HOPE MEDI 100% · HOPE Medi allows including dependent parents of members irrespective of age(...
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Dear IDA Hope member, Greetings from the IDA Hope Office Our group Health insurance policy - HOPE MEDI is moving to its 4 th year of operation now. The scheme is extended for IDA HOPE Members, Spouse, Children and Parents. 1066 member families were covered under HOPE MEDI in the current year with an amount of more than 1 crore 90 Lakhs already disbursed. With an ICR (Incurred Claims Ratio) of more than 100% every year and claim rejection ratio of less than 0.2%, this undoubtedly is the most beneficial and economical Medical Insurance scheme available to us. It may be also noted that our scheme has benefited many of our members for treatment of life threatening diseases, some of whom were in a dire financial crisis. This year we utilized our Critical illness buffer for one of our members (5 lakhs). It may be noted that 47% of the claims have been availed for parents of members who otherwise may have been denied insurance cover due to age bar and pre-existing diseases. For them this is the most economical insurance scheme considering the risk profile. As you are aware the hospital admission expenses and treatment charges are increasing due to the higher Hospital expenses (minimum wages revision, operational cost escalation and GST tax additions are among the reasons). Since the claim ratio of the previous years far exceeds permissible limits, our premium will also have an unavoidable hike. The payout policy has been gently limited to avoid premium going overboard in the coming years. It has also been decided to make the members aware on how effectively we can use the scheme to our advantage and also prevent unnecessary excess expenses being incurred on your claims by hospitals. The scheme is up for renewal by October 2 nd 2018. In order to renew our policy and provide continuous coverage we have successfully negotiated the renewal terms to pay the premium for the next year before 1 st October 2018. We had invited proposals from different insurers / brokers and negotiated the premium to be paid for the year 2018–19 to the best advantage of our members. The HOPE office has decided to renew our policy with UNITED INDIA INSURANCE CO. LTD, with Cosmos Insurance Brokers, Kochi as our service providers for the coming year 2018-19. The salient features of HOPE Medi Ours is a specifically tailor made Group Health Insurance policy (Family Floater policy) for our members and their families. 1. No medical check-up for entry, irrespective of age 2. Cover starts from day one itself. 3. Pre-existing diseases are covered for members and their dependants(standard policies require medical checkup and any diseases found are excluded from coverage) 4. Parents can be included in the cover (Pre-existing illness for a period of 1 year will not be covered for parents joining for the first time) 5. HOPE Medi allows including dependent parents of members irrespective of age( standard mediclaim policies do not allow parents to be included) 6. Group Critical Illness Buffer - HOPE Medi extends an additional cover of Rs 5 Lakhs per individual in addition to the sum insured selected by the individual member, for the treatment of specified major illness like cancer, heart diseases etc. 7. Critical Illness Buffer (listed below) exceeding the claim limit is provided for members, spouse and children (excluding parents)but limited to only for the first instance of the illness under the scheme 1) Cancer 2) Heart Ailments 3) Multiple Sclerosis 4) Paralysis 5) Heart Surgery 6) Accident Induced Trauma Care 7) Stroke 8) Renal Failure 9) Motor Neuron Disease with permanent symptoms 10) Major Organ Transplantation 11) Major Burns 12) Benign Brain Tumors 13) Bacterial Meningitis 14) Apallic Syndrome 15) Chronic Lung Disease 16) End Stage Liver disease 17) Inter vertebral disc prolapse. 8. The additional critical illness buffer is provided with a provision of reserve fund for claims up to 5 lakhs per person and maximum of 20 claims per year. 9. The scheme offers insurance under 4 slabs for Members, Spouse, and Children - 3 lakhs, 5 lakhs, 7 lakhs & 10 lakhs. The scheme can be extended to cover parents under slabs 2, 3, & 4 only – 5 lakhs, 7 lakhs and 10 lakhs.
Transcript of HOPE MEDI 100% · HOPE Medi allows including dependent parents of members irrespective of age(...
Dear IDA Hope member, Greetings from the IDA Hope Office
Our group Health insurance policy - HOPE MEDI is moving to its 4th year of operation now. The scheme is extended for IDA HOPE Members, Spouse, Children and Parents.
1066 member families were covered under HOPE MEDI in the current year with an amount of more than 1 crore 90 Lakhs already disbursed. With an ICR (Incurred Claims Ratio) of more than 100% every year and claim rejection ratio of less than 0.2%, this undoubtedly is the most beneficial and economical Medical Insurance scheme available to us. It may be also noted that our scheme has benefited many of our members for treatment of life threatening diseases, some of whom were in a dire financial crisis. This year we utilized our Critical illness buffer for one of our members (5 lakhs).
