Easy Health Insurance Easy Health Product Benefit Sum
Easy Health Insurance
Easy Health Product Benefit Sum Insured Basis – – Individual Sum Insured Floater Sum Insured Benefit Type – – Indemnity Benefit Plans Standard Exclusive Premium Individual 1. 00, 1. 50, 2. 00, 2. 50, 3. 00, 4. 00, 5. 00, 7. 50, 10. 00 Family Floater 2. 00, 3. 00, 4. 00, 5. 00, 7. 50, 10. 00 2
Easy Health Product Benefit Basic Features – – – – – In-patient treatment Pre-hospitalisation Post-hospitalisation Domiciliary hospitalisation Day Care Treatment Daily Cash – Shared Accommodation Organ Donor Emergency Ambulance Health Check-up 3
Easy Health Product Benefit In-patient Treatment – – – – Room rent, boarding expenses, Nursing, Intensive care unit, Medical Practitioner, Anaesthesia, blood, oxygen, operation theatre charges, surgical appliances, Medicines, drugs and consumables, Diagnostic procedures, Cost of prosthetic and other devices or equipment if implanted internally during a Surgical Procedure. 4
Easy Health Product Benefit Pre-hospitalisation – – The Medical Expenses incurred due to an Illness in the 30 days immediately before the Insured Person was Hospitalised, provided that We have accepted an inpatient Hospitalisation claim For 60 days, if we intimated at least 5 days before the Hospitalisation NEW Post-hospitalisation – – The Medical Expenses incurred in the 60 days immediately after the Insured Person was discharged post Hospitalisation, provided that We have accepted an inpatient Hospitalisation claim For 90 days, if we intimated at least 5 days before the Hospitalisation NEW 5
Easy Health Product Benefit Domiciliary Treatment – – – The Medical Expenses incurred by an Insured Person for medical treatment taken at home, which requires Hospitalisation • Could not be transferred to a Hospital, or • Hospital bed was unavailable The condition continues for at least 3 days No payment for Asthma, Bronchitis, Tonsillitis and Upper Respiratory Tract infection including Laryngitis and Pharyngitis, Cough and Cold, Influenza, Arthritis, Gout and Rheumatism, Chronic Nephritis and Nephritic Syndrome, Diarrhoea and all type of Dysenteries including Gastroenteritis, Diabetes Mellitus and Insupidus, Epilepsy, Hypertension, Psychiatric or Psychosomatic Disorders of all kinds, Pyrexia of unknown Origin. 6
Easy Health Product Benefit Day Care Procedures – The Medical Expenses for a day care procedure or surgery where the procedure or surgery is taken by the Insured Person as an inpatient for less than 24 hours. 7
Easy Health Product Benefit Daily Cash - Shared Accom. NEW – Hospitalized in Shared Accommodation in a Network Hospital for each continuous and completed period of 24 hours if the Hospitalisation exceeds 48 hours Organ Donor – The Medical Expenses for an organ donor’s treatment for the harvesting of the organ donated provided the donor is a blood relative – Pre and Post hospitalisation expenses for Donor is not covered Emergency Ambulance – Expenses incurred on ambulance offered by a healthcare or ambulance service provider used to transfer the Insured Person to the nearest Hospital following an emergency 8
Easy Health Product Benefit Additional Features – – – Daily Cash – Accompanying Child Maternity Expenses Out-patient Dental Spectacles, Contact Lenses, Hearing Aid E-opinion for Critical Illness Coverage for New Born Optional Rider – Critical Illness 9
Easy Health Product Benefit Daily Cash – Accompanying Person NEW – If the Insured Person Hospitalized is a child Aged 12 years or less, We will pay a daily cash amount for 1 accompanying adult for each complete period of 24 hours if Hospitalisation exceeds 72 hours Maternity Expenses NEW – Medical Expenses for a delivery (including caesarean section) while Hospitalised or the lawful medical termination of pregnancy during the Policy Period limited to 2 deliveries or terminations – Waiting period of 4/6 years – Prenatal & post natal expenses covered upto sublimit Newborn baby NEW – If we have accepted a claim under Maternity expenses we will cover the new born baby under Inpatient Treatment from Day 1 10
