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CDAC Health Insurance Program

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by

Prasanth Peter

on 8 April 2016

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Transcript of CDAC Health Insurance Program

Health Insurance Program for Retired Employees
Benefits of
Standard Mediclaim Insurance
with Continuity
for RETIRED EMPLOYEES

How
FAMILY MEDICLAIM
differs from
GROUP MEDICLAM

What is
Standard Mediclaim
with Continuity

This is essential for getting coverage for pre-existing diseases and time bound exclusions
ADVANTAGES TO
RETIRED EMPLOYEES

Pre-Existig Diseases covered if Employee has completed 4 years in CDAC's Group Mediclaim
Pre-acceptance check-up not required at the time of taking Family mediclaim Policy
Insurance company bound to give policy irrespective of the retired employee and his/ her dependents' health condition
Claim ratio of the group will not effect the renewal premium
Policy can be renewed for life long
Income Tax Benefit as per Section 80D can be availed for the premium paid under the policy.
THANK YOU
AIMS Insurance Broking Pvt. Ltd.

5th floor, Chittoor Towers, Bakery Jn., Trivandrum

0471 4010333, support@aimsinsurance.in
Scenario 1
Scenario 2
Group Mediclaim Insurance
The terms and conditions are customized as per CDAC's requirement
For Employees
For Parents
Parents covered on a Floater Sum Insured of Rs.1 Lakh
EXISTING SCENARIO
Comprehensive coverage
Family Floater Sum Insured of Rs.1 Lakh and 2 lakhs
Default Terms and conditions
Pre-acceptance health check up required for individuals above the age of 45 years
PRE-ACCEPTANCE HEALTH CHECK-UP
GROUP MEDICLAIM
FAMILY MEDICLAIM
Pre-acceptance health check-up NOT REQUIRED
Insurance company may decline coverage in case of adverse medical results
All Employees and their dependents are covered irrespective of their medical condition
COVERAGE
GROUP MEDICLAIM
FAMILY MEDICLAIM
Terms and conditions of the policy customized as per CDAC's requirement
Pre-Existing Diseases
Group Mediclaim
Family Mediclaim
Covered after
four
continuous years of coverage
Covered from day one
30 Days Waiting Period
Group Mediclaim
Family Mediclaim
30 days waiting period at inception of the policy
Not applicable
2 years Exclusion
Group Mediclaim
Family Mediclaim
Certain Diseases covered only after 2 continuous years of cover
All Diseases Covered from day one
Cataract
Benign Prostatic Hyperthrophy
Hysterectomy
Hernia
Hydrocele
Congenital Internal Diseases
Fistula in Anus
Piles
Sinusitis
Gall Bladder Stone Removal
Gout & Rheumatism
Calculus Disease
Joint Replacement due to Degenerative condition
Age Related Osteoarthritis
Limits for Specified Surgeries
Group Mediclaim
Family Mediclaim
Only Cataract limited to Rs.25000
Limits applied for Nine Surgeries
Cataract
Hernia
Hysterectomy
Cardiac Surgery
Cancer Surgery
Brain Tumour Surgeries
Pacemaker implantation for sick, sinus syndrome
Knee joint replacement
20% of Sum Insured, Maximum of Rs.50000
15% of Sum Insured, Maximum of Rs.30000
10% of Sum Insured, Maximum of Rs.25000
70% of Sum Insured, Maximum of 4Lakhs
Pre-fixed Premium
PREMIUM
GROUP MEDICLAIM
FAMILY MEDICLAIM
Negotiated Premium
Premium based on age and Sum Insured
Claims Loading
No Claim Discount
3% on renewal premium after three continuous claim free years and every subsequent claim free year.
Subject to a maximum of 15%
If three or more claims are lodged in two year.
Claim up to 25% of S.I
26 to 50% of S.I
51 to 75% of S.I
Above 75% of S.I
25% loading on renewal premium
50% loading on renewal premium
75% loading on renewal premium
100% loading on renewal premium
Income Tax Exemption as per Section 80D eligible for the Policy Holder
INCOME TAX EXEMPTION
GROUP MEDICLAIM
STANDARD MEDICLAIM
No Income Tax Exemption is eligible either for the Employee or for the Employer
Exemption for Premium paid up to Rs.20000 for Senior Citizens and up to Rs.15000 for others
The number of years an Employee and his family covered under Group Mediclaim policy of CDAC will be considered and counted while taking a Family Mediclaim Policy from the Same Insurance Company at the time of Retirement.
Existing Policy issued by United India Insurance Company
Employee, Spouse and Children covered under the policy
Individually parents can be covered for a Sum Insured of Rs.50000
On Retirement..
Retired Employee can take a Family Mediclaim policy from United India Insurance Company.
Continuity Benefit from Group Mediclaim Policy will be provided for the same Sum Insured
This benefit is provided only for the Same Sum Insured as in CDAC's Policy
Premium can be loaded only as per the defined terms in the policy
No maximum age limit.
30 days waiting period will not be applicable
Mr. Das and Mr. Vijay, retires from CDAC after 10 years of service and was insured under CDAC's GMC for 4 years.
Retired employee and his/her dependents will be removed from group mediclaim policy
All illness covered from day one
Waiting period not applied for accidental hospitalization
After 6 months, both of their Spouse was admitted to KIMS Hospital for Hysterectomy and the total bill amounted to Rs.65000.
Illustration
Mr.Das took a Family mediclaim with Continuity for his family from United India and Mr.Vijay took a Mediclaim from ABC insurance company.
Approved as Two years Exclusion will not be applied because of Continuity Benefit.
Repudiated as Hysterectomy is not covered for the first Two Years.
Mr. Vijay's Claim
Mr. Das's Claim
Claim amount was limited to Rs.50000 as per policy condition
Scenario 2
After 6 months, both of their Spouse was admitted to KIMS Hospital for Hysterectomy and the total bill amounted to Rs.65000.
Approved as Two years Exclusion will not be applied because of Continuity Benefit.
Repudiated as Hysterectomy is not covered for the first Two Years.
Mr. Vijay's Claim
Mr. Das's Claim
Claim amount was limited to Rs.50000 as per policy condition
Full transcript