Health First

Individual /Non-Linked /Non-Participating/ Fixed Benefit Health Insurance Plan

"This is the authorized presentation and should not be altered without the permission of the Insurance Company.“Version : Oct’19

Key BenefitsPresenting an ideal and comprehensive solution

• Option to cover yourself against Heart ailments, Cancer conditions or Major Critical Illness

• High coverage at affordable premiums

• Increasing cover option to take care of increasing medical needs

• Offers lump-sum payout on the first diagnosis of illness irrespective of actual amount spent on treatment

• Waiver of all future premiums on first diagnose of Minor Conditions covered under Cancer Cover and Heart Cover

• Option of additional monthly income in case of Major Claim (Heart and Cancer Cover) & Major Critical Illness Cover

• Get all your premiums paid back on maturity, under Major Critical Illness Cover, if Return of Premium Option is opted (if there is no claim during the Policy Term)

• Premiums paid towards this Policy is eligible for tax benefits* as per Section 80D of Income Tax Act 1961.

*Premiums paid towards this Policy is eligible for tax benefits as per Section 80D of Income Tax Act 1961. Tax laws are subject to amendments from time to time. Please consult your independent tax advisor for tax related matters.

Plan OptionsBuild your own plan as per need

• Covers Major critical illnesses

• Excludes conditions related to cancer and Heart

Major Critical Illness Cover

• Minor and Major Conditions

• Covers all Major Heart DiseasesHeart Cover

• Minor and Major Conditions

• Cover all types of CancerCancer Cover

Option A

Option B

Option C

Choose more than one option Stand Alone Coverage

Plan OptionsBuild your plan as per need

• Separate Terms and Conditions for each option

• More than one option can be selected

• Customer to receive Terms & Conditions of each of the coverage option

Coverage OptionsChoose suitable plan option to align with Healthcare needs

Level Sum Assured

Increasing Sum Assured

• Fixed Sum Assured for entire policy term

Level cover

Increasing cover option

• 10% increase in SA each year

• Maximum increase upto 150% of initial SA

100%110%

120%130%

140%150% 150%

Coverage OptionsIncreasing Cover Option - Conditions

Increasing cover option will continue till the earlier of:

Once claim is made,

• All future claims shall be based on the increased Sum Assured as at the time of first claim

• No further increases to the Sum Assured

Increased Sum Assured becoming 150% of the Initial SA

Any claim event or

Parameters Minimum MaximumEntry Age 18 years 65 years

Maturity Age 23 years 80 years

Sum Assured (Rs.)Major Critical Illness - 5 lacsHeart Cover- 5 lacsCancer Cover- 5 lacs

Major Critical Illness - 50 lacsCancer Cover- 50 lacsHeart Cover- 40 lacs(For Increasing Cover option under Heart Cover, the maximum Sum Assured allowed is 25 lacs)

Policy Term

5 Years

Return of Premium Option under Major Critical Illness Cover: 10 years

40 years, subject to maximum maturity age of 80 years

Return of Premium Option under Major Critical Illness Cover: 20 years, subject to maximum maturity age of 80 years

Premium Payment Term

Regular Pay (Same as policy term)

Premium PaymentMode

Annual and Monthly(In case of Monthly mode, Annual premium needs to be multiplied with a factor of 0.09 to arrive at the monthly installment premium payable)

Boundary conditions

Ready Reckoner of annual premium

Sum Assured Age Plan OptionPolicy Term

10 years 20 years

20,00,000

30 years

Cancer Cover 1,035 1,195

Heart Cover 1,909 2,916

Major Critical Illness Cover

1,804 1,806

40 years

Cancer Cover 1,966 3,263

Heart Cover 6,353 8,989

Major Critical Illness Cover

2,389 2,535

Above premiums are without additional option (s) and for a healthy male and exclusive of Goods and Services Tax & applicable cess (es)/levy

Premiums paid towards this Policy is eligible for tax benefits as per Section 80D of Income Tax Act 1961. Tax laws are subject to amendments from time to time. Please consult your independent tax advisor for tax related matters.

