BSLI HOSPITAL CASH PLAN. Frequently Asked Questions

Transcription

1 BSLI HOSPITAL CASH PLAN Frequently Asked Questions TRA/1/12-13/5654 January, 17, 2013

2 1. What is BSLI Hospital Cash Plan? This is a non - participating, non - linked, and regular pay, health insurance product and is available as an individual or a family policy (non floater). The key features of the plan are as follows: Enrolment procedures are simple with no medicals or paper work You need to answer only four health related questions. No further underwriting The benefit amounts are fixed on hospitalization irrespective of the actual billing amount. The benefits are paid in addition to any other health insurance plan There would be an increase in the hospitalization benefit, recuperative benefit and stand by benefit by 30% if there are no claims by the individual or his family in case of family policy The coverage term is for 12 years Tax benefit available under section 80 D of the Income Tax Act, Who is eligible to buy the plan? You can buy the plan as a family plan for self, spouse and upto 4 dependent children with individual cover for every family member. You can also buy this plan as an individual plan for yourself. 3. What is the minimum & maximum age at entry? For Self & Spouse Minimum age at entry is 18 years & Maximum age at entry is 50 years as on last birthday (LBD). For Children Minimum age at entry is 1 year & Maximum age at entry is 17 years as on last birthday. 4. What is the maximum age at maturity? The maximum age at maturity is 61 years for Principal and Spouse and 28 years for Children. 5. Can this product be offered to foreign nationals or foreign nationals of Indian origin? No This product will not be offered to foreign nationals or foreign nationals of Indian origin. 6. What is the Policy Term? Policy term for this plan is 12 years. 7. What are the different types of plan options and their benefits?

3 You can choose any one plan option; each plan has fixed benefits for each Life Insured: Benefit Benefits under Plan A Plan B Plan C Hospitalization Benefit Rs.2,000 Rs.4,000 Rs.6,000 - In Intensive Care Unit (ICU) per Day per Day per Day OR - Other hospitalization Rs.1,000 per Day Rs.2,000 per Day Rs.3,000 per Day Recuperative Benefit # - Accidental OR - Non-accidental Stand by Benefit # - For child hospitalization Rs.10,000 Rs. 5,000 Rs.20,000 Rs.10,000 Rs. 500 per Day Rs.30,000 Rs.15, What do you mean by hospitalization benefit? In case of hospitalization for a period of more than 24 hours, you will receive the hospitalization benefit for each day in hospital starting from the second day. 9. What is recuperative benefit? On hospitalization for consecutive 10 days or more, you will receive lump sum amount as recuperative benefit. You are eligible to get this benefit only when the hospitalization benefit is payable for the event. 10. What is stand - by benefit? On hospitalization of a child (up to age of 17 years) for a period of more than 24 hours, you will receive stand-by benefit for each day in hospital starting from the second day. You are eligible to get this benefit only when the hospitalization benefit is payable for the event. 11. Whether Recuperative Benefit or Stand-by Benefit is available even if Hospitalization Benefit is not payable for that event? Recuperative Benefit and Stand-by Benefits are available only if Hospitalization Benefit is payable for that event.

4 Can you give some sample cases Following are sample cases for Plan A Sample Case (a) Sample Case (b) Sample Case (c) Hospitalization for Typhoid for 5 days Hospitalization for Malaria for 12 days (out of 12 days in hospital first 3 days in ICU) Hospitalization of Child (age 6 years) for 6 days for Pneumonia Total Benefit = Rs. 4,000 Total Benefit = Rs. 18,000 Total Benefit = Rs. 7,500 Hospitalization Benefit for 4 days- Other hospitalization starting from day Rs.1000 per day Hospitalization Benefit for 11 days- Other hospitalization 9 Rs.1000 per day + ICU 2 Rs.2000 per day starting from day 2 + Recuperative Benefit Rs.5000 lump sum Hospitalization Benefit for 5 days- Other hospitalization starting from day Rs per day + Stand-by Benefit for 5 Rs. 500 per day starting from day What is a no claim benefit? No claim benefit is when you or your family members have not claimed during the preceding 4 coverage years. Under the no claim benefit, the hospitalization benefit, recuperative benefit and the stand by benefit will be increased by 30% at the beginning of 5 th and 9 th coverage years. The maximum benefits payable per life insured will however remain unchanged. 13. What are the maximum benefit limits per policy year and per policy term? This plan has a maximum limit per life insured on benefits we will pay within one policy year and during the policy term. These limits are: Maximum Benefit Limit Plan A Plan B Plan C For each policy year Rs.100,000 Rs.200,000 Rs.300,000 For policy term Rs.500,000 Rs.10,00,000 Rs.15,00,000

