This is L&T General Insurance’s first health policy and it attempts to provide a comprehensive cover. Along with the basic mediclaim cover, ‘My: Health Medisure Prime’ has added insurance for hospitalisation related to personal accidents and critical illnesses. A feature-laden product, it does have several exclusives, including a guarantee on response time, doubling of critical illness cover and reinstatement of sum assured for accidents.
New features: L&T Insurance is the only insurer guaranteeing its customers a quick response for both cashless (six hours) and reimbursement claims (six working days). Else, it shall give a fixed compensation of Rs 1,000.
There is a lifetime renewal, with co-pay for those above 70. Premiums will remain constant for those above 80.
The policy will double the sum assured for its listed 10 critical illnesses. So, a customer with Rs 10 lakh cover will automatically be insured up to Rs 20 lakh once he undergoes treatment.
Typically, critical illness covers are benefit plans that hand out a fixed sum assured on diagnosis of an illness. The doubled amount, therefore, will come in handy if expenses exceed the sum assured.
There will be a reinstatement of sum insured in case of accident. So, those who have exhausted their sum insured will benefit if they are hospitalised within the remaining term of the policy.
However, according to Mahavir Chopra, head, e-business of medimanage, a health insurance portal: "Though the product offers benefits similar to a critical illness policy or a personal accident cover, one will still need to buy these separately. The lump sum they pay promptly should take care of the loss of income in case of accident or diagnosis of a critical illness."
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Another feature of the policy is the differential rates for three different zones. "As the cost of living is higher in cities like Mumbai (zone one), customers there will have to pay 15 per cent more than in zone three," says Joydeep Roy, CEO, L&T Insurance.
However, if a zone three person is hospitalised in zone one, he will have to co-pay 10-20 per cent. Zones can be changed, though, at the time of renewing the policy. A similar family floater policy from New India Assurance offers a zone-wise premium, based on cities.
The waiting period for pre-existing diseases to be covered is lower at two years, instead of the usual three. Also, there will be no deductions made for pre-medical check-up, even if the application is rejected. Typically, if a case is rejected, insurers deduct the amount spent on the check-up, before returning the sum remaining.
Costs: Premiums, however, are on the higher side. A 30-year male based in Mumbai pays a premium of Rs 10,174 for a sum insured of Rs 5 lakh. A similar policy in Pune (zone two) would cost Rs 9,266, while in Kanpur or in any other zone three city, it would cost Rs 8,813. A basic Mediclaim of Rs 5 lakh from Apollo Munich, which also offers life-time renewal, would cost almost half, at Rs 5,908.