Easy Health Product Benefit Outpatient Dental Treatment – – NEW From the fourth year onwards We will pay 50% of the expenses for dental treatment taken from a Network dentist We will only pay for Consultation, X-rays, extractions, amalgam or composite fillings, root canal treatments and prescribed drugs for the same Spectacles, Contact Lenses, Hearing Aid – – NEW Every third year, We will pay up to 50% of the actual cost of One pair of spectacles or contact lenses, and/or A hearing aid These items must be prescribed by a Network EYE/ENT specialised Medical Practitioner 11
Easy Health Product Benefit E-Opinion in respect of a Critical Illness NEW – If an Insured Person suffers a Critical Illness – At the Insured Person’s request We will arrange a second opinion from Our panel doctor. 12
Easy Health Product Benefit Critical Illness NEW – Cancer, Coronary Artery (Bypass) Surgery , Heart Attack (Myocardial Infarction), Kidney Failure, Major Organ Transplantation, Multiple Sclerosis, Paralysis, Stroke – The Insured Person is first diagnosed as suffering from a Critical Illness during the Policy Period and he survives for at least 30 days following such diagnosis. – Maximum three claims in lifetime – Cover ceasing age – 70 years – Optional Rider – 50% or 100% of Sum Insured – On Individual Sum Insured basis 13
Easy Health Product Benefit Exclusions – – – – – 30 days waiting period 2 year specific disease waiting period Pre-existing disease covered from 4 th year HIV, AIDS Internal & external congenital disease Non-allopathic treatment Artificial limb and external devices Cosmetic treatment Weight loss treatment Maternity (if not opted and within waiting period) 14
Easy Health Renewal Incentives Cumulative Bonus – – Available for every claim free year Sum Insured increased by 10% Maximum upto 50% of SI In the event of Claim, CB reduced by 20% of SI Health Check-up – Available in Claim Free year – Subject to waiting period of 2/3/4 year – Expenses reimbursed towards health check-up upto the sublimit 15
Easy Health Cashless Hospitalisation – – – Available in the Network hospital only Subject to pre-authorisation by TPA Approximately 4000+ network hospitals Specialised network for Dentist & ENT in the coming years Panel Doctors for Critical Illness 16
Easy Health Age Who can be insured – Self, Spouse, Children and Parents Entry Age – Self • Minimum 18 years and Maximum 60 years – Adult Dependent • Minimum 18 years and Maximum 60 years – Child Dependent • Can be covered from 91 st day if parent covered under same policy Cover Ceasing Age – Nil NEW 17
Easy Health Premium Calculation - Individual Premium excludes service tax and cess Family Discount 10% - 3 or more 18
Easy Health Premium Calculation – Family Floater Premium excludes service tax and cess Premium computed on Maximum age in the family 19
Easy Health Premium Calculation – Critical Illness Premium excludes service tax and cess 20
Easy Health Portability • • Comparable Individual Health Insurance Plans 30 days exclusion waiver 2 year exclusion waiver NEW Pre-existing Exclusion waiver – Min waiting period of 1 year • Transfer of Cumulative Bonus – 5% every year max 20% • No reduction in waiting period for other benefits 21
