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Medisure Prime Insurance

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Medisure Prime Insurance

One of India’s most thoughtful insurance
plans with 22 distinctive features

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Making happy plans is human nature. Plans for a bigger house, a comfier car, an exotic holiday, a great education for the children – colourful dreams that fuel the journey of life.

Just to safeguard these dreams, there's a need to plan for the unexpected. So that, you won't have to compromise your lifestyle, to meet an urgent medical need. So that, you can live as planned. No matter what.

L&T Insurance presents - my:health Medisure Prime Insurance

My health: Medisure Prime Insurance is a feature rich innovative product that comes with a service guarantee.

  • Prime Covers of my:health Medisure Prime Insurance(Must Have covers)

    The many Prime reasons to insure your health with L&T Insurance

    Get twice the helping hand in case of critical illnesses
    Illnesses such as cancer, first heart attack, coronary bypass surgeries, kidney failures and more are termed as critical illnesses by the insurance industry. Their treatment costs a lot more than most other illnesses. Therefore the L&T insurance Medisure Prime product offers you double the sum insured in the event of any of the specified 9 critical illness.

    Important TIP: If you plan to buy a cover for Rs 10 lacs sum assured which covers critical illness, you may want to consider the option of purchasing a Rs 5 lacs cover which will automatically double (sum assured of Rs 10 lacs) during critical illnesses.

    For the newborn and the mother
    The policy provides cover for the hospitalization expenses related to childbirth. 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 is applicable towards the first two children for Self and lawful Spouse who are covered under a single policy for a continuous period of 48 months.

    New born baby will be covered for a period of 90 days from date of birth (without intimation) within the maternity limits.

    IMPORTANT TIP: You need to share the good news of your child's birth with us to continue the coverage even after 90 days, on our Toll free no. 1800-209-5846 and we shall make the necessary arrangements to include your child in your family floater policy with an incremental addition in the annual premium.
    Reinstatement of Sum Insured in case of hospitalisation due to an accident
    If during the term of your policy, the entire sum insured gets used up and there is a second hospitalization due to an accident, the sum insured of your policy is 'reinstated' or 'replenished' to the extent of claim amount but not exceeding the Sum Insured. This additional amount will be available only ONCE during the 12-month policy period and shall be available when the basic Sum Insured opted under the policy has been exhausted or is inadequate to cover this second hospitalization due to accident.
    Lump-sum recovery benefit
    If you have been hospitalized beyond 10 continuous days, it is possible that you would need some more time to recover fully before you get back to your usual lifestyle. With this insight, L&T my:health Medisure Prime Insurance offers you a lumpsum recovery benefit of Rs 10,000.

    You might wish to take a short holiday away from the city and rejuvenate yourself.
    FREE Health Check up every alternate year
    After every two consecutive renewals (if you are above 45 years at the time of the 2nd renewal). L&T Insurance will sponsor a free medical check up, provided no claims have been lodged in the preceding two years.
    Pre-existing conditions covered, after a probation period of 2 years.
    We do cover any hospitalization expenses arising out of illnesses that you had prior to the commencement of your policy (commonly called pre-existing diseases). This expense will automatically be covered after you have completed two years of continuous coverage.

    IMPORTANT TIP: To avail of the coverage, please ensure that you renew your policy before the policy expires. To be on the safe side, we recommend you go for the two year policy period option.
    Unlimited Day Care Procedures up to Sum Insured limit
    Medical science has advanced such that many of the operations that used to require hospital stay for a few days are now treated in a day and patients can go home the same day. my:health Medisure Prime Insurance has not limited the number of procedures that can be covered under your policy.
    Donor Expenses
    In case of hospitalization due to organ transplants, my:health Medisure Prime Insurance policy covers not only the hospitalization expenses related to the person under treatment but also the hospitalization and treatment expenses of the donor.
  • Standard Covers of my:health Medisure Prime Insurance cover

    Hospitalisation Expenses up to Sum Insured limit


    Pre-hospitalisation expenses up to 60 days and Post hospitalisation expenses up to 90 days

    Medical expenses start piling up soon after one is diagnosed with an illness, for example, doctors fees, medical test etc. my:health Medisure Prime Insurance covers these expenses if they have been incurred 60 days prior to hospitalization or 90 days after discharge from hospitalization.

