Ensure your family s health with. my:health Medisure Plus

Transcription

1 Ensure your family s health with my:health Medisure Plus

2 Good health has always been one of the most basic and important human needs. Even today, in spite of our busy schedules and hectic lives, we strive to keep healthy in our own way. Each of us is unique in the way we think about our health and look after ourselves. And insuring all these unique aspects of our health is no easy task. At L&T Insurance, it is our constant endeavor to not just cover all your health needs, but also to provide you with an insurance plan that can be customized to suit your exact requirements. Introducing my:health Medisure Plus Insurance, a thoughtfully designed, insurance solution that is tailor-made to your unique health needs. From the basics of good health to the tiniest detail in critical situations, our Policy covers every possible aspect when it comes to protecting your health. Be it a guaranteed response time, a cumulative bonus or just a health check up, we go that extra mile to make sure our Policy meets your exact needs and also exceeds your expectations. Additionally, we also offer you the option of choosing and paying only for the covers you want. So you don't waste money on covers that you don't need in your insurance plan. Making this a truly custom-made insurance offering. At L&T Insurance, we understand that the key to good health is the personal touch of thoughtfulness and care. Covers under my:health Medisure Plus Insurance? Standard We believe there are certain standard covers that are necessary in every health insurance policy. That s why we provide you with the 9 essential standard covers that are built into your Policy. These ensure that your health is broadly protected in a variety of situations, so that you always have a safety net to count on. The following covers form the bedrock of the Policy are: In-patient Hospitalisation Expenses If the treatment of a disease, illness or injury is taken we will pay the medical expenses incurred by you towards; Room Rent/Boarding & Nursing: Actuals limited to 1% of Sum Insured (excluding cumulative bonus) per day subject to a maximum of `4,000/- per day; ICU Rent/Boarding & Nursing: Actuals limited to 2% of Sum Insured (excluding cumulative bonus) per day subject to a maximum of `6,000/- per day; Fees of Surgeon, Anesthetist, Nurses and Specialists: Actuals Cost of Operation Theatre, diagnostic tests, medicines, blood, oxygen and cost of prosthetic and other devices or equipment if implanted internally like pacemaker during a Surgical Procedure: Actuals

3 This also covers any relapse within 45 days from the date of last hospitalisation at the hospital/nursing home where treatment was taken. Occurrence of the same illness after 45 days would be a fresh instance of illness. Medical expenses will be reimbursed subject to the following: If you are hospitalised as an in-patient for a minimum period of 24 hours. If the expenses on account of room rent/boarding and nursing and ICU rent/ boarding and nursing are higher than the limits mentioned, the additional amount shall be reduced in the same proportion as such actual costs bears to the eligible limits. These limits shall not apply in case you have selected the optional cover for waiver of room rent sub-limits. Pre-hospitalisation This covers the relevant medical expenses you incur within a period of 30 days before you are admitted to a Hospital/Nursing Home provided that; i. such medical expenses are incurred for the same condition for which Your hospitalisation was required and ii. the in-patient Hospitalisation claim for such hospitalisation is admissible by Us Post-hospitalisation This covers the relevant medical expenses, up to a period of 60 days, after you are discharged from the Hospital/Nursing Home provided that; i. such medical expenses are incurred for the same condition for which your hospitalisation was required and ii. the In-patient Hospitalisation claim for such Hospitalisation is admissible by us. Thus, ensuring that you don t have to worry about expenses post-hospitalisation. Day Care Treatment This covers the medical expenses for a day care procedure or surgery incurred by you for treatment or procedures that requires less than 24 hours of hospitalisation undertaken under general or local aneasthesia. There is no static list for day care procedures in the Policy as advances in medical science leads to many more being added continuously. So, whether it s recommended by a medical practitioner or even if it is a new procedure, you can be rest assured that, we will cover it. However, this cover excludes diagnostic procedures and treatments taken on an outpatient basis. For indicative list of Day Care Procedures, please refer Policy wordings or our website Treatment at Home or Domiciliary Hospitalisation RENEWAL This covers the medical expenses you incur for treatment at home, in case you are not shifted to a Hospital/Nursing home based on the advice of the attending medical practitioner or due to the unavailability of a hospital bed. This is applicable provided the medical condition continues for at least 3 days. In such cases we will not cover your post-hospitalisation expenses; however pre-hospitalisation expenses for up to 30 days will be covered.

4 Pre-existing Diseases Medical expenses arising out of your pre-existing diseases are covered from the 4 th year of your Policy, after you have been continuously insured with us for 36 months. Health Check-Up On completion of every 2 consecutive years of your Policy, we will provide a health check up coupon worth `1000 towards the cost of a medical check up for the insured above age 50 years. This limit is available per individual in case of an individual policy/individual Sum Insured basis and for all members put together in case of a floater policy. Ambulance Charges This covers your ambulance charges to the hospital/nursing home for treatment which requires you to be admitted to a hospital/nursing home. The maximum cover will be actuals or upto `1,500 per hospitalisation whichever is less. Advantage - Custom Covers Since you have completely unique needs, we have created a health plan that can be tailor-made to suit your exact requirements. While all our health plans offer you a basic set of covers, our range of optional covers give you the freedom to customize your own health insurance policy. You can select from 9 optional covers, out of which 7 are available on the payment of an additional premium and 2 are available on reduction of Premium. Please note that Reinstatement of Sum Insured and Critical Illness covers cannot be opted together. Hence you can opt for maximum 8 optional covers. Just pick the ones that you need and we will ensure that every detail is taken care of, so that you can enjoy absolute peace of mind. Without payment of additional premium 1. Deletion of Pre/Post-Hospitalisation option This gives you a choice to delete the pre/post-hospitalisation coverage and reduce the premium payable under the Policy. No claim will be paid for any expenses incurred pre/post-hospitalisation once you choose this option. 2. Deductibles By choosing this option, the premium you ll have to pay shall reduce. In this case, a part of the claim shall be paid by you as per the deductible option chosen. The deductible options are: no deductibles `5000 `10000 `15000 `20000 `25000 `30000 `35000 `40000 `50000 `75000 `100000

