L&T Medisure Prime Plan

    L&T Health Insurance

    Our repeated efforts to adapt to ever-changing lifestyle has taken a severe toll on our well-being. Thanks to the soaring medical costs, treatment for a small illness can burn large holes in your pocket. Thus, investing in a worthy health insurance is the only way out.

    L&T Insurance’s my:health Medisure Prime Insurance Plan is one such health policy that will cover your hospitalization expenses. It also offers benefits related to maternity and newborn baby, organ donor expenses and coverage against Critical Illness.

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    Highlights of Medisure Prime Plan

    • L&T's Location Based Premiums is a move towards reducing the costs. Thus, if you belong to a town where the healthcare costs are lower than say Metro cities, you’ll pay a lower premium.
    • This plan offers additional coverage for critical illnesses from those listed in the document along with restore benefit in case of an accident.
    • Two-year policy option allows you to renew your policy at the end of 24 months v/s the traditional 12 months
    • If you opt for Individual Sum Insured for each of your family members under a single policy instead of a Family Floater option, you are eligible to get a Family Discount of 10%. This discount applies to more than two members and is available for a maximum of 6 persons only.

    Scope of cover

    Indivdual Plan

    Entry Age

    For children : 91 days

    Adults :

    Minimum : 18 years

    Maximum : 65 years

    Number of Members Covered

    Maximum Members : 6

    Maximum Adults : 4

    Maximum Children : 2

    Sum Insured

    3 - 10 lakhs


    discount

    For longer policy term
    family discount


    Policy Periods Available

    1 and 2 years


    Pre-Policy Medical Check-up

    51 years and above


    Family Floater Plan

    Entry Age

    For children : 91 days

    Adults :

    Minimum : 18 years

    Maximum : 65 years

    Number of Members Covered

    Maximum Members : 4

    Maximum Adults : 2

    Maximum Children : 2

    Sum Insured

    3 - 10 lakhs


    discount

    For longer policy term
    family discount


    Policy Periods Available

    1 and 2 years


    Pre-Policy Medical Check-up

    51 years and above


    Important Features

    Day Care Treatments

    Due to scientific progress, some procedures/treatments do not require you to be hospitalized for a minimum of 24 hours to raise a claim. Moreover, as L&T; updates this list on continuous basis, there is no static one.

      No-Claim Benefits

      In this policy no-claim bonus equal to 5% of basic sum insured up to a maximum of 50% is available. However, the bonus amount is reduced to zero once you make any claim. Rest assured, your sum insured will not be affected.

        Organ Donor Cover

        The policy will reimburse medical expenses incurred towards donor in case of major organ transplant, for the harvesting of the organ provided that:

        • The Organ donor is any person following the Transplantation of Human Organs Act 1994 (amended) and other applicable laws and rules
        • The Organ donated is for the use of the Insured Person
        • Coverage under this section excludes Pre-Post hospitalization expenses, donor screening, and the cost of an organ or any other medical treatment for the donor consequent on the harvesting.

          Pre Hospitalization

          The insurance company will compensate you for the medical expenses related to your hospitalization 60 days before the hospitalization.

            Post Hospitalization

            The insurance company will pay you for the medical expenses related to your hospitalization 90 days post hospitalization.

              Restore Benefits

              This plan offers restoration of 100% of the sum insured in case of an accident. This benefit gets activated irrespective of complete exhaustion of the sum insured.

                Good to Have Benefits

                OPD Expense Cover

                This plan does not cover expenses related to outpatient treatment.

                  Daily Hospitalization Allowance

                  The policy provides you a payment of a Daily Hospital Cash of Rs. 1000 per day from day 4 to day 10 provided the hospitalization should exceed three continuous days

                    Health Check-up

                    Offers complimentary health check-up that covers some listed tests, once every two years for persons above 45 years.

                      Home Hospitalization/ Domiciliary Hospitalization

                      The plan does not cover any treatments taken at home.

                        Non- Allopathic Treatment Expense Cover

                        This plan does not cover expenses related to non-allopathic treatment.

                          Emergency Ambulance

                          This plan provides reimbursement for ambulance expenses up to INR 1500 per hospitalization.

                            Value Adds

                            Eye-cover

                            This plan does not provide coverage for any costs towards eye treatment.

                              Maternity Cover

                              The policy offers to cover for the hospitalization costs related to Maternity. The sum insured for this particular cover is 5% of Sum Insured or Rs 25,000 for a normal delivery and 10% of Sum Insured or Rs 50,000 for a caesarean section or actual cost, whichever is lower. Coverage applies to the first two children for Self and lawful Spouse, who are a part of a single policy for a continuous period of 48 months. The plan covers for the New Born Baby for 90 days from the date of birth (without intimation) within the maternity limits.

                                Dental Coverage

                                This policy does not cover any dental treatments.

                                  Recovery Benefit

                                  You will get a lump sum amount of Rs. 10,000 in the case of hospitalization exceeding ten days.

                                    Critical Illness Cover

                                    The treatment costs of critical illnesses are considerably higher than most other diseases. Hence, L&T; insurance Medisure Prime Policy offers you double the sum insured in the event of any of the listed nine critical illness.

                                      FREE LOOK PERIOD

                                      For any reason, should you decide not to proceed with the policy, you can return the same and request for a refund within 15 days from the date of receipt of the policy document.

                                        EXPENSES FOR ACCOMPANYING PERSON

                                        The policy will pay Rs. 500 per day for a maximum period of 7 days towards expenses of accompanying person towards the treatment of the insured member in Hospital/Nursing home exceeding three days.

                                          Terms & Conditions

                                          Room Rent / Room Category

                                          This plan does not have any limit on room expenses.

                                            Co-Payment

                                            The plan has two co-payments.

                                            • Age-based co-pay of 25% is applicable for individuals above 70 years old irrespective of the treatment location.
                                            • Zone-based co-pay of 10% or 20% applies depending on geographical location.

                                              Waiting Period

                                              Cooling Off Period

                                              A 30 days cooling off period for all claims except any arising out of accidental injuries.

                                                Maternity

                                                Any expenses towards maternity is covered only after 48 months.

                                                  Pre-Existing Illnesses

                                                  The policy covers any pre-existing illness and some specific diseases/treatments only after 24 months. These include Cataract, Hysterectomy, Myomectomy for Fibroids, and so forth.

                                                    Permanent Exclusions

                                                    The Plan will not cover any liabilities towards the treatments of following conditions-

                                                    • Whose signs or symptoms first occur within 30 days of the policy period
                                                    • Attempted suicide
                                                    • Use of alcohol or drug
                                                    • AIDS
                                                    • Pregnancy, childbirth, miscarriage, and abortion
                                                    • Congenital disease
                                                    • Infertility and in vitro fertilization.
                                                    • Hospitalization out of war, riot, strike and nuclear weapons

                                                    Review of L&T Medisure Prime Plan

                                                    Location based premiums, cover for maternity, newborn and donor expenses are few of the many useful benefits offered by L&T;’s my:health Medisure Prime Insurance plan. Moreover, if you are below 45 years of age, you can get the policy issued instantly without the need for any pre-policy medical screening. When such useful features are paired off with convenient claim processing, all you can expect is a guaranteed and class service with complete peace of mind.

                                                    **Reviews and ratings are based only on Benefits and Conditions. Things like Claim Settlement Ratio, Hospital Network have not been covered under product ratings. These are covered under Company ratings.

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