L&T Health Insurance

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

1. Claims made within the 30 days immediately following policy inception.
2. Domiciliary treatment
3. 2 year waiting period for: Cataract, Benign Prostatic Hypertrophy, Congenital Internal Diseases, Anal Fistula, Piles, Hysterectomy, Hernia, Sinusitis and associated ailments.
4. Suicide attempts, self-harm, mental disorders, use of intoxicants.
5. HIV/AIDS and related illnesses.

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:

Sub-limits

1. Hospitalization Costs: Actuals or 1% of sum assured, whichever is lower; room, including nursing, charges: Up to Rs.4,000 a day.
2. ICU Costs: Actuals or 2% of sum assured;
3. Room, including nursing, charges: Up to Rs.6,000 a day.
4. 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

1. Claims made within the 30 days immediately following policy inception.
2. Domiciliary treatment
3. 2 year waiting period for: Cataract, Benign Prostatic Hypertrophy, Congenital Internal
4. Diseases, Anal Fistula, Piles, Hysterectomy, Hernia, Sinusitis and associated ailments.
5. Suicide attempts, self-harm, mental disorders, use of intoxicants.
6. 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

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

1. Rs.3 lakhs or Rs.8 lakhs, deductible is Rs.2 lakhs.
2. Rs.7 lakhs or Rs.12 lakhs, deductible is Rs.3 lakhs.
3. Rs.6 lakhs, Rs.11 lakhs or Rs.16 lakhs, deductible is Rs.4 lakhs.
4. 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

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.

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

1. 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.
2. Education benefits- It cover the cost of education for children, in case the policyholder meets with an accident.
3. Loss of employment benefits.
4. It also cover the cost involved in transportation, ambulance service and outpatient medical expense.
5. Medical extension benefits
6. 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.
7. Medical extension benefits