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Report on Health Insurance A SUMMER TRAINING REPORT IN ICICI Prudential Life Insurance ON HEALTH INSURANCE SUBMITTED TO PUNJAB TECHNICAL UNIVERSITY, JALANDHAR IN PARTIAL FULFILLMENT OF THE REQUIREMENT FOR THE DEGREE OF MASTER IN BUSINESS ADMINISTRATION (M.B.A.) SUPERVISED BY: SUBMITTED BY: Mr.SUDESH KUMAR. (HEAD OF THE DEPARTMENT) RAJMEET GILL UNI. ROLL NO. 80605317036 (SESSION 2008-2010) SWAMI SATYANAND COLLEGE OF MANAGEMENT AND TECHNOLOGY, AMRITSAR. 1 Report on Health Insurance CONTENTS Topic Pages ACKNOWLEDGEMENT PREFACE INSURANCE INDUSTRY OVERVIEW ABOUT ICICI PRU LIFE INSURANCE CO. LTD. ABOUT HEALTH INSURANCE HEALTH INSURANCE PRODUCTS → Health Assure Plus → Crisis Cover → Hospital Cover → Cancer Care → Cancer Care Plus → Diabetes Care CONCLUSION BIBLIOGRAPHY 03 04 06 12 22 27 62 63 2 Report on Health Insurance ACKNOWLEDGEMENT First of fall I would like to thank the Management at ICICI Prudential Life Insurance Co. LTD. for giving me the opportunity to do my twomonth project training in their esteemed organization. I am highly obliged to Mr. Sham Bhatia for granting me to undertake my training at Eminent Mall, ASR. Branch. I express my thanks to all Sales Managers under whose able guidance and direction, I was able to give shape to my training. Their constant review and excellent suggestions throughout the project are highly commendable. My heartfelt thanks go to all the executives who helped me gain knowledge about the actual working and the processes involved in various departments. Rajmeet Gill PREFACE 3 Report on Health Insurance The liberalization of the Indian insurance sector has been the subject of much heated debate for some years. The policy makers where in the catch 22 situation wherein for one they wanted competition, development and growth of this insurance sector extremely essential for channeling the investments into the infrastructure sector. At the other end the policy makers had the fears that the insurance premia, which are substantial, would seep out of the country; and wanted to have a cautious approach of opening for foreign participation in the sector. As one of the rare occurrences the entire debate was put on the back burner and the IRDA saw the day of the light thanks to the maturing polity emerging consensus among factions of different political parties. Though some changes and some restrictive clauses as regards to the foreign participation were included the IRDA has opened the doors for the private entry into insurance. Whether the insurer is old or new, private or public, expanding the market will present multitude of challenges and opportunities. But the key issues, opportunities and challenges that insurance sector will have still remains under the realms of the possibilities and speculation. What is the likely impact of opening up India’s insurance sector? The large scale of operations, public sector bureaucracies and cumbersome procedures hampers nationalized insurers. Therefore, potential private entrants expect to score in the areas of customer service, speed and flexibility. They point out that their entry will mean better products and choice for the consumer. The critics counter that the benefit will be slim, because new players will concentrate on affluent, urban customers as foreign banks did until recently. Start-up costs-such as those of setting up a conventional distribution network-are large and high-end niches offer better returns. However, the middle-market segment too has great potential. Since insurance is a volumes game. Therefore, private insurers would be best served by a middle-market approach, targeting customer segments that are currently untapped. 4 Report on Health Insurance INSURANCE INDUSTRY OVERVIEW The year 1999, was a revolution for Indian Life Insurance Industry, as major structural changes took place. The Insurance Regulatory and Development Authority (IRDA) bill was passed in this year, lifting all entry restrictions for private players and allowing foreign players to enter into Indian market. IRDA regulates both Life Insurance and General Insurance Companies respectively. With annual growth rate of 15-20% and the largest number of insurance policies in force, the potential of Indian Insurance industry is huge. 5 Report on Health Insurance IRDA General Insurance Company Private Ltd. Companies Life Insurance Company Public Ltd. Companies Private Ltd. Companies Public Ltd. Companies THE INSURANCE REGULATORY AND DEVELOPMENT AUTHORITY(IRDA) MISSION- To protect the interest of policyholders, to regulate, promote and ensure orderly growth of the insurance industry and for matters connected therewith or incidental thereto.  The Insurance and Regulatory and Development Authority (IRDA) are the national agency of the government of India, based in Hyderabad.  It was formed by an act of Indian Parliament known as IRDA Act 1999, which was amended in 2002 to corporate some emerging requirements.  IRDA allows registration of new players in Insurance field.  It also has the authority to renew, modify, withdraw, suspend or cancel such registration. It specifies requisite qualifications, code of conduct and practical training for intermediary or Insurance intermediaries and agents. After creation of IRDA, Insurance sector has seen tremendous growth. Before IRDA came into force there were only two players in the Insurance sector, namely Life Insurance Corporation in India (LIC) and General Insurance Corporation of 6 Report on Health Insurance India (GIC). Since then many players have entered in the Insurance sector. LIFE AND NON-LIFE INSURANCE PLAYERS –IN THE MARKET The introduction of Private players in the industry has brought of changes in the Insurance Industry. The initiatives taken by the private players are very competitive and have given the immense competition to LIC, which was the only life insurance player in the market The entry of new market players in the market has created a revolution in Indian Insurance industry LIFE INSURANCE PLAYERS IN THE MARKET Public Limited Companies Private Limited Companies ICICI Prudential Life Insurance Co. Ltd Birla Sun Life Insurance Co. Ltd HDFC Standard Life Insurance Co. Ltd Bajaj Allianz Life Insurance Co. Ltd ING Vyasa Life Insurance Co. Ltd Life Insurance Co. Ltd 7 Report on Health Insurance LIC Max New York Life Insurance Co. Ltd Met Life India Life Insurance Co. Ltd Kotak Mahindra Old mutual Life Insurance Co. Ltd SBI Life Insurance Co. Ltd TATA AIG Life Insurance Co. Ltd Reliance Life Insurance Co. Ltd Aviva Life Insurance Co. Ltd Sahara India Life Insurance Co. Ltd Shriram Life Insurance Co. Ltd Bharati Axa Life Insurance Co. Ltd Future Generali India Life Insurance Co. Ltd IDBI Fortis Life Insurance Co. Ltd GENERAL INSURANCE PLAYERS IN THE MARKET Public Limited Companies Private Limited Companies The Oriental Insurance Co. Ltd Royal Sundaram Alliance Insurance Co. Ltd The New India Assurance Co. Ltd Reliance General Insurance Co. Ltd National Insurance Co. Ltd TATA AIG General Insurance Co. Ltd United India Insurance Co. Ltd Bajaj Allianz General Insurance Co. Ltd ICICI Lombard General Insurance Co. Ltd Star Health & Allied IFFCO Tokoi General Insurance Co. Ltd HDFC Chubb Cholamandalam Apollo DKV Insurance Co. Ltd Future Generali India Insurance Co. Ltd 8 Report on Health Insurance INSURANCE IN INDIA The insurance sector in India has come a full circle from being an open competitive market to nationalization and back to liberalized market again. Tracing the developments in Indian Insurance sector reveals the 360 degree turn witnessed over a period of almost two centuries. SOME OF THE IMPORTANT MILESTONES IN THE LIFE INSURANCE BUSSINESS IN INDIA ARE: 1912- The Indian Life Assurance Companies Act enacted as the first statute to regulate the life Insurance business. 