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1. 2 Product Construct – Lifeline Lifeline – Base Cover Inpatient All Day Care Procedure Pre & Post Hospitalization Organ Donor Expenses Domiciliary Treatment.

Jan 12, 2016

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Oswald Boyd
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Page 1: 1. 2 Product Construct – Lifeline Lifeline – Base Cover Inpatient All Day Care Procedure Pre & Post Hospitalization Organ Donor Expenses Domiciliary Treatment.

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Page 2: 1. 2 Product Construct – Lifeline Lifeline – Base Cover Inpatient All Day Care Procedure Pre & Post Hospitalization Organ Donor Expenses Domiciliary Treatment.

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Product Construct – Lifeline

Lifeline – Base Cover

• Inpatient• All Day Care Procedure• Pre & Post Hospitalization• Organ Donor Expenses• Domiciliary Treatment• Emergency Ambulance• Re-load of Sum Insured• Ayush Treatment• No Claim Bonus• Health Check-up ( once in 2 yrs)• Vaccination for Animal Bite• Health & Wellness• PED – 4 years

2nd Opinion for CI

Emergency Domestic Evacuation

ClassicSI – 2,3,4 lacs

Supreme SI – 5,10,15,20,50lacs

EliteSI – 25, 30,50,100,150lacs

International Treatment for 11 Critical Illness

Worldwide Emergency Hospitalization

PED – 3 years PED – 2 years

Classic Supreme

Lifeline – Customer Level Options

1. Top up plan on annual deductible basis

2. Hospital cash

Maternity Benefit

1. US/Canada option for worldwide emergency hospitalization & international treatment for 11 CI

2. Hospital Cash

1. Top up plan on annual deductible basis

2. Hospital cash

Note - Geographic pricing – Entire country is divided into 2 Zones (Zone 1 - 7 metros and Gujarat State, Zone 2 – Rest of India) . Premium in Zone 2 is lower than Zone 1 by 15% as cost of treatment is lower in non metros

OPD Benefit

10% Higher NCB

Annual Health check up

Page 3: 1. 2 Product Construct – Lifeline Lifeline – Base Cover Inpatient All Day Care Procedure Pre & Post Hospitalization Organ Donor Expenses Domiciliary Treatment.

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Lifeline – Classic

No room rent cap

All day care procedures covered

Ayush treatment

Vaccination for animal bite

Organ donor expenses covered upto SI

10% NCB every year upto max of 50%

Pre & post covered upto SI

Reload benefit – Incase SI including NCB is exhausted by insured and he is admitted for a different illness then the SI is automatically reloaded upto 100% of base SI. Reload in family floater is applicable to the entire family

Key FeaturesFeatures Benefit

Sum Insured 2/3/4 Lacs

Inpatient Care Covered upto SI

Pre and post hospitalization expenses 30/60 days, Covered upto SI

All Day care procedures Covered upto SI

Ambulance Cover Upto Rs.3000

Organ Donor Expenses Covered upto SI

Domiciliary Hospitalization Covered upto SI

No Claim Bonus 10% of Base Sum Insured upto a max of 50%

Re-load of Sum Insured Upto base SI

Ayush TreatmentGovernment Hospitals - Covered upto SI; Other Hospitals – Covered upto Rs.20,000

Vaccination in case of Animal Bite Upto Rs.2500

Customer level options

1. Top-up plan on annual aggregate basis

Deductible of Rs.1,2,3,4,5 and 10 lacs

2. Hosptial Cash (for 30 days in case of hospitalization beyond 2 days) Rs.1000/day

Page 4: 1. 2 Product Construct – Lifeline Lifeline – Base Cover Inpatient All Day Care Procedure Pre & Post Hospitalization Organ Donor Expenses Domiciliary Treatment.

