IOB HEALTH CARE PLUS Indian Overseas Bank as corporate agent under IRDAI does not underwrite the risk or act as insurer. IOB Health Care Plus a unique health/ mediclaim cover offered by Universal Sompo General Insurance in association with Indian Overseas Bank. The IOB Health Care Plus is a complete health Insurance Plan that covers Proposer, spouse, two dependent children, dependant parents and unlike any other regular policy, wherein a family has to take individual policies for each member, this unique family floater gives you the flexibility of taking one policy that covers the entire family under a single sum insured. The Policy takes care of the hospitalization expenses, subject to maximum Sum Insured, in respect of the following eventualities: a. Sudden illness b. An accident c. Any surgery that is required in respect of any disease. Who can take the Policy? The policy provides for Mediclaim Insurance cover, which is available to all the customers of IOB maintaining a S.B. or C.D account with them including NRI customers. However, the cover is available for treatment in hospitals, in India only. How can one become a member? The procedure to become a member of the scheme is very simple. There is no medical examination. All that the account holder requires to do is fill up and sign a proposal form which includes declaration of good health. How the premium is to be paid? The premium will be debited to the S.B. or C.D. account as per the authorization given in the proposal form. What is the period for which the insurance is available and how it is renewed? The insurance cover is available for a period of one year from the date of debit of the premium. Renewals are to be done on yearly basis on or before the due date. What are the documents given in proof of insurance? The account holder will be issued with a copy of the proposal form duly acknowledged by the branch for having debited the premium amount to the account. After receipt of the proposal form by the Insurance company and (in house TPA), a policy will be issued by Insurance company and ID card will be issued by (in house TPA). Eligibility All account holders of Indian Overseas Bank within the age band of 18 to 65 years are eligible to take the Policy. An individual may cover himself/ herself and his/ her spouse, dependent children under Plan A of the Policy and himself/herself, his/her spouse, dependent children and dependent parents under Plan B of the policy. Wide Range of Sum Insured - Options ranging from Rs 0.5 Lac to Rs 5 Lakhs are available. Enrollment age under the policy is between 5 years and 65 years. Dependent children from age 3 months can be covered with at least one parent under the Policy. Maximum age under, till which dependent male child can be covered is 21 years and Female up to 25 years or till their marriage whichever is earlier. What is covered under the Policy? The Policy covers reimbursement of Hospitalization expenses for illness / diseases contracted or injury sustained by the Insured Person. In the event of any claim becoming admissible under Policy, the company will pay to the Hospital / Nursing Home / Insured person but not exceeding Sum Insured selected for the family as stated in the Schedule and subject to terms and conditions of the Policy, during the Period of Insurance for the following expenses: A. Room, Boarding expenses as charged by the Hospital / Nursing Home B. Nursing expenses C. Fees paid to Surgeon, Anesthetist, Medical Practitioner, Consultants and Specialists D. Anesthetist, Blood, Oxygen, Operation Theatre charges, Surgical appliances, Medicines & Drugs, Diagnostic Material and X-ray, Dialysis, Chemotherapy, Radiotherapy, Cost of Pacemaker, Artificial Limbs. Expenses on hospitalization incurred anywhere in India are covered. Expenses on hospitalization in Bhutan and Nepal are also covered but Cashless service is not available. Claim settlement will be only in Indian Currency. Duration of Hospitalization Expenses on hospitalization for a minimum period of 24 hours are admissible. However, this time limit is not applied to specific treatments, i.e. Dialysis, Chemotherapy, Radiotherapy, Eye Surgery, Lithotripsy (Kidney stone removal), D&C, Tonsillectomy taken in the Hospital / Nursing Home and where in the insured is discharged on the same day, such treatment will be considered to have been taken under hospitalization benefit. This condition will also not apply in case of stay in Hospital for less than 24 hours provided (a) the treatment is such that it necessitates hospitalization and the procedure involves specialized infrastructural facilities available in hospitals (b) due to technological advances hospitalization is required for less than 24 hours only. Features 1. Choice of Sum Insured ranges from Rs 50,000 to Rs 5,00,000 in multiples of Rs 50,000. 