Birla Sun Life Insurance Saral Health Plan

Transcription

1 Birla Sun Life Insurance Saral Health Plan Frequently Asked Questions Prepared by Product Management 1 TRA/12/10-11/4400 For Internal Circulation only

2 Contents Need of Health Insurance Why does one need a health insurance plan? I am young & healthy. Do I still need health insurance? Is health insurance same as life insurance? Do I have to renew health insurance policy every year?... 4 BSLI Saral Health Plan Summary What are the significant features of BSLI Saral Health Plan? Is this a unit linked plan? Whether the product is available to foreign nationals and NRIs? Can I take a policy for my family members? Do I need to undergo any medical tests? Who can buy this plan? How can I buy this plan? What is the policy term?... 5 Benefits of BSLI Saral Health Plan What are the benefits offered under this plan? What is minimum period of Hospitalization for Health Insurance Benefit? What is Health Insurance Benefit? What is the maximum amount that can be claimed under the Health Insurance Benefit? Are the surgeries listed or specified? Are there any conditions applicable for Critical Illness cover? If I am hospitalized for a critical illness can I claim for hospitalization also? Are there any deductibles applicable under this plan? Is there a limit on maximum number of days in hospital? Is there any waiting period applicable? Can I claim for multiple surgeries? Can I go to any hospital? Can I take treatment outside India? Will my policy continue if I claim for Critical Illness Benefit in midst of Health Insurance Benefit term? What if my Surgical or non surgical hospitalization expenses are more or less than the benefit amount given by BSLI? Can you show me some sample cases for Health Insurance Benefit? What is Health Reimbursement Benefit? When can I claim expenses under Health Reimbursement Benefit? Are there any charges levied for reimbursement of claim under Health Reimbursement Benefit? How much amount can I claim in year? Can I claim Health Reimbursement Benefit for expenses incurred for my family members? Can the Health Reimbursement Benefit be claimed without bills? What is terminal illness? What is Guaranteed Addition? What will happen to the Health Reimbursement Benefit amount, if I do not make a claim for it? Till what age the Health Reimbursement Benefit will be available? What will happen to balance Health Reimbursement Benefit? What will happen to the Health Reimbursement Benefit amount, if I do not make a claim for it? What will happen to balance Health Reimbursement Benefit in case of my death? Can I claim entire fund value as a Health Reimbursement Benefit? Can I surrender my policy? Can sum of all Health Benefits in a year be lesser than total premiums paid?... 9 Prepared by Product Management 2 For Internal Circulation only

3 44. Can I avail of tax benefits under this plan? What are the benefits available? How many years do I need to pay my premium? What is Minimum Annual Premium? What is additional annual premium? How is the policy premium calculated? How can I pay my premiums? Can I increase or reduce my Sum Assured? Investment Portfolio Strategy How will my annual premium be invested? Which are the investment funds used to invest under LifeCycle options? What is the asset allocation of the investment fund option? What is the benefit of LifeCycle Portfolio Strategy? Can I switch between the risk profile i.e. if I have chosen aggressive can I switch to conservative or moderate? How do I keep a track of my investments? Policy Charges What are the charges applicable to this plan? Premium Discontinuance and Revival What happens if I do not pay my premium on time? What happens if I do not pay my premium within the grace period? What are the revival conditions? More Questions Is nomination facility available under this policy? Is assignment facility there under this policy? Are policy loans available under this policy? What is the free look period available to me? When will my plan get terminated? What application form is rquired for BSLI Saral Health Plan Are there any exclusions applicable under this plan? Whom do I have to contact for claim intimation and settlements? Who is a Third Party Administrator? How is the claim settled? Is cashless facility available under this plan? Is my claim payable in grace period? Can claim be submitted even if covered by any other plan? What is the maximum number of claims allowed during a Health Insurance Benefit term? Who will receive the claim amount if the policyholder dies during the time of treatment? Prepared by Product Management 3 For Internal Circulation only

