margin is an insurer's profit.
Insurers make money in two ways: (1) through underwriting, the process by
which insurers select the risks to insure and decide how much in premiums
to charge for accepting those risks and (2) by investing the premiums they
collect from insured parties.
Origin of Insurance
Whenever there is uncertainty there is risk. We do not have any control over
uncertainties
which involves financial losses. The risk may be certain events like death,
pension,
retirement or uncertain events like theft, fire, accident, etc.
Insurance is a financial service for collecting the savings of the public and
providing
them with risk coverage. It comes under service sector and while marketing
this service
due care is taken in quality product and customer satisfaction. The main
function of the
Insurance is to provide protection against the possible chances of generating
losses.
The insurance sector in India has come a full circle from being an open
competitive
market to nationalization and back to a liberalized market again. Tracing the
developments in the Indian insurance sector reveals the 360-degree turn
witnessed over a
period of almost two centuries.
Brief History of the Insurance Sector
The business of life insurance in India in its existing form started in India in
the year
1818 with the establishment of the Oriental Life Insurance Company in
Calcutta. Some of
the important milestones in the life insurance business in India are:
1912: The Indian Life Assurance Companies Act enacted as the first statute
to regulate
the life insurance business.
1956: 245 Indian and foreign insurers and provident societies taken over by
the central
government and nationalized. LIC formed by an Act of Parliament, viz. LIC
Act, 1956,
with a capital contribution of Rs. 5 crore from the Government of India. The
General
insurance business in India, on the other hand, can trace its roots to the
Triton Insurance
Company Ltd., the first general insurance company established in the year
1850 in
Calcutta by the British.
Some of the important milestones in the general insurance business in India
are:
1907: The Indian Mercantile Insurance Ltd. set up, the first company to
transact all
classes of general insurance business.
1957: General Insurance Council, a wing of the Insurance Association of
India, frames a
code of conduct for ensuring fair conduct and sound business practices.
2
1968: The Insurance Act amended to regulate investments and set minimum
solvency
margins and the Tariff Advisory Committee set up.
1972: The General Insurance Business (Nationalization) Act, 1972
nationalized the
general insurance business in India with effect from 1st January 1973. 107
insurers
amalgamated and grouped into four companies’ viz. the National Insurance
Company
Ltd., the New India Assurance Company Ltd., the Oriental Insurance
Company Ltd. and
the United India Insurance Company Ltd. GIC incorporated as a company.
INSURANCE SECTOR
Over the past three years, more than thirty companies have expressed
interest in doing
business in India. The IRDA (Insurance Regulatory Development Authority)
is the
regulatory authority, which looks over all related aspects of the insurance
business. The
provisions of the IRDA bill acknowledge many issues related to insurance
sector.
The IRDA bill provides guidance for three levels of players - Insurance
Company,
Insurance brokers and Insurance agent. Life Insurance sector is one of the
key areas
where enormous business potential exists. In India currently the life
insurance premium
as a percentage of GDP is 1.3 % against, 5.2 per cent in the US.
General Insurance is another segment, which has been growing at a faster
pace. But as
per the current comparative statistics, the general insurance premium has
been lower
than life insurance. General Insurance premium as a percentage of GDP was
a mere 0.5
'per cent in 1996. In the General Insurance Business, General Insurance
Corporation
(GIC) and its four subsidiaries viz. New India Insurance, Oriental Insurance,
National
Insurance and United India Insurance, are doing major business. The
General Insurance
Industry has been growing at a rate of 19 percent per year.
Regulatory Body:
1. The Insurance Act should be changed.
2. GIC and its subsidiaries are not to hold more than 5% in any company
(There current
holdings to be brought down to this level over a period of time.)
Customer Service:
Life Insures:
• Life Insurance Corporation of India (LIC)
General Insurers
• General Insurance Corporation of India (GIC) (with effect from Dec ‘2000,
a
national reinsurer)
• Intangibility:
Insurance is a guarantee against risk and neither the risk nor the guarantee is
tangible. Hence, insurance rightly come under services, which are intangible.
Efforts have been made by the insurance companies to make insurance
tangible to
some extent by including letters and forms
• Inconsistency
Service quality is often inconsistent. This is because service personnel have
different capabilities, which vary in performance from day to day. This
problem of
inconsistency in service quality can be reduced through standardization,
training
and mechanization.
• Inseparability
Services are produced and consumed simultaneously. Consumers cannot and
do
not separate the deliverer of the service from the service itself. Interaction
between
consumer and the service provider varies based on whether consumer must
be
physically present to receive the service.
• Inventory
No inventory can be maintained for services. Inventory carrying costs are
more
subjective and lead to idle production capacity. When the service is available
but
there is no demand, cost rises as, cost of paying the people and overhead
remains
constant even though the people are not required to provide services due to
lack of
demand.
In the insurance sector however, commission is paid to the agents on each
policy
that they sell. Hence, not much inventory cost is wasted on idle inventory.
As the
cost of agents is directly proportionate to the policy sold.
1. Introduction
Over the last 50 years India has achieved a lot in terms of health
improvement. But still India is way behind many fast developing countries
such as China, Vietnam and Sri Lanka in health indicators (Satia et al 1999).
In case of government funded health care system, the quality and access of
services has always remained major concern. A very rapidly growing private
health market has developed in India. This private sector bridges most of the
gaps between what government offers and what people need. However, with
proliferation of various health care technologies and general price rise, the
cost of care has also become very expensive and unaffordable to large
segment of population. The government and people have started exploring
various health financing options to manage problems arising out of growing
set of complexities of private sector growth, increasing cost of care and
changing epidemiological pattern of diseases.
The new economic policy and liberalization process followed by the
Government of India since 1991 paved the way for privatization of insurance
sector in the country. Health insurance, which remained highly
underdeveloped and a less significant segment of the product portfolios of
the nationalized insurance companies in India, is now poised for a
fundamental change in its approach and management. The Insurance
Regulatory and Development Authority (IRDA) Bill, recently passed in the
Indian Parliament, is important beginning of changes having significant
implications for the health sector.
The privatization of insurance and constitution IRDA envisage to improve
the performance of the state insurance sector in the country by increasing
benefits from competition in terms of lowered costs and increased level of
consumer satisfaction. However, the implications of the entry of private
insurance companies in health sector are not very clear. The recent policy
changes will have been far reaching and would have major implications for
the growth and development of the health sector. There are several
contentious issues pertaining to development in this sector and these need
critical examination. These also highlight the critical need for policy
formulation and assessment. Unless privatization and development of health
insurance is managed well it may have negative impact of health care
especially to a large segment of population in the country. If it is well
managed then it can improve access to care and health status in the country
very rapidly.
.
2. Economic policy context and imperatives of liberalization of
insurance sector
There are several imperatives for opening of the insurance and health
insurance sector in India for private investment. Here we review some of
these imperatives.
Economic policy reforms started during late eighties and speeded up in
nineties are the context in which liberalization of insurance sector happened
in India. It was very obvious that the liberalization of the real (productive)
and financial sector of the economy has to go hand in hand. It is imperative
that these sectors are consistent with policies of each other and unless both
function efficiently and are in equilibrium, it would be difficult to ensure
appropriate economic growth. Given these facts liberalization of both sectors
has to proceed simultaneously.
Indian economic system has been developed on paradigm of mixed economy
in which public and private enterprises co-exist. The past strategies of
development based on socialistic thinking were focusing on the premise of
restrictions, regulations and control and less on incentives and market driven
forces. This affected the development process in the country in serious way.
After the economic liberalization the paradigm changed from central
planning, command and control to market driven development.
Deregulation, decontrol, privatization, delicensing, globalization became the
key strategies to implement the new framework and encourage competition.
The social sectors did not remain unaffected by this change. The control of
government expenditure, which became a key tool to manage fiscal deficits
in early 1990s, affected the social sector spending in major way. The
unintended consequences of controlling the fiscal deficits have been
reduction in capital expenditure and non-salary component of many social
sector programmes. This has led to severe resource constraints in the health
sector in respect of non-salary expenditure and this has affected the capacity
and credibility of the government health care system to deliver good quality
care over the years. Given the increasing salaries, lack of effective
monitoring and lack of incentives to provide good quality services the
provides in the government sector became indifferent to the clients. Clients
also did not demand good quality and better access, as government services
were free of cost.
Under this situation more and more clients turned to the private sector health
providers and thus the private sector healthcare has expanded. Given the
socialistic political thinking and populist policy it has been generally
difficult for any government to introduce cost recovery in public health
sector. Given that government is unable to provide more resources for health
care, and institute cost recovery, one of the ways to reduce the under-
funding and augment the resources in the health sector was to encourage the
development health insurance.
Another imperative for liberalization of the insurance sector was the need for
long-term financial resources on sustainable basis for the development of
infrastructure sector such as roads, transports etc. It was realized that during
the course of economic liberalization, the funds to development the
infrastructure also became a major constraint. Country certainly needed
infrastructure development. For this the finances are major constraint. In
these investments the benefits are more social than private. The major
concern was how these finances can be made available at low costs. In past
the development of social sector were financed using government channeled
funds through various semi-government financial institutions. Under the
liberalized economy this may not be possible. One hope is that if the
insurance sector develops rapidly under privatization then it can provide
long-term finance to the infrastructure sector.
3. Health sector and its financing: present scene and issues for the
future
During the last 50 years India has developed a large government health
infrastructure with more than 150 medical colleges, 450 district hospitals,
3000 Community Health Centers, 20,000 Primary Health Care centers and
130,000 Sub-Health Centers. On top of this there are large number of private
and NGO health facilities and practitioners scatters though out the country.
Over the past 50 ears India has made considerable progress in improving its
health status. Death rate has reduced from 40 to 9 per thousand, infant
mortality rate reduced from 161 to 71 per thousand live births and life
expectancy increased from 31 to 63 years. However, many challenges
remain and these are: life expectancy 4 years below world average, high
incidence of communicable diseases, increasing incidence of non-
communicable diseases, neglect of women's health, considerable regional
variation and threat from environment degradation. It is estimated that at any
given point of time 40 to 50 million people are on medication for major
sickness in India. About 200 million workdays are lost annually due to
sickness. Survey data indicate that about 60% people use private health
providers for outpatient treatment while 60 % use government providers for
in-door treatment. The average expenditure for care is 2-5 times more in
private sector than in public sector.