5 What are deductibles? A deductible is a cost-sharing requirement under this Policy that provides that we will not be liable for a specified rupee amount of the covered expenses, which will apply before any benefits are payable. A deductible does not reduce the Sum Insured. Deductible is applicable per Insured per claim. On payment of additional premium 3. Critical Illness Cover (Indemnity Basis) This cover provides you with an additional amount equivalent to the Sum Insured (excluding cumulative bonus) for treatment of the below listed Critical Illnesses. This means you get double the Sum Insured under this cover. This includes: - Cancer (of specific severity) - Major Organ Transplant - Coronary Artery Bypass Surgery - Stroke (resulting in permanent symptoms) - First Heart Attack (of specific severity) - Aorta Graft Surgery - Kidney Failure (requiring regular dialysis) - Primary Pulmonary Arterial Hypertension - Multiple Sclerosis - Permanent Paralysis of Limbs - Motor Neurone Diseases with permanent symptoms - Coma (of specific severity) For definitions of the above mentioned Critical Illness please refer to the Policy wordings or contact your insurance partner. Conditions for opting Critical Illness cover This cover can be availed by Individuals up to 65 years of age and shall be available during subsequent renewals for life time. All those opting Sum Insured above `1,000,000/-, coverage under Critical Illness will be restricted to 1,000,000/- only. 4. Reinstatement of Sum Insured We understand that medical emergencies like accidents and illnesses are unpredictable. That's why if your Sum Insured including cumulative bonus is exhausted due to claims paid and/or payable and is not enough to cover your expenses incurred towards hospitalisation, we offer an additional amount as reinstatement. This additional amount is equivalent to Sum Insured and is available only once during the 12-month policy period. This cover is applicable only for new illnesses/diseases and will not be applicable to illnesses/diseases (including its complications) for which claims are already paid/payable. The cumulative bonus benefit is also not applicable to the reinstated Sum Insured. This cover is available only for those opting for Sum Insured of `3 Lacs to 5 lacs. Those opting for Sum Insured above `500,000/-, coverage under Restatement of Sum Insured will be restricted to `500,000/- only. Note: Only one of the above covers i.e. Critical Illness or Reinstatement of Sum Insured can be opted under the Policy. Both the covers cannot be availed of together.

6 5. Waiver of Room Rent and ICU Sub-limits If you have opted for this cover, we shall waive the sub-limits under room rent/boarding and nursing and ICU rent/boarding and nursing. We shall pay expenses incurred on room rent and/or ICU as per the actuals. 6. Extended Pre/Post-Hospitalisation Cover This lets you extend the pre/post-hospitalisation coverage available under the standard cover. Limits for the expenses incurred against pre and post hospitalisation are extended to 60 days and 90 days respectively. 7. Hospital Cash This cover helps you avail daily hospital cash allowance of `500 per day for a maximum of 7 days, starting from day 4 to day 10, provided your hospitalisation exceeds 3 continuous days. For example, if you are hospitalised for 12 days, we will reimburse you `500 each day from the 4 th day onwards for 7 days. So the maximum reimbursement under this cover cannot exceed `3500 (`500 x 7 days). 8. Recovery Benefit This cover entitles you to a recovery benefit where we will pay you a lump-sum amount of `10,000 in the event that your hospitalisation for a disease/illness/injury extends - more than 10 days. 9. Expenses of Accompanying Person This cover provides you a reimbursement of up to `500 per day for the expenses incurred by the person who accompanies you to the hospital/nursing home. This amount will be reimbursed for a maximum period of 7 days if your hospitalisation exceeds 3 days. For example, if you are hospitalised for 10 days, we will reimburse you `500 each day from the 4th day onwards for 7 days. The maximum reimbursement under this cover cannot exceed `3500 (`500 x 7 days). How you benefit with my:health Medisure Plus Insurance? With this policy you don t just protect your health in every way possible, but also enjoy a host of special benefits that we offer you. These 8 covers are assured to you, irrespective of the package you choose. So, no matter what your plan is the advantages we offer you will never change. At L&T Insurance, we strive to make every Policy and plan keeping your interests in mind. 1. Lifetime Renewal You can renew your Policy throughout your lifetime, provided your application for renewal and the renewal premium in full has been received 30 days from the due date. However, no claim will be payable for hospitalisation expenses incurred during the gap period. This is also subject to the realization of your premium. This benefit is not available in case of fraud, misrepresentation, non-disclosure or suppression of material facts on the Proposal Form.

7 2. Cumulative Bonus (CB) If you have made no claim under the Policy in a year and you renew the policy with us the next year, we will apply a cumulative bonus by automatically increasing 10% of the Sum Insured for the next policy year. The maximum cumulative bonus shall not exceed 50% of the Sum Insured in any policy year. Example - If your Sum Insured for the first year is `3 lakhs, and you don t make a claim and renew it on time, to reward this, we will give you additional 10% Sum Insured which makes the total Sum Insured of `3.3 lakhs. If a claim is made, the cumulative bonus that has accrued will be reduced by 10% of the basic Sum Insured. Only accrued cumulative bonus will get reduced by 10%. The basic Sum Insured will remain intact. In case of 2 years Policy, CB for both the years (10% for year 1 and 10% for year 2) will be applied at the time of renewal however increased limit of 10% will be available in case of any claim in 2nd year of the Policy. Where the Policy is issued as a Family Floater, cumulative bonus will be considered with respect to the Sum Insured of such Family Floater. Cumulative Bonus is not applicable to Value added covers and is calculated on Basic Sum Insured under the Policy excluding Sum Insured of Optional covers. 3. Policy Period Option This gives you the convenience of opting and renewing your Policy for a single year or for two continuous years. If you renew your Policy for two continuous years, we will give you a discount of 5% on the total premium of 2 years. 4. Free-look Period This gives you an option of cancelling the Policy within 15 days from the date of receipt of Policy documents, if you are not satisfied with the coverage and terms of the Policy. We will refund the premium paid after adjusting the amounts spent on stamp duty charges, Medical examination (wherever applicable) and proportionate premium (If Policy has already commenced). Refund will not be applicable if you have made a claim against the Policy during that period. 5. Family Floater This gives you an option of covering three other family members apart from yourself in one Policy. The three other family members can be your lawful spouse and two dependent unmarried children up to the age of 23 years or 3 dependent unmarried children up to the age of 23 years, excluding your spouse. 6. Age Eligibility (age last birthday as at Policy inception date) With our Policy, you can insure your children from the age of 3 months to the age of 23 years. Adults can be insured from the age of 18 years to 65 years. Maximum age at entry for adults is 65 years. But you can renew your Policy throughout your life.

