Medisure Prime Insurance - Individual

Product Description:

Medisure Prime Insurance is the health insurance offering of L&T Insurance to Indian residents between the age group of 91 days and 65 yrs. The entry age for the proposer is between 18 yrs and 65 yrs while the plan can be renewed lifelong (there is a co-pay of 25% if the Insured is above 70 yrs). The Insurer allows online purchase of Medisure Prime Insurance without pre-medical acceptance tests for people upto the age of 45 yrs (subject to clean medical history) while those above 45 yrs need to undergo mandatory pre-acceptance medical tests before policy purchase (100% of the medical test expense will be reimbursed by the Carrier upon acceptance of risk). Along with the Primary Insured adult, one can also take cover for a child who is 90 months – 18 yrs old under this policy, provided at least one parent is concurrently insured under the same plan. L&T Insurance divides India into 3 regions – Zone 1, Zone 2 and Zone 3 (refer the below premium tables for a list of cities under various zones) depending on the cost of healthcare in these zones. People opting for the premium rates of a lower zone have a co-pay clause of 10% on every 1 step high that they go on their zone for treatment. (e.g. A Zone 3 Insured will pay 10% of the healthcare expense if he/she takes treatment in Zone 2 and 20% if the treatment is taken in Zone 1)

Know more about your Insurance

Key features: Availability, Benefits and Exclusions

Minimum Age at Entry : 91 days
Maximum Age at Entry : 65 years
Maximum Age at Renewal : Lifelong
Minimum Sum Assured : Rs 3 lacs
Maximum Sum Assured : Rs 10 lacs
 
No claim Bonus – Annual : 5%
No claim Bonus – cumulative : upto 50%
Maternity Benefits : after 4 years
Pre-Existing Disease cover : after 2 years
Waiting Period : 30 Days


Product pricing (Incl. S/Tax)   (Rs)
Zone 1 (Mumbai, Thane, Navi Mumbai, Delhi & NCR)
Age SA 1 lac SA 3 lacs SA 4 lacs SA 5 lacs SA 6 lacs SA 7 lacs SA 8 lacs SA 9 lacs SA 10 lacs SA 15 lacs
0 – 25 yrs NA 5,449 6,930 8,413 9,843 11,221 12,343 13,330 13,997 NA
26 – 35 yrs NA 6,575 8,374 10,174 11,904 13,569 14,927 16,120 16,927 NA
36 – 40 yrs NA 7,700 9,818 11,934 13,964 15,918 17,510 18,911 19,856 NA
41 – 45 yrs NA 8,950 11,278 13,608 15,921 18,149 19,964 21,561 22,639 NA
 
Zone 2 (Chennai, Hyderabad, Bangalore, Pune, Kolkata & Gujarat)
Age SA 1 lac SA 3 lacs SA 4 lacs SA 5 lacs SA 6 lacs SA 7 lacs SA 8 lacs SA 9 lacs SA 10 lacs SA 15 lacs
0 – 25 yrs NA 4,971 6,318 7,666 8,968 10,224 11,246 12,146 12,754 NA
26 – 35 yrs NA 5,995 7,631 9,266 10,841 12,359 13,596 14,683 15,418 NA
36 – 40 yrs NA 7,018 8,943 10,868 12,714 14,495 15,944 17,220 18,080 NA
41 – 45 yrs NA 8,199 10,316 12,433 14,546 16,584 18,241 19,701 20,686 NA
 
Zone 3 (Rest of India – other than locations provided for in Zone 1 & 2)
Age SA 1 lac SA 3 lacs SA 4 lacs SA 5 lacs SA 6 lacs SA 7 lacs SA 8 lacs SA 9 lacs SA 10 lacs SA 15 lacs
0 – 25 yrs NA 4,732 6,012 7,292 8,532 9,726 10,698 11,554 12,132 NA
26 – 35 yrs NA 5,705 7,259 8,813 10,311 11,755 12,930 13,964 14,662 NA
36 – 40 yrs NA 6,676 8,505 10,334 12,090 13,783 15,162 16,374 17,192 NA
41 – 45 yrs NA 7,824 9,835 11,846 13,860 15,800 17,380 18,771 19,710 NA


Claim procedure

  1. Intimation & Assistance - In case of planned hospitalization, contact the Insurer at their Claims Helpline 1800 102 3243, preferably at least 72 hrs in advance. Use your L&T Insurance Health card for details regarding your policy no. You can also write to the Insurer at myhealthclaim@ltinsurance.com. Please note in case of an emergency pre-authorization needs to be done with in 24 hrs of admission.

  2. Pre-authorization: Submit the cashless request form to the Insurer along with all the policy related information and documents pertaining to illness. After verifying the identity of the Insured and the policy coverage, the Insurer will provide you the confirmation of Cashless treatment authorization within 6 hrs of receipt of such request (if request is placed between 9 am – 9 pm).

  3. Cashless settlement: Get admitted for treatment at the network hospital and sign all forms, invoices and documents on discharge. L&T Insurance will directly make the payment to the hospital for pre-approved treatment and as per policy terms & conditions. Any non-medical expense and/or expenses towards conditions not authorized under hospitalization need to be paid directly by the beneficiary of treatment. Also, remember signing the L&T Insurance claims form and hand it over to the hospital along with all the relevant supporting documents.

*In case of treatment at non-network hospitals, please collate the original bills along with other documents as required and submit everything to the Insurer.

Some key statistics for L&T Insurance

ITEM   NUMBER
Claims Pending Ratio : To be Announced soon
Complaints Resolved Ratio : To be Announced soon
Provider Network (cashless) : To be Announced soon


General Health Insurance Tips

Understand the cost of healthcare in your city/area before deciding the total cover (Sum Assured)

If your family includes a young bride, it is important to ensure the coverage of maternity benefits

Ask about the coverage of pre-existing diseases

Look at the waiting period

Satisfy yourself about the specific disease’s coverage under the Critical Illness cover

Inquire about the availability of cashless facility at the Network hospitals

Always compare before buying

Disclaimer: This is only an illustrative document to serve as a quick guide for aide in decision making.

Information Source: L&T Insurance website www.ltinsurance.com as on 13th Jan’2011
IRDAI annual report’2010