India spends about 6% of GDP on health expenditure. Private health care
expenditure is 75% or 4.25% of GDP and most of the rest (1.75%) is
government funding. At present, the insurance coverage is negligible. Most
of the public funding is for preventive, promotive and primary care
programmes while private expenditure is largely for curative care. Over the
period the private health care expenditure has grown at the rate of 12.84%
per annum and for each one percent increase in per capital income the
private health care expenditure has increased by 1.47%. Number of private
doctors and private clinical facilities are also expanding exponentially.
Indian health financing scene raises number of challenges, which are:
• neglect of preventive and primary care and public health functions due to
under funding of the government health care.
Objectives of LIC
• Spread Life Insurance widely and in particular to the rural areas and to
the socially and economically backward classes with a view to
reaching all insurable persons in the country and providing them
adequate financial cover against death at a reasonable cost.
• Conduct business with utmost economy and with the full realization
that the moneys belong to the policyholders.
• Meet the various life insurance needs of the community that would
arise in the changing social and economic environment.
• Involve all people working in the Corporation to the best of their
capability in furthering the interests of the insured public by providing
efficient service with courtesy.
Mission
"Explore and enhance the quality of life of people through financial security
by providing products and services of aspired attributes with competitive
returns, and by rendering resources for economic development."
Vision
"A trans-nationally competitive financial conglomerate of significance to
societies and Pride of India."
Board of directors
At the time of taking a policy, policyholder should ensure that all questions
in the proposal form are correctly answered. Any misrepresentation, non-
disclosure or fraud in any document leading to the acceptance of the risk
would render the insurance contract null and void.
Protection:
Savings through life insurance guarantee full protection against risk of death
of the saver. Also, in case of demise, life insurance assures payment of the
entire amount assured (with bonuses wherever applicable) whereas in other
savings schemes, only the amount saved (with interest) is payable.
Aid To Thrift:
Life insurance encourages 'thrift'. It allows long-term savings since
payments can be made effortlessly because of the 'easy instalment' facility
built into the scheme. (Premium payment for insurance is either monthly,
quarterly, half yearly or yearly).
For example: The Salary Saving Scheme popularly known as SSS, provides
a convenient method of paying premium each month by deduction from
one's salary.
In this case the employer directly pays the deducted premium to LIC. The
Salary Saving Scheme is ideal for any institution or establishment subject to
specified terms and conditions.
Liquidity:
In case of insurance, it is easy to acquire loans on the sole security of any
policy that has acquired loan value. Besides, a life insurance policy is also
generally accepted as security, even for a commercial loan.
Tax Relief:
Life Insurance is the best way to enjoy tax deductions on income tax and
wealth tax. This is available for amounts paid by way of premium for life
insurance subject to income tax rates in force.
Assessees can also avail of provisions in the law for tax relief. In such cases
the assured in effect pays a lower premium for insurance than otherwise.
Money When You Need It:
A policy that has a suitable insurance plan or a combination of different
plans can be effectively used to meet certain monetary needs that may arise
from time-to-time.
Children's education, start-in-life or marriage provision or even periodical
needs for cash over a stretch of time can be less stressful with the help of
these policies.
Alternatively, policy money can be made available at the time of one's
retirement from service and used for any specific purpose, such as, purchase
of a house or for other investments. Also, loans are granted to policyholders
for house building or for purchase of flats (subject to certain conditions).
Any person who has attained majority and is eligible to enter into a valid
contract can insure himself/herself and those in whom he/she has insurable
interest.
Policies can also be taken, subject to certain conditions, on the life of one's
spouse or children. While underwriting proposals, certain factors such as the
policyholder’s state of health, the proponent's income and other relevant
factors are considered by the Corporation.
At present, women who work and earn an income are treated at par with
men. In other cases, a restrictive clause is imposed, only if the age of the
female is up to 30 years and if she does not have an income attracting
Income Tax.
In 'without' profit plan the contracted amount is paid without any addition.
The premium rate charged for a 'with' profit policy is therefore higher than
for a 'without' profit policy.
Keyman Insurance
Vision
Mission
As a responsible, customer focused market leader, we will strive to understand the
insurance needs of the consumers and translate it into affordable products that deliver
value for money.
Our Achievements
Bajaj Allianz has received "iAAA rating, from ICRA Limited, an associate of Moody's
Investors Services, for Claims Paying Ability.This rating indicates highest claims paying
ability and a fundamentally strong position
The Company was granted Certificate of Registration for carrying out Life
Insurance business, by the Insurance Regulatory and Development Authority
on November 24, 2000. It commenced commercial operations on December
19, 2000, becoming one of the first few private sector players to enter the
liberalized arena.
Till March 31,2002 the Company has issued 100,000 polices translating into
a Premium Income of around Rs. 1,200 Million and a sum assured of over
Rs.15,000 Million.
The Company recognizes that the driving force for gaining sustainable
competitive advantage in this business is superior customer experience and
investment behind the brand. The Company aims to achieve this by striving
to provide world class service levels through constant innovation in
products, distribution channels and technology based delivery. The
Company has already taken significant steps to achieve this goal..
The success of the organisation will be founded on its strong focus on values
and clarity of purpose. These include:
Understanding the needs of customers and offering them superior products
and service
They believe that they can play a significant role in redefining and reshaping
the sector. Given the quality of their parentage and the commitment of their
team, they feel that tere will be no limits to their growth.
Sponsors
ICICI Ltd was established in 1955 by the World Bank, the Government of
India and the Indian Industry, to promote industrial development of India by
providing project and corporate finance to Indian industry.
Prudentialplc:
Prudential plc was founded in 1848. Since then it has grown to become one
of the largest providers of a wide range of savings products for the
individual including life insurance, pensions, annuities, unit trusts and
personal banking. It has a presence in over 15 countries, and caters to the
financial needs of over 10 million customers. It manages assets of over US$
259 billion (Rupees 11,39,600 crores approx.) as of December 31, 1999.
Prudential plc. has had its presence in Asia for the past 75 years catering to
over 1 million customers across 11 Asian countries.
In the US, Prudential owns Jackson National Life, one of the leading life
insurance companies. Prudential controls approximately 4% of all the listed
shares on the second largest stock exchange in the world, the London Stock
Exchange, making it one of the largest institutional investors in the UK.
Prudential is focused on the internet generation and is one of the first
financial service organisations to use the internet on a fully integrated basis.
Development of superior products and services that offer value for money
and security while producing superior financial returns, enables Prudential to
maximise the value of its shareholder's investment and to establish lasting
relationships with customers and policy holders.
ICICI and Prudential came together in 1993 to provide mutual fund products
in India and today are the largest private sector mutual fund company in
India. The two companies bring together two of the strongest financial
service brands in Asia known for their professionalism, excellent quality of
service and long term commitment to YOU.
Board of Directors
The ICICI Prudential Life Insurance Company Limited Board comprises reputed people
from the finance industry both from India and abroad.
HEALTH INSURANCE
Health insurance policies insure you against several illnesses and guarantee you stay
financially secure should you ever require treatment. They safeguard your peace of mind,
eliminate all worries about treatment expenses, and allow you to focus your energy on
more important things, like getting better. Let's learn more about the various types of
health insurance available, and what the best policy for you might be.
There are several health insurance or medical insurance plans in India. These can be
divided into the following categories based on the coverage offered:
Hospitalization Plans: These health insurance plans cover your expenses in case you
need to be hospitalized. Within this category, products may have different payout
structures and limits for various heads of expenditure. The hospitalisation coverage may
be reimbursement based plans or fixed benefit plans. These plans aim to cover the more
frequent medical expenses. Click to know about our hospitalisation insurance plan
(Hospital Care)
Critical Illness Plans: These health insurance plans provide you coverage against critical
illnesses such as heart attack, organ transplants, stroke, and kidney failure among others.
These plans aim to cover infrequent and higher ticket size medical expenses. Click to
know about our critical illness plans (Crisis Cover, Health Assure Plus)
Specific Conditions Coverage: These plans are designed specifically to offer health
insurance against certain complications due to diabetes or cancer. They may also include
features such as disease management programs which are specific to the condition
covered. Click to know more about our diabetes (Diabetes Care, Diabetes Care
Plus, Diabetes Assure) and cancer (Cancer Care, Cancer Care Plus) suite of products.
HEALTH INSURANCE
Health insurance policies insure you against several illnesses and guarantee
you stay financially secure should you ever require treatment. They
safeguard your peace of mind, eliminate all worries about treatment
expenses, and allow you to focus your energy on more important things, like
getting better. Let's learn more about the various types of health insurance
available, and what the best policy for you might be.
There are several health insurance or medical insurance plans in India. These
can be divided into the following categories based on the coverage offered:
Hospitalization Plans: These health insurance plans cover your expenses in
case you need to be hospitalized. Within this category, products may have
different payout structures and limits for various heads of expenditure. The
hospitalisation coverage may be reimbursement based plans or fixed benefit
plans. These plans aim to cover the more frequent medical expenses. Click
to know about our hospitalisation insurance plan (Hospital Care)
Critical Illness Plans: These health insurance plans provide you coverage
against critical illnesses such as heart attack, organ transplants, stroke, and
kidney failure among others. These plans aim to cover infrequent and higher
ticket size medical expenses. Click to know about our critical illness plans
(Crisis Cover, Health Assure Plus)
Reason 1: Lifestyles have changed. Indians today suffer from high levels of
stress. Long hours at work, little exercise, disregard for a healthy balanced
diet and a consequent dependence on junk food have weakened our immune
systems and put us at an increased risk of contracting illnesses.
18% of the urban population suffers from hypertension, which leads to renal
failure, stroke and cardio-vascular diseases
Cardio-vascular diseases (CVDs) like heart disease and stroke are the main
causes of death and disability
Sound health cover planning ensures you receive both, direct medical
expenses and indirect expenses, as soon as any medical emergency or
hospitalisation event occurs.
Covers a wide spectrum of medical conditions from the most basic to the
most critical health complication
An ideal health insurance solution must help cover for both the frequent and
low cost medical expenses while also enabling adequate coverage to meet
less frequent high cost critical complications as described in the diagram
below
Point to Remember: Select a health solution by taking into consideration
factors such as income, age, number of dependants, quality of care desired,
current coverage etc.
