LifeLine MediCash^TM Plus Plan

Multiple claims and cashless hospitalisationThe policyholder will be able to avail of medical services at designated hospitals and the bills will be settled through TPAs (third party administrators) who additionally offer a 24 hours toll free helpline, access to physicians, specialties, diagnostic centres and ambulance services.:

• Cashless hospitalisationThe policyholder will be able to avail of medical services at designated hospitals and the bills will be settled through TPAs (third party administrators) who additionally offer a 24 hours toll free helpline, access to physicians, specialties, diagnostic centres and ambulance services. and cash benefit is available in over 4000+ network hospitals across the country irrespective of actual billing.
• In case you are hospitalized in a hospital outside our network, submit your bills, discharge summary, etc and the amount will be reimbursed after assessment.

PremiumA regular payment made to the insurance company to keep the policy in force. guarantee:

The premiumA regular payment made to the insurance company to keep the policy in force.s are guaranteed / fixed for 5 years from the effective date. After 5 years, the premiumA regular payment made to the insurance company to keep the policy in force. rates may be revised after reviewing the claims experience subject to prior approval of IRDA.

Discount for a claimNotification to an insurance company that payment of an amount is due under the terms of the policy.-free policy:

You get discount on premiumA regular payment made to the insurance company to keep the policy in force. in case policy is claimNotification to an insurance company that payment of an amount is due under the terms of the policy. free for first 5 years.

Payout in addition to other plans:

Benefits are payable in addition to any other health insurance cover that you may have with us or any other insurer.

Other benefits:

• Guaranteed long term coverage for 10 years subject to premiumA regular payment made to the insurance company to keep the policy in force. payments made by you and termination provisions
• You may be entitled to certain tax benefits on your premiums and benefits. Please note all the tax benefits are subject to tax laws prevailing at the time of payment of PremiumA regular payment made to the insurance company to keep the policy in force. or receipt of benefits by you.
• Fair, friendly, and fast claims process

Benefit structure:

*Maximum surgical benefit limit in a policy year will increase by 5% simple rate each policy year
Subject to the terms and conditions of the policy.

**Please note in respect of "other" category of surgeries, an amount equal to the actual hospital bill for carrying out the surgery shall only be reimbursed subject to a maximum payout of Rs 10,000 in a policy year. The "actual hospital bill for carrying out the surgery" shall include the surgeon fee, operation theatre cost, medical consumables directly linked to the surgery and anaesthesist's cost.

For example: If you are looking for a plan that can pay you for Daily Hospital Cash of only Rs. 2000, with reference to above table of benefits you will buy 2 units of MediCash Plus. When you are hospitalized the plan will provide you:

• Daily Hospitalization Cash Benefit of Rs. 2000
• ICU Cash Benefit of Rs. 4000 per day and
• Recuperating Benefit of Rs. 6000 (This benefit is applicable only in case of hospitalization for 7 or more consecutive days before discharge.)
• Surgical benefit of up to Rs. 1,00,000 per policy year and 200% of the applicable* maximum benefit over the term of the policy.

*Maximum surgical benefit limit in a policy year will increase by 5% simple rate each policy year
Subject to the terms and conditions of the policy.

Benefits

Hospital Cash Benefits:

In case of an unfortunate event of your being hospitalized for a medically necessary treatment or surgery for any illness or injury, for a continuous and consecutive period of at least 48 hours, the company shall pay fixed per diem benefit as per the unit/ scale of benefit applicable, for the period of hospitalization but excluding the first 24 hours of such hospitalization and subject to limits of the policy.

Please Note: Any period less than 24 hours spent by the life insured during hospitalization after the initial 48 hours will be counted for payment of full per diem rate

This is a fixed amount paid irrespective of your actual hospital bill.

In scenarios, when you are hospitalized again for the same illness or injury that occurred during previous hospitalization, within 30 days from the date of discharge, we will pay from the first 24 hours of such hospitalization.

ICU Cash Benefit:

In case of your being required to and is admitted into an intensive care unit for a medically necessary treatment or surgery of any illness or injury for a continuous period of 8 hours or more during hospitalization for a continuous period of 24 hours or more, in addition to hospital cash benefit, an intensive care unit cash benefit equivalent to 200% of hospital cash benefit will be payable on per diem basis as per the unit/ scale of benefit subject to the terms and conditions of the policy.

Recuperating Benefits:

Expenses don't stop at hospital discharge, do they? Max Life Lifeline - MediCash^TM Plus also offers a fixed lump sum recuperation cash benefit to help you meet your follow-up investigation costs, consultation fees, cost of medicines etc.

Provided there has been a continuous and consecutive period of hospitalization of 7 days or more and is discharged alive from the hospital. Then in addition to hospital cash and ICU cash benefit, a lump sum recuperating cash benefit equivalent to 300% of the hospital cash benefit will be payable as per the unit/ scale of benefit.

