MASTER PRODUCT - Total Health Advantage

Transcription

1 MASTER PRODUCT - Total Health Advantage Campaign Code: C088/C095 QUALITY HEALTH INSURANCE AND MUCH MORE Your family is the most important part of your life. You try to plan out the best for them. But life sets its own course. And at times, you do face misfortunes like a sudden illness, a serious accident or an unavoidable surgery. To provide them with suitable medical attention in such a scenario, you fall back on your hard earned savings. There is a better way to keep your savings intact. Royal Sundaram brings to you, an unique health insurance plan, Master Product - Total Health Advantage providing optimum health coverage at an affordable price and with an assured renewal for lifelong. It offers coverage much larger than the ones offered by basic health insurance. This product comes to you with a choice of Silver, Gold and Platinum plans. It has been designed to offer complete protection to you and your family. Complete Family Coverage Cover offered to self, spouse, dependent parents aged between 18 years to 65 years and dependent children aged between 91 days to 21 years. Dependent children shall be offered cover under same policy with other family members. Adults who are of female gender opting for Silver plan shall be offered cover with any other adult member. Key Benefits Hospitalisation Expenses Day Care Expenses Pre / Post Hospitalisation Expenses Maternity Benefit Hospital Cash Outpatient Treatment Charges Outpatient Dental Care Cost of Contact Lens, Spectacles and Hearing Aids Ambulance Charges Master Health Check Up Key Benefits Hospitalisation Expenses Expenses incurred towards Inpatient Hospitalisation for a period of more than 24 hours, for the illnesses/diseases contracted or injury sustained by the insured person during the period of Insurance shall be reimbursed. Room, Boarding and Nursing Expenses as provided by the Hospital/ Nursing Home subject to a limit of 2% of Sum Insured for n-icu stay and 4% of Sum Insured for ICU stay. Nursing Expenses incurred during Inpatient Hospitalisation. Surgeon, Anaesthetist, Medical Practitioner, Consultants and Specialist Fees. Anaesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Appliances, Medicines and Drugs, Diagnostic Materials and X-ray, Cost of Pacemaker, Prosthesis/Internal implants and Cost of Organs. Day Care Expenses It is not always necessary that there should be a 24 hours hospitalisation. This plan shall pay for medical expenses for day care procedures (requiring less than 24 hours of hospitalisation) also. This plan covers 147 day care procedures. Our representative can share this list, if requested. Limit of Claim Cataract 10% of the sum insured subject to a maximum of `1 lakh. Dialysis, Chemotherapy and Radiotherapy 10% of the sum insured per month. Physiotherapy charges `250 per day. Pre/Post Hospitalisation Expenses Expenses incurred prior to date of admission into the hospital and after discharge from hospital are payable, if the hospitalisation claim is found admissible. Number of days of pre /post hospitalisation are 30 days and 60 days respectively. It is essential that the expenses are in connection with the disease/injury for which hospitalisation happened. Maternity Benefit (applicable for Silver Plan only) Expenses incurred as inpatient, towards maternity, are payable with a waiting period of 3 years. This benefit is available for 2 children. Benefit limit shall be `20,000. Any complication arising out of pregnancy, will be deemed to be covered under this benefit only, and the limits mentioned herein would apply. Any accident/medical emergency induced abortion/miscarriage shall be covered under this benefit without imposition of waiting period.