Quick tip
Hospitalisation Plans
MediAssure
Hospital Care
Crisis Cover
HealthAssure Plus
Cancer Products
Cancer Care
Diabetes Products
Diabetes Care
Diabetes Care Plus
Diabetes Assure
Hence you need a solution that gives you peace of mind by providing
financial cover to both you and your family against unforeseen
hospitalisation events.
Does the plan ensure that no new exclusions are added or no increase in
premiums occurs just because a claim is made?
Does the plan clearly state exclusions at the time of taking the policy and
also offer you cover against pre-existing conditions?
Moreover, this policy covers all your hospitalisation needs with the
flexibility to choose your location and quality of treatment.
At a glance
Term 3 years
No claim bonus of 5% of annual limit for every claim free policy year
Avail tax benefits on premium paid u/s section 80D of IT Act, 1961
Benefits in detail
1.Family Floater
With the family floater option, you can additionally cover your spouse and
up to the first three dependent children to the same annual aggregate limit.
You can renew the policy once and within 30 days from the termination date
with the same terms and conditions. You can further renew the cover under
the then offered ICICI Pru MediAssure product or its nearest substitute
within 30 days from the policy termination date. The outstanding waiting
period from the current policy will be applied on continuation of cover. Your
premium payable on renewal and on subsequent continuation of cover shall
be reviewed subject to IRDA approval.
Pre existing illnesses and conditions which are declared at inception and
specifically accepted by the company would be covered under this policy.
For conditions of diabetes or hypertension which are disclosed at inception
and which are accepted for cover, any complications arising from these
conditions will be covered after the first two consecutive policy years.
You are entitled to a 5% increase in your annual limit for every claim free
year subject to a maximum of 25% increase in the annual limit. Incase a
claim is made during a policy year; the bonus amount would revert to 0% in
the following year.
W
H
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T
D
O
ES
M
E
DI
A
SS
U
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E
C
O
V
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R?
HOW DOES MY PLAN WORK?
WHAT HAPPENS WHEN I ACCESS OUT OF NETWORK
FACILITIES?
WHAT HAPPENS IN AN EMERGENCY?
What does MediAssure cover?
Please note:
Payout for Doctors’ fees (including surgeon, anaesthetist) will be limited to 30% of
eligible claim amount for inpatient claims.
Payout for artificial limbs would be limited to lower of Rs 25,000 or 10% of the Annual
Limit.
The Annual Limit is the maximum benefit payable under the policy towards
all the eligible medical expenses described above and incurred during a
policy year. You can select between various Annual Limit options i.e. Rs 2
Lacs, Rs 3 Lacs, Rs 5 Lacs, Rs 7 Lacs or Rs 10 Lacs.
You can choose between the Premium and Classic plans. The Premium plan
gives you access to all List A and List B hospitals across India. The Classic
plan gives you access to all List A hospitals across India along with limited
access to List B hospitals as shown in the table below.
Plan Type
Eligible
Premium Classic
Room Type
Upto Single List A hospitals
List A hospitals all over India
A/C room all over India
All List B hospitals all over
All List B
Upto Twin India except districts of
hospitals all
A/C room Mumbai, Navi Mumbai and
over India
Thane
• Upgrade to a higher room type in the network hospitals, eg, a single A/C
room at List B hospital, or,
• Access facilities at hospitals not listed in the chosen network, eg, if you
have chosen the Classic plan and access care at a List B Mumbai hospital,
or, if you access care at a hospital not given in List A or B.
Please Note: Co-pay is that percentage of the total eligible medical expenses that is borne
by you while the balance is settled by the Company
Claims Process
With ICICI Prudential’s MediAssure policy, you can now plan ahead, be in
control in any medical eventuality and focus on getting better without
having to worry about the money. ICICI Prudential provides a seamless and
hassle-free claims experience with MediAssure.
Planned Hospitalisation
Emergency Hospitalisation
Claims can either be in a ‘Network Hospital’ or in ‘Non-Network Hospital’
depending on the need and location of the claim.
On issuance of the policy, as part of the Welcome Kit, you will receive the
following:
• Health Card - a card with your unique policy number and 24 hours Claims
Helpline Toll Free number. This card can be utilized only in Network
Hospitals)
• List of Network Hospitals (An updated list would be available at
www.iciciprulife.com)
• Claims and Pre-Authorization Forms
When there is a need for hospitalization (includes day care procedures), you
can inform ICICI Prudential about hospitalisation by calling on the contact
number provided on the health card. You need to provide following
information when you call ICICI Prudential about the claim
Please note additional documents may be warranted / asked for at the time of
claims adjudication in exceptional circumstances.
Pre & Post Hospitalisation treatment
Complete disclosure:
Make sure that all the information related to your health is given to the
company as this would ensure faster settlement of claims and avoid
disappointments later. Please refer to the copy of your application form in
the welcome kit to check the disclosure made by you.
During such an unexpected situation, your only concern should be that the
best doctors and medical facilities are available and cost should not be a
constraint so that you can take care of things without compromise but to
ensure that best in class treatment is provided, the key to that is to be
financially prepared for it.
You will receive lump-sum benefit amount, irrespective of the actual billing.
The premiums are valid for one year from the date of commencement of the
policy. Thereafter, the company reserves the right to change the premium.
Any change in the above premiums will take place subject to approval from
IRDA and after giving notice to the policyholder. These premiums are
exclusive of any service tax and education cess.
Premium rates for Male and Female lives for term 10 - 20 years excluding
service tax and Education cess.
A summary of the benefits payable on the insured events is given in the table
below
1.Hospitalisation for
1.Hospitalisation more than 24 hrs. 1. 1.Plan's DHCB will be
for more than 24 The patient is paid for each day of
hrs. charged for at least 2 hospitalisation.
full days room &
board.
7.No benefit is
7.On stopping of
7.Surrender/Lapse payable on
premiums
Surrenders/Lapses.
Get a benefit amount if you are hospitalized for more than 24 hours i.e. at
least 2 consecutive nights and must be charged for 2 days room expenses.
An additional 50% of DHCB amount per day is paid to you if you get
admitted to an Intensive Care Unit (ICU), and this amount is paid depending
on the plan chosen.
The ICU benefit is payable for hospitalisation up to 30 days per policy year,
and is paid in addition to DHCB.
3. Recuperating benefit
4. Surgery benefit
Grades Surgeries
1 Tennis elbow release, bladder stone
removal
2 Hernia, Removal of uterus
Removal of kidney, removal of thyroid
3
gland
Open heart surgery, removal of brain
4
tunour
Claims Process
On issuance of the policy, as part of the Welcome Kit, you will receive the
following:
Health Card (a card which has your policy number and contact information
of ICICI Prudential and it can be utilized only in Network Hospitals)
When there is a need for hospitalization, you can inform ICICI Prudential
about hospitalisation by calling on the contact number provided on the
health card. You need to provide following information when you call ICICI
Prudential about the claim
Duly filled claim form (provided along with the welcome kit or available on
our website)
a. PLANNED HOSPITALISATION
Step 1: Call and inform ICICI Prudential (on the help line number provided
on the reverse of the health card) about the planned hospitalization 4 days
prior to the treatment, before admitting into the hospital.
Step 2: Download the pre-authorization form from our website
(www.iciciprulife.com) or you could even visit any of our branches.
Step 3: To gain access to the network hospitals, just show your health card
and also submit a duly filled pre-authorization form at the treating hospital.
Step 4: The forms shall be scrutinized and further processed and the cashless
facility will be activated. We will inform you about the cashless facility
being activated through SMS. Also the status of the case will be updated on
the website.
Step 5: On discharge, you need to sign the required documents at the
hospital.
Step 6: ICICI Prudential will pay the amount to hospital.
b. EMERGENCY HOSPITALISATION
Step 1: In case of emergency, first admit the patient in the Hospital and then
inform ICICI Prudential, within 24 hours. You can call up on the number
provided on the reverse of the health card.
Step 2: As it's an emergency, you have the facility of collecting the pre-
authorization form from the treating hospital or you could even download
the pdf format from the website.
Step 3: Show your health card to the network hospital and also submit the
pre-authorization form to the treating hospital.
Step 4: The forms shall be scrutinized and further processed and the cashless
facility will be activated.
Step 5: On discharge, you need to sign the required documents.
Step 6: ICICI Prudential will pay the hospital.
The Cashless Settlement Scenario:
Hospital bill amount is more than your eligible amount: ICICI prudential
settles the eligible amount with the hospital and balance bill amount is
payable by you.
Hospital bill is less than eligible amount: ICICI Prudential settles the claim
with the hospital and the balance eligible amount is paid to you
While it's suggested that you choose a network hospital, you are at liberty to
choose a Non-network hospital also. In case you avail treatment in a non-
network hospital, ICICI Prudential will pay you the eligible amount as per
the plan opted by you.
Step 1: Get admitted to the hospital and take the complete treatment.
The claim will be processed within 7 working days from the date of
receiving all the required documents.
PROCESS AT A GLANCE:
Life is hectic in today's fast paced world. Along with the rapid pace and
progress comes the bane of modern life such as increased stress, poor diet
and lack of exercise. The alarming aspect is that, owing to these factors,
more and more Indians are becoming vulnerable to critical illnesses every
year. These illnesses, coupled with increasing costs of treatment, have made
recovery a long and expensive process.
It goes without saying that securing your family's financial future is a part of
prudent financial planning. However, no less important is your health and
well-being, for which you need a comprehensive health coverage. And,
given our lifestyles, it should ideally be a plan that provides complete
protection against Disease, Disability and Death.
Keeping this need in mind, ICICI Prudential Life Insurance presents Crisis
Cover. This all-inclusive long term insurance policy provides coverage
against 35 critical illnesses, total and permanent disability, and also death.
So, get the right protection tailored to suit your lifestyle, with this plan
which is
• Comprehensive
• Affordable
• Long Term
Maximum Coverage
75 years
Ceasing Age
Sum Assured
Premium payment
Monthly, Half-yearly, Annual
frequency
Cash*
Cheques
Demand Drafts
Pay Orders
Bankers Cheque
Your Premium will fall due in every policy year based on the periodicity of
payment of premiums, i.e.
Yearly,
Half-Yearly or
Monthly
The most comprehensive coverage is also affordable. Below are the annual
premium rates for a Sum Assured of Rs. 500,000 for various policy terms
and entry ages for Males.
