OPD ICICI BANK
Under this policy, the insurance premium remains the same at Rs.15,000 or Rs.20,000 (depending upon age of the insured). What changes is the Sum Insured (amount of coverage) depending on the age and the number of members covered. The amount of the premium (Rs. 15,000) is fully deductible under Section 80D of the Income Tax Act#. Thus, you save up to Rs.5099 on your tax payable.*
#Maximum tax benefit of Rs.5099/- subject to the provisions of Section 80D of the Income Tax Act, 1961 and amendments made thereafter
*For highest income tax slab of 33.66% (including 10% surcharge for income above Rs.8.50 Lakh and education cess @ 2%).
Additionally, you can claim OPD (Outpatient Department) up to Rs.10,000 (depending on sum insured chosen and age of the insured) Total Savings = Tax Benefit + OPD Reimbursement Effective Premium = Total Premium - Total Savings
In a scenario wherein an Adult aged 34 years, were to buy the Health Advantage Individual plan for Rs. 2 lakhs.Then, effective cost of Health Advantage Plus Insurance would be: Effective Premium = Premium Paid - (Maximum OPD Benefit + Maximum Tax Benefit) Rs. 15,000 - (Rs. 9,000 + Rs. 5,099) = Rs. 901 Refer to the table below to find out how much you save.
"We are offering vouchers for OPD treatment with sub limits," said Antony Jacob, MD and CEO of Apollo Munich Health Insurance. "This is available in designated outlets. We reimburse if the hospital is not in our network list." There are limits — for consultations, the insurance company gives a voucher of Rs 600. There are also caps on the number of times a customer can seek a consultation to check against misuse.
Under this policy, the insurance premium remains the same at Rs.15,000 or Rs.20,000 (depending upon age of the insured). What changes is the Sum Insured (amount of coverage) depending on the age and the number of members covered. The amount of the premium (Rs. 15,000) is fully deductible under Section 80D of the Income Tax Act#. Thus, you save up to Rs.5099 on your tax payable.*
#Maximum tax benefit of Rs.5099/- subject to the provisions of Section 80D of the Income Tax Act, 1961 and amendments made thereafter
*For highest income tax slab of 33.66% (including 10% surcharge for income above Rs.8.50 Lakh and education cess @ 2%).
Additionally, you can claim OPD (Outpatient Department) up to Rs.10,000 (depending on sum insured chosen and age of the insured) Total Savings = Tax Benefit + OPD Reimbursement Effective Premium = Total Premium - Total Savings
In a scenario wherein an Adult aged 34 years, were to buy the Health Advantage Individual plan for Rs. 2 lakhs.Then, effective cost of Health Advantage Plus Insurance would be: Effective Premium = Premium Paid - (Maximum OPD Benefit + Maximum Tax Benefit) Rs. 15,000 - (Rs. 9,000 + Rs. 5,099) = Rs. 901 Refer to the table below to find out how much you save.
| Age of Senior Most Member (as on his last birthday) | Individual | |||||
| Fixed Premium Rs. 15,000 | ||||||
Sum Insured under Hospitalisation Benefit =
Rs. 2 Lakhs
|
Sum Insured under Hospitalisation Benefit -
Rs. 3 Lakhs
| |||||
Age in Years
|
Sum Insured under OPD Benefit as below
|
How much do you save?
Total Savings = (OPD Benefit + Tax Benefit)
|
Effective Premium = (Total Premium - Total Savings)
| Sum Insured under OPD Benefit as below |
How much do you save?