4 Need of Health Insurance 1. Why does one need a health insurance plan? You need health coverage to meet out the unforeseen health related expenses which may come suddenly due to onset of some disease or external injury. The growing age, uncertainties coupled with stress & strain and evolving infectious diseases will inevitably bring the increased financial burden for medical care along with mounting medical inflation. Health Insurance will help to cope up the additional financial burden under such eventualities. 2. I am young & healthy. Do I still need health insurance? Yes - You will need health insurance. Even if you're young, healthy and haven't had to see a doctor in years, you will need coverage against unexpected events like accidents or an emergency. While your health insurance coverage may not (depending upon the policy taken) pay for things that aren't too costly like routine doctor's visits, the main reason to have coverage is to have protection against the large treatment expenses of serious illness or injury. No one knows when a medical emergency might strike. It is best to buy health insurance, to save money for a medical emergency. 3. Is health insurance same as life insurance? No - Life Insurance protects your family (or dependents) from financial loss that may arise in the event of your untimely death/or if something happens to you. The payout is made only post the death of the person insured or at the maturity of the policy. Health insurance protects you against financial miseries by providing for the expenses you might incur (for treatment, diagnosis etc.) in case you are affected by disease or injury. There is no payout made at maturity. 4. Do I have to renew health insurance policy every year? Health insurance offered by BSLI is a long term plan and you enjoy coverage for the selected term of 10 or 20 years just by paying your applicable premiums regularly. BSLI Saral Health Plan Summary 5. What are the significant features of BSLI Saral Health Plan? The BSLI Saral Health Plan is a non-participating, unit linked health insurance plan. Significant features of BSLI Saral Health plan are as follows: This is a whole life plan which provides you a fixed cash benefit to cover hospitalization expenses for both surgical and non-surgical events. And, if you are diagnosed with a critical illness you also receive a lump sum amount in addition to the hospitalization cash benefits. You pay the minimum policy premium to cover Health Insurance Benefit and Health Reimbursement Benefit. Health Insurance Benefit provides you cover in case of hospitalization, you can use Health Reimbursement Benefit to cover your routine health and medical related expenses such as dental care, pathology expenses. OTC drugs, and other health and wellness related expenses in the long run. You may choose to pay additional premium towards enhancement of health reimbursement benefit. And you get all this without having to undergo any medical tests. You only have to fill up a simple application form and reply to four questions related to your medical history. Prepared by Product Management 4 For Internal Circulation only

5 6. Is this a unit linked plan? Yes - this is a unit-linked, non-participating plan with defined benefits. 7. Whether the product is available to foreign nationals and NRIs? No - this product is not allowed to foreign nationals, foreign nationals of Indian origin and NRIs. However NRI can be proposer for his family member who is an Indian resident. 8. Can I take a policy for my family members? Yes you can be a proposer and your family member can be the life insured. 9. Do I need to undergo any medical tests? No you need not undergo any medical tests to get this plan. Just answer four questions relating to your health in the application form. 10. Who can buy this plan? You can buy this plan if You are in the age group of 18 to 50 years Your replies to the questions relating to your medical history are favorable. 11. How can I buy this plan? You can buy this plan in 2 simple and convenient steps Choose your pay term and health insurance benefit term o You have an option to choose from 10 pay / 10 term, 10 pay / 20 term, 20 pay / 20 term. Choose your additional premium (if any) You choose your additional premium to enhance your health reimbursement benefit to take care of your future Health & Medical related expenses. Your health insurance benefit is fixed at Rs. 10 Lacs. Above all, you don t go through the trouble of any medical test. 12. What is the policy term? BSLI Saral Health Plan is a whole life plan where you can choose the pay term and Health Insurance Benefit Term from options of 10 pay / 10 term, 10 pay / 20 term, 20 pay / 20 term. Health Reimbursement Benefit will continue till the fund value becomes zero. Benefits of BSLI Saral Health Plan 13. What are the benefits offered under this plan? Following benefits are covered under BSLI Saral Health Plan: a. Health Insurance Benefit b. Health Reimbursement Benefit c. Guaranteed Addition d. Terminal Illness and Death Benefit 14. What is minimum period of Hospitalization for Health Insurance Benefit? Health Insurance Benefit will be payable if minimum period of hospitalization is 48 hours. Prepared by Product Management 5 For Internal Circulation only