Premium in Rupees
The premiums are guaranteed for first five years from the date of
commencement of the policy. Thereafter, the premiums are annually
reviewable. Any change in premium will only be effected with approval
from IRDA.
Above premiums are inclusive of modal rebate and Large SA discount &
exclusive of any service tax and education cess.
Waiting Period:
K
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B
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N
EF
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O
F
C
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SI
S
C
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HOW DOES CRISIS COVER WORK?
FLEXIBLE PAYOUTS FOR THE 35 CRITICAL ILLNESSES
COVERED
CLAIMS PROCESS MADE SIMPLE
DEFINITION OF CRITICAL ILLNESSES COVERED
LIST OF EXCLUSIONS
Premium paid is eligible for deduction under section 80C & section 80D*
* The overall limit of deduction for investment u/s 80C & u/s 80D of the Income Tax
Act, 1961 are Rs. 1,00,000 & Rs. 15,000 respectively, subject to conditions mentioned
therein.
Pay Premium based on your age and sum assured and term of cover chosen
Get the applicable sum assured in the event of being diagnosed with a
critical illness or on being rendered totally disabled or on death, whichever
occurs first.
Get the Sum Assured on under the plan on first occurrence of Death or Total
Permanent Disability or on diagnosis of any one of the following 35 Critical illnesses.
Major Burns
Paralysis
Stroke
Surgery to aorta
Terminal Illness
The Critical Illnesses with Full Payout Advantage : Get the full benefit
amount for Critical Illnesses covered under this category. The benefit
amount payable is equal to the full sum assured chosen under the policy.
The Full Sum Assured as chosen under the plan is paid in the event of Death
or Total Permanent Disability of the Life Assured. This benefit is payable
even if death or disability occurs because of an accident.
Our claims process is an easy 3-step process. This will ensure that you get a
hassle-free and convenient claims experience.
Submit a written notice along with the proof of diagnosis of the critical
illness / disability / death required for claim.
LIC PRODUCTS
New Features :
LIC's Health Plus (Plan 901) : Health Plus is a first ever UNIT LINKED
HEALTH INSURANCE PLAN launched by L.I.C. of India. Health Plus
Unit Plans policy guards against the trauma that you may face due to
increased financial burden during hospitalization.The worst nightmare that
anyone can have is the one when a family member is hospitalized. Today,
when everything is uncertain nobody can be sure what will happen. A
seemingly small ailment can turn into major one. And what happens when
the earning member of your family is hospitalized? The family goes through
the trauma of a loved one being hospitalized as well as an increased financial
burden. There are hospitalization expenses, doctors fees and various tests to
be carried out.. Meanwhile the patient loses out on his earning for being
away from work, and a dismayed and worried family begins to feel the
anxiety of the financial implications.But with a policy from LIC you and
your family can rest assured!
LIC's Health Plus is unit linked Health Insurance plan which provides for
insurance cover against following health risks:
Hospital Cash Benefit (HCB)
Major Surgical Benefit (MSB)
Eligible for a person (the Principle Insured (PI)) aged between 18 and 55
covering himself / herself. The spouse and/or dependent children may also
be covered under the policy
Premium amount paid upto Rs. 15000/- p.a .is eligible for tax exemption
under SEC 80-D of the Income Tax Act
ICICI Prudential offers health insurance plans under the following major need categories:
Hospitalisation Plans
• MediAssure
• Hospital Care
This financial guarantee during illness is not all that HealthAssure Plus
delivers. HealthAssure Plus comes with an added benefit: it insures your
life, as well. So should an unexpected accident or disability claim your life,
your family will receive the entire Sum Assured-an amount large enough to
ensure they live securely, even in your absence.
Maturity benefit: Receive a 'No claim benefit' when the policy term ends,
provided you have made no claims during the tenure. The Maturity Benefit
is equal to the sum total of all the premiums paid.
Surrender Value: You can surrender your plan after 3 years of cover. The
Surrender Value will be paid immediately, provided you have paid all your
premiums in the first 3 years.
Tax benefits: Enjoy tax benefits on the premiums you pay (under u/s 80 C)
for premiums paid for both Critical Illness and Life Cover.
Why Cancer Care
As someone who has seen family members and friends struggle to survive
Cancer, you have undoubtedly suffered yourself. You know the extent to
which the illness drains the family; that the loss is both emotional, and
financial.
You would have also read, time and again, articles where medical experts
unanimously agree that Cancer can attack anyone, anywhere, at any time.
But this truth is only one part of the whole picture. Doctors also verify that
those with a family history of Cancer are especially prone to being affected
by it.
Given all these important facts, have you stopped for a moment and asked
yourself, "Why have I not insured myself against Cancer?"
ICICI Prudential suggests you insure yourself, right away, with Cancer
Care-a comprehensive Cancer insurance policy, which enables you and your
family to stay financially and mentally secure should you be diagnosed with
early or advanced Cancer.
Read more about the features and benefits of this plan that provides you with
a Sum Assured of up to Rs. 25 lakhs.
Cancer Care covers most forms of early and advanced stages of cancer that
affects both men and women. Following are the most common cancers that
are covered under Cancer care:
Breast Cancer
Cancer of Cervix
Ovary Cancer
Oesophagus Cancer
Lung Cancer
Lung Cancer
Oesophagus Cancer
Larynx
Stomach Cancer
Hypolarynx Cancer
Prostrate Cancer
Cancer of the stomach, large bowel, bladder, head and neck, liver, pancreas,
gall bladder, brain, kidney, lymphoma, leukemia, thyroid, and skin. These
cancers also affect men and women at an advanced stage.
Cash payouts: Meet your expenses at for diagnosis, treatment and surgery,
with cash payouts at various stages.
Sum Assured up to Rs. 10 lakhs: Receive this amount for a premium as low
as Rs. 250 a month.
If you would like to know more about this plan, please click here for our
advisor to contact you!
This Plan goes a set beyond providing you comprehensive coverage against
Cancer by providing a wellness program to all the Cancer Care Plus policy
holders.
Cancer does not discriminate between the rich and poor, young and old,
educated and uneducated. But the good news is that if detected early, the
chances of surviving the illness increases substantially.
With Cancer Care Plus, you not only safeguard your well-being but also
your savings, which stays intact, for this comprehensive plan pays for
diagnosis, oncological treatment and surgery of early and advanced Cancer.
Cover yourself with Cancer Care Plus today. It is the surest way to keep
yourself well-armed against India's most rapidly growing illness.
Wellness Program
What sets apart Cancer Care Plus is its unique Wellness Program. This is a
screening package that enables you to undergo specific tests, free of cost.
The tests will be conducted once in 2 years, starting from the second year of
the policy. This program will help in diagnosing the possibility of cancer at
the earliest stage, thereby initiating early treatment and increasing the
chances of survival. The tests will be conducted by the Company's
empanelled medical centers.
Minimum/Maximum
20 years to 60 years
Entry Age
Maximum Age at Policy
70 years
Maturity
Minimum/Maximum
10 years to 50 years
Policy Term
Breast Cancer
Cancer of Cervix
Ovary Cancer
Oesophagus Cancer
Lung Cancer
Lung Cancer
Oesophagus Cancer
Larynx
Stomach Cancer
Hypolarynx Cancer
Prostrate Cancer
Early cancers that affect men and women:
Hodgkin’s Disease
Cancer of the stomach, large bowel, bladder, head and neck, liver, pancreas,
gall bladder, brain, kidney, lymphoma, leukemia, thyroid, and skin. These
cancers also affect men and women at an advanced stage.
Free Cancer Screening through medical tests under the Wellness Program,
for the entire duration of the policy term.
Payout is independent of any other medical insurance plan you may have.
Cover up to Rs.10 lakhs against cancer, for a premium as low as Rs 300 per
month#
Tax benefits under Section 80D on premium paid as per prevailing Income
Tax laws.
# The premium is for a 30 year old male with 10 year term.
Free Cancer Screening Tests: As a Cancer Care Plus Policy holder, you are
entitled for FREE regular Cancer check-ups during the entire duration of the
policy term.
The screening package for the most common cancers amongst men and
women can be availed once in every two years from our network of medical
centres starting from the second policy year depending on the attained age at
that time.
The various tests which will be conducted for different ages are indicated
below:
Males
51 years Clinical examination, Prostate specific
and antigen (PSA) test, Stool examination-occult
above blood, Complete blood count, Chest X Ray,
Ultrasound of Upper Abdomen
20 to 40 Clinical examination, PAP smear, Complete
years Blood count, Chest X Ray
Females
Clinical examination, PAP smear,
41 years
Mammogram, Stool examination-occult
and
blood, Complete blood count, Ultrasound of
above
Pelvis, Chest X Ray
Cash payouts: Meet your expenses for diagnosis, treatment and surgery, with
cash payouts at various stages.
Claim starts at
Claim at Early
advanced cancer
Cancer Stage
stage
Rs. 1 lakh
Diagnosis of Early Cancer* NA
(10% of units)
Rs. 1 lakh NA
(10% of units)
Oncological Treatment
Benefit for Early Cancer
Oncological Treatment
Rs. 1 lakh Rs. 1.5 lakh (15% of
Benefit for Advanced
(10% of units) units)
Cancer
Rs. 10 lakh
Rs. 10 lakh (100%
Total Cover (100% of
of units)
units)
Tax benefits: Enjoy tax benefits on the premiums you pay (under u/s 80 D).
According to the WHO, India is the diabetes capital of the world, with more
than 20% of the diabetes cases. The main causes are our sedentary lifestyle,
poor eating habits and genetic pre disposition. India also has a high
prevalence of people with Impaired Glucose Tolerance (IGT) or Impaired
Fasting Glucose (IFG), pre-diabetic conditions, which lead to diabetes if not
managed early. Moreover, there is an increasing trend of onset of these
conditions at younger ages in India.
For the many diabetics, the above translates into an altered lifestyle
characterized by change in food habits, physical activity & medication. It
also brings along many serious health complications such as heart attack,
kidney failure & stroke, which may entail a huge financial burden.
On the other hand, regular monitoring, life style changes, medication and
diet control, can lead to a healthy life and postpone or possibly even avoid
the complications.
