Following are the innovative key benefits that are unique to my:health Medisure Prime Insurance.

• Pay for your Policy based on your location
  • The healthcare costs differ in different cities across India. We have carefully
    factored the same while arriving at the premium.
  • So if you belong to a city where the cost of a particular treatment is lower than say Mumbai, you will have to pay a lower rate of premium (Read on to know which zone you belong to)
    .
• Double Sum Insured for treatment of a critical illness
  • The Policy provides an additional cover equivalent to the Sum Insured (which essentially doubles the Sum Insured) for treatment of a critical illness.
  • This includes 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 Cover
  • The Policy provides coverage towards maternity expenses and new born baby cover up to the limit of Sum Insured below.
  • Maximum of 5% of Sum Insured or `25,000 for a normal delivery and 10% of Sum Insured or `50,000 for a caesarean section or actual cost, whichever is lower.
  • Coverage is applicable only towards the first two children for Self and lawful Spouse who are covered under a single Policy for a continuous period of 48 months.
  • New born baby will be covered for a period of 90 days from date of birth within the maternity limits.
    
• Reinstatement of Sum Insured in case of hospitalisation due to an Accident

  If during the term of your Policy, the entire Sum Insured gets used up and there is a second hospitalisation due to an accident, the Sum Insured of your Policy is ‘reinstated’ or ‘replenished’ to the extent of claim amount but not exceeding the Sum Insured. This additional amount will be available only ONCE during the 12-month Policy period and shall trigger when the basic Sum Insured opted under the Policy has been exhausted or is inadequate to cover this second hospitalisation due to accident.

• Lump-sum recovery benefit for hospitalisation exceeding 10 continuous days
  
• Two year Policy option allows you to renew your Policy at the end of 24 months v/s the traditional 12 months
  
• FREE Health Check-up after every two consecutive renewals once you are above 45 years at the time of the 2nd renewal
  
• Treatment expenses for Pre-Existing Diseases/Injury/Illness will be covered from the 3rd year of the Policy
  
• Instant Policy issuance and no medical test if you are below 45 years at the time of Policy issuance with no adverse medical history
• Lifetime renewal of Policy

For over 7 decades, across industries, the L&T Group practiced and perfected incisive solutions and its precise delivery. We are a state-of-the-art technologically-driven company that has the calibre and expertise to provide world-class customer service.

Our rigorous innovative and unique product benefits coupled with seamless customer support is what will give you the L&T Insurance Advantage:

• Claims Service Assurance* – Cashless decision within 6 business hours (where the request is received between 9 am to 9 pm on working days) and during non-working hours cashless decision will be in a maximum of 8 hours, failing which a fixed compensation of `1,000 will be paid to the insured. Reimbursement claim settlement within 6 working days of receipt of complete documents.
• Concierge Service* – (Claims Associate) available on request in select cities, to personally assist you during the cashless procedure between 9 am to 9 pm on working days, when there is a claim
• Personal Case Manager* – (Policy Manager) available at your option in select cities to meet you with prior appointment to explain the benefits and clarify your doubts on the Policy
• 24 X 7 Claims Assistance

* Service features are inbuilt in to the Policy and will be available to all Insured Persons without any additional cost.

Your my:health Medisure Prime Insurance offers you a host of additional features:

• Family Floater option: You can cover up to 4 members of your family – your lawful spouse & 2 dependent children up to the age of 18 years under a single Policy and single Sum Insured.
• Family Discount: If you choose to opt for Individual Sum Insured for each of your family members under a single Policy instead of a Family Floater option, you are eligible to get a Family Discount of 10% on the total premium payable for covering more than 2 members which include yourself, lawful spouse, maximum 2 dependent children and dependent parents only. Family discount will be available for a maximum of 6 persons only.
• Cumulative Bonus: The ‘Sum Insured’ of your Policy progressively increases by 5% on every renewal, for every claim-free year, subject to a maximum accumulation of 50% of your Sum Insured (If a claim is made, the Cumulative Benefit that has accrued will be available for claim but will become zero from the next renewal).
• Income Tax Benefit: You can get tax exemption on the premium paid under section 80D of the Income Tax Act.
• Free-look Period: 15 days from date of receipt of Policy documents, you have the option to cancel the Policy if you are not satisfied with the coverage, terms of the Policy, provided there is no claim. A minimum premium towards medical test charges, stamp duty and proportionate risk premium will be retained by us.
  