2. Enlisted Day Care procedure (procedures covered without 24 hrs hospitalization) covered. 3. Maternity Benefit - covered up to 5 % of SI with waiting period of 9 months 4. Pre Existing Illness - Covered after 48 months of continuous coverage 5. Ambulance cover - Covered up to 1 % of basic SI or Rs 1000/- per claim 6. Pre Hospitalization & Post Hospitalization- Covered for 30 & 60 days, before & after hospitalization respectively subject to availability of Sum Insured. 7. Hospital Cash to Parents- In case of Hospitalization of Children up to Age 12 years Cash allowance of Rs.100/- per day subject to a maximum of Rs.1000/- will be given to account holder. 8. Cost of Health check up- The insured shall be entitled for reimbursement of cost of 1% of the amount of average Sum Insured for health check-up once at the end of block of every Three Policy years (under this scheme) provided there are no claims reported during the block. 9. Funeral Expenses-In case of death of any of the insured persons following hospitalization with valid claim under the Policy, Funeral expenses of Rs.1000/- will be paid under the Policy. 10. Personal Accident Cover - Available on payment of additional premium Coverage against death on floater basis as mention below I. Account holder 100% of CSI II. Spouse -50 % of CSI III. Dependent Children above 12 yrs of age - 20 % of CSI IV. Dependent Children below 12 yrs of age - 10 % of CSI CSI is the floater sum insured 11. Portability Benefit available-We can cover portability of benefits to similar cover under indemnity plan subject to intimation of complete details by application atleast 45 days prior to the expiry of existing policy. 12. Tax benefit: Only the Medical Premium Component (excluding Service Tax thereon) is eligible for rebate under Section 80D of the Income Tax Act. Free Look Period We shall give You a Free Look Period at the inception of the Policy and 1. You will be allowed a period of at least 15 days from the date of receipt of the Policy to review the terms and conditions of the Policy and to return the same if not acceptable. 2. If You have not made any claim during the Free Look period, You shall be entitled to a) A refund of the premium paid less any expenses incurred by us on Your medical examination and the stamp duty charges or; b) where the risk has already commenced and the option of return of the Policy is exercised by You, a deduction towards the proportionate risk premium for period on cover or; c) Where only a part of the risk has commenced, such proportionate risk premium commensurate with the risk covered during such period Exclusions Pre-existing diseases will not be covered until 48 months of continuous coverage have elapsed, since inception of the first Policy Hospitalization expenses incurred in first 30 days from the date of commencement of the cover will not be covered except in the case of death due to accident. Hospitalization expense incurred in the first year of operation of the insurance cover on treatment of the following Diseases: Cataract, Benign Prostatic Hypertrophy, Myomectomy, Hysterectomy, Hernia, Hydrocele, Fistula in anus, Piles, Arthritis, Gout, Rheumatism, Joint replacement unless due to accident, Sinusitis and related disorders, Stone in the urinary and biliary systems, Dilatation and Curettage, Skin and all internal tumors/cysts/nodules/polyps of any kind, including breast lumps, unless malignant, adenoids and hemorrhoids Dialysis required for rental failure, Surgery on tonsils and sinuses, Gastric and duodenal ulcers Domiciliary hospitalization is not covered under the policy. 