INTRODUCTION • Pure Health Insurance, hence no mortality cover • A unit-linked product – Premium paid will be subject to allocation charge – Balance credited to Policy Fund Account
POLICY FUND – A UNITLINKED ACCOUNT • Policy Fund Account will be subject to – Health cover charge plus service tax – Policy charge
• These charges shall be deducted on monthly basis
POLICY FUND – A UNITLINKED ACCOUNT (Contd) • Policy fund will be invested as per below – Not less than 50% in Govt. securities/Govt. guaranteed securities & Corporate debt – Not less than 10% & not more than 50% Equity – Balance Money Market instruments – Single fund - no choice of funds, no switching – NAV declared daily
ELIGIBILITY CONDITIONS • Premium : – Max. Premium – No limit – Min. Premium (p.a) - Rs.5,000 for single life - Rs.7,500 for 2 lives - Rs.10,000 for more than 2 - Minimum will also depend on level of cover - In multiples of Rs.500/-
ELIGIBILITY CONDITIONS • Age : – Min. entry age :
18 for PI & Spouse (lbd) 3 months for children – Max. entry age : 55 for PI & Spouse 17 years for children – Max. cover ceasing age : 65 for PI & Spouse 25 for children – Max. premium ceasing age: 65 for PI
BENEFITS • Following health covers shall be provided – Hospital Cash Benefit (HCB) – Major Surgical Procedures (MSP)
• Policy fund shall also provide – Domiciliary Treatment benefit (DTB) – Any excess spent on treatment than what is available on hospitalisation/surgical procedure
BENEFITS (Contd) • Covers can be taken for – self (Principal Insured (PI)) – spouse – dependent children (no ceiling of number)
• Any eligible existing spouse/children if not covered cannot be covered in future • Any subsequent spouse (on marriage/ remarriage) or children (on birth/adoption) can be covered within one year from policy anniversary
BENEFITS (Contd) • On death of PI :
paid • On death of other members :
- Premium stops - If other lives are there cover continues if at least, 3 years’ premiums have been paid otherwise balance in policy fund
No change except charges for them stop
BENEFITS (Contd) • Benefits : – Hospital Cash Benefit (HCB) Min. Rs.250/Max. Rs.2,500 for PI & Rs.1,500 for others (in multiples of Rs.50) For others benefit cannot be more than that of PI In case of ICU – double
BENEFITS (Contd) HSB (Contd) Inflation/Increase : 5% p.a. subject to max. 150% of initial benefit 1st year maximum : 18 days which may include 9 days’ ICU Subsequent year max.: 60 days which may
BENEFITS (Contd) • Maximum life time : • Waiting period :
365 days 180 days except accident
• Exclusions : • Qualified per day :
Usual After 2 days every day or part (4 hrs or more)
BENEFITS (Contd) – Major Surgical Benefit (MSB) : S.A = 200 times of per day HSB Minimum age for benefit eligibility : 18 : 40%, 60% and 100% for different procedures : Each surgery covered once only Per year maximum : 100% of SA
BENEFITS (Contd) Max. life time Waiting period Exclusions
: 3 times of S.A : 180 days : Usual
BENEFITS (Contd) – Domiciliary Treatment Benefit (DTB) • Benefit can be claimed after payment of 3rd year premium (i.e. after 2 years) • Not more than twice in a year • Equal to actual expenses subject to minimum of Rs.2,500/- at a time • Not more than 50% of policy fund at a time • Leaving at least one annualized premium in policy fund after payment
OTHER SALIENT FEATURES • Surrender equal to policy fund after completion of 3 years • Partial withdrawals not allowed • Loan not allowed • Revival within 2 years of first unpaid premium • Alteration not allowed
OTHER SALIENT FEATURES • Increase in premium permitted without increase in benefits • Reduction in premium permitted without reduction in benefits (within conditions of minima/maxima) • Premium holidays permitted subject to conditions
CHARGES • Allocation charge
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• Policy Charge
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• HCB & MSB charges • Service Tax • Fund Mgt. charges -
30% in F.Y 6% in SYs Rs.75/- p.m in FY Rs.25/- p.m in SYs Competitive rates Actual (12.36% presently) 1.25% p.a. of unit fund
TARGET GROUP • Policy provides complete health solution for the family with/without mediclaim • Along with mediclaim, one may opt for lower HCB/HSB so that maximum amount goes in policy fund from which expenses for DTB may be claimed as and when needed. • If one is already covered under mediclaim, then also the policy shall provide Benefit which will take care of additional expenses incurred by the family for which no bills might be available
TAX OPINION • Premium paid under the policy shall qualify for 80D • Benefits received under HCB, MSB and DTB not taxable • Surrender value, if received at any time will be taxable • Amount received from policy fund either on termination or on death will be taxable