True Value Presentation


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True Value Presentation

  1. 1. Presentation on TRUE VALUE
  2. 2. <ul><li>Hospitalization Expenses incurred as an inpatient for </li></ul><ul><li>Sickness/Illness/Diseases </li></ul><ul><li>Accident </li></ul>Coverages
  3. 3. <ul><li>Hospital, Nursing Home means any institution in India established for indoor care and treatment of sickness and injuries </li></ul><ul><li>It has been registered with the local authorities and is under the supervision of a registered and qualified Medical Practitioner </li></ul><ul><li>or </li></ul><ul><li>Should comply with minimum criteria as under </li></ul><ul><li>It should have at least 15 inpatient beds (10 in Class ‘C’ Towns). </li></ul><ul><li>Fully equipped operation theatre of its own wherever surgical operation is carried out. </li></ul><ul><li>Fully qualified nursing staff under its employment round the clock </li></ul><ul><li>Fully qualified Doctor(s) should be in charge round the clock. </li></ul>What is a Hospital?
  4. 4. <ul><li>Self </li></ul><ul><li>Spouse </li></ul><ul><li>Dependent Children up to 25 Years </li></ul><ul><li>Dependent Parents up to 55 Years </li></ul><ul><li>Proposals from persons above 45 yrs, age proof in the form of DL, Pass Port, Ration Card or School Certificate is required </li></ul>Family Means
  5. 5. <ul><li>Entry Age 5 Months – 55 Yrs renewable upto 70 yrs </li></ul><ul><li>Dependent Children can be covered only with any one of their Parents </li></ul>Age Limits
  6. 6. <ul><li>Minimum Sum Insured - Rs. 30,000/- </li></ul><ul><li>Maximum Sum Insured - Rs. 80,000/- </li></ul><ul><li>The following Sum Insured options are available </li></ul><ul><li>Rs. 30,000/- </li></ul><ul><li>Rs. 40,000/- </li></ul><ul><li>Rs. 60,000/- </li></ul><ul><li>Rs. 70,000/- </li></ul><ul><li>Rs. 80,000/- </li></ul>Sum Insured
  7. 7. <ul><li>Room rent & boarding charges @ 2% of the sum insured </li></ul><ul><li>Nursing charges </li></ul><ul><li>Surgeons, Anesthetist, Consultants and Specialists fees </li></ul><ul><li>Operation Theatre charges, drugs and medicines diagnostic materials, cost of pace maker etc </li></ul>Allowable Expenses
  8. 8. <ul><li>Expenses on Hospitalization for minimum period of 24 hours are admissible. However, this time limit will not apply for </li></ul><ul><li>Dialysis, </li></ul><ul><li>Chemotherapy, </li></ul><ul><li>Radiotherapy, </li></ul><ul><li>Cataract surgery, </li></ul><ul><li>Dental Surgery, </li></ul><ul><li>Lithotripsy (Kidney stone removal), </li></ul><ul><li>Tonsillectomy, </li></ul><ul><li>Cutting and Draining of Abscess, </li></ul><ul><li>Liver Aspiration, </li></ul><ul><li>Pleural Effusion Aspiration, </li></ul><ul><li>Colonoscopy, </li></ul><ul><li>Sclerotheraphy, </li></ul><ul><li>taken in the Hospital / Nursing Home and the Insured is discharged on the same day. </li></ul>Day Care Treatment
  9. 9. Sub limits Name of the Ailment / Surgery / Procedure Sub Limit Cataract surgery Rs. 15,000/-
  10. 10. Rating Age Sum Insured (Rs.) 30000 40000 60000 70000 80000 5 Months to 25 Years 340 400 550 600 660 26 Years to 35 Years 375 450 620 710 850 36 Years to 45 Years 475 525 700 900 1005 46 Years to 55 Years NA NA 1275 1515 1800
  11. 11. <ul><li>If two persons are Covered – 10% Discount </li></ul><ul><li>If more than two persons are covered 15% Discount </li></ul>Family Discount
  12. 12. <ul><li>Cumulative Bonus at 5% for every </li></ul><ul><li>Claim Free Year </li></ul><ul><li>Upto a maximum of 10 Claim Free Years i.e., </li></ul><ul><li>50% </li></ul>Cumulative Bonus
