Claim Form Ttk “A New Revolution In Health –

							“A New Revolution In
         Health – Care”
SyndArogya
Mediclaim Insurance cum Personal Accident
Scheme.
Individual Policy with benefit of Group
size of 2 lacs policy holders
Floater Policy 1+3 (Husband, wife & two
dependent children) with premium as per
Plan A table and 1+5 (Husband, wife, two
dependent children & dependent Parents)
with premium as per Plan B table annexed
SyndArogya
Benefits to Policyholders
Mediclaim Scheme meets 100 % of all types of
Hospitalisation Expenses viz.:
  Room Rent

  Doctors’/Surgeon Fees

  Medicine & Drugs

  Anesthesia, OT, Diagnostics Materials

  Blood, Oxygen, X-ray

  Chemotherapy, Radiotherapy

  Nursing expenses

  Cost of pacemaker & Artificial Limbs etc.
Benefits to Policyholders
 Cashless Facility at Networked Hospitals of
 TPA
 Treatment at any Hospital/Nursing Home in
 India
 Relevant medical expenses 30 days prior to
 and 60 days subsequent to hospitalisation
 covered
 Income Tax relief on Premium under S80D
Attractive Benefits Added to
        SyndArogya
   Cover Available to Dependent Parents also
    as per Plan B. Entry age for parents also 65
    years renewable up to 80 years of age.
   Ambulance charge up to Rs 1000/-
   Maternity Benefits and Baby Care covered up
    to maximum 5% of Sum Assured
   Max Sum Insured Increased to Rs 5 lacs in
    multiples of 50000
   Cost of Health Check reimbursed up to 1% of
    Average Sum Insured after 3 claim free years
   Hospital cash up to Rs 1000 in case of
    hospitalisation of child below 12 years age
   Treatment anywhere in India, Nepal or
    Bhutan in Indian currency
Unique Benefits in
SyndArogya
Floater Policy i.e. any one or all dependant
family members up to 4 (Plan A) or 6(Plan B)
can take benefits to the maximum extent of
Sum Insured
Sum Insured Min Rs 50000/- Max Rs 5 lacs
Uniform Premium irrespective of age of main
policyholder i.e. min 5 years maximum 65
years renewal up to 80 years Min Floater age
3 months baby if covered with parents
Unique Benefits in
SyndArogya
     No Medical Checkup even above 45 years
     Pre-existing diseases covered from 4th year
     subject to certain conditions
     In Addition to hospitalisation charges,
     following death claim Payable in case of
     accident resulting into death within one year
     from the date of accident
      Accountholder 100% of Sum Insured selected
      Spouse 50% of SI
      Child above 5 years 20 % of SI
      Child below 5 years 10% of SI
SyndArogya
TPA(Third Party Administrator)
 Following Outsourced Third Party agency
 (TPAs) are empanelled by United India for
 servicing SyndArogya insurance policies
1) Med Save Health Care Ltd. 2) Medicare TPA
   Services (I) Pvt.Ltd. 3)TTK Healthcare Services
   Pvt. Ltd. 4) GENINS India Ltd. 5) Heritage
   Health Services Pvt.Ltd. 6) M/s Vipul Medcorp
   Pvt Ltd. 7) E-Meditek Solutions Ltd.
Role of TPA
(Third Party Administrator)
Issues Photo identity card, Insurance
Certificate, Members Guide Book with list of
Network Hospitals, Certificate
Arranges Cashless facility at Networked
Hospitals
Reimburses to Policyholders expenses
incurred in Non networked hospitals
Call centre facility with Toll free no. and
Website
 SyndArogya
 Claim Procedures
For treatment at Non-networked hospitals:
 Intimation immediately after hospitalisation
 Claim for reimbursement within 15 days
   from discharge or completion of post hosp treatment
Documents required:
 Copy of policy & Photo Identity card
 Original of discharged summary & consolidated bills
  with breakup
 Original reports and pharmacy bills with break up.
SyndArogya
Claim Procedures
    For Treatment at Networked Hosp. no claim
    as cashless facility. Prior Authorisation
    required from TPA before commencing
    treatment for cashless facility.
    For Personal Accident death claim
     Notice to Nodal Office of Insurance Co.to get
      claim form
     Filled up claim form , FIR, Death Certificate,
      Postmortem report, legal heir certificate etc.
     Main Exclusions
Domiciliary hospitalisation
Pre-existing diseases (covered from 4th year onwards if without any
break in cover)
Waiting period of first 30 days - commencement of policy except
those arising out of accident.
Treatment for Cataract, benign, prostatihypertrophy, hysterectomy,
hernia, hydrocele, piles, sinusitis, etc., during the first year of
operation of insurance cover.
Cost of spectacles, hearing aids, vitamins, tonics and expenses
relating to dental treatment, convalescence, general debility,
naturopathy, etc.
Dental treatment unless requiring hospitalisation
                Premium Table
                                             (Amt in Rs.)

Sum Insured             Plan-A(1+3)          Plan-B(1+5)
                                             with “Parents”
50,000                  939                     1567
1,00,000                1814                    3029
1,50,000                2659                    4436
2,00,000                3424                    5708
2,50,000                4104                    6840
3,00,000                4786                    7971
3,50,000                5384                    8964
4,00,000                5983                   9957
4,50,000                6583                   10952
5,00,000                7182                   11944
NB:Premium all inclusive of charges for TPA and Service Tax
Thank You