Group health insurance policy from ICICI LOMBARD
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Group health insurance policy from ICICI LOMBARD

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Presentation about GROUP HEALTH INSURANCE Policy offered by ICICI Lombard. This policy is offered to even small organizations with employee strength of as low as 10 people. Policy can be availed to......

Presentation about GROUP HEALTH INSURANCE Policy offered by ICICI Lombard. This policy is offered to even small organizations with employee strength of as low as 10 people. Policy can be availed to the employees plus their family (which includes their spouse and kids).

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  • 1. Group Health Insurance(GHI) Call +91 9900113820 for more information
  • 2. Who said I need health Insurance My clients don’t fall sick!! How do I tell them importance of GHI??
  • 3. Why Health Insurance? Health insurance is needed more now than ever before because of - Skyrocketing medical costs Need for routine medical check ups and care Expensive trips to specialist doctors Possibility of hospitalization and treatment
  • 4. USP of Group Health Insurance No physical examination Covers people regardless of their age or present state of health Helps to reduce a company’s liability and decrease risks Customized health care Cheaper than individual Health plans Having such a great benefit boosts morale among employees
  • 5. Scope/ Coverage Illness can be from anything.. Thought of serve the client entire life is giving me stress attack!!
  • 6. Scope of cover  Disease/ Injury    Treated medically/ surgically By Hospitalisation/ Domiciliary hospitalisation At Nursing home/ hospital in India as in-patient  Pre hospitalisation   Post hospitalisation   Age limit  90 days – 80 years Relevant medical expenses 30 days prior to hospitalisation Relevant medical expenses 60 days after hospitalisation
  • 7. Compensation payable  Reasonable and necessarily incurred    Room expenses in hospital/ nursing home Nursing expenses Medical practitioner fee  Treatment cost       Medicines/ diagnostic cost Blood/ oxygen Cost of pacemaker Operation theatre charges Surgical appliances Dialysis, chemotherapy, radiotherapy
  • 8. Compensation payable contd.…     Pre and post hospitalisation expenses Max of SI Surgical operation Manual operative procedure for  Deformity  Defect correction  Diagnosis cure  Prolongation of life
  • 9. Hospitalisation   Min period of 24 hrs Time limit not applicable for specific treatment      Dialysis Chemotherapy Tonsillectomy D&C Cataract
  • 10. Pre & post hospitalisation  Pre hospitalisation   Post hospitalisation   Relevant medical expenses 30 days prior to hospitalisation Relevant medical expenses 60 days after hospitalisation Any one illness  Continuous Period of Illness  Relapse within 45 days of the earlier treatment
  • 11. Domiciliary hospitalization    Treatment exceeding 3 days at Residence  Serious condition of patient does not allow removal to hospital  Lack of accommodation in nursing home Pre / post hospitalisation expenses not covered Specified diseases excluded Asthma/ Diabetes/ Dysentery/ Hypertension/ Flu/ Epilepsy/ Arthritis
  • 12. My No Service Areas.. Ok.. Lot of things are covered under GHI…Is there anything left that we don’t cover???
  • 13. First year exclusions Cataract Benign prostratic hypertrophy Hysterectomy for menonhargia or fibromyoma Hernia/ hydrocele Congenital internal disease Fistula in anus/ piles Sinusitis & related disorder
  • 14. General exclusions         War/ war group Nuclear perils Plastic surgery Spectacles/ contact lens/ hearing aid Dental treatment Convalescence/ general debility Sterility/ venereal disease / circumcision Intentional self injury
  • 15. General exclusions contd.…  Use of intoxicating drugs/ alcohol  Aids  Diagnostic/ laboratory expenses not consistent with treatment  Vitamins/ tonic inconsistent with treatment  Pregnancy  Naturopathy
  • 16. Extensions  Pregnancy        9 months from inception Pre and post natal care not covered Max liability Rs. 50,000 First two children Abortion within 12 weeks not covered Day one cover Pre existing disease covered
  • 17. Mediclaim…No Money What if client has emergency. Can we provide service without cash??
  • 18. Cashless mediclaim  Claim handled by both ICICI Lombard Health care & Outside TPA depending upon Client  Planned treatment in notified hospital  Inform TPA & get treatment post approval  Cashless / Hassle free claims settlement  Emergency – What to do???  Give TPA membership no  Intimate TPA & approval  Cashless / Hassle free claims settlement
  • 19. Reimbursement Process of Reimbursement and claims is giving me Nausea.. I think I am sick..
  • 20. Reimbursement – mediclaim  Planned / Emergency treatment in non-notified hospital  Notice to TPA & approved  Submit  Duly completed claim form  Bills, receipts and discharge certificate/card from the Hospital  Bills from Chemists supported by proper prescription.  Test reports and payment receipts  Settlement within a week on complete submission
  • 21. Information to be taken from client for quote generation 1. No of lives to be covered Age Band /Sum Insured 3 months - 18 yrs. 19 yrs. - 35 yrs. 36 yrs. - 45 yrs. 46 yrs. - 55 yrs. 56 yrs. - 60 yrs. 61 yrs. - 65 yrs. >65 years Rs. 100,000 2. No of employees & No. of dependents 3. Add on covers required 4. Past 3 years claims data Rs. 200,000 Rs. 300,000
  • 22. Thank you Call +91 9900113820 for more information