    Ambulance Charges

    In the event any ambulance has been used to take the patient to the hospital Medisure Prime will reimburse Rs 1500 per hospitalisation.

    Hospital Cash & Expenses for accompanying person

    Not all expenses during hospitalization can be accounted for in bills.... the taxi fare to and fro from the hospital…the midnight snack for the person who stays back with the patient. For these small expenses, Medisure Prime policy will pay
    Hospital Cash of Rs 1000 per day from 4th to 10th day when hospitalisation exceeds 3 continuous days and
    Expenses for accompanying person – up to Rs. 500 per day from 4th to 8th day when hospitalisation exceeds 3 continuous days.

    Cost of Health Check up

    my:health Medisure Prime Insurance covers the cost of health check-up after every 2 years of continuous renewals for all Insured persons who have attained 45 years of age at the time of the 2nd consecutive renewal.

  • L&T Insurance Service Advantage

    For over 7 decades, across industries, the L&T Group practiced and perfected incisive solutions and its precise delivery. We are a state-of-the-art, ‘technologically-driven’ company that has the calibre and expertise to provide world-class customer service. Our rigorous innovative and unique product benefits coupled with seamless customer support is what will give you the L&T Insurance Advantage:

    • Claims Service Assurance In the event of hospitalization, L&T Insurance will ensure that the decision to provide cashless settlement will be given within 6 business hours from the time you have intimated the claim to us. In case you opt for reimbursement of the medical expenses incurred, the claim will be settled within 6 working days of receipt of all documentation.

    We are immensely confident of keeping our promises and hence we offer you a service guarantee under which we will pay the insured a fixed amount of Rs 1000/- in the event of failure to keep our promise of the guaranteed response time.

    • Concierge Service available on request in select cities. In the event of hospitalisation, we shall send an executive to personally assist you with the paperwork for cashless procedure. This service will be provided between 9 am to 9 pm on working days.

    • Personal Case Manager available in select cities at your option to meet you with prior appointment to explain the benefits and clarify your doubts on the Policy.

    • 24 X 7 claims assistance
  • What are the value added benefits available under my:health Medisure Prime Insurance?

    My: health Medisure Prime offers you a host of value added benefits:

    No Sub-limits
    my: health Medisure Prime has no sub-limits for any of the medical expenses incurred for eg. room rent, surgeon’s fees, operation theatre charges, etc. As long as the total cost of hospitalization is below the total sum insured that you have opted for and the claim is approved, we shall reimburse the total expense incurred.

    Two year Policy Option
    You have the option to renew your policy once in two years. Not only is it convenient, but you also get the benefit of lower premium per year.

    Family Floater option
    You can cover up to 4 members of your family – your lawful spouse and two dependent children up to the age of 18 years under a single policy and single sum insured.

    Family Discount
    You can opt for individual sum insured for each of your family members under a single policy instead of opting for a Family Floater. For example, you may wish to cover each of your family members for a sum insured of Rs. 5 lac each instead of opting for a Rs 5 lac sum insured for your entire family. You are eligible to get a Family Discount on premium payable for more than 2 members which includes yourself, lawful spouse, dependent children and dependent parents only. Family discount will be available for a maximum of 6 persons only.

    Cumulative Bonus
    The sum insured of your policy progressively increases by 5% on every renewal, for every claim-free year, subject to a maximum accumulation of 50% of your sum insured. If a claim is made, the Cumulative Benefit that has accrued will be available for claim but will become zero from the next renewal.

