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Max Bupa – Our ambition over the next 5 years

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2021-10-12 published at Sports&Entertainment category

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1.
2.Product Construct – Lifeline Lifeline – Base Cover Inpatient All Day Care Procedure Pre & Post Hospitalization Organ Donor Expenses Domiciliary Treatment Emergency Ambulance Re-load of Sum Insured Ayush Treatment No Claim Bonus Health Check-up ( once in 2 yrs) Vaccination for Animal Bite Health & Wellness PED – 4 years 2nd Opinion for CI Emergency Domestic Evacuation Classic SI – 2,3,4 lacs Supreme SI – 5,10,15,20,50lacs Elite SI – 25, 30,50,100,150lacs International Treatment for 11 Critical Illness Worldwide Emergency Hospitalization PED – 3 years PED – 2 years Classic Supreme Lifeline – Customer Level Options 1. Top up plan on annual deductible basis 2. Hospital cash Maternity Benefit 1. US/Canada option for worldwide emergency hospitalization & international treatment for 11 CI 2. Hospital Cash 1. Top up plan on annual deductible basis 2. Hospital cash Note - Geographic pricing – Entire country is divided into 2 Zones (Zone 1 - 7 metros and Gujarat State, Zone 2 – Rest of India) . Premium in Zone 2 is lower than Zone 1 by 15% as cost of treatment is lower in non metros OPD Benefit 10% Higher NCB Annual Health check up
3.Lifeline – Classic No room rent cap All day care procedures covered Ayush treatment Vaccination for animal bite Organ donor expenses covered upto SI 10% NCB every year upto max of 50% Pre & post covered upto SI Reload benefit – Incase SI including NCB is exhausted by insured and he is admitted for a different illness then the SI is automatically reloaded upto 100% of base SI. Reload in family floater is applicable to the entire family Key Features
4.Lifeline – Supreme No room rent cap All day care procedures covered Ayush treatment Vaccination for animal bite Organ donor expenses covered upto SI 20% NCB every year upto max of 100% Annual Health Check up Emergency domestic evacuation Pre & post covered upto SI Reload benefit Second opinion for 11 Critical illness PED waiting period – 3 years Key Features
5.Lifeline – Elite No room rent cap All day care procedures covered Ayush treatment Vaccination for animal bite Organ donor expenses covered upto SI 20% NCB every year upto max of 100% Annual Health Check up Emergency domestic evacuation Pre & post covered upto SI Reload benefit Second opinion for 11 Critical illness Worldwide emergency hospitalization International treatment for 11 CI Maternity & OPD covered PED waiting – 2 years Key Features
6.Key Differentiating Features No Room rent capping – No deduction in claim because of room rent No Disease specific sub-limits – for eg, no sub-limits on cataract treatment, etc Reload of Sum Insured – Doubling the sum insured (in case of different illness for same insured or different insured person) at no extra cost Accelerated No Claim Bonus – Doubling the Sum Insured in 5 claim free year in Supreme & Elite Plan and 1.5 times in case of Classic Plan. No Reduction of No Claim Bonus earned in case of claim in any particular year Vaccination in case of Animal Bite Geography based Pricing – Zone 2 customers are charged 15% less compared to Zone 1 Health & Wellness Benefit including Free Health Check-up (Annually in Supreme & Elite, Once in 2 years in Classic Plan) International Coverage including return Air Fare (covered in Elite Plan) Maternity & OPD Treatment (covered in Elite Plan) Comprehensive coverage like All Day Care Procedures, Organ Donor , Pre & Post Hospitalization, etc covered upto Sum Insured
7.Key Policy Criteria Entry Age: Child – 91days to 25 years Adult – 18 years onward Policy Type Individual Family Floater (relationship between insured should be Self, Spouse and upto 4 children) Policy Tenure – 1 year, 2 years and 3 years. Get discount of 7.5% and 12% in case of 2 years or 3 years respectively Lifetime Renewability Geographic pricing – Entire country is divided into 2 Zones and premium varies as per customer Zone. Zone 2 customers get 15% discount in premium Zone 1 – Delhi/NCR, Mumbai (including Thane, Vashi, etc), Bengaluru, Hyderabad, Chennia, Pune, Kolkata and Gujarat State Zone 2 – Rest of India)