6 15. What is Health Insurance Benefit? Health Insurance Benefit Your Health Insurance Benefit is for a sum assured of Rs. 10 Lacs. You can claim your benefit in case of Hospitalization and/or in case of Critical Illness. In case of Hospitalization every time you are hospitalized for a period of at least 48 hours and for medically necessary treatment of any illness or injury, you will receive for each day hospitalized (starting from the first day): (a) (b) (c) Rs. 2,000 if you had no surgical procedure during your hospitalization; or Rs. 4,000 if you had any surgery during your hospitalization; or Rs. 8,000 if surgery directly involved your brain, heart (including coronary arteries), liver or lung. With regards to (b) only, the Rs. 4,000 claim is limited to 10 days per policy year. For any excess days hospitalized in this category, you will receive Rs. 2,000 per day. In case of Critical Illness should you ever suffer from one of the four covered critical illnesses heart attack, cancer, stroke and major organ transplant (see definitions) then you will receive a lump sum equal to Rs. 20,000 times the policy year in which the critical illness occurs. 16. What is the maximum amount that can be claimed under the Health Insurance Benefit? The maximum amount that can be claimed under the Health Insurance Benefit is Rs. 2 Lacs per policy year for Hospitalization and Rs. 10 Lacs over the health insurance benefit term for hospitalization and critical illness combined. 17. Are the surgeries listed or specified? No - all surgeries are covered subject to hospitalization for 48 hours and applicable exclusions. 18. Are there any conditions applicable for Critical Illness cover? The Critical Illness benefit is payable only once during the health insurance benefit term and the life insured must survive at least 30 days from the date of diagnosis before the claim is eligible. 19. If I am hospitalized for a critical illness can I claim for hospitalization also? Yes- you can claim lump sum for critical illness and hospitalization at applicable per day rate for no. of days in the hospital. 20. Are there any deductibles applicable under this plan? No deductibles are applicable under this plan. 21. Is there a limit on maximum number of days in hospital? No you can get admitted for any number of days in hospital subject to maximum limits applicable in the policy. Benefits- more clarity 22. Is there any waiting period applicable? Any sickness related condition manifesting itself within 90 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 90-day waiting period. Prepared by Product Management 6 For Internal Circulation only

7 23. Can I claim for multiple surgeries? BSLI Saral Health plan pays per day benefit even for surgeries. 24. Can I go to any hospital? Yes - You can go to any hospital falling under the definition of the term hospital. 25. Can I take treatment outside India? No - The policy does not provide Health Insurance Benefit for hospitalization outside India. 26. Will my policy continue if I claim for Critical Illness Benefit in midst of Health Insurance Benefit term? If you claim for Critical Illness benefit then your policy will continue for benefits other than critical illness. 27. What if my Surgical or non surgical hospitalization expenses are more or less than the benefit amount given by BSLI? This plan is a defined benefit plan and each benefit is fixed for hospitalization and critical illness. We will pay the fixed eligible amount as per terms and conditions of policy irrespective of the actual expenses incurred by you. 28. Can you show me some sample cases for Health Insurance Benefit? Following are some sample cases for Health Insurance Benefit In case of Hospitalization Sample Case (a) Sample Case (b) Sample Case (c) Hospitalization without surgery 12 days in hospital Hospitalization for any surgery 12 days in hospital Hospitalization for heart surgery 12 days in hospital Total Benefit = Rs. 24,000 Total Benefit = Rs. 44,000 Total Benefit = Rs. 96, days in 2000 each 10 days in 4000 each 12 days in 8000 each +2 days in 2000 each In case of Critical Illness Heart Attack in policy year and so on Total Benefit = Rs. 20,000 40,000 60, ,000 20,000 x year Health Reimbursement Benefit 29. What is Health Reimbursement Benefit? Under BSLI Saral Health Plan your policy premium is used to create a unit-linked fund which will take care of your future health and medical related expenses such as: General practitioners fees, medicines and drugs Pathology and diagnostics expenses Dental treatment Ayurvedic and homeopathic treatment Any health related expense not covered under medical insurance Prepared by Product Management 7 For Internal Circulation only

