Reliance HealthWise Policy

1. Reliance HealthWise Policy December 2006

2. Introduction - Clinical Indian Health Industry and Health Insurance Product Offering – Reliance HealthWise Policy Underwriting Overview Claims Overview Agenda

3. Health Risks could arise from various factors such as Physical Condition Psychological Conditions Occupation Lifestyle Related Factors Growing concern over prevalence of chronic illnesses in India obesity heart-illnesses diabetes and hypertension among others These factors will have significant impact on the health-care cost. Introduction

4. Our Life Style.. A Ticking Time Bomb Tremendous change in our life style • More nuclear families…more responsibilities • Late working • Extreme work pressures • No time for self • Not eating on time…eating out • Eating unhealthy….junk food • High inflation….everything getting expensive

5. Alarming Symptoms Increased risk of falling sick More and more younger people fall sick One has to pay heavily for medical treatments Medical costs directly affect one’s hard earned savings Savings which were meant for important needs is drained on medical expenses Our Life Style.. A Ticking Time Bomb

6. Every day I promise to myself I will get up early and go for a walk I will come home early after office I will eat on time I stop drinking..Ok ..Only a little bit I will eat healthy, absolute NO to junk food Go to a gym..Take care of my health I will sleep early Our Daily Solemn Promise – what we should do As Promises are meant to be broken..so I break them every day!!

7. It’s never too early to plan for future….. Health Insurance… The Next Best Alternative….

8. Urban Lifestyle and Rural Infrastructure support Inadequate Facilities in Government Hospitals Privately run hospitals are expensive Increased cost of medication Diagnostic Expenses have spiraled Specialist Doctors come expensive Increasing Population with income disparity More nucleus family means less savings and less disposable income Changing disease profile and lack of Medical Information Need for Health Insurance

9. Only 85m people in India are covered under Health Insurance Among them, only 10.8m are covered by Insurance Companies The rest are covered under government and company schemes Contributes to 9.6% of the general insurance market Intense competition among the public and private players Historically perceived as a loss making portfolio Lack of spread of risk Lack of adequate Underwriting guidelines Inadequate claims control High perceived fears of fraud and abuse Very little variation in product and price among the insurance providers Inadequate distribution Coverage of Pre-existing diseased - still a question Current Market Scenario

10. Healthcare spending in the next 10 years will Double Healthcare spending will increase to 2,00,000 crores by 2012 (Rs.86,000 crores in 2000-01) Health care insurance sector is to become a Rs 25,000 crore industry by 2009 (Rs.1200 crores- in 2001-02) Rs 75,000 crore by 2020 Healthcare Opportunity in India - Mckinsey report

11. Increased customer awareness for more spread of insurance Higher standards of customer service Popularisation of Floater Concept Reduction of Claim Ratio through efficient underwriting guidelines/ control / product offerings / spread of risk Value Adds and Increased Features which further sweetens the product Affordable pricing – cross subsidize across age categories Increased Marketing Communication Increased Cashless Coverage through TPA Ensure Hassle-Free Policy Issuance and Claim Procedures Inclusion of Preventive elements The Way Forward….

12. Introduction - Clinical Indian Health Industry and Health Insurance Product Offering – Reliance HealthWise Policy Underwriting Overview Claims Overview Agenda

13. Reliance HealthWise Policy provides for ……………. What is Reliance HealthWise Policy? Financial Assistance for you and your family against Hospitalisation Expensestowards disease / illness / injury in India along with host of value additions / options

14. Reliance HealthWise Policy • Basic Features • Value Added Features • Policy Features • Exclusions • Plan Details • Our Advantage

15. Hospitalisation Expenses Daycare Treatment Domiciliary Hospitalisation Pre and Post Hospitalisation Coverage of Pre-Existing Diseases Critical Illness Cover Donor Expenses 1. Basic Features

