L&T Health Insurance

L&T has a few health insurance plans that come with a number of advantages and benefits. The coverage offered, treatments covered, hospital network, add-on covers and discounts and bonuses on renewal are some of the many perks.
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Company Limited L&T General Insurance Company Limited (L&T Insurance) is a wholly owned subsidiary of Larsen & Toubro Limited. L&T General Insurance offers products like Motor Insurance, Health Insurance, corporate Insurance and Home Insurance.


L&T General Insurance Highlights Updated on 12 Aug 2020

Features Specifications
Network Hospitals 2800+
Waiting Period for Pre-existing Disease 3 years
Incurred Claims Ratio 77.83%
Number of Policies Issued 71931
Grievances Solved 100.00%
Renewability Lifetime

*For Year 2017-2018

Overview of L&T Health Insurance:

L&T General Insurance Co. Ltd. is a subsidiary owned entirely by Larsen & Toubro Ltd. , one of the largest Indian business enterprises.

L and T Health Insurance Plans

L&T General has developed assurance solutions for all segments of the market ranging from individuals to small and medium enterprises to large corporates and for all lines including property, casualty, motor and health among others. It pays particular attention to rural areas through its rural and micro insurance plans.

The company has adopted a customer-centric approach, keeping quality at the forefront at all times. It follows a prudent and disciplined method to underwriting and leverages on technology to facilitate smooth and efficient operations.

It benefits from the world-class branding of its parent group Larsen and Toubro which is known all over the globe for its strong standing in the fields of engineering, construction and technology. Financial services is a strategically important, though relatively new, segment in L&T’s business portfolio.

L&T’s strong financials has placed it in an advantageous spot within the Indian insurance industry. Health insurance is a line of growing importance and L&T has a number of options for its customers in this segment as well. They have a host of interesting health insurance plans crafted for individuals and families alike.

Types of Health Insurance Policies Provided by L&T:

  1. L&T Health Medisure Prime Insurance
  2. L&T Health Insurance Medisure Classic
  3. L&T Health Medisure Super Top Up Insurance
  4. L&T Health Medisure Plus Insurance
  5. L&T Personal Accident Insurance

Details of individual plans are provided below.

L&T Health Medisure Prime Insurance:

Medisure Prime is a health insurance policy offered by L&T Limited. It is one of the most well-organized health insurance plans that comes with a host of attractive features and service guarantee.

Entry age 18 years to 65 years
Sum assured 3, 00,000 to Rs. 10,00,000.
Basis Individual or Family Floater
Policy Period 1 year or 2 years
Premiums 1 year term: Rs. 4,290 to Rs.6,09,780 2 year term: Rs.8,151 to Rs.11,03,445
Medical screening Required above 45 years
Pre-hospitalisation 60 days.
Post-hospitalisation 90 days
Ambulance costs Rs.1,500 per hospitalisation (reimbursed).
Cash allowance Rs.1,000 per day for hospital stay beyond 3 days; maximum 10 days.
Escort Rs.500 per day for hospital stay beyond 3 days; maximum 8 days.
Health check costs Reimbursed, upon completion of 2 successive renewals, for insured members aged 45 years and above.
No-claim/Cumulative Bonus Increase in sum assured upon renewal @ 5% after every claim-free year, maximum of 10 years i.e. 50%
Sub-limits None; Co-payment of 10% for insured members over 80 years.
Waiting period 4 years.
Critical Illness Cover 9 specific illnesses
Maternity Period 90 days
Maternity/Newborn Cover Up to 2 children. Payout is the lower of 5% of the chosen sum assured or Rs.25,000 (normal deliveries) and the lower of actuals or 10% of the A or Rs.50,000 (c-sections).
Restoration of sum assured Hospitalisation due to accident; restored to 100% of original value after a successful claim, once until renewal, if balance for next claim is inadequate.
Lumpsum for Extended hospital stay Rs.10,000.00
Free health check-ups Every alternate year after consecutive renewal of the policy for two years.
Daycare procedures Limited to the chosen sum assured.
Superior claim service Approval for cashless claims within 6 hours or settlement of reimbursable claims within 6 working days; Rs.1,000 payout in case of delay.
Concierge service For certain areas; assigned executive to help process cashless claims
Personal Case Manager 24-hour claim support; For certain areas; assigned executive to discuss the policy.
Organ Transplantation Expenses Covered
Major Exclusions
  • Claims made within the 30 days immediately following policy inception.
  • Domiciliary treatment
  • 2 year waiting period for: Cataract, Benign Prostatic Hypertrophy, Congenital Internal Diseases, Anal Fistula, Piles, Hysterectomy, Hernia, Sinusitis and associated ailments.
  • Suicide attempts, self-harm, mental disorders, use of intoxicants.
  • HIV/AIDS and related illnesses.