8.We will not cover any treatment taken during the first 30 days since the commencement of the Policy, unless the treatment needed is a result of an Accident. This waiting period does not apply for any subsequent and continuous renewals of Your Policy. For Cirtical Illness Benefit (in Supreme & Elite), the initial waiting period is of 90 days Waiting periods and exclusions (1/2) Initial Waiting Period 17 specified conditions not covered for first 2 Years Stones in biliary and urinary systems Lumps / cysts / nodules / polyps / internal tumours Gastric and Duodenal Ulcers Surgery on tonsils / adenoids Osteoarthrosis / Arthritis / Gout / Rheumatism / Spondylosis / Spondylitis / Intervertebral Disc Prolapse Cataract Fissure / Fistula / Haemorrhoids Hernia / Hydrocele Chronic Renal Failure or end stage Renal Failure Sinusitis / Deviated Nasal Septum / Tympanoplasty / Chronic Suppurative Otitis Media Benign Prostatic Hypertrophy Knee/Hip Joint replacement Dilatation and Curettage Varicose veins Dysfunctional Uterine Bleeding / Fibroids / Prolapse Uterus / Endometriosis Diabetes and related complications Hysterectomy for any benign disorder
9.Addictive conditions and disorders; Adventurous or Hazardous Sports; Ageing and puberty; Alternative Treatment; Ancillary Hospital Charges; Artificial life maintenance; Charges for Medical Papers; Circumcision; Conflict and Disaster; Congenital conditions; Convalescence and Rehabilitation; Cosmetic surgery; Dental/oral treatment; Drugs and dressings for OPD Treatment or take-home use; Eyesight; Health hydros, nature cure, wellness clinics etc.; HIV and AIDS; Hereditary conditions (specified); Hospitalization undertaken for observation or for investigations only; Items of personal comfort and convenience; Psychiatric and Psychosomatic Conditions; Obesity; OPD Treatment; Preventive care; Reproductive Medicine; Self-inflicted injuries; Sexual problems and gender issues; Sexually transmitted diseases; Sleep disorders; Speech disorders; Stem Cell Implantation; Treatment for Alopecia; Treatment for developmental problems; Treatment received outside India; Unproven/Experimental Treatment; Unrecognized physician or Hospital; Unrelated diagnostic, X-ray or laboratory examinations; Unlawful Activity; Any costs or expenses specified in the List of Expenses Generally Excluded as Annexure II in Policy Wording Waiting periods and exclusions (2/2) Classic – 4 years Supreme – 3 years Elite – 2 years Pre-Existing Conditions Permanent Exclusions
10.Underwriting Criteria Sum Insured >=10lacs Age >= 46 years Any ‘yes’ to 6 medical questions in proposal form All Portability proposal (external as well as internal) Body Mass Index >= 33 Policy Issuance Process TVS FOS submits proposal form, documents and payment at branch ops Is policy straight pass on following 5 criteria Operations team enters details in policy issuance system Policy dispatched to customer at T+7 Policy received by customer T+9-T+12 Yes Case flows to medical underwriting team who calls customer & asks 15-20 health questions PPMC Yes Policy dispatched to customer at T+12, T+25 Policy received by customer T+14-T+25 No Policy approved Yes Case rejected, customer informed No No
11.Example of Lifeline VS United India Age-45 years SI-3 Lacs Premium Rs. 10,406 (Zone 2 – Cochin, Calicut, etc) (for a family combination of 2 Adult + 2 Children) Lifeline Age-45 years SI-3 Lacs Premium Rs.11,149 (for a family combination of 2 Adult + 2 Children) United Family Medicare Customer admitted for Kidney Stone @ Aster Medicity with room rent of Rs.4000. No room rent capping under Lifeline Cost of treatment Rs.80,000 Claim paid by RS under Lifeline- Rs.80,000 Customer admitted for Kidney Stone @ Aster Medicity with room rent of Rs.4000. Room rent cap of 1%, ie.Rs.3000 Cost of treatment Rs.80,000 Claim paid by Star Health- Rs.60,000 The premium paid in Zone 2 is lower than United and due to no room rent cap, entire amount is paid in case of claim
12.Lifeline Premiums
13.Market positioning – Classic Plan
14.Market positioning – Supreme Plan
15.Market positioning – Elite Plan
16.Premium Comparison – Individual (excluding service tax) (1/2)
17.Premium Comparison – Individual (excluding service tax) (2/2)
18.Premium Comparison – 2 Adults 2 Children (excl Service Tax) (1/2)
19.Premium Comparison – 2 Adults 2 Children (excl Service Tax) (2/2)
20.Thank You

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