Understanding Maxima

1. Understanding Maxima

2. Who can be insured • Self • Self + Adult Dependent • Self + Adult Dependent + up to 2 Children • Maximum 4 members can be Insured under one policy • Self • Minimum 18 years and Maximum 65 years • Adult Dependent • Minimum 18 years and Maximum 65 years • Child Dependent • Minimum 5 years and Maximum 21 years, Child dependent can be covered from 91st day onwards if either of the parents are covered under this policy. Entry Age Cover Ceasing Age: NIL 2

3. Out-patient Benefits 3

4. Outpatient Consultations* • Outpatient consultation by a General Medical Practitioner or a Specialist Medical Practitioner • Network as well as Non-Network outpatient Consultations covered • Reimbursement of Non-network Outpatient consultations 4

5. Diagnostic Tests within specified Network • Outpatient diagnostic tests taken by the Insured Person from a Network diagnostic centre. Pharmacy within specified Network • Medicines purchased by the Insured Person from a Network pharmacy, provided that such medicines have been prescribed in writing by a Medical Practitioner. 5

6. Outpatient Dental Treatment within specified Network • Any necessary dental treatment taken by an Insured Person from a Network dentist, excluding any dental treatment that comprises cosmetic treatment. Specs, Contact lenses within specified Network • Either one pair of spectacles or contact lenses provided that these have been prescribed for the Insured Person by a Eye specialist Network Medical Practitioner upto an amount specified in schedule of benefits 6

7. Annual Health Checkup within specified Network • A Health Check-up for the Insured Person in a Network Hospital. • This benefit is not available for the Insured Persons above the age of 45 years in the first Policy Year and Insured Persons below 18 years of Age. Comprehensive list of available tests include: Hb, PCV, RBC, MCHC, MCV, MCH, Total WBC, Differential Count, ESR, PLT, Peripheral Smear, Complete Urine Analysis, GTT,Serum Calcium, Serum Creatinine, Lipid Profile (Total Cholesterol, HDL Cholesterol, LDL Cholesterol, Triglycerides, Cardiac Risk Ratio), Liver Function Test (Total Protein, Albumin, Globulin, Total bilirubin, ALT, AST, GGTP), Blood group, ECG (Resting), X-ray (chest), Ultrasound (Upper abdomen screening), Consultation by General Physician, Consultation by Gynecologist, Consultation by General Physician. 7

8. Schedule of Benefits Outpatient Module 8

9. Outpatient Consultations are available in following locations:- • Bangalore • Chennai • Delhi • Hyderabad • Kolkata • Mumbai 9

10. In-patient Benefits 10

11. In-patient Treatment • Room rent, boarding expenses • Nursing • Intensive Care Unit • Medical Practitioner • Anaesthesia, blood, oxygen, operation theatre charges, surgical appliances • Medicines, drugs and consumables • Diagnostic procedures • Cost of prosthetic and other devices or equipment if implanted internally during a Surgical Procedure 11

12. Pre-hospitalisation • The Medical Expenses incurred in the 30 days immediately before the Insured Person was Hospitalised, provided that We have accepted an inpatient Hospitalisation claim • For 60 days, if we are intimated at least 5 days before the Hospitalisation • Entitlement Certificates used for Pre-hospitalisation will be refunded Post-hospitalisation • The Medical Expenses incurred in the 60 days immediately after the Insured Person was discharged post Hospitalisation, provided that We have accepted an inpatient Hospitalisation claim • For 90 days, if we are intimated at least 5 days before the Hospitalisation • Entitlement Certificates used for Post-Hospitalisation will NOT be refunded 12

13. Day Care Procedures • The Medical Expenses for a day care procedure or surgery mentioned in the list of Day Care Procedures (Annexure 1) where the procedure or surgery is taken by the Insured Person as an inpatient for less than 24 hours. 13

14. Organ Donor Expenses • The Medical Expenses for an organ donor’s treatment for the harvesting of the organ donated provided that: • The organ donor is any person in accordance with The Transplantation of Human Organs Act, 1994 (amended) and other applicable laws and rules, • The organ donated is for the use of the Insured Person, • We have accepted an In-patient Hospitalisation claim under the policy. • Pre and Post hospitalization expenses for Donor is not covered. 14

15. Domiciliary Treatment • The Medical Expenses incurred by an Insured Person for medical treatment taken at home, which requires Hospitalisation provided: • Insured could not be transferred to a Hospital, or • Hospital bed was unavailable • The condition continues for at least 3 days Emergency Ambulance • Expenses incurred up to Rs 2000 per hospitalisation on ambulance offered by a healthcare or ambulance service provider used to transfer the Insured Person to the nearest Hospital or from one hospital to another hospital following an emergency 15

