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Certified Corporate Agent:
Health Assure Plan
Health Assured. Pride Secured.
PLAN DETAILS
HEALTH INSURANCE PLAN:
A Mediclaim Plan Guide for Prospective Policy Holders
2. Plan Eligibilities – Age and policy term limits for HDFC Life Health Assure
Plan are as follows:
In today’s fast paced & stressful life you are striving hard to give best of
everything to your family. Yet you never know when you or your family may
AGE* AT ENTRY (Yrs.)
PREMIUM
have to face any medical emergencies. If at all such situation arises, it puts
POLICY TERM
FREQUENCY
pressure on your immediate cash flows. In the absence of adequate health MINIMUM MAXIMUM
insurance protection there may be a need to liquidate assets or borrow money
18 for adults and
to pay medical expenses²³. Moreover in such situations other financial
policyholder
Whole life plan
commitments of regular savings may take back seat thus impacting 70 Annual
91 days for
achievements of any long term financial goals. Even the cost of medical care is
dependent children
increasing day by day.
* Age Last Birthday
While it is important for you to adopt a healthy life style, it is also important to
have a health insurance plan which will take care of some of the medical 3. Eligible Family Members – Under the Family Floater plan type, you may
expenses that you may incur. cover your spouse, children, both parents and parents-in-law subject to
underwriting norms.
HDFC Life presents HDFC Life Health Assure Plan, a comprehensive, pure
protection health insurance plan that reimburses medical expenses incurred
PLAN BENEFITS
in a hospital. The plan offers you the following key features:
HDFC Life Health Assure Plan provides a host of benefits. The benefits you
• Cover for whole of life
get will depend upon the plan option you have chosen as mentioned below:
• Option to increase the Sum Insured subject to the maximum limit or
PLAN TYPE Single Life FAMILY FLOATER
upgrade the type of plan, subject to underwriting on the completion of
PLAN OPTION SILVER GOLD SILVER GOLD
three policy years and every three years thereafter
SUM INSURED
` 3 ` 5 ` 3 ` 5 ` 7 ` 10
• Cashless Claim Service⁵ at specified Network²⁶ Hospitals across India
BENEFITS LAKHSLAKHSLAKHSLAKHSLAKHSLAKHS
• Hassle free Claim Reimbursement Process
Inpatient ¹⁹
Covered Covered
Hospitalisation
• Premium Guarantee for 3 years even if you make a claim
Day Care Benefit ¹⁰ Covered Covered
• Automatically doubles your cover after 2 claim free years
Pre and Post
Covered Covered
• Choice of Individual Cover and Family Floater Covers &
Benefits Hospitalisation ³¹ ³⁰
within
Emergency Ambulance Covered Covered
• Flexibility to choose Restore Benefit Option , by paying additional
Annual
premiums under all Plan Options.
Donor Expense
Limit² Covered Covered
Benefit
• For policies with Sum Insured of Rs 5 Lakhs & above, additional flexibility to
#
Maternity Benefit ²¹ Not Covered Not Covered Covered
choose Room Rent Enhancement Option , by paying additional premiums.
Hospital¹⁵ Not
Covered Not Covered Covered
Cash Benefit Covered
3 EASY STEPS TO OWN YOUR PLAN
Additi-
Step 1 Choose your Plan Type – Individual or Family Floater
Not
onal Wellness Benefit Covered Not Covered Covered
Covered
Step 2 Choose your Plan Option – Gold or Silver
Benefit
36
Step 3 Choose the Sum Insured
Benefits Description
PLAN DETAILS
The plan will cover eligible actual medical expenses under the benefits
1. Plan Type – You have flexibility to customize a plan as per your & your
described below up to the applicable Annual Limit only. The amount payable
family’s needs.
under all the benefits described below will be added to determine utilization
of Annual Limit.