Keeping in mind the above, ICICI Prudential proudly presents ICICI Pru
Diabetes Care Active. This offering aims to provide you a comprehensive
diabetes management solution. While our Wellness Programme ensures that
you stay healthy, our insurance guarantees financial assistance in case a
critical illness does strikes. The plan aims to encourage, enable & offer you
incentives to manage your diabetes by reducing premiums for good diabetes
management.
Reduced premiums upto 20% on showing good control over your diabetes
Tax benefits under section 80D of the Income Tax Act, 1961
Wellness Programme
To enable you to regularly monitor your health and take necessary care, the
policy provides for a wellness programme, under which, you have to
undergo checkups as per a defined protocol every six months. This protocol
is described below and would be applicable in each policy year.
6th month of every policy year: HbA1c test, blood pressure and pulse
12th month (except in the last policy year*): HbA1c, lipid profile, blood
pressure, pulse rate and a doctor consultation
* The annual check-up would however not be provided for in the last policy
year as it would coincide with the end of the policy term.
Age at entry
25 - 35 36 - 50 51 - 65
years years years
Premium Reduction
7.50 % 10% 12.50%
Level 1
Premium Reduction
10% 15% 20%
Level 2
However, if your Diabetes Control Index increases, you may be required to
pay a higher premium on your base premium for the following year, as per
table below.
Age at entry
25 - 35 36 - 50
51 - 65 years
years years
Higher Premium Level
10% 15% 17.50%
1
Higher Premium Level
20% 30% 37.50%
2
Diabetes Coach
Aren’t there times when you have wished for someone who could help you
lead a healthy life? We present to you – Diabetes Coach!
Diabetes education
In addition, you will also receive support through information booklets and
goal trackers. That's not all. We also present to you our Diabetes Hotline, a
dedicated helpline for all your diabetes related queries. You can call us on
1800 - 419 - 1000 between 10:00 AM to 07:00 PM, Monday to Friday.
Diabetes Hotline and Diabetes Coach are value added initiatives by ICICI
Prudential Life Insurance Company Limited. These initiatives are purely
voluntary and free of charge. ICICI Prudential Life Insurance Company
Limited does not purport to provide advice of any nature. Only general
guidelines will be suggested in order to facilitate you to maintain good
health. We urge you to consult your family doctor for any medical needs as
these guidelines are not medical advice.
Financial Support
We know that when faced with a critical illness, money matters should be
the last thing on your mind. ICICI Pru Diabetes Care Active offers you
coverage till 65 years of age with 3 options of Sum Assured (SA) - Rs 3
lakh, Rs 5 lakh or Rs10 lakh.
ICICI Pru Diabetes Care Active will pay the full Sum Assured on diagnosis
of six critical illnesses and 50% of the sum assured on diagnosis of
Angioplasty, with the unused cover continuing for the remaining critical
illnesses.
Cancer
Heart attack
Stroke
Angioplasty*
Rider Options
ICICI Pru Diabetes Care Active offers you two optional rider benefits which
provide you additional protection.
If you opt for this rider, you get an additional procedure based cover for
Limb Amputation
The benefit under this rider shall be payable only once and only upon the
first ever occurrence of either of the above conditions. The benefit payable
shall be 10% of the sum assured under this policy. After the payment of the
benefit, the rider shall terminate but the base plan shall continue.
Time of diagnosis DEBR payout
First 6 months of the Return of the rider premiums paid till date
policy and policy terminates
50% of the rider sum assured, which is 5%
6 - 12 months of the base plan sum assured is payable and
rider shall terminate thereafter.
100% of the rider sum assured, which is
After 1 year 10% of the base plan sum assured is payable
and rider shall terminate thereafter.
However in case of poor control (as indicated by increase in DCI), you may
be charged an additional rider premium as below :
Note:
Incase on Angioplasty claim under base Diabetes Care Active, the rider will
continue for the 50% of the sum assured for the death benefit and future
premiums will reduce proportionately from the next policy anniversary. The
policyholder will continue to be eligible for the complete wellness
programme and reduced premiums / higher premiums as applicable.
However, subsequent premium reductions/ increase will apply to this
reduced premium.
The Sum assured will be payable on death any time during the policy term
before of a Critical Illness payment.
Health Support
Healthcare Partners
Fitness Centres
Tie-ups with over 250 fitness centre outlets across the country
Web Support
With ICICI Pru Diabetes Care Active, you also get access to a customized
web-pages which have been designed exclusively to help you monitor your
diabetes more effectively by providing you:
Claims
Claims Process
Our claims process is an easy 3 step process. This will ensure that you get a
hassle-free and convenient claims experience.
Submit a written notive along with proof of diagnosis of criticall illness/
surgery, required for the claim.
What does ICICI Pru Diabetes What does ICICI Pru Diabetes
Care Active cover Care Active not cover
Financial Cover Financial Cover
Therefore, if you show good control, your Diabetes Control Index will go
down and your premium will be reduced for the next year by 5% to 30% of
your 1st year's base premium!
If your results worsen or you miss any of the tests, your Diabetes Control
Index will go up. If it rises beyond a scale, you will be required to pay a
higher premium for the following year, as indicated below:
Financial Cover
The payout is made only in case the critical illness occurs for the first
time.
Regular free testing (HbA1c, Blood Pressure and Pulse rate check)
every 4th & 8th month, during the policy term.
One free consultation every year with an expert physician, till the
end of the first 4 policy years.
Financial Cover
If the policyholder does not survive beyond 28 days from the date of
diagnosis of a critical illness, the policyholder will not be eligible to
receive the critical illness payout.
After the lump-sum payout is made for the 1st critical illness, the
policy stands terminated.
Tests from diagnostic centers or doctors who are not from our
empanelled network will not be accepted/will not be paid for.
Partnerships
Diabetes Care Plus is a unique insurance policy that covers critical illnesses
and death for Type 2 diabetics and pre-diabetics. Diabetes Care Plus not
only provides financial support but also helps you manage your condition
more effectively.
Product Features
Eligibility
Type 2 Diabetics or Pre-Diabetics (IFG/IGT)
Sum Assured
The Sum Assured for CI/Rider will be paid as per the table below:
Rider Benefit
Time of Diagnosis CI Benefit Amount
Amount
Return of rider
First 6 months of the Return of premiums
premiums paid till
policy paid till date
date
50% of Sum 50% of Rider Sum
6-12 months
Assured * Assured
100% of Sum 100% of Rider Sum
After 1 year
Assured * Assured
Full death benefit is payable on death of the Life assured any time during the
entire policy term, including 1st policy year.
Premium
Premiums payable for Sum Assured of 3 Lakhs for a male are g iven below:
Policy Term
* The claim is payable only on survival for 28 days from the date of
diagnosis of the critical illness
# The premiums shown are exclusive of service tax and education cess
Wellness Program
Managing your diabetes is the key to staying healthy. As part of our
Wellness Program, we will sponsor you for three diagnostic tests and one
consultation every year, absolutely FREE.
In the 4th and 8th month every year after issue of the policy, you will need
to undergo HbA1c test and need to get your blood pressure and pulse rate
measured, which will help monitor your condition.
We will also offer a free consultation every year with an empanelled doctor,
for advice and an appropriate health care plan.
To make sure you don't miss any of your tests, we will send you periodic
reminders also.
Therefore, if you show good control, your Diabetes Control Index will go
down and your premium will be reduced for the next year by 5% to 35% of
your 1st year's base premium!
Age at Entry (years) 25-35 36-50 51-60
Premium Reduction
5% 10% 15%
Level 1
Premium Reduction
10% 20% 30%
Level 2
Premium Reduction
15% 25% 35%
Level 3
If your results worsen or you miss any of the tests, your Diabetes Control
Index will go up. If it rises beyond a scale, you will be required to pay a
higher premium for the following year, as indicated below:
Coverage
Regular free testing (HbA1c, Blood Pressure and Pulse rate check)
every 4th & 8th month, during the policy term.
One free consultation every year with an expert physician, till the
end of the first 4 policy years.
After the lump-sum payout is made for the 1st critical illness, the
policy stands terminated.
Diagnosis & Testing
Tests from diagnostic centers or doctors who are not from our
empanelled network will not be accepted/will not be paid for.
Diabetes Assure
Tax benefit on premiums paid under Section 80D of the Income Tax Act
You can choose from sum assured options of Rs.2 lakhs, Rs.3 lakhs, Rs.4
lakhs or Rs.5 lakhs
In the unfortunate event of kidney failure, diabetic retinopathy or limb
amputation due to diabetic complications, the policy will pay you the sum
assured as defined in the financial benefits section
Your premium is based on your age and the sum assured chosen by you
Premium Rates
SA/ 2L 3L 4L 5L
Age
30 2070 2418 2767 3115
40 2286 2738 3199 3644
50 2936 3705 4472 5239
60 3517 4548 5580 6611
The premiums shown include 2% rebate for annual payment mode and are
exclusive of service tax and education cess.
Financial Support
We know that when faced with a critical illness, money matters should be
the last thing on your mind. Diabetes Assure plan offers a cover for a period
of 5 years with four Sum Assured options - Rs.2 lakh, Rs.3 lakh, Rs.4 lakh
or Rs.5 lakh.
Tax Benefits
The premiums paid by you under this plan will be eligible for tax benefits
under Sec 80D, as a premium paid towards a health insurance product.
The worst nightmare that anyone can have is the one when a family member is
hospitalized. Today, when everything is uncertain nobody can be sure what will happen.
A seemingly small ailment can turn into major one. And what happens when the earning
member of your family is hospitalized? But with a policy from Bajaj Allianz you and
your family can rest assured!
It is rightly said ‘Health is Wealth’. We are all aware that health care costs are high and
getting higher. At times, unfortunately we fall prey to unanticipated accidents & illness.
Bajaj Allianz promises to stand by you during those difficult times of physical and mental
stress. Our Health Guard policy takes care of your hospitalization expenses & also offers
a wide coverage of pre & post hospitalization expenses. We are the first company to
provide the higher coverage of SI 10 lacs
Features
• The member has cashless facility at over 2400 hospitals across India
• The member can opt for hospitals besides the empanelled ones, in which the
expenses incurred by him shall be reimbursed within 14 working days from
submission of all documents.
• Pre and post - hospitalization expenses covers relevant medical expenses incurred
60 days prior to and 90 days after hospitalization.
• Cumulative bonus of 5 % is added to your sum assured for every claim free year.
• Family discount of 10 % is applicable.
