Transcript Family Health Optima Insurance Plan

Revision
FAMILY HEALTH OPTIMA INSURANCE
PLAN (REVISED)
SNAP SHOT
Room rent revised
 Class A and Class B cities redefined
 Cataract limits revised
 Portability brought in
 101 day-care procedures included
 Cumulative bonus in lieu of discount
 Claims Loading removed
 Automatic replenishment of SI upon exhaustion
of SI

SNAP SHOT ……
Two tier rating introduced
 Zone 1 applicable for Mumbai, Delhi ( Delhi
city, Noida, Gurgoan,Ghaziabad, Faridabad)
and entire Gujarat State will carry a higher rate
 Zone 2 applicable for the rest of India will carry
a slightly lower rate
 Premium variation between the zones is
between 4% to 11%

SNAP SHOT ……
Premium chargeable will be based on the
address of the customer
 It is mandatory for the operating offices to get
the correct and complete address.
 Incomplete proposal forms NOT TO BE
ACCEPTED

SNAP SHOT …..
Policy taken with Zone 2 rates and treatment in
Zone 1 areas
NO co-payment as is the case with other
insurance companies
 But the difference in premium between the
Zones will be recovered (adjusted in the claims)
 Medical screening as per the usual practice to
continue
 New Rs 15lacs option introduced

TRANSFER FROM EXISTING FHO OF STAR

Bonus eligibility-

Where the previous policy is claims free then
the insurance will be renewed under New FHO
with the first slab of Bonus as applicable for
the expiring sum insured.
BENEFIT ILLUSTRATION…..
Expiring policy FHO
 2A+ 2C sum insured Rs 2 lacs
 Renewed under New FHO
 Same family Size but SI is Rs 4 lacs
 No claim under the previous policy
 Eligible Bonus will be 10% that is Rs20000/
IMPACT ON PORTABILITY
This policy is portable.
 The benefit of continuity will be given only for
30 Days, PED, FY and F2Yrs exclusion
 The sum insured will be limited to the expiring
policy sum insured only
 BONUS EARNED WITH THE PREVIOUS INSURER
WILL NOT BE GIVEN CREDIT

BENEFITS
EXISTING
BENEFITS
REVISED
Room Rent
 A Class City Rs1500/
 B Class City Rs 750/
 Other s
Rs 500/


Room Rent
 A Class City Rs 5000/
 B Class City Rs3000/
 Others
Rs1000/
BENEFITS------- ROOM RENT
BENEFITS
EXISTING
BENEFITS
REVISED
Less than 24 Hrs
Now 101 Procedures
treatment at Hospital
allowed
“Day Care Procedure”
 Specific named
procedures

BENEFITS –DAY CARE PROCEDURE
LIMITS FOR CATARACT SURGERY
EXISTING
RS 12000/PER POLICY PERIOD
REVISED
Sum Insured
Amount Per Eye
Rs
Upto Rs200000/
Amount Per Policy
Period Rs
12000/
Rs 3/4/5 Lakhs
Rs 20000/
30000/
Rs 10 lakhs
Rs 30000/
40000/
EXISTING
Average
Loading on
claims ratio Premium %
of preceding
two
consecutive
years
>100%30
125%
>125%50
150%
CLAIMS
LOADING
> 150 %
80
REVISED
 NO
CLAIMS
LOADING
EXISTING

A discount of 10% is allowed
on renewal of the policy if
there is no claim in the
immediately preceding year
of the policy. This discount is
not cumulative
REVISED
No discount
NO CLAIM DISCOUNT- SUBSTITUTED BY
CUMULATIVE BONUS
NEW FEATURE (1)

Automatic Restoration of Sum Insured
WHERE THE SUM INSURED IS EXHAUSTED
DURING THE POLICY PERIOD IT IS
AUTOMATICALLY TOPPED UP BY 50% FOR SUM
INSURED OF RS 3 LACS AND BY 100% FOR
SUM INSURED ABOVE RS 4 LACS AND ABOVE
AUTOMATIC RESTORATION OF SUM INSURED
Sum Insured
%of restoration on the Basic Sum Insured
Up to Rs 2 Lakhs
Rs 3 Lakhs
Nil
50%
Rs 4 and above
100%
SUCH REPLENISHED
AMOUNT SHALL NOT BE
UTILISED FOR ANY
AILMENT FOR WHICH
CLAIM HAS BEEN MADE
BENEFIT ILLUSTRATION