1928- The Indian Insurance Companies Act enacted to enable the government to collect statistical information about both life and non-life insurance business. 1938- Earlier legislation consolidated and amended to, by the 9 Report on Health Insurance Insurance Act with the objective of protecting the interests of the insuring public. 1956- 245 Indian and foreign Insurers and Provident societies taken over the Central government and nationalized. LIC formed by an Act of Parliament, viz. LIC Act 1956, with a capital contribution of Rs 5crore from the Government of India. SOME OF THE IMPORTANT MILESTONES IN THE GENERAL INSURANCE BUSSINESS IN INDIA ARE: 1957- The Indian Mercantile Insurance Ltd. Set up the first company to transact all classes of General Insurance business. 1968- General Insurance Council, a wing of the Insurance Association of India, frames a code of conduct for ensuring fair conduct and sound business practices. 1972- The Insurance Act amended to regulate investments and set minimum solvency margins and the Tariff Advisory Committee set up. The General Insurance Business (Nationalization) Act, 1972 nationalized the General Insurance business in India with effect from 1st January 1973. 107 Insurers amalgamated and grouped into four companies viz National Insurance Company Ltd., the New India Assurance Company Ltd., the Oriental Insurance Company Ltd. And the United India Insurance Company Ltd. These were subsidiaries of General Insurance Company (GIC). 10 Report on Health Insurance ICICI PRUDENTIAL LIFE INSURANCE CO. LTD. ICICI Prudential Life Insurance Company is a joint venture between ICICI Bank, a premier financial powerhouse, and prudential plc, a leading international financial services group headquartered in the United Kingdom. ICICI Prudential was amongst the first private sector insurance companies to begin operations in December 2000 after receiving approval from Insurance Regulatory Development Authority (IRDA). ICICI Prudential Life's capital stands at Rs. 37.72 billion (as on March, 2008) with ICICI Bank and Prudential plc holding 74% and 26% stake respectively. For the year ended March 31, 2008, the company garnered Retail New Business Weighted premium of Rs. 6,684 crores, registering a growth of 68% over the last year and has underwritten nearly 3 million retail policies during the period. The company has assets held over Rs. 30,000 crore as on April 30, 2008.ICICI Prudential Life is also the only private life insurer in India to receive a National Insurer Financial Strength rating of AAA (Ind) from Fitch ratings. The AAA (Ind) rating is the highest rating, and is a clear assurance of ICICI Prudential's ability to meet its obligations to customers at the time of maturity or claims. For the past seven years, ICICI Prudential Life has retained its leadership position in the life insurance industry with a wide range of flexible products that meet the needs of the Indian customer at every step in life. 11 Report on Health Insurance ICICI Prudential Life has one of the largest distribution networks amongst private life insurers in India. It has a strong presence across India with 2074 branches (including 1,116 microoffices) and an advisor base of over 225,000 (as on June 30, 2009). Last year Company broaden the unit linked Insurance plans (ULIPs) horizon to offer superior consumer experience. Its Life Stage series introduced the benefits of automatic asset allocation and quarterly portfolio rebalancing for the consumers. It further strengthened its health insurance product portfolio with unique products such as Hospital Care and Crisis Cover. Keeping in mind the need for health insurance in the country, the company continues to launch products to enable consumers meet their healthcare expenses, effectively. Company expanded its distribution network across the country, with a distinct focus on rural India and as on March 31, 2008, it had one of the strongest distribution networks with over 1,950 offices. These offices along with over 290,000 advisors, a strong agency force and distribution partners collectively ensure that our present and prospective consumers can access us at their convenience. In addition to being physically present amongst rural consumers, co. also introduced easyyet-safe premium-paying options through various collaborations. It have partnered with India Post in several states and government-led initiatives such as E-mitra in Rajasthan and AP online in Andhra Pradesh, to enable its rural consumers pay their premiums at a location closest to them. Strong IT infrastructure of the Company not only remains our key differentiator within the industry but also enables the company to provide a superior service experience to all our consumers. ABOUT THE PROMOTORS ICICI Bank About ICICI Bank: ICICI Bank Ltd (NYSE:IBN) is India's largest private sector bank and the second largest bank in the country with consolidated total assets of about US$ 102 billion as of June 30, 12 Report on Health Insurance 2009. ICICI Bank’s subsidiaries include India’s leading private sector insurance companies and among its largest securities brokerage firms, mutual funds and private equity firms. ICICI Bank’s presence currently spans 19 countries, including India. Prudential Plc Established in London in 1848, Prudential plc, through its businesses in the UK, Europe, US, Asia and the Middle East, provides retail financial services products and services to more than 21 million customers, policyholder and unit holders and manages over £249 billion of funds worldwide (as of March, 2009). In Asia, Prudential is the leading Europe-based life insurer with life operations in China, Hong Kong, India, Indonesia, Japan, Korea, Malaysia, the Philippines, Singapore, Taiwan, Thailand, and Vietnam. Prudential is one of the largest asset management companies in terms of overall assets sourced in Asia ex-Japan, with £36.8 billion funds under management (as of March, 2009) and operations in ten markets including China, Hong Kong, India, Japan, Korea, Malaysia, Singapore, Taiwan, Vietnam and United Arab Emirates. Products Insurance Solutions for Individuals ICICI Prudential Life Insurance offers a range of innovative, customer-centric products that meet the needs of customers at every life stage. Its products can be enhanced with up to 4 riders, to create a customized solution for each policyholder.  