5 14. What if the maximum benefit limit is exhausted for one of the life insured? If the maximum benefit limit for policy term is utilized by any of the life insured the coverage will continue for other life/lives insured and the policy premium needs to be paid for the remaining period. 15. Can I get the benefits from day one of hospitalization? If you are hospitalized for more than 24 hours then you will get the benefits starting from the second day. 16. Is there any waiting period applicable? Any sickness related condition manifesting itself within 60 days from the effective date of the policy or revival thereof, whichever is later is not covered. Only claims in respect of injuries caused by accidents will be payable during this 60-day waiting period. 17. Can I go to any Hospital? Yes - You can go to any hospital falling under the definition of the term Hospital. 18. Can I take treatment outside India? No - The policy does not provide the Health Insurance Benefit for hospitalization outside India. 19. What is the minimum & maximum policy premium? Policy premium depends on age and gender of the life insured. 20. What is the premium paying frequency? You can pay your premium annually, semi-annually, quarterly and monthly. 21. Is the premium guaranteed? Premium is guaranteed for the first four policy years. 22. What happens if I do not pay my premium on time? If you are unable to pay your policy premium by the due date, you will be given a 30-day grace period, to pay your due premiums, during which your policy will continue. 23. What happens if I do not pay my premium within the grace period? If you do not pay the entire instalment premium by the end of the grace period, this policy will be deemed lapsed and all insurance will cease immediately. You will then be given 150 days from the lapse date to revive the policy. To revive your policy, you must pay all due and unpaid instalment premiums till date with interest at a rate of 1% per month outstanding and provide us with evidence of insurability

6 satisfactory to us with respect to each life insured under the policy. The effective date of the revival is when these requirements are met and approved by us, at our sole discretion. No benefit shall be payable by us with respect to an insured event occurring while the policy is lapsed and prior to the effective date of the revival. 24. Is addition or deletion of life insured allowed? No - addition or deletion of life insured is not allowed. 25. What do you mean by continuity of coverage? In case the maximum benefit for the policy term is claimed for a particular life insured under this policy, the coverage for that particular life insured will cease but the coverage for other lives insured, if any, will continue. The next installment premium will be reduced accordingly. In case of death of a life insured under this policy, other than the Principal life insured, the coverage for the deceased life insured will cease but the coverage for other lives insured will continue. The next installment premium will be reduced accordingly. 26. Is there a death/maturity/surrender benefit available under this plan? There is no death/maturity/surrender benefit available under this plan. 27. Is there a nomination facility available under this policy? Yes - You can nominate a nominee under this plan. 28. Is there an assignment facility there under this policy? No - Assignment facility is not available under this plan. 29. Are policy loans available under this policy? No - Policy loans are not available under this plan. 30. What is the free look period available to me? You can exercise free look option within 15 days of receipt of the policy. 31. When will my plan get terminated? Your policy will terminate at the earliest of: (i) the date on which the revival period ends; (ii) the date on which the Principal life insured dies; (iii) the date maximum benefit limit for the policy term is claimed for all lives insured; or (iv) the policy expiry date shown in Your Policy Details. 32. Are there any exclusion s applicable under this plan? Yes kindly refer the product brochure for details.

7 33. Is there a Tax benefit available under this plan? The premiums paid under this plan are eligible for deduction under Section 80D as per present tax provisions. The individual can avail tax benefit: (i) Upto Rs. 15,000/- for health insurance coverage for self and family and (ii) Upto Rs. 20,000/- for health insurance coverage for parents 34. Can I buy multiple policies for myself or for any of my family members? No- you can buy only one policy for you and your family members. 35. Whom do I have to contact for claim intimation and settlements? You have to contact the TPA for intimation and claims settlements. 36. Who is a Third Party Administrator? A Third Party Administrator (commonly referred to as TPA) is an IRDA (Insurance Regulatory and Development Authority) approved specialized health care service provider. A TPA provides the insurance company with a variety of services like networking with hospitals, arranging for cashless hospitalization as well as claims processing & timely settlement. The details of the TPA are shown in your policy contract and welcome kit 37. How is the claim settled? You need to pay all hospitalization bills directly and submit the claims documents post discharge. Once we approve the claim, a cheque will be sent to you for the benefit amount payable under your policy. Following graph shows the stepwise process to claim the benefits: Hospitalization Customer settles the bill with Hospital Post discharge, submit claim form Scrutiny of documents Cheque sent to customer Reject 38. What are the documents required for the claim to be settled? We shall require as a minimum the following information to settle the claim:

8 - Policy number; - Duly completed claim form in our prescribed format; and - Duly certified photocopy/duplicate of Hospital Discharge Card / Summary - Medical evidence in the form of diagnostic reports, bills, prescriptions, any other document to support Hospital Admission / Surgery. 39. Is there a cashless facility available under this plan? There is no cashless facility available under this plan. 40. Is my claim payable in grace period? Yes-Your claim is payable in grace period subject to deduction/payment of due premium/s. 41. Can a claim be submitted even if covered by any other plan? Yes we will pay the claim amount irrespective of other plans you may have. The defined benefit amount payable per hospital admission is paid irrespective of the actual medical expenses incurred and whether or not they are reimbursed by another plan you may have. We require only the photocopies or duplicates of bills duly attested by the treating doctor and certificates enabling you to retain the originals if required by other insurers. 42. What is the maximum number of claims allowed during a policy term? Any number of claims is allowed during the policy term subject to the maximum benefit limits for the policy year and policy term. 43. Who will receive the claim amount if the policyholder dies during the time of treatment? The claim amount is paid to the nominee of the policyholder.