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).

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

20. Reimbursement
Process of
Reimbursement and
claims is giving me
Nausea.. I think I am sick..

21. 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

23. 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

24. Thank you
Call +91 9900113820
for more information