8 30. When can I claim expenses under Health Reimbursement Benefit? Health Reimbursement Benefit can be claimed after completion of 5 policy years to an extent of 100% of the Fund Value. Simply produce bills or proof of expense and we will reimburse such expenses by reducing the Fund Value by the same. 31. Are there any charges levied for reimbursement of claim under Health Reimbursement Benefit? You can claim reimbursements 4 times a year free of charge subject to a minimum claim amount of Rs. 2,000. Additional claims within a policy year will be subject to Rs. 250 per claim charge. 32. How much amount can I claim in year? You can claim any amount in a year subject to balance amount in your fund. 33. Can I claim Health Reimbursement Benefit for expenses incurred for my family members? Yes you can claim Health Reimbursement Benefit for expenses incurred for your family members. 34. Can the Health Reimbursement Benefit be claimed without bills? No you must submit bills for medical and health related expenses for reimbursement. The only exception is in case the life insured suffers a terminal illness or condition. In such a case, any unclaimed Health Reimbursement Benefit will be immediately payable without the submission of bills. The unclaimed amount is paid once we receive evidence satisfactory to us that the life insured is suffering from a terminal illness or condition resulting in life expectancy of one year or less. 35. What is terminal illness? A terminal illness is a medical condition which is expected to result in a person's death within 12 months; where the recovery is not expected. 36. What is Guaranteed Addition? At the end of the health insurance benefit term, your Fund Value will be augmented by a Guaranteed Addition, if all premiums are paid. The Guaranteed Addition is according to the following schedule: 10 Pay / 10 Term 10 Pay / 20 Term 20 Pay / 20 Term Minimum Guaranteed addition Rs. 3,000 Rs. 8,000 Rs. 10,000 Plus, per Rs. 1,000 Additional Premium Rs. 300 Rs. 800 Rs. 1, What will happen to the Health Reimbursement Benefit amount, if I do not make a claim for it? If you will not make claim for the Health Reimbursement Benefit, it will remain attached to the policy. 38. Till what age the Health Reimbursement Benefit will be available? What will happen to balance Health Reimbursement Benefit? You can claim your Health Reimbursement Benefit throughout your life subject to availability in fund. At the end of the health insurance benefit term, your Health Insurance Benefit will cease but any Fund Value balance will continue indefinitely until you have fully claimed Health Reimbursement Benefits against it. Upon continuation of the Fund Value after the Health Insurance Benefit term, only the fund management charge will be deducted from the Fund Value. Prepared by Product Management 8 For Internal Circulation only

9 39. What will happen to the Health Reimbursement Benefit amount, if I do not make a claim for it? If you will not make claim for the Health Reimbursement Benefit, it will remain attached to the policy. Fund value will continue to grow and you can claim it anytime till you are alive. 40. What will happen to balance Health Reimbursement Benefit in case of my death? In case of your death fund value will be paid to your nominee. 41. Can I claim entire fund value as a Health Reimbursement Benefit? Yes - you can claim entire fund value as a Health Reimbursement Benefit, but post claim if the Policy Fund Value goes below one policy premium, then we will give you an option to reduce the claim amount so that the Policy Fund Value does not fall below the one policy premium post payment of claim. If you do not opt to reduce the claim amount; then we will pay your claim in full and the Policy Fund Value after the claim payment will be held in suspense. Such Policy Fund Value will not vary on the performance of investment funds, no charges will be deducted and Health Insurance Benefit coverage will cease. No further premiums will be accepted under the policy. You can claim the Policy Fund Value kept in suspense against Health Reimbursement Benefit. 42. Can I surrender my policy? No Surrender option is not available under BSLI Saral Health Plan. 43. Can sum of all Health Benefits in a year be lesser than total premiums paid? No - At all times the sum of all Health Benefits in a year shall never be lesser than 105% of the total premiums paid less total health reimbursement benefits availed till date. 44. Can I avail of tax benefits under this plan? What are the benefits available? Yes- the plan is eligible for tax benefits under section 80 D of Income Tax Act, The Health insurance premium paid by you up to Rs.15,000 (Rs.20,000 for senior citizens) per annum to insure yourself and/or spouse and dependent children, is eligible for tax benefit under Section 80D of the Income Tax Act, Additionally, the premium paid by you, upto Rs (Rs.20,000 for senior citizens), to insure your parent(s), is eligible for tax benefit under Section 80D of the Income Tax Act, The above benefits may change as per the extant tax laws Section 80D is not available for premium paid in cash. Premium 45. How many years do I need to pay my premium? To pay your premiums you have an option to choose from 10 premium paying years for 10 year health insurance benefit term, 10 premium paying years for 20 year health insurance benefit term, 20 premium paying years for 20 year health insurance benefit term. 46. What is Minimum Annual Premium? Minimum annual premium is based on your age, gender and pay term/ health insurance benefit term 47. What is additional annual premium? Additional annual premium is a premium in addition to minimum annual premium to enhance your health reimbursement benefit. It is in multiples of Rs. 1,000. Any additional premium is subject to a maximum policy premium of Rs. 40,000. Prepared by Product Management 9 For Internal Circulation only

