Future Generali Health Total Plan
Future Generali Health Total is a complete health insurance plan which provides a comprehensive coverage comprising of inbuilt basic coverage features, additional benefits and also optional riders. The plan comes in three variants offering different levels of Sum Assured.
Key Features
The plan can be taken either on an individual basis or on floater basis.
There are three plan variants of Vital, Superior and Premier with varying Sum Assured levels and the policyholder can choose any option as per his choice.
The plan promises lifelong renewability.
Even extended family members up to 15 can be covered under the Superior and Premier plan’s floater option.
The plan has Sum Assured restoration feature which restores the Sum Assured if it is exhausted in any policy year.
No medical check-ups till 50 years of age in case of the first plan variant Vital.
There is no limit on the entry age.
The Sum Assured is increased by 50% if a claim is not made in any year. The maximum increment allowed is limited to 100%.
In case of hospitalization due to an accident, the Sum Assured is increased by 25% to a maximum of Rs.10 lakhs.
Benefits
Being a health insurance plan, a range of benefits are provided under the plan the value of which depend on the plan variant selected. the table lists all the benefits provided by all the plan variants:
| Plan benefits | Variant – Basic | Variant – Essential | Variant – Privilege |
| Pre and post hospitalization | Covered for 60 and 90 days respectively | Covered for 60 and 120 days respectively | Covered for 60 and 180 days respectively |
| Inpatient hospitalization | Covered | Covered | Covered |
| Day care procedures | Covered | Covered | Covered |
| Domiciliary treatment | Covered up to 10% of the Sum Assured | Covered up to 10% of the Sum Assured | Covered up to 10% of the Sum Assured |
| Organ donor expenses | Covered | Covered | Covered |
| Medical treatments abroad | Not covered | Not covered | Covered after a waiting period of 4 years |
| Ambulance cost | Rs.1500 | Actuals for treatment at network hospitals or Rs.2000 | Actuals for treatment at network hospitals or Rs.5000 |
| Emergency Medical Evaluation | Not covered | Covered up to 5% of the Sum Assured | Covered up to 5% of the Sum Assured |
| E-opinion | Covered | Covered | Covered |
| AYUSH benefits | Covered | Covered | Covered |
| Daily cash for accompanying person | Rs.500 per day | Rs.500 per day | Rs.500 per day |
| Child Vaccination | Not covered | Not covered | Up to Rs.5000 for children aged up to 12 years |
| Patient Care benefits for individuals aged above 60 years | Rs.350 per day for a maximum of 10 continuous days | Rs.500 per day for a maximum of 10 continuous days | Rs.1000 per day for a maximum of 10 continuous days |
| Outpatient benefits: A) For consultation and diagnostics B) Prescribed medicines |
Not covered | A) Rs.3000 for individual plan and Rs.10, 000 for floater plan. B) Not covered |
Rs.10,000 for individual plan and Rs.20, 000 for floater plan. |
| Maternity expenses | Sum Assured 3 lakhs – Rs.15,000 for normal delivery and Rs.25,000 for Cesarean Sum Assured 5 lakhs – Rs.20,000 for normal delivery and Rs.35,000 for Cesarean Sum Assured 10 lakhs – Rs.25,000 for normal delivery and Rs.45,000 for Cesarean |
Sum Assured 15 lakhs – Rs.30,000 for normal delivery and Rs.50,000 for Cesarean Sum Assured 20 lakhs – Rs.40,000 for normal delivery and Rs.60,000 for Cesarean Sum Assured 25 lakhs – Rs.40,000 for normal delivery and Rs.60,000 for Cesarean |
Sum Assured 50 lakhs – Rs.50,000 for normal delivery and Rs.1 lakh for Cesarean Sum Assured 1 crore – Rs.50,000 for normal delivery and Rs.1 lakh |
| Pre and post-natal hospitalization | Not covered | Covered for 90 and 45 days respectively | Covered for 90 and 45 days respectively |
| New born baby cover | Not covered | Up to the Sum Insured from first day till policy renewal | Up to the Sum Insured from first day till policy renewal |
| Restore benefit | Covered | Covered | Covered |
| Wellness benefits | Covered | Covered | Covered |
The plan offers three types of rebates or discounts which are as follows:
- Family Discount – If family members are included in the cover a premium discount of 10% is allowed.