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Lifeline – Supreme

No room rent cap

All day care procedures covered

Ayush treatment

Vaccination for animal bite

Organ donor expenses covered upto SI

20% NCB every year upto max of 100%

Annual Health Check up

Emergency domestic evacuation

Pre & post covered upto SI

Reload benefit

Second opinion for 11 Critical illness

PED waiting period – 3 years

Key FeaturesFeatures Benefit

Sum Insured 5/10/15/20/50 Lacs

Inpatient Care Covered upto SI

Pre and post hospitalization expenses

60/90 days, Covered upto SI

All Day care procedures Covered upto SI

Ambulance Cover Upto Rs.5000

Organ Donor Expenses Covered upto SI

Domiciliary Hospitalization Covered upto SI

No Claim Bonus 20% of Base Sum Insured upto a max of 100%

Re-load of Sum Insured Upto base SI

Ayush TreatmentGovernment Hospitals - Covered upto SI; Other Hospitals - Covered upto Rs.30,000

Vaccination in case of Animal Bite

Upto Rs.5000

Emergency Domestic Evacuation (Bed to Bed on advise of treating doctor)

Covered upto Rs.100,000

Customer level options

1. Top-up plan on annual aggregate basis

Deductible of Rs.1,2,3,4,5 and 10 lacs

2. Hosptial Cash (for 30 days in case of hospitalization beyond 2 days)

Rs.2000/day

Page 5: 1. 2 Product Construct – Lifeline Lifeline – Base Cover Inpatient All Day Care Procedure Pre & Post Hospitalization Organ Donor Expenses Domiciliary Treatment.

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Lifeline – Elite

No room rent cap

All day care procedures covered

Ayush treatment

Vaccination for animal bite

Organ donor expenses covered upto SI

20% NCB every year upto max of 100%

Annual Health Check up

Emergency domestic evacuation

Pre & post covered upto SI

Reload benefit

Second opinion for 11 Critical illness

Worldwide emergency hospitalization

International treatment for 11 CI

Maternity & OPD covered

PED waiting – 2 years

Key FeaturesFeatures Benefit

Sum Insured 25/30/50/100/150 Lacs

Inpatient Care Covered upto SI

Pre and post hospitalization expenses 60/180 days, Covered upto SI

All Day care procedures Covered upto SI

Ambulance Cover Upto Rs.10000

Organ Donor Expenses Covered upto SI

Domiciliary Hospitalization Covered upto SI

No Claim Bonus 20% of Base Sum Insured upto a max of 100%

Re-load of Sum Insured Upto base SI

Ayush TreatmentGovernment Hospitals - Covered upto Sum Insured; Other Hospitals - Covered upto Rs.50,000

Vaccination in case of Animal Bite Upto Rs.7500

Emergency Domestic Evacuation (Bed to Bed on advise of treating doctor)

Covered upto Rs.300,000

Worldwide Emergency Hospitalization (excluding US and Canada)

50% of Base Sum Insured upto max of Rs.20lacs; Deductible of $1,000 per hospitalization

International Treatment abroad for specified 11 CI(excluding US and Canada)

Covered upto SI;Airfare covered upto Rs.3 lac

OPD Covered upto Rs.10000

Maternity cover upto 2 deliveriesMaternity covered upto Rs.2.5 Lacs; New born cover upto Rs.37.5 Lacs;1st year Vaccinations for new born- Rs.10000

Customer level options1. Include US/Canada for worldwide emergency hospitalization & international treatment for 11 CI

Available

2. Hosptial Cash (for 30 days in case of hospitalization beyond 2 days)

Rs.5000/day

Page 6: 1. 2 Product Construct – Lifeline Lifeline – Base Cover Inpatient All Day Care Procedure Pre & Post Hospitalization Organ Donor Expenses Domiciliary Treatment.

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Key Differentiating Features

1. No Room rent capping – No deduction in claim because of room rent

2. No Disease specific sub-limits – for eg, no sub-limits on cataract treatment, etc

3. Reload of Sum Insured – Doubling the sum insured (in case of different illness for same insured or different insured person) at no extra cost

4. Accelerated No Claim Bonus – Doubling the Sum Insured in 5 claim free year in Supreme & Elite Plan and 1.5 times in case of Classic Plan. No Reduction of No Claim Bonus earned in case of claim in any particular year

5. Vaccination in case of Animal Bite

6. Geography based Pricing – Zone 2 customers are charged 15% less compared to Zone 1

7. Health & Wellness Benefit including Free Health Check-up (Annually in Supreme & Elite, Once in 2 years in Classic Plan)

8. International Coverage including return Air Fare (covered in Elite Plan)

9. Maternity & OPD Treatment (covered in Elite Plan)

10. Comprehensive coverage like All Day Care Procedures, Organ Donor , Pre & Post Hospitalization, etc covered upto Sum Insured

Page 7: 1. 2 Product Construct – Lifeline Lifeline – Base Cover Inpatient All Day Care Procedure Pre & Post Hospitalization Organ Donor Expenses Domiciliary Treatment.

