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L&T Health Insurance

L & T health insurance aims at being a customer-centric company and has developed assurance solutions for vast segments ranging from individuals to small and medium enterprises to large corporate. They are known particularly for their focus on the rural areas with products such as rural and micro insurance plans.

HDFC Ergo General Insurance Co. acquires L & t General Insurance Co. on 3rd June 2016

Backed by a strong financial advantage coupled with a stellar history in technology, the newly formed L & T Health Insurance Company has developed a huge spectrum of comprehensive plans that guarantee smooth and efficient experience for their customers.So far this has been recorded as the first biggest buyout in the general insurance industry in India.

Features of L&T Health Insurance

  • No. of members- The plan covers maximum 4 members of your family with up to 2 children and 2 adults.
  • Lifelong Renewal – The plans offered are lifelong renewable, hence it saves you from the financial burden and stress caused by a medical emergency and keeps you well prepared to handle any situation.
  • Pre & Post hospitalization cover- The plan covers medical expenses for 30 days prior to hospitalization and 60 days post hospitalization only for related medical expenses.
  • Health Check-ups – Offers health check-up for all insured after 4 continues claim-free years.
  • Pre-existing diseases- Pre-existing diseases are covered after 3 years of waiting period

Benefits of Buying L&T Health Insurance Plans

  • The company brings reliability, financial strength and proficiency, backed by a world class brand and seven decades of supreme leadership of the L&T Group.
  • A personal case manager is allotted on request to explain policy benefits, resolve any doubts along with around the clock claim assistance services. -The company promises cashless claim settlement within 6 hours for requests made between 9am-9pm on working days and cash reimbursement within 6 working days.

Products offered by L&T Health Insurance

Health Medicare Classic Insurance

Individual Coverage : This is a basic health insurance plan offered by L&T, which covers basic hospitalization expenses. Following are the details of coverage under this plan:

  • It offers basic health coverage in the range of Rs.1 lakh and Rs.5 lakh for individuals of any age above 3 months.
  • Pre and post hospitalization expenses, coverage for day care procedures, maternity coverage, health checkup, no-claim bonus, etc. are the benefits provided in this plan.
  • The plan has two options which one can opt for in addition to the base plan.
  • Base plan + critical illness cover- This option can be added up to age 65 years and for people with sum insured of Rs.2 lakh and above. Addition of this option will provide a double sum insured in case of critical illness.
  • Base plan + no sub-limits- This option can be added up separately. Addition of this option would remove all sub-limits over treatment like e.g. room rent limit, ICU rent, etc.

Family Floater Coverage : In case you want to cover your entire family under my:health Medisure Classic plan on a shared basis, here are the details of the coverage are given below:

  • This is a basic family floater plan, which covers health cost for the entire family in the range of Rs.2.5 lakh and Rs.4.5 lakh. Policyholder, spouse and 2 dependent children (up to age 25 years) can be covered under the same policy.
  • Pre and post hospitalization expenses, coverage for day care procedures, maternity coverage, health checkup, no-claim bonus, etc. are the benefits provided in this plan
  • The plan has two options, which one can opt for in addition to the base plan.
  • Base plan + critical illness cover- This option can be added up to age 65 years and for people with sum insured of Rs.2 lakh and above. Addition of this option will provide a double sum insured in case of critical illness.
  • Base plan + no sub-limits- This option can be added up separately. Addition of this option would not remove all sub-limits over treatment like room rent limit, ICU rent, etc.

Note: For both individual and family floater coverage,

  • The premium amount in this policy would change with different geographical regions.
  • Co-pay (percentage expense to be paid out of pocket before claiming) of 10% is applicable above age 80 years.

Health Medisure Prime

Individual Coverage : This is health insurance plan covers basic hospitalization expenses along with additional benefit in case of critical illness. Details of coverage under this plan are as follows:

  • This plan offers coverage for health in the range of INR Rs. 3 lakh and Rs. 10 lakh for individuals between age 3 months and 65 years.
  • Pre and post hospitalization expenses, coverage for day care procedures, health checkup (every two years), no-claim bonus, etc. are the benefits provided in this plan
  • Additionally, this plan has critical illness cover, which will provide a double sum insured in case of critical illness.

Family Floater Coverage : In case you want to cover your entire family under my:health Medisure Prime plan on a shared basis, here are the details of the coverage are as follows:

  • This is a family floater plan, which covers health cost for the entire family in the range of Rs.3 lakh and Rs.10 lakh.
  • The floater can be opted for policyholder, spouse up to maximum age 65 years and 2 dependent children between age 3 months and age 18 years.
  • Pre and post hospitalization expenses, coverage for day care procedures, health checkup (every two years), no-claim bonus, etc. are the benefits provided in this plan.
  • Additionally, this plan has critical illness cover, which will provide a double sum insured in case of critical illness.