Savings & Wealth Creation Solutions 13 Report on Health Insurance • • • ICICI Pru Save 'n' Protect is an ideal plan for those who want to accumulate funds on a regular basis while enjoying insurance protection. ICICI Pru CashBak is a single policy that combines the triple benefit of protection, savings & periodic liquidity. ICICI Pru LifeTime Gold is a unit-linked plan which offers potentially higher returns over the long term with flexible investment options to help you achieve your goals. It offers 8 fund options - Preserver, Protector, Return Guarantee Fund, Balancer, Flexi Balanced, Multiplier, R.I.C.H and Flexi Growth. • • • • • • ICICI Pru LifeStage RP is unit linked plan that provides you with an option of lifecycle-based portfolio strategy that continuously re-distributes your money across various asset classes based on your profile, helping you achieve your desired financial goals. ICICI Pru LifeLink Super is a single premium unit linked insurance which offers attractive premium allocation along with the opportunity to enjoy potentially high returns over the long term, without compromising on the protection of your family. ICICI Pru InvestShield Life New is a unit linked plan that allows the customer to enjoy the benfits of potentially higher returns while guaranteeing him that he will get back atleast all the premiums paid by him, while providing protection to his family with a life insurance cover. ICICI Pru InvestShield Cashbak is a unit linked plan that provides premium guarantee while maintain a balance between return, safety & liquidity. ICICI Pru Wealth Advantage is a unique whole life single premium unit linked plan that provides long term coverage up to the age of 70 years and provides you the option to systematically withdraw your money. ICICI Pru LifeStage Assure a unit linked insurance plan that provides Guaranteed Maturity Addition of 100%- 450% of first year premium based on the term and number of premiums 14 Report on Health Insurance • • paid, with the additional advantage of a lifecycle based portfolio strategy that allocates the investor’s money across various asset classes based on his age and risk appetite. ICICI Pru SecureSave is a unique unit linked insurance plan which aims to grow your money over time with an assurance of a minimum guaranteed amount at maturity to protect you from any market downside. ICICI Pru Assure Life is a unit linked insurance plan that provides a Guaranteed Maturity Addition ranging from 140% to 450% of the first year premium while giving you the flexibility to choose your portfolio strategy from the second year.  Protection Solutions ICICI Pru Pure Protect is a flexible and affordable term product, with which you can ensure your life and provide total security for your family in case of an unfortunate event. ICICI Pru LifeGuard is a protection plan, which offers life cover at low cost. It is available in 2 options –level term assurance with return of premium & single premium. • • ICICI Pru HomeAssure is a mortgage reducing term assurance plan designed specifically to help customers cover their home loans in a simple and cost-effective manner. •  Child Plans ICICI Pru SmartKid New ULRP is a policy that is designed to provide money at key educational milestones in the child's life. SmartKid plans are also available in traditional form. •  Retirement Solutions 15 Report on Health Insurance • • ICICI Pru ForeverLife is a traditional retirement product that offers guaranteed returns for the first 4 years. ICICI Pru LifeTime Super Pension is a regular premium unit linked pension plan that helps one accumulate over the long term and offers 5 annuity options (life annuity, life annuity with return of purchase price, joint life last survivor annuity with return of purchase price, life annuity guaranteed for 5, 10 and 15 years & for life thereafter, joint life, last survivor annuity without return of purchase price) at the time of retirement. • • • • • ICICI Pru LifeStage Pension is a regular premium unit linked pension plan that provides you with a unique lifecycle-based strategy that continuously re-distributes your money across various asset classes based on your age and risk profile ICICI Pru LifeLink Super Pension is a single premium unit linked pension plan. ICICI Pru Immediate Annuity is a single premium annuity product that guarantees income for life at the time of retirement. It offers the benefit of 5 payout options. ICICI Pru LifeStage Assure Pension is a unique pension plan that assures guaranteed additions of up to 200% of the first year premium, giving investors an unmatched start towards accumulating for their retirement kitty. ICICI Pru Elite Pension is a unit linked pension plan that provides flexibility to the customer to pay for a limited term and lets him build a kitty for his retirement to provide an annuity for life.   Health Solutions Flexible Rider Options ICICI Prudential Life offers flexible riders, which can be added to the basic policy at a marginal cost, depending on the specific needs of the customer. 16 Report on Health Insurance • Accident & disability benefit: If death occurs as the result of an accident during the term of the policy, the beneficiary receives an additional amount equal to rider sum assured under the policy. If an accident results in total and permanent disability, 10% of rider sum assured will be paid each year, from the end of the 1st year & disability date for the remainder of the base policy term or 10 years, whichever is lesser. • Critical illness benefit: Critical Illness Benefit Rider provides protection against 9 critical illnesses to the policyholder when attached to the basic plan. VISION AND VALUES VISION To be the dominant Life, Health and Pensions player built on trust by world-class people and service. It wants to achieve by: • • • • • Understanding the needs of customers and offering them superior products and service Leveraging technology to service customers quickly, efficiently and conveniently Developing and implementing superior risk management and investment strategies to offer sustainable and stable returns to our policyholders Providing an enabling environment to foster growth and learning for our employees And above all, building transparency in all our dealings 17 Report on Health Insurance The success of the company will be founded in its unflinching commitment to 5 core values -- Integrity, Customer First, Boundary less, Ownership and Passion. Each of the values describes what the company stands for, the qualities of its people and the way in which it works. VALUES Every member of the ICICI Prudential team is committed to 5 core values: Integrity, Customer First, Boundary less, Ownership, and Passion. These values shine forth in all we do, and have become the keystones of our success. 18 Report on Health Insurance BOARD OF DIRECTORS Mr. K. V. Kamath Chairman Mr. M. P. Modi Mr. Keki Dadiseth Ms. Kalpana Morparia Mr. Barry Stowe Prof. Marti G. Subrahmanyam Vice Chairperson 19 Report on Health Insurance Ms. Chanda D. Kochhar Mr. H.T. Phong Ms. Rama Bijapurkar WHOLETIME DIRECTORS Mr. N. S. Kannan Executive Director Ms. Shikha Sharma Managing Director & CEO 20 Report on Health Insurance Mr. Bhargav Dasgupta Executive Director HEALTH INSURANCE Health insurance policies insure you against several illnesses and guarantee you stay financially secure should you ever require treatment. They safeguard your peace of mind, eliminate all worries about treatment expenses, and allow you to focus your energy on more important things, like getting better. Let's learn more about the various types of health insurance available, and what the best policy for you might be. HEALTH INSURANCE: A STRATEGIC IMPERATIVE FOR INSURANCE PLAYERS Post 1991 reforms, Insurance Industry have witnessed several changes. The untapped growing Indian market, improving life styles and aspirations of younger generation has opened a several opportunities for innovation for existing and upcoming Insurance players. Health being the latest as this sector is itself is emerging in India with the emergence of increasing life expectancy and ageing population, increasing consumer demands due to deteriorating health conditionds, new innovations and technological developments in the medical industry. Thus, a foray into health Insurance will help the insurers get a foothold into the gigantic Rs150, 000 Crore Health Care Industry. 