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Key Policy Criteria

Entry Age:• Child – 91days to 25 years• Adult – 18 years onward

Policy Type• Individual• Family Floater (relationship between insured should be Self, Spouse and upto 4

children)

Policy Tenure – 1 year, 2 years and 3 years. Get discount of 7.5% and 12% in case of 2 years or 3 years respectively

Lifetime Renewability

Geographic pricing – Entire country is divided into 2 Zones and premium varies as per customer Zone. Zone 2 customers get 15% discount in premium

Zone 1 – Delhi/NCR, Mumbai (including Thane, Vashi, etc), Bengaluru, Hyderabad, Chennia, Pune, Kolkata and Gujarat StateZone 2 – Rest of India)

Page 8: 1. 2 Product Construct – Lifeline Lifeline – Base Cover Inpatient All Day Care Procedure Pre & Post Hospitalization Organ Donor Expenses Domiciliary Treatment.

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We will not cover any treatment taken during the first 30 days since the commencement of the Policy,

unless the treatment needed is a result of an Accident. This waiting period does not apply for any

subsequent and continuous renewals of Your Policy. For Cirtical Illness Benefit (in Supreme & Elite), the

initial waiting period is of 90 days

Waiting periods and exclusions (1/2)

Initial Waiting Period

17 specified conditions not covered for first 2 Years

1. Stones in biliary and urinary systems2. Lumps / cysts / nodules / polyps / internal

tumours3. Gastric and Duodenal Ulcers4. Surgery on tonsils / adenoids5. Osteoarthrosis / Arthritis / Gout / Rheumatism

/ Spondylosis / Spondylitis / Intervertebral Disc Prolapse

6. Cataract7. Fissure / Fistula / Haemorrhoids8. Hernia / Hydrocele9. Chronic Renal Failure or end stage Renal

Failure

10. Sinusitis / Deviated Nasal Septum / Tympanoplasty / Chronic Suppurative Otitis Media

11. Benign Prostatic Hypertrophy12. Knee/Hip Joint replacement13. Dilatation and Curettage14. Varicose veins15. Dysfunctional Uterine Bleeding / Fibroids /

Prolapse Uterus / Endometriosis16. Diabetes and related complications17. Hysterectomy for any benign disorder

Page 9: 1. 2 Product Construct – Lifeline Lifeline – Base Cover Inpatient All Day Care Procedure Pre & Post Hospitalization Organ Donor Expenses Domiciliary Treatment.

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Addictive conditions and disorders; Adventurous or Hazardous Sports; Ageing and puberty; Alternative Treatment; Ancillary Hospital Charges; Artificial life maintenance; Charges for Medical Papers; Circumcision; Conflict and Disaster; Congenital conditions; Convalescence and Rehabilitation; Cosmetic surgery; Dental/oral treatment; Drugs and dressings for OPD Treatment or take-home use; Eyesight; Health hydros, nature cure, wellness clinics etc.; HIV and AIDS; Hereditary conditions (specified); Hospitalization undertaken for observation or for investigations only; Items of personal comfort and convenience; Psychiatric and Psychosomatic Conditions; Obesity; OPD Treatment; Preventive care; Reproductive Medicine; Self-inflicted injuries; Sexual problems and gender issues; Sexually transmitted diseases; Sleep disorders; Speech disorders; Stem Cell Implantation; Treatment for Alopecia; Treatment for developmental problems; Treatment received outside India; Unproven/Experimental Treatment; Unrecognized physician or Hospital; Unrelated diagnostic, X-ray or laboratory examinations; Unlawful Activity; Any costs or expenses specified in the List of Expenses Generally Excluded as Annexure II in Policy Wording

Waiting periods and exclusions (2/2)

• Classic – 4 years• Supreme – 3 years• Elite – 2 years

Pre-Existing Conditions

Permanent Exclusions

Page 10: 1. 2 Product Construct – Lifeline Lifeline – Base Cover Inpatient All Day Care Procedure Pre & Post Hospitalization Organ Donor Expenses Domiciliary Treatment.