10 48. How is the policy premium calculated? You can calculate the policy premium as follows Find minimum annual policy premium based on Age, Gender and Pay Term /Health Insurance Benefit Term plus Any Additional Annual Premium to enhance Health Reimbursement Benefit ; over and above Minimum Annual Policy Premium, in increments of Rs.1,000 subject to a maximum policy premium of Rs. 40, How can I pay my premiums? You can pay your policy premium annually, semi-annually, quarterly or monthly. For annual and semi-annual installments, you can pay your policy premium by cash* (up to Rs. 50,000), cheque, credit card, and direct debit. For monthly and quarterly installments, you can pay by salary deduction or ECS only. In case of monthly mode minimum three months premium is required. *Premiums paid in cash are not eligible for tax benefits under section 80D. 50. Can I increase or reduce my Sum Assured? No, the Sum Assured cannot be increased or reduced. Sum Assured is fixed irrespective of the additional premium. Investment Portfolio Strategy 51. How will my annual premium be invested? Your annual premium will be invested in LifeCycle Option. Under the LifeCycle Option, your portfolio will be structured as per your age and risk profile you can decide whether you are conservative, moderate or aggressive in your approach towards investments. Your portfolio will then be monitored and administered by us, saving you the time and effort involved in overseeing it yourself. We automatically shift your investments from riskier assets to safer assets in line with your increasing age and risk profile. 52. Which are the investment funds used to invest under LifeCycle options? We will invest your premiums between the two investment funds, Maximiser (100% equity) and Income Advantage (100% debt) in a predetermined proportion based on the selected risk profile and your age when the premium is invested. 53. What is the asset allocation of the investment fund option? The proportion invested in Maximiser (100% equity) will be according to the schedule given below the remaining amount will be invested in Income Advantage (100% debt): Age Risk Profile Conservative 50% 40% 30% 15% 0% 0% Moderate 70% 60% 50% 35% 20% 5% Aggressive 90% 80% 70% 55% 40% 25% For example if person A aged 35 years, opts for a Health Insurance Benefit term of 20 years with LifeCycle Option and a conservative risk profile, then based on the age and the risk profile the investment portfolio will change with time as below: Prepared by Product Management 10 For Internal Circulation only

11 Percentage of investments in Age Maximiser Income Advantage Age % 60% Age % 70% Age % 85% 54. What is the benefit of LifeCycle Portfolio Strategy? LifeCycle Portfolio Strategy is a global concept. The distinguishing feature of this strategy is that its overall asset allocation automatically adjusts to become more conservative as your grow older. With this strategy you not only have the benefit of automatic asset allocation, which balances your Equity-Debt proportion but you also have the choice of deciding your own risk profile. As shown in the schedule - as your age increases your equity (Maximiser) proportion will automatically reduce and will be switched towards debt (Income Advantage). This strategy conserves your earnings from market volatilities as it is spread over a long time horizon. Thus it enhances the possibility of better earnings over a longer time period of time. 55. Can I switch between the risk profile i.e. if I have chosen aggressive can I switch to conservative or moderate? At any point of time you can request to switch between the risk profiles i.e. from aggressive to conservative or moderate or from conservative to moderate or aggressive or from moderate to aggressive or conservative. All policy premiums paid from that point onwards will be invested in Maximiser and Income Advantage according to the new risk profile. 56. How do I keep a track of my investments? You can monitor your investments on our website ( with your CPIN and TPIN number; through the annual statement detailing the number of units you have in each investment fund and their respective unit price as of the last policy anniversary; and through the published unit prices of all investment funds on our website as well as in the newspapers. Policy Charges 57. What are the charges applicable to this plan? Premium Allocation Charge Premium allocation charge is deducted from the policy premium before it is invested in the chosen funds. It is guaranteed never to increase. Percentage of Policy Premium Paid Policy year 10 pay/ 10 term 10 pay/ 20 term 20 pay/ 20 term % 24.00% 30.00% 4 onwards Nil Nil Nil Policy Administration Charge A policy administration charge of 0.25% per month of the annual Policy premium is deducted monthly by canceling units from the investment fund/s at that time. This charge is guaranteed to never increase for the first three years, after which it can be increased by no more than by 5% per annum since inception. Prepared by Product Management 11 For Internal Circulation only