8 7. Family Discount If you seek to cover your family members including your lawful spouse, dependent children and yourself, in a single Policy, a Schedule will be issued naming all such individuals along with the chosen individual Sum Insured. If you choose to avail insurance for equal to or more than 3 members in the family you will receive a 10% discount on the premium payable. 8. Sum Insured Options Plan Type Basic Sum Insured Critical Illness Sum Insured* Reinstatement of Sum Insured** Individual Minimum: `2,00,000/- Maximum: `25,00,000/- Equal to basic Sum Insured subject to following. Minimum Basic Sum Insured should be : `200,000/- Equal to basic Sum Insured subject to following. Minimum Basic Sum Insured should be : `300,000/- Maximum: `1,000,000/- Maximum: `500,000/- Floater Minimum: `2,00,000/- Minimum: `200,000/- Minimum: `300,000/- Maximum: `25,00,000/- Maximum: `10,00,000/- Maximum: `500,000/- Sum Insured to be in multiples of lakhs only; however above 10 Lakhs, the options available are 15 Lakhs, 20 Lakhs and 25 Lakhs. *Critical Illness: For those having Basic Sum Insured for `1,000,000/- and above, Coverage for Critical Illness will be restricted to `1,000,000/- **Reinstatement of Sum Insured: For those having Basic Sum Insured for `500,000/- and above, Reinstatement of Sum Insured will be restricted to `500,000/- 9. Income Tax Benefit The Policy gives you benefits under Income Tax laws prevailing from time to time. Currently, deduction is available up to `15,000 under Sec 80 D of the Income Tax Act, Service Assurance We make sure our services are robust and actionable, so that you find us whenever you need us the most. In case of a Cashless Claim, We assure a response within 6 hours for a cashless facility request, provided the intimation is received during working hours from 9 am to 9 pm on Monday to Saturday. If the intimation is received after working hours on a working day, or at any time during a holiday, we assure a response within 8 hours. In case of a Reimbursement Claim, We assure a response within 6 working days from the date of receipt of the complete set of documents. In case we fail to meet the assurance as stated above for the cashless and reimbursement facility, we will pay you a fixed compensation of `1,000 for a single claim.

9 What are the Medical Test Requirements? All Individuals up to 50 years (age as on last birthday as at Policy inception) have to fill a declaration on the Proposal Form. If any medical adversity exists, only then will you be required to undergo appropriate medical tests. The age group years (age as on last birthday as at Policy inception) may be required to undergo the following pre-acceptance medical tests :- Medical Examination Report, TMT, Lipid Profile, HBA1C, Serum Creatinine, Complete Blood Count and Urinalysis. For the following category: Scenarios Medical Tests Requirement Charges of Medical check up pre agreed with the network provider Age group 50 to 65 years Age group years with Optional Cover for Double Sum Insured for Critical Illness or Optional cover of Reinstatement of Sum Insured If Sum Insured of `1,000,000/- or more is opted Optional Cover for Double Sum Insured for Critical Illness at Renewal with or without Claim irrespective of age Medical Examination Report, ECG, Lipid Profile, HbA1C, Serum Creatinine, Complete Blood Count, Urinalysis. Medical Examination Report, Electrocardiogram, Complete Blood Count, Lipid Profile, HbA1C, Serum Creatinine, Urinalysis, SGOT, SGPT and GGT. Medical Examination Report, ECG, Complete Blood Count, Lipid Profile, HBA1C, Serum Creatinine, Urinalysis, SGOT, SGPT and GGT As agreed with network provider> As agreed with network provider> *Age as on last birthday as at Policy inception date to be considered. Medical Underwriting The Company reserves the right to Accept on standard terms/decline/accept will exclusion and/or premium loading (up to maximum of 100% on Basic Premium).

10 Loading on the premium is arrived at on the basis of factors given below; Health condition at the time of proposal Pre existing disease/medical condition (Exiting or cured) Test results Other co-morbid factors Indicative range of loadings for most common diseases based on above factors is given below. These loadings are for your reference purpose only and are subject to change based on medical test results. Illness Premium loading % on Basic Premium (For reference only) Diabetes 10% - 40% Blood Pressure/Hypertension 10% - 30% Asthama 10% - 30% Kidney Related disorders 10% - 30% For those having following Health conditions, proposal may be accepted with premanent exclusion (for those specific condition only) however acceptance is subject to submission of treatment reports and subsequent medical examination by us. Policy mellitus (not on treatment) Cancer (fully cured) Hysterectomy (operated before 1 year from proposal date) Fracture with foreign objects inserted For those having multiple illnesses and for other health conditions, loading may be charged and/or exclusion may be applied or Proposal may be declined on severity of the condition at the time of proposal. Loading will be subject to an amount ranging from 10% to 100% of Basic Premium. Proposed loading/exclusion will be intimated to proposer and Policy will be issued with written consent from the proposer on premium loading/exclusion. The Health check up and subsequent Medical reports are valid upto 30 days from date of Health Check up. On acceptance of proposals, we will reimburse 50% of the expenses (on our pre agreed rates with the network provider) incurred on the pre-acceptance medical tests. Please refer our website for the list of DC in your area. Final decision of acceptance and related criteria will lie with Company.

11 How to make a Quick and Transparent Claim with L&T Insurance? Claim Process Cashless Hospitalisation Contact L&T Insurance and Submit a Cashless request form with required documents Reimbursement of Expenses Collate original bills with other documents as required and submit it to L&T Insurance Cashless decision made within 6 hours by L&T Insurance Reimbursement Claims response Made within 6 Working days Third Party Administrator E-Meditek is a TPA appointed by us for processing of Claims however ultimate responsibility of acceptance or rejection of a Claim lies with Us only. What the Policy Doesn t Cover? We shall not be liable to make any payment for any claim directly or indirectly caused by, based on, arising out of or howsoever attributable to any of the following: 1. All pre-existing diseases/illness/injury/conditions as defined in the Policy, until 36 months of continuous covers have elapsed since inception of the first Policy with us. 2. Any disease contracted and/or medical expenses incurred by You in respect of any disease/illness during the first 30 days from the commencement date of the Policy except in case of accidental injuries. This exclusion doesn t apply for those having any health insurance indemnity policy in India at least for 1 year prior to taking this Policy as well as for subsequent renewals with Us without a break.

