FAQ s Health Saver. Why the Health Saver is different from other reimbursement based health insurance plans?

Transcription

1 General FAQ s Health Saver What is the Health Saver? The Health Saver is a cmprehensive reimbursement based health insurance plan fr yur family, it nt nly cvers yu against any hspitalisatin event (Hspitalisatin Insurance Benefit) but als creates a health fund t help meet all ther health care expenses (health Savings benefit). Als it is the first health ULIP plan which gives yu cmplete tax benefits n the ttal premium paid under sectin 80D. Why the Health Saver is different frm ther reimbursement based health insurance plans? Features Health Saver Traditinal Health Insurance (Mediclaim) Term f Hspitalisatin Cverage Cverage fr Outpatient and daily medical expenses (Such as dentist fees, regular diagnstics etc) Return n invested premiums Cver Cntinuance Optin Tax Benefits Guaranteed hspitalisatin cverage till 75 years f age with n reevaluatin f health status during term f plicy. Cvers all health expenses ver and abve hspitalisatin insurance under the Health Savings Benefit Part f yur premiums are invested t create a health fund which meets future health expenses and pay fr future premiums The CCO ptin allws yu t cntinue yur cver even after stpping yur premiums pst 5 years f the plicy. The future premiums are deducted frm yur health savings fund Tax benefits u/s 80 D n the entire premium paid including the premium invested t create the Health Fund Term f nly 1 r 2 years which needs t be renewed n a regular basis where there may be a revaluatin f yur health status at renewal Nt cvered N returns ffered n premiums N such ptin Tax benefits u/s 80D with n premium invested in savings benefit Why is the Health Saver a better prpsitin than a mutual fund and mediclaim plan? The Health Saver definitely ffers advantages ver the cmbinatin f a traditinal mediclaim and mutual fund. The entire premium including the part f the premium invested in the health savings plan wuld be eligible fr tax benefits under sectin 80D hence yu can avail the maximum tax benefit f upt Rs under this plan. Als the biggest advantage is the cnvenience f having a cmplete health insurance plan which nt nly cvers yu fr any medical emergency but als prvides yu with a lng term savings mechanism meant specifically t meet likely heath expenses that ccur during ld age r when medical catastrphes ccur.

2 What is cvered by the Hspitalisatin Insurance Benefit? The fllwing expenses incurred during hspitalisatin are cvered, subject t yur annual limit: 1. Rm, Barding and Nursing expenses as charged by the hspital where the insured availed medical treatment. Yu are entitled t a single A/C rm (rm rent capped at 1% f annual limit per day). Hwever fr twin share A/C rm there is n such cap applicable. 2. Intensive Care Unit (ICU) charges 3. Fees fr Dctr, Surgen, Anaesthetist, Medical Practitiner, Cnsultant and Specialist 4. Anaesthesia, Bld, Oxygen, Operatin Theatre Charges, Surgical appliances, Medicines and Drugs, Diagnstic Materials and X-ray, Dialysis, Chemtherapy, Raditherapy, Cst f Pacemaker, Cst f Artificial Limbs The benefit als ffers the fllwing benefits under the hspitalisatin insurance benefit Ambulance expenses subject t a maximum f Rs. 1,000 per plicy year Free medical check-ups subject t a limit f Rs. 5,000 r 1% f the annual limit, whichever is lwer, nce every tw years after the first year What are the annual limit ptins available under the Hspitalisatin Insurance Benefit? ICICI Pru Health Saver allws yu t avail 5 Annual Limit ptins i.e. Rs 2 Lakhs, Rs 3 Lakhs, Rs 5 Lakhs, Rs 7 Lakhs and Rs 10 Lakhs under the Hspitalisatin Insurance Benefit. The Annual Limit is the maximum benefit payable under the plicy twards all the eligible medical expenses cvered under the plicy and incurred during a plicy year. The annual limit is renewed every plicy year. Fr instance, if Mr B had purchased ICICI Pru Health Saver with Annual Limit f Rs 5 Lakhs and incurred an expense f Rs 2 lakhs, the balance annual limit available fr the rest f that year wuld be Rs 3 lakhs. In the subsequent plicy year, Mr B s Annual Limit wuld be renewed t Rs 5 Lakhs and he can avail f the full amunt in that year as well. What is cvered under the Health Savings Benefit? This benefit entitles yu t claim reimbursement fr health care expenses incurred by any f the insured members frm yur health fund. Sme f the benefits cvered under the health savings benefit are Medicines and drugs Diagnstic expenses Dental expenses C-pays r deductibles as part f the medical insurance cver Other miscellaneus medical expenses nt cvered under medical insurance Hw is the health fund created under the Health savings Benefit? Yur health savings kitty is built by investing in different financial instruments with a special investment strategy that autmatically allcates yur premiums in the right mix f debt and equity investments t suit yur age, this is knwn as a lifecycle based prtfli strategy. Yu als have the ptin t select yur wn investment prtfli frm a mix f 7 funds which range frm equity, debt, mney market and a mixture f tw r mre instruments using the fixed benefit strategy.