12 Fund Management Charge The daily unit price of each investment fund is adjusted to reflect the fund management charge. This may be increased by us in the future subject to IRDA approval. Investment Fund FMC Income Advantage 1.00% Maximiser 1.35% Morbidity Charge Morbidity charge is deducted every month for providing you with the insurance cover. It is charged by canceling units from the investment fund/s at that time. It is guaranteed for 3 years and can be revised thereafter subject to IRDA approval. Health Reimbursement Benefit Charge No charge is levied on the first 4 Health Reimbursement Benefit claims in a policy year. Subsequent claims will be charged Rs. 250 per claim. This charge may increase in future subject to a maximum of Rs. 1,000. Revival Charge An amount of Rs. 100 is charged for policy revival. This amount may increase in future subject to a maximum of Rs. 1,000. Service Tax Service Tax and other levies, as applicable, will be extra and levied as per the extant tax laws. Premium Discontinuance and Revival 58. 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 30-day grace period, to pay your due premiums, during which your policy will continue. 59. What happens if I do not pay my premium within the grace period? If you do not pay your premium within the said grace period of 30 days, the following will be applicable: During the first three policy years Your policy will lapse if we do not receive the entire policy premium by the end of the grace period. All insurance cover under your policy will cease without value. You can revive your policy within two years from its lapse date by paying all outstanding policy premiums and providing us with evidence of insurability satisfactory to us. If the life insured dies while the policy is not yet revived, we will pay the fund value as of the lapse date immediately and terminate the contract. After three completed policy years If we do not receive the entire policy premium by the end of the grace period, you will be given a period of two years to pay all outstanding premiums till date. After this two-year period, no premiums will be accepted by us. During this two-year period and thereafter, your policy with all insurance cover and charges will continue until the Fund Value is exhausted. 60. What are the revival conditions? The revival of policy is not allowed after 2 year revival period Requirements: For revival upto attained age 50 years all due premiums to be paid with evidence of insurability satisfactory to us (COI). If adverse findings in COI to be referred for underwriting. For revival after attained age 50 years, all due premiums to be paid with evidence of insurability satisfactory to us (as per underwriting grid). Prepared by Product Management 12 For Internal Circulation only

13 Other conditions: Following conditions will apply if revival request is received: During the period of 60 days from the lapse date - Waiting period of 90 days will apply from effective date of revival and - Remaining part of the 2 years specific waiting period will be applicable. During the period from 61 st day to 2 years from the lapse date - The exclusions and waiting period of 90-days and specific waiting period of 2 years will apply from the effective date of revival. Also, all the exclusions applicable at the policy effective date shall once again become applicable. - All diseases claimed for, prior to lapsation of the policy and any disease condition diagnosed or investigated or treated or consulted for since inception of the policy would be considered as Pre-Existing Diseases for the purpose of Underwriting and Claims. - Any disclosures made at the time of the proposal, considered to be adverse by the company, would continue to be considered adverse at the time of revival. - Any premium loadings applied to the policy shall continue to apply to the revived policy also. - Claims for any accidents in the revived policy will be admissible only if the accident occurred when the policy is in force. The effective date of revival is when these requirements are met and approved by us. On the effective date of revival, the policy fund value as of the lapse date will first be reduced by all outstanding policy charges due since the lapse date and then reinvested at the then prevailing unit price(s). (Revival request means a written request from the customer accompanied with the outstanding premium and other documents confirming insurability) More Questions 61. Is nomination facility available under this policy? Yes - You can nominate a nominee under this plan. 62. Is assignment facility there under this policy? Yes - Assignment facility is available under this plan. 63. Are policy loans available under this policy? No - Policy loans are not available under this plan. 64. What is the free look period available to me? You can exercise free look option within 15 days of receipt of the policy. 65. When will my plan get terminated? The policy will terminate at the earliest of: (a) the date the termination request is confirmed; (b) the date on which the two years of revival period ends after the policy has lapsed, as per the Premium Discontinuance provision; (c) the date the Life Insured dies; (d) the fund value becomes zero Prepared by Product Management 13 For Internal Circulation only

14 66. What application form is required for BSLI Saral Health Plan? A separate application form is available for this plan. 67. Are there any exclusions applicable under this plan? Yes kindly refer the product brochure for details. Claims 68. Whom do I have to contact for claim intimation and settlements? You have to contact the TPA for intimation and claims settlements. 69. 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. 70. 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 71. Is cashless facility available under this plan? No - cashless facility is not available under this plan. 72. Is my claim payable in grace period? Yes - Your claim is payable in grace period subject to deduction/payment of due premium/s. Prepared by Product Management 14 For Internal Circulation only

15 73. Can claim be submitted even if covered by any other plan? Yes we will pay 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. 74. What is the maximum number of claims allowed during a Health Insurance Benefit term? Any number of claims is allowed during the policy period. However the sum insured is the maximum limit under the policy. 75. 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. Prepared by Product Management 15 For Internal Circulation only