12 3. All expenses towards following ailments/diseases along with their complications are excluded and will be covered after the first two years (24 months) of continuous operation of this insurance cover: Cataract Hysterectomy other than for malignancy Uterine prolapse including any condition requiring Hysterectomy Polycystic Ovarian Diseases, Myomectomy for Fibroids Knee Replacement Surgery (other than caused by an accident) Osteoarthritis and Osteoporosis Arthritis, Arthroscopic Surgery, Rheumatism, Joint Replacement Surgery (other than caused by accident), Prolapse of Intervertibral discs(other than caused by accident) Varicose Veins and Varicose Ulcers, Hernia, Stones in the urinary, uro-genital and biliary systems, Benign Prostate Hypertrophy, Hydrocele Congenital internal anomaly Fistula in anus, Piles, Fissures Fibroids, Dilatation & Curettage for treatment purposes, Pilonidal sinus, Chronic Suppurative Otitis Media (CSOM) Deviated Nasal Septum, Sinusitis and related disorders Surgery on tonsils/adenoids Gastric and duodenal ulcer, any type of Cysts/Nodules/Polyps, and any type of Breast lumps, benign ear, Nose and Throat disorders and surgeries Chronic Nephritis and Nephropathy (Kidney diseases) Hypertension and Diabetes and related complications 4. Domiciliary hospitalisation expenses in respect of following: a. Asthma, Bronchitis, Tonsillitis and Upper Respiratory Tract infection including Laryngitis and Pharyngitis, Cough and Cold, Influenza, b. Arthritis, Gout and Rheumatism, c. Chronic Nephritis and Nephritic Syndrome, d. Diarrhoea and all type of Dysenteries including Gastroenteritis, e. Diabetes Mellitus and Insipidus,

13 f. Epilepsy, g. Hypertension, h. Psychiatric or Psychosomatic Disorders of all kinds, i. Pyrexia of unknown Origin. 5. Co-payment: All person(s) named in the Schedule to this Policy above the age of 80 years (age last birthday) shall bear a co-pay of 10% for each and every claim. 6. Deductible: Claims/Claim amount falling with in deductible limit as opted by you and mentioned in the Schedule. 7. Any treatment arising from or traceable to pregnancy, childbirth including caesarean section. However, this exclusion/waiting period will not apply to Ectopic Pregnancy proved by diagnostic means. 8. Genetic disorder and stem cell implantation/surgery. 9. Dental treatment or surgery of any kind unless necessitated due to an accident and requiring minimum 24 hours Hospitalisation or treatment of irreversible bone disease involving the jaw which cannot be treated in any other way, but not if it is related to gum disease or tooth disease or damage. 10. Birth control procedures, hormone replacement therapy and voluntary termination of pregnancy during the first 12 weeks from the date of conception. 11. Routine medical, eye and ear examinations, cost of spectacles, laser surgery for cosmetic purposes or corrective surgeries, contact lenses or hearing aids, vaccinations except post-bite treatment, issue of medical certificates and examinations as to suitability for employment or travel. 12. All expenses arising out of any condition directly or indirectly caused due to or associated with human T-call Lymph tropic virus type III (HTLV-III) or Lymphadinopathy Associated Virus (LAV) or Acquired Immune Deficiency Syndrome (AIDS), AIDS related complex syndrome (ARCS) and all diseases/illness/injury caused by and/or related to HIV and sexually transmitted diseases. 13. Vitamins and tonics unless forming part of treatment for disease, illness or injury and prescribed by a Medical Practitioner. 14. Instrument used in treatment of Sleep Apnoea Syndrome (C.P.A.P.) and Continuous Peritoneal Ambulatory Dialysis (C.P.A.D.) and Oxygen Concentrator for Bronchial Asthmatic condition, Infusion pump or any other external devices used during or after treatment. 15. Artificial life maintenance, including life support machine use, where such treatment will not result in recovery or restoration of the previous state of health. 16. Treatment for developmental problems including learning difficulties eg. Dyslexia, behavioural problems including attention deficit hyperactivity disorder (ADHD).

14 17. Treatment for general debility, ageing, convalescence, run-down condition or rest cure, Congenital external anomaly/ies or defects, sterility, infertility including IVF, impotency, venereal disease, puberty or menopause. 18. Committing or attempting to commit a criminal or illegal act, or intentional self injury or attempted suicide while sane or insane. 19. Certification/Diagnosis/Treatment by a family member or from persons not registered as Medical Practitioners under the respective Medical Councils, or any diagnosis or treatment that is not scientifically recognized or experimental or unproven. 20. Ailment requiring treatment due to use, abuse or a consequence of an abuse of any substance, intoxicant, drug, alcohol or hallucinogen and treatment for de-addiction, or rehabilitation. 21. Any illness or hospitalisation arising or resulting from You or any of Your family members committing any breach of law with criminal intent. 22. Any treatment received in convalescent homes, convalescent hospitals, health hydros, nature cure clinics or similar establishments. 23. Prostheses, corrective devices and medical appliances, which are not required intra-operatively for the disease/illness/injury for which You were hospitalised. 24. Any stay in Hospital/Nursing Home without undertaking any treatment or where there is no active line of treatment by the Medical Practitioner. 25. Treatment of any mental illness or sickness or disease including a psychiatric condition, disorganisation of personality or mind, or emotions or behaviour, Parkinson s or Alzheimer s disease even if caused or aggravated by or related to an Accident or Illness or general debility or exhaustion ( run-down condition ). 26. Any cosmetic surgery unless forming part of treatment for cancer or burns, surgery for sex change or treatment of obesity/morbid obesity or treatment/surgery /complications/illness arising as a consequence thereof. 27. Charges incurred primarily for diagnostic, X-ray or laboratory examinations or other diagnostic studies not consistent with or incidental to the diagnosis and treatment even if the same requires confinement at a Hospital/Nursing Home. 28. Costs of donor screening and organ. 29. Costs incurred on all medical treatments other than Allopathy Treatments. 30. Whilst You are engaging in speed contest or racing of any kind (other than on foot), bungee jumping, parasailing, ballooning, parachuting, skydiving, paragliding, hang gliding, mountain or rock climbing necessitating the use of guides or ropes, potholing, abseiling, deep sea diving using hard helmet and breathing apparatus, polo, snow and ice sports or involving a naval military or air force operation. 31. Whilst You are flying or taking part in aerial activities (including cabin crew) except as a fare-paying passenger in a regular Scheduled airline or air Charter Company. 32. All expenses caused by ionizing radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel.