Quick and easy idea of the annual premium payable for each of the options

Benefits available

Lump-sum payout on the first diagnosis of covered illness irrespective ofactual amount spent on treatment

Benefit payableLump-sum on occurrence of Insured event

Lumpsum Benefit on first diagnosis

Heart & Cancer

Minor Condition Claim

25% of Sum Assured

Major Condition Claim

Occurred after minor condition claim

75% of Sum Assured

Without occurrence of minor condition claim

100% of Sum Assured

Major Critical Illness

100% of Sum Assured

Benefit payable

Major & Minor Condition Example of covered illnesses

Major Critical Illness Cover

• 26 Critical Illnesses covered

• Example : Alzheimer Disease, Brain Surgery, Lung Failure, Kidney Failure, Third Degree Burns, Deafness, Blindness etc.

Heart Cover

Minor conditionExample : Insertion of a permanent cardiac pacemaker, Angioplasty, Stenting, Valve repair or replacement etc.

Major condition

Example : Heart Attack, Stroke, Open Chest CABG, Aorta Surgery Heart Transplant etc.

Cancer Cover

Minor conditionExample : Early stage cancer -Tumor, Carcinoma-in-situ covering organs like Breast, Uterus, Cervix, Lung, Stomach, Urinary tract etc.

Major conditionExample : Cancer of specified severity – malignant tumor, term cancer – leukaemia, lymphoma and sarcoma etc.

For details on covered illnesses, refer to product brochure or sample policy contract available on our corporate website

Waiver of Premium BenefitIn-built benefit

Heart Cover Cancer CoverApplicable in case of

Minor Condition claim

Benefit• No Need to pay further premiums

• Coverage continues

• Premium waived only for plan option on which the claim is made

• For other plan options (if opted), premium will continue to be paid

Monthly Income BenefitHelp family deal with loss of income

• Following the date of the diagnosis of Major Heart/Cancer Condition/Major Critical Illness Cover

• Paid as and when due irrespective of the expiry of the policy term

• Optional benefit to be chosen at inception of the policy

• This monthly income payment is over and above the lump-sum payment made on diagnosis of the illness/ condition, and iscontinued to be paid to your Nominee for the total defined period of 5 years, even in case of your unfortunate death

Heart Cover Cancer CoverApplicable in case of

Major Condition claim

Major Critical Illness Cover

Benefit 1% of Sum Assured chosen at inception paid every month for 5 years (i.e. 60 months)

Monthly Income BenefitOption to Nominee for Commutation

• Nominee can also request for commuting the remaining monthly instalments into lump sumwithin six months of the death of the Life Assured

• On the request for such commutation, the value of the remaining monthly instalments,discounted at 4.0% per annum, shall be payable and no further benefit shall be payable thereafter

Return of Premium OptionTakes care of ongoing health/medical expenses

Applicable in case of Major Critical Illness CoverFor Policy term 10 to 20 years

Benefit All premiums* paid returned at maturity

*includes modal loading but excludes underwriting extra & Goods and Services Tax & applicable cess(es)/levy, if any

• Not available with Heart and Cancer cover

• Paid upon survival of the Life Assured till the end of the Policy Term without any claim having made, whilethe Policy is in-force

Maturity Benefit

Maturity Benefit applicable in case of

Major Critical Illness CoverWhen “Return of Premium”

benefit chosen

No Maturity Benefit, in case of

• Heart Cover or Cancer Cover

• Major Critical Illness Cover if “Return of Premium” benefit is not opted for

Summary of Benefits

Heart Cover Cancer CoverMajor Critical Illness Cover

Waiver of Premium (Inbuilt)Applicable for Minor Condition Claim

Monthly Income Benefit (Optional)Applicable for Major Condition Claim

Return of Premium Benefit (Optional)Applicable on Maturity

Increasing Sum Assured (Optional)Maximum 150% of initial SA

Other conditions

Waiting Period

Risk Commencement date Revival date

Applicable

or

whichever is later

From

180Days

Waiting PeriodConditions

In case more than one cover is opted,

• Only that particular cover will terminate for which signs and symptoms have occurred during the waiting period

• Premiums will be payable for the cover that continues

Heart Cover Cancer CoverMajor Critical Illness Cover

No Benefit payable within Waiting period

Survival Period

Heart Cover

Cancer Cover

Major Critical Illness Cover

15 days from the date of diagnosis of any of the covered illnesses/first performance of any of the covered surgeries

