F amily h ealth o ptima insurance plan revised
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F amily H ealth O ptima Insurance Plan (Revised). Features. Age at Entry : 5 months to 65 years Family size: 2A + 3C ( Maximum) Dependant children less than 25years of age Renewability : Up to 65 years Coverage on

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F amily H ealth O ptima Insurance Plan (Revised)

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F amily h ealth o ptima insurance plan revised

Family Health Optima

Insurance Plan

(Revised)


F amily h ealth o ptima insurance plan revised

  • Features

Age at Entry:5 months to 65 years

Family size: 2A + 3C ( Maximum)

Dependant children less than 25years of age

Renewability :Up to 65 years

Coverage on

Floater Basis : Single Sum Insured on Floater Basis covering all members of the family


F amily h ealth o ptima insurance plan revised

  • Features

For entry age between 61 and 65 years, only 2 Adults option is available for Sum Insured of Rs.3,00,000/- and above

Co Pay

20% Co pay on each and every eligible claim amount for insured persons between 61- 65 years, at entry level


F amily h ealth o ptima insurance plan revised

  • Features

Two Tier rating of Premium according to Zone

Zone 1 - Mumbai including Thane, Delhi ( Delhi city, Noida, Gurgoan, Ghaziabad & Faridabad) and the entire State of Gujarat

Zone 2 - Rest of India

Premium would be charged according to the residential address of the customer.

When a policy is charged as per Zone 2 rate and a treatment is taken in one of the Zone 1 cities, the difference in the premium is recovered from the claim amount


F amily h ealth o ptima insurance plan revised

  • Benefits

Hospitalization Benefit

Hospitalization expenses incurred owing to disease, illness, sickness or accidents as inpatient in a registered hospital for a minimum period of 24 hours is covered on Cashless or reimbursement basis.

Pre Hospitalization

Reasonable Expenses incurred upto 30 days prior to the date of admission.

Post Hospitalization

7% of the Hospitalization expenses (excluding room rent) subject to a maximum of Rs.5000/-


F amily h ealth o ptima insurance plan revised

  • Benefits

Room Rent :Class A Cities

2% of Sum Insured subject to maximum of Rs.5000 per day

Class B Cities

1% of Sum Insured subject to maximum of Rs.3000 per day

Other Locations

1% of Sum Insured subject to maximum of Rs.1000 per day


F amily h ealth o ptima insurance plan revised

  • Benefits

  • Nursing charges, Surgeons, Anesthetist, Consultants and Specialists fees, Operation Theatre Charges, Drugs and medicines diagnostic materials, cost of pace maker etc.,

  • Ambulance Charges

  • Rs. 750/- per hospitalization subject to a maximum of Rs. 1500/- per policy period


F amily h ealth o ptima insurance plan revised

  • Benefits

Day Care Procedures - 101 treatments covered as day care.

Limit for Cataract is based on the Sum Insured

SI OptionLimit for Cataract


F amily h ealth o ptima insurance plan revised

  • Benefits

Automatic Restoration of SI

Where the sum insured is fully exhausted during the policy period, either under a single claim or multiple claims put together there is an automatic top up of Sum insured for the rest of the policy period


F amily h ealth o ptima insurance plan revised

  • Benefits

Automatic Restoration of SI – An Illustration

Mr.A has a Rs.5,00,000 policy and a claim is made in full for treatment of an ailment by him.

Rs.500,000 is again reinstated in the policy for the rest of the policy period.

No extra Premium is charged. This is automatic restoration.

This amount can now be availed by all members covered in the policy including Mr. A.

However in the case of Mr. A, the restored Sum Insured will be available for diseases other than for which the claim was made.


F amily h ealth o ptima insurance plan revised

  • Benefits

Bonus Additions

The policy holder is now bestowed with additional Sum Insured in case of a claim free year.

Different % age of bonus additions for Different Sum Insured options.

A maximum of 35% of Basic Sum Insured is accumulated as Bonus.

Ex: A policy with Sum insured of Rs.10,00,000/- will now automatically provide cover upto Rs. 12,50,000/- in the second year (I Renewal),Rs.13,50,000/- in the third year without any extra premium


F amily h ealth o ptima insurance plan revised

  • Benefits

Bonus Additions


F amily h ealth o ptima insurance plan revised

  • Benefits

What happens to Bonus Additions when there is claim in the subsequent year ?

The Bonus will be reduced by 50% following a claim under the policy.

