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) | |
| Minimum | 18 |
| Maximum | 65 |
| Maximum Policy Renewal Age (years) | Lifetime renewal |
| Coverage Type | Individual/ Family floater |
| Sum Insured (Rs) | |
| Maximum | 10 lakh |
| Minimum | 3 lakh |
| Policy Term (years) | 1/2 |
| Discount | 10% 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 Bonus | 5% no claim bonus for every claim free renewal till it reaches 50% of initial sum insured |
| Pre Policy Medical Check Up | Not required upto 45 years of age |
| Free look Period | 15 days |
| Grace Period for Policy Renewal | 15 days |
| Co Payment Clause | Insured persons above 70 years of age have to bear 25% of the admissible claim amount |
| Policy Termination | Either 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 | |
| Address | L&T General Insurance Company Limited 601-602, 6th Floor, Trade Centre, Bandra-Kurla Complex, Bandra (East), Mumbai - 400051 |
| Mail to | [email protected] |
| Call to | 1800-209-5846 |
| SMS | ‘LTI’ to 5607058 |
| Network Hospitals | Http://110.234.8.38/ltweb/SearchNspWithoutLogin.aspx |
Additions to the Plan
| Scope Of Cover | |
| Cashless facility | available if treatment taken in network hospital |
| Reimbursement facility | available if treatment availed in non-network hospital |
| Pre & post hospitalisation benefit | covers medical expenses upto 60 days prior to hospitalisation and upto 90 days after discharge |
| Hospitalisation expenses | covered |
| Hospitalisation due to accident | once the opted sum insured is exhausted, equivalent sum insured is restored for hospitalisation due to accident only |
| Day care procedures | covered upto sum insured limit |
| Hospital cash | pays Rs 1000 per day after 3 continuous days of hospitalisation for maximum of 7 days |
| Ambulance charges | covered 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 baby | 5% 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 expenses | covered upto certain limit |
| Lumpsum recovery benefit | a 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 person | upto Rs 500 per day after 3 continuous days of hospitalisation for maximum of 7 days |
| Donor expenses | covered in case of major organ transplant |
| Exclusions and Waiting Period | |
| Pre-existing diseases | covered from 3rd year of the policy |
| No claim period | 30 days from the start of the policy |
| Waiting period | 4 years for maternity benefit2 years for certain diseases such as cataract, hernia, sinusitis etc. |
| General exclusions | AIDS 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 I | All India cover: Mumbai, Delhi and NCR Regions | |
| Zone II | Chennai, Hyderabad, Bangalore, Pune, Kolkata and Gujarat Regions | |
| Zone III | Rest of India (other than Zone I and Zone II locations) | |