    Income Tax Benefit
    You can get tax exemption on the premium paid under section 80D of the Income Tax Act.

    Free-look Period
    You have the option to cancel the Policy within 15 days of receipt of policy documents if you are not satisfied with the coverage or terms of the Policy, provided there is no claim. A minimum premium for stamp duty and proportionate premium will be retained by us.

    Life time renewal of Policy
    With my: health Medisure Prime insurance, you will be allowed to renew your policy every year irrespective of your age at the time of renewal. So no more worries that you will be without a health insurance policy in your old age.

    Instant Policy issuance without medical tests
    We think you're too young for a test, even if you're 44.
    If you are below 45 years at the time of policy issuance with no adverse medical history, you need not go through any medical tests to be issued a my: health Medisure Prime Policy. Imagine the convenience! You get to purchase a policy with all its bells and whistles with just a phone call.

    Policy premium based on your location
    Pay premium depending on which city you live in, since the cost of healthcare differs across cities.

  • Who all can be covered under my:health Medisure Prime Insurance and what is the age limit for
    different family members?

    •   Entry age for you (the proposer) is 18 years and you can opt for this policy up to the age of 65 years

    •   Renewal of the Policy is for your lifetime

    •   Children above the age of 3 months and adults below the age of 65 years can be covered in a single policy

    •   Children up to the age of 18 years can be covered only if one or both parents are covered

    •   If you are above the age of 45 years, your policy issuance is subject to pre-acceptance medical tests and approval from us.

  • What is the range of Sum Insured under my:health Medisure Prime Insurance?

    Rs 3 Lakhs to 10 Lakhs in multiples of 1 Lakhs.
  • What does my:health Medisure Prime Insurance not cover?

    The following ailments are not covered after 2 years of policy with: Cataract, Benign Prostatic Hypertrophy, Congenital Internal Diseases, and Fistula in Anus, Piles, and Hysterectomy for Menorrhagia or Fibromyoma, Hernia, Sinusitis and related disorders.

    • Pre-existing disease/illness/injury/condition will not be covered for first 2 years of the policy
    • Any disease contracted during the first 30 days from start of the Policy.
    • Any domiciliary treatment
    • Treatment due to suicide, self-inflicted injury or illness, mental disorder, anxiety, stress or depression, use of alcohol or drugs.
    • Diseases such as AIDS or HIV and its complications.
  • What is the cancellation procedure for my:health Medisure Prime Insurance Policy?

    In case you wish to cancel the policy you may intimate us by giving 15 days notice in writing and we will refund the premium for the unexpired term as per the short period scale given below.

    Period of Cover up to                   Refund of Annual Premium rate (%)

             1 Months                                              75%
             3 Months                                              50%
             6 Months                                              25%
    Exceeding 6 Months up to 365 days         NIL

    For two year policies we will retain 15% of the premium for the balance period.
    Eg. 2 Year Policy issued for 730 days.
    Cancellation request received on day 395(1 year and 1 month) The amount refunded will be calculated as follows:
    The amount to be refunded will be 15% less than the pro-rata premium for the balance period. 2 year premium Rs 1000. Utilised period 395 days, unutilised period 335. Pro-rata premium for unutilised premium will be Rs 458.9 Refund amount shall be 458.9-15% i.e (458.9 – 68.83) = Rs 390

    No refund will be done if you have reported a claim under the policy.
  • What are the renewal terms of my:health Medisure Prime Insurance?

    You can renew your policy within 15 days from expiry of policy to be eligible to ‘continuity benefits’ like the cumulative benefit. If you do not renew your policy within 15 days, it will be treated as a new/fresh policy.

    Change in Sum Insured or Zone of cover may be allowed on renewals. A loading of maximum up to 100% may be considered on the renewal premium based on adverse or recurring claims reported under the expiring policy.

    The Company reserves its rights to vary the premium from time to time subject to approval of IRDA.