15 33. All expenses directly or indirectly, caused by or arising from or attributable to foreign invasion, act of foreign enemies, hostilities, warlike operations (whether war be declared or not or while performing duties in the armed forces of any country), civil war, public defense, rebellion, revolution, insurrection, military or usurped power. 34. All non-medical expenses as mentioned in the Policy wordings. 35. Any condition after the point at which it is certified by the attending Medical Practitioner to be of such a nature that further medical treatment may serve to stabilise or maintain it but it is unlikely to result in a material improvement within a reasonable time. 36. Service charges or any other charges levied by the Hospital/Nursing Home, except registration/admission charges. 37. Expenses incurred on alternative treatments. How to Renew your Policy? You can renew your Policy by making a request to us before the expiry date. You can also renew policy within 30 days from expiry of your Policy subject to the fact that the premium for the renewal is received within the same period. In such a situation, you will be eligible to continuity benefits like the cumulative benefits and others. Please note that we shall not be liable for any claims arising out of ailments/hospitalisation during the period between expiry and renewal. If the renewal of the Policy is not done within 30 days of due date, it will be considered as a new policy. We will not be liable to pay hospitalisation expenses incurred during break period. Any disease/condition contracted in the break in period will not be covered and will be treated as Pre-existing condition. The Policy can be renewed for lifetime unless: I. any fraud, misrepresentation or suppression of material facts as sought to be declared on the Proposal form by You or on Your behalf is found either in obtaining insurance or subsequently in relation thereto or, II. We have discontinued issuance of Policy under this Product, in which event You will have the option of renewal under any similar Policy being issued by Us; provided however, benefits payable shall be subject to the terms contained in such other Policy. Such modification or revision of the terms and conditions of the Product shall be intimated to you 3 months in advance along with reasons of modification and revision. A change in the Sum Insured is allowed on renewals, however it may be subject to Medical test and subsequent Underwriting approval. Any enhanced Sum Insured during subsequent policy renewals will not be available for an illness, disease, injury already contracted under the preceding policy periods. All Waiting periods as defined in the Policy shall apply for this enhanced limit from the effective date of enhancement of such Sum Insured considering such Policy Period as the first Policy with Us. Sum Insured enhancement will be subject to Underwriting approval.

16 Based on the experience of the Product, Premium, terms and conditions may be revised subject to prior approval of Insurance Regulatory and Development Authority. Such revision shall be intimated to you 3 months in advance with an option of renewal under any similar Policy being issued by Us. However, benefits payable shall be subject to the terms contained in such other Policy. Individual Claims experience loading is not applicable under the Policy. If you are above the age of 80 years, there is a 10% co-payment obligation as there is no further premium increase. For any changes desired at the time of Renewal, please communicate with us. Contact Details are provided here below. The Company reserves its right to vary the premium from time to time subject to approval of IRDA (Insurance Regulatory and Development Authority). Portability Option: Portability will be provided on the Policy in accordance with IRDA guidelines issued on Portability from time to time. You may approach us atleast 45 days before the expiry date to avoid any break in coverage. Portability benefits are not automatically applicable under the Policy unless application for portability has been specifically made and subsequently accepted by the Company. The acceptance criteria for portability proposals is same as applicable to new proposals. How to Cancel your Policy? In case you wish to cancel your Policy, you may intimate us by giving 15 days notice in writing and we will refund the premium. We reserve the right and may at any time, cancel Your Policy, on grounds of misrepresentation, fraud, non disclosure or suppression of material facts as sought to be declared on the Proposal form or non co-operation, by giving 15 days notice in writing by Registered Post Acknowledgment Due to You at Your last known address in which case, We shall not be liable to repay the premium for the unexpired term. You may also give 15 days notice in writing, to Us, for the cancellation of this Policy, in which case We shall from the date of receipt of notice cancel the Policy and retain the premium for the period this Policy has been in force at Our short period scales as under Period On Risk Rate of Premium Refunded In case of 2 year Policy; Up to 1 month Up to 3 months Up to 6 months Exceeding six months upto 365 days 75% of annual Premium 50% of annual Premium 25% of annual Premium If cancellation done before completion of 1 year: same grid as given above is applicable on first year Premium and second year Premium will be completely refunded. If cancellation is done after completion of 1 year: same grid as given above is applicable however retention Premium on second year premium will be calculated on Annual Premium without long term Policy discount. NIL

17 An individual policy with a single person named in the Schedule to this Policy shall automatically terminate in case of death of the Policyholder. In case of an individual Policy with multiple persons named in the Schedule to this Policy and incase of a floater, the Policy shall continue to be in force for the remaining members of the family upto the expiry of current Policy Period. The Policy may be renewed on an application by another adult person named in the Schedule to this Policy, whenever such is due. However, in case of a valid claim having been paid or reported under this Policy, there would be no refund of premium. Minimum premium of `250 per Policy will be retained by Us towards administrative charges. Special channel for Insured Persons who are Senior Citizens Good things come with time and so for our customers who are above 60 years of age we have created special channels to address any health insurance related query. At L&T Insurance, our senior citizen customers can reach us through the below dedicated channels to enable us to service them promptly. Note: Dedicated prompt in our Toll Free Number ( LTIN ) SMS SENIOR to us at senior@ltinsurance.com Age, wherever mentioned shall be completed age last birthday as at Policy inception date. Premium: Is payable in advance. Premium As Annexure attached Get the L&T Advantage For over 7 decades, across industries, the L&T Group has practiced and perfected incisive solutions and its precise delivery. We are a state-of-the-art, technology-driven company that has the caliber and expertise to provide world-class customer service. We combine innovative and unique product benefits with seamless customer support to make sure our approach to your life is a thoughtful one. At L&T Insurance, you are our priority. Contact Details The information provided here includes only the salient features of my:health Medisure Plus Insurance Policy. For more details please call us on TOLL FREE on or call a branch in your city. Alternatively, to get a Quick-Quote you can log on to or leave your name and number if you want us to contact you. You can even SMS LTI <your name> to IRDA Reg. No. 146 L&T General Insurance Company Ltd. Address: 6 th Floor, City 2, Plot No. 177, Near Bandra-Kurla Telephone Exchange, Kalina, Santacruz (East), Mumbai I Phone: I Fax: /0145 Insurance is the subject matter of solicitation. For detailed terms and conditions please refer the policy wordings, visit our website or contact your insurance partner.