16. Covers hospitalisation expenses incurred as an in-patient in a Hospital which will include Room, Boarding and Operation Theatre charges Fees of Surgeon, Anesthetist, Nurses, Specialists The cost of diagnostic tests, medicines, blood, oxygen, appliances like pacemaker, artificial limbs and organs etc Hospitalisation for a minimum period of 24 hours is a must 1.a. Hospitalisation The cover provided is to a maximum of the Sum Insured as selected by the Customer

17. Hospitalisation less than 24 hrs Due to advancement of technology, hospitalisation expenses for certain treatments / diseases like the following are also covered, even though the hospitalisation is for less than 24 hours 1.b. Day Care Treatment • Cardiac Catheterization • Cataract • Chemotherapy • Coronary Angiography • Coronary Angioplasty • Dialysis • Dilation & Curettage • Eye Surgery • Hernia Repair Surgery • Hydrocele Surgery • Lithotripsy (Kidney stone removal) • Radiotherapy • Tonsillectomy

18. Medical Treatment at your Home Medical Treatment for a period exceeding three days, which in the normal course, would require hospitalisation, but treatment is actually taken at home, under any of the following circumstances: - the condition of the patient does not permit him/her to be removed to Hospital or the patient cannot be admitted to Hospital for lack of accommodation therein This benefit also covers expenses on employment of a qualified nurse, as recommended by the attending Doctor. 1.c. Domiciliary Hospitalisation • The cover provided is to a maximum of 10% of the Sum Insured • as selected by the customer

19. Extended Pre and Post Hospitalisation Policy also covers relevant medical expenses incurred during a specified period, before & after hospitalisation (for which a claim is payable) 1.d. Pre and Post Hospitalisation

20. Pre-Existing Diseases Coverage Hospitalisation expenses incurred on treatment towards Pre-existing diseases / condition can be covered: Gold Plan: after completion of 2 consecutive years of the policy period Silver Plan: after completion of 2 consecutive years of the policy period Standard Plan:after completion of 4 consecutive years of the policy period 1.e. Coverage of Pre-Existing Diseases

21. Double Sum Insured Benefit If Insured contracts any of the following nine Critical Illnesses, the Sum Insured under the Policy (chosen by the Insured), is doubled towards hospitalisation expenses incurred for treatment of such Critical illness. Cancer Coronary Artery Bypass Surgery First Heart Attack Kidney Failure Multiple Sclerosis Major Organ Transplant Stroke Aorta Graft Surgery Paralysis Primary Pulmonary Arterial Hypertension 1.f. Critical Illness Cover This feature is available only in Gold Plan

22. Major Organ Transplant Covers hospitalisation expenses towards donor in case of major organ transplant. 1.g. Donor Expenses This feature is available to customers of Gold and Silver Plans

23. Expenses on accompanying person at the Hospital Local Road Ambulance Services Recovery Benefit Cost of Health Check up Nursing Allowance Hospital Daily Allowance 2. Value Added Features Value added benefits are payable up to the Sum Insured for the plan opted. These features become applicable once a valid claim is admitted under the basic hospitalisation expenses cover of the Policy

24. Payment towards expenses incurred by an accompanying person at the hospital while Insured is hospitalised for a minimum period of 5 days. Gold Plan: Rs. 300/- per day for a maximum of 5 days Silver Plan : Rs. 250/- per day for a maximum of 5 days Standard Plan : Rs. 200/- per day for a maximum of 5 days 2.a. Expenses on Accompanying Person This is a common feature available to all Policyholders

25. Reimbursement of Expenses incurred for necessary transportation of the insured to the Hospital in an ambulance for hospital admission and requiring immediate treatment. Maximum limit: Gold Plan – Rs. 1000/- Silver Plan – Rs. 750/- Standard Plan – Rs. 500/- 2.b. Local Road Ambulance Services This is a common feature available to all Policyholders

26. In an unfortunate event, if the Insured is hospitalised for more than 10 consecutive days, a lump sum benefit of Rs. 10,000 will be payable as Recovery Benefit. Basic Hospitalisation claim is enough. No need to provide for bills as this is a benefit payment. This benefit is applicable for All the members of the floater separately Irrespective of the number of occurrence during the policy period 2.c. Recovery Benefit This feature is available only to customers of Gold Plan

