Health Plans

I wish to have protection against critical illnesses that I may suffer from.

HDFC Critical Care Plan: This plan pays a lump sum amount on survival of a period of 30 days from the date of diagnosis of a critical illness as defined under the policy. The lump sum amount is not linked to any health care expenditure hence you can spend the same for treatment, paying off mortgages, paying EMI, travel, family income etc. In the absence of the cover you will have to dig into the savings or raise loans as the expenses associated with Critical Illnesses can be very high.

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I prefer to financially safeguard my self against major surgical procedures that I may undergo.

HDFC SurgiCare Plan: This Plan provides you with timely support in case of medical emergencies with respect to hospitalization and surgeries, as the case maybe, ensuring your financial independence at all times.

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HDFC Critical Care Plan

Can I purchase the HDFC Critical Care Plan for my entire family?

HDFC Critical Care Plan is a single life plan. Only one person can be covered under one policy. In case the whole family is to be covered then individual policies can be proposed for each insurable member of the family.

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What are the critical illnesses covered under the HDFC Critical Care Plan?

We cover 30 critical illnesses under the HDFC Critical Care Plan. The 30 illnesses are divided into two broad groups.

Group A: Cancer, Coronary Artery Bypass Graft Surgery (CABGS), Kidney Failure, Major Organ Transplant (as a recipient) and stroke.

Group B: Alzheimer’s Disease, Apallic Syndrome, Aplastic Anaemia, Benign Brain Tumour, Cardiomyopathy, Coma, End Stage Liver Disease, End Stage Lung Disease, Heart Valve Surgery, Loss of Hearing, Loss of Independent Existence, Loss of Limbs, Loss of Sight, Loss of Speech, Major Burns, Major Head Trauma, Major Neurone Disease, Multiple Sclerosis, Muscular Dystrophy, Paralysis/Paraplegia, Parkinson’s Disease, Primary Pulmonary Hypertension, Surgery of Aorta and Systematic Lupus Erythematosus.

On survival of a period of 30 days post the diagnosis of any critical illness listed in Group A, the sum assured is paid and the policy is terminated

On survival of a period of 30 days post the diagnosis of any critical illness listed in Group B, 50% of the sum assured is paid immediately and the policy continues for the balance 50% of sum assured with a waiver of premium from the date of admission of the claim.

For definitions of the critical illness covered under the HDFC Critical Care Plan please click here.

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What benefit is paid on expiry of the policy term under the HDFC Critical Care Plan?

HDFC Critical Care Plan is a pure protection product which does not have any benefit on expiry of the policy term. No benefit is payable on expiry of the policy term under the plan.

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What benefit is paid on death under the HDFC Critical Care Plan?

HDFC Critical Care Plan covers the risk of survival post the diagnosis of a critical illness as defined in the policy document. There is no death benefit under the plan and hence no benefit is paid in death of the life assured. In case there is any claim for critical illness which is outstanding at the time of death the claim will be paid to the nominee under the policy.

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Are alterations to the premium and term of the policy allowed under the HDFC Critical Care Plan?

Yes alterations to the policy term and premium are allowed after the completion of the first three years of the policy. The alterations are allowed subject to minimum premium and term conditions which are mentioned in the plan brochure.

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What are the income tax benefits under the HDFC Critical Care Plan?

Premium paid under the HDFC Critical Care Plan is allowed as a deduction from gross taxable income under section 80D, of Income Tax Act 1961. This benefit is available only of the payment is made from taxable income and in a mode other than cash. This is as per the current tax laws. Please note that the tax provisions may change from time to time.
The maximum deduction that can be claimed currently is Rs 30000 (inclusive of Rs 15000 for insurance on the life of parent/parents)

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What are the unique benefits of the HDFC Critical Care Plan?

HDFC Critical Care Plan has the following unique benefits

• Valuable financial help in case of survival post diagnosis of a critical illness
• Cover against 30 critical illnesses
• The lump sum benefit is paid out irrespective of actual medical costs
• Cover continues even after the benefit payment on selected illnesses (listed under Group B)
• Flexible premium payment options

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Will the benefit paid under HDFC Critical Care Plan cover all costs related to the critical illness?

The critical illness benefit paid under the HDFC Critical Care Plan is not linked to any health care costs. A lump sum benefit is paid on survival of a period of 30 days from the date of diagnosis of a critical illness as defined in the policy document. You can opt for a cover ranging from Rs 2 lakh to Rs 20 lakh as per your income and financial needs. While deciding the amount of cover, please ensure that you provide for the hidden costs like loss of family income, payment of housing loan EMIs, monthly expenses etc. The hidden costs of survival with a critical illness can be substantially high and need to be covered by a Critical Illness cover. Please request your financial consulant to evaluate your need and suggest an appropriate cover amount.

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Is there a waiting period for claims under the HDFC Critical Care Plan?

Yes there is a waiting period of 180 days from the date of commencement and the date of revival. No claims except claims arising due to an accident will be considered during this waiting period which please note.

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HDFC SurgiCare Plan

What are the types of surgeries covered under the HDFC SurgiCare Plan?

HDFC SurgiCare Plan covers 82 major surgical procedures. The surgical procedures are graded as follows:

Grade A – 25 per cent of the current sum assured is paid on undergoing any of the surgeries listed below, for the first time in the life time of the life assured.