18 Reach us at the touch points below Toll - free No.: ( LTIN) SMS: LTI to (56070LT). We will call you back. help@ltinsurance.com Write to us: L&T General Insurance Company Limited 6th Floor, City 2, Plot no. 177, CST Road, Near Bandra-Kurla Telephone Exchange, Kalina, Santacruz East, Mumbai Website: LTGICL/HL-01 / Oct-2014 is the brand of L&T General Insurance Company Limited. Registered Office: L&T House, N.M. Marg, Ballard Estate, Mumbai Corporate Office: 6th Floor, City 2, Plot No. 177, CST Road, Near Bandra Kurla Telephone Exchange Kalina, Santacruz (East), Mumbai , India. The information provided herein includes only the salient features of my:health Medisure Plus Insurance. For more details on coverage, exclusions, terms and conditions, please refer to the Policy wordings before concluding a sale. Beware of spurious phone calls and fictitious/fraudulent offers. IRDA clarifies to public that it / its officials do not involve in activities like sale of any kind of insurance. Public receiving such phone calls are requested to lodge a police complaint along with details of phone call and number. IRDA Registration No Insurance is the subject matter of solicitation. Advt.no. LTGICL/FY14-15/007 UIN No. IRDA/NL-HLT/L&TGI/P-H/V.II/34/14-15 CIN No. U66030MH2007PLC177117

19 Premium Chart my:health Medisure Plus Insurance Premium is payable in advance on or before inception of the policy Medisure Plus - Simple Rate Card (No Sub Limits) Age Group Plan Type Plan A Plan B - Critical Illness Plan C - Reinstate 2 Lac 3 Lac 4 Lac 5 Lac 2 Lac 3 Lac 4 Lac 5 Lac 3 Lac 4 Lac 5 Lac Upto 35 Years Individual 3,386 4,217 5,257 6,088 3,641 4,430 5,399 6,202 4,488 5,401 6, to 40 Years Individual 3,769 4,710 5,886 6,827 4,109 4,994 6,075 6,978 5,323 6,389 7, to 45 Years Individual 4,212 5,280 6,614 7,682 4,638 5,634 6,851 7,871 5,893 7,117 8, to 50 Years Individual 6,285 7,944 10,019 11,679 6,966 8,512 10,398 11,982 9,399 11,118 12, to 55 Years Individual 7,247 9,106 11,431 13,290 9,461 10,951 12,661 14,274 10,561 12,530 14, to 60 Years Individual 9,901 12,518 15,790 18,408 12,625 14,789 17,304 19,619 13,973 16,890 19, to 65 Years Individual 11,528 14,609 18,461 21,542 14,594 17,164 20,164 22,904 19,650 22,447 24,550 Upto 35 Years 2 Adults 5,410 6,820 8,582 9,992 5,842 7,181 8,823 10,184 7,280 8,827 10, to 40 Years 2 Adults 6,052 7,650 9,644 11,240 6,628 8,130 9,965 11,496 8,692 10,500 11, to 45 Years 2 Adults 6,801 8,614 10,877 12,687 7,521 9,214 11,278 13,008 9,656 11,733 13, to 50 Years 2 Adults 10,053 12,799 16,227 18,970 11,174 13,735 16,851 19,469 15,200 18,041 20, to 55 Years 2 Adults 11,730 14,807 18,648 21,720 15,376 17,849 20,677 23,344 17,208 20,462 23, to 60 Years 2 Adults 16,001 20,351 25,766 30,104 20,459 24,079 28,256 32,097 22,752 27,580 31, to 65 Years 2 Adults 18,666 23,786 30,160 35,265 23,681 27,980 32,961 37,508 32,103 36,738 40,229 Upto 35 Years 2 Adults + 1 Child 7,139 9,043 11,422 13,326 7,826 9,616 11,804 13,631 9,774 11,810 13, to 40 Years 2 Adults + 1 Child 7,781 9,872 12,485 14,574 8,612 10,566 12,947 14,944 11,185 13,484 15, to 45 Years 2 Adults + 1 Child 8,530 10,837 13,717 16,021 9,505 11,650 14,259 16,455 12,149 14,717 16, to 50 Years 2 Adults + 1 Child 11,781 15,022 19,067 22,304 13,159 16,170 19,833 22,917 17,693 21,025 23, to 55 Years 2 Adults + 1 Child 13,459 17,030 21,488 25,054 17,361 20,284 23,659 26,791 19,701 23,446 26, to 60 Years 2 Adults + 1 Child 17,730 22,574 28,606 33,438 22,443 26,514 31,238 35,545 25,245 30,564 34, to 65 Years 2 Adults + 1 Child 20,395 26,009 33,000 38,599 25,666 30,416 35,943 40,956 34,597 39,722 43,624 Upto 35 Years 2 Adults + 2 Child 8,832 11,221 14,205 16,592 9,775 12,007 14,729 17,011 12,222 14,737 16, to 40 Years 2 Adults + 2 Child 9,474 12,050 15,267 17,841 10,561 12,956 15,871 18,324 13,634 16,410 18, to 45 Years 2 Adults + 2 Child 10,224 13,014 16,500 19,288 11,454 14,040 17,184 19,835 14,598 17,643 20, to 50 Years 2 Adults + 2 Child 13,475 17,199 21,850 25,570 15,108 18,561 22,758 26,297 20,141 23,951 27, to 55 Years 2 Adults + 2 Child 15,153 19,208 24,271 28,321 19,310 22,675 26,583 30,171 22,150 26,372 29, to 60 Years 2 Adults + 2 Child 19,424 24,751 31,389 36,704 24,392 28,905 34,162 38,925 27,693 33,490 38, to 65 Years 2 Adults + 2 Child 22,089 28,187 35,783 41,866 27,615 32,806 38,867 44,336 37,045 42,648 46,951 Upto 35 Years 1 Adult + 1 Child 5,115 6,440 8,097 9,422 5,626 6,866 8,381 9,649 6,981 8,384 9, to 40 Years 1 Adult + 1 Child 5,498 6,932 8,726 10,161 6,094 7,429 9,057 10,426 7,816 9,373 10, to 45 Years 1 Adult + 1 Child 5,941 7,502 9,454 11,016 6,622 8,070 9,832 11,318 8,386 10,101 11, to 50 Years 1 Adult + 1 Child 8,013 10,167 12,859 15,013 8,950 10,948 13,379 15,429 11,893 14,102 15, to 55 Years 1 Adult + 1 Child 8,976 11,329 14,271 16,624 11,445 13,387 15,643 17,721 13,055 15,514 17, to 60 Years 1 Adult + 1 Child 11,629 14,741 18,630 21,742 14,610 17,224 20,286 23,066 16,467 19,874 22, to 65 Years 1 Adult + 1 Child 13,257 16,832 21,301 24,876 16,578 19,599 23,146 26,351 22,143 25,431 27,945 *Premium inclusive of Service Tax of 14% & Swachh Bharat Cess of 0.5% 1/6

