Bandhan Life - iHealth Plan

Objectives

AEGON Religare s iHealth plan is a plan with No Surprises, you get what you are promised. It provides fixed benefit and comprehensive cover for all kinds of surgeries including 240 day care treatments.

Features

1. Pays you a fixed lump sum amount irrespective of your hospital bill.
2. Does not increase premium, even if you claim.
3. Lets you increase the benefit amount as per your changing needs
4. Allows you to renew your plan irrespective of the claims made.
5. Covers your family members under one policy.

Advantages

* AEGON Religare iHealth Insurance Plan covers all surgeries. All surgeries which do not form part of the list are covered under Category 6 except for the exclusion mentioned herein. Refer to Annexure 1 for details.
* It pays you a fixed claim amount, irrespective of the actual hospital bills.
* You get a fixed amount in addition to the payment you would have received from other health plans, which means that you will have to submit only the photocopy of the bills to claim the benefits.
* You can avail of the Cashless facility (no need to pay any money for the treatment) in more than 3,000 key hospitals across the country.
* You are guaranteed a lifelong renewal of your health cover. The premium applicable on renewal will depend upon the attained age.
* You benefit from a fixed premium rate for 3 years. This means even if you have a claim in year 1 or 2, the premium will not increase.
* Your benefit amount increases by 10% for every no claim year (the maximum increase will be capped at 50%).
* You can include additional family members at any point of time during the policy duration.
* If you are up to the age of 45 and in good health, no medicals are required.

Benefits

Daily Hospitalisation Cash Benefit (DHCB):
You will get a fixed amount of money for each day spent in the hospital. You should have been admitted to the hospital for a continuous period of 24 hours for a medically necessary procedure. This benefit will be paid in addition to Surgical Cash Benefit.
Surgical Cash Benefit (SCB):
The plan covers all kinds of surgeries. These surgeries have been classified into 6 categories depending upon the type and severity of each surgery.
849 surgeries are in the defined list. These surgeries are classified in category 1 to 5 (List of the surgeries falling under categories 1 to 5 is available in Annexure 1). The remaining surgeries which do not form a part of the list are covered under category 6 except for the exclusion mentioned herein. The surgeries covered under Category 6 require 24 hours of continuous hospitalisation.
A fixed amount is paid in respect of each surgery depending upon the category of the surgery.
Congenital Cover :
This will cover the listed Medically Necessary Surgical Procedures required to correct congenital defects in achild born / adopted by a mother who is continuously covered for a period of 9 months under the plan.
No Claim Benefit :
The benefit amount under DHCB & SCB will increase by 10% p.a. for every claim free year. The maximumincrease is capped at 50% of the benefit amount at inception of the policy.
Guaranteed Renewability :
The maximum maturity age is 100 years subject to exercising of Guaranteed Renewability feature or else the maximum maturity age would be 85 years (i.e. maximum entry age (70 years) + 15 years). You need to intimate theCompany, within 30 days from the date of expiry of the policy to continue the policy for another term. The GuaranteedRenewability feature can only be exercised if the sum of age at the time of renewability and Policy Term of 15 years does not exceed 100 years of age of the Life Assured.
Increase in Benefit Amount :
Keeping in mind the increasing medical inflation, the policy also allows you to increase the benefit amount under DHCB & SCB by 10% after every 3 years. This increase will be subject to underwriting rules of the company.
Policy Benefit :
No benefits are payable in case of death of the Life Assured. In case of death of the Life Assured during or post themedical treatment before the claim is made, the benefits payable under the plan, if any, will be paid to the legal heir of the Life Assured.
Post the death of the Life Assured, remaining members covered under the policy, if any, will continue to be covered and the premium for the remaining members will be revised from the next premium due date.
Surrender Benefit :
If the policy is surrendered or lapsed, then no benefits will be payable.
Maturity Benefit : No benefits are payable on maturity of the plan or at the end of the Policy Term.