The Bonus becomes Zero when there is a claim in the successive year also

Bonus additions would continue according to slab for the further claim free year


F amily h ealth o ptima insurance plan revised

Revised FHO Rates

Service Tax extra

A-Adult

Choose the age of the oldest member for calculating the premiumC- Child


F amily h ealth o ptima insurance plan revised

Revised FHO Rates

Service Tax extra

A-Adult

Choose the age of the oldest member for calculating the premiumC- Child


F amily h ealth o ptima insurance plan revised

Revised FHO Rates

Service Tax extra

A-Adult

Choose the age of the oldest member for calculating the premiumC- Child


F amily h ealth o ptima insurance plan revised

Revised FHO Rates

Service Tax extra

A-Adult

Choose the age of the oldest member for calculating the premiumC- Child


F amily h ealth o ptima insurance plan revised

Revised FHO Rates

Service Tax extra

A-Adult

Choose the age of the oldest member for calculating the premiumC- Child


F amily h ealth o ptima insurance plan revised

Revised FHO Rates

Service Tax extra

A-Adult

Choose the age of the oldest member for calculating the premiumC- Child


F amily h ealth o ptima insurance plan revised

Revised FHO Rates

Service Tax extra

A-Adult

Choose the age of the oldest member for calculating the premiumC- Child


F amily h ealth o ptima insurance plan revised

  • Declined Risk

Persons who are suffering from or have suffered

from the following ailments cannot be issued policy –

Heart Problem (CVD)

Cancer

Kidney Failure


F amily h ealth o ptima insurance plan revised

  • Exclusions

  • All Pre Existing Diseases not covered. However covered after 48 months of continuous coverage with any of Indian Insurer.

  • Any Diseases contracted during the first 30 days of the first policy year.


F amily h ealth o ptima insurance plan revised

  • Exclusions

First year ExclusionsBenign prostate hypertrophy, Hernia HydroceleFissures, Fistula in Anus / PilesSinusitisCongenital internal disease/defectTreatment for Gall stone and

Treatment for Renal stone


F amily h ealth o ptima insurance plan revised

  • Exclusions

First 2 year’s ExclusionsCataract

Hysterectomy following menorrhagia or fibromyoma, Treatment for Knee,Treatment for JointProlapse of intervertibral discVaricose veins/ulcers


F amily h ealth o ptima insurance plan revised

  • Portability

This policy is portable

Proposals from less than 45 years of age without any previous claim or PED, can be ported to this policy by the operating office.

The requisition has to be received 7 days before the date of expiry.

Beyond 45 years of age, portability acceptance routed through portability cell and applications will have to be received atleast 30 days prior to the date of Expiry.


F amily h ealth o ptima insurance plan revised

  • Portability

Continuity benefits of First 30 days, First year exclusions, First two years’ exclusions and PED allowed according to the previous policy.

Cumulative Bonus of the previous insurer is not

given credit. However the Insured can opt for Sum Insured including the cumulative Bonus and Premium will be charged on the total Sum Insured.


F amily h ealth o ptima insurance plan revised

  • Pre Insurance Medical

Pre Insurance medical examination as per latest underwriting guidelines.

Tests to be taken as per the guidelines given.

Acceptance based upon the medical officer’s opinion of the MER.

Persons with adverse medical history may also be referred for medical examination.


F amily h ealth o ptima insurance plan revised

  • IT Benefit

Deductions under Sec 80 D of Income Tax Act is available for all modes of payment other than cash


F amily h ealth o ptima insurance plan revised

Revision of Sum Insured on Renewal

Please refer the latest underwriting guidelines.

The No Claim Discount for a claim free year is withdrawn in view of introduction of Bonus.

The policy will now attract Bonus Additions as per the conditions.


F amily h ealth o ptima insurance plan revised

Renewal (contd.,)

An illustration

Rs.4,00,000 claim free FHO policy is now renewed for Rs.5,00,000 Sum insured.

There will be a bonus addition of Rs.1,00,000. (25% of Basic Sum insured which is Rs.4,00,000)

Total Sum insured is Rs.6,00,000

(Rs.5,00,000 + Rs.1,00,000)

Premium is charged for Rs.5,00,000 Sum insured


F amily h ealth o ptima insurance plan revised

Documents required

  • Proposal form duly filled in all respects and signed by the proposer. Care to be taken to observe the PED details, if any.

  • One Photograph of each person to be insured

  • Two photographs for those who have to undergo medical examination

  • Age proof in case of age above 45 years

  • Full and Correct Premium of the plan

  • Portability Form, wherever applicable


F amily h ealth o ptima insurance plan revised

USP’s of Revised FHO

  • 101 day care procedures covered

  • Revised limits for Cataract

  • Inclusion of Goa, Rajkot, Allahabad in B Cities

  • Automatic Restoration of SI up to 100% of Sum insured

  • Bonus additions for claim free year

  • Bonus additions is reduced by only 50% in case of a claim

  • No decrease in Basic SI

  • No loading on claims

  • Two tier pricing


F amily h ealth o ptima insurance plan revised

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