• Hospitalisation expenses up to Sum Insured limit
• Pre-hospitalisation expenses up to 60 days and Post hospitalisation expenses up to 90 days
• Day Care Procedures up to Sum Insured limit
• Ambulance Charges maximum up to Rs.1,500 per hospitalisation
• Critical Illness Cover up to double the Sum Insured opted for listed Critical Illnesses
• Hospitalisation due to Accident – When opted Sum Insured has been exhausted equivalent Sum Insured is restored for hospitalisation due to accident only
• Maternity & New Born Baby Cover – Maximum of 5% of opted Sum Insured or Rs.25,000 for a normal delivery and 10% or Rs.50,000 for a caesarean section or actuals, whichever is lower including expenses towards new born baby.
• Hospital Cash – Rs.1,000 per day from 4th to 10th day when hospitalisation exceeds 3 continuous days
• Recovery Benefit – Rs.10,000 when hospitalisation exceeds 10 continuous days or more
• Expenses for accompanying person – up to Rs.500 per day from 4th to 8th day when hospitalisation exceeds 3 continuous days
• Donor Expenses – Donor expenses reimbursement in case of major organ transplant
• Cost of Health Check-up – After every 2 years of continuous renewals for all Insured Persons who have attained 45 years of age at the time of the 2nd consecutive renewal.

• Entry age for you (the proposer) is 18 years and you can opt for this Policy up to the age of 65 years
• Renewal of the Policy is for your lifetime
• Children above the age of 3 months and adults below the age of 65 years can be covered in this Policy
• Children up to the age of 18 years can be covered only if one or both parents are covered
• If you are above the age of 45 years your Policy issuance is subject to Pre-acceptance medical tests and approval from us.

Rs.3 lakhs to 10 lakhs in multiples of 1 lakh.

• The following ailments are not covered during the first 2 years of the Policy: Cataract, Benign Prostatic Hypertrophy, Congenital Internal Diseases, and Fistula in Anus, Piles, and Hysterectomy for Menorrhagia or Fibromyoma, Hernia, Sinusitis and related disorders. (For a detailed list of exclusions, please refer the prospectus or visit our website www.ltinsurance.com)
• Pre-Existing disease/illness/injury/condition will not be covered for first 2 years of the Policy
• Any disease contracted during the first 30 days from the start of Policy
• Any domiciliary treatment
• Treatment due to suicide, self-inflicted injury or illness, mental disorder, anxiety, stress or depression, use of alcohol or drugs
• Diseases such as AIDS or HIV and its complications

Note: For detailed list of exclusions please refer to the prospectus or contact your Insurance advisor.

In case you wish to cancel the Policy you may intimate us by giving 15 days notice in writing and we will refund the premium for the unexpired term as per the short period scale given below.

Period of Cover up to Refund of Annual Premium Rate (%) 1 Month 75% 3 Months 50% 6 Months 25% Exceeding Six Months up to 365 days NIL

For two year policies we will retain 15% of the premium for the balance period.
Eg. 2 Year Policy issued for 730 days.
Cancellation request received on day 395 (1 year and 1 month)
The amount refunded will be calculated as follows:
The amount to be refunded will be 15% less than the pro-rata premium for the balance period. 2 year premium Rs.1000. Utilised period 395 days, unutilised period of 335 days. Pro-rata premium for unutilised premium will be Rs.458.9
Refund amount shall be Rs.458.9 – 15% i.e (Rs.458.9 – Rs.68.83) = Rs.390
No refund will be done if you have reported a claim under the Policy.