Coverage

covered under the plan :
Plan 1 : Proposer & Insured
Plan 2 : Proposer & Insured :
* Spouse (Insured) ,
* Children (Insured)
Plan 3 : Proposer :
* Spouse (Insured) ,
* Children (Insured)
Plan 4 : Proposer :
* Father / in-law (Insured),
* Mother / in-law (Insured)
Plan 5 : Proposer :
* Brother (Insured),
* Sister (Insured)

Entry Age Details

Minimum age at entry : 18 years completed for Adults and 90 days completed for Children
Maximum age at entry : 70 years last birthday for Adults

Maturity Age Details

Minimum Maturity Age: years. Maximum Maturity Age depends on the Premium Payment Term(PPT)

Policy Term

Policy Term : 15 years

Premium Payment Term

5 years / 7 years / 10 years / equal to the Policy Term.

Sum Assured Details

Sum Assured :
Gold : Rs.3,00,000
Platinum: Rs.5,00,000

Death Benefits

In case of an unfortunate demise of the Life Assured during the Policy Term, the nominee receives higher of Total Sum Assured on death or Total Fund Value or 105% of all the premiums paid. Where,Total Sum Assured on death = Base Sum Assured on death + Top-Up Sum Assured on death (if any),Total Fund Value = Base Fund Value + Top-Up Fund Value (if any).

Rider Options

Rider :
You can further customise your plan by opting for AEGON Religare Health CI Rider. The Sum Assured under this rider is paid out on diagnosis of any of the following critical illness:* Alzheimer s disease
* Blindness
* Muscular dystrophy
* Cardiomypathy
* Cancer
* Stroke
* Paralysis
* Coma
* Aplastic anaemia
* Kidney Failure

Free Look Period

Free Look Option :
If you are not satisfied with the terms and conditions of the policy, you have an option to cancel the policy stating the reason within 15 days from the date of receipt of the policy bond/document. Upon such cancellation, you will be paid back the premiums after deducting stamp duty and medical examination charges, if any.

Grace Period

Grace Period:
You are allowed a grace period of 30 days for payment of your renewal premium from the last premium due date. The insurance coverage continues during the grace period. In case of a claim during the grace period, premium due will be debited from the benefits payable. No new Waiting Periods or Fresh Underwriting will apply if premium is received during the Grace Period.

Policy Loans

Policy loan is not available.

Partial Withdrawal

This feature is allowed only if the Life Assured is more than 18 years of age. All due premiums for the first five years have to be fully paid. The amount of any partial withdrawal should not be less than Rs.5,000. An amount equal to a minimum of 2 years Annualized premium should be maintained as fund balance after any partial withdrawal. Any Partial withdrawal requests made shall be first allowed from the Top-Up Fund Value as long as such Fund Value supports the partial withdrawal and subsequently the partial withdrawals may be allowed from the base Fund Value.

General Exclusions

* Any claim occurring as a result of Pre-existing conditions or their resultant complications unless stated in the proposal form and specifically accepted by the company and endorsed thereon.
* AIDS, HIV related complications or any Sexually Transmitted Diseases.
* Attempted suicide or self inflicted injury, irrespective of the mental condition.
* Hazardous sports or activities included but not limited to bungee jumping, mountaineering etc.
* Any flying activity other than as a bonafide passenger.
* Under the influence of alcohol, drugs or any substance not prescribed by a Registered Medical Practitioner.
* War, riots, civil commotion, strikes, civil war or service in the military or paramilitary forces of a country at war.
* Criminal, unlawful or illegal activity participation.
* Any treatment directly or indirectly arising from Exposure of Life Assured to Radioactive, explosive or hazardous nature of nuclear fuel materials or property contaminated by nuclear fuel materials or Accident arising from such nature.
* Diagnosis or treatment taken outside India.
* Psychiatric or mental illness.
* Circumcision, any Cosmetic procedures or Plastic Surgery.
* Pregnancy, childbirth or their complications, Abortion, Medical Termination of Pregnancy, Infertility or sex changeoperation.
* Organ donation (donor costs).
* Rehabilitation or convalescent care or treatments or tests not consistent with customary medical treatment or diagnosis or stay in hospital beyond the customary length of stay where no active treatment is provided.
* Non-Allopathic treatment
* Purely investigative procedure not resulting in any treatment or unreasonable failure to seek medical advice.
* Congenital conditions, genetic disorders or birth defects unless specifically covered.
* All dental surgery or treatment are excluded except those arising due to accident and recommended by a registered and qualified medical practitioner.