It may be noted that 47% of the claims have been availed for parents of members who otherwise may have been denied insurance cover due to age bar and pre-existing diseases. For them this is the most economical insurance scheme considering the risk profile. As you are aware the hospital admission expenses and treatment charges are increasing due to the higher Hospital expenses (minimum wages revision, operational cost escalation and GST tax additions are among the reasons). Since the claim ratio of the previous years far exceeds permissible limits, our premium will also have an unavoidable hike.
The payout policy has been gently limited to avoid premium going overboard in the coming years. It has also been decided to make the members aware on how effectively we can use the scheme to our advantage and also prevent unnecessary excess expenses being incurred on your claims by hospitals.
The scheme is up for renewal by October 2nd 2018. In order to renew our policy and provide continuous coverage we have successfully negotiated the renewal terms to pay the premium for the next year before 1st October 2018.
We had invited proposals from different insurers / brokers and negotiated the premium to be paid for the year 2018–19 to the best advantage of our members. The HOPE office has decided to renew our policy with UNITED INDIA INSURANCE CO. LTD, with Cosmos Insurance Brokers, Kochi as our service providers for the coming year 2018-19.
The salient features of HOPE Medi Ours is a specifically tailor made Group Health Insurance policy (Family Floater policy) for our members and their families.
1. No medical check-up for entry, irrespective of age
2. Cover starts from day one itself.
3. Pre-existing diseases are covered for members and their dependants(standard policies require medical checkup and any diseases found are excluded from coverage)
4. Parents can be included in the cover (Pre-existing illness for a period of 1 year will not be covered for parents joining for the first time)
5. HOPE Medi allows including dependent parents of members irrespective of age( standard mediclaim policies do not allow parents to be included)
6. Group Critical Illness Buffer - HOPE Medi extends an additional cover of Rs 5 Lakhs per individual in addition to the sum insured selected by the individual member, for the treatment of specified major illness like cancer, heart diseases etc.
7. Critical Illness Buffer (listed below) exceeding the claim limit is provided for members, spouse and children (excluding parents)but limited to only for the first instance of the illness under the scheme
1) Cancer 2) Heart Ailments 3) Multiple Sclerosis 4) Paralysis 5) Heart Surgery 6) Accident Induced Trauma Care 7) Stroke 8) Renal Failure 9) Motor Neuron Disease with permanent symptoms 10) Major Organ Transplantation 11) Major Burns 12) Benign Brain Tumors 13) Bacterial Meningitis 14) Apallic Syndrome 15) Chronic Lung Disease 16) End Stage Liver disease 17) Inter vertebral disc prolapse.
8. The additional critical illness buffer is provided with a provision of reserve fund for claims up to 5 lakhs per person and maximum of 20 claims per year.
9. The scheme offers insurance under 4 slabs for Members, Spouse, and Children - 3 lakhs, 5 lakhs, 7 lakhs & 10 lakhs. The scheme can be extended to cover parents under slabs 2, 3, & 4 only – 5 lakhs, 7 lakhs and 10 lakhs.
10. Room rent will be limited to a maximum of 2500/- per day for slabs 1 & 2 (3 & 5 lakhs) and 3500/- for slab 3 (7 lakhs)and 4000/-per day for Slab 4 ( 10 lakhs). The claim would be reduced in proportion for claims in which the room rent exceeds the allowed limit. Members are advised to restrict selection of room rent according to the above mentioned so as to avoid reduction in claim payout amount (Proportionate reduction will apply to all charges if room rent exceeds the limit for the particular plan )
11. Pre-hospitalization and post- hospitalization expenses cover for 30 days and 60 days respectively.
12. No co-sharing of hospital expenses for members, spouse and kids. Claim amount is limited to 70% of admissible claim (ie. co-sharing of 30% exclusively for Parents only.)
13. Expenses for cataract surgery is capped to Rs 25,000/- maximum. Expenses for knee replacement, hip surgery and the like will be restricted to maximum- Joint Replacement – Knee / Hip (per joint including Implant) Rs.150,000/-
14. Treatment expenses in hospitals in states other than the State of Kerala will be considered at par with the expenses likely to incur in hospitals in Kerala / maximum in the institutions like AIIMS, CMC Vellore and select Government Institutions.* Cost of Robotic surgery and the like may be admitted as per cost of conventional surgical treatment only.
15. Ayurvedic, Naturopathy, Yunani, Homeopathic, Acupressure, Acupuncture, Magnetic and such other therapies are excluded from our policy.