2 Master Health Check Up (applicable for all 3 plans) Once in every 4 consecutive claim free years, all insured persons can claim reimbursement of the cost of a Master Health Check Up. However the benefit levels differ as per the plan chosen. Key Features Life long renewal Cumulative bonus for every claim free year. A slab of 5% with a maximum of 10 slabs. Coverage of Pre-existing disease with 3 years waiting period. Day care procedures covered. need for 24 hours stay. Income Tax deduction as per Section 80D of IT Act,1961. Cashless hospitalisation in over 3000 networked hospitals. ISO 9001:2008 certified Claims Service. 3.5% discount for opting 2 year tenure. Hospital Cash (applicable for all 3 plans) For each completed 24 hours of hospitalisation, the daily benefit towards incidental expenses, without necessity of submission of proof for spending, shall become payable as per plan. This benefit follows admitted liability under hospitalisation benefit. However claims for pre-existing disease shall not have the hospital cash benefit. The daily benefit is payable for a maximum period of 30 days per year. Under the floater Sum Insured option, this benefit shall be applicable 30 days per year per family. Outpatient Treatment Charges (applicable for Gold and Platinum Plans only) Expenses incurred, related to medical treatment as out patient shall be reimbursed as per plan selected. This can be towards a consultation/ pharmacy/diagnostic tests incurred in any clinic/hospital/diagnostic centre. Upon your presenting the relevant bills/receipts in one go there shall be an assured settlement of claim. Outpatient Dental Care (applicable for Gold and Platinum Plans only) Reimbursement of expenses on Fillings and Crowns, Emergency Tooth Replacement, n Cosmetic Oral Surgeries, Dental Xrays upto `5,000 once in 4 completed years with 25% copay. This benefit shall be commonly available for all insured members in a floater plan. Cost of Contact Lens, Spectacles and Hearing Aids (applicable for Gold and Platinum Plans only) Reimbursement of expenses on Spectacles or Contact Lens or Hearing Aids upto `5,000 once in 4 completed years with 25% copay. This benefit shall be commonly available for all insured members in a floater plan. Ambulance Charges (applicable for all 3 plans) Emergency ambulance charges, for transporting the patient to the hospital, up to a limit as per plan per admissible hospitalisation, will be reimbursed. This is subject to an annual limit of two times of applicable benefit. Pre-Application Medical Tests Sum Insured Age Reports requirement Upto `5 lakhs Above `5 lakhs Plan and coverage Indemnity Hospitalisation (in lakhs) Above 50 Years Above 45 Years Silver Gold Platinum 2 / 3 / 5 5 / 7.5 / / 20 Room Rent 2% of SI n ICU / 4% of SI- ICU Pre Hospitalisation Post Hospitalisation Maternity Benefit (Waiting period 3 years) Waiting period for Pre-existing disease 30 days 60 days Hospital Cash ,000 Cataract Limit (per eye) 20,000 N.A N.A Outpatient Charges N.A 2,500 5,000 Dental Care with 25% copay Once in 4 completed years Spectacles/Hearing Aid with 25% copay- Once in 4 completed years Ambulance Charges Master Health Check Up - Reimbursement N.A 5,000 5,000 N.A 5,000 5,000 1,500 1,500 5,000 1,500 1,500 5,000 10% of SI subject to max `1 lakh 3 Years ECG, Urine Sugar Test, Blood Sugar Test (both fasting & PP) Medical Examination report by Doctor, ECG, Routine Urine Analysis, HBA1C (Blood Sugar Test) Lipid Profile, Haemoglobin, Creatinine, Liver Function Test The Company (Royal Sundaram) shall bear 50% of the cost of medical examination, if you have opted for an annual cover and 100% of the cost of medical examination if you have opted for a 2 year cover, in the event of the risk being accepted. (`)

3 Key Exclusions* Pre-exiting diseases and its complication for a period of 3 years. 30 days waiting period: Diseases contracted during first 30 days from commencement of policy. First year exclusions: Congenital Internal Anomaly, Any type of Migraine/Vascular head ache, Stones in the Urinary and Biliary systems, Surgery on Tonsils/Adenoids, Gastric and Duodenal Ulcer, Any type of Cyst/dules/Polyps/Benign Tumors/Breast Lumps First Two year exclusions: Spondylosis/Spondilitis, Any type, Inter vertebral Disc Prolapse and such other Degenerative Disorders, Cataract, Benign Prostatic Hypertrophy, Hysterectomy, Salphingo - Oophorectomy, Fistula, Fissure in Anus, Piles, Hernia, Hydrocele, Sinusitis and Deviated Nasal Septum, Heart ailments, Chronic Renal Failure or end stage Renal Failure, Any type of cancer including but not limited to Carcinoma/ Sarcoma Blood Cancer, Diabetes and its related complications both direct and indirect, Hypertension and its related complications both direct and indirect, Organ Transplant, Retinal detachment surgery with or without vitrectomy First Three year exclusions: Osteoarthritis of any joint, Treatment of Joint replacement Surgery by any cause other than accident, Chronic Obstructive Pulmonary Disease (C.O.P.D), Operations for age related macular degeneration (ARMD) or chroidal neo vascular membrane (CNVM) Other Important Exclusions* Treatment of psychiatric, mental or insanity related diseases. Any stay in Hospital not warranting inpatient treatment. Any treatment received outside India. Any treatment in Excluded Hospital. Genetic disorders and stem cell implantation/surgery/storage. Expenses related to pregnancy, maternity (unless covered by the specific plan). Disease due to use of alcohol, drugs, specified diseases due to tobacco use. * The above list of exclusions are illustrative only and is not exhaustive. For detailed list, refer to the policy terms and conditions, which will be made available upon request, by our representative. Important Definition Pre-existing condition: Any condition, ailment or injury or related condition(s) for which you had signs or symptoms, and/or were diagnosed, and/or received medical advice/treatment, within 48 months prior to your first Master Product - Total