21 Report on Health Insurance Lastly, an Insurance Companies, they have role to play in educating the customer about the need to insure oneself against critical illness. Asset protection is incomplete unless and until one has health insurance over and above life insurance. Life Insurance Companies have to look at Health Insurance as social responsibility to fulfill, apart from the vast business opportunity it presents them with. There are different types of health plans offered by various Life Insurance Companies and Non-Life Insurance Companies. The health cover offered by different companies is based on Critical Illness, Hospitalization, surgery, accident, disability etc. Some of the health plans provide cashless benefit and some do not. Therefore, depending on the types of benefit different companies offer different kind of plans. THE HEALTH PORTFOLIO OFFERED BY VARIOUS LIFE INSURANCE COMPANIES LIFE INSURANCE INDUSTRY Health Product Portfolio COMPANY Hospitalization Specific Critical & Surgical Illness ICICI Prudential LIC X Aviva X X Bajaj Allianz Birla Sun Life X X Bharti AXA X X ING Vysya X HDFC Standard Life X X Kotak X X Max New York Life MetLife X X Reliance X SBI Life X X Tata AIG 22 Report on Health Insurance THE HEALTH PORTFOLIO OFFERED BY VARIOUS GENERAL INSURANCE COMPANIES GENERAL INSURANCE INDUSTRY Health Product Portfolio Hospitalization Specific Critical & Surgical Illness X X X X X X X X X X COMPANY PSU Companies Bajaj Allianz Cholamandalam HDFC Chubb ICICI Lombard Max Health Care Reliance Royal Sundaram Star Health & Allied Tata AIG IFFCO Tokio Apollo DKV 5 reasons why health insurance is a must Indians at greater risk • Reason 1: Lifestyles have changed. Indians today suffer from high levels of stress. Long hours at work, little exercise, dependence on junk food have weakened our immune systems and put us at an increased risk of contracting illnesses. 23 Report on Health Insurance • Reason 2: Rare non-communicable diseases are now common. Obesity, high blood pressure, strokes, and heart attacks, which were earlier considered rare, now affect an increasing number of urban Indians. Shocking Truths • • • • • 18% of the urban population suffers from hypertension, which leads to renal failure, stroke and cardio-vascular diseases 30% of the population suffers heart attacks before age 40 66% of deaths today are due to cardio-vascular diseases Almost 3.5 million Indians suffer from diabetes Cardio-vascular diseases (CVDs) like heart disease and stroke are the main causes of death and disability The Cost Factor • Reason 3: Medical care is unbelievably expensive: Medical breakthroughs have resulted in cures for dreaded diseases. These cures, however, are available only to a select few. High operating expenses—therapy for breast cancer costs as much as Rs. 2 lakhs for 3 days—have restricted treatment to the richest. In fact, even among the affluent groups, 20% need to sell their valuable assets so they can accumulate the required amount to meet healthcare costs. • Reason 4: Indirect costs add to the financial burden: Indirect sources of expense—travel, boarding and lodging, and even temporary loss of income—account for as much as 35% of the overall cost of treatment. Most often, we overlook this fact when planning for medical expenses. 24 Report on Health Insurance • Reason 5: Incomplete financial planning: Most of us have insured our home, vehicle, child’s education, and even our retirement years. Ironically however, we have not insured our health. We ignore the fact that illnesses strike without warning—and seriously impact our finances and eat into our savings in the absence of a good health insurance or medical insurance plan. Over two thirds of all Indians sell assets or dip into existing savings to meet healthcare costs. HEALTH INSURANCE POLICIES IN INDIA- An Overview There is several health insurance or medical insurance plans in India. These can be divided into the following categories based on the coverage offered: These plans provide you complete health coverage through a hospitalization cover while at the same time also creating a health fund to cover any other healthcare expenses. Click to know more about our comprehensive coverage plan (Health Saver) Comprehensive health insurance coverage: 25 Report on Health Insurance Hospitalization Plans: These health insurance plans cover your expenses in case you need to be hospitalized. Within this category, products may have different payout structures and limits for various heads of expenditure. The hospitalization coverage may be reimbursement based plans or fixed benefit plans. These plans aim to cover the more frequent medical expenses. Click to know about our hospitalization insurance plan (Hospital Care, MediAssure) Critical Illness Plans: These health insurance plans provide you coverage against critical illnesses such as heart attack, organ transplants, stroke, and kidney failure among others. These plans aim to cover infrequent and higher ticket size medical expenses. Click to know about our critical illness plans (Crisis Cover) These plans are designed specifically to offer health insurance against certain complications due to diabetes or cancer. They may also include features such as disease management programs which are specific to the condition covered. Click to know more about our diabetes (Diabetes Care Active) and cancer (Cancer Care) suite of products. Specific Conditions Coverage: HEALTH INSURANCE PRODUCTS ICICI Prudential offers health insurance plans under the following major need categories: COMPREHENSIVE HEALTH COVERAGE: Health Saver: A comprehensive whole life plan that covers you against hospitalisation expenses and creates a health fund to cover any other health expenses. 26 Report on Health Insurance HOSPITALIZATION COVERAGE: MediAssure: A reimbursement hospitalization plan covering hospitalization stay and treatment. The claim payout is based on actual expense incurred. Hospital Care: A fixed benefit cashless hospitalization plan covering various stages of treatment and over 900 surgeries. CRITICAL ILLNESS COVERAGE: Crisis Cover: A comprehensive health insurance policy that covers 35 critical illnesses, death and disability. CANCER COVERAGE: Cancer Cover: A unique health insurance plan covering most early and advance types of cancers. DIABETES COVERAGE: Diabetes Care Active: A one of its kind critical illness health insurance plan only for diabetics and covers 7 major complications for a long term of upto 20 years. THE ICICI PRUDENTIAL HEALTH STORY 27 Report on Health Insurance  ICICI Prudential began its foray into Health in Jan 2006 with the two primary products Health Assure and Health Assure Plus, which were the first products of its kind offering a cover against critical illness. “Cancer Care” which helps to meet treatment and surgery related needs of someone afflicted with the dreaded disease.  This was followed by Comprehensive Cancer Insurance Plan  In 2006, ICICI Prudential introduced Diabetes Care which was a revolutionary product of its kind world over. The policy was the first Insurance policy specially designed for diabetics. It not only offers cover against Critical Illness but also provides a specially designed wellness program for diabetics.  In 2007, ICICI Prudential came out with a plan which covers the widest possible range of the medical conditions for the longest possible term and also meet all possible expenses during hospitalization and surgery i.e. Hospital Care.  