SUM INSURED (`)
PLAN 1. Inpatient Hospitalization Benefit¹⁹ – If you or any of your insured
SINGLE LIFE FAMILY FLOATER
OPTION family member suffers an illness¹⁷ or meets an accident¹ and is hospitalized
MINIMUM MAXIMUM MINIMUM MAXIMUM for a period exceeding 24 hours, this benefit will reimburse medical
expenses incurred by the life insured on:
Silver 3 Lakhs 3 Lakhs 3 Lakhs 5 Lakhs
I. Room Rent³⁵, which will be paid on actual expenses incurred subject to a
Gold 5 Lakhs 5 Lakhs 7 Lakhs 10 Lakhs
per day limit of 1% of Sum Insured for hospitalisation¹⁶ in regular
Sum Insured is the maximum amount of claim per policy per year that can be
rooms/wards and 2% of Sum Insured for hospitalization in an intensive
availed. This amount may increase in subsequent years due to Multiplier
care unit (ICU)²⁰.If the Room Rent Enhancement is opted for, the limit of
Benefit (please refer to the Multiplier Benefit Section for details.).
1% of Sum Insured will not apply provided the room chosen for
treatment is a standard private room.
ii. Nursing Charges, Surgeons’, Anesthetists’, Dieticians and other Doctors’
fees (provided the same is included within the hospitalisation bill) • This benefit is not available to lives insured which were included in the
family floater policy as dependent children and/or dependent adults
iii. Investigation charges including pathology, radiology and other
other than the spouse of Policyholder
diagnostic tests during hospitalisation
• Expenses of new born child/baby²⁷ from a successful delivery will be
iv. Cancer treatment including chemotherapy and radio therapy
not be payable under this benefit. No reimbursements for any
v. Cost of Artificial Limbs, subject to maximum of Rs. 25,000 per life vaccinations will be done.
insured per annum
7. Hospital Cash Benefit – If you have taken Gold plan option (Individual or
vi. ICU charges, Anesthesia, blood, oxygen, operation theatre charges,
Family Floater) and are admitted to a hospital for period exceeding 24
surgical appliances, medicines and drugs, diagnostic materials and X-
continuous hours, then we will pay Hospital Cash Benefit for each day of
Rays, dialysis, cost of pacemaker, Angioplasty stents, Heart prosthetic
hospitalization. This benefit is not a stand-alone benefit and shall be paid
valves and joint replacement implants
along with settlement of claim payable under Inpatient Hospitalisation
Benefit and is payable from within the Annual Limit.
The claim would be subject to:
• The maximum of sum insured,
Policy Sum Insured (`) 5 Lakhs 7 Lakhs 10 Lakhs
• Applicable sub-limits, if any Per Day Amount (`) 500 700 1000
• Any other exclusions applicable to the type of expense claimed or the
type of ailment as mentioned herewith. WELLNESS BENEFIT
If you have taken Gold plan option (Individual or Family Floater) we will provide
Please refer to section 30 of Annexure 1 for more details.
you Wellness Health check-up Vouchers which can be redeemed at any of the
2. Day Care Benefit¹⁰ – We will pay actual permissible medical expenses
network diagnostic center/providers towards Health Check-up. These
incurred upon undergoing any of the Day Care procedures listed in
Wellness Vouchers will bear a value equal to 0.1% of Sum Insured and must be
Annexure 2 where 24 hour hospitalisation is not necessary. Any other
utilized within 1 year of issue. These Wellness Vouchers will not be exchanged
procedures which do not require the minimum 24 hour hospitalisation due
for cash and are not transferrable and have to be utilized only by the life
to subsequent advancement in Medical Technology will be considered
under Day Care Benefit only if they are preauthorized. This list can be insured. These Wellness Vouchers will be provided every three years starting
modified from time to time subject to prior approval from IRDA. from second policy year. HDFC Life will ensure a valid Wellness voucher is
& honoured. The value of these Wellness Vouchers does not reduce your
3. Pre and Post Hospitalisation Benefit³¹ ³⁰– We will pay the actual
Annual Limit.
medical expenses incurred by you up to 30 days prior to the date of
admission and 60 days from the date of discharge of Inpatient
Policy Sum Insured (`) 5 Lakhs 7 Lakhs 10 Lakhs
Hospitalisation or Day Care Benefit, subject to maximum amount of 10% of
policy Sum Insured. This benefit will be payable only if the Inpatient
Benefit Value (Per Insured Member) (`) 500 700 1000
Hospitalisation Benefit or Day Care Benefit is payable.