3 Hw can ne prtect the health fund created under the Health Savings benefit frm market fluctuatins? Inrder t prvide a means t cunter market fluctuatins we ffer yu tw prtfli strategies and a variety f ptins which help prtect yu frm market fluctuatins. In the first prtfli strategy the mney is invested in a mix f debt and equity accrding t yur age. The percentage is decided by yur age because with age the risk taking ability als gets affected. If yu prefer the fixed prtfli strategy we ffer yu the ptin fr the Autmatic Transfer Plan that allws yu t cunter market vlatilities. The premium is initially invested in a debt fund and a certain percentage frm the fund gets transferred t an equity fund every mnth. This helps in averaging ut the NAV fluctuatins and yu get maximum benefits frm a vlatile market. What is the cver cntinuance ptin? Hw des it benefit the plicy hlder? In case any time during the term f the plicy after the fifth plicy year, the plicy hlder is unable t cntinue paying his premiums he has the ptin f pting fr the cver cntinuance ptin. The ptin allws the plicy hlder t cntinue the cverage and benefits under his plan the charges fr the future years will be deducted in the frm f units frm his remaining fund value. Hw des the Health Checkup benefit functin under the plan? The free health checkup will be available t all insured members after the first year nce every 2 years. Each member can submit nly a single bill in every blck f 2 years after the first year. (i.e. nce in the 2 nd -3 rd yr, 4 th -5 th yr and s n). The bills f any ne member cannt be accumulated. The cumulative limit fr all the members under the plicy wuld be 1% f the annual limit r Rs 5000 whichever is lwer. Can ICICI Pru Health Saver cver my family members als? ICICI Pru Health Saver cvers the entire family under a single plicy in case yu have availed f the family flater ptin. The family can include self, spuse and the first three dependant children. Hwever the cver fr children wuld end n reaching the age f 25 years. Fr Ex: Mr A has bught ICICI Pru Health Saver fr Rs 3 lacs fr himself, his wife and 2 children. The ttal annual limit available under the hspitalisatin insurance benefit fr all the family members put tgether is Rs 3 lakhs. In case Mr A was hspitalised and claimed fr Rs 1 lakh, the cver available fr the entire family fr that plicy year wuld nw be reduced t Rs 2 lakhs. Of curse, in the next plicy year, the cver wuld be renewed t Rs 3 lakhs. Can the family flater be issued in a case single parent and children? Yes, the family flater in MediAssure allws fr a single parent t include himself /herself and upt 3 dependant children under the plan. Can I add a family member t my plan at a later date? Additin f family members t the plicy shall be allwed nly in the event f marriage r birth r legal adptin f a child. Yu shuld pt fr this within 90 days frm the date f event r at the next plicy anniversary. Such change shall be carried ut subject t receipt f the prf f the event by the Cmpany and subject t the fulfilment f the underwriting nrms f the

4 Cmpany in this regard. The change shall be effective fr the purpse frm the next premium due date which wuld be the risk cmmencement date fr the new member added. Yu shall have t pay additinal premium n additin f a family member as determined by the Cmpany. Can I change my annual limit during the term f the plan? Yu can increase r decrease yur annual limit at every plicy anniversary with deductin f apprpriate insurance charges based n change in annual limit. Any increase in the annual limit will be subject t underwriting an as per terms and cnditin set by the cmpany. Can I change my premium during the term f the plan? Yu can increase r decrease yur premium at every plicy anniversary, any decrease in premium will be subject t the minimum premium grid based n annual limit, age and number f members in the family. What if I am unable t pay my premiums after the first 3 years? If premium is discntinued in the first three plicy years and if the plicy is nt revived within the perid f tw years frm the due date f the first unpaid premium, then the plicy will be terminated. During this perid, Hspitalisatin Insurance Benefit will cease and the plicyhlder will nly have the benefit f investment in the respective unit funds. What if I am unable t pay my premiums after the first five years? On payment f at least first five years premium, yu have the ptin f pting fr a cver cntinuance ptin wherein yur further charges wuld be deducted frm yur fund until fund value falls belw 110% after which the plicy wuld be freclsed. What happens if my fund value falls belw 110%? If premiums have been paid fr three full plicy years and after three plicy years have elapsed and fund value falls belw 110% f ne full year s premium, the plicyhlder will be given intimatin and ptin t reduce the Health Savings Benefit claim amunt s that the fund value des nt fall belw 110%. If the plicyhlder des nt pt t reduce the Health Savings Benefit claim then, the benefit shall be paid and the plicy will be freclsed. What happens n freclsure? On the date f freclsure, the fund value will be calculated as per prevailing NAV n that date. The fund value s calculated can be withdrawn by yu within 5 years fr health expenses upn submissin f riginal bills fr expenses incurred. This withdrawal will be subject t a maximum f 50% per annum f the fund value as n date f freclsure. This cnditin will als apply during the cver cntinuance stage, if pted fr. Claim Queries Health Savings Benefit When can I claim frm my Health Savings Benefit? The benefit can be claimed after 3 cmpleted years f the plicy and is subject t the existing fund value as given belw