Health Advantage policy with us. When the Company is admitting liability for pre-existing disease after the requisite waiting period the least sum insured opted in all years of insurance will be considered and cumulative bonuses will not be applicable. IMPORTANT INFORMATION Tax Benefits Premium paid towards Master Product - Total Health Advantage will be eligible for Income tax benefits under Section 80 D in the assessment year in which the premium is paid. This is available on premium paid by you on behalf of yourself, your spouse and dependent children upto a maximum of `25,000 per year. In case of premium paid towards dependent parents you can avail an additional benefit of `25,000 and if they are senior citizens the benefit is extended to upto a maximum of `30,000. The above exemption is as per the Income tax act 1961 and is subject to change as per amendments made thereto from time to time. Application Once you decide to apply for the plan, the applicable premium depending upon the plan chosen by you will be debited from your Credit Card or Bank Account. Your coverage begins from the date the premium is received by Royal Sundaram towards your Master Product Total Health Advantage Plan. Royal Sundaram will issue the policy along with your cashless health card and send it to your mailing address. Exiting the plan Should you wish to cancel your Master Product Total Health Advantage coverage, you can contact Royal Sundaram General Insurance Co. Limited through the contact details shared in this brochure.

4 Free Look / Refund Details This plan, at inception, has a free look period of 15 days from the date of receipt of policy. On review of the policy terms and conditions, If you are not satisfied with this plan, then you can cancel your plan within this 15 days free look period. You shall be eligible for a refund of premium, after deducting applicable risk premium, less the cost of medical examination incurred by the Company and stamp duty charges, where applicable, provided your intimation of cancellation reach us within the free look period. Your policy documents will reach you within 15 days from the date of debit of your card / account. In case you cancel your coverage after the free look period, refund of premium shall be as per the short period rates mentioned in the Policy. company 45 days before the renewal date to initiate the necessary porting formalities there. Even in the event of the individual ceasing to be a customer of the bank / corporate agent, the existing policy shall be renewed under normal circumstances on the terms and conditions prevailing at the time of expiry of the policy. Claims You can claim under your Master Product - Total Health Advantage coverage in two ways: 1. If you plan to get admitted to a hospital that is part of the Master Product - Total Health Advantage network, please call the 24-Hour Paramount Health Services (TPA) Pvt. Ltd. helpline number in your city and take an authorization at least 72 hours in advance. This way you can avail of Master Product - Total Health Advantage Cashless Hospitalization benefit. Once your treatment is over, you can simply walk out of the hospital without worrying about the bills. Royal Sundaram General Insurance Co. Limited will settle the bills directly with the hospital. In case of an emergency hospitalization, you can call Paramount Health Services (TPA) Pvt. Ltd. up to 48 hours after being admitted to take the authorization. 2. In case you have to be admitted to any other hospital, you need to send all the bills along with supporting documentation to Royal Sundaram General Insurance Co. Limited who will then reimburse you. The list of hospitals that are currently part of Master Product - Total Health Advantage network is available in the Policy Summary booklet. Renewal Disclosure Premium will be charged based on the age band in the premium table and the table of rates are subject to a maximum increase of 40%. Any further increase subject to IRDAI's approval. Any change in the terms of cover during renewal shall be subject to IRDAI's approval and a notice of 90 days before expiry of the policy shall be given. The sum insured can be enhanced at the time of renewal up to a maximum of 100% of the expiring sum insured if there are no claims lodged / paid during all years of insurance and the age of the insured person is under 45 years. Such increased sum insured shall however not be applicable for treatment of diseases contracted prior to such increase and also in respect of any pre-existing diseases at the time of application under this policy. However the quantum of increase shall be at the discretion of the company. If a claim has been settled for any of the covered family members in the expiring policy, the earned cumulative bonus, if any, will be reduced by 1 slab in the renewal policy. Children completing 21 years of age at the time of renewal, will be moved to the adult category and the renewal premium will be charged as per the revised family plan. There will be a 30 day grace period available to you from the expiry date to renew your policy. However there will be no coverage during the period of break in insurance. This product can be ported to another company before the renewal date. In case you wish to port, to ensure continuous coverage of the policy with out any break in insurance, please get in touch with the other insurance Summary This brochure is only a brief summary of Master Product - Total Health Advantage. This is not an insurance contract or an offer of insurance. The coverage will be subject to the terms & conditions of the Master Product - Total Health Advantage issued by Royal Sundaram General Insurance Co. Limited. The Company may terminate the policy on grounds like misrepresentation, false representation of a matter of fact or non-disclosure of material fact by the applicant / insured and in such cases the policy shall be terminated immediately, from inception, and applicant / insured shall not be eligible for any refund.