20% co-pay shall be applicable on each and every claim of Insured above 55 years of age Expenses essentially non-medical in nature Dental treatments except warranted due to accident and taken as inpatient. Injury or diseases directly or indirectly caused by or arising from or attributable to war, invasion, act of foreign enemy. Cost of spectacles and contact lens or hearing aids Any expense on treatment related to HIV, AIDS and all related medical conditions. Naturopathy treatment Cosmetic treatment unless required due to an accident Other standard exclusions applicable to mediclaim policy will also apply. How to make a claim in case of hospitalization? Cash less treatment can be availed at network hospitals by showing the ID card issued by TPA along with the necessary photo ID proof as prescribed by the Insurance company and copies of valid insurance policies and in case for any reason cashless service could not be availed, the insured can meet the hospital expenses and claim reimbursement from Universal Sompo General Insurance Company Limited (USGI). Claims Procedure A) Reimbursement Claims Process: Upon happening of any injury / Disease which may give rise to a claim under this Policy You shall give USGI a notice to Our call centre immediately and also intimate in writing to Our Policy issuing office but not later than 7 days from the date of Hospitalization. A written statement of the claim will be required and a Claim Form will be completed and the claim must be filed within 30 days from the date of discharge from the Hospital or completion of treatment. You must give all original or copies of bills, receipts, certificates, post-mortem report in the event of death, information and evidences from the attending Medical Practitioner / Hospital / Chemist / Laboratory as required by USGI. On receipt of intimation from You regarding a claim under the Policy, We are entitled to carry out examination and obtain information on any alleged Injury or Disease requiring Hospitalization if and when We may reasonably require. B) Cashless Claims: Cashless Service: You can avail cashless hospitalization facility at any hospital in the network of the TPA. We will provide a Cashless Service by making payment to the extent of Our liability direct to the Network Hospital as long as We are given notice that the Insured Person wishes to avail Cashless Service accompanied by full particulars at least 48 hours before any planned treatment or Hospitalization or within 24 hours after the treatment or Hospitalization in the case of an emergency (namely a sudden, urgent, unexpected occurrence or event, bodily alteration or occasion requiring immediate medical attention). In case if You want to avail cashless facility in any of the network hospital you shall follow the process as mentioned below. Carry the Health Card/ copy of E-cards. Obtain Pre Authorization form from the hospital counter. Fill up the form and submit it at the hospital counter. Ensure that hospital faxes the pre authorization form to TPA or you can fax the form to TPA yourself. Once the form has been faxed, TPA will send the authorization to the Hospital. Once cash less approval is received, patient need not pay the bill to the hospital for covered medical expenses Cashless facilities at over 4000+ quality hospitals across India. Processing Prompt settlement of both Cashless and Reimbursement claim by In House TPA. Customer Service Center Address: Universal Sompo General Insurance Company Ltd., Plot No - EL-94, KLS Tower, TTC Industrial Area, MIDC, Mahape, Navi Mumbai 400710. Phone: Customer Care Helpline: 1800 22 4030, 1800 200 4030, 022 - 27 63 9800, 022 - 39133700 Email: contactus[at]universalsompo[dot]com, For Claims: contactclaims[at]universalsompo[dot]com Address of TPA: Universal Sompo General Insurance Company Limited Health Claims Management Office 5th Floor, Assotech One C-20/1 A, Block- C Sector- 62, Noida Uttar Pradesh, Pincode: 201309 Health Product Customers Helpline: 1800 200 5142, 022 - 39 63 5200 Fax - 1800 200 9134 or email at healthserve[at]universalsompo[dot]com PREMIUM CHART INCLUDING GST 18% PLAN A WITH PA COVER AGE CAP 50000 100000 150000 200000 250000 300000 350000 400000 450000 500000 0-25 1106 2139 3134 4037 4839 5643 6347 7053 7761 8465 26-35 1213 2348 3440 4430 5310 6190 6963 7736 8513 9284 36-45 1322 2556 3744 4823 5780 6739 7578 8419 9264 10104 46-55 1429 2765 4050 5214 6250 7287 8194 9104 10016 10923 56-65 1645 3182 4661 6000 7191 8383 9426 10470 11519 12562 66-70 1968 3808 5577 7178 8601 10025 11273 12521 13773 15019 71-80 2077 4016 5881 7571 9072 10574 11887 13204 14525 15839 PLAN A WITHOUT PA COVER AGE CAP 50000 100000 150000 200000 250000 300000 350000 400000 450000 500000 0-25 1079 2085 3053 3927 4702 5479 6156 6835 7515 8193 26-35 1186 2294 3358 4320 5173 6026 6772 7518 8267 9012 36-45 1294 2502 3663 4713 5643 6575 7387 8201 9019 9832 46-55 1402 2710 3968 5105 6114 7122 8003 8885 9770 10651 56-65 1618 3128 4580 5891 7054 8219 9235 10252 11274 12290 66-70 1941 3754 5495 7068 8464 9861 11081 12303 13528 14746 71-80 2050 3961 5800 7461 8935 10410 11696 12986 14279 15567 PLAN B WITH PA COVER AGE CAP 50000 100000 150000 200000 250000 300000 