27. This benefit provides for reimbursement of cost / charges incurred for medical check up. Applicable once at the end of a block of 4 claim free years. Reimbursement is limited to 1.25% of the average sum insured. 2.d. Cost of Health Check up This is a common feature available to all Policyholders

28. Payment of Nursing Allowance for expenses towards employment of registered nurse at the residence of Insured or at the Hospital provided such services are: Confirmed as being necessary by the treating Physician Relate directly to a disease / illness / injury for which the Insured has been hospitalised. This is applicable irrespective of the number of times of occurrence Allowance is payable for 5 days. In case of Critical Illness under Gold Plan this is payable for 10 days. Gold Plan Rs 300/- per day Silver Plan Rs. 250/- per day 2.e. Nursing Allowance This feature is available to customers of Gold and Silver Plans

29. Daily Hospital Allowance of Rs. 250 per day up to 7 days will be paid to Insured, provided he/she is hospitalised for more than 3 days. It is irrespective of the number of occurrences If case two people of the same floater are hospitalised, concurrently, each one of them will be eligible for hospital daily allowance separately 2.f. Hospital Daily Allowance This feature is available only for Gold Plan customers

30. Income Tax Benefit Family Floater Sum Insured Pre-insurance Health Check up Option in Policy Duration Renewal Discount Cashless Facility (Through Third Party Administrators - TPA) Age Slabs 3. Policy Features

31. Premium paid for Reliance HealthWise Policy is eligible for tax deduction under section 80 D of the Income Tax Act, subject to the condition that the premium amount is paid by cheque/DD by the customer from his bank account. Rs. 10,000/- for self, spouse, kids and parents Rs. 15,000/- if the policy includes senior citizens whose ages is above 65 yrs 3.a. Income Tax Benefit

32. Policy can be issued on a Floater basis covering the family members of the Insured comprising the Insured, spouse and two dependant children (upto the age limit of 21 years). What is floater, how does it benefit? All members of the family (Self, Spouse, 2 Kids) can be covered under one single policy Single premium payable for the entire family The amount of Sum Insured “floats” over the entire family No need to insure individual members separately No hassles of tracking renewals for different members 3.b. Family Floater

33. Family: Mr. Ashish Sethi, Mrs. Sethi & their kid Nikki Scenario 1: They take an insurance policy with a SI of Rs.1 Lakh each Mr. Sethi unfortunately needs to undergo angioplasty The total bill amount Rs. 1.4 lakhs Insurance company pays only Rs. 1 Lakh as he is covered for only 1 Lakh. He cannot adjust the rest in the unused coverage amount of his wife and daughter Mr. Sethi needs to bear the reminder of the cost – i.e. Rs, 40,000!! 3.b. Family Floater - Illustration

34. 3.b. Family Floater - Illustration Family: Mr. Ashish Sethi, Mrs. Sethi & their kid Nikki Scenario 2: • They take a Reliance Healthwise Policy with a SI of Rs. 3 Lakh for the family • Mr. Sethi unfortunately needs to undergo angioplasty • The total bill amount Rs. 1.4 lakhs • The entire amount is paid for by Reliance HealthWise Policy • Mr. Sethi does not need shell out any money out of his own picket

35. OR 3.b. Your Choice!

36. Chance of all in the Sethi family falling ill in one year is low as compared to one member falling severely ill – Theory of probability 3.b. Advantage Floater!