  13. 13. <ul><li>To obtain the following benefits there should be a continuous renewal of the expiring policy </li></ul><ul><li>(a) Renewal with Cumulative Bonus details </li></ul><ul><li>Cumulative Bonus as shown in the Renewal Notice is given </li></ul><ul><li>(b) No Renewal Notice or Renewal Notice without cumulative Bonus details </li></ul><ul><li>Cumulative Bonus as shown in the Previous Policy is given </li></ul><ul><li>A declaration stating No Claim has to be obtained from the insured </li></ul>Transfer of Policy
  14. 14. <ul><li>Benefits under Section 80-D of the IT Act </li></ul><ul><li>Cashless Service without intervention of TPA </li></ul><ul><li>Direct Tie up with hospitals on an All India Basis </li></ul><ul><li>24 X 7 In-House Call center </li></ul><ul><li>Toll Free Telephone line assistance </li></ul><ul><li>Full knowledge based website to offer medical information, including Health Tips. </li></ul><ul><li>Frequent health meets to disseminate info on the health related topics </li></ul>Other Benefits
  15. 15. <ul><li>Pre and Post Hospitalisation Treatment </li></ul><ul><li>Pre Existing Diseases (covers after 4 yrs of continuous renewal with us, without break) </li></ul><ul><li>Any Disease contracted during first 30 days </li></ul><ul><li>First Year Exclusions </li></ul><ul><li>Benign prostate hypertrophy </li></ul><ul><li>Hernia, Hydrocele, Fistula in Anus, Piles </li></ul><ul><li>Sinusitis </li></ul><ul><li>Renal stone and Gall stone removal </li></ul><ul><li>First Two Years Exclusions </li></ul><ul><li>Cataract </li></ul><ul><li>hysterectomy following menorrhia or fibromyoma </li></ul><ul><li>Knee Replacement Surgery </li></ul><ul><li>Joint Replacement Surgery </li></ul><ul><li>Prolapse of intervertibral </li></ul><ul><li>Vericose veins/ulcers </li></ul><ul><li>Congenital internal disease/defect </li></ul>Exclusions
  16. 16. <ul><li>Injury / Disease arising due to War, Invasion, Act of Foreign Enemy, Warlike operations </li></ul><ul><li>Circumcision unless necessary for treatment of a disease </li></ul><ul><li>Cost of spectacles and contact lens, hearing aids, walkers, crutches wheel chairs and such other aids </li></ul><ul><li>Dental treatment or surgery </li></ul><ul><li>Convalescence, general debility, Run-down condition or rest cure, congenital external disease or defects or anomalies, sterility, venereal disease, intentional self injury and use of intoxicating drugs/alcohol </li></ul><ul><li>Naturopathy Treatment </li></ul><ul><li>Expenses incurred on Lasik Laser or Refractive Error Correction treatment </li></ul>Exclusions (Contd.)
  17. 17. <ul><li>Hospital registration charges, record </li></ul><ul><li>charges, telephone charges and such other </li></ul><ul><li>similar charges. </li></ul><ul><li>Expenses incurred on Non Allopathic </li></ul><ul><li>treatment. </li></ul>Exclusions (Contd.)
  18. 18. <ul><li>In case of Network Hospitals </li></ul><ul><li>Immediate intimation to the Call Centre (1800 425 2255) </li></ul><ul><li>The insured has to send a request for ‘Pre Authorization Form’ signed by the Doctor in the Network Hospital </li></ul><ul><li>Based on the intimation a field visit will be done by the Star Doctor </li></ul><ul><li>Pre Authorization will be issued to the Hospital </li></ul><ul><li>Based on the Pre Authorization and the Report by the Star Doctor, Cash Less Treatment will be given by the Network Hospital </li></ul>Claim Procedure
  19. 19. <ul><li>In case of Non Network Hospitals </li></ul><ul><li>Immediate intimation to the Call Centre (1800 425 2255) </li></ul><ul><li>Claim form will be sent to the Insured. </li></ul><ul><li>Based on the intimation a field visit will be done by the Star Doctor </li></ul><ul><li>Bills has to be settled by the Insured and will be reimbursed by Star on submitting the following documents </li></ul><ul><li>Original Discharge Summary </li></ul><ul><li>Main Hospital Bill with Break Up </li></ul><ul><li>Investigation Reports with X-Ray Film </li></ul><ul><li>Medical Bills with Prescriptions </li></ul>Claim Procedure (Contd.)
  20. 20. Thank You