Surgical Cash Benefit:

Over and above routine hospitalization expenses, a fixed Lump-sum amount will be paid under Max Life Lifeline - MediCash^TM Plus for more than 400 listed surgeries that you may undergo. These surgeries are divided into 5 categories depending on clinical severity. Accordingly a certain percentage of the maximum benefit will be paid out for a surgery undergone by you.

We also understand that cost of medical facilities is rising year by year. To partner with you in attempting to meet them, our surgical cash benefit will increase every year at a simple rate of 5% of the benefit amount at policy inception.

Total amount of Surgical Cash Benefit that can be availed throughout the policy termIt is the number of years the policy will be active. will be twice the applicable benefit amount for that particular year surgical cash benefit for a few surgeries is payable for few covered surgeries carried out in the first 90 days of the effective date and few covered surgeries carried out in the first 24 months of the effective date except where the surgery is carried out for treatment of an injury. List of such surgeries can be provided on demand.

The company reserves the right to add to or delete any surgery from the list of surgeries and change the categorization of the surgeries depending upon the experience and advancement in medical treatment and diagnostic techniques. The policyholder shall be notified in writing 30 days in advance about the same and the same shall be binding upon the policyholder.

A sample list of surgeries is given below:

For detailed List of surgeries, look up on our web site or please ask your agent advisor.

In case you undergo any other surgery, which is not listed in the above categories, we pay you a Fixed amount of upto Rs. 10,000 or as per your actual hospital bill, whichever is lesser.

Maximum benefit in a policy year:

Benefit shall be payable in aggregate across all benefits for a maximum of 50 days of hospitalization of the life insured in a policy year. The balance days, if not claimed, cannot be carried forward to the following policy year. Similarly, 100% of the maximum surgical benefit can be claimed during a policy year as per the scale of benefits.

Maximum benefit during the policy termIt is the number of years the policy will be active.:

Benefits shall be payable in aggregate across all benefits for a maximum of 250 days of hospitalization of the life insured during the policy termIt is the number of years the policy will be active.. In case of these 250 days has been claimed, the policy will terminate and insurance cover would cease. Similarly, 200% of the applicable maximum surgical benefit as per the scale of benefits.

List of illnesses covered and their classification

List of network hospitals

You are eligible if:

Take a look at how this plan works:

Example:

If the hospitalisation is in one of our network hospitals, there are 2 ways you can claimNotification to an insurance company that payment of an amount is due under the terms of the policy. your benefit. Take a look:

Hospitalisation

Route 1

• Fill and fax pre-authorization form
• Scrutiny of pre-authorization request
• Authorization letter faxed back
• Benefit amount settled with hospital

Route 2

• Policyholder settles the hospital bill himself
• Submission of claimNotification to an insurance company that payment of an amount is due under the terms of the policy. documents post discharge
• Scrutiny of claims request
• Benefit amount paid back to policyholder

Sample premiumA regular payment made to the insurance company to keep the policy in force. table -

ExclusionsSpecific conditions or circumstances listed in an insurance policy for which the policy will not provide benefit payments.:

Grace periodPeriod of time after the due date of a premium, during which the policy remains in force. provision

A grace periodPeriod of time after the due date of a premium, during which the policy remains in force. of thirty days from the due date for payment of each premiumA regular payment made to the insurance company to keep the policy in force. will be allowed. During the grace periodPeriod of time after the due date of a premium, during which the policy remains in force. the Company will accept the premiumA regular payment made to the insurance company to keep the policy in force. without interest.

The insurance coverage continues during this grace periodPeriod of time after the due date of a premium, during which the policy remains in force.. But if the claimNotification to an insurance company that payment of an amount is due under the terms of the policy. arises during the grace periodPeriod of time after the due date of a premium, during which the policy remains in force., the Company shall be entitled to deduct the unpaid PremiumA regular payment made to the insurance company to keep the policy in force. from the Benefits payable under the policy.

Lapse

If a premiumA regular payment made to the insurance company to keep the policy in force. is not received by the company by the end of the grace periodPeriod of time after the due date of a premium, during which the policy remains in force., the policy will lapse. All Insurance cover will end upon lapse of the policy. No benefit is payable for any hospitalization undertaken during the period when the policy has lapsed even though the policy may be subsequently revived.

Revival of Policy

Within 180 days from the due date of the premiumA regular payment made to the insurance company to keep the policy in force. (period of revival) and before termination of the policy, the policyholder may apply in writing for revival of the policy.

The company may upon receipt of written request from the policyholder, along with a declaration of good health and at the absolute discretion of the company revive the policy on such terms and conditions as are applicable at the time of revival of the policy. All overdue premiums must be paid together with interest at such rates as may be intimated by the company from time to time. The revival of the policy shall take effect only after revival of the policy is approved by the company and communicated to the policyholder in writing.

If, at the end of the period of revival, the policy is not revived, the policy shall terminate, and no benefit shall be payable thereafter.