Total Savings = (OPD Benefit + Tax Benefit)
|
Effective Premium = (Total Premium - Total Savings)
|
| 5 - 18 | Rs. 10,000 | Rs. 15, 099 | - NA - | Rs. 9,500 | Rs. 14, 599 | Rs. 401 |
19 - 35
|
Rs. 9,000
| Rs. 14,099 | Rs. 901 | Rs. 8,800 | Rs. 13, 899 | Rs. 1101 |
| 36 - 45 | Rs. 8,500 | Rs. 13, 599 | Rs. 1401 | Rs. 8,000 | Rs. 13,099 | Rs. 1901 |
| 46 - 55 | Rs. 6,000 | Rs. 11,099 | Rs. 3901 | Rs. 5,500 | Rs. 10, 599 | Rs. 4401 |
| 56 - 60* | Rs. 4,500 | Rs. 9599 | Rs. 5401 | Rs. 3,500 | Rs. 8599 | Rs. 6401 |
| Fixed Premium Rs. 20,000 | ||||||
| 61 - 65 | Rs. 7,000 | Rs. 12,099 | Rs. 7901 | Rs. 5,500 | Rs. 10,599 | Rs. 9401 |
| 66 - 70 (for renewal only)** | Rs. 4,000 | Rs. 9099 | Rs. 10, 901 | Rs. 2,000 | Rs. 7099 | Rs. 12, 901 |
| 2 Adults (Floater Benefit) | ||||||
| Fixed Premium Rs. 15,000 | ||||||
Sum Insured under Hospitalisation Benefit =
Rs. 2 Lakhs
|
Sum Insured under Hospitalisation Benefit -
Rs. 3 Lakhs
| |||||
| Age in Years |
Sum Insured under OPD Benefit as below
|
How much do you save?
Total Savings = (OPD Benefit + Tax Benefit)
|
Effective Premium = (Total Premium - Total Savings)
| Sum Insured under OPD Benefit as below |
How much do you save?
Total Savings = (OPD Benefit + Tax Benefit)
|
Effective Premium = (Total Premium - Total Savings)
|
| 5 - 18 | Plan not available | |||||
19 - 35
|
Rs. 8,000
| Rs. 13, 099 | Rs. 1901 | Rs. 7,500 | Rs. 12, 599 | Rs. 2401 |
| 36 - 45 | Rs. 7,000 | Rs. 12, 099 | Rs. 2901 | Rs. 6,500 | Rs. 11, 599 | Rs. 3401 |
| 46 - 55 | Rs. 3,000 | Rs. 8099 | Rs. 6901 | Rs. 2,000 | Rs. 7099 | Rs. 7901 |
| 56 - 60* | Plan not available | |||||
| Fixed Premium Rs. 20,000 | ||||||
| 61 - 65 | Plan not available | |||||
| 66 - 70 (for renewal only)** | Plan not available | |||||
*Medical Tests mandatory for insured aged 56 and above
**Age at entry: max. upto 65 years; renewable upto 70 years
**Age at entry: max. upto 65 years; renewable upto 70 years
Insurance is the subject matter of solicitation.
"ICICI Bank Limited ("ICICI Bank") is licensed by the IRDA to act as a Corporate Agent of ICICI Lombard General Insurance Company Limited. The contract of insurance will be between ICICI Lombard General Insurance Company Limited and the Insured, and not between ICICI Bank and the Insured. ICICI Bank is acting merely as the Corporate Agent of ICICI Lombard General Insurance Company Limited and there is no direct or indirect linkage between the provisions of the banking services offered by ICICI Bank and your usage of the product or participation in the scheme offered by ICICI Lombard General Insurance Company Limited. Your participation in this product is purely on a voluntary basis. ICICI Bank is not liable or responsible for any claim, dispute, liability, loss or shortfall resulting from the scheme. This policy is brought to you from ICICI Lombard General Insurance Company Limited. No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take out or renew or continue an insurance in respect of any kind of risk relating to lives or property in India, any rebate of the whole or part of the commission payable or any rebate of the premium shown on the policy, nor shall any person taking out or renewing or continuing a policy accept any rebate, except such rebate as may be allowed in accordance with the published prospectus or tables of the insurer.