Health Medisure Plus

Individual Coverage : This plan has a unique feature wherein an individual can customize the coverage offered. Given below are the details of this plan:

  • This is a special plan which offers standard health coverage and an option to opt for custom health coverage for individuals between age 18 years and 65 years.
  • The coverage offered in this plan is in the range of Rs.2 lakh and Rs.25 lakh.
  • The standard coverage option includes benefits like pre and post hospitalization expense cover, health check-up (every 2 years), coverage for ambulance charges, coverage for day care treatments, etc.
  • The custom coverage option allows customization of standard coverage by addition or deletion of certain benefits (e.g. deletion of pre and post hospitalization cover, addition of deductible option or critical illness cover, etc.) as per individual's requirement.
  • A minimum of 8 benefits are covered in this plan.

Family Floater Coverage : In case you want to get this plan for your entire family, here are is a brief overview of coverage offered:

  • This is a special family floater plan which offers standard health coverage and an option to opt for custom health coverage.
  • Proposer and spouse between age 18 years and 65 years and maximum of 3 dependent children between age 3 months and 25 years can be covered in the range of Rs.2 lakh and Rs.25 lakh under the same policy.
  • The standard coverage option includes benefits like pre and post hospitalization expense cover, health check-up (every 2 years), coverage for ambulance charges, coverage for day care treatments, etc.
  • The custom coverage option allows customization of standard coverage by addition or deletion of certain benefits (e.g. deletion of pre and post hospitalization cover, addition of deductible option or critical illness cover, etc.) as per individual's requirement.
  • A minimum of 8 benefits are covered in this plan.

Health Personal Accident Insurance

Individual Coverage : This is personal accident disability plan offered by L&T Insurer. The details of coverage offered by this plan are as follows:

  • This plan provides accidental cover for individuals between age 5 years and 70 years.
  • The plan is divided into four tables:
  • Table A– provides compensation for accidental death
  • Table B- provides compensation for accidental death or permanent total disability
  • Table C– provides compensation for accidental death or permanent partial disability
  • Table D– provides compensation for accidental death or permanent partial or total disability or temporary total disability
  • This plan offers education coverage to cover education cost of dependent children post accidental death or disability of insured person.
  • The plan also covers for loss of employment, transportation cost of dead body, etc.

Family Floater Coverage :

  • This is a family floater plan which covers accidental coverage for the entire family in the range of Rs.3 lakh and Rs.10 lakh.
  • The floater cover can be opted for the policyholder, spouse and 2 dependent children (between age 5 years and 18 years) and dependent parents between age 5 years and 70 years can be covered under this policy.
  • The plan is divided into four tables:
  • Table A– provides compensation post accidental death
  • Table B- provides compensation post accidental death or permanent total disability
  • Table C– provides compensation post accidental death or permanent partial disability
  • Table D– provides compensation post accidental death or permanent partial or total disability or temporary total disability
  • This plan offers education coverage to cover education cost of dependent children post accidental death or disability of insured person.
  • The accident insurance policy also covers for loss of employment, transportation cost of dead body, etc.

Note:

  • In this plan, there are three risk categories (based on the nature of job) which are used to calculate the premium.

Health Medisure Super Top-Up Insurance

Individual Coverage : This is a top-up plan, which offers coverage after your medical expenses exceed the deductible value. Here are the details of coverage offered:

  • This is a top-up plan (these plans have an agreed upon deductible amount to be paid at the time of claim) for individuals between age 18 years and 65 years.
  • The coverage amount for this health insurance plan is in the range of Rs.3 lakh and Rs.20 lakh and the deductible amount is in the range of Rs.2 lakh and Rs.5 lakh.
  • Pre and post hospitalization expenses, coverage for day care procedures, etc. are benefits provided in this plan.

Family Floater Coverage :

  • This is a top-up plan for families which offers coverage to all the family members in one plan.
  • The plan would cover adults between age 18 years and 65 years and children between age 3 months and 23 years.
  • The coverage amount for this plan is in the range of Rs.3 lakh and Rs.20 lakh and the deductible amount is in the range of Rs.2 lakh and Rs.5 lakh.
  • Pre and post hospitalization expenses, day care procedures, etc. are covered under this plan.

Jeevika Medisure Micro Insurance

Individual Coverage : This health insurance plan is available for rural population of India. The benefits offered are as follows:

  • This plan provides coverage of Rs. 30,000 especially for poor individuals between age 18 years and 65 years.
  • Pre and post hospitalization expenses, coverage for day care procedures, etc. are benefits provided in this plan.

