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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) 
Minimum18
Maximum65
Maximum Policy Renewal Age (years)Lifetime renewal
Coverage TypeIndividual/ Family floater
Sum Insured (Rs) 
Maximum10 lakh
Minimum3 lakh
Policy Term (years)1/2
Discount10% 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 Bonus5% no claim bonus for every claim free renewal till it reaches 50% of initial sum insured
Pre Policy Medical Check UpNot required upto 45 years of age
Free look Period15 days
Grace Period for Policy Renewal15 days
Co Payment ClauseInsured persons above 70 years of age have to bear 25% of the admissible claim amount
Policy TerminationEither 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 
AddressL&T General Insurance Company Limited
601-602, 6th Floor, Trade Centre,
Bandra-Kurla Complex, Bandra (East),
Mumbai - 400051
Mail to[email protected]
Call to1800-209-5846
SMS‘LTI’ to 5607058
Network HospitalsHttp://110.234.8.38/ltweb/SearchNspWithoutLogin.aspx
Additions to the Plan
Scope Of Cover
Cashless facilityavailable if treatment taken in network hospital
Reimbursement facilityavailable if treatment availed in non-network hospital
Pre & post hospitalisation benefitcovers medical expenses upto 60 days prior to hospitalisation and upto 90 days after discharge
Hospitalisation expensescovered
Hospitalisation due to accidentonce the opted sum insured is exhausted, equivalent sum insured is restored for hospitalisation due to accident only
Day care procedurescovered upto sum insured limit
Hospital cashpays Rs 1000 per day after 3 continuous days of hospitalisation for maximum of 7 days
Ambulance chargescovered 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 baby5% 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 expensescovered upto certain limit
Lumpsum recovery benefita 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 personupto Rs 500 per day after 3 continuous days of hospitalisation for maximum of 7 days
Donor expensescovered in case of major organ transplant
Exclusions and Waiting Period
Pre-existing diseases covered from 3rd year of the policy
No claim period30 days from the start of the policy
Waiting period4 years for maternity benefit2 years for certain diseases such as cataract, hernia, sinusitis etc.
General exclusionsAIDS or HIV and other related diseases
Premiums for the policy will depend on number of family members to be insured, age of members, sum assured amount, policy tenure and insured's location. Premiums can be calculated using calculator on companyu0092s website. For premium calculation, different cities have been categorized into a total of three zones as given below:
Zone IAll India cover: Mumbai, Delhi and NCR Regions
Zone IIChennai, Hyderabad, Bangalore, Pune, Kolkata and Gujarat Regions
Zone IIIRest of India (other than Zone I and Zone II locations)

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