CLAIM LOADING: If any Claim of above 1 lakh was availed during the current year a loading amount will be added to the premium payable based on the Sum insured and Claimed amount. This amount has been calculated based on the claim utilization to insured amount. The Claim loading is based on last years premium and hence opting for a new premium doesn’t change the claim loading. Claim loading will be individually intimated to all members applicable. The list is also uploaded on our website. For online renewals, it is automatically added to the premium payable. In spite of hike in premium, our rate is still the best in comparison with standard mediclaim policies
issued by various insurers in the market, considering the features and age limits of the senior members and parents. Claim loading will applicable on renewal of policy every year.
Unique service with expertise is extended to the members in the event of a claim through our brokers - Cosmos Insurance Brokers.
HOPE MEDI will meet the hospitalization expenses of the members and their dependents including parents by way of Cashless facility offered by at the network hospitals OR Reimbursement of such expenses through TPA where there is no cashless facility. Here in our case M/s Vidal Health is the Third party administrator, based in Kochi.
Please note that if any member / family member drops out without renewing HOPE MEDI after availing claim in the current or previous year they might not be able join HOPE MEDI later. All members are requested to renew all their dependants without miss.
Members are advised to restrict cashless facility as far as possible to reduce the increase of bill amount.
Only members whose IDA membership and HOPE membership are current & valid will be eligible to renew / join HOPE MEDI. PLEASE ENSURE YOUR IDA & HOPE MEMBERSHIP ARE PAID & RENEWED FOR THIS YEAR.
For payment of premium we have made arrangement with FEDERAL BANK, Alathur branch for VIRTUAL account. The details are as under. A/C Name : IDA HOPE Virtual Account Number : HOPEXXXX (Replace “XXXX” by your hope number) Bank Name : FEDERAL BANK, ALATHUR branch IFSC Code : FDRL0001764
Please remember to quote your HOPE number and Mobile number in remittance slip. For any clarifications please contact Federal Bank, Alathur. Phone No: 04922 222210.
Completed application form is a must for HOPE office for NEW members joining or new additions of dependants. For new members joining and any additions or deletions from your family members, list & photos must be attached. Otherwise insurance company cannot issue ID card. For renewals without additions/ deletions of dependants forms need not be sent and the previous ID cards can be used.
RETENTION BENEFIT – For the first time we are giving a reduction of Rs 1450 in the premium amount for members who have been in HOPE MEDI for 3 continuous years and have not availed any claim for 3 years. The list is uploaded on our website, Kindly check and confirm your name in the list before payment. For Online renewals it will be automatically deducted from the premium payable.
For renewal / joining the filled Application forms with payment details are to reach the Hope office on or before 5.30 pm, 27th September 2018. Payment shall be made only online or directly to the Federal Bank virtual account as per details furnished above.
Cheques / DD / or other modes for transfer are NOT accepted. PREMIUM CALCULATION CHART FOR HOPEMEDI 2018-19 Age of primary member (HOPE member) is to be calculated as on 30-09-2018.
Premium for primary member below age 45 years
Relation 3 Lakhs 5 Lakhs 7 Lakhs 10 Lakhs
Self 6100 10166 12669 15555
Spouse 1220 2033 2534 3111
Each Child 915 1525 1900 2333
Each Parents 9638 12010 14746
Premium chart (Claim loading Extra) Sum Insured 3 Lakhs 5 Lakhs 7 Lakhs 10 Lakhs
Self Only 6100 10166 12669 15555
Self+ 1 Child 7015 11691 14569 17888
Self + Spouse 7320 12199 15203 18666
Self + 2 Child 7930 13216 16469 20221
Self+ Spouse+ 1 Child 8235 13724 17103 20999
Self+ Spouse+ 2 Child 9150 15249 19003 23332
Self+ 1 Parent NA 19804 24679 30301
Self+ 1 Child+ 1 Parent NA 21329 26579 32634
Self + Spouse+ 1 Parent NA 21837 27213 33412
Self+ 2 Child+ 1 Parent NA 22854 28479 34967
Self+ Spouse+ 1 Child+ 1 Parent NA 23362 29113 35745
Self+ Spouse+ 2 Child +1 Parent NA 24887 31013 38078