In August 2007, Crisis Cover was launched which the most comprehensive critical illness cover is offering cover against 35 Critical illnesses along with Life and Disability cover. HEALTHASSURE PLUS 28 Report on Health Insurance Illnesses have a way of sneaking up on us, weakening our financial stability and stealing our family's peace of mind. It is best to keep oneself insured at all times against the most critical illnesses that are also the most common: Cancer, Coronary Artery Bypass Graft or Surgery, Heart Attack, Kidney Failure, Major Organ Transplant, and Stroke. ICICI Prudential's HealthAssure Plus financially insures you against these six critical illnesses. Should you ever be diagnosed with one or more of these, HealthAssure Plus provides you with a fixed sum, irrespective of your actual medical expenses. The health plan thus shoulders the heavy costs of your treatment and ensures you stay financially stable, come what may by providing a lumpsum payout irrespective of actual medical expenses. Since payout is independent of actual billing it also compensates for the loss of income and additional expenses like traveling, boarding, and lodging expenses of self and family. The plan also offers like Insurance coverage that protects the family in the unfortunate event of one’s death. This financial guarantee during illness is not all that HealthAssure Plus delivers. HealthAssure Plus comes with an added benefit: it insures your life, as well. So should an unexpected accident or disability claim your life, your family will receive the entire Sum Assured-an amount large enough to ensure they live securely, even in your absence. DEFINING FEATURES It provides cover against six critical illnesses: 29 Report on Health Insurance       Cancer Major Organ Transplant Coronary Artery Bypass Graft/Surgery Stroke Kidney Failure Heart Attack Incase of the diagnosis of any of the above mentioned critical illnesses, the benefit amount(Critical Illness Sum Assured) will be paid and all future premiums towards the Life Insurance cover are waived off, while the life insurance cover continues until maturity. The benefit amount will be paid only if the life assured survives for 28days from the date of diagnosis of critical illness. HEALTHASSURE PLUS at a Glance Coverage Against Life and Six Critical Illnesses: Cancer, Coronary Artery Bypass Graft or Surgery, Heart Attack, Kidney Failure, Major Organ 30 Report on Health Insurance Transplant, and Stroke Minimum Sum Assured Rs. 1 lakh Maximum Sum Assured Rs. 10 lakhs Minimum/Maximum Entry Age Maximum Age at Policy Maturity Minimum Policy Term Maximum Policy Term Maturity Benefit Freelook Period Tax Benefits 18 years to 55 years 65 years 10 years 30 years Yes, calculated on basis of no claims made 15 days from the date on which you receive your documents Tax benefit under Sec. 80 (C) for premiums paid towards both, Life and Critical Illness covers. About Critical Illnesses A “Critical Illness“ for the purpose of benefit, shall mean anyone of the following illnesses which first occurs or first manifests itself as defined hereunder and first diagnosed after six months from the issue date of the policy:(a) Cancer: A disease manifested by the presence of a malignant tumour characterized by the uncontrolled growth and spread of 31 Report on Health Insurance malignant cells, and the invasion of tissue. The diagnosis must be evidenced by definite histology and confirmed by qualified oncologist or pathologist. The term cancer also includes leukaemia and malignant disease of the lymphatic system such as Hodgkin’s Disease. Excluded are: any CIN stage (cervical intraepithelial neoplasia); any pre-malignant tumour; any non-invasive cancer (cancer in situ); prostate cancer stage 1 (T1a, 1b, 1c); all skin cancers including malignant melanoma stage IA (T1a N0 M0); any malignant tumour in the presence of any Human Immunodeficiency Virus. (b) Heart attack (Myocardial Infarction) The death of a portion of the heart muscle as a result of inadequate blood supply to the relevant area. The diagnosis for this will be evidenced by all of the following criteria: a) A history of typical chest pain b) New characteristic electrocardiogram changes c) Elevation of infarction specific enzymes, Troponins or other biochemical markers Excluded are: 1. Non-ST-segment elevation myocardial infarction (NSTEMI) with elevation of Troponin I or T; 2. Other acute Coronary Syndromes 3. Any type of angina pectoris (c) Stroke: 32 Report on Health Insurance Any cerebrovascular incident resulting in permanent neurological deficit and including infarction of brain tissue, haemorrhage and embolisation from an extra cranial source. Diagnosis has to be confirmed by a neurologist and by typical clinical symptoms and by CT scan or MRI of the brain. Evidence of neurological deficit for at least 3 months has to be produced. Excluded are: Transient ischemic attacks (TIA); traumatic injury of the brain; neurological symptoms due to migraine. (d) Coronary Artery By-Pass Graft Surgery (CABGS): The actual undergoing of open chest surgery for the correction of one or more coronary arteries, which is/are narrowed or blocked, by coronary artery bypass graft (CABG). The surgery must have been proven by a consultant cardiologist to be necessary by means of coronary angiography. Excluded are: Angioplasty and/or any other intra-arterial procedures; any key-hole surgery including but not limited to Minimally Invasive Coronary Artery Surgery (MICAS) procedure. (e) Kidney failure: End stage renal disease presented as chronic irreversible failure of both kidneys to function, as a result of which either regular renal dialysis (hemodialysis or peritoneal dialysis) is instituted or renal transplantation is carried out. (f) Major Organ Transplant : The actual undergoing of transplantation as the recipient of a heart, lung, liver, pancreas, small bowel, kidney or bone marrow. 33 Report on Health Insurance FEATURES AND BENEFITS OF HEALTHASSURE PLUS Long-term coverage against 6 critical illnesses: Choose a cover, for as long as 30 years with a premium guarantee for 5 years, depending on your age. Sum Assured of up to Rs. 10 lakhs: Receive the Sum Assured on diagnosis of any of the 6 covered critical illnesses: Cancer, Coronary Artery Bypass Graft/Surgery, Heart Attack, Kidney Failure, Major Organ Transplant, and Stroke. Life Insurance Sum Assured: This amount is paid to the nominee should something happen to the policyholder. 34 Report on Health Insurance Flexible withdrawal options: Choose to receive the benefit amount either in a lump-sum amount or in installments over 5 years. These installments will be payable as 25% in the first years and 20% each year for the next 4 years. Waiver of premium: Enjoy a waiver of premiums towards your Life Cover even after you receive the benefit amount on being diagnosed with a critical illness. Maturity benefit: Receive a 'No claim benefit' when the policy term ends, provided you have made no claims during the tenure. The Maturity Benefit is equal to the sum total of all the premiums paid. Surrender Value: You can surrender your plan after 3 years of cover. The Surrender Value will be paid immediately, provided you have paid all your premiums in the first 3 years. Guaranteed = No. of years premium paid Surrender Value Total term of the policy Total premium paid No medical/other bills: Receive your claim amount on diagnosis without having to show any bills. No medical examinations: Enjoy a waiver on medical examinations if you choose a Sum Assured up to Rs. 5 lakhs. Tax benefits: Enjoy tax benefits on the premiums you pay (under u/s 80 C) for premiums paid for both Critical Illness and Life Cover. 35 Report on Health Insurance CRISIS COVER Life is hectic in today's fast paced world. Along with the rapid pace and progress comes the bane of modern life such as increased stress, poor diet and lack of exercise. The alarming aspect is that, owing to these factors, more and more Indians are becoming vulnerable to critical illnesses every year. These illnesses, coupled with increasing costs of treatment, have made recovery a long and expensive process. It goes without saying that securing your family's financial future is a part of prudent financial planning. However, no less important is your health and well-being, for which you need a comprehensive health coverage. And, given our lifestyles, it should ideally be a plan that provides complete protection against Disease, Disability and Death. 