EASY HEALTH Standard Exclusive Premium Sum Insured per Insured Person per Policy Year 1. 00, 1. 50, 2. 00, 2. 50, 3. 00, 4. 00, 5. 00 1 a) In-patient Treatment Covered 1 b) Pre-hospitalization Covered 1 c) Post-hospitalization Covered 1 d) Day Care Procedures Covered 1 e) Domiciliary Treatment Covered 2 a) Daily Cash for choosing Shared Accommodation Rs. 500 per day, Maximum Rs. 3, 000 2 b) Organ Donor Covered 2 c) Emergency Ambulance Upto Rs. 2000 2 d) Daily Cash for accompanying an insured child Not Covered Rs. 300 per day, Maximum Rs. 9, 000 Rs. 500 per day, Maximum Rs. 15, 000 Rs. 300 per day, Maximum Rs. 9, 000 Rs. 500 per d Maximum Rs. 15, 000 2 e) Newborn baby Not Covered Optional Normal Delivery Rs. 25, 000* Caesarean Delivery Rs. 40, 000* (* Including Pre/Post Natal limit of Rs. 2, 500 and New Born limit of Rs. 3500) Normal Delivery Rs. 15, 000* Caesarean Delivery Rs. 25, 000* (* Including Pre/Post Natal limit of Rs. 1, 500 and New Born limit of Rs. 2, 000) Normal Deli Rs. 25, 000* Caesarean Delivery Rs. 40, 000* (* Including Pre/Post Na limit of Rs. and New Bo limit of Rs. 3 3 a) Maternity Expenses Waiting Period of 6 years Not Covered Normal Delivery Rs. 15, 000* Caesarean Delivery Rs. 25, 000* (* Including Pre/Post Natal limit of Rs. 1, 500 and New Born limit of Rs. 2, 000) 3 b) Outpatient Dental Treatment Waiting Period 3 years Not Covered 7. 50 Rs. 800 per day, Maximum Rs. 4, 800 3. 00, 4. 00, 5. 00 Rs. 500 per day, Maximum Rs. 3, 000 7. 50, 1 Rs. 800 per d Maximum Rs. 4, 800 Upto 1 % of Sum insured subject to Maximum of Rs. 5, 00022
Apollo DKV Service Commitment Documentation Timeframe Commitment: • Issuance of receipt on the same working day • Issuance of Policy in maximum 2 working days for clear cases. • Welcome kit Dispatch in 5 to 7 working days from the policy issuance date (Depending on location) Claim Process Timeframe Commitment: • Pre-authorization in maximum 2 Hours. • Query handling and Reply in 4 working days. • Rejection in maximum of 7 working days. • Claims reimbursement in maximum of 10 working days.
Executive Summary: Easy Health Retail Key Product Differentiators n Member is covered from ‘cradle’ to ‘grave’ i. e. no age restriction once member Guaranteed Renewal is covered with us n Competition stops coverage at a certain age n Sum insured ranges from 1 L to 10 L across the range of Standard, Exclusive and Choice of SI and Plans Outpatient Dental & Vision New Born and Maternity Premium plans with several intermediate options n More floater options than competition on SI and family definition n Vision and Dental benefits available in the Premium product n Dental benefit has a waiting period of 3 years, Vision can be availed every 3 rd year n New born baby cover is optionally available in the Exclusive and Premium product (provided parents are covered with us) n Maternity waiting period of six years in the individual product and 4 years in the floater CI rider and E-Opinion n Critical Illness rider available as optional rider benefit with core inpatient offering (Exclusive and Premium). Competition offers as stand alone n E-Opinion offered as standard benefit with Exclusive and Premium products n Up to 1% of SI for all products Health Checkup n Available every 4 th, 3 rd and 2 nd year for Standard, Exclusive and Premium product respectively 24
Executive Summary: Easy Health Retail Key Service Differentiators Health Risk Assessment n ‘Basic’ Health Risk Assessment available to all prospects Discounted MHC n One coupon for discounted MHC provided to every policy holder n Sophisticated version, with detailed prescription, available to members n Discounts available at ‘exclusive’ hospitals / clinics / diagnostic centers (price range from rs. 1200 to rs. 1800) SMS based information n Welcome message n Basic information made available to members e. g. 3 nearest providers based on zip code Community building Stay healthy card Health Line n Through use of “Let’s Stay Healthy” Blog n Personalized health information, newsletters etc n Mailed to members in the event of a hospitalization event n Reinforce ‘Let’s Stay Healthy’ and focused on positive health n Toll free contact number to for health tips and consultation manned by experts and professionals. n Personalized health consulting. 25
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