350000 400000 450000 500000 0-25 1848 3578 5242 6744 8082 9420 10594 11766 12943 14115 26-35 2030 3931 5757 7407 8876 10345 11635 12921 14213 15499 36-45 2213 4282 6274 8070 9671 11271 12674 14075 15483 16883 46-55 2394 4635 6790 8734 10465 12196 13715 15230 16752 18268 56-65 2759 5340 7822 10061 12055 14048 15795 17540 19293 21037 66-70 3304 6397 9369 12051 14437 16824 18917 21004 23102 25189 71-80 3487 6748 9886 12715 15233 17751 19956 22158 24372 26574 PLAN B WITHOUT PA COVER AGE CAP 50000 100000 150000 200000 250000 300000 350000 400000 450000 500000 0-25 1821 3523 5160 6634 7945 9256 10403 11547 12698 13843 26-35 2002 3876 5676 7297 8739 10181 11444 12703 13968 15227 36-45 2185 4228 6193 7960 9534 11107 12483 13857 15237 16611 46-55 2367 4581 6708 8625 10329 12032 13524 15012 16507 17995 56-65 2732 5285 7741 9951 11918 13884 15604 17321 19048 20764 66-70 3277 6343 9288 11942 14300 16660 18725 20786 22857 24917 71-80 3460 6694 9805 12605 15096 17587 19765 21940 24126 26301 Note:- Above Premium is calculated on basis of age of the Proposer Premium paid (excluding PA component) is eligible for Tax deduction under 80 D of IT Tax Act, 1961(Tax benefits are subject to change as per tax laws) All premium rates are annual rates in Rs. PA cover is not available for parents Rates are including all taxes, cess and duties as applicable (subject to applicable revisions) Please note: This prospectus contains only an indication of cover offered, for complete details on terms, conditions, coverages and exclusions please get in touch with us and read policy wordings carefully before concluding a sale. Insurance is a subject matter of solicitation.
IOB HEALTH CARE PLUS
Indian Overseas Bank as corporate agent under IRDAI does not underwrite the risk or act as insurer.
IOB Health Care Plus a unique health/ mediclaim cover offered by Universal Sompo General Insurance in association with Indian Overseas Bank. The IOB Health Care Plus is a complete health Insurance Plan that covers Proposer, spouse, two dependent children, dependant parents and unlike any other regular policy, wherein a family has to take individual policies for each member, this unique family floater gives you the flexibility of taking one policy that covers the entire family under a single sum insured.
The Policy takes care of the hospitalization expenses, subject to maximum Sum Insured, in respect of the following eventualities:
a. Sudden illness
b. An accident
c. Any surgery that is required in respect of any disease.
Who can take the Policy?
The policy provides for Mediclaim Insurance cover, which is available to all the customers of IOB maintaining a S.B. or C.D account with them including NRI customers. However, the cover is available for treatment in hospitals, in India only.
How can one become a member?
The procedure to become a member of the scheme is very simple. There is no medical examination. All that the account holder requires to do is fill up and sign a proposal form which includes declaration of good health.
How the premium is to be paid?
The premium will be debited to the S.B. or C.D. account as per the authorization given in the proposal form.
What is the period for which the insurance is available and how it is renewed?
The insurance cover is available for a period of one year from the date of debit of the premium. Renewals are to be done on yearly basis on or before the due date.
What are the documents given in proof of insurance?
The account holder will be issued with a copy of the proposal form duly acknowledged by the branch for having debited the premium amount to the account. After receipt of the proposal form by the Insurance company and (in house TPA), a policy will be issued by Insurance company and ID card will be issued by (in house TPA).
Eligibility
All account holders of Indian Overseas Bank within the age band of 18 to 65 years are eligible to take the Policy. An individual may cover himself/ herself and his/ her spouse, dependent children under Plan A of the Policy and himself/herself, his/her spouse, dependent children and dependent parents under Plan B of the policy. Wide Range of Sum Insured - Options ranging from Rs 0.5 Lac to Rs 5 Lakhs are available. Enrollment age under the policy is between 5 years and 65 years. Dependent children from age 3 months can be covered with at least one parent under the Policy. Maximum age under, till which dependent male child can be covered is 21 years and Female up to 25 years or till their marriage whichever is earlier.
What is covered under the Policy?