5 Premium - One Year Option PREMIUM CHART - FLOATER SUM INSURED OPTION Silver Plan 2,00,000 3,00,000 5,00,000 Age Band 2A 2 A+1C 2 A+2C 1 A+1 C 1 A+2C 2A 2 A+1C 2 A+2C 1 A+1 C 1 A+2C 2A 2 A+1C 2 A+2C 1 A+1 C 1 A+2C Upto 30 yrs 6,107 8,108 10,063 6,510 7,518 7,178 9,459 11,688 7,567 8,697 10,504 13,870 17,160 11,121 12,796 Upto 40 Yrs 6,729 8,707 10,642 6,901 7,834 7,953 10,199 12,407 8,053 9,091 11,728 15,041 18,297 11,890 13,414 Upto 50 Yrs 11,300 14,005 16,642 9,523 11,260 13,462 16,547 19,558 11,194 13,141 21,147 25,684 30,106 17,229 20,020 Upto 55 Yrs 14,844 17,507 20,103 11,506 13,012 17,685 20,722 23,682 13,554 15,229 25,957 30,436 34,803 19,918 22,396 Upto 60 Yrs 18,318 20,940 23,494 13,445 14,727 21,954 24,940 27,851 15,938 17,338 32,398 36,801 41,092 23,516 25,578 Upto 65 yrs 22,340 24,914 27,422 15,694 16,715 26,948 29,876 32,726 18,728 19,805 40,132 44,445 48,643 27,839 29,401 Upto 70 yrs 33,575 36,020 38,394 21,973 22,268 40,802 43,568 46,256 26,472 26,652 58,177 62,279 66,265 37,923 38,318 Upto 75 yrs 48,647 50,911 53,109 28,875 29,713 59,511 62,056 64,525 35,081 35,896 85,619 89,399 93,063 50,595 51,877 Upto 80 yrs 54,669 56,864 58,991 32,916 33,507 66,986 69,444 71,824 40,076 40,579 96,589 1,00,238 1,03,772 57,903 58,729 Gold Plan 5,00,000 7,50,000 10,00,000 Age Band 2A 2 A+1C 2 A+2C 1 A+1 C 1 A+2C 2A 2 A+1C 2 A+2C 1 A+1 C 1 A+2C 2A 2 A+1C 2 A+2C 1 A+1 C 1 A+2C Upto 30 yrs 19,421 26,267 33,060 19,330 24,346 23,914 31,432 38,911 23,151 28,295 29,009 37,563 46,076 27,821 33,319 Upto 40 Yrs 22,916 29,610 36,302 22,647 27,022 28,838 36,146 43,486 27,797 32,045 35,560 43,834 52,160 33,974 38,286 Upto 50 Yrs 31,432 39,489 47,431 26,120 32,259 42,166 51,186 60,062 33,347 39,739 52,758 63,225 73,512 41,043 48,116 Upto 55 Yrs 36,675 44,670 52,552 29,050 34,852 49,052 57,987 66,783 37,195 43,141 61,973 72,329 82,511 46,195 52,669 Upto 60 Yrs 41,936 49,870 57,690 31,988 37,451 56,688 65,537 74,243 41,463 46,914 72,303 82,540 92,599 51,967 57,773 Upto 65 yrs 50,078 57,917 65,639 36,539 41,473 68,504 77,210 85,779 48,063 52,750 88,289 98,336 1,08,205 60,900 65,673 Upto 70 yrs 66,011 73,660 81,197 45,444 49,347 91,628 1,00,064 1,08,360 60,986 64,177 1,19,572 1,29,251 1,38,753 78,381 81,130 Upto 75 yrs 93,453 1,00,781 1,07,995 60,778 62,907 1,31,459 1,39,424 1,47,251 83,244 83,859 1,73,447 1,82,493 1,91,361 1,05,776 1,07,749 Upto 80 yrs 1,04,422 1,11,621 1,18,705 66,907 68,325 1,47,374 1,55,154 1,62,794 89,837 91,722 1,94,983 2,03,774 2,12,388 1,17,509 1,18,392 Platinum Plan 15,00,000 20,00,000 Age Band 2A 2 A+1C 2 A+2C 1 A+1 C 1 A+2C 2A 2 A+1C 2 A+2C 1 A+1 C 1 A+2C Upto 30 yrs 53,000 69,760 86,398 51,873 63,030 69,896 90,348 1,10,655 67,678 80,207 Upto 40 Yrs 60,818 77,241 93,654 57,749 67,775 81,018 1,00,993 1,20,983 76,081 86,989 Upto 50 Yrs 92,731 1,13,103 1,33,135 74,139 88,493 1,27,382 1,52,884 1,77,917 99,768 1,16,691 Upto 55 Yrs 1,03,867 1,24,105 1,44,006 80,360 93,995 1,44,038 1,69,344 1,94,179 1,09,074 1,24,922 Upto 60 Yrs 1,20,748 1,40,789 1,60,492 89,795 1,02,336 1,69,297 1,94,307 2,18,846 1,23,191 1,37,402 Upto 65 yrs 1,46,866 1,66,598 1,85,996 1,04,390 1,15,241 2,08,370 2,32,919 2,56,998 1,45,026 1,56,709 Upto 70 yrs 1,97,980 2,17,112 2,35,907 1,32,955 1,40,498 2,84,840 3,08,490 3,31,670 1,87,759 1,94,497 Upto 75 yrs 2,86,020 3,04,116 3,21,875 1,82,153 1,84,000 4,16,556 4,38,656 4,60,286 2,54,831 2,59,579 Upto 80 yrs 3,21,205 3,38,887 3,56,232 1,96,772 2,01,387 4,69,199 4,90,679 5,11,691 2,83,514 2,85,590 Applicable only for Renewals. The above premium is inclusive of 14% service tax, 0.5% Swachh Bharat Cess & 0.5% Krishi Kalyan Cess. The Service Tax rate is subject to change, as and when there is an amendment passed by the government. This product has life long renewal. Renewal premium for insured