Self+ 2 Parent NA 29442 36689 45047
Self+ 1 Child+ 2 Parent NA 30967 38589 47380
Self+ Spouse+ 2 Parent NA 31475 39223 48158
Self+ 2 Child+ 2 Parent NA 32492 40489 49713
Self+ Spouse+ 1 Child+ 2 Parents NA 33000 41123 50491
Self+ Spouse+ 2 Child+ 2 Parents NA 34525 43023 52824
Premium for primary member age 45 years & above Relation 3 Lakhs 5 Lakhs 7 Lakhs 10 Lakhs
Self 7320 12200 15203 18666
Spouse 1464 2440 3041 3733
Each Child 1098 1830 2280 2800
Each Parent NA 9638 12010 14746
Premium chart (Claim loading Extra) Sum Insured 3Lakhs 5 Lakhs 7 Lakhs 10 Lakhs
Self Only 7320 12200 15203 18666
Self+1 Child 8418 14030 17483 21466
Self + Spouse 8784 14640 18244 22399
Self + 2 Child 9516 15860 19763 24266
Self+ Spouse+ 1 Child 9882 16470 20524 25199
Self+ Spouse+ 2 Child 10980 18300 22804 27999
Self+ 1 Parent NA 21838 27213 33412
Self+ 1 Child+ 1 Parent NA 23668 29493 36212
Self + Spouse+ 1 Parent NA 24278 30254 37145
Self+ 2 Child+ 1 Parent NA 25498 31773 39012
Self+ Spouse+ 1 Child+ 1 Parent NA 26108 32534 39945
Self+ Spouse+ 2 Child + 1 Parent NA 27938 34814 42745
Self+ 2 Parent NA 31476 39223 48158
Self+ 1 Child+ 2 Parent NA 33306 41503 50958
Self+ Spouse+ 2 Parent NA 33916 42264 51891
Self+ 2 Child+2 Parent NA 35136 43783 53758
Self+ Spouse+ 1 Child+2 Parents NA 35746 44544 54691
Self+ Spouse+ 2 Child+ 2 Parents NA 37576 46824 57491
This year we are promoting ONLINE facility through our website for renewals as well as joining. Online payment facility using Credit / Debit cards / net banking is also provided. All members are requested to complete the renewal / joining and payment ONLINE as its very easy & fast considering the shortage of time. ONLINE RENEWAL / JOINING
1. Login in our website www.idakerala.org.in using your login id & password. (those who do not have login id & password please follow the info on site or contact IDA State office at 9744956663 / 97449 53056 or email at [email protected])
2. On your home page click on HOPE Medi, if you are an existing member of HOPE Medi all your details will be displayed on the screen. Please check and verify it before proceeding.
3. You can edit and change the sum insured slab, add or delete dependants , do any corrections in name, DoB, age and click on SAVE.
4. New joining members have to select the sum insured slab, enter the names of dependants with DoB & age and click on SAVE.
5. The premium is automatically calculated for you based on the slab selected and age of member. The Claim loading amount and Retention Benefit is also added automatically.
6. Next is payment which is available in 2 modes – Online & Offline. 7. Clicking on Online mode will take you to the payment gateway where you can make the
payment using any bank Credit/Debit cards or netbanking. 8. After payment is made through Online mode a confirmation of renewal will be displayed on
screen and a copy can be printed. 9. For Offline mode print the payment details and make the payment to Virtual account given
above. Then enter the details in our website with an image/photo of the payment slip from the bank. A confirmation of renewal / joining will be displayed on screen which can be printed out.
10. For New joining members or addition of dependants, please take a print out, paste the photos and send to HOPE office.
11. Online renewal /joining with online payment can be done till 29th September 2018.
All details of premium, loading amount, Retention benefit etc as applicable to you are available on IDA website www.idakerala.com Please contact your branch rep for clarifications before calling HOPE office. HOPE Office Address: Dr. Anvar M. Ali Hon. Secretary, IDA HOPE KSB Crescent Hospital ALATHUR P.O. Palakkad 678541 Kerala We request each one of you to subscribe to our Group Family Health Insurance scheme. COME, LETS US ALL JOIN HOPE MEDI FOR OUR MUTUAL BENEFIT.
Dr.Ciju A. Poulose Dr. Anvar M. Ali Chairman, IDA HOPE KSB Hon. Secretary, IDA HOPE KSB
10-09-2018
For more information and premium calculation you can contact our insurance consultant Mr. Alex. P.V. - 9447608146, 999518805 (Retd .Senior Manager, United India insurance Co Ltd) Director of Cosmos insurance brokers Pvt. ltd. 39/2338, 2nd floor, Durbar hall Road, Ernakulum 682016 Mob: 9995368466 Tel : 0484 2351432 ,09447608146, Tele fax: 0484 2351433 E mail: [email protected]