36 Report on Health Insurance Keeping this need in mind, ICICI Prudential Life Insurance presents Crisis Cover. This all-inclusive long term insurance policy provides coverage against 35 critical illnesses, total and permanent disability, and also death. So, get the right protection tailored to suit your lifestyle, with this plan which is: •Comprehensive •Affordable • Long Term DEFINING FEATURES 37 Report on Health Insurance This policy provides cover against 35 critical illnesses related to most body organs and senses. These critical illnesses are divided into two groups, depending upon the benefit amount payable.   The Critical Illnesses with Full Payout Advantage The Critical Illnesses with Coverage Continuation Advantage Group 1: CRITICAL ILLNESSES WITH FULL PAYOUT ADVANTAGE Get the full benefit amount for Critical Illnesses covered under this category. The benefit amount payable is equal to the full sum assured chosen under the policy. CI with Full Payout Advantage • • • • • • • • • • • • Apallic Syndrome Benign Brain Tumour Blindness Brain Surgery Cancer Chronic Lung Disease Coma Coronary Artery Bypass surgery End stage liver disease Heart Attack Heart Valve Surgery Kidney Failure 38 Report on Health Insurance • • • • • • • • • Loss of Independent existence Loss of Limbs Major Burns Major Head Trauma Major Organ Transplant Paralysis Stroke Surgery to aorta Terminal Illness Group 2: CRITICAL ILLNESSES WITH COVERAGE CONTINUATION ADVANTAGE The maximum benefit amount payable is Rs. 500,000* for Angioplasty and Rs. 1,000,000 for all other critical illnesses in this category and the cover continues for all other remaining illnesses benefits for the remaining sum assured chosen under the policy. The premium is also revised proportionately on the following Policy anniversary for the reduced Sum Assured. 50% of sum assured with a max limit of Rs. 500,000 CI with coverage continuation Advantage • • • • • Angioplasty Alzheimer's Disease Aplastic Anaemia Cardiomyopathy Deafness 39 Report on Health Insurance • • • • • • • • • Loss of Speech Medullary Cystic Disease Motor Neurone Disease Multiple Sclerosis Muscular Dystrophy Parkinson’s Disease Poliomyelitis Primary Pulmonary hypertension SLE with Lupus Nephritis Death or Total & Permanent Disability The Full Sum Assured as chosen under the plan is paid in the event of Death or Total Permanent Disability of the Life Assured. This benefit is payable even if death or disability occurs because of an accident. How does Crisis Cover work?    Choose a Sum Assured under Crisis Cover Pay Premium based on your age and sum assured and term of cover chosen Get the applicable sum assured in the event of being diagnosed with a critical illness or on being rendered totally disabled or on death, whichever occurs first. 40 Report on Health Insurance  Remain covered even after a claim on select Critical Illnesses Get the Sum Assured on under the plan on first occurrence of Death or Total Permanent Disability or on diagnosis of any one of the following 35 Critical illnesses. CRISIS COVER at a Glance Eligible Age Coverage term 18 years to 60 years 10 years to 50 years Maximum Coverage Ceasing Age 75 years Sum Assured Premium payment frequency Tax Benefit Rs. 300,000 to Rs. 2,000,000 Monthly, Half-yearly, Annual As per prevailing tax laws under Section 80C & 80D Modes of Premium Payment: 41 Report on Health Insurance Premiums are payable through any of the following modes: o o o o o o o o Cash Cheques Demand Drafts Pay Orders Bankers Cheque Internet facility as approved by the Company from time to time. Electronic Clearing System Credit Cards (Only standing instruction) Premium Payment frequency: Your Premium will fall due in every policy year based on the periodicity of payment of premiums, i.e. Yearly, Half-Yearly or Monthly BENEFITS OF CRISIS COVER Benefit amount paid on diagnosis of any of the 35 diseases (critical Illnesses), disability or death Receive lump-sum benefit amount irrespective of actual billing Benefit amount will be paid in addition to payment received by you from other medical insurance plan 42 Report on Health Insurance Long term coverage upto 75 years of age Coverage continues even after claiming benefit on select critical illness Premium paid is eligible for deduction under section 80C & section 80D* HOSPITAL CARE Today, when you are young and healthy, planning for a contingency is not always a priority but the cost of treating even the smallest of ailments is on the rise. You realize it only when you or your loved ones has to undergo some medical emergency and you are faced with the challenge of organizing funds to meet the hospitalisation related expenses. Hence a medical emergency comes not only with emotional turmoil but also with a huge expense attached to it. During such an unexpected situation, your only concern should be that the best doctors and medical facilities are available and cost should not be a constraint so that you can take care of things without compromise but to ensure that best in class treatment is provided, the key to that is to be financially prepared for it. To help you manage this unexpected emergency, ICICI Prudential presents Hospital Care - a comprehensive insurance policy that has: • Facility of cashless hospitalisation in an extensive network of hospitals in India 43 Report on Health Insurance • Benefit amount will be paid in addition to payment received by you from other medical insurance plans. • You will receive lump-sum benefit amount, irrespective of the actual billing. • Long term guaranteed coverage up to 20 years. • Tax benefits on premium paid up to Rs.15, 000 under Section 80D. DEFINING FEATURES 1. 2. 3. 4. Daily Hospitalization Cash Benefits(DHCB) Intensive Care Unit Benefit(ICU) Recuperating Benefit Surgery Benefit 1. Hospitalisation Benefits (DHCB) o o o Get a benefit amount if you are hospitalized for more than 24 hours i.e. at least 2 consecutive nights and must be charged for 2 days room expenses. The benefit amount is fixed and will be paid irrespective of actual hospitalisation expenses DHCB is payable for hospitalisation up to 90 days per policy year, which includes any days spent in Intensive Care Unit. 44 Report on Health Insurance 2. Intensive Care Unit (ICU) benefit o o An additional 50% of DHCB amount per day is paid to you if you get admitted to an Intensive Care Unit (ICU), and this amount is paid depending on the plan chosen. The ICU benefit is payable for hospitalisation up to 30 days per policy year, and is paid in addition to DHCB. 3. Recuperating benefit o o A post-hospitalisation benefit amount in addition to all other amounts will be paid out to ensure that follow-up tests, medicines and consultations go ahead as planned . You are eligible for recuperating benefit only on being hospitalized continuously for 5 or more days DHCB. 4. Surgery benefit Over and above the hospitalisation expenses, a fixed lumpsum amount is also paid for more than 900 surgical procedures. These surgeries have been classified into four grades, depending on the type and severity. A sample list of surgeries is given below: Grades 1 2 Surgeries Tennis elbow release, bladder stone removal Hernia, Removal of uterus 45 Report on Health Insurance 3 4 Removal of kidney, removal of thyroid gland Open heart surgery, removal of brain tumor 5. Benefit amounts at-a-glance You can choose any