• Covers ambulance charges in an emergency subject to limit of Rs. 1000 /-
• No tests required up to 45 years up to SI 10 lacs*
• 10% co- payment applicable if treatment taken in non-network hospitals. Waiver
of co-payment is available on payment of additional premium
• Pre-existing diseases covered after 4 years continuous renewal with Bajaj Allianz
Benefits
• In house Health Administration Team for hospitalisation claims to lower turn
around time
• Access to over 2400 hospitals all over India for cashless facility.
• No Sub-limits applicable on room rent and other expenses.
• Hassle-free claim settlement due to In-house claim administration.
• Income tax benefit on the premium paid as per section 80-D of Income Tax Act as
per existing IT law.
• Health Check up for maximum amount of Rs. 1000 /- at the end of continuous
four claim free years
• Family discount of 10% is applicable
Coverage
With a Hospital Cash policy from Bajaj Allianz you and your family can now breathe a
sigh of relief! As this is a benefit policy which covers the incidental expenses incurred
during the Hospitalization period. In the event of hospitalization this policy provides a
cash allowance of Rs 500-2500 for each day of hospitalization.
Features
Benefits
• . Covers miscellaneous expenses incurred during hospitalization.
Coverage
• SI available from 500-2500.
• Cover available for 30days & 60 days.
Critical illness policy provides protection from the life threatening illness, which can
hamper your routine life style. With a critical illness cover you can secure yourself from
such contingencies. This is a benefit policy which pays the SI as lump sum amount once
you are diagnosed with one of the listed critical illness*
• Cancer
• Multiple Sclerosis
• Paralysis
• Coronary Artery Bypass Surgery
• Major Organ Transplant
• Primary Pulmonary Arterial Hypertension.
• First Heart Attack
• Stroke
• Kidney Failure
• Arota Graft Surgery
Features
Medical examination may be required in some cases based on the age and the benefit
amount opted by the propose
Benefits / Advantages
Coverage
Life is full of uncertainties and unexpected events. Accidents can happen at home, at
work, even at play. The death or injury of a breadwinner can create serious financial
problems for any family. It is in situation like these, that you need to be prepared. To help
you soften the blow Bajaj Allianz offers the Personal Guard cover. Our Personal Guard
Policy offers these additional benefits.
Features
Benefits
Coverage
Features
Advantages
Coverage
In the times of rising medical costs Bajaj Allianz's Insta Insure Family Health Policy is
the perfect health protection for you and your family. It takes care of the medical
treatment costs incurred during hospitalization due to serious accident or illness. The
policy also pays an amount equivalent of 2 % of admissible hospitalization expenses
towards pre and post hospitalization medical expenses and ambulance charges in case of
emergency (subject to a maximum of Rs1000). The proposer (self insured) under the
policy is also covered for a sum insured of Rs1lac against death due to accident
3 easy steps -
Select your desired insurance plan
Pick the Kit to fill the proposal form
Pay your Premium by Cheque/Card/Cash and get insured
Features
Benefits
Coverage
• 1 lac family floater cover towards Hospitalization expenses & 1 lac death cover
for the proposer
• The policy covers ambulance charges in case of emergency subject to a maximum
of Rs 1000
• 130 day care procedures subject to terms and conditions
• Pre-existing diseases covered after 4 years’ continuous renewals with us
• A flat benefit of 2% of admissible hospitalization expenses towards pre and post
hospitalization medical expenses
Eligibility
Premium
Self
Rs.1,550
Self + Spouse Rs.2,050
Self + Spouse + 1 Child Rs.2,300
Self + Spouse + 2 Children Rs.2,550
Star Package policy is a unique family floater policy which protects your family against
various risks and contingencies. It provides a gamut of covers for various health risks,
household contents, education grant, travel baggage and public liability all under a single
policy. It has 8 sections and you would have to opt for a minimum 3 sections to avail for
this policy.
Features
Coverage
As the age of an individual increases the health care costs increase & become a burden on
the individual. The senior citizens have to pay out the hard earned savings to meet the
expenses. Bajaj Allianz’s Silver Health plan is exclusively designed for the senior
citizens, which covers medical expenses incurred during hospitalization period.
Features
Advantages
Cumulative bonus of 5 % added to your sum assured for every claim free year.
Health Check up at the end of continuous four claim free years.
Family discount of 5 % is applicable.
Income tax benefit on the premium paid as per section 80-D of the Income Tax Act as
per existing IT law
Coverage
Bajaj Allianz launches e-opinion rider, which will cover the expenses of 2nd opinion e-
consultation services for serious illness in India. The policy offers unprecedented access
to over 7000 physicians employed by the renowned hospitals of the WorldCare
Consortium. This innovative e-opinion rider gives you an opportunity to obtain best of
international expertise at a fraction of the cost.
Features
• Anyone taking this plan is entitled to take a second opinion should there be any
illness and an expert consultation is required.
• This rider entitles you to have a 2nd opinion from renowned hospitals of the
WorldCare consortium of hospitals like Clevland Clinic, Duke University,
Massachusetts General Hospital, Brigam and Women's Hospital.
• Qualified physicians from these renowned hospitals will render a written report
which includes a diagnosis and treatment plan within 7 working days .
Benefits
Advantages
• Valuable 2nd opinion at nominal cost without physically visiting these renowned
hospitals.
• Opinions for major critical illnesses
QUESTIONNAIRE
How do you come to know about this particular plan in this company?
a) Advertisements b) Hoardings
Does the company informs you about the premium renewal for every period
a) Yes b) No
Do you think that the premium paid in this company is less compared to
another company?
a) Yes b) No
a) Yes b) No
What is the policy term? How much return are you getting?
a) 3 b) 24 c) 10
a) Yes b) NO
How do you come to know about this particulars plan in this company ?
a) Advertisement b) Hoardings
4 LIC
3 ICICI
BAJAJ
2
0
1st Qtr 2nd Qtr 3rd Qtr 4th Qtr
OBSERVATION:
In insurance sectors all the private companies are trying to promote their
insurance plans through media. but LIC is still bringing its plans through
newspapers, hoardings and through LIC agents.
Even private sector companies are recruiting more and more agents to sell
more policies.
Dos the company informs you about the premium renewal for every period?
a) Yes b) No
YES NO
LIC 9 1
ICICI 10 0
BAJAJ 11 0
12
10
8
LIC
6
ICICI
4
BAJAJ
2
0
YES NO
OBSERVATION:
a) Yes b) No
YES NO
LIC 6 3
ICIC 4 6
BAJAJ 2 7
7
6
5
4 LIC
3 ICICI
2 BAJAJ
1
0
YES NO
OBSERVATION:
a) Yes b) No
YES NO
LIC 6 3
ICICI 9 1
BAJAJ 9 0
10
6 LIC
4 ICICI
BAJAJ
2
0
YES NO
OBSERVATION:
Both private and public sector companies investors are satisfied by taking
the policy.
But there are some investors who are not satisfied by taking polices its
because the companies did not reached to their expectations.
What is the policy term? How much return are you getting?
400000
350000
300000
250000 LIC
200000
ICICI
150000
100000 BAJAJ
50000
0
10YEARS 20YEARS
OBSERVATION:
Infect HDFC is also given good returns in long term but its not happening in
the period of short term.
3 24 4 6 NO
LIC 0 0 0 9 0
ICICI 0 0 0 5 5
BAJAJ 0 0 0 5 4
10
6 LIC
4 ICICI
BAJAJ
2
0
3 24 4 6 NO
OBSERVATION:
10
8
6
LIC
4 ICICI
2 BAJAJ
0
EXCELLENT GOOD
OBSERVATION:
The service provided by both private and public sector companies are on
average.As the ICICI health insurance is providing more and more service to
investors it is rated as excellent.EX: SWITCHING OPTION -6 TIMES
FLEXIBLE ALLOCATION OF FUNDS
Do you have the chance of partial withdrawals per policy.
a) Yes b) No
YES NO
LIC 0 9
ICICI 6 4
BAJAJ 7 5
10
6 LIC
4 ICICI
BAJAJ
2
0
YES NO
But investors can take loans against these plans. EX: HDFC-
MINIMUM AMOUNT 5000/-
e) No Idea
10
6 LIC
4 ICICI
BAJAJ
2
0
25% 10%TO60% NO IDEA
OBSERVATION:
For every year these premium allocation charges varies from company to
company.
How much is the additional allocation of units ?
8
7
6
5
4 LIC
3 ICICI
2
BAJAJ
1
0
0.10% 0.50% NO
IDEA
OBSERVATION:
90
80
70
60
50 LIC
40
30 ICICI
20 BAJAJ
10
0
EXCELLENT VERY GOOD NOT BAD
GOOD
OBSERVATION:
The performance rated by the customers for both public and private sectors
on are average they still need to be improved in both services as well as in
returns.
As feed back given by the LIC investors what we found is the development
officers are not giving proper service to them.
LIC 1 1 2 5
ICICI 5 2 1 2
BAJAJ 6 3 1 2
3
LIC
2 ICICI
BAJAJ
1
0
EXCELLENT GOOD
OBSERVATION:
In overall rating ICICI is the company which are giving returns and going to
launch more and more plans.
Even LIC is performing well in giving returns but the infrastructure and
delightment given to the customers are not up to the mark of private
companies.
YOUNG STAR TERM PREMIUM RETURNS
LIC 20 15094 69000
ICICI 20 15000 602737
BAJAJ 20 15000 600000
600000
500000
400000
LIC
300000
ICICI
200000 BAJAJ
100000
0
TERM RETURNS
OBSERVATION:
Both private and public sector companies are giving more retunes. But in
LIC the amount for premium is very less it depends on age of policy holder.
ICICI is giving good returns on par with rest of the companies in young star
plan.
OUR FINDINGS
LIC comfortable: the public sector major life insurance corporation (LIC)
was comparatively in a much more comfortable situation ,reporting a
22%growth in profit at rs.774 crore .
The average break even period for life insurance companies was said to be
when the sector was opened upto private sector entry at the term of this
millennium. A few private players have been able to reduce their losses this
year or prevent from getting work.
GOOD PERFORMANCE:
ICICI- 68 crore
The general insurance markets grew at about 22%to reach a level just under
rs/-25000 crore in premium in 2006-2007 . the public sector companies head
a market share of 65% which eight companies head a market share of 35%s
"In total LIC planned to invest around Rs 117 lakh crore this financial year
of which Rs 52,000 crore had been already invested," he said.