20 Age Group Plan Type Plan A Plan B - Critical Illness Plan C - Reinstate 2 Lac 3 Lac 4 Lac 5 Lac 2 Lac 3 Lac 4 Lac 5 Lac 3 Lac 4 Lac 5 Lac Upto 35 Years 1 Adult + 2 Child 6,808 8,618 10,879 12,689 7,575 9,256 11,305 13,029 9,430 11,311 12, to 40 Years 1 Adult + 2 Child 7,191 9,110 11,509 13,427 8,043 9,820 11,982 13,806 10,264 12,300 13, to 45 Years 1 Adult + 2 Child 7,635 9,680 12,237 14,282 8,571 10,460 12,757 14,698 10,834 13,028 14, to 50 Years 1 Adult + 2 Child 9,707 12,345 15,642 18,279 10,899 13,338 16,304 18,809 14,341 17,029 19, to 55 Years 1 Adult + 2 Child 10,669 13,507 17,053 19,891 13,394 15,777 18,567 21,102 15,503 18,440 20, to 60 Years 1 Adult + 2 Child 13,323 16,919 21,413 25,009 16,559 19,615 23,211 26,447 18,915 22,800 25, to 65 Years 1 Adult + 2 Child 14,951 19,010 24,083 28,142 18,527 21,990 26,070 29,732 24,592 28,358 31,272 Upto 35 Years 1 Adult + 3 Child 8,520 10,818 13,691 15,989 9,541 11,669 14,258 16,443 11,900 14,266 16, to 40 Years 1 Adult + 3 Child 8,903 11,310 14,320 16,728 10,010 12,233 14,935 17,220 12,735 15,255 17, to 45 Years 1 Adult + 3 Child 9,346 11,880 15,048 17,582 10,538 12,874 15,710 18,112 13,305 15,983 18, to 50 Years 1 Adult + 3 Child 11,418 14,545 18,453 21,580 12,866 15,751 19,257 22,223 16,812 19,984 22, to 55 Years 1 Adult + 3 Child 12,381 15,707 19,865 23,191 15,361 18,190 21,520 24,515 17,974 21,395 24, to 60 Years 1 Adult + 3 Child 15,034 19,119 24,224 28,309 18,525 22,028 26,164 29,860 21,386 25,755 29, to 65 Years 1 Adult + 3 Child 16,662 21,210 26,895 31,442 20,494 24,403 29,023 33,145 27,062 31,313 34,633 *Premium inclusive of Service Tax of 14% & Swachh Bharat Cess of 0.5% Note: Plan A Plan B Plan C Base Cover + Waiver of Room Rent Sub Limits Plan A + Critical Illness cover Plan A + Reinstatement cover DISCLAIMER 1. This rate card is a tool for Ease of Business with limited options as stated under the plans. 2. For complete set of Custom Covers and their Premium; refer to the Master Rate Card. 3. The Master Rate Card Premium is Final & Binding 2/6