The Policy covers reimbursement of Hospitalization expenses for illness / diseases contracted or injury sustained by the Insured Person. In the event of any claim becoming admissible under Policy, the company will pay to the Hospital / Nursing Home / Insured person but not exceeding Sum Insured selected for the family as stated in the Schedule and subject to terms and conditions of the Policy, during the Period of Insurance for the following expenses:
A. Room, Boarding expenses as charged by the Hospital / Nursing Home
B. Nursing expenses
C. Fees paid to Surgeon, Anesthetist, Medical Practitioner, Consultants and Specialists
D. Anesthetist, Blood, Oxygen, Operation Theatre charges, Surgical appliances, Medicines & Drugs, Diagnostic Material and X-ray, Dialysis, Chemotherapy, Radiotherapy, Cost of Pacemaker, Artificial Limbs. Expenses on hospitalization incurred anywhere in India are covered.
Expenses on hospitalization in Bhutan and Nepal are also covered but Cashless service is not available. Claim settlement will be only in Indian Currency.
Duration of Hospitalization
Expenses on hospitalization for a minimum period of 24 hours are admissible. However, this time limit is not applied to specific treatments, i.e. Dialysis, Chemotherapy, Radiotherapy, Eye Surgery, Lithotripsy (Kidney stone removal), D&C, Tonsillectomy taken in the Hospital / Nursing Home and where in the insured is discharged on the same day, such treatment will be considered to have been taken under hospitalization benefit. This condition will also not apply in case of stay in Hospital for less than 24 hours provided (a) the treatment is such that it necessitates hospitalization and the procedure involves specialized infrastructural facilities available in hospitals (b) due to technological advances hospitalization is required for less than 24 hours only.
Features
1. Choice of Sum Insured ranges from Rs 50,000 to Rs 5,00,000 in multiples of Rs 50,000.
2. Enlisted Day Care procedure (procedures covered without 24 hrs hospitalization) covered. 3. Maternity Benefit - covered up to 5 % of SI with waiting period of 9 months 4. Pre Existing Illness - Covered after 48 months of continuous coverage 5. Ambulance cover - Covered up to 1 % of basic SI or Rs 1000/- per claim
6. Pre Hospitalization & Post Hospitalization- Covered for 30 & 60 days, before & after hospitalization respectively subject to availability of Sum Insured.
7. Hospital Cash to Parents- In case of Hospitalization of Children up to Age 12 years Cash allowance of Rs.100/- per day subject to a maximum of Rs.1000/- will be given to account holder.
8. Cost of Health check up- The insured shall be entitled for reimbursement of cost of 1% of the amount of average Sum Insured for health check-up once at the end of block of every Three Policy years (under this scheme) provided there are no claims reported during the block.
9. Funeral Expenses-In case of death of any of the insured persons following hospitalization with valid claim under the Policy, Funeral expenses of Rs.1000/- will be paid under the Policy.
10. Personal Accident Cover - Available on payment of additional premium Coverage against death on floater basis as mention below I. Account holder 100% of CSI II. Spouse -50 % of CSI III. Dependent Children above 12 yrs of age - 20 % of CSI IV. Dependent Children below 12 yrs of age - 10 % of CSI CSI is the floater sum insured
11. Portability Benefit available-We can cover portability of benefits to similar cover under indemnity plan subject to intimation of complete details by application atleast 45 days prior to the expiry of existing policy.
12. Tax benefit: Only the Medical Premium Component (excluding Service Tax thereon) is eligible for rebate under Section 80D of the Income Tax Act.
Free Look Period
We shall give You a Free Look Period at the inception of the Policy and
1. You will be allowed a period of at least 15 days from the date of receipt of the Policy to review the terms and conditions of the Policy and to return the same if not acceptable.
2. If You have not made any claim during the Free Look period, You shall be entitled to
a) A refund of the premium paid less any expenses incurred by us on Your medical examination and the stamp duty charges or;
b) where the risk has already commenced and the option of return of the Policy is exercised by You, a deduction towards the proportionate risk premium for period on cover or;
c) Where only a part of the risk has commenced, such proportionate risk premium commensurate with the risk covered during such period
Exclusions
How to make a claim in case of hospitalization?
Cash less treatment can be availed at network hospitals by showing the ID card issued by TPA along with the necessary photo ID proof as prescribed by the Insurance company and copies of valid insurance policies and in case for any reason cashless service could not be availed, the insured can meet the hospital expenses and claim reimbursement from Universal Sompo General Insurance Company Limited (USGI).