members above the age of 80, will be charged based on applicable premium rates prevailing at the time of their renewal. For the purpose of calculating the premium, please take the highest age among all the applicants and check for the total family premium from the plan options displayed above. Based on the individual risk profile of the customer, the above mentioned premium may be loaded by 25%. (`) Premium - Tow Years Option PREMIUM CHART - FLOATER SUM INSURED OPTION Silver Plan 2,00,000 3,00,000 5,00,000 Age Band 2A 2 A+1C 2 A+2C 1 A+1 C 1 A+2C 2A 2 A+1C 2 A+2C 1 A+1 C 1 A+2C 2A 2 A+1C 2 A+2C 1 A+1 C 1 A+2C Upto 30 yrs 11,784 15,649 19,419 12,565 14,511 13,852 18,254 22,557 14,606 16,785 20,270 26,767 33,115 21,465 24,694 Upto 40 Yrs 12,988 16,803 20,538 13,321 15,121 15,347 19,687 23,946 15,544 17,543 22,635 29,031 35,314 22,948 25,891 Upto 50 Yrs 21,809 27,031 32,120 18,382 21,731 25,980 31,938 37,746 21,602 25,363 40,813 49,568 58,105 33,253 38,639 Upto 55 Yrs 28,649 33,789 38,800 22,206 25,111 34,130 39,994 45,706 26,158 29,392 50,098 58,741 67,170 38,440 43,225 Upto 60 Yrs 35,352 40,414 45,344 25,950 28,424 42,371 48,136 53,752 30,763 33,462 62,528 71,027 79,307 45,386 49,368 Upto 65 yrs 43,115 48,086 52,926 30,289 32,258 52,009 57,662 63,163 36,145 38,223 77,456 85,779 93,883 53,730 56,744 Upto 70 yrs 64,802 69,517 74,101 42,406 42,976 78,749 84,089 89,274 51,091 51,438 1,12,281 1,20,198 1,27,891 73,190 73,952 Upto 75 yrs 93,886 98,260 1,02,502 55,727 57,345 1,14,854 1,19,767 1,24,530 67,704 69,278 1,65,245 1,72,538 1,79,609 97,650 1,00,122 Upto 80 yrs 1,05,512 1,09,749 1,13,853 63,527 64,668 1,29,284 1,34,027 1,38,620 77,346 78,321 1,86,416 1,93,459 2,00,281 1,11,753 1,13,348 Gold Plan 5,00,000 7,50,000 10,00,000 Age Band 2A 2 A+1C 2 A+2C 1 A+1 C 1 A+2C 2A 2 A+1C 2 A+2C 1 A+1 C 1 A+2C 2A 2 A+1C 2 A+2C 1 A+1 C 1 A+2C Upto 30 yrs 37,485 50,696 63,805 37,307 46,985 46,154 60,664 75,101 44,680 54,608 55,987 72,497 88,928 53,693 64,308 Upto 40 Yrs 44,225 57,145 70,063 43,710 52,155 55,660 69,763 83,928 53,647 61,849 68,629 84,598 1,00,669 65,568 73,892 Upto 50 Yrs 60,664 76,213 91,545 50,410 62,262 81,384 98,788 1,15,921 64,360 76,694 1,01,825 1,22,024 1,41,878 79,213 92,865 Upto 55 Yrs 70,785 86,214 1,01,427 56,066 67,260 94,670 1,11,918 1,28,892 71,784 83,260 1,19,609 1,39,599 1,59,244 89,155 1,01,651 Upto 60 Yrs 80,938 96,247 1,11,341 61,737 72,278 1,09,412 1,26,487 1,43,290 80,024 90,544 1,39,547 1,59,303 1,78,715 1,00,296 1,11,502 Upto 65 yrs 96,650 1,11,778 1,26,687 70,521 80,043 1,32,210 1,49,016 1,65,553 92,762 1,01,809 1,70,398 1,89,788 2,08,838 1,17,537 1,26,748 Upto 70 yrs 1,27,402 1,42,166 1,56,710 87,704 95,238 1,76,843 1,93,125 2,09,133 1,17,705 1,23,862 2,30,772 2,49,455 2,67,793 1,51,274 1,56,579 Upto 75 yrs 1,80,364 1,94,509 2,08,428 1,17,302 1,21,409 2,53,713 2,69,090 2,84,197 1,60,663 1,61,846 3,34,753 3,52,212 3,69,329 2,04,149 2,07,960 Upto 80 yrs 2,01,535 2,15,428 2,29,101 1,29,130 1,31,868 2,84,432 2,99,445 3,14,191 1,73,384 1,77,024 3,76,315 3,93,284 4,09,910 2,26,791 2,28,495 Platinum Plan 15,00,000 20,00,000 Age Band 2A 2 A+1C 2 A+2C 1 A+1 C 1 A+2C 2A 2 A+1C 2 A+2C 1 A+1 C 1 A+2C Upto 30 yrs 1,02,293 1,34,637 1,66,747 1,00,113 1,21,648 1,32,958 1,71,862 2,10,493 1,28,742 1,52,572 Upto 40 Yrs 1,17,380 1,49,075 1,80,754 1,11,458 1,30,805 1,54,117 1,92,113 2,30,139 1,44,722 1,65,473 Upto 50 Yrs 1,78,971 2,18,287 2,56,949 1,43,089 1,70,792 2,42,311 2,90,820 3,38,438 1,89,780 2,21,975 Upto 55 Yrs 2,00,462 2,39,521 2,77,931 1,55,096 1,81,410 2,73,994 3,22,132 3,69,375 2,07,485 2,37,632 Upto 60 Yrs 2,33,042 2,71,722 3,09,748 1,73,307 1,97,508 3,22,043 3,69,616 4,16,294 2,34,338 2,61,373 Upto 65 yrs 2,83,449 3,21,535 3,58,971 2,01,473 2,22,417 3,96,368 4,43,066 4,88,872 2,75,871 2,98,098 Upto 70 