No Claim Bonus: It is the amount by which your sum-assured increases in case of claim-
free year.
Family Discount: When the husband or wife and children or dependent parents are
covered under one policy, a ceratin percentage of discount is given on total premium
called Family discount.
No Claim Discount: It is the discount you get on premium amount in case of any claim-
free year.
ARTICLES
Mumbai, Oct. 5
Life Insurance Corporation of India will file its maiden health insurance
product with the insurance regulator by next month. The product will be a
long-term policy and have a savings element, said Mr D.D. Singh, Executive
Director (Health), LIC.
Munich Re will be the reinsurer for LIC on this product. The premium for
the product will increase progressively on an annual basis as the customer’s
age increases.
LIC has already chosen eight third party administrators for servicing claims
from this product. The payment of claims will, however, be made by banks,
selected by LIC. “We have selected Syndicate Bank, Axis Bank and Bank of
America for the payment of claims,” Mr Singh told reporters, on the
sidelines of a health seminar organised by CII.
Mr Singh said the Government was inclined to have LIC’s health insurance
business as a separate subsidiary. But the Corporation had to take a call on
going ahead with this.
Among the other life insurance companies, Bajaj Allianz Life has a long
term health insurance product. ICICI Prudential Life and HDFC Standard
Life are also looking at health insurance products.
New Delhi: Life Insurance Corporation of India has got the approval of
regulator IRDA for its health insurance product 'LIC Health Plus', which
would be launched by February.
LIC is targeting to provide health cover to close to one crore families in the
first year of the launch of the product and expects over Rs 5,000 crore of
revenues.
The company has claimed that the present cashless model is not in favour of
the customer as many hospitals were not accepting the facility. Moreover, in
many cases hospitals are charging more if a patient comes with an insurance
cover that offers cashless treatment.
The sources said unlike the current mediclaim products offered by general
insurance companies that cover the insured's hospitalisation expenses and
are annual in nature, LIC would pay the insured a predetermined lumpsum
amount, depending on his premium payment.
LIC has set up its health department at Hyderabad, which will contain the
centralised data. It is also learnt that the product will not have a level
premium and will increase with the age of the insured and if more benefits
are opted for. The pre-existing diseases will be covered, but with some
clauses.
The company's prospects in health insurance business may brighten once the
premium rates are liberalised by the IRDA early next year, as the group
health insurance premium rates would go up.
The timing is also right as January-March are busy months for life insurers
as people buy policies to save on their taxes. With an army of around 10
lakh agents LIC plans to sell around 1 crore policies during this period.
To cope with the expected sales, the life insurer''''s technology team is
already getting the software ready to sell the product.
It is also learnt the primary insurance cover will be hospital cash. The value
of surgical benefit would be arrived as a multiple of the hospital cash.
On the death of the principal policyholder, the spouse would become the
principal policyholder and could use the balance in the fund.
On the death of the spouse, the fund balance would be given to the
nominees or legal heirs.
Challenging target
While the concept of unit-linked health insurance is interesting, is this
target of earning Rs5,000 crore in three months from crore policies, an
ambitious one?
A 1977 batch officer cadre recruit, the 53-year old Singh is charting LIC''''s
entry in to health insurance foray sitting in Hyderabad. He has more than a
decade''''s experience in marketing at branch and divisional office levels,
apart from working in LIC''''s information technology, and training
divisions.
Singh is betting on LIC''''s army of ten lakh agents and an existing client
base of 17 crore policies. Moreover, the productivity of LIC''''s agents in
terms of number of policies sold in a year is high, averaging around 37,
compared to the agents of private life insurers.
A life insurance agent gets around 40 per cent commission on the first year
premium when he sells a life policy. On the other hand the commission
paid by non-life insurer on its health insurance policy is not more than 15
per cent.
"The intensity of post sales service in the case of health insurance is high as
compared to a life insurance policy. Given the ticket size, the commission
rate and post sales service, it is doubtful whether a life insurance agent
would be enthused to sell what is primarily a non-life product," adds
Gopalarathnam.
What he says may hold true for private life insurers who pay their
individual agents around 40 per cent of the first year premium as
commission up to 70 per cent for bancassurance / corporate agents.
According to Singh, LIC has priced its health insurance product taking
everything into account.
Adds Agarwal, "Unlike other Indian life insurers, the commission paid to
our agents on selling life policies is low."
Perhaps LIC''''s health insurance policy may eat into the sales of normal
ULIP and that too of private life insurers.
The TPA would first advice LIC on the permissibility of the claim. "LIC
would in turn instruct a select group of bankers to issue the claim cheque to
its health insurance policyholders," explains Singh. LIC has tied up with
Syndicate Bank, Axis Bank (formerly called UTI Bank) and Bank of
America for issuance of claim cheques to health insurance policyholders.
"We have drawn strict level agreements with the TPAs whereby identity
cards and claims processing should be done within a stipulated time,"
explains Singh.
This way LIC avoids the problem of funding the TPA to settle the claims
as it happens in the non-life insurance sector.
Agrees Ramakrishnan, "In India there is no data that tells the number of
times a person falls sick, in order to be able to design a long-term health
insurance policy. It is a great challenge for any actuary in India."
To overcome this crucial handicap, Agarwal and his team used the
morbidity experience of UK and South Africa.
The non life insurers have to contend with fraudulent health insurance
claims as their policies deal with reimbursement of expenditure.
Is there a downside?
The downside of LIC''''s policy is that the policyholder is tied to a sum
insured chosen at the time of taking the policy for a long term.
"What LIC would offer is a long-term document. A policy that does not
factor inflationary trends in health care costs will not be of much help to a
policyholder in the long run," feels K N Bhandari, former chairman and
managing director, New India Assurance Company Limited, and secretary
general, General Insurance Council of India.
"The existing health insurance policyholders can also take our policy as it
is beneficial. If a policyholder suffers some life critical illness like cancer,
kidney failure, etc, then the entire family''''s wealth is wiped out during the
last six months of the patient''''s life. Our policy will help to meet such
contingencies."
LIC would pay the agreed fixed sum even if its policyholder holds a
separate mediclaim policy, while non-life insurers contribute
proportionately to the claim when a policyholder holds more than one
mediclaim policy
Singh says, "The Indian insurance market is also getting ready for co-
payment of expenditure where the insured is made to share part of the
claim amount. "In motor insurance the concept of co-payment has been in
vogue for the past several decades."
Today the non life insurers are making their policyholders share some part
of the hospital bill.
If all goes according to its plans, LIC seems to have a winning product on
its hands. Realising this, it plans to launch some more health insurance
products.
ICICI PRU LIFE INSURANCE CROSSES 2 MN
POLICIES MILESTONE
ICICI Prudential was one of the first private life insurance companies to
commence operations after the privatization of the sector in 2000. Over the
years, it has enhanced its understanding of various saving and investments
need of customers and launched a series of flexible products to meet the
same, spanning the segments of child plans, retirement solutions, health
plans, savings solution as well as pure protection plan. For the period April-
December 2005, the company’s retail market share stood at 31.8% amongst
all private companies and 11% of the total market.
PLAN
Private sector life insurance business jumps 90%
Mumbai, May 10 In a tough battle to expand market shares the private sector
life insurance industry consisting 14 life insurance Companies at 26% have
lost 3% of market share to the state owned Life Insurance Corporation(LIC)
in the domestic life insurance industry in 2006-07.
Among other private players, SBI Life and Reliance Life continued to do
well, each gaining 4% market share in FY07. SBI Life’s growth was driven
by increasing contribution from ULIP premiums. Another notable
developments of the 2006-07 performance has been the expansion of retail
Markets by the life insurance comapnies. Bajaj Alliannz Life insurance has
added 20 lakh policies while ICICI Prudential has expanded over 19 lakh
policies during the year
1. 1st time in India a ‘Health+Life’ policy that provides health insurance benefits
coupled with life insurance.
5. Tie-up with leading hospitals across 200 towns and growing to more towns
9. All medical records available online and can be accessed by insured from
anywhere.
Kolkata, June 11th , 2007: Bajaj Allianz Life Insurance has once again taken the lead
amongst pvt. sector life insurance cos. in providing superior products which suite
customer needs by launching India’s first ‘Health+Life’ cover plan.
First of its kind long term medical policy, already has access to finest hospital across 200
towns in India and speaking at this occasion Sam Ghosh Country Manager Allianz &
CEO Bajaj Allianz Life was very proud to say that “With the new & unique cashless
Bajaj Allianz Care First Plan the common man would also be able to get the finest
medical care incase of emergencies and hospitalisation without the worry of
arranging for paying heavy bills.” He also said “ we are the only company to offer a
long-term medical policy with guaranteed renewal upto age 65 without medicals
BAJAJ ALLIANZ
Bajaj Allianz Care First the finest medical policy.”
Some of the key highlights of this products are:
.
6. Same premium for 3 years: this long term health care plan comes with
an assurance of 3 year same premium.
SUGGESTIONS:
1. Both public and private sector companies are to be improved in giving
services to their investors.
3. Even plans for students should be implemented so that they can have a
financial security in long term.
5. The insurance agents have to explain them thoroughly about the policies and
their advantages. But most of the agents are just trying to sell their policies
for their benefit.
7. Even the branch manager should train their development officers in knowing
about the market share.
ex: in LIC most of the development officers are not aware about their market
share .that’s they failed in explaining to their investors.
8. Both the percentage of repudiation and declining claims are increased from
company to company in private sector. But in public sector its the only LIC
company going on an average.
9. In private sector insurance companies they are selling more number of unit
linked plans. They are not concentrating on traditional plans. So people are
diverting to LIC. Today it’s the only LIC which is having more number of
customers its all because of their long term policies.
11. As per the feedback given by the investor what we found is not even a single
investor is able to tell how much percentage of premium is allocated every
year.
12. The Information about the allocation of funds i.e. how much amount of
premium is invested on different funds must be inform to the investors.
• By this investor also have an idea that how much return will they get
and even the fund value.
FAQs - General
Q2. When does the cover start? (What is the waiting period under
Hospital Care policy?)
Ans: There is a waiting period of 90 days except for accidental claims. Thus
your cover starts from 90 days of policy issue date.