Let us assume a family of 2A + 1C has taken a policy for
Rs 300000/1A is hospitalised for ailment (say for example Hernia)
and the entire sum insured of Rs 300000/- is exhausted.
Now the restoration clause will operate and a sum of Rs
150000/- will now be available for the remaining policy
period only and no additional premium is chargeable for
this
This Rs 150000/- can be utilised by the same person 1A
for any ailment unrelated to Hernia. Other persons under
the policy can also utilise the sum insured until policy
expiry date.
NEW FEATURE (2)
Bonus
For every claim free year Bonus upto the scales is
allowed.
The bonus ranges from 10% to 25% in the first
renewal and additional 5% to 10% for the
second renewal.

BONUS
Basic Sum I Year
Insured
Rs
IIYear
%
III Year
%
Maximum
Cumlative
Bonus %
100000
Nil
10
5
15
200000
Nil
10
5
15
300000
Nil
25
10
35
400000
Nil
25
10
35
500000
Nil
25
10
35
1000000
Nil
25
10
35
1500000
Nil
25
10
35
BENEFIT ILLUSTRATION….
Year
Basic Sum
Insured Rs
Claims Rs
Bonus in Rs
First Year
300000
Nil
Nil
Second Year
300000
Nil
75000
Third Year
300000
Nil
105000
Fourth Year
300000
Nil
105000
BENEFIT ILLUSTRATION
In any case the maximum bonus shall not
exceed 35% for sum insured of Rs 3 lacs and
above and 15% for sum insured below Rs 3
lacs
BONUS (CONTD)
Bonus will be computed on the basic
sum insured
 If there is a claim the earned bonus will
be reduced by 50%
 If there is a claim in the successive
year the bonus will become zero

HOW DOES IT COMPARE WITH THE OTHER
POLICIES IN THE MARKET???
SUM INSURED OPTION-WISE
2 LACS – MAX DIFF RS 2600 IN AGE BAND-51
TO 55 YRS
3 LACS – RS 2560
4 LACS- RS 2000
5 LACS – RS 3800
ALL FOR ZONE 1

COMPAR……


EXAMPLE – INSURED 52YRS FAMILY SIZE 2A+ 2C SUM
INSURED RS 5 LACS ZONE 2
2 CLAIM FREE YEARS. THE SAVINGS CAN BE USED FOR BUYING
A SURPLUS POLICY
SUM
INSURED
PREMIUM
STAR
MARKET
PREM
SAVING
TOTAL COVERAGE INCL BONUS
500000
16075
20474
4399
500000 + 175000=675000
1000000*
4300
*SUPER
SURPLUS
675000+1000000=1675000**
** BUT MARKET POL SI WILL BE RS 500000 +BONUS
RS500000= TOTAL RS 1000000 ONLY
COMPARISON COVERAGE….

NO ONE YEAR WAITING PERIOD – MIN WAITING
PERIOD IS 2 YRS UNDER POLICY

BONUS; IF THERE IS A CLAIM THE BONUS IS
REDUCED BY 50% OF THE BASIC SI.
THAT IS WHAT IS EARNED IS LOST
BONUS ILLUSTRATION
FOR EG X TAKES A POLICY FOR RS 3 LACS
 HAS ONE CLAIM FREE YR
 IN YR 2 HIS COVERAGE AMNT IS RS450000/ IN YR 3 HE LODGES A CLAIM AND IN YR 4 HIS
COVERAGE WILL BE ONLY THE BASIC SI OF RS
3LACS
 THE BONUS EARNED IS TOTALLY LOST – BUT
HE CONTINUES TO PAY THE HIGHER PREMIUM

BONUS ILLSTR CONTD…..
NOW UNDER OUR POLICY
 YR 1 POLICY FOR RS 3LACS- NO CLAIM
 YR 2 HIS COVERAGE IS RS 300000+75000(B)
 YR 3 THERE IS A CLAIM
 YR 4 HIS COVERAGE WILL BE 300000+37500

HE CAN HAVE THE CAKE & EAT IT
TOO !