yrs 3,82,098 4,19,026 4,55,301 2,56,604 2,71,161 5,41,837 5,86,822 6,30,916 3,57,162 3,69,978 Upto 75 yrs 5,52,017 5,86,945 6,21,220 3,51,557 3,55,121 7,92,389 8,34,426 8,75,575 4,84,748 4,93,780 Upto 80 yrs 6,19,924 6,54,054 6,87,527 3,79,768 3,88,674 8,92,529 9,33,387 9,73,355 5,39,309 5,43,259 Applicable only for Renewals. The above premium is inclusive of 14% service tax, 0.5% Swachh Bharat Cess & 0.5% Krishi Kalyan Cess. The Service Tax rate is subject to change, as and when there is an amendment passed by the government. This product has life long renewal. Renewal premium for insured members above the age of 80, will be charged based on applicable premium rates prevailing at the time of their renewal. For the purpose of calculating the premium, please take the highest age among all the applicants and check for the total family premium from the plan options displayed above. Based on the individual risk profile of the customer, the above mentioned premium may be loaded by 25%. (`)

6 UIN: IRDAI/NL-HLT/RSAI/P-H/V.I/213/Plan I/13-14 Disclaimer Master Product - Total Health Advantage product is underwritten and issued by Royal Sundaram General Insurance Co. Limited. Claims will be settled by Royal Sundaram General Insurance Co. Limited as per the terms and conditions of the policy. This brochure is not a contract of Insurance. Please refer policy document for exact terms and conditions and specific details applicable to this Insurance. Your participation in this insurance product is purely on a voluntary basis. We advise you to take your own professional advice before you participate. Master Product - Total Health Advantage product of Royal Sundaram is approved by IRDAI. Section 41 of the Insurance Act, Prohibition of rebates 1) 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. 2) Any person making default in complying with the provisions of this section shall be liable for penalty which may extend to ten lakh rupees. Complaints/Grievances Incase of complaints/grievances please call Royal Sundaram General Insurance Co. Limited. Toll : or customer.services@royalsundaram.in ABOUT ROYAL SUNDARAM Royal Sundaram General Insurance Co. Limited is the first private non-life Insurance Company licensed to operate in India. Started in the year 2000, Royal Sundaram offers a range of innovative general Insurance products which includes Health, Personal Accident, Home and Travel Insurance for individual customers. The company s Accident and Health claims process received ISO certification for its effective customer service delivery. For commercial clients, Royal Sundaram offers a wide range of specialised insurance covers in Fire, Marine, Engineering, Liability and Business Interruption risks. The company also offers specially designed products to the Small and Medium Enterprises and rural customers. REACH US Call: Log on to: customer.services@royalsundaram.in Follow us on Facebook/Twitter Royal Sundaram General Insurance Co. Limited (Formerly known as Royal Sundaram Alliance Insurance Company Limited) Vishranthi Melaram Towers,. 2 / 319, Rajiv Gandhi Salai (OMR), Karapakkam, Chennai Registered Office: 21, Patullos Road, Chennai Royal Sundaram IRDAI Registration.102 CIN-U67200TN2000PLC PR16029/JUL16/C088/C095