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Underwriting Criteria1. Sum Insured >=10lacs2. Age >= 46 years3. Any ‘yes’ to 6 medical

questions in proposal form4. All Portability proposal

(external as well as internal)5. Body Mass Index >= 33

Policy Issuance Process

TVS FOS submits proposal form, documents and payment at branch ops

Is policy straight pass on following 5 criteria

Operations team enters details in policy issuance system

Policy dispatched to customer at T+7

Policy received by customer T+9-T+12

Yes

Case flows to medical underwriting team who calls

customer & asks 15-20 health questions

PPMCYes

Policy dispatched to customer at T+12, T+25 Policy received by

customer T+14-T+25

No

Policy approved

Yes

Case rejected, customer informed

No

No

Page 11: 1. 2 Product Construct – Lifeline Lifeline – Base Cover Inpatient All Day Care Procedure Pre & Post Hospitalization Organ Donor Expenses Domiciliary Treatment.

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Example of Lifeline VS United India

Age-45 yearsSI-3 LacsPremium Rs. 10,406 (Zone 2 – Cochin, Calicut, etc) (for a family combination of 2 Adult + 2 Children)

Lifeline

Age-45 yearsSI-3 LacsPremium Rs.11,149 (for a family combination of 2 Adult + 2 Children)

United Family Medicare

Customer admitted for Kidney Stone @ Aster Medicity with room rent of Rs.4000.

No room rent capping under Lifeline

Cost of treatment Rs.80,000

Claim paid by RS under Lifeline- Rs.80,000

Customer admitted for Kidney Stone @ Aster Medicity with room rent of Rs.4000.

Room rent cap of 1%, ie.Rs.3000

Cost of treatment Rs.80,000

Claim paid by Star Health- Rs.60,000

The premium paid in Zone 2 is lower than United and due to no room rent cap, entire amount is paid in case of claim

Page 12: 1. 2 Product Construct – Lifeline Lifeline – Base Cover Inpatient All Day Care Procedure Pre & Post Hospitalization Organ Donor Expenses Domiciliary Treatment.

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Lifeline Premiums

Individual Classic Supreme EliteAge 2L 3L 5L 10L 50L 150L30 3,567 3,984 4,911 6,726 43,959 62,082 35 3,923 4,303 5,549 7,638 47,789 68,543 40 4,391 4,818 6,289 8,551 53,622 75,677 45 5,567 6,122 7,724 10,092 59,772 83,554 50 7,263 8,129 10,082 12,816 72,226 88,726

55 9,654 11,577 15,497 19,217 83,557 1,02,035

60 12,654 15,557 21,176 27,452 98,437 1,18,629

65 17,072 21,331 27,793 35,330 1,22,160

1,46,778

2A+2C Classic Supreme EliteAge 2L 3L 5L 10L 50L 150L

30 6,502 7,478 10,183 14,465 83,491 1,09,402

35 7,101 8,116 11,106 15,734 91,323 1,13,756

40 7,670 8,817 12,221 17,075 95,982 1,20,691

45 9,736 10,739 12,967 19,219 1,05,289

1,36,616

50 13,017 14,617 18,051 24,204 1,23,595

1,52,557

55 17,246 20,740 24,858 32,666 1,43,589

1,76,541

60 22,701 27,975 33,347 43,477 1,73,439 2,11,607

65 30,973 38,778 47,409 61,394 2,27,752

2,69,894

Page 13: 1. 2 Product Construct – Lifeline Lifeline – Base Cover Inpatient All Day Care Procedure Pre & Post Hospitalization Organ Donor Expenses Domiciliary Treatment.

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Market positioning – Classic Plan

AreaRoyal

Sundaram – Lifeline

Star Health – Medi Classic

Baja Allianz Health Guard

ICICI Lombard CHI United India

No room rent capping

All Day care procedures

Pre/Post Hospitalization upto SI

Ayush Treatment

Reload benefit

Vaccination in case of Animal Bite

Health check-up irrespective of claim

NCB benefit without penalty

No Disease specific sub-limit

Domiciliary Treatment

Health & Wellness

Organ donor expenses

No Co-payment

Page 14: 1. 2 Product Construct – Lifeline Lifeline – Base Cover Inpatient All Day Care Procedure Pre & Post Hospitalization Organ Donor Expenses Domiciliary Treatment.

