L&T my: health Medisure Prime Insurance

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L&T my: health Medisure Prime Insurance

 

	Objective			A special health insurance policy that aims to provide a wide coverage for hospitalisation expenses, critical illness, maternity and other expenses. The policy also automatically restores the sum assured in case of accidental hospitalisation.
Suited for			This policy can be bought for an individual or family to cover spouse and up to two dependent children.
What does it do?			The policy offers a bouquet of benefits including hospitalisation benefit, critical illness cover for 10 major illnesses, maternity expenses, automatic restoration of sum insured in case of accidental hospitalisation and other incidental expenses. Maternity expenses will be covered only after four years from inception of the policy. There is a special provision in case of hospitalisation due to accident that can restore the sum insured once the opted cover is exhausted. For policy premiums, persons paying premium for Zone I, can avail treatment all over India without any sub-limits. Similarly, a person paying premium in Zone II can avail treatment in Zone II and III. If a policyholder paying premiums according to Zone II avails treatment in Zone I, he would have to co-pay 10 per cent of the concerned claim. A person paying premium in Zone III will be required to bear 10 per cent and 20 per cent if treatment is availed in Zone II and Zone I respectively.
Pros			The policy has no sub-limits. It allows lifetime renewal. It also offers a convalescence benefit to cover expenses during recovery period, after discharge. It also provides for pre and post natal expenses. Premium paid under this policy will be eligible for tax exemption under Section 80D of Income Tax Act.
Our View			This policy offers a broad range of benefits. Automatic restoration of sum insured for hospitalisation due to an accident is a valuable feature but cannot be seen as a substitute of Personal Accident policy as the former does not provide accidental death and disability benefits. Similarly critical illness benefit covers 10 major illnesses whereas, a standalone critical illness covers more illnesses
Eligibility
Entry Age (years)
Minimum		18
Maximum		65
Maximum Policy Renewal Age (years)		Lifetime renewal
Coverage Type		Individual/ Family floater
Policy Term (years)		1/2
Sum Insured (Rs)
Maximum		10 lakh
Minimum		3 lakh
Discount		10% if family members are insured on an individual basis under the same policy. Family discount is available for a maximum of 6 persons only
No Claim Bonus		5% no claim bonus for every claim free renewal till it reaches 50% of initial sum insured
Pre Policy Medical Check Up		Not required upto 45 years of age
Free look Period		15 days
Grace Period for Policy Renewal		15 days
Co Payment Clause		Insured persons above 70 years of age have to bear 25% of the admissible claim amount
Policy Termination		Either of the parties may terminate this policy by giving a 15 days notice. The insurer would pay proportionate premiums if no claim has been made.
Customer Service
Address		L&T General Insurance Company Limited 601-602, 6th Floor, Trade Centre, Bandra-Kurla Complex, Bandra (East), Mumbai - 400051
Mail to		help@ltinsurance.com
Call to		1800-209-5846
SMS		'LTI' to 5607058
Network Hospitals		Http://110.234.8.38/ltweb/SearchNspWithoutLogin.aspx

 

	Scope Of Cover
Cashless facility		available if treatment taken in network hospital
Reimbursement facility		available if treatment availed in non-network hospital
Pre & post hospitalisation benefit		covers medical expenses upto 60 days prior to hospitalisation and upto 90 days after discharge
Hospitalisation expenses		covered
Hospitalisation due to accident		once the opted sum insured is exhausted, equivalent sum insured is restored for hospitalisation due to accident only
Day care procedures		covered upto sum insured limit
Hospital cash		pays Rs 1000 per day after 3 continuous days of hospitalisation for maximum of 7 days
Ambulance charges		covered upto maximum of Rs 1500 per hospitalisation
Critical Illness		Covers Cancer, Coronary Artery Bypass Surgery, First Heart Attack, Kidney Failure, Multiple Sclerosis, Major Organ Transplant, Stroke, Aorta Graft Surgery, Primary Pulmonary Arterial Hypertension
Maternity and new born baby		5% of sum insured or Rs 25000 whichever is lower in case of normal delivery and 10% of sum insured or Rs 50000 in case of caesarean delivery
Pre and post natal expenses		covered upto certain limit
Lumpsum recovery benefit		a lumpsum equal to Rs 10000 payable if hospitalisation exceeds 10 continuous days
Free health check-up (for those above 45 years of age)		allowed after 2 consecutive renewals
Expenses on accompanying person		upto Rs 500 per day after 3 continuous days of hospitalisation for maximum of 7 days
Donor expenses		covered in case of major organ transplant

 

	Exclusions and Waiting Period
Pre-existing diseases		covered from 3rd year of the policy
No claim period		30 days from the start of the policy

Waiting period	4 years for maternity benefit2 years for certain diseases such as cataract, hernia, sinusitis etc.
General exclusions	AIDS or HIV and other related diseases

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