7 Master Product - Total Health Advantage Campaign Code: Please tick C088 C095 To ensure priority processing, please complete all sections in CAPITAL letters. Please tick in the relevant boxes. For Office use only: Sum Insured Type : Floater Plan : Silver Gold Platinum Tenure Opted : 1 year 2 years PLEASE TELL US ABOUT YOURSELF ( APPLICANT DETAILS) Title Mr. Ms. Others (Please Specify) Name First Name Middle Name Last Name Postal Address City State Pincode Landmark Date of Birth Married PAN.* Telephone(Office) Area Code - Phone Number (Residence) Area Code - Phone Number Mobile Number Area Code - Phone Number minee Name : minee Relationship to Applicant : * Mandatory if premium under this application is Rs. 50,000 or more Is your nominee also proposed for cover in this policy PLEASE TICK AGAINST THE APPLICABLE DESCRIPTION, IF YOU FALL UNDER ANY OF THE BELOW LISTED CATEGORIES. IF YOU FALL UNDER MORE THAN ONE OF THE LISTED TITLES BELOW, PLEASE TICK AGAINST ALL THE APPLICABLE HEADS. Head of State or of Government Senior Executive of State-Owned Corporation Senior Politician Important Political Party Official Senior Government/Judicial/Military Officer Details of members to be covered Sl.. Name Sex Relationship with the Applicant Date of Birth (DD/MM/YYYY) Floater Sum Insured (`) Total Premium (`) MEDICAL HISTORY DETAILS Are you/ other family members proposed in good health and free from physical and mental disease or infirmity or medical complaints : Have you / other family members proposed, in the past 48 months ever suffered from any symptom of Diseases/illness / or sustained any accident and / or Diagnosed with any disease/illness or have received any treatment or undergone any surgery for any diseases/illness. : If yes, give details for each person proposed Sl. Name of the Proposed Person Nature of illness/disease/injury Date first diagnosed Treatment taken/now being taken/surgery done Name of the attending medical practitioner with phone number Are there any additional facts affecting the proposed Insurance which should be disclosed to Insurers? :... Continued Overleaf

8 Have you ever suffered from or currently suffering from or under treatment for the following? Details Member 1 Member 2 Member 3 Member 4 Member 5 Member 6 High blood sugar / Diabetes Heart Disease Blood Pressure (Hypertension ) / Stroke Chronic Obstructive Pulmonary disease Any type of Cancer Any type of Arthritis Seizure disorder/epilepsy Kidney / Liver problems / Any type of Hepatitis Do you have any other Health Insurance / Mediclaim / Personal Accident Insurance Policies under any other schemes including credit cards, employee schemes etc. (from Royal Sundaram or any other company) If, please give the following details Health / Mediclaim/ PA Name of the Person covered Name of the Company Policy Number Period of Insurance Sum Insured Declaration I declare that persons proposed include my family members and they are not engaged in high - risk occupation. I also declare that I have explicitly given information of any pre - existing disease that they have and understand that such pre - existing medical conditions will not be covered under the policy (as per policy conditions). I/We hereby declare, on my behalf and on behalf of all persons proposed to be insured, that the above statements, answers and/or particulars given by me are true and complete in all respects to the best of my knowledge and that I/We am/are authorized to propose on behalf of these other persons. I understand that the information provided by me will form the basis of the insurance policy, is subject to the Board approved underwriting policy of the insurance company and that the policy will come into force only after full receipt of the premium chargeable. I/We further declare that I/we will notify in writing any change occurring in the occupation or general health of the life to be insured/proposer after the proposal has been submitted but before communication of the risk acceptance by the company. I/We declare and consent to the company seeking medical information from any doctor or from a hospital who at anytime has attended on the life to be insured/proposer or from any past or present employer concerning anything which affects the physical or mental health of the life to be assured/proposer