4.Emergency Ambulance Benefit – We will pay the actual expenses
MULTIPLIER BENEFIT⁸
incurred up to Rs. 2,000 per policy year per insured member towards
In case you do not make any claim for any of the insured member in any policy
ambulance service provided to transport the insured member who is
year, we will reward you with a Multiplier Limit equal to 50% of your policy Sum
admitted in the hospital. This benefit is payable only in case the
Insured in the following year. If you do not make any claim even in the second
hospitalisation is in an ICU or Emergency ward/care³⁹ of the hospital and
consecutive year, your Multiplier Limit will increase to 100% of policy Sum
the Inpatient Hospitalisation Benefit is eligible for payment.
Insured. Thus your Annual Limit may increase to maximum of 200% of your
5. Donor Expense Benefit – We will pay the actual medical expenses
policy Sum Insured in case there are no claims in two consecutive years.
incurred during the procedure of donation of an organ provided the insured
Similarly, if you make a claim in any year, in the following year we will reduce
member is a recipient of the organ. This includes any hospitalisation
the Multiplier Limit by 50% of your policy Sum Insured. Claims in two
expense incurred by the Donor. However we will not pay the cost of the
consecutive years will reduce the Multiplier Limit to 0%. However at no point
organ. Pre and Post hospitalisation expenses incurred by the insured
member only (who is recipient of the organ) will be payable. will the Annual Limit fall below your policy Sum Insured, irrespective of any
number of claims in the previous year.
6.Maternity Benefit²¹ – If you have taken Gold Family Floater option, then
we will reimburse the actual medical expenses incurred by the insured life
Following is an illustration of How Multiplier Benefit multiplies your coverage
towards Hospitalisation as an inpatient due to pregnancy or any
if there are no claims in any year:
complications thereof, including delivery and medical termination of
pregnancy. The total medical expenses that we will reimburse will be
AFTER TWO
subject to a maximum limit of 3% of the Sum Insured per pregnancy, AT AFTER ONE CLAIM
CONSECUTIVE CLAIM
provided that: INCEPTION FREE POLICY YEAR
FREE POLICY YEARS
• The policy is a family floater policy wherein the female insured life is
Sum Insured 10 Lakhs 10 Lakhs 10 Lakhs
either a Policyholder herself or spouse of Policyholder
Multiplier Limit Nil 5 Lakhs 10 Lakhs
• The life insured (female life) has been covered in the family floater policy
Annual Limit 10 Lakhs 15 Lakhs 20 Lakhs
for at least three continuous years.
This benefit is subject to following additional conditions:
In case if the policyholder decides to increase the Sum Insured, the multiplier
• Pre and post hospitalisation expenses will not be payable benefit will apply separately for the original Sum Insured and increased
amount based on the respective claim-free durations (in years)
• This benefit shall be available only for two episodes of pregnancy in
lifetime of insured life, including new policies taken by the life insured
with the company
Death of Life Insured
RESTORE BENEFIT
• In case of death of a Life Insured the coverage will cease from date of
If the Basic Sum Insured and multiplier benefit (if any) is exhausted due to
death of the Life Insured without any refund of Premium. In case of
claims made and paid during the Policy Year or made during the Policy Year
Family Floater Policies the eldest of the remaining members will become
and accepted as payable, then it is agreed that a Restore Sum Insured (equal
the main life insured and the Policy will continue to remain in-force for
to 100% of the Basic Sum Insured) will be automatically available for the
surviving Lives Insured.
particular policy year, provided that:
• Upon receiving intimation from Policyholder about the death of Life
• The Restore Sum Insured will be enforceable only after the basic sum
Insured along with death certificate prior to next Premium Due Date, the
insured including the multiplier bonus have been completely exhausted in
Premium payable on the next Premium Due Date shall be calculated on
that year
the surviving Lives Insured for whom the coverage shall continue.
• The Restore Sum Insured can be used for claims made by the Insured Person
• There is no death benefit payable upon death of the Life Insured.
in respect of the following basic benefits covered by the policy:
However a claim for covered benefits incurred prior to death of Life
• Inpatient Hospitalization Benefit Insured will be payable subject to terms and conditions stated herein.