5 4 th Yr & 5 th Yr 6 th Yr t 10 th Yr 11 th year nwards 20% f Health Fund 50% f Health 100% f Health Fund Fund Claims can be made nce in a plicy year n prducing actual bills r prf f expenses. The minimum amunt that can be claimed is Rs. 1,000. Claim under the Health Savings Benefit can be availed by submitting the actual bills r prf f expenses within 2 years f incurring the expense. What wuld happen t the fund value in case f death f the primary insured member? In the unfrtunate event f death f the primary insured member during the term f the plicy, the nminee shall receive the ttal fund value and the plicy shall be terminated. The fund value paid ut n death f the primary insured may be taxable in the hands f the nminee as per the prevailing tax regulatins at that time. In the unfrtunate event f death f any ther insured members the plicy wuld cntinue fr remaining insured members with the apprpriate reductin in health insurance charges Claim Queries Hspitalisatin Insurance Benefit Can we cver same prcedure r treatment multiple times during the 3 year cntract? As Health Saver is a reimbursement based hspitalisatin insurance plan it allws fr multiple claims during the entire term f the plicy. Hence it is pssible t claim fr the same cnditin r prcedure multiple times during the plicy term prvided the same is cvered by the plicy. What is defined as a within netwrk claim? When hspitalisatin r listed day care prcedure ccurs at a hspital defined within the netwrk f listed hspitals it wuld be defined a Within Netwrk claim Als the claim within a listed netwrk hspital wuld be treated as a within netwrk claim nly if the custmer accesses upt a single A/C rm with a rm rent f capped at 1% f the annual limit else the claim wuld be treated as a utside netwrk claim. There wuld be a cpay f 20% applicable n a utside netwrk claim. C-pay is that percentage f the eligible medical expenses that is brne by the custmer while the balance is settled by the Cmpany. What happens in an emergency which ccurs in a nn netwrk hspital? In case f a trauma (accidents) and acute cardiac related emergencies the custmer can access any hspital i.e. bth hspitals within the netwrk and utside the netwrk. In bth cases the netwrk c-pay wuld nt be applicable, as lng as the custmer accesses rm facilities up t twin share air cnditined rms. It is als advised that the custmer must transfer t a netwrk hspital nce his cnditin is stabilized. Can I make a claim if I get treated utside India? N, yu are entitled t a claim fr treatment undergne in India nly. What des day care cver mean?

6 Day care prcedures/treatments are thse in-patient prcedures which d nt require hspitalizatin f mre than 24 hurs. ICICI Pru Health Saver cvers 136 listed day care prcedures/ treatment fr which the custmer need nt stay in hspital fr mre than 24 hurs. The list is prvided in yur plicy dcument and als at What is the Health Card? Hw des it wrk? Upn enrlling under the ICICI Pru Health Saver plan each insured member in the plicy shall be issued a health card bearing yur plicy number. The health card acts as an identifier that helps yu access cashless facilities in ur extensive netwrk f hspitals and als a cpy wuld be required t be attached while claiming reimbursement. This card als bears ther essential data such as The plicy number Claims helpline tll free number Plicy duratin & expiry dates Kindly keep this card with yu at all times with a view t be prepared in case f any eventuality fr emergencies cme unannunced. Uses The call centre/assistance number allws fr immediate supprt by prviding infrmatin n the nearest netwrk hspital The card allws fr the use f cashless facility at ur netwrk hspitals A cpy f the health card needs t be prvided in rder t access a reimbursement claim. What is cvered under the pre hspitalisatin expenses? Pre Hspitalisatin expenses up t 30 days prir t hspitalisatin, which are related t the main hspitalisatin event wuld be payable under ICICI Pru Health Saver. Hwever the expenses wuld be payable nly in the event f the main hspitalisatin claim being accepted by the cmpany. Fr example: If a patient has undergne investigatins fr Typhid fever (eg Cmplete Bld cunt, Widal test and urine analysis) within 30 days prir t the date f admissin, these medical expenses (riginal bills with supprting lab reprts) shall be cnsidered under Pre hspitilisatin expenses. What is cvered under the pst hspitalisatin expenses? Pst Hspitalisatin expenses incurred up t 60 days pst discharge frm hspital, which are related t the main hspitalisatin event wuld be payable under ICICI Pru Health Saver. Hwever the expenses wuld be payable nly in the event f the main hspitalisatin claim being accepted by the cmpany. Fr Example: In case a custmer was hspitalised fr pneumnia, pst discharge all medical expenses with supprtive prescriptin related t pneumnia fr a perid f up t 60 days (frm discharge) wuld be cvered. What is a n claim bnus