21 Medisure Plus - Simple Rate Card (Sub Limits Applicable) Age Group Plan Type Plan A Plan B - Critical Illness Plan C - Reinstate 2 Lac 3 Lac 4 Lac 5 Lac 2 Lac 3 Lac 4 Lac 5 Lac 3 Lac 4 Lac 5 Lac Upto 35 Years Individual 2,554 3,199 3,926 4,633 2,810 3,412 4,068 4,747 3,469 4,070 4, to 40 Years Individual 2,828 3,557 4,380 5,180 3,169 3,841 4,570 5,332 4,170 4,884 5, to 45 Years Individual 3,144 3,972 4,906 5,813 3,570 4,327 5,142 6,003 4,585 5,409 6, to 50 Years Individual 4,625 5,911 7,364 8,774 5,306 6,479 7,742 9,077 7,366 8,463 9, to 55 Years Individual 5,388 6,829 8,456 10,036 7,601 8,673 9,685 11,020 8,284 9,555 10, to 60 Years Individual 7,283 9,312 11,602 13,827 10,008 11,582 13,116 15,038 10,767 12,702 14, to 65 Years Individual 8,447 10,835 13,531 16,150 11,513 13,390 15,234 17,512 15,876 17,518 19,158 Upto 35 Years 2 Adults 4,003 5,096 6,329 7,527 4,435 5,456 6,569 7,719 5,556 6,574 7, to 40 Years 2 Adults 4,461 5,700 7,096 8,452 5,037 6,180 7,416 8,708 6,742 7,952 9, to 45 Years 2 Adults 4,997 6,401 7,986 9,524 5,716 7,002 8,386 9,844 7,443 8,841 10, to 50 Years 2 Adults 7,319 9,447 11,847 14,177 8,441 10,383 12,471 14,677 11,848 13,661 15, to 55 Years 2 Adults 8,668 11,052 13,741 16,352 12,314 14,094 15,769 17,975 13,453 15,555 17, to 60 Years 2 Adults 11,719 15,087 18,878 22,561 16,176 18,814 21,368 24,555 17,487 20,692 23, to 65 Years 2 Adults 13,626 17,590 22,053 26,388 18,641 21,784 24,853 28,631 25,907 28,631 31,352 Upto 35 Years 2 Adults + 1 Child 5,238 6,713 8,379 9,997 5,925 7,287 8,761 10,302 7,444 8,767 10, to 40 Years 2 Adults + 1 Child 5,696 7,317 9,146 10,921 6,527 8,010 9,608 11,291 8,630 10,145 11, to 45 Years 2 Adults + 1 Child 6,231 8,019 10,035 11,994 7,206 8,832 10,578 12,428 9,332 11,035 12, to 50 Years 2 Adults + 1 Child 8,554 11,065 13,897 16,647 9,931 12,213 14,663 17,260 13,736 15,854 18, to 55 Years 2 Adults + 1 Child 9,903 12,670 15,790 18,821 13,804 15,924 17,961 20,558 15,341 17,748 20, to 60 Years 2 Adults + 1 Child 12,953 16,704 20,928 25,031 17,667 20,645 23,559 27,138 19,376 22,886 26, to 65 Years 2 Adults + 1 Child 14,861 19,208 24,102 28,857 20,131 23,614 27,045 31,214 27,795 30,824 33,882 Upto 35 Years 2 Adults + 2 Child 6,447 8,298 10,387 12,416 7,391 9,084 10,911 12,836 9,299 10,919 12, to 40 Years 2 Adults + 2 Child 6,906 8,902 11,154 13,341 7,993 9,808 11,758 13,825 10,485 12,297 14, to 45 Years 2 Adults + 2 Child 7,441 9,604 12,044 14,413 8,672 10,630 12,728 14,961 11,187 13,187 15, to 50 Years 2 Adults + 2 Child 9,764 12,649 15,905 19,067 11,397 14,011 16,813 19,793 15,591 18,007 20, to 55 Years 2 Adults + 2 Child 11,113 14,254 17,799 21,241 15,270 17,722 20,111 23,091 17,196 19,900 22, to 60 Years 2 Adults + 2 Child 14,163 18,289 22,936 27,451 19,132 22,443 25,710 29,672 21,231 25,038 28, to 65 Years 2 Adults + 2 Child 16,070 20,792 26,111 31,277 21,596 25,412 29,195 33,747 29,651 32,976 36,362 Upto 35 Years 1 Adult + 1 Child 3,789 4,816 5,976 7,103 4,300 5,242 6,260 7,330 5,358 6,264 7, to 40 Years 1 Adult + 1 Child 4,063 5,175 6,430 7,650 4,659 5,671 6,761 7,915 6,058 7,077 8, to 45 Years 1 Adult + 1 Child 4,379 5,589 6,956 8,283 5,060 6,157 7,334 8,586 6,473 7,603 8, to 50 Years 1 Adult + 1 Child 5,860 7,529 9,413 11,244 6,796 8,309 9,934 11,660 9,254 10,656 12, to 55 Years 1 Adult + 1 Child 6,622 8,446 10,505 12,506 9,092 10,504 11,877 13,603 10,172 11,749 13, to 60 Years 1 Adult + 1 Child 8,518 10,929 13,652 16,297 11,498 13,413 15,308 17,621 12,655 14,895 17, to 65 Years 1 Adult + 1 Child 9,682 12,453 15,581 18,620 13,003 15,220 17,426 20,095 17,764 19,711 21,689 *Premium inclusive of Service Tax of 14% & Swachh Bharat Cess of 0.5% 3/6

22 Age Group Plan Type Plan A Plan B - Critical Illness Plan C - Reinstate 2 Lac 3 Lac 4 Lac 5 Lac 2 Lac 3 Lac 4 Lac 5 Lac 3 Lac 4 Lac 5 Lac Upto 35 Years 1 Adult + 2 Child 4,999 6,401 7,984 9,522 5,765 7,040 8,410 9,863 7,213 8,416 9, to 40 Years 1 Adult + 2 Child 5,273 6,760 8,439 10,070 6,124 7,469 8,912 10,448 7,914 9,229 10, to 45 Years 1 Adult + 2 Child 5,589 7,174 8,964 10,703 6,526 7,955 9,484 11,119 8,329 9,755 11, to 50 Years 1 Adult + 2 Child 7,070 9,114 11,422 13,664 8,262 10,107 12,084 14,193 11,110 12,809 14, to 55 Years 1 Adult + 2 Child 7,832 10,031 12,514 14,925 10,557 12,302 14,027 16,136 12,027 13,901 15, to 60 Years 1 Adult + 2 Child 9,728 12,514 15,660 18,716 12,963 15,211 17,458 20,154 14,510 17,047 19, to 65 Years 1 Adult + 2 Child 10,892 14,038 17,589 21,039 14,468 17,018 19,576 22,629 19,620 21,864 24,169 Upto 35 Years 1 Adult + 3 Child 6,221 8,003 10,014 11,967 7,243 8,854 10,581 12,421 9,085 10,589 12, to 40 Years 1 Adult + 3 Child 6,495 8,361 10,468 12,514 7,602 9,283 11,083 13,006 9,786 11,402 13, to 45 Years 1 Adult + 3 Child 6,811 8,776 10,993 13,147 8,004 9,769 11,655 13,677 10,200 11,928 13, to 50 Years 1 Adult + 3 Child 8,292 10,715 13,451 16,108 9,739 11,921 14,255 16,752 12,982 14,981 17, to 55 Years 1 Adult + 3 Child 9,055 11,632 14,543 17,370 12,035 14,116 16,198 18,695 13,899 16,074 18, to 60 Years 1 Adult + 3 Child 10,950 14,115 17,689 21,161 14,441 17,025 19,629 22,713 16,382 19,220 22, to 65 Years 1 Adult + 3 Child 12,114 15,639 19,618 23,484 15,946 18,832 21,747 25,187 21,491 24,036 26,674 *Premium inclusive of Service Tax of 14% & Swachh Bharat Cess of 0.5% Note: Plan A Plan B Plan C Base Cover ONLY with 1% or Rs for Room / 2% or Rs for ICU Plan A + Critical Illness cover Plan A + Reinstatement cover DISCLAIMER 1. This rate card is a tool for Ease of Business with limited options as stated under the plans. 2. For complete set of Custom Covers and their Premium; refer to the Master Rate Card. 3. The Master Rate Card Premium is Final & Binding 4/6