7 days from the date of diagnosis of any of the listed conditions

7 days from the date of diagnosis of any of the listed conditions

Paid-up value benefit

Paid-up Value applicable in case of

Major Critical Illness CoverWhen “Return of Premium” benefit

chosen

Paid-up Benefit

• Paid – up Sum Assured

In case monthly income benefit opted for,

• Monthly income benefit = 1% of (i𝑛𝑖𝑡𝑖𝑎𝑙 𝑆𝐴 ∗𝑵𝒐.𝒐𝒇 𝒑𝒓𝒆𝒎𝒊𝒖𝒎𝒔 𝒑𝒂𝒊𝒅

𝑵𝒐.𝑷𝒓𝒎𝒆𝒊𝒖𝒎𝒔 𝒑𝒂𝒚𝒂𝒃𝒍𝒆)

• Payable on first diagnosis or first performance of any of the listed Surgeries in relation to a Major Critical Illness

• Monthly income benefit

• Payable for a period of 5 years from the date of the diagnosis of Major Critical Illness

Surrender

Surrender Value applicable in case of

Major Critical Illness CoverWhen “Return of Premium”

benefit chosen

• Surrender anytime during the policy term

• No Surrender benefit under Heart or Cancer cover

• Policy will terminate and cannot be revived thereafter

Surrender Value payable

Guaranteed Surrender Value (GSV)

Special Surrender Value (SSV)

OR Whichever is higher

Premium Guarantee

Any such change in premium is subject to prior approval from IRDAI

Premium rates reviewed after completion of

5 Policy Years

Reviewed premiums remain unchanged for every block of 5 Policy

Years

Revival

Due date of first unpaid premiumYears

Revive within

From

Reapply

180Days

Waiting Period

Stay Covered

Revival

Revive after expiry of grace period

Within 30 days

Outstanding premium

Interest

Post 30 days & within 5 years

Complete health declaration

Outstanding premium

Interest

• Policy will continue with all benefits during the grace period of 30 days (15 days for monthly mode)

• Request for revival may be accepted or declined based on Board approved underwriting policy

Stay Covered

Unpaid PremiumBenefit payable

• Benefit payable after deducting due premiums

If illness is diagnosed during the grace period

• No benefit payable

If illness diagnosed after the grace period and before/after end of revival period

ClaimConditions

Admissible on diagnosis of first ever occurrence of any of listed conditions

Possible to raise One Minor & One Major claim

Total pay-out <= 100% of SANo impact on SA of other cover in case

of Claim under one type of cover

Ailments Covered

• Any condition, ailment or injury or related condition(s) for which there were signs or symptoms, and / or were diagnosed, and / or for which medical advice / treatment was received within 48 months prior to the first policy issued by the insurer and renewed continuously thereafter.

• Pre- Existing Disease/ Condition/s are not covered unless Insured has disclosed the same at the time of proposal or date of Revival whichever is later and the Company has accepted the same. Even if Pre-existing Disease/Condition is accepted by the insurer upon disclosure, a waiting period of 180 days would still apply from the Risk Commencement Date or the date of Revival whichever is later

ExclusionsPre-existing condition

Major Critical Illness Cover Heart Cover

1. Alzheimer's Disease

2. Aplastic Anaemia

3. Deafness

4. Loss of Speech

5. Medullary Cystic Kidney Disease

6. Parkinson’s Disease

7. Systemic Lupus Erythematosus (SLE) with Lupus Nephritis

8. Motor Neurone Disease With Permanent Symptoms

9. Multiple Sclerosis With Persisting Symptoms

10. Apallic Syndrome

11. Benign Brain Tumour

12. Blindness

13. Brain Surgery

14. End-stage Lung Failure

15. End Stage Liver Failure

16. Loss of Limbs

17. Third Degree Burns

18. Major Head Trauma

19. Coma Of Specified Severity

20. Kidney Failure Requiring Regular Dialysis

21. Permanent Paralysis Of Limbs

22. Fulminant Viral Hepatitis

23. Muscular dystrophy

24. Poliomyelitis

25. Loss of independent existence

26. Pneumonectomy

Major Conditions Covered:

1.MYOCARDIAL INFARCTION First Heart Attack – Of Specified Severity

2.Cardiomyopathy

3.Stroke Resulting in Permanent Symptoms

4.Coronary Artery Bypass Graft (Open, Keyhole or minimally invasive or Robotic

Cardiac CABG)

5. Major surgery of the Aorta

6.Open Heart Replacement or Repair of Heart Valves

7.Heart Transplant

8.Primary (Idiopathic) Pulmonary Arterial Hypertension

Minor Conditions Covered

1.. Initial implantation of permanent pacemaker of the heart or implantable

cardioverter-defibrillator (icd)

