0
Group Health
Insurance(GHI)

Call +91 9900113820
for more information
Who said I need health Insurance
My clients don’t fall sick!!
How do I tell them
importance of GHI??
Why Health Insurance?
Health insurance is needed more now than ever
before because of -

Skyrocketing
medical costs

Need ...
USP of Group Health Insurance
No physical
examination

Covers people
regardless of their
age or present state
of health
He...
Scope/ Coverage
Illness can be from
anything.. Thought of
serve the client entire life
is giving me stress attack!!
Scope of cover


Disease/ Injury




Treated medically/
surgically
By Hospitalisation/
Domiciliary hospitalisation
At ...
Compensation payable


Reasonable and
necessarily incurred




Room expenses in
hospital/ nursing home
Nursing expense...
Compensation payable contd.…





Pre and post
hospitalisation expenses
Max of SI
Surgical operation
Manual operative
...
Hospitalisation



Min period of 24 hrs
Time limit not applicable for specific treatment







Dialysis
Chemothera...
Pre & post hospitalisation


Pre hospitalisation




Post hospitalisation




Relevant medical expenses 30 days prior...
Domiciliary hospitalization





Treatment exceeding 3 days at
Residence
 Serious condition of patient does
not allow ...
My No Service Areas..
Ok.. Lot of things are
covered under GHI…Is
there anything left that we
don’t cover???
First year exclusions
Cataract
Benign prostratic
hypertrophy
Hysterectomy for
menonhargia or fibromyoma
Hernia/ hydrocele
...
General exclusions









War/ war group
Nuclear perils
Plastic surgery
Spectacles/ contact lens/
hearing aid
De...
General exclusions contd.…


Use of intoxicating drugs/
alcohol
 Aids
 Diagnostic/ laboratory
expenses not consistent
w...
Extensions


Pregnancy









9 months from inception
Pre and post natal care not
covered
Max liability Rs. 50,0...
Mediclaim…No Money
What if client has
emergency. Can we
provide service without
cash??
Cashless mediclaim


Claim handled by both ICICI Lombard Health care
& Outside TPA depending upon Client
 Planned treatm...
Reimbursement
Process of
Reimbursement and
claims is giving me
Nausea.. I think I am sick..
Reimbursement – mediclaim


Planned / Emergency treatment in
non-notified hospital
 Notice to TPA & approved
 Submit

...
Information to be taken from client for
quote generation
1. No of lives to be covered
Age Band /Sum Insured
3 months - 18 ...
Thank you

Call +91 9900113820
for more information
Group health insurance policy from ICICI LOMBARD
Group health insurance policy from ICICI LOMBARD
Upcoming SlideShare
Loading in...5
×

Group health insurance policy from ICICI LOMBARD

587

Published on

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).

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
587
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
51
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Transcript of "Group health insurance policy from ICICI LOMBARD"

  1. 1. Group Health Insurance(GHI) Call +91 9900113820 for more information
  2. 2. Who said I need health Insurance My clients don’t fall sick!! How do I tell them importance of GHI??
  3. 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. 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. 5. Scope/ Coverage Illness can be from anything.. Thought of serve the client entire life is giving me stress attack!!
  6. 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. 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. 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. 9. Hospitalisation   Min period of 24 hrs Time limit not applicable for specific treatment      Dialysis Chemotherapy Tonsillectomy D&C Cataract
  10. 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. 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. 12. My No Service Areas.. Ok.. Lot of things are covered under GHI…Is there anything left that we don’t cover???
  13. 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. 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. 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. 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. 17. Mediclaim…No Money What if client has emergency. Can we provide service without cash??
  18. 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. 19. Reimbursement Process of Reimbursement and claims is giving me Nausea.. I think I am sick..
  20. 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. 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. 22. Thank you Call +91 9900113820 for more information
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×