You can renew your Policy within 15 days from expiry of Policy to be eligible to ‘continuity benefits’ like the cumulative benefit etc., If you do not renew your Policy within 15 days, it will be treated as a new/fresh Policy.

Change in Sum Insured or Zone of cover may be allowed on renewals.

The Company reserves its rights to vary the premium from time to time subject to approval of IRDA.

Portability Option: Portability will be provided on this Policy in accordance to IRDA guidelines issued on Portability from time to time. You may approach another insurer at least 45 days before the expiry date to avoid any break in coverage.

For the purpose of premium calculation, there are 3 major Zones classified on the basis of your location:

Zone I (All India Cover): Mumbai, Thane, Navi 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)

• Zone I premium gives you an All-India cover. i.e., you can avail treatment all over India without any co-payment
  
• Zone II premium allows you to avail treatment in Zone II and Zone III locations without any sub-limits. But if you have to avail treatment in a Zone I city, you will have to bear a 10% co-payment on each and every claim
  
• Zone III premium allows you to avail treatment only in Zone III locations without sub-limits. In case you have to avail treatment in a Zone II location, you will have to bear a 10% co-payment on each and every claim. And if you have to avail treatment in a Zone I location, you will have to bear a 20% co-payment on each and every claim

You have a choice to opt for Zone I (All India Cover) even if you belong to a Zone II or III by paying the premium applicable under Zone I.

Insured Persons above the age of 70 years will have an additional co-payment obligation of 25% irrespective of the Zone.

To find out which Zone you belong call us at 1800-209-5846 (1800-209-LTIN) or visit our nearest office or contact your Insurance Advisor.

The Premium will be based on the age of the senior most member in the Policy, Zone of cover, total number of persons you wish to cover, the Policy tenure and Sum Insured you opt for.

For complete details on the premium structure please call us at 1800-209-5846 (1800-209-LTIN) or visit our nearest office or contact your insurance advisor.

For person below 45 years with a clean medical history, all you need to do is fill in the necessary details in the Proposal Form and hand it over along with your premium payment instrument to your Insurance Advisor or at any of our offices. You will be given an instant Policy Kit. All proposals above 45 years or for proposals below 45 years of age with an adverse medical/claim history will have to undergo a pre-enrollment medical test.

Medical Tests required for age group 46-55 includes Medical Examination Report, Electrocardiogram, Serum Triglycerides, Fasting Blood Sugar, Serum Creatinine, Urinalysis, SGOT & SGPT. Medical Tests required for age group 56-65 includes Medical Examination Report, Electrocardiogram, Complete Blood Count, Lipid Profile, Fasting & Post Prandial Blood Sugar, Serum Creatinine, Urinalysis, SGOT, SGPT and GGT.

Medical tests will be conducted at our list of diagnostic centres and 100% cost for the same will be borne by us. Based on the evidence from the above reports the Company may call for additional reports on a case to case basis to determine the acceptance of a Proposal. 50% Cost of any additional test shall be borne by the Company for accepted proposals.

For Cashless* hospitalisation: (*Cashless facility is available only at our network hospitals)

• You will need to contact us at the contact numbers provided on your health card immediately
• You need to submit a Cashless Request form to us, along with all information and documents pertaining to the illness as required
• Our representative will guide you further and help you process the request and based on the coverage under your Policy the Cashless request will be approved.

For a Reimbursement of expenses:

• You will need to collate the original bills along with other documents as required and submit it to the address mentioned in your Policy schedule.

In case of planned hospitalisation, please inform us 72 hours in advance and in case of emergency within 24 hours of admission. (Our network of hospitals as well as documentation for cashless claims is available in detail on www.ltinsurance.com)

Our Claims settlement procedure is quick and transparent. For any kind of support or information, please call our helpline 1800-102-3243 or write to us at myhealthclaim@ltinsurance.com. Undue delay in intimation of claim or submission of documents may prejudice a claim.

Click Here to download the claims guide for detail information on the claim process, and to get a checklist of the documentation.