Family Floater Coverage : If you want to buy this health insurance policy for your entire family on a shared basis, here are the details of coverage offered:

  • This is a family floater plan, which offers coverage of Rs. 30,000 especially to poor families.
  • Proposer and spouse between age 18 years and 65 years and 2 dependent children between age 6 months and 18 years can be covered under this policy.
  • Pre and post hospitalization expenses, day care procedures, etc. are covered under this plan. In case you want to buy this plan for yourself and your family know more about this plan contact Coverfox.

Jeevika Personal Accident Micro Insurance

Individual Coverage : This is personal accident disability plan for the poorer section of India. The benefits under this plan are as follows:

  • This plan offers accidental coverage of Rs. 50,000 for individuals between age 5 years and 70 years.
  • The plan offers compensation in case of accidental death, permanent total disability, etc.
  • Education fund, cumulative bonus, etc. are covered in this policy.

Family Floater Coverage : In case you want to buy a personal accident disability plan for your entire on a shared basis then here is a brief of coverage offered:

  • This is a family floater plan, which offers accidental coverage of Rs. 50,000.
  • This plan offers compensation in case of accidental death, permanent total disability, etc.
  • Education fund, cumulative bonus, etc. are covered in this policy.

If you want to buy this plan for yourself or your family, please contact Coverfox to know more about this plan.

Jeevika Cash @ Hospital Micro Insurance

Individual Coverage : This is a benefit plan, which offers a lump-sum benefit on daily basis in case of hospitalization. With this plan, other expenses apart from the hospitalization expenses could be covered:

  • This plan offers certain amount of cash every day during hospitalization period only after hospitalization exceeds 24 hours.
  • Individuals between age 18 years and 65 years can be covered under this policy.
  • This plan has three variables:
  • Silver plan- provides maximum coverage of Rs. 7,500.
  • Gold plan- provides maximum coverage of Rs. 15,000.
  • Platinum plan- provides maximum coverage of Rs. 30,000.

Family Floater Coverage : In case you wish to have such coverage for your entire family on a shared basis. Then here are the details of the benefits offered:

  • This is a family floater plan, which provides certain amount of cash every day during hospitalization period (only after hospitalization exceeds 24 hours).
  • Individuals between age 18 years and 65 years and children between age 6 months and 18 years can be covered under this policy.

This plan has three variables:

  • Gold plan- provides maximum coverage of Rs. 15,000.
  • Platinum plan- provides maximum coverage of Rs. 30,000.

Note:

  • The platinum plan cannot be opted for children.

Claims Process at L&T Health Insurance

There are two ways to make claim under a Health Insurance Policy: on cashless basis and on reimbursement basis. In simple terms, for making a claim on cashless basis, the treatment must be done only at a network hospital of the insurance company servicing your policy. For availing the treatment, you would have to first seek an authorization as per the procedures laid down and in the prescribed form. In case of claims on reimbursement basis, the insurance company has to be informed as per their prescribed procedures. The policyholder has to ensure that documents such as claim form, discharge summary, prescriptions and bills to be submitted for the claim on reimbursement are obtained after hospitalization.

L&T Health Insurance has a well-defined claim processing system.

Cashless Service: Seeking Pre-Authorization

  • Complete the pre-authorization form available at the hospital’s insurance/TPA Desk.
  • Send the completed form via email or fax.
  • Approved letter will be sent by the claim management team. Remember that the claim management team could send an inquiry to the hospital or you before authorization.
  • In case the authorization is rejected, initiate the treatment and file for reimbursement claim.

Reimbursement Claim: Claim Submission

  • Complete the necessary form and submit along with required documents, as per the policy terms and conditions.
  • Necessary documents include discharge summary, prescriptions, bills etc.
  • Approved letter will be sent by the claim management team. Remember that you will be answerable to any queries raised by the claim management team before the letter is issued.
  • In case the claim is rejected, the reasons will be communicated by the team.

In case of any emergencies, you need to inform L&T within 24 hours of the admission. In case of planned emergencies, the notification has to reach the company 48 hours prior to the hospitalization. The claim intimation can be done via L&T's toll free number 1800-209-5846. The same could also be emailed to help@ltinsurance.com.

Note: If you are a Coverfox customer, you can directly reach out to us for all your claim-related issues and queries.

Review of L&T Health Insurance

Backed by the array of top-notch insurance professionals and a trustworthy brand, L&T insurance company delivers unbeatable services to their customers. Their commitments about stringent response times for service delivery and claims undeniably reserves one of the top slots for them in insurance domain in India. With an option of waiving the room rent sub-limits and the waiting period of only 3 years for Pre-Existing Diseases, L&T Health Insurance plans definitely scores the brownie points.