2.Angioplasty and Stenting for Coronary Arteries

3.Angioplasty and Stenting for Carotid Arteries

4.Renal Angioplasty

5.Percutaneous procedures for heart valve repair or replacement

6..Surgical septal myomectomy to relieve left ventricular outflow tract (lvot)

obstruction in hypertrophic obstructive cardiomyopathy (hocm)

7.Pericardectomy

Conditions and ailments covered

Cancer Cover

Minor Conditions

(a) Early Stage Cancer

Early Stage Cancer shall mean first ever diagnosis with the presence of one of the following malignant conditions:

i. Tumour of the thyroid histologically classified as T1N0M0 according to the TNM classification;

ii. Prostate tumour should be histologically described as TNM Classification T1a or T1b or T1c are of another equivalent or lesser classification.

iii. Chronic lymphocytic leukaemia classified as RAI Stage I or II;

iv. Basal cell and Squamous skin cancer that has spread to distant organs beyond the skin,

v. Hodgkin’s lymphoma Stage I by the Cotswold’s classification staging system.

Vi All tumours of the urinary bladder histologically classified as T1N0M0 (TNM Classification)

The Diagnosis must be based on histopathological features and confirmed by a Pathologist.

Pre-malignant lesions and conditions, unless listed above, are excluded.

(b). Carcinoma-in-situ

Carcinoma-in-situ shall mean first ever diagnosis of a histologically proven, localized preinvasion lesion where cancer cells have not yet penetrated the basement membrane or invaded (in the sense of infiltrating and / or actively

destroying) the surrounding tissues or stroma in any one of the following covered organ groups, and subject to any classification stated:

i. Breast, where the tumour is classified as Tis according to the TNM Staging method;

ii. Uterus, vagina, vulva or fallopian tubes where the tumour is classified as TIS according to the TNM Staging method or FIGO* Stage 0;

iii.Cervix uteri, classified as cervical intraepithelial neoplasia grade III (CIN III) or as Tis according the TNM Staging method or FIGO* Stage 0;

iv.Ovary –include borderline ovarian tumours with intact capsule, no tumour on the ovarian surface, classified as T1aN0M0, T1bN0M0 (TMN Staging) or FIGO 1A, FIGO 1B;

v. Colon and rectum;

vi. Penis;

vii. Testis;

viii. Lung;

ix. Stomach and esophagus;

x. Urinary tract, for the purpose of in-situ cancers of the bladder and uroepithelium, stage Ta papillary carcinoma is included

xi. Nasopharynx

For purposes of this Policy, Carcinoma-in-situ must be confirmed by a biopsy & confirmed by a Registered Medical Practitioner.

* FIGO refers to the staging method of the Federation Internationale de Gynecologie et d’Obstetrique

Pre-malignant lesions and carcinoma in situ of any organ, unless listed above, are excluded.

Major Condition:

Major Stage Cancer

A malignant tumour characterized by the uncontrolled growth and spread of malignant cells with invasion and destruction of normal tissues. This diagnosis must be supported by histological evidence of malignancy. The term cancer

includes leukaemia, lymphoma and sarcoma

Conditions and ailments covered

Termination

Due Premiums not paid during revival period

Earliest of these events – Major Condition claim/Major Critical Illness claim or maturity claim amount

In case of fraud or misrepresentation, the policy shall be cancelled immediately

Valid free-look cancellation request

On the date of the Insured’s death

On the date of intimation of acceptance of the claim in respect of an Insured Event, in accordance with the terms and conditions of the Policy

On the Maturity Date

In case of misstatement of Age, fraud, misrepresentation or forfeiture

Benefit Illustration

“Always Expect the Unexpected from Life”All 3 Plan options

Age 45

Diagnosed with minor condition on Heart

Immediate payout of Rs. 5 Lacs for minor condition Heart Cover

All Future premiums are waived for Heart cover

Major Critical Illness & Cancer Cover premium to be paid as is

Age 55

Undergoes a Major condition under Heart Cover

Immediate payout of Rs. 15 Lacs for major Heart condition

Major Critical Illness & Cancer Cover premium to be paid as is

Age 60Diagnosed Major Critical Illness

Immediate payout of Rs. 10 Lacs for major Critical Illness cover

Cancer Cover premium to be paid as is

Age 35 Sachin Purchases Health First with all 3 coverage options for 30 yrs – CI 10 Lacs, Heart – 20 Lacs and Cancer – 10 Lacs

Annual Premium for Major CI : Rs 1,340/-, Heart : Rs 7,374/- and Cancer : Rs 1,687/-Total Premium* : Rs. 10,401/-

*The above premiums are for a healthy male and exclusive of Goods and Services Tax & applicable cess (es)/levy.