• Pre-Hospitalization This plan is a pure protection health indemnity plan and it does not provide
any life cover. The plan also does not provide any maturity value or
• Post-Hospitalization
surrender value.
• Day Care Procedures
OPTIONS
• Organ Donor
The following options are available under the product:
• Emergency Ambulance
• Conversion Option from Family Floater to Single Life
• The Restore Sum Insured can be used for only future claims made by the
• Conversion Option from Single Life to Family Floater
Insured Person and not against any claim for an illness/disease (including
its complications) for which a claim has been paid in the current policy year.
• Option to increase the Sum Insured subject to the maximum limit or
upgrade the type of plan, subject to underwriting
• No Multiplier Benefit will apply to the Restore Sum Insured.
• Option to add a new member or remove a member under a Family Floater
• The Restore Sum Insured can be used for Multiple claims in the Policy year of
plan subject to terms and conditions
restoration until the restored Sum Insured is exhausted. However, the
restoration of Sum Insured will happen only once in a Policy Year and once
• Miscellaneous alterations; namely, change of address, correction in
exhausted there will be no subsequent restoration.
Name, correction in Date of Birth, change of Address, change of
Nominee/ Appointee, issuance of duplicate policy.
• If the Restore Sum Insured is not utilized in a Policy Year, it shall not be
carried forward to any subsequent Policy Year.
Conversion from Family Floater to Single Life will be allowed where the
customer need justifies the same such as divorce, death etc. The option to
If the Policy is a Family Floater, then the Restore Sum Insured will only be
increase the Sum Insured or upgrade the type of plan or to convert plan
available In respect of claims made by those Insured Persons who were
option shall be available on the completion of three policy years and every
Insured Persons under the Policy before the Sum Insured was exhausted.
three years thereafter. The option to add or remove a member under a
The Restore Benefit Option can only be opted at the inception of the policy.
Family Floater plan shall be available on every policy anniversary.
Upgrading the type of plan represents a switch by the policyholder from a
#
ROOM RENT ENHANCEMENT
‘Silver’ plan option to a ‘Gold’ plan option. Any increase in sum insured or
upgrade of plan type as a result of exercising any of the above options shall
• The product has a sub-limit on room rent equal to 1% of the Sum Insured.
be subject to applicable underwriting requirements. In addition,
The Policyholder can instead opt for an enhanced limit, wherein the Sum
exclusions relating to pre-existing conditions and waiting periods shall
Insured linked sub limit shall not be applied as long as a standard private
apply to the extent of increased sum insured or additional benefits from
room is opted for.
the effective date of alteration.
• This optional benefit can only be opted for Sum Insured of Rs 5 Lakhs and
In case of death of the main life under Family Floater policies, the eldest of
above and is subject to the payment of additional premiums.
the remaining members will become the main life and the policy continues.
• The Room Rent Enhancement Option can only be opted at the inception of
A Family Floater policy will be converted to a Single Life policy on policy
the policy.
anniversary if only one member remains under the Family Floater policy.
Conversion Option for Dependent Children
OTHER BENEFITS
The plan offers the flexibility for children covered under family floater
Benefits on Death
plans who have attained the age of 18 years to convert their cover in to a
Death of Policyholder
separate policy with continuity of benefits and without any fresh
underwriting up to the Sum Insured in the family floater policy wherein
• In case of Single Life option where Life Insured is the Policyholder himself,
they were originally covered.
the Policy will automatically terminate upon death of the Policyholder.
There will be no refund of Premium.
Any addition of life into the (converted) new policy shall also be subject to
underwriting norms and all time bound exclusions and waiting period shall
• In case of Policy with Single Life option where Life Insured is not the
apply for such added lives.
Policyholder himself and in Family Floater Policy, the Policy shall continue
to remain in-force for surviving Lives Insured up to the next Premium Due
Please note that the following options are not available under the product:
Date. Any of the surviving Lives Insured eligible to contract can make a fresh
• Option to downgrade from Gold plan to Silver plan
application and can continue the cover from such Premium Due Date. We
will issue a new Policy with continuity of benefits and without any fresh
• Option to reduce the Sum Insured except in case of transfer from
underwriting at the then prevailing premium rates, terms and conditions.
Family Floater to Single Life
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