L&T Health Insurance Medisure Classic Insurance:

Entry Age 18 years minimum; 3 months to 23 years for children
Basis Individual or Family Floater
Policy Period 1 year or 2 years
Medical screening Required for persons above 50 years.
Health checks-ups After every 4 successive claim-free years; costs reimbursed up to 1% of sum assured.
Premiums For policy period of 1 year: Rs.1, 994 to Rs.82, 642; For policy period of 2 years: Rs.3, 789 to Rs.1, 57,020.
Premiums are calculated based on Age of the insured, Basis of the policy, Chosen sum assured, Family size, Add on covers and sub-limits.
Pre-existing conditions Subject to a 3 year waiting period.
Family Discount 10% of total premium if the policy is taken on individual basis, for more than 2 additional members (maximum of 6).
Inpatient hospitalization Required minimum stay of 24 hours
Pre-hospitalization 30 days
Post-hospitalization 60 days
Day-care procedures Lower of actuals or 1% of the sum assured or Rs.4,000 for each day of stay.
Room and Nursing Approved on a case to case basis (does not include diagnostic and outpatient procedures).
Domiciliary Hospitalization Includes pre-hospitalization costs up to 30 days.
Add-on coverage at additional premium For Critical Illness: Basic sum insured is doubled in the event of Contracting any one of the specified critical illnesses; available to persons up to the age of 65.
Sub-limits
  • Hospitalization Costs: Actuals or 1% of sum assured, whichever is lower; room, including nursing, charges: Up to Rs.4,000 a day.
  • ICU Costs: Actuals or 2% of sum assured;
  • Room, including nursing, charges: Up to Rs.6,000 a day.
  • Maternity/Newborn Cover: Lower of actuals or Rs.20,000 or 10% of sum assured (normal delivery); Lower of actuals or Rs.40,000 or 20% of sum assured (C-section).
No-claim/Cumulative Bonus 5% increase in the sum assured, upon renewal, after every claim-free year, on a cumulative basis for a maximum bonus of 50%.
100% restoration If balance sum assured, after the first claim, is inadequate to pay for second claim; the first claim amount is added back; One-time option for a policy period.
Ayurvedic (non-cosmetic) Treatment Up to Rs.25,000 in a policy year for inpatient hospitalization more than 24 hours; prior approvals and waiting period apply.
Major Exclusions
  • Claims made within the 30 days immediately following policy inception.
  • Domiciliary treatment
  • 2 year waiting period for: Cataract, Benign Prostatic Hypertrophy, Congenital Internal
  • Diseases, Anal Fistula, Piles, Hysterectomy, Hernia, Sinusitis and associated ailments.
  • Suicide attempts, self-harm, mental disorders, use of intoxicants.
  • HIV/AIDS and related illnesses.
Free Look Period 15 days from policy inception, for cancellation with refund (adjusted)
Tax Benefits Under section 80D of the Income Tax Act

L&T Health Medisure Medisure Super Top-Up Insurance:

A top-up policy with a an option of deductibles, to enhance the cover of the in an economical manner.

Entry Age 18 to 65 years; 91 days to 23 years for children
Basis Individual and Floater
Policy Period 1 year or 2 years.
Premiums Rs.865 to Rs.19, 157 (inclusive of GST); depends on age, sum assured and deductible, basis and family size. 5% discount on total premium if 2 a year plan term is chosen.
Medical screening For persons above 55 years
Sum Assured
  • Rs.3 lakhs or Rs.8 lakhs, deductible is Rs.2 lakhs.
  • Rs.7 lakhs or Rs.12 lakhs, deductible is Rs.3 lakhs.
  • Rs.6 lakhs, Rs.11 lakhs or Rs.16 lakhs, deductible is Rs.4 lakhs.
  • Rs.5 lakhs, Rs.10 lakhs, 15 lakhs or Rs.20 lakhs, deductible is Rs.5 lakhs
Sub-limits No
Pre/Post Hospitalization expenses up to 30 and 60 days, respectively.
Day Care Procedures Approved for coverage.
Pre-existing diseases waiting period 3 successive years.
Day Care Procedures Approved for coverage; excludes diagnostic and outpatient procedures

L&T Health Medisure Plus Insurance:

A novel offering from L&T that offers a standard health insurance cover while letting customers design the plan to suit their requirements.