16. Daily Cash for Choosing Shared Accommodation • Daily Cash amount will be provided, If the Insured is hospitalized in Shared Accommodation in a Network Hospital for each continuous and completed period of 24 hours if the Hospitalisation exceeds 48 hours Daily Cash for Accompanying an Insured Child • Daily Cash amount will be provided, If the Insured Person hospitalized is a child aged 12 years or less, We will pay a daily cash amount for 1 accompanying adult for each completed period of 24 hours if Hospitalisation exceeds 72 hours. 16

17. Maternity Expenses • Medical Expenses for a delivery (including caesarean section) while Hospitalised or the lawful medical termination of pregnancy during the Policy Period limited to 2 deliveries or terminations. • Waiting period of 4 years • Prenatal & post natal expenses covered up to sublimit New Born Baby (Optional) • If we have accepted a claim under Maternity expenses we will cover the new born baby under Inpatient Treatment from Day 1 17

18. Critical Illness (Optional Cover) • Cover for Cancer, Coronary Artery (Bypass) Surgery , Heart Attack (Myocardial Infarction), Kidney Failure, Major Organ Transplantation, Multiple Sclerosis, Paralysis, Stroke. • Waiting Period - 90days • Survival period – 30days from the date of first diagnosis. • Maximum 3 claims in a lifetime • Cover ceasing age – 70 years • Sum Insured – 100% of Basic Sum Insured • On Individual Sum Insured basis 18

19. Schedule of Benefits Inpatient Module 19

20. Inpatient • Inpatient Treatment • Pre-Hospitalization • Post-Hospitalization • Day Care Procedures • Domiciliary Treatment • Organ Donor Expenses • Emergency Ambulance • Daily Cash for choosing shared accommodation • Daily Cash for accompanying Insured child • Maternity • Rider - Critical Illness (Optional) • Outpatient • Outpatient Consultations (Non Network & Network Specific) • Diagnostic Tests within specified Network • Annual Health Check Up within specified Network • Outpatient Dental within specified Network • Spectacles, Contact Lenses within specified Network MAXIMA Coverage- HIGHLIGHTS 20

21. Major Exclusions [Applicable to Inpatient Benefit] • 30 days waiting period • 2 year specific disease (Ref-Annexure 2) waiting period like cataract, hernia, hysterectomy, joint replacement and hydrocele • Pre-existing disease covered from 4th year • HIV, AIDS and related disease • Non-allopathic treatment • Cosmetic treatment • Items of personal comfort and convenience • Treatment of Obesity and weight control program • Complete list of exclusion -Annexure 2 21

22. Other Benefits 22

23. Portability • Comparable Individual Health Insurance Plans • 30 days exclusion waiver • 2 year exclusion waiver • Pre-existing Exclusion waiver(Minimum waiting period of 1 year applies) • Transfer of Cumulative Bonus @ 5% every year max. 20% • No reduction in waiting period for other benefits 23

24. Renewal Incentives • Outpatient Carry Forward Bonus • If any available Entitlement Certificates are not used by the Insured Person in a Policy Year, then We will carry forward 50% of these Entitlement Certificates to the next Policy Year. • Inpatient Cumulative Bonus • Available for every claim free year. • Cumulative Bonus of 10% added to the Sum Insured. • Maximum Cumulative Bonus available upto 50% • In case of claim Cumulative Bonus reduced by 20% 24

25. Tax benefit under Sec 80D • As per Section 80D • An person is entitled to a deduction of Rs. 15000 in respect of medical insurance premium paid on the health of himself, his spouse and children. • In addition thereto, if he pays health insurance premium on the health of his parents( senior Citizen), he will be entitled to additional deduction of Rs. 20000/ 25

26. Pre Policy Check (PPC) • PPC will be arranged by AMHI only, customers should not go on their own for Pre Policy check up. • In case a proposal is accepted after PPC, AMHI will reimburse 100% of the expenses incurred subject to maximum of Rs. 2000/- per insured person on filling a reimbursement request along with the receipt of payment made at DC at the time of PPC. • DCs forward all PPC reports directly to AMHI and confidentiality of the same is maintained. DCs will not provide any copy of reports or duplicate set to customers/agents or any third party. 26

27. Premium Table 27

28. Annual Premium in INR [Excluding Service tax and applicable cess] Critical Illness Rider 28

29. Annual Premium in INR [Including Service tax @10.30% and applicable cess] Critical Illness Rider 29

30. THANKS: • 99858 98765 • 99853 98765 • customerservice@sanghiconsultancy.com, • sanghiconsultancy@gmail.com 30