- One-time discount – If the proposer dies and the plan is renewed, a one-time discount of 10% is allowed.
- Deductible discount – If the policyholder chooses a voluntary deductible, a premium discount ranging from 10% to 25% is allowed based on the level of deductible opted.
- Long Term Discount – If a two-year plan is taken, a discount of 7.5% is allowed. If a 3-year plan is taken the discount becomes 10%.
For each year where the proposer has not made any claim in the policy, the Sum Assured is increased by 50% subject to a maximum of 100% increment in the Sum Assured.
If the proposer wants to port his existing health insurance plan taken from another company to this plan, he can do so. Such portability should be requested at least 45 days before the expiry of the previous policy which is being ported.
A cooling off period or a free look period of 15 days is granted to the policyholder after the policy issuance to review the policy terms and conditions. If found unsatisfactory, the plan can be cancelled within this period and the premium paid would be refunded after deducting the relevant mortality charge, service tax, cess and stamp duty paid.
A grace period of 30 days is allowed for paying the premium after the due date during which the policy cover continues.
The Company can cancel the policy on grounds of fraud, misrepresentation or non-disclosure. In this case premiums paid are not refunded. The proposer can also cancel the policy if he wants and in this case premiums would be refunded after deducting the coverage cost for the period for which the policy was in force and other expenses. The proportion of premium refunded in a cancelled policy is as follows:
| Risk period | Proportion of premium refunded |
| Up to 1 month | 75% |
| Up to three months | 50% |
| Up to six months | 25% |
| Beyond 6 months | Nil |
How it works
- The policyholder chooses the plan option and the Sum Assured and decides whether he wants an individual plan or a floater one.
- There are three plan types with different Sum Assured levels and different members covered which are as follows:
| Plan Types | Sum Assured range | Members covered under the floater variant |
| Vital | Rs.3,5 and 10 lakhs | Self, spouse, dependent children up to 25 years of age and dependent parents. |
| Superior | Rs.15,20 and 25 lakhs | Self, spouse, dependent children up to 25 years of age, dependent or non-dependent parents, dependent siblings, daughter or son-in-law, parents-in-law, grandparents and grandchildren |
| Premier | Rs.50 lakhs and Rs.1 crore | Self, spouse, dependent children up to 25 years of age, dependent or non-dependent parents, dependent siblings, daughter or son-in-law, parents-in-law, grandparents and grandchildren |
- A maximum of 15 members can be covered under the Superior and Premier options.
- The premium is then determined based on the above parameters.
- On any contingency covered by the plan, compensation would be paid. However, there is a co-pay clause wherein a specified proportion of the claim would be borne by the policyholder if insured’s the age is 60 years and above. The co-pay ratios are as follows:
| Age bracket | Co-pay ratio |
| 60-64 years | 20% |
| 65-69 years | 25% |
| 70-74 years | 30% |
| 75 years and above | 40% |
Eligibility
The plan can be bought only by permanent Resident Indians. Individuals can buy the policy for themselves and their family and the plan is renewable throughout the insured’s lifetime. The other eligibility criteria of the plan include:
| Minimum | Maximum | |
| Entry age | 1 day | NA |
| Plan tenure | 1, 2 or 3 years | |
| Premium payable | Depends on the age and Sum Assured chosen | |
| Sum Assured | Rs.3 lakhs | Rs.1 crore |
| Premium payment mode | Annually. Half-yearly, quarterly or monthly | |
Exclusions
- Pre-existing illnesses are covered completely only after a continuous coverage period of 48months. However, in the 3rd year, 50% claim for any treatment related to pre-existing illnesses would be admissible.
- Specific treatments like cataract, hernia, fistula, joint replacement, etc. are not covered in the first two years of the policy.
- Hospitalization within the first 30 days of the policy is excluded.
- Joint replacement and organ transplant are covered after 4 years.
- Maternity related coverage is available after 3 policy years.
- Epidemic ailments and debilitating ailments are excluded.
- Hospitalization due to suicide or self-inflicted injury, alcohol or drug abuse, participation in hazardous sports and activities, criminal act, war, commotion, consequential loss, pregnancy and related causes, defense related operations, curative treatments, aviation, radioactive contamination, circumcision, cosmetic treatments, STD or HIV, etc. would also be excluded.
