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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

Happy Investing!!

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OR

You can write back to us at PrajnaCapital [at] Gmail [dot] Com

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