"ICICI Bank Limited ("ICICI Bank") is licensed by the IRDA to act as a Corporate Agent of ICICI Lombard General Insurance Company Limited. The contract of insurance will be between ICICI Lombard General Insurance Company Limited and the Insured, and not between ICICI Bank and the Insured. ICICI Bank is acting merely as the Corporate Agent of ICICI Lombard General Insurance Company Limited and there is no direct or indirect linkage between the provisions of the banking services offered by ICICI Bank and your usage of the product or participation in the scheme offered by ICICI Lombard General Insurance Company Limited. Your participation in this product is purely on a voluntary basis. ICICI Bank is not liable or responsible for any claim, dispute, liability, loss or shortfall resulting from the scheme. This policy is brought to you from ICICI Lombard General Insurance Company Limited. No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take out or renew or continue an insurance in respect of any kind of risk relating to lives or property in India, any rebate of the whole or part of the commission payable or any rebate of the premium shown on the policy, nor shall any person taking out or renewing or continuing a policy accept any rebate, except such rebate as may be allowed in accordance with the published prospectus or tables of the insurer.
This is a comprehensive Tax-Saving health plan and shall cover the insured for:
- Basic Hospitalisation Cover
- Outpatient Department (OPD)
Basic Hospitalisation Cover
This covers inpatient hospitalisation expenses up to sum insured of Rs. 2 or Rs. 3 Lakhs (depending on the plan chosen). You can avail the cashless claim facility in any of the 4,500+ network hospitals across India.
Basic Hospitalisation cover includes: Medical expenses incurred as an inpatient during hospitalisation for more than 24 hours, including room charges, doctor’s / surgeon’s fee, medicines, diagnostic tests, etc.
This covers inpatient hospitalisation expenses up to sum insured of Rs. 2 or Rs. 3 Lakhs (depending on the plan chosen). You can avail the cashless claim facility in any of the 4,500+ network hospitals across India.
Basic Hospitalisation cover includes: Medical expenses incurred as an inpatient during hospitalisation for more than 24 hours, including room charges, doctor’s / surgeon’s fee, medicines, diagnostic tests, etc.
- 30 days prior to hospitalisation.
- 60 days post hospitalisation.
- Declared pre-existing diseases can be covered after the 2nd year provided the policy is renewed with us for two consecutive years.
- Technologically advanced treatment that do not need 24-hour hospitalisation but are covered under this policy are:-
- Cataract
- Lithotripsy (Kidney Stone Removal)
- Tonsillectomy
- Eye Surgery
- Dialysis
- Dilatation & Curettage
- Chemotherapy
- Radiotherapy
- Coronary Angiography
- Cardiac Catheterization
Coverage limit for specific ailments / conditions:
Certain specific ailment(s) / surgery(s)/ procedure(s) are covered up to pre-defined limits under this policy (subject to the total sum insured).Click here for the details.
All others ailment(s) / surgery(s)/ procedure(s) are covered up to the sum insured under the policy.
*- Pre-hospitalisation period, the period of Hospitalisation and the Post-hospitalisation period, should fall within the Period of Insurance.
Outpatient Department (OPD)
This covers outpatient treatment expenses. In case of an OPD treatment (Outpatient Department), the claims will be settled later after furnishing the medical prescription documents/bills.
Outpatient Department Covers:
Certain specific ailment(s) / surgery(s)/ procedure(s) are covered up to pre-defined limits under this policy (subject to the total sum insured).Click here for the details.
All others ailment(s) / surgery(s)/ procedure(s) are covered up to the sum insured under the policy.
*- Pre-hospitalisation period, the period of Hospitalisation and the Post-hospitalisation period, should fall within the Period of Insurance.
Outpatient Department (OPD)
This covers outpatient treatment expenses. In case of an OPD treatment (Outpatient Department), the claims will be settled later after furnishing the medical prescription documents/bills.
Outpatient Department Covers:
- Room, Boarding Expenses as charged by the Hospital
- Nursing Expenses
- Expenses related to Dental Treatment
- Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialist Fees
- Anesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Consumables, Medicines and Drugs, Diagnostic Materials and X-ray, Dialysis, Chemotherapy, Radiotherapy, Cost of Pacemaker, Cost of Artificial Limbs External Medical Aids, ambulance charges
- OPD claims can be lodged only once during the Period of Insurance, within a period of 90 days from start of cover and 30 days of end of cover.
Sum Insured for Plans covering 2 individuals comes under the Floater benefit.