1 2 3 4 5 6 7 8 9 10So

on…15

So on…

20So

on…25

So on…

30

Annual Premium Payable : Rs.10,401/- , Policy & Premium Payment Term : 30 years

Age 45

Undergoes Major Heart condition = 15 lacs (remaining

SA) paid immediately

Diagnosed with MinorHeart condition = 5 lacs

paid immediately

Diagnosed with Major Critical Illness = 10 lacs

paid immediately

Age 55

Age 60

Major CI & Cancer Cover premium ContinueCancer Cover

premium Continue

Age 65

Major CI, Heart Cover & Cancer Cover premium being paid

Total Benefit paid Rs. 30 lacs

Age 35

Total benefit Paid = Rs 30 lacs (5 lacs Minor Heart Claim + 15 lacs Major Heart Claim + 10 lacs Major Critical Illness)

Sachin was prepared to expect the unexpected of a heart ailment and Critical Illness

Future premiums payable for Heart cover - Waived

Monthly Income Benefit

Age 45

Diagnosed with minor Cancer condition

Immediate payout of 5 Lacs for minor Cancer condition

All Future premiums are waived

Age 55

Diagnosed with Major Cancer condition

Immediate payout of Rs. 15 Lacs for major Cancer condition

Rs 20,000 is paid for next 60 months as monthly income

Age 58

Unfortunately passes away at the age of 58

Monthly income of Rs. 20,000 continues for family for the remaining duration

“Continue achieving your life goals without any speed breaker”

Policy terminates after payment of the last monthly income

Age 40 Shilpa purchases Health First Cancer Cover – SA 20 LacsPolicy Term – 30 yrs ; Annual Premium* – Rs. 12,420/-

*The above premiums are for a healthy female and exclusive of Goods and Services Tax & applicable cess (es)/levy.

1 2 3 4 5 6So

on..10 14 15 16 17 18 20

So on…

25So

on…30

Annual Premium Payable : Rs.12,420/-, Policy & Premium Payment Term = 30 years

Age 45

Age 55

Age 58

Future premiums payable Waived

Age 70

Premium paid for 5 years

Total Benefit paid Rs. 32 lacs

Age 40

Diagnosed with MinorCancer condition = 5 lacs

paid immediately

Policy terminated after payment of last

monthly income

Age 60

Total benefit Paid = Rs 32 lacs (5 lacs Minor Cancer Claim + 15 lacs Major Cancer Claim + 12 lacs Monthly Income [20,000*12*5])

Diagnosed with Major Cancer conditionA. 15 lacs paid immediatelyB. Monthly Income Rs.20,000

paid for next 60 months

Shilpa continued her Life Goals without any speedbreaker with Monthly Income Benefit

Enjoy peace of mind knowing that someone will take care of your rising medical bills when you are illIncreasing Cover Benefit

Age 37 Years Buys Health First Plan with Heart Cover for 20 Lacs for 20 Years with Increasing Cover BenefitAnnual Premium* – Rs.9,439/-

Age 42Years

Undergoes Angioplasty

Immediate payout of Rs. 7 Lacs (25% of Increased SA of Rs.28 Lacs)

No payment of further Premiums

Age 50 YearsUnderwent Major Surgery of the Aorta

Remaining Rs.21 Lacs Paid & Policy terminates*The above premiums are for a healthy male and exclusive of Goods and Services Tax & applicable cess (es)/levy.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 So on.. 20

Annual Premium Payable : Rs.9,439/-, Policy & Premium Payment Term = 20 years

Age 50

Diagnosed with Major Heart condition = 21 lacs

paid immediately

Age 57

Total benefit Paid = Rs 28 lacs for Major Heart Claim

Age 37

Policy terminates

20 lacs

22 lacs

24 lacs

26 lacs

28 lacs

Increasing Sum Assured

Enjoy peace of mind knowing that someone will take care of your rising medical bills when you are ill

Diagnosed with Minor Heart condition = 7 lacs

paid immediately

Age 42

Future premiums payable for Heart cover - Waived

No further increase in SA

Thank You

"This is the authorized presentation and should not be altered without the permission of the Insurance Company.“Version : Oct’19