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Market positioning – Supreme Plan

AreaRoyal

Sundaram – Lifeline

Star Health – Medi Classic

Baja Allianz Health Guard

ICICI Lombard CHI United India

No Room Rent capping

No Entry Age Restriction

Pre/Post Hospitalization upto SI

Reload of Sum Insured

NCB benefit without penalty

Second opinion

Annual Health Check-up

Domestic Evacuation

Ayush Treatment

All Day Care Procedures

No Disease Specific Capping

Organ donor expenses

Health & Wellness

Page 15: 1. 2 Product Construct – Lifeline Lifeline – Base Cover Inpatient All Day Care Procedure Pre & Post Hospitalization Organ Donor Expenses Domiciliary Treatment.

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Market positioning – Elite Plan

AreaRoyal

Sundaram – Lifeline

Star Health – Medi Classic

Baja Allianz Health Guard

ICICI Lombard CHI United India

Sum Insured

No Room Rent capping

Pre/Post Hospitalization upto SI

Reload of Sum Insured

NCB benefit without penalty

Second opinion

Annual Health Check-up

International Coverage

Maternity benefit

Domestic Evacuation

Ayush Treatment

All Day Care Procedures

No Disease Specific Capping

Organ donor expenses

Page 16: 1. 2 Product Construct – Lifeline Lifeline – Base Cover Inpatient All Day Care Procedure Pre & Post Hospitalization Organ Donor Expenses Domiciliary Treatment.

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Premium Comparison – Individual (excluding service tax) (1/2)

3 Lacs

Age LifeLineReligare Care

IL CHIStar MediClassic

Bajaj - Health Guard

United - Family Medicare

Religare Care IL CHIStar MediClassic

Bajaj - Health Guard

United - Family Medicare

20 2,952 2,271 2,949 4,400 3,306 - 30% 0% -33% -11% NA25 3,081 3,491 2,949 4,400 3,306 - -12% 4% -30% -7% NA30 3,387 3,491 4,250 4,400 4,430 - -3% -20% -23% -24% NA35 3,658 3,491 4,250 4,400 4,430 - 5% -14% -17% -17% NA40 4,095 3,643 5,551 4,650 4,430 - 12% -26% -12% -8% NA45 5,204 4,572 5,551 4,650 6,065 - 14% -6% 12% -14% NA50 6,910 6,682 9,305 7,665 8,380 - 3% -26% -10% -18% NA55 9,841 7,592 12,889 11,365 8,380 - 30% -24% -13% 17% NA60 13,223 9,969 17,828 13,750 12,826 - 33% -26% -4% 3% NA65 18,131 14,222 23,682 14,350 14,749 - 27% -23% 26% 23% NA

SI

5 Lacs

Age LifeLineReligare Care

IL CHIStar MediClassic

Bajaj - Health Guard

United - Family Medicare

Religare Care IL CHIStar MediClassic

Bajaj - Health Guard

United - Family Medicare

20 3,615 2,949 3,595 - 5,244 - 23% 1% NA -31% NA25 3,782 4,595 3,595 - 5,244 - -18% 5% NA -28% NA30 4,174 4,595 5,514 - 6,156 - -9% -24% NA -32% NA35 4,717 4,595 5,514 - 6,156 - 3% -14% NA -23% NA40 5,346 4,793 7,033 - 6,156 - 12% -24% NA -13% NA45 6,565 6,042 7,033 - 9,576 - 9% -7% NA -31% NA50 8,570 8,668 10,533 - 15,236 - -1% -19% NA -44% NA55 13,173 10,421 14,710 - 15,236 - 26% -10% NA -14% NA60 18,000 12,997 20,378 - 17,879 - 38% -12% NA 1% NA65 23,624 15,841 26,902 - 20,561 - 49% -12% NA 15% NA

SI

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Premium Comparison – Individual (excluding service tax) (2/2)

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Premium Comparison – 2 Adults 2 Children (excl Service Tax) (1/2)

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Premium Comparison – 2 Adults 2 Children (excl Service Tax) (2/2)

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