Claim Service

* You can opt for cashless hospitalisation from any of our 3,000 plus network hospitals available across the country. Alternatively, you can claim for reimbursement of your benefit amount for any treatment carried out in any non-network hospital through our hassle-free claims process.
* You will need to present your AEGON Religare iHealth Plan ID Card and any photo ID while making a claim along with a duly filled claim form
* Photocopies of hospital bills, discharge card, doctor s certificate, prescriptions, diagnostic reports and any other relevant documents will be needed to process your claim.

Claim & Solvency Ratio

Claim Ratio	Solvency Ratio
100% (2023-24)	2% (March 2024)

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Frequently Asked Questions About Insurance

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What is health insurance? +

Health insurance is a type of coverage that pays for medical and surgical expenses incurred by the insured. It may also provide coverage for other types of health-related costs, such as prescription drugs, mental health services, and preventive care.

Why do I need health insurance? +

Health insurance helps protect you from high medical costs. It provides access to medical care when you need it, helping to pay for doctor visits, hospital stays, surgeries, prescription medications, and other health-related services.

What is a premium? +

A premium is the amount you pay for your health insurance every month. Depending on your plan, the premium may vary based on factors like age, location, and level of coverage.

What is a deductible? +

A deductible is the amount of money you must pay out-of-pocket before your health insurance starts covering your medical expenses. For example, if you have a deductible of $1,000, you must pay $1,000 out-of-pocket before your insurance starts covering your medical bills.

What are copayments and coinsurance? +

Copayment (copay): A fixed amount you pay for a covered health care service, typically when you get the service. Coinsurance: The percentage of the cost you pay for covered health services after you've paid your deductible. For example, if your coinsurance is 20%, you pay 20% of the bill, and the insurance company pays the remaining 80%.

What is an out-of-pocket maximum? +

The out-of-pocket maximum is the maximum amount you can spend on your health insurance. If you exceed this amount, your insurance company will pay 100% of your medical expenses.

What is the difference between in-network and out-of-network providers? +

In-network providers: Health care providers that have a contract with your health insurance plan to provide services at negotiated rates. Out-of-network providers: Providers that don't have a contract with your insurance plan. Services from these providers may cost more or not be covered at all.

What is a Special Enrollment Period (SEP)? +

The Special Enrollment Period (SEP) is a special time during the year when you can sign up for or make changes to your health insurance plan. If you miss this period, you may have to wait until the next one unless you qualify for a Special Enrollment Period (e.g., due to a life event like marriage or having a baby).

Can I keep my doctor with health insurance? +

If you have a preferred doctor, it’s important to check if they are in-network with your insurance plan. If they are not in-network, you may need to pay more out-of-pocket, or you may have to switch to another doctor who is in-network.

What is a Health Savings Account (HSA)? +

A tax-advantaged account for people with high-deductible health plans (HDHPs). The funds roll over from year to year and can be used for qualifying medical expenses.

What is a Flexible Spending Account (FSA)? +

A tax-advantaged account for people with low-deductible health plans (LDHPs). The funds roll over from year to year and can be used for qualifying medical expenses.

What is a Health Maintenance Organization (HMO)? +

An HMO is a type of health insurance plan that requires you to choose a primary care physician (PCP) and get referrals from them to see specialists. HMOs often have lower premiums and out-of-pocket costs but offer less flexibility in choosing providers.

What is a Preferred Provider Organization (PPO)? +

A PPO is a health insurance plan that offers more flexibility in choosing healthcare providers and doesn’t require referrals to see specialists. You can see any doctor, but you’ll pay less if you use in-network providers.

What is the difference between a Health Savings Account (HSA) and a Flexible Spending Account (FSA)? +

HSA: A tax-advantaged account for people with high-deductible health plans (HDHPs) The funds roll over from year to year and can be used for qualifying medical expenses. FSA: A tax-advantaged account for people with low-deductible health plans (LDHPs) The funds roll over from year to year and can be used for qualifying medical expenses.

What does the term "pre-existing condition" mean? +

A pre-existing condition is a medical condition that you had before you got your health insurance. It could include things like diabetes, high blood pressure, or heart disease.