Entry Age 18 years to 65 years; 91 days to 23 years for children.
Policy Period 1 year or 2 years.
Sum Assured Up to Rs.25 lakhs.
Renewability Lifelong
Basis Individual or Family Floater.
discount 10% discount on premiums if more than 2 member are covered
Medical screening Required above 50 years
Coverage for Grandparents, Siblings, Grandchildren, Sons/Daughters-in-law, Nieces, Nephews.
Customised (nominal, additional premium) Add-on cover for critical illnesses, Restoration of Sum Assured, Waiver of sub-limits on room and ICU expenses, Extended pre/post-hospitalization coverage, Recovery benefits, Escort expenses.

L&T Personal Accident Insurance:

The Personal Accident Insurance offered by L&T is a product that is aimed specifically at damages caused by an unfortunate incident

Entry Age For Adults: 5 years to 70 years; For Children: 5 years to 18 years.
Basis Family Package Cover as well as Individual Cover.
Renewability The policy can be renewed.
Policy coverage Accidental Death only, Permanent Total Disability/ Accidental Death, Accidental Death/Permanent Partial/ Total Disability, Accidental Death/Permanent Total Disability/Permanent Partial Disability/ Temporary Total Disability
Discount Family discount of 10% on the premiums paid for Family Package cover and Individual cover.
Exclusions The policy does not cover any existing disability, claims for more than one categories mentioned in the policy document. It also does not cover death and disablement caused due to self-injury, suicide or attempted suicide, consumption of alcohol or drugs, childbirth, pregnancy etc.
Benefits
  • It provides compensation for a physical loss such as death or disablement caused by accidental injury within a period of 12 months from the date of accident.
  • Education benefits- It cover the cost of education for children, in case the policyholder meets with an accident.
  • Loss of employment benefits.
  • It also cover the cost involved in transportation, ambulance service and outpatient medical expense.
  • Medical extension benefits
  • The cost of travel to your home or any other place is covered. Get paid 2% of the sum assured or up Rs. 10,000 as cost of travel.
  • Medical extension benefits

L&T Health Insurance Network Hospitals:

L&T Health Insurance offers cashless treatments at various network hospitals spread across the country. The insured member can avail cashless facility at any of the medical facilities that L&T Health has partnered with. Cashless claims can be made only for the medical treatments taken at a network hospital. To locate a network hospital of L&T Health near you, use the online network hospital locator tool. Just enter your state and city or place of residence on the tool. You will immediately get a list of network hospitals in your area with contact details.

Find cashless network hospitals nearby: L&T Health Insurance Network Hospitals

How to File a Claim with L&T Health?

Cashless claim and reimbursement claim are the 2 types of health insurance claim you can make with L&T Health. Here is quick guide to how you can file a claim with L&T Health:

  • Cashless Claim: Visit a network hospital and display your health card at the hospital desk. The hospital will verify your ID details and send a duly-filled and signed pre-request authorisation form to the insurer or the insurer's TPA. The insurer or TPA will review the request and approve or deny the pre-authorisation request accordingly. In the case of approval, the insurer will settle the bills directly with the hospital. In the case of rejection, the insured member can receive treatment at the network hospital, pay the bills out of his or her pocket, and make a reimbursement claim with L&T Health after discharge.
  • Reimbursement Claim: For treatment taken at a non-network hospital, the insured member can pay the bills out of his or her pocket, and later make a reimbursement claim on the medical expenses incurred during the policy term with L&T Health. Collect all the original medical documents from the hospital at the time of discharge and submit it to the insurer along with a duly-filled and signed claim form. Upon approval of the claim request, the claim amount will be sent to the insurer.

L&T Health Insurance FAQs:

  1. What are the hospital claim exclusions in the Medisure Classic insurance policy?

    The major hospital claim exclusions in the Medisure Classic are as follows-

    • Hysterectomy, Anal Fistula, Hernia, Piles, Sinusitis and ailments associated with the same.
    • HIV/AIDS and any illnesses related to the same.
    • Suicide attempts, self-harm, mental disorders, use of intoxicants.
  2. What are the optional features of coverage of the L&T health insurance plan?