one plan, from the following four options Each plan has fixed benefit amounts, as shown below: Benefit Daily Hospitalistion Cash Benefit (per day) ICU (Intensive Care Unit) Benefit per day) Recuperating Benefit Surgery Benefit Surgery grade 1 Surgery grade 2 Surgery grade 3 Plan (Rs.) 1,000 A Plan (Rs.) 2,000 B Plan (Rs.) 3,000 C Plan (Rs.) 4,000 D 500 1,000 1,500 2,000 3,000 6,000 9,000 12,000 15,000 50,000 75,000 30,000 1,00,000 1,50,000 45,000 1,50,000 2,25,000 60,000 3,00,000 4,00,000 46 Report on Health Insurance Surgery 4 grade 1,00,000 2,00,000 3,00,000 4,00,000 Sample Case 1 In case you opt for plan A, then for an 8-day hospitalisation, your benefit amount is DHCB = 8 days * Rs. 1,000 per day = Rs. 8,000 + Recuperating Benefit = Rs. 3,000 (refer to the table below for benefit amounts) Total benefit amount = Rs. 11,000 Sample Case 2 In case you opt for plan D, then for an 6-day hospitalisation, including 4 days in ICU, with a Grade 2 surgery, your benefit amount is DHCB = 6 days * Rs. 4,000 per day = Rs. 24,000 + 4-day ICU benefit = 4 days * Rs. 2,000 per day = Rs. 8,000 + + Grade 2 Surgery benefit = Rs. 2,00,000 (refer to the table below for benefit amounts) Total benefit amount=Rs 2,44,000 47 Report on Health Insurance 6. High benefit limits Hospital Care policy offers you high benefit limits. For instance, under plan A, you can claim up to Rs.4 lakhs for multiple claims, including surgical benefit up to Rs.3 lakhs annually. However, for the entire policy term, you can make multiple claims up to Rs.20 lakhs. Benefit Limits Yearly Limit Surgical benefit Policy Term Limit Plan A (Rs.) Plan B (Rs.) Plan C (Rs.) Plan D (Rs.) 4,00,000 3,00,000 20,00,000 8,00,000 6,00,000 40,00,000 12,00,000 9,00,000 60,00,000 16,00,000 80,00,000 BENEFITS OF HOSPITAL CARE Payout in addition to other plans You can claim benefit amount from this policy as well as any other medical insurance policy you may have, since the company only requires submission of photocopies or duplicates of bills and certificates. The lump-sum benefit amount will be paid to you, irrespective of your actual medical expenses. 48 Report on Health Insurance Cashless hospitalisation You don't need to make any payment upfront. We shall pay the billed amount upto the benefit payable under the product, directly to the hospital, as settlement of your dues. This facility is available through our extensive list of network hospitals across the country. Multiple claims Life being uncertain, you may incur medical treatment costs several times. You can make multiple claims during the policy term, so long as the total amount payable does not exceed the benefit limit you are entitled to. Transparent coverage norms This policy is very transparent and informs you upfront about benefit payouts, the coverage and exclusions. This helps you plan your finances in the event of an emergency, so that you can concentrate on the treatment. Guaranteed coverage Medical eventualities can occur at any time. This policy guarantees you coverage for the entire policy term, so that you enjoy the benefit of the cover, irrespective of any claims made or a change in your health status during the policy term. 49 Report on Health Insurance Tax benefit The premium paid by you up to Rs.15, 000 p.a. is eligible for tax benefit under Section 80 D, as per prevailing Income Tax laws. THE CLAIMS PROCESS On issuance of the policy, as part of the Welcome Kit, you will receive the following: • • Health Card (a card which has your policy number and contact information of ICICI Prudential and it can be utilized only in Network Hospitals) Claims and Pre-Authorization Forms When there is a need for hospitalization, you can inform ICICI Prudential about hospitalisation by calling on the contact number provided on the health card. You need to provide following information when you call ICICI Prudential about the claim 1. 2. 3. 4. Your Policy Number (as mentioned on the health card) Name of insured person who is hospitalized. Nature & Details (location, date of accident or commencement of sickness) Name & Address of Hospital, where life insured is admitted All the above information can be provided to ICICI Prudential immediately or prior to availing treatment and in any case within 4 days of hospitalization in case of a network hospital. 50 Report on Health Insurance CANCER CARE ICICI Prudential suggests you insure yourself, right away, with Cancer Care-a comprehensive Cancer insurance policy, which enables you and your family to stay financially and mentally secure should you be diagnosed with early or advanced Cancer, the plan provides the necessary financial resources so that one can get the best possible treatment as early as possible and maximize the chance of survival. CANCER CARE at a Glance Coverage Against Minimum/Maximum Sum Assured Minimum/Maximum Entry Age Maximum Age at Policy Maturity Minimum/Maximum Policy Term Minimum Single Premium Freelook Period Tax Benefit Cancer 10 units to 25 units (Cover of Rs. 10 lakhs to Rs. 25 lakhs) 20 years to 55 years 70 years 10 years to 50 years Rs. 1,200 per annum 15 days from the date on which you receive your documents Tax benefit under Section 80 (D) for premiums paid 51 Report on Health Insurance TYPES OF CANCER COVERED UNDER CANCER CARE Cancer Care covers most forms of early and advanced stages of cancer that affects both men and women. Following are the most common cancers that are covered under Cancer care: Early Cancer: is defined as Cancer which is localized and had not invaded the normal tissues beyond the basement membrane of the cell. Following types of cancer covered under Early Cancer:  Chronic lymphocytic leukemia  Cancer of the colon or rectum  Cancer of urinary bladder  Hodgkin’s Disease  Breast Cancer  Cancer of Cervix Advanced Cancer: is defined as malignant tumor (cancerous growth) in which the malignant cells spread and invade the normal, surrounding tissues. Also surgical and non-surgical or palliative treatment should have been initiated. Following types of Cancer covered under Advanced Cancer:     Cancer of stomach, large bowel, bladder, head and neck, liver, pancreas, gall bladder, kidney and lymphoma Blood Cancer(Leukemia) Cancer of Thyroid Metastaticskin Cancer Cancer that commonly affects women: • • • • • Breast Cancer Cancer of Cervix Ovary Cancer Oesophagus Cancer Lung Cancer Cancer that commonly affects men: 52 Report on Health Insurance • • • • • • Lung Cancer Oesophagus Cancer Larynx Stomach Cancer Hypolarynx Cancer Prostrate Cancer Early Cancer that commonly affects men & women: • • • • • Hodgkin’s Disease Chronic Lymphocitic Leukemia Chronic Lymphocitic Leukemia Cancer of Colon or Rectum Cancer of Urinary Bladder Cancer of the stomach, large bowel, bladder, head and neck, liver, pancreas, gall bladder, brain, kidney, lymphoma, leukemia, thyroid, and skin. These cancers also affect men and women at an advanced stage. CASH PAYOUT FOR EARLY AND ADVANCED CANCER Claim at Early Cancer Stage Diagnosis of Early Cancer Oncological Treatment Benefit For Early Cancer Diagnosis of Advanced Cancer Oncological Treatment Benefit For Advanced Cancer Surgery for Advanced Cancer Total Benefit Rs. 1 lakh Rs. 1 lakh Rs. 5.5 lakh Rs. 1 lakh Rs. 1.5 lakh Rs. 10 lakh Claim at advanced Cancer Stage NA NA Rs. 6.5 lakh Rs. 1.5 lakh Rs. 2 lakh Rs. 10 lakh 53 Report on Health Insurance FEATURES AND BENEFITS OF CANCER Comprehensive cancer insurance plan: Get covered for most forms of cancer. Unique design: Receive pay benefits at both early and advanced stages. Cash payouts: Meet your expenses at for diagnosis, treatment and surgery, with cash payouts at various stages. Sum Assured up to Rs. 10 