    Portability Option: All policies are portable wef 1st July 2011. Insured may approach another insurer well before the expiry date to avoid any break in coverage.
  • How are the Zones classified for premium calculation?

    For the purpose of premium calculation, there are 3 major Zones classified on the basis of your location:

    Zone I (All India Cover): Mumbai, Thane, Navi Mumbai, Delhi and NCR Regions
    Zone II: Chennai, Hyderabad, Bangalore, Pune, Kolkata and Gujarat Regions
    Zone III: Rest of India (other than Zone I and Zone II locations)

    •   Zone I premium gives you an All-India cover. i.e., you can avail treatment all over India without any co-payment.

    •   Zone II premium allows you to avail treatment in Zone II and Zone III locations without any sub-limits. But if you have to avail treatment in a Zone I city, you will have to bear 10% co-payment on each and every claim.

    •   Zone III premium allows you to avail treatment only in Zone III locations without sub-limits. In case you have to avail treatment in a Zone II location, you will have to bear 10% co-payment on each and every claim. And if you have to avail treatment in a Zone I location, you will have to bear 20% co-payment on each and every claim.

    You have a choice to opt for Zone I (All India Cover) even if you belong to a Zone II or III by paying the premium applicable under Zone I. Insured Persons above the age of 70 years will have an additional co-payment obligation of 25% irrespective of the Zone.
  • What is the premium payable for my:health Medisure Prime Insurance Policy?

    The Premium will be based on the age of the senior most member in the Policy, Zone of cover, total number of persons you wish to cover, the policy tenure and Sum Insured you opt for.

    For complete details on the premium structure please visit us at www.ltinsurance.com / call us at 1800-209-5846 / visit our nearest office or contact your insurance agent with Click here to calculate your premium.
  • How do I get my:health Medisure Prime Insurance Policy?

    For person below 45 years with a clean medical history, all you need to do is fill in the necessary details in the Proposal Form and hand it over along with your premium payment instrument to your Insurance Advisor or at any of our offices. You will be given an instant Policy Kit. All proposals above 45 years or for proposals below 45 years of age with an adverse medical/claim history will have to undergo a pre-enrolment medical test.

    Medical Tests required for age group 46-55 includes Medical Examination Report, Electrocardiogram, Serum Triglycerides, Fasting Blood Sugar, Serum Creatinine, Urinalysis, SGOT & SGPT. Medical Tests required for age group 56-65 includes Medical Examination Report, Electrocardiogram, Complete Blood Count, Lipid Profile, Fasting & Post Prandial Blood Sugar, Serum Creatinine, Urinalysis, SGOT, SGPT and GGT.

    Medical tests will be conducted at our list of diagnostic centres and 100% cost for the same will be borne by us. Based on the evidence from the above reports the Company may call for additional reports on a case to case basis to determine the acceptance of a Proposal. 50% Cost of any additional test shall be borne by the Insurer for accepted proposals.
  • What is the process to lodge a Claim under my:health Medisure Prime Insurance ?

    For cashless* hospitalization: (*cashless facility is available only at our network hospitals)

    • You will need to contact us at the contact numbers provided on your health card immediately
    • You need to submit a Cashless Request form to us, along with all information and documents pertaining to illness as required
    • Our representative will guide you further and help you process the request and based on the coverage under your policy the cashless request will be approved.

    For a reimbursement of expenses: (at other hospitals outside of our network or at network hospitals where cashless is not availed):

    • You will need to collate the original bills along with other documents as required and submit it to the address mentioned in your Policy Schedule.

    In case of planned hospitalization, please inform us 72 hours in advance and in case of emergency within 24 hours of admission.
    Our Claims settlement procedure is quick and transparent. For any kind of support or information, please call our helpline 1800 209 5846 or write to us at myhealthclaim@ltinsurance.com. Undue delay in intimation of claim or submission of documents may prejudice a claim.
    To understand the claims process in detail, and to get a checklist of the documentation, please view the ‘claims process’ section.