7 Yu are entitled t a 5% increase in yur annual limit fr every claim free year subject t a maximum f 25% increase in the annual limit. The n claim bnus wuld be awarded nly in case yu have been insured with the cmpany fr a cntinuus perid under the same plicy. In case a claim is made during a plicy year; the bnus amunt wuld revert t 0% frm the next plicy year. Claim Queries The Prcess 1. Where can I get a Claim frm? A claim frm can be btained by getting in tuch with either f the belw tuch pints Our Website By calling ur call center Branch The claim frm is als a part f the welcme kit. 2. Where can I submit a reimbursement claim? After cmpleting all frmalities yu can depsit the dcuments at any f ur nearest branches. Yu can call n tll free number t lcate the nearest ICICI Prudential branch. Or yu can fax yur claim dcuments t (tll free) 3. Hw d I check n the status f my claim? The updated status fr prcessing f the claim can be knwn by directly calling up n ur 24*7 call center n r cntact any f ur nearest branches. Yu wuld need t cite yur plicy number fr getting this infrmatin. Yu can sms ICLAIM space <8 Digit Plicy Number>t Hw can ne avail f a cashless benefit at the time f hspitalizatin? Cashless authrizatin is a service rendered within the netwrk list f hspitals by the cmpany t all its plicy hlders. - The plicy hlder wuld be required t prduce his/her health card at the time f hspitalizatin within the netwrk list f hspitals. - The hspital directly puts acrss an estimate by way f a preauthrizatin request citing the clinical cnditin f the patient fr the prbable bill amunt fr the patient s hspitalizatin at the insurer/dedicated service prvider s end. - Upn adjudicatin f the claim, an authrizatin is given fr the eligible amunt admissible as per the plicy terms & cnditins at the hspitals end based n which the hspital renders cashless service t the patient. Kindly nte this service is applicable nly within the list f netwrk hspitals upn shwing the health card. Patients are requested t kindly put in a pre-authrizatin request at least 4 days prir t admissin in case f elective admissins & within 4 hurs f admissin fr all emergency admissins t avail f the cashless benefit. *Kindly nte the patient shall be liable fr settling the amunts nt admissible under the plicy terms & cnditins directly t the hspital.

8 5. Hw d I ldge a grievance regarding a grievance r any deficiency in service Fr any clarificatin r assistance, the Plicy hlder may cntact ur advisr r call ur Custmer Service Representative at the telephne numbers listed belw during ffice hurs (Call Centre Timings: 9.00 A.M. t 9.00 P.M., Mnday t Saturday; excluding natinal Hlidays). State Number State Number Andhra Pradesh Maharashtra (Mumbai) Chattisgarh Maharashtra (Rest) Delhi West Bengal (Klkatta, Hwrah) Ga Punjab Gujarat Rajasthan Haryana (Karnal) Tamil Nadu (Chennai) Haryana (Faridabad) Tamil Nadu (Rest) Karnataka Uttar Pradesh (Agra, Bareilly, Meerut, Varanasi) Uttar Pradesh (Kanpur, Kerala Lucknw) Madhya Pradesh Uttaranchal Fr all ther cities, kindly call ur Custmer Service Tll Free Number frm yur MTNL r BSNL line. Alternatively the Plicyhlder may cmmunicate with the Cmpany: By mail at : Custmer Service Desk, ICICI Prudential Life Insurance Cmpany Limited, Vind Silk Mills Cmpund, Chakravarthy Ashk Nagar, Ashk Rad, Kandivali (East), Mumbai Facsimile : / lifeline@iciciprulife.cm The Cmpany Web prtal must be checked fr updated cntact numbers