Q4. Can I switch from one plan A to some other plan during the tenure
of the policy?
Ans: No. You cannot switch from one plan to another. You can take a fresh
additional policy under any plan subject to a maximum Daily
Hospitalization Cash Benefit (cumulative of all policies) equal to plan D.
Q5. Can I buy this policy for my family? For whom all can I buy this
policy?
Ans:You can buy this policy for your family, which includes your spouse
and children.
Q6. Can a married woman take the policy for her parents?
Ans: No. A married woman cannot take the policy for her parents.
Q7. Do I have to undergo medical tests before enrolling under any Plan
type?
Ans: As per underwriting norms, if you choose plan A or plan B, and you
happen to be in the age group of 1 - 45 years, you would not required to
undergo medical tests.
Our representative will call the proposed insured(s) for prior appointment for
the medical tests (mentioned above) within 2 days of receipt of full
premium.
This leaflet is indicative of terms, conditions, warranties and exceptions
contained in the insurance policy. For further details, please refer to the
policy document. In the event of conflict, if any, between the terms and
conditions contained in this leaflet and those contained in the policy
document, the terms and conditions contained in the policy document shall
prevail. Insurance is the subject matter of the solicitation © 2007, ICICI
Prudential Life insurance Company Limited. Hospital Care: Form No.: T12
FAQs - Claims
Q1. How many claims can be made during the policy term?
Ans:One can make multiple claims during the policy term subject to the
yearly limit and Policy Term limits available.
Q2. In case of taking claim from two insurers, will I need to furnish all
original documents to ICICI Prudential?
Ans:
- It is always preferred to submit all the documents in original only.
However, if you need to retain the originals (for claim to be raised with other
company) the photocopies can be provided (the same to be verified against
originals by ICICI Prudential official)
- Incase the hospital has submitted the original documents directly to your
insurance company; the hospital can issue duplicate copies of the same.
These will be accepted only if the hospital issues a certificate stating that the
originals are submitted to another insurance company. The certificate must
state name of the insurance company / TPA whom the documents are
submitted.
Q6. Will a claim be entertained if it's not from the Network Hospital?
Ans:Yes, we will entertain the claim from Non Network Hospital provided
the terms and conditions under the policy are met. A Hospital Network is
created by the company in order to facilitate the cashless hospitalization and
convenience to customer.
Q9. What is grading of surgery and are the procedures according to any
standardised definition?
Ans:There are 4 surgery grades under this policy, the benefit are payable
based on the type of surgery undergone.
The surgical procedures are described as per the International Classification
of Diseases (ICD) prescribed by World Health Organization.
Q10. Can a surgery claim be made even if the procedure does not
require Hospitalisation?
Ans:Yes. The applicable surgery benefit will be paid as per the surgery
grade. As long as the surgery is in the list of covered procedures, the payout
is not dependent on Hospitalization. However other benefits (Daily
Hospitalisation Cash Benefit, Intensive Care Unit Benefit & Recuperating
Benefit) will not be paid.
Q14. What is a health card and the benefit of carrying a health card?
Ans:A health card is a card that comes along with the policy. It sent to you
as part of the Welcome Kit and contains your name and policy number. This
card would entitle you to avail cashless hospitalisation facility at any of our
network hospitals.
BENEFITS:
Q17. What if I have to get admitted but my Health Card is lost and I am
waiting for the new card?
Ans:In case of a hospitalisation you need to quote the Policy number and
card number in the authorization form and get the authorization. Carry a
photo ID card with you at the time of admission.
Q18. What is the turn around time for receiving the re-imbursements in
case of non-network hospitals?
Ans: We will process the claim and dispatch the cheque in 7 working days
Q19. With which hospitals, is the cashless facility available and how can
I get the list?
Ans: The list of more than 3000 hospitals across India is available on our
website. This list will also be sent to you along with the policy certificate.
The claims procedure and the health card will also be sent along.
Ans: You are entitled for a claim made overseas, provided the diagnosis and
treatment occurs from the specified list of countries mentioned in policy
document. List of countries covered: Australia, Brunei, Canada, Dubai,
Hong Kong, Japan, Malaysia, New Zealand, Singapore, Switzerland, UAE,
USA, and countries of the European Union.
Q3. Can this policy be proposed to family? Which family members are
eligible?
Ans: The claim needs to reported within 60 days from the date of
discharge/diagnosis All claims will be settled in 7 working days after
receiving request.
Ans: Apart from the 35 conditions covered under the plan, a diabetic will be
denied the plan
Ans:Yes. Both claims will be entertained since CIBR and CC are considered
as two separate policies. However, the total payout can not increase Rs. 20
Lakhs.
Q9. Can I buy another health or life policy from ICICI Prudential in
case my crisis cover plan is lapsed?
Ans:Yes, you can buy another life plan even if Crisis Cover is lapsed.
However, in case you are buying another health plan within 12 months of
lapsing Crisis Cover, all the arrear in premium will have to be cleared first.
There is no such condition if you buy another plan after 12 months
Q11. If somebody has both Health Assure and Crisis Cover plans, can
he claim them for two different CIs?
Ans:The CI plans cover the person for the first occurrence of the CI. Hence,
he would be paid all the benefit under various CI products/riders he has
taken from the company on the first occurrence of any of the CIs. It would
be very essential for a person to take all the money when a CI strikes him
first rather wait for a second CI to happen since the chances of the same
happening are very low.
Ans:No. Crisis Cover covers 35 critical illnesses along with death &
disability. The 35 critical illnesses are split under Group I & Group II, based
on their payout structure.
Ans:If the policy is in the waiting period, the benefit will not be payable.
The Premiums paid till date would be returned (ROP) and the policy will
close.
Ans:No, the cover cannot be increased. One can buy another crisis cover
plan, provided the total CI bucket does not exceed 20 lakhs.
Cancer Care FAQs, Benefits of Cancer Care, Cancer Cover, Cancer Care
Claims
Disease-related FAQs
Q2. If an individual has a history of early cancer and has just developed
cancer in another part of the body, what financial benefit can he or she
avail of under the policy?
Claims-related FAQs
Ans: For making a Cancer Care claim, you will be required to show all your
original documents at our branch. The originals will immediately be verified
and attested and the original documents will be returned to you. You can
submit the originals to your mediclaim company.
Q2. Why is there a 6-month waiting period for receiving a claim benefit
under advanced cancer while there is a one-year waiting period for
early cancer?
Q3. What benefits can I avail of for treatment of advanced cancer i.e.
chemotherapy, which is taken every 6 months or on a yearly basis for
more than 2 years?
Ans: In advanced cancer, the treatment benefit is a lump sum of 10% (if
early cancer benefit was claimed). The policy will continue to be in force
with cover for treatment and/or surgical benefits. This cover will be for a
maximum period of 2 years from the date of diagnosis of advanced cancer.
Q4. What benefits are given under Cancer Care if life assured is
diagnosed with cancer 3 months after the policy has been issued?
Ans: The individual will not be eligible for any claim if diagnosed after 3
months of policy issuance, as the waiting period in early cancer is 12 months
and advanced cancer is 6 months. He/she will be returned the premiums.
Q5. If I make a claim under advanced cancer in the 7th month, will you
settle the claim?
Ans: You will be eligible for treatment/surgical benefit for 2 years from the
date of diagnosis.
Miscellaneous FAQs
Ans: The following cancers are excluded under advanced cancer benefit:
Any pre-existing medical condition that can attribute to or increase the risk
of a particular cancer such as HIV/AIDS.
Diagnosis and treatment for cancer outside India. The company will waive
this clause for anyone residing in the following countries: USA, Canada,
countries of the European Union, Switzerland, Japan, Hong Kong,
Singapore, Brunei, Australia, New Zealand, UAE, and Malaysia. ICICI
Prudential may at its discretion review the list of accepted foreign
residencies from time to time. Claims documents from outside India are only
acceptable in English language unless specifically agreed otherwise.
Q2. Which benefits are given to the life assured if he or she dies within
the survival period i.e. 28 days?
Ans: If the life assured dies within the survival period he or she will get
treatment benefits but not diagnosis benefits.
Q4. Will you accept the proposal form if the life assured has family
history of cancer?
Ans:Yes, we will accept the proposal form. You will be required to submit
a detailed description of the parent's cancer history.
FAQs - Illness
Q2. If an individual has a history of early cancer and has just developed
cancer in another part of the body, what financial benefit can he or she
avail of under the policy?
FAQs - Claims
Q1. If I have a mediclaim as well as a Cancer Care Plus policy, I will not
be able to give you the original documents of treatments, surgeries etc.
since these papers cannot be issued in duplicate. How will I manage to
get both claims in such a case?
Ans: For making a Cancer Care Plus claim, you will be required to show all
your original documents at our branch. The originals will immediately be
verified and attested and the original documents will be returned to you. You
can submit the originals to your mediclaim company.
Q2. Why is there a 6-month waiting period for receiving a claim benefit
under advanced cancer while there is a one-year waiting period for
early cancer?
Q3. What benefits can I avail of for treatment of advanced cancer i.e.
chemotherapy, which is taken every 6 months or on a yearly basis for
more than 2 years?
Ans: In advanced cancer, the treatment benefit is a lump sum of 10% (if
early cancer benefit was claimed). The policy will continue to be in force
with cover for treatment and/or surgical benefits. This cover will be for a
maximum period of 2 years from the date of diagnosis of advanced cancer.
Q4. What benefits are given under Cancer Care Plus if life assured is
diagnosed with cancer 3 months after the policy has been issued?
Ans: The individual will not be eligible for any claim if diagnosed after 3
months of policy issuance, as the waiting period in early cancer is 12 months
and advanced cancer is 6 months. He/she will be returned the premiums.
Q5. If I make a claim under advanced cancer in the 7th month, will you
settle the claim?
Ans: You will be eligible for treatment/surgical benefit for 2 years from the
date of diagnosis.
BIBLIOGRAPHY
PRIMARY DATA:
IN LIC COMPANY WE GATHERED INFORMATION FROM:
1. Mr.AKASH
SECONDARY DATA:
a. www.licgov.in
b. www.moneycontrol.com
c. www.kotakmahindra.in
d. www.hdfc.com
e. www.licindia.in
f. www.bajaallianz.com
g. www.icicprudential.com
h. www.wikipedia.com
i. www.google.com
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