Comprehensive Accidental Hospitalization Cover Policy

ITGI

Salient features of the Product

There are 2 Sections under the Policy.

Section 1 (family floater cover) Covers Hospitalization Expenses

due to Accidental injury which includes the following: Room, Boarding and Nursing Expense as provided in the Hospital/Nursing Home. Medical Practitioner/ Anesthetist, Consultant fees. Expenses on Anesthesia, Blood, Oxygen, Operation Theatre, Surgical Appliances, Medicines and Drugs, Diagnostic Materials and X-ray, Artificial Limbs, Cost of Organs and reconstructive surgery and similar expenses.

Scope of Benefits under Section 1:

Accidental Hospitalization benefit - The cover pays the actual cost incurred as a result of hospitalization due to an accident On Cashless basis. Outpatient Managed Fracture benefit -Covers the actual cost of treatment of confirmed Fractures which do not result in Hospitalization, subject to a maximum limit of Rs. 10,000 per episode.- On cash basis Supplementary benefits-reimbursement basis (i) Hospital Cash (ii) Post Hospitalization medical benefit Ancillary service-Ambulance charges upto max of Rs 1000 per event , max 3 events in a year

Section 2
This cover is not on floater basis. Each insured member shall be covered for a Capital Sum Insured (C.S.I.) and coverage as given below: Proposer - equal to the limit of Basic Accidental Hospitalization Coverage. Insured Spouse - 50% of the C.S.I. of the Proposer. Proposer and Insured Spouse shall be covered as per Item 1-6 of the Table of Benefits-Death PTD, PPD and TTD Insured Children -equal to 50% of Proposers CSI each with , the coverage as per Item 1-4 of the Table of Benefits -Death , PTD only

Scope of Benefits under Section 2:

Education Fund: In the event of death, Permanent Total Disablement of the Proposer only triggering a claim under Item 1 to 4 of Table of Benefits above compensation towards Education Fund for dependent children as below:

For one child upto the age of 21 yrs. -10% of the CSI of proposer subject to max Rs 5000 For 2 children upto the age of 21 yrs-. 10% of the CSI of proposer subject to Rs 5000 each child and a max of Rs 10,000

Scale of Benefit
Plan Gold : INR 300,000 per annum Plan A: INR 300,000 per annum Plan B: INR 200,000 per annum Plan C: INR 100,000 per annum Plan D: INR 50,000 per annum Plan E: INR 50,000 per annum Family Cover: Self Self + spouse Self + spouse + two dependent children up to age of 21 years. Age Limit : 3 months to 60 years.

Exclusions under Section 1:

Pre-existing Condition including congenital defects and anamolies. Dental treatment or surgery of any kind. Fractures arising from pathological conditions of bone like pagets Disease / Osteogenesis imperfectia. Any expense on treatment of any disease or medical condition unless the same is directly caused by an accident. Expenses on treatment arising from or traceable to pregnancy, childbirth, Miscarriage, abortion or complications of any of these. Any expense on treatment of Insured Person as outpatient in a Hospital except as covered under Outpatient Managed Fracture benefit.

Exclusions under Section 2:

Compensation under more than one of the benefits mentioned in Table of Benefits in respect of same period of disablement.
Any other payment after a claim under one of the benefits 1,2,3 and 4 in Table of benefits has been admitted and becomes payable. Any payment in case of more than one claim under this section during any one period of Insurance.

Payment of compensation in respect of injury as a consequence of Committing or attempting suicide, intentional self-injury, Venereal disease or insanity, directly or indirectly arising from or attributable to HIV

EMERGENCY ASSISTANCE SERVICES

provides a value added Emergency Medical Assistance and Emergency Services. by Assist America Emergency Medical Services (India) Private Ltd. (AAEMSIL). Emergency Services are available under all Plans except Plan E. Specific Exclusions applicable to Emergency Assistance Services Benefit Travel by Insureds spouse when it is for the benefit of the spouses employer (spouse business travel) Trips exceeding 90 days from declared residence without prior notification to AAEMSIL. Students at home/school campus address (as they are not considered to be in travel status)

Services provided by Assist America Service Provider

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

Target Market
This product is targeted at the budget buyers. Budget buyers means the younger customers who are constrained by affordability and driven by the cost. Who do not see a probability of falling sick and hospitalised but are concerned of accidents

Target distribution channel

Agency force franchisees other partners and cooperative sector partners Bima kendras and bancassurance partners. Among the distribution partners franchisees, partners like Bajaj capital, Mahindra Finance will cater to A and B category locations. Cooperative sector partners and partners like Peerless will cater to customers in C and D category locations

Segmentation
The Product is segmented for urban and rural segment and is being designed with Six Plans Gold ,A,B,C , D and E variants. Plans Gold A,B and C can be sold in Urban location Plan C , D and E can be sold in Rural locations due to its simplicity and affordability. D&E can also be explored as a Value add on to products and with tieups

Target Sales Channel

Direct sales Agency selling OTC selling. Five locations are to designed where A&B variants and C&D variants are to be sold exclusively. So the product designed for the C&D category locations should ideally not be sold in A&B category locations.

Premium chart Gold and Plan A

Gold Plan Principal Life Principal Life and Spouse Age Bracket Single Band and Spouse and children 0-29 1675 2125 2625

30-54
55-59 60-65

1175
1300 1400

1600
1900 2050

2125
2500 2600

Note:

Gold Plan is similar to Plan A in all aspects except for the Gold Plan offers double Death benefit under the Section 2 -Personal Accident Cover for the Proposer only Plan A

Principal Life Principal Life and Spouse Age Bracket Single Band and Spouse and children
0-29 30-54 55-59 1500 1025 1150 2000 1450 1750 2450 1975 2350

Plan B &C
Plan B Age Bracket 0-29 30-54 Single Band 1200 800 Principal Life and Spouse 1525 1100 Principal Life and Spouse and children 1925 1500

55-59
60-69

900
975

1350
1500

1800
1900

Plan C Age Bracket 0-29 30-54 55-59 60-69 Single Band 950 600 700 775 Principal Life and Spouse 1200 825 1025 1150 Principal Life and Spouse and children 1500 1125 1400 1475

Plan D

Plan d&e
600 375 425 475 750 525 625 700 925 700 850 900

Principal Life Principal Life and Spouse Age Bracket Single Band and Spouse and children 0-29 30-54 55-59 60-69

Plan E Principal Life Principal Life and Spouse Single Band and Spouse and children 500 260 325 350 575 350 450 550 675 460 600 650

Age 0-29 30-54 55-59 60-69