and seeking information from any insurance company to which an application for insurance on the life to be assured/proposer has been made for the purpose of underwriting the proposal and/or claim settlement. I/We authorize the company to share information pertaining to my proposal including the medical records for the sole purpose of proposal underwriting and/or claims settlement and with any Governmental and/or Regulatory authority. This proposal shall form the basis of contract of Insurance. If any statements, answers, particulars are untrue or incorrect, the insurer shall incur no liability under this insurance. I hereby agree to apply on behalf of myself and / or my family members to the Master Product Total Health Advantage product offered by Royal Sundaram General Insurance Co. Limited. I am also aware that the entire amount of the initial premium needs to be paid for the insurance policy to come into force and the renewal premia is subject to change as per the relevant age band and service tax rates, amended by Govt. of India, Ministry of Finance. I hereby authorize the bank to debit my bank account / credit card and pass on the proceeds to the insurance company. This debit authority will stay in force till such time that I make a written representation to cancel the said instruction. I hereby authorize Paramount Health Services (TPA) Pvt. Ltd., to process claims and receive reimbursement proceeds from Royal Sundaram General Insurance Co. Limited. I understand that the corporate agent will earn 15% as commission on this policy in their capacity as the licensed Corporate Agent of Royal Sundaram General Insurance Co. Limited. Please note that suppression of information about pre existing disease at the time of application will make the contract void from inception I confirm that I have understood all the terms, conditions, coverages, and exclusions (related to: pre-existing diseases, first 30 days exclusions, first year exclusions, first two years exclusions and first three years exclusions) and I accept them. I confirm that I have understood the premium amount ( including loading charges, as applicable) payable by me for this policy to be issued by the insurance company and I agree to pay this amount. I understand that the company may terminate the policy immediately, from inception, on grounds of misrepresentation, false representation of a matter of fact or nondisclosure of material fact by the applicant / Insured and in such case the Company shall not refund any portion of the premium to the applicant. All insurance applications are subject to the Insurance Company s under writing and acceptance. This policy is underwritten by Royal Sundaram General Insurance Co. Limited with its registered office at. 21, Patullos Road, Chennai For more details on risk factors, please read the policy terms and conditions, which can be made available on request, before concluding the sale. Section 41 of the Insurance Act, Prohibition of rebates: 1) 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. 2) Any person making default in complying with the provisions of this section shall be liable for penalty which may extend to ten lakh rupees. Signature : Date: For detailed terms and conditions, please refer insurance policy document. D D M M Y Y FOR INTERNAL USE SP Name SP Employee ID SP Branch SP Code SP Signature UIN: IRDAI/NL-HLT/RSAI/P-H/V.I/213/Plan I/13-14 Royal Sundaram General Insurance Co. Limited. (Formerly known as Royal Sundaram Alliance Insurance Company Limited) Vishranthi Melaram Towers,. 2 / 319, Rajiv Gandhi Salai (OMR), Karapakkam, Chennai Registered Office: 21, Patullos Road, Chennai Royal Sundaram IRDAI Registration.102 CIN-U67200TN2000PLC customer.services@royalsundaram.in PR16029/JUL16/C088/C095