Can I cancel my health insurance at any time? +

Yes, you can cancel your health insurance plan at any time. However, if you cancel outside the open enrollment period, you may not be able to get another plan until the next enrollment period unless you qualify for a Special Enrollment Period.

Are prescription drugs covered by health insurance? +

Many health insurance plans cover prescription medications, but the coverage may vary. Plans typically have a formulary, or list of covered drugs, and different drugs may have different levels of coverage, depending on whether they are generic, brand-name, or specialty drugs.

What is preventive care? +

Preventive care includes health services that help prevent illnesses, such as vaccinations, screenings, and annual checkups. Under the Affordable Care Act, most preventive services are covered by health insurance plans at no additional cost to the policyholder.

What should I do if my health insurance claim is denied? +

If your claim is denied, you can appeal the decision. Review the denial letter for reasons, contact your insurer for assistance, and file a written request for a hearing. If you win the appeal, you may be able to get a refund or other compensation.

How can I choose the best health insurance plan for me? +

When selecting a plan, consider factors like: Your health care needs (e.g., frequent visits, prescriptions) The plan’s network of doctors and hospitals The cost of premiums, deductibles, copays, and out-of-pocket maximums Coverage for specialized care or treatments Compare the different plans and benefits to find one that meets your needs.

What happens if I don't have health insurance? +

If you don’t have health insurance, you can still access some health care services, such as emergency care, in-network doctors, and in-network hospitals. You may be eligible for Medicaid, which provides some health care services at no cost to you.

What is life insurance? +

Life insurance is a contract between you and an insurance company, where you pay regular premiums in exchange for a lump sum payment (death benefit) to your beneficiaries upon your death.

What are the different types of life insurance? +

Term Life Insurance: Provides coverage for a specific period (e.g., 10, 20, or 30 years). If you pass away during this term, your beneficiaries receive the death benefit. It does not build cash value. Whole Life Insurance: Offers lifetime coverage with a death benefit and also builds cash value over time, which you can borrow against or use. Universal Life Insurance: A flexible policy that allows you to adjust the premiums and death benefit while also building cash value.

How much life insurance coverage do I need? +

The amount of coverage you need depends on factors like your income, debts, family needs, and long-term financial goals. A common rule is to have coverage worth 10 to 15 times your annual income, but this can vary based on your individual situation.

What is the difference between beneficiaries and policyholders? +

The policyholder is the person who owns the life insurance policy and pays the premiums, while the beneficiary is the person or group that receives the death benefit when the policyholder passes away.

Can I change my beneficiaries? +

Yes, you can change your beneficiaries at any time during the life of the policy, as long as the policy is in force and you follow the correct procedure with the insurance company.

What is the contestability period? +

The contestability period is the time during which you have the right to contest the decision of the insurer to pay the death benefit. This period varies depending on the type of life insurance policy and the insurer.

Does life insurance cover accidental death? +

Some life insurance policies include accidental death coverage, while others may require a separate rider for this benefit. Be sure to review your policy to understand what’s covered.

Can I cancel my life insurance policy at any time? +

Yes, you can cancel your life insurance policy at any time, provided you follow the correct procedure with the insurance company.

What is cash value? +

Cash value is the accumulated value of the life insurance policy that can be used to pay for expenses, such as medical bills or funeral expenses.

How do I borrow against cash value? +

You can borrow against the cash value of your life insurance policy, but it will need to be repaid, and any unpaid loan will reduce the death benefit.

What is the difference between whole life and universal life insurance? +

Whole life insurance provides coverage for a specific period (e.g., 10, 20, or 30 years) and builds cash value over time. Universal life insurance offers lifetime coverage with a death benefit and also builds cash value over time.

How are life insurance premiums determined? +

Life insurance premiums are based on factors like age, health, lifestyle (e.g., smoking), coverage amount, and type of policy. Generally, younger, healthier individuals pay lower premiums.

Can I borrow money from my life insurance policy? +

If you have a whole life or universal life policy, it may build cash value over time. You can borrow against this cash value, but it will need to be repaid, and any unpaid loan will reduce the death benefit.

What happens if I stop paying my life insurance premiums? +

If you stop paying premiums, your policy may lapse. For permanent policies like whole or universal life, the cash value may cover the premiums for a time, but eventually, if premiums are not paid, the policy will end.

