Revision

Room rent revised Class A and Class B cities redefined Cataract limits revised Portability brought in 101 day-care procedures included Cumulative bonus in lieu of discount Claims Loading removed Automatic replenishment of SI upon

exhaustion of SI

Two tier rating introduced Zone 1 applicable for Mumbai, Delhi

( Delhi city, Noida, Gurgoan,Ghaziabad, Faridabad) and entire Gujarat State will carry a higher rate

Zone 2 applicable for the rest of India will carry a slightly lower rate

Premium variation between the zones is between 4% to 11%

Premium chargeable will be based on the address of the customer

It is mandatory for the operating offices to get the correct and complete address.

Incomplete proposal forms NOT TO BE ACCEPTED

Policy taken with Zone 2 rates and treatment in Zone 1 areas NO co-payment as is the case with other insurance companies

But the difference in premium between the Zones will be recovered (adjusted in the claims)

Medical screening as per the usual practice to continue

New Rs 15lacs option introduced

Bonus eligibility-

Where the previous policy is claims free then the insurance will be renewed under New FHO with the first slab of Bonus as applicable for the expiring sum insured.

Expiring policy FHO 2A+ 2C sum insured Rs 2 lacs Renewed under New FHO Same family Size but SI is Rs 4 lacs No claim under the previous policy Eligible Bonus will be 10% that is

Rs20000/-

This policy is portable. The benefit of continuity will be given

only for 30 Days, PED, FY and F2Yrs exclusion

The sum insured will be limited to the expiring policy sum insured only

BONUS EARNED WITH THE PREVIOUS INSURER WILL NOT BE GIVEN CREDIT

BENEFITSEXISTING

BENEFITSREVISED

Room Rent A Class City

Rs1500/ B Class City Rs 750/ Other s Rs

500/

Room Rent A Class City Rs 5000/ B Class City Rs3000/ Others Rs1000/

BENEFITSEXISTING

BENEFITSREVISED

Less than 24 Hrs treatment at Hospital “Day Care Procedure”

Specific named procedures

Now 101 Procedures allowed

Sum Insured Amount Per Eye Rs

Amount Per Policy Period Rs

Upto Rs200000/ 12000/

Rs 3/4/5 Lakhs Rs 20000/ 30000/

Rs 10 lakhs Rs 30000/ 40000/

EXISTINGREVISED

Average claims ratio of preceding two consecutive years

Loading on Premium %

>100%-125%

30

>125%-150%

50

> 150 % 80

NO CLAIMS LOADING

EXISTING REVISED A discount of 10% is

allowed on renewal of the policy if there is no claim in the immediately preceding year of the policy. This discount is not cumulative

No discount

Automatic Restoration of Sum Insured WHERE THE SUM INSURED IS

EXHAUSTED DURING THE POLICY PERIOD IT IS AUTOMATICALLY TOPPED UP BY 50% FOR SUM INSURED OF RS 3 LACS AND BY 100% FOR SUM INSURED ABOVE RS 4 LACS AND ABOVE

Sum Insured %of restoration on the Basic Sum Insured

Up to Rs 2 Lakhs Nil

Rs 3 Lakhs 50%

Rs 4 and above

100%

SUCH REPLENISHED AMOUNT SHALL NOT BE UTILISED FOR ANY AILMENT FOR WHICH CLAIM HAS BEEN MADE

Let us assume a family of 2A + 1C has taken a policy for Rs 300000/-

1A is hospitalised for ailment (say for example Hernia) and the entire sum insured of Rs 300000/- is exhausted.

Now the restoration clause will operate and a sum of Rs 150000/- will now be available for the remaining policy period only and no additional premium is chargeable for this

This Rs 150000/- can be utilised by the same person 1A for any ailment unrelated to Hernia. Other persons under the policy can also utilise the sum insured until policy expiry date.

BonusFor every claim free year Bonus upto the

scales is allowed.The bonus ranges from 10% to 25% in

the first renewal and additional 5% to 10% for the second renewal.

Basic Sum InsuredRs

I Year IIYear%

III Year%

Maximum Cumlative Bonus %

100000 Nil 10 5 15

200000 Nil 10 5 15

300000 Nil 25 10 35

400000 Nil 25 10 35

500000 Nil 25 10 35

1000000

Nil 25 10 35

1500000

Nil 25 10 35

Year Basic Sum Insured Rs

Claims Rs Bonus in Rs

First Year 300000 Nil Nil

Second Year 300000 Nil 75000

Third Year 300000 Nil 105000

Fourth Year 300000 Nil 105000

In any case the maximum bonus shall not exceed 35% for sum insured of Rs 3 lacs and above and 15% for sum insured below Rs 3 lacs

Bonus will be computed on the basic sum insured

If there is a claim the earned bonus will be reduced by 50%

If there is a claim in the successive year the bonus will become zero

SUM INSURED OPTION-WISE 2 LACS – MAX DIFF RS 2600 IN AGE

BAND-51 TO 55 YRS 3 LACS – RS 2560 4 LACS- RS 2000 5 LACS – RS 3800ALL FOR ZONE 1

EXAMPLE – INSURED 52YRS FAMILY SIZE 2A+ 2C SUM INSURED RS 5 LACS ZONE 2

2 CLAIM FREE YEARS. THE SAVINGS CAN BE USED FOR BUYING A SURPLUS POLICY

SUM INSURED

PREMIUM STAR

MARKET PREM

SAVING

TOTAL COVERAGE INCL BONUS

500000 16075 20474 4399 500000 + 175000=675000

1000000* 4300 675000+1000000=1675000**

*SUPER SURPLUS

** BUT MARKET POL SI WILL BE RS 500000 +BONUS RS500000= TOTAL RS 1000000 ONLY

NO ONE YEAR WAITING PERIOD – MIN WAITING PERIOD IS 2 YRS UNDER POLICY

BONUS; IF THERE IS A CLAIM THE BONUS IS REDUCED BY 50% OF THE BASIC SI.

THAT IS WHAT IS EARNED IS LOST

FOR EG X TAKES A POLICY FOR RS 3 LACS HAS ONE CLAIM FREE YR IN YR 2 HIS COVERAGE AMNT IS RS450000/- IN YR 3 HE LODGES A CLAIM AND IN YR 4

HIS COVERAGE WILL BE ONLY THE BASIC SI OF RS 3LACS

THE BONUS EARNED IS TOTALLY LOST – BUT HE CONTINUES TO PAY THE HIGHER PREMIUM

NOW UNDER OUR POLICY YR 1 POLICY FOR RS 3LACS- NO CLAIM YR 2 HIS COVERAGE IS RS 300000+75000(B) YR 3 THERE IS A CLAIM YR 4 HIS COVERAGE WILL BE 300000+37500

HE CAN HAVE THE CAKE & EAT IT TOO !