Claims Procedure
A) Reimbursement Claims Process:
Upon happening of any injury / Disease which may give rise to a claim under this Policy
B) Cashless Claims:
Cashless Service: You can avail cashless hospitalization facility at any hospital in the network of the TPA. We will provide a Cashless Service by making payment to the extent of Our liability direct to the Network
Hospital as long as We are given notice that the Insured Person wishes to avail Cashless Service accompanied by full particulars at least 48 hours before any planned treatment or Hospitalization or within 24 hours after the treatment or Hospitalization in the case of an emergency (namely a sudden, urgent, unexpected occurrence or event, bodily alteration or occasion requiring immediate medical attention).
In case if You want to avail cashless facility in any of the network hospital you shall follow the process as mentioned below.
Cashless facilities at over 4000+ quality hospitals across India. Processing Prompt settlement of both Cashless and Reimbursement claim by In House TPA.
Customer Service Center
Address: Universal Sompo General Insurance Company Ltd.,
Plot No - EL-94, KLS Tower, TTC Industrial Area,
MIDC, Mahape,
Navi Mumbai 400710.
Phone: Customer Care Helpline: 1800 22 4030, 1800 200 4030, 022 - 27 63 9800,
022 - 39133700
Email: contactus[at]universalsompo[dot]com, For Claims: contactclaims[at]universalsompo[dot]com
Address of TPA:
Universal Sompo General Insurance Company Limited
Health Claims Management Office
5th Floor, Assotech One C-20/1 A, Block- C Sector- 62,
Noida Uttar Pradesh,
Pincode: 201309
Health Product Customers Helpline: 1800 200 5142, 022 - 39 63 5200
Fax - 1800 200 9134
or email at healthserve[at]universalsompo[dot]com
PREMIUM CHART INCLUDING GST 18%
PLAN A WITH PA COVER
AGE CAP
50000
100000
150000
200000
250000
300000
350000
400000
450000
500000
0-25
1106
2139
3134
4037
4839
5643
6347
7053
7761
8465
26-35
1213
2348
3440
4430
5310
6190
6963
7736
8513
9284
36-45
1322
2556
3744
4823
5780
6739
7578
8419
9264
10104
46-55
1429
2765
4050
5214
6250
7287
8194
9104
10016
10923
56-65
1645
3182
4661
6000
7191
8383
9426
10470
11519
12562
66-70
1968
3808
5577
7178
8601
10025
11273
12521
13773
15019
71-80
2077
4016
5881
7571
9072
10574
11887
13204
14525
15839
PLAN A WITHOUT PA COVER
1079
2085
3053
3927
4702
5479
6156
6835
7515
8193
1186
2294
3358
4320
5173
6026
6772
7518
8267
9012
1294
2502
3663
4713
6575
7387
8201
9019
9832
1402
2710
3968
5105
6114
7122
8003
8885
9770
10651
1618
3128
4580
5891
7054
8219
9235
10252
11274
12290
1941
3754
5495
7068
8464
9861
11081
12303
13528
14746
2050
3961
5800
7461
8935
10410
11696
12986
14279
15567
PLAN B WITH PA COVER
1848
3578
5242
6744
8082
9420
10594
11766
12943
14115
2030
3931
5757
7407
8876
10345
11635
12921
14213
15499
2213
4282
6274
8070
9671
11271
12674
14075
15483
16883
2394
4635
6790
8734
10465
12196
13715
15230
16752
18268
2759
5340
7822
10061
12055
14048
15795
17540
19293
21037
3304
6397
9369
12051
14437
16824
18917
21004
23102
25189
3487
6748
9886
12715
15233
17751
19956
22158
24372
26574
PLAN B WITHOUT PA COVER
1821
3523
5160
6634
7945
9256
10403
11547
12698
13843
2002
3876
5676
7297
8739
10181
11444
12703
13968
15227
2185
4228
6193
7960
9534
11107
12483
13857
15237
16611
2367
4581
6708
8625
10329
12032
13524
15012
16507
17995
2732
5285
7741
9951
11918
13884
15604
17321
19048
20764
3277
6343
9288
11942
14300
16660
18725
20786
22857
24917
3460
6694
9805
12605
15096
17587
19765
21940
24126
26301
Note:-
Please note: This prospectus contains only an indication of cover offered, for complete details on terms, conditions, coverages and exclusions please get in touch with us and read policy wordings carefully before concluding a sale. Insurance is a subject matter of solicitation.