What is auto insurance? +

Auto insurance is a contract between you and an insurance company that provides financial protection against damage or injury caused by accidents, theft, or other incidents involving your vehicle. It covers both liability and your vehicle's repair costs depending on the type of policy.

What types of auto insurance coverage are available? +

There are several types of auto insurance coverage, including liability, collision, comprehensive, uninsured/underinsured motorist, and additional coverage like roadside assistance and collision damage waiver.

How much auto insurance do I need? +

The amount of coverage you need depends on factors such as the value of your car, your driving habits, your state's legal requirements, and whether you own or lease your vehicle. A good starting point is to meet your state's minimum required coverage, but you may want additional coverage for added protection.

Can I cancel my auto insurance policy at any time? +

Yes, you can cancel your auto insurance policy at any time, provided you follow the correct procedure with the insurance company.

What is the difference between liability and comprehensive coverage? +

Liability coverage covers the damages and injuries caused by accidents, while comprehensive coverage also covers non-accident damages, such as theft or vandalism.

How do I choose the right auto insurance policy? +

When selecting an auto insurance policy, consider factors such as the type of coverage you need, your driving habits, the value of your vehicle, and your state's legal requirements.

What factors affect my auto insurance premium? +

Several factors impact your insurance premium, including: Your driving history (accidents, tickets), The make, model, and age of your car, Your location (accident rates in your area), Your age, gender, and marital status, The level of coverage you choose, Your credit score (in some states).

What is a deductible? +

A deductible is the amount you must pay out of pocket before your insurance policy starts to cover the remaining cost of repairs or claims. For example, if you have a $500 deductible and incur $2,000 in damages, you will pay $500, and your insurer will pay the remaining $1,500.

What is the difference between comprehensive and collision coverage? +

Collision coverage pays for repairs to your vehicle after a collision with another vehicle or object, regardless of who is at fault. Comprehensive coverage covers non-collision incidents, such as theft, vandalism, or damage from natural disasters.

Can I get uninsured/underinsured motorist coverage? +

Yes, uninsured/underinsured motorist coverage is available in some states. This coverage provides financial protection for you if another driver is uninsured or underinsured.

Is auto insurance required by law? +

Yes, in most states, you are required to have a minimum level of liability insurance. Some states also require additional coverage like Personal Injury Protection (PIP) or uninsured motorist coverage. The requirements vary by state, so it’s important to check your local laws.

What happens if I don’t have auto insurance? +

If you drive without insurance, you risk facing legal penalties, fines, and the possibility of your driver's license being suspended. If you're involved in an accident, you could be held responsible for the damages.

Can I add other drivers to my auto insurance policy? +

Yes, you can add other drivers, such as family members or friends, to your policy. However, their driving record and age may affect your premium. It's important to inform your insurer about all the drivers in your household.

What should I do if I get into an accident? +

If you're in an accident, follow these steps: Ensure safety by moving to a safe location if possible. Call the police and file a report. Exchange contact and insurance information with the other driver(s). Take photos of the accident scene, vehicle damage, and injuries. Notify your insurance company about the accident as soon as possible.

What is home insurance? +

Home insurance is a contract between you and an insurance company that provides financial protection against damage or loss caused by natural disasters, theft, or other incidents.

What types of home insurance coverage are available? +

There are several types of home insurance coverage, including flood, fire, burglary, and liability. You may also have coverage for water damage, mold, and other property damage.

How much home insurance do I need? +

The amount of home insurance coverage you need depends on the value of your property, the type of coverage you want, and your insurance provider. You may also need additional coverage for water damage, mold, and other property damage.

Can I cancel my home insurance policy at any time? +

Yes, you can cancel your home insurance policy at any time, provided you follow the correct procedure with the insurance company.

What is the difference between flood and fire coverage? +

Flood coverage covers damage caused by floods, while fire coverage covers damage caused by fires.

How do I choose the right home insurance policy? +

When selecting home insurance, consider factors such as the type of coverage you need, the value of your property, and your insurance provider.

What factors affect my home insurance premium? +

Factors such as the type of coverage you need, the value of your property, and your insurance provider can significantly impact your premium.