INDIVIDUAL MEDICLAIM

MEDICLAIM COVERAGEThe Individual Medishield Policy covers :

Hospitalisation Expenses & Domiciliary Hospitalisation (treatment at home in case patient is not in condition to be moved to hospital) incurred for treatment of disease / injury sustained during policy period. The expenses can be under following category :

ROOM EXPENSES

SURGEON

Anaesthesia, Blood, Oxygen

NURSING EXPENSES

COVERAGE

AMBULANCE CHARGES

PRE & POST HOSPITALISATION

HEALTH CHECKUP

DOMICILIARY HOSPITALISATION

MEDICAL EMERGENCY ASSISTANCE

SERVICES

MEDICAL EMERGENCY ASSISTANCE

SERVICES

ELIGIBILITY

NATIONALITY

ELIGIBILITY FOR FAMILY COVERAGE

SPOUSE

AGE LIMIT-(Medical Check Up)

UNMARRIED CHILDREN

DEPENDANT PARENTS

THINGS TO REMEMBER

FOR A MINIMUM PERIOD OF 24 HOURS

CUMULATIVE BONUS

BENEFIT UNDER INCOME TAX

DOMICILIARY HOSPITALISATION COVERED UPTO 20% OF BASIC SI

EXCLUSIONS

PRE-EXISTING DISEASES

30 DAYS WAITING PERIOD

ILLNESS CONTRACTED DURING FIRST YEAR OF POLICY

WAR & NUCLEAR RISKSCIRCUMCISSION

COST OF

SPECTACLES

DENTAL / TREATMENT

COSMETIC TREATMENT AIDS

TREATMENT OUT OF

CHILDBIRTH NATUROPATHY

EXCLUSIONS

PREGNANCY OUT PATIENT TREATMENT

TRAVEL /TRANSPORTATION

EXPENSES

RACING,BUNGEE JUMPING,

PARACHUTING

ADVENTURE SPORTS

DIAGNOSTIC

EXPENSES

EXTERNAL MEDICAL EQUIPMENT

New Exclusions

• Genetic Disorders, stem cell implantation/surgery• All Non Medical Expenses including personal comfort & convenience items or

services. • Treatment of Obesity, Hormone Replacement Therapy, Sex Change

CRITICAL ILLNESSES

• Paralytic Stroke• Cancer• Renal Failure• Coronary Artery Disease(Angioplasty removed)• Major Organ Transplant• Major Injuries(loss of eyes along with loss of limbs)• End Stage Liver Disease• Major Burns• Coma• Multiple Sclerosis

Cumulative Bonus

• Within 15 days of the expiry of the earlier cover.• 15% CB-Medical test at the age of 55 years.• 10% CB-Medical test at the age of 50 years.

DOCUMENTS REQUIRED FOR CLAIMS

DISCHARGE SUMMARY, BILLS

CASH MEMO

DOCTOR’S REPORT

DIAGNOSTIC TEST REPORTS

CLAIM FORM

Revision in Individual Mediclaim -WHY THE CHANGES?

Demand for introducing new / modified products A product differentiator through Value Added Services, apart from the Critical

Illness option Some concerns on interpretation of Policy wording in the event of claims Need to update Policy wording in view of developments in medical science Review of prices by the competition – a step towards rationalization

OPPORTUNITIES

We are introducing a unique concept in the countryFirst mover advantageTieup with a leading global Company – Assist America

Medical Emergency Services (AAMES) Similar value addition to other products possibleGive a push to our Retail business in line with Corporate

strategyEnsure sustainable profitable growth with brand

building.

SALIENT FEATURESNo charge backs to ITGI or maximum limits

stipulatedNo preexisting exclusion applicable for these

assistance servicesNo geographical or territorial exclusions in IndiaNo adventure sports exclusions for these servicesAvailable to all insured persons w.e.f. 1st May 2007Direct service to insured person free of cost. No

facility for cash payment or reimbursement of

expenses incurredServices available for domestic travel not exceeding

90 days but beyond 150 kms. of residence

TPA AND AAMES

We continue with Paramount as our TPA We have chosen only select services of AAMES to avoid an overlap and

confusion on who is to render which service in the event of a claim AAMES gets into action in the event of medical emergency before actual

hospitalization The TPA’s role starts when the insured person is hospitalized TPA arranges and facilitates cashless services at medical establishments

EMERGENCY ASSISTANCE SERVICES

• Medical Consultation, Evaluation& Referral: Access to a 24hours,365 Days a Year Operations Center

• Emergency Medical Evacuation: In case of a Medical Emergency when an adequate medical facility is not available, an emergency evacuation can be arranged

• Medical Repatriation: When medically necessary, repatriation to the insured address can be done if adviced by ASSEMSIL’s physican.

• Transportation to Join Patient: A family friend/personal friend can be given a round economy trip to the hospital of the insured if the insured needs to be hospitalized for more than 7 days.

• Care and/or Transportation of Minor Children: If the insured’s minor child/children is/are left unattended as a result of the insured’s medical situtation,ASSEMSIL will provide the child with transportation to a safe place.

• Emergency Message Transmission: AAEMSIL will receive & transmit messages to/from home.

• Return of Mortal Remains: AAEMSIL will arrange and pay for the death of mortal remains.

• Emergency Cash Coordination: AAEMSIL will assist in coordinating the transfer of emergency cash.

CONDITIONS FOR EMERGENCY ASSISTANCE• The emergency medical and personal assistance services are available to those traveling

beyond 150 kms within India from their residence for a period of not more than 90 days in a trip.

• The services shall be provided by Assist America Medical Emergency Services (India ) Private Ltd which is the Indian group company of Assist America

• The benefits will be provided as direct services to the Insured by AAMESIL free of cost. No facility of any cash payment or reimbursement of expenses incurred directly by the Insured or through any other service / agency.

• With effect from the date of its implementation (i.e. 1.5.2007), all Individual Medishield Policies will be issued with the revised wordings which include the Emergency Medical and Personal Assistance Services provided by AAMESIL. This would apply to all fresh Policies, as well as our renewals effected from and after that date.

FREQUENTLY ASKED QUESTIONS

• Will AAMESIL transport a family member or friend to be with the insured?• Yes. If you are traveling alone and it seems likely that you will be hospitalized for

more than seven days, AAMESIL will transport a family member or friend to your location.

• What happens when the insured is ready to be discharged but he/she still needs assistance?

• If the insured still needs assistance at the point of discharge from the hospital, AAMESIL will arrange for the insured to come home with a medical/non-medical escort.

• Are there other services that the insured should know about?• AAMESIL also provides emergency message transmission, care of minor children left

unattended due to the medical incident, return of mortal remains, prescription assistance and legal and interpreter referrals.

• Are the insured’s spouse and children covered?• Spouse and minor children are eligible for services if they are covered under the

terms of our Iffco Tokio’s (ITGI) Individual Medi-Shield Insurance Policy.• If the insured’s doctor at home tells him that he needs to go to a particular

hospital for treatment, will AAMESIL transport the insured?• No. AAMESIL assists travellers who are travelling more than 150 kilometers from

home and need emergency medical help in such a situation.• If the insured has an accident or illness, and if he or the hospital arranges for

all the necessary transportation, will AAMESIL reimburse me for the expenses involved?

• No. AAMESIL is a Service Provider, not an Insurance Company. AAMESIL will make the arrangements for all services, which will be free of charge for the insured.