37. Family covered under floater policy Choice to cover Individual Couple Couple & One kid Couple & Two kids Choice of cover amount Rs. 1 to 5 Lakh per family depending on the plan selected 3.b. Fits all in the Family

38. Wide range of Sum Insured option depending upon his medical requirement: Gold Plan: 1 lac, 2 lac, 3 lac, 4 lac, 5 lac Silver Plan: 1 lac, 2 lac, 3 lac, 4 lac, 5 lac Standard Plan: 1 lac, 2 lac, 3 lac, 4 lac, 5 lac 3.c. Sum Insured

39. The Reliance HealthWise Policy offers to the Insured an option of 1 year Policy 2 years Policy If two year policy option is taken………………. No worries for the insured members regarding: Any price increase Remembering to renewing the policy again next year Premium to be paid for 2 years at the beginning itself 3.d. Two Year Policy Option

40. No medical tests required at enrollment stage for family members under the age of 45 and the Policy is issued immediately based on proposal form and declaration Applicants above 45 yrs will be covered only after completion of medical tests, submission of reports and the approval of Underwriting team 3.e. Pre-insurance health Check up

41. A renewal discount of 5 % on the renewal premium will be allowed, in case no claim is made during the expiring policy period This renewal discount can be accumulated upto a maximum of 50% 3.f. Renewal Discounts

42. Each Policy holder will get a Health Card Using Health Card the Insured can avail of Cashless Hospitalisation facility through contacting the TPA Cashless facility is available in over 3000 networked hospitals across the country TPA provides assistance in Cashless hospitalisation Information on Claims status Information on Hospitals 24 hour helpline 3.g. Cashless Facility (Through TPA) (TPA - Third Party Administrators)

43. 3.h. Age Slabs – Applicability • Anyone between the age of 3 months to 65 yrs can be covered under the various plans • No fresh policy to be issued after 55 yrs in case of Gold Plan; 60 yrs incase of Silver Plan; 65 yrs incase of Standard Plan • 3 months - 45 yrs can be covered without Pre-insurance medical tests • 46 yrs & above Mandatory medical test & necessary approval from the UW

44. First year Exclusions There are certain ailments which are not covered for the First year of inception of health insurance cover, but are covered subsequently – Cataract Benign Prostatic Hypertrophy Myomectomy, Hysterectomy or menorrhagia or fibromyoma unless because of malignancy Dilation and curettage Hernia, hydrocele, congenital internal disease, fistula in anus, sinusitis Skin and all internal tumors/ cysts/nodules/ polyps of any kind including breast lumps unless malignant /adenoids and hemorrhoids Dialysis required for chronic renal failure Gastric and Duodenal ulcers 4. Exclusions This exclusion will not apply for roll over cases

45. Permanent Exclusion Disease/ Injury existing before inception of health insurance policy being pre-existing disease (however, these will be covered after 2nd year, depending on the choice of plan) Any disease contacted during the first 30 days of inception of policy – accidents excluded and roll over cases excluded Naturopathy or other forms of local medication Pregnancy & childbirth related diseases Intentional self-injury / injury under influence of alcohol, drugs Diseases such as HIV or AIDS Diseases existing from the time of birth (Congenital diseases) 4. Exclusions

46. Cost of spectacles, contact lenses and hearing aids Dental treatment or surgery of any kind unless requiring hospitalization Charges incurred at Hospital or Nursing Home primarily for diagnostic without any treatment Expenses on vitamins and tonics unless forming part of treatment for disease or injury as certified by the medical practitioner Cosmetic, aesthetic, treatment unless arising out of accident Treatment related to obesity War, riot, strike, terrorism, nuclear weapons induced hospitalisation Routine medical, eye and ear examinations Treatment of mental illness 4. Exclusions contd……..

47. Plan Comparison – Basic Features 5. Plan Details

48. Plan Comparison – Value added Benefits 5. Plan Details

49. Plan Comparison – Policy Features 5. Plan Details

50. 6. Our 17 points Advantage! Family Floater Option Coverage of Pre-Existing Diseases after 2nd year of renewal Automatic Double Sum Insured under Critical Illness cover Policy duration for 2 years Extended Pre and Post-hospitalisation Wider Sum Insured options Hospital Daily Allowance Nursing Allowance Recovery Benefit Reimbursement of Cost of Health Check up after 4 years Local Road Ambulance Services Expenses on Accompanying Person Cashless Facility Policy without Medical test till 45 yrs Renewal Reward - No Claim Bonus Income Tax Benefits And you tell me the Last Advantage…. The 17 advantage