    Following are the optional features of the L&T health insurance plan-

    • Two year policy renewal offered after 24 months versus the norm of 12 months
    • After the age of 45, free health checkup offered
    • Health insurance offered on pre-existing disease after completing 24 months of holding health insurance policy
    • Issuance of policy instantly
    • Lifetime renewal of policy offered
    • Equivalent of the sum insured is given as additional coverage for treatment of critical illness excluding cumulative bonus
    • Room rent sub limits waiver available
  3. What is the advantage of taking a L&T health insurance policy?

    The advantages of taking the L&T health insurance policy are as follows-

    • Assurance of claims service wherein all cashless decisions for requests made between 9 am and 9 pm on working days is settled within 6 hours. All cash reimbursement is made within 6 working days.
    • Provision of concierge service on request in select cities which includes assistance on any cashless procedures between 9 am and 9 pm, when there is a claim.
    • A personal case manager is assigned upon request to define benefits and resolve any doubts.
    • Around the clock services for claims assistance provided.
  4. What are the various critical illnesses included in the L&T health insurance plan?

    The list of critical illnesses including in the L&T health insurance plan is as follows -

    • Cancer
    • Coronary artery bypass surgery
    • First heart attack
    • Kidney failure
    • Multiple sclerosis
    • Major organ transplant
    • Stroke
    • Aorta graft surgery
    • Primary pulmonary arterial hypertension
  5. What is the age limit to be eligible to be covered by L&T health insurance plan?

    • The age limit of the proposer of the L&T health insurance plan is between the ages of 18 years and 65 years of age.
    • There is lifetime renewal of the L&T health insurance policy once the policy has been issued.
    • If one or both parents are insured under the L&T health insurance policy then children up to 18 years of age can also be covered under the policy.
    • For subscribers who are above the age of 45 years, the issuance of the L&T health insurance policy is subject to pre acceptance of medical and thereof approval by L&T health insurance.
  6. I have a Medisure Prime insurance policy. What is the policy period for the same?

    The policy period for the Medisure Prime insurance policy is 1 year or 2 years.

    I would like to apply for the Medisure Classic insurance policy. What is the eligibility for the same?

    In order to apply for the Medisure Classic insurance policy, you have to fulfill the following counts-

    • Completed 18 years of age
    • Persons above 50 years of age require medical screening
  7. Are there any discounts offered on the premiums of Medisure Prime insurance policy?

    Yes, there are discounts offered for two or more additional members upto a maximum of 6 members for a Medisure Prime policy taken on individual basis.

    The sum assured as well as the premium payable is applicable to each of the insured members.

  8. What health insurance plans are offered by L&T health insurance?

    Following are the insurance policies offered by L&T health insurance-

    • Medisure Plus Insurance
    • Medisure Classic Insurance
    • Medisure Prime Insurance
    • Medisure Super Top Up Insurance
  9. I have a Medisure Super Top Up Insurance policy. Can my parents be insured under the same plan?

    Under the Medisure Super Top Up Insurance policy, parents and inlaws both can be insured under the same plan so along as the plan is taken on individual basis.

  10. I am 60 years old. Am I eligible for the Medisure Super Top Up Insurance policy?

    Yes, you are eligible for the Medisure Super Top Up Insurance policy as long as you have undergone medical screening which is a mandate for persons above 55 years applying for the Medisure Super Top Up Insurance policy.

  11. Examples of Network Hospitals in Major Cities

    CITY NAME OF HOSPITAL
    DELHI JEEVAN ANMOL HOSPITAL
    MUMBAI HOLY SPIRIT HOSPITAL
    KOLKATA KOTHARI MEDICAL CENTRE
    BANGALORE HEALTHCARE GLOBAL ENTERPRISES LIMITED
    CHENNAI K. J. HOSPITAL PVT. LTD.

    *Note - Larsen & Toubro Limited has divested its complete stake in L&T General Insurance Company Limited. HDFC ERGO General Insurance Company Limited has bought stakes in L&T on June 3, 2016 through a share Purchase Agreement.

    *Disclaimer - This is not an exhaustive list but an indicative representation of hospitals that form a part of the company's wider network.


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