lakhs: Receive this amount for a premium as low as Rs. 250 a month. No medical bills required: Enjoy a hassle-free claim procedure. Receive the benefit amount without showing any medical bills. No medical examinations: Enjoy a waiver on medical examinations if you purchase up to 15 units (equivalent to Rs. 15 lakhs). Waiver of premium: Have your premiums waived if diagnosed with advanced Cancer. Tax benefits: Enjoy tax benefits on the premiums you pay (under u/s 80 D). CANCER CARE PLUS 54 Report on Health Insurance This Plan goes a set beyond providing you comprehensive coverage against Cancer by providing a wellness program to all the Cancer Care Plus policy holders. Cancer does not discriminate between the rich and poor, young and old, educated and uneducated. But the good news is that if detected early, the chances of surviving the illness increases substantially. Keeping this in mind, ICICI Prudential introduces Cancer Care Plus A wellness plan that includes all the benefits of Cancer Care and also provides an additional critical benefit: FREE periodical cancer screenings at a partner diagnostic centre close to you. These regular cancer screening tests empower you to proactively keep a track of your health, detecting any early signs of cancer and taking immediate treatment. With Cancer Care Plus, you not only safeguard your well-being but also your savings, which stays intact, for this comprehensive plan pays for diagnosis, oncological treatment and surgery of early and advanced Cancer. Cover yourself with Cancer Care Plus today. It is the surest way to keep yourself well-armed against India's most rapidly growing illness. Wellness Program What sets apart Cancer Care Plus is its unique Wellness Program. This is a screening package that enables you to undergo specific tests, free of cost. The tests will be conducted once in 2 years, starting from the second year of the policy. This program will help in diagnosing the possibility of cancer at the earliest stage, thereby initiating early treatment and increasing the chances of survival. The tests will be conducted by the Company's empanelled medical centers. 55 Report on Health Insurance Benefits of the Wellness Program are applicable only on policies whose premiums have been paid till date. DEFINING FEATURES  The objective of this program is to help in detecting Cancer at the earliest stage, thereby initiating timely treatment and increases chances of survival.  The Cancer screening test will be conducted once in 2 years,starting from the second year of policy  The test is absolutely free of cost  This test will be conducted by the Company’s empanelled panel canters. CANCER CARE PLUS at a Glance Coverage Against Minimum/Maximum Sum Assured Minimum/Maximum Entry Age Maximum Age at Policy Maturity Minimum/Maximum Policy Term Minimum Single Premium Cancer Rs 5 lakhs to 25 lakhs 20 to 60 years 70 years 10 to 50 years Rs 1200 per annum 56 Report on Health Insurance Freelook Period Tax Benefit Wellness Program 15 days from the date you receive your documents Tax benefit under Section 80(D) for premiums paid Free Cancer Screen at predefined frequency for the entire term of the policy THE CLAIMS PROCESS 1. 2. 3. Submit a written notice along with a proof of diagnosis of the critical illness/disability/death required for claim. The company verifies the document and admits the claim. The company pays the entire benefit amount as applicable. DIABETES CARE According to the WHO, India is the diabetes capital of the world, with more than 20% of the diabetes cases. The main causes are our sedentary lifestyle, poor eating habits and genetic pre disposition. India also has a high prevalence of people with Impaired Glucose Tolerance (IGT) or Impaired Fasting Glucose (IFG), pre-diabetic conditions, which lead to diabetes if not managed early. Moreover, 57 Report on Health Insurance there is an increasing trend of onset of these conditions at younger ages in India. For the many diabetics, the above translates into an altered lifestyle characterized by change in food habits, physical activity & medication. It also brings along many serious health complications such as heart attack, kidney failure & stroke, which may entail a huge financial burden. On the other hand, regular monitoring, life style changes, medication and diet control, can lead to a healthy life and postpone or possibly even avoid the complications. Keeping in mind the above, ICICI Prudential proudly presents ICICI Pru Diabetes Care Active. This offering aims to provide you a comprehensive diabetes management solution. While our Wellness Programme ensures that you stay healthy, our insurance guarantees financial assistance in case a critical illness does strikes. The plan aims to encourage, enable & offer you incentives to manage your diabetes by reducing premiums for good diabetes management. DIABETES CARE at a Glance Through ICICI Pru Diabetes Care Active, we aim to help you manage your diabetic or a pre-diabetic condition effectively to reduce the risk of a complication arising as well as provide financial support to ensure proper treatment at the critical junctures. We provide this support in the form of a unique insurance that provides 58 Report on Health Insurance • • • • • Wellness Programme to help you manage diabetes avoid complications, which includes o Regular medical testing and annual doctor consultation o Diabetes Coach to facilitate diabetes management o Special offers from our healthcare partners o Support through online tools Reduced premiums upto 20% on showing good control over your diabetes Payment of lump-sum amount on diagnosis of 7 critical illnesses including Angioplasty Long term coverage upto 65 years of age Tax benefit under section 80D of the Income Tax Act 1961 THE CLAIMS PROCESS Claims process is an easy 3 step process. This will ensure that you get a hassle-free and convenient claims experience. 1. Submit a written notive along with proof of diagnosis of criticall illness/ surgery, required for the claim. 2. The company verifies the documents and admits the claim. 3. The company pays the entire benefit amount as applicable. CONCLUSION About 85% of Indian Population does not have any kind of Health Insurance. Most of people do not have any kind of Health Insurance as a matter of prime importance and at the time of urgency, they have no option left but either to dilute their 59 Report on Health Insurance existing funds and saving which were earmarked for some other purposes or to borrow money from elsewhere. Health care cost in India is not only high but also rising fast. Health care cost have been rising over 20% annually. Since 2001, health care costs have been raised by 150%. The same is expected in future. With the increasing number of patients suffering from illnesses, they spend on daily day to day expenses as well as hospitalization and surgeries is also likely to increase over time. So it is needed to create awareness among the people of India that how health Insurance companies especially ICICI Prudential providing benefit to meet the health-care cost. BIBLIOGRAPHY 1. BOOKS/MAGAZINES REFFERED: STUDY GUIDE- PRINCILES & PRACTICES OF LIFE / GENERALINSURANCE, by AIMA. 60 Report on Health Insurance Books published by INSURANCE INSTITUTE OF INDIA LIFE-INSURANCE, by Mc GILL INSURANCEWATCH. MONEYOUTLOOK. 2. WEBSITES REFFERED:  IFAINSURANCE.COM WWW.C  ONEYOUTLOOK.COM WWW.M  NSURANCE.IND.COM WWW.I  CICIPRUDENTIAL.COM 3. REPORTS/ARTICLES REFFERED: WWW.I REPORT: ISSUES & CHALLENGES FACING THE INSURANCE INDUSTRY…. Dec2008. BRIEF PROFILE OF HDFC, INDIA…Dec 2008. REPORT: COPING WITH COMPETITION…Jan2009 61 Report on Health Insurance 62