For more details, kindly refer to the Policy Wordings.
| Age of Senior Most Member (as on his last birthday) | Individual | 2 Adults | ||
| SI under Hospitalisation Benefit = Rs. 2 Lakhs |
SI under Hospitalisation Benefit = Rs. 3 Lakhs
| SI under Hospitalisation Benefit = Rs.2 Lakhs (with Floater Benefit) |
SI under Hospitalisation Benefit = Rs. 3 Lakhs
(with Floater Benefit) | |
SI under OPD Benefit as below
|
SI under OPD Benefit as below
| |||
Fixed Premium Rs. 15,000
| ||||
5 yrs. - 18 yrs.
|
Rs. 10,000
|
Rs. 9,500
|
Plan not available
| |
19 yrs. - 35 yrs.
| Rs. 9,000 |
Rs. 8,800
| Rs. 8,000 |
Rs. 7,500
|
36 yrs. - 45 yrs.
|
Rs. 8,500
|
Rs. 8,000
|
Rs. 7,000
|
Rs. 6,500
|
46 yrs. - 55 yrs.
|
Rs. 6,000
|
Rs. 5,500
|
Rs. 3,000
|
Rs. 2,000
|
56 yrs. - 60 yrs.*
|
Rs. 4,500
|
Rs. 3,500
|
Plan not available
| |
Fixed Premium Rs. 20,000
| ||||
61 yrs. - 65 yrs.
|
Rs. 7,000
|
Rs. 5,500
|
Plan not available
| |
66 yrs. - 70 yrs. (for renewal only)**
|
Rs. 4,000
|
Rs. 2,000
|
Plan not available
| |
*Medical Tests mandatory for insured aged 56 and above
**Age at entry: max. upto 65 years; renewable upto 70 years
| ||||
Insurance companies lining up cashless OPD plans to make life easier
(As with anything related…)
MUMBAI: The next time you want to see the doctor, you may not have to pay, even if you are just an outpatient. But that's only if you are covered by a health insurer which includes the hospital that you are visiting in its network. As with anything related to the business, there are many caveats, but this could still end up being the next big thing in health insurance — cashless OPD.
Some companies are experimenting with the concept of customers not having to pay when they visit an outpatient department, or OPD. Insurance companies only started covering outpatient treatment a few years ago, but strictly through reimbursements. That meant the customer paid and then put in a claim for the money. It wasn't covered before that, with medical insurance policies only kicking in when there was a minimum 24 hours of hospitalisation.
Apollo Munich's Maxima is now offering vouchers for various services such as consultation and pharmacy.
"We are offering vouchers for OPD treatment with sub limits," said Antony Jacob, MD and CEO of Apollo Munich Health Insurance. "This is available in designated outlets. We reimburse if the hospital is not in our network list." There are limits — for consultations, the insurance company gives a voucher of Rs 600. There are also caps on the number of times a customer can seek a consultation to check against misuse.
The average premium for such plans is Rs 13,000-15,000, providing for coverage of Rs 3-5 lakh. ICICI Lombard is planning a similar product. "We are planning to bring OPD on cashless platform," said Sanjay Datta, head of health at ICICI Lombard. "We will soon start a pilot." This should help ease life for the average insurance customer.
"Cashless OPD is more about convenience, so that you do not have to follow up with the company for reimbursement," said Rahul Agarwal, managing director, Optima Insurance Broker.
The move could encourage more people to opt for health insurance. At a time the economic slump has hit the nonlife insurance business, health is the fastest-growing segment, having benefitted from increased awareness due to the rise in medical costs. Health is also profitable for insurers with an incurred claim ratio of 96.43%. This is the ratio of claims paid to premium earned. The government has also sought to promote health insurance by providing a tax break to those who buy policies.
Health insurance premiums grew 18.66% to Rs 13,975 crore in 2012-13 from Rs 11,777 crore a year before. Over the past seven years, the segment has grown at a compounded annual growth rate of 30%, compared with 17.5% for the non-life industry.
The Insurance Regulatory & Development Authority issued guidelines last year to bring uniformity in health insurance policies. These have led to the standardisation of commonly used medical terms, procedures,exclusions and claim forms.
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