Cornea transplantation due to Trauma (for each eye)	Drainage of extra dural space
Open Reduction and Fixation for Compound Fracture of Mandible	Drainage of lesion of tissue of brain
Open Reduction of Hip Dislocation	Drainage of subdural space
Traumatic Amputation of lower limb- Below Knee level	Excision of lesions (other than tumours)of tissue of brain
Traumatic Amputation of upper limb- Below elbow level	Excision of the pituitary gland
Surgery to remove cerebral tumours (benign)	Stereotactic ablation of tissue of brain Placement of prosthesis in oesophagus
Drainage of pericardium	Open Surgery for treatment of Peptic Ulcer
Incision of pericardium	Total Thyroidectomy

Grade B – 50 per cent of the current sum assured paid on undergoing any of the surgeries listed below, for the first time in the life time of the life assured.

Reduction and Fixation with Bone Graft for Major Craniofacial Trauma	Traumatic Amputation of upper limb- Above elbow level	Replacement of mitral valve
Reconstruction surgery due to major burns(>25% body surface area)	Radical Vulvectomy for Malignant Condition of Vulva	Replacement of pulmonary valve
Facial reconstruction surgery due to major trauma	Parotidectomy for Malignant Tumour	Replacement of tricuspid valve
Major Repair of Multiple Ruptures in Abdominal cavity due to trauma	Radical Excision of Malignant Bone Tumour	Clipping of Aneurysm/Arterio- Venous Malformation in Brain

Operation for Compound Fracture with Dural Penetration	Orchidectomy for Malignant Testis Tumour	Excision of pineal gland
Total prosthetic replacement of hip joint due to trauma	Wide Excision and Major Reconstruction of Malignant Mouth Tumor	Graft to cranial nerve
Total prosthetic replacement of knee joint due to trauma	Excision of pericardium	Intracranial transection of Cranial nerve
Traumatic Amputation of lower limb- Above Knee level	Replacement of aortic valve	Operations on Surbaracahnoid space of brain
Osteopathic Craniotomy/Extensive Craniotomy for Intracranial Haemorrhage	Permanent Artificial opening into stomach	Bypass for Portal Hypertension
Open operations on varices of oesophagus	Partial Lobectomy/Segmental Resection for various liver lesions (other than tumours)	Open surgery for partial resection of colon for malignant tumour
Nephrectomy due to medical advice (not as a transplant donor)	Open Lobectomy of Lung	Partial Extirpation of Bronchus
Partial or Total Pharyngectomy	Pleurectomy or Pleural decortication	Excision of acquired Cholesteatoma

Grade C – 75 per cent of the current sum assured is paid on undergoing any of the surgeries listed below, for the first time in the life time of the life assured.

Abdomino-Perineal Resection for Malignant Anal Tumour	Carotid Endarterectomy	Open surgery for complete resection of colon for malignant tumour
Decompression/Removal via Craniotomy for Intra and extra cerebral Malignant Brain Tumour	Coronary Artery Bypass Graft for Coronary Disease	Total excision of stomach
Glossectomy with Radical Neck Dissection for Malignant Tongue Tumour	Excision and Insertion of Graft for Aortic Aneurysm	Total Cystectomy for Malignant Bladder Tumour
Laryngectomy with Radical Neck Dissection/Block Dissection for Malignant Tumour	Replacement of more than one cardiac valve under single anesthesia	Total excision of oesophagus (other than tumours)
Surgery for Malignant Liver tumour	Excision of stomach and oesophagus (other than tumours)	Total Pharyngectomy for Malignant Tumour
Total Esophagectomy for Malignant Tumour	Partial Gastrectomy (other than tumours)	Partial Pancreatectomy
Total Pelvic Exenteration for Malignant Conditions

Grade D – 100 per cent of the current sum assured is paid on undergoing the any of the surgeries listed below, for the first time in the life time of the life assured.

Pancreatico-Duodenectomy for Malignant Tumour	Combined Heart-Lung Transplant	Isolated Heart Transplant
Pulmonary Artery Embolectomy using Cardiopulmonary Bypass	Triple Bypass for Malignant Pancreatic Tumour	Renal Transplant as recipient for Complete Renal Failure
Pneumonectomy or Pleuropneumonectomy - total lung of one side	Total Laryngectomy	Transplantation of Lungs
Bone Marrow Transplant

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What is paid on undergoing surgeries listed under the HDFC SurgiCare Plan?

The benefit under HDFC SurgiCare Plan is defined as a percentage of the current sum assured. A percentage of the sum assured depending on the Grade of surgery is paid. Grade Percentage of Current Sum Assured payable

Grade	Payout % of Annual Sum assured
A	25
B	50
C	75
D	100

Please click to view the grade for the various surgeries covered under the plan.

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Can I purchase the HDFC SurgiCare Plan for my entire family?

HDFC SurgiCare Plan is a single life plan. Only one person can be covered under one policy. In case the whole family is to be covered then individual policies can be proposed for each insurable member of the family.

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What are the cover options available under the HDFC SurgiCare Plan?

The following cover options are available under the HDFC SurgiCare Plan
Option A – Surgical benefit along with Hospital Cash benefit
Option B – Only Surgical benefit

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What benefit is paid on expiry of the policy term under the HDFC SurgiCare Plan?

HDFC SurgiCare Plan is a pure protection product which does not have any benefit on expiry of the policy term. No benefit is payable on expiry of the policy term under the plan.

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Are alterations to the premium and term of the policy allowed under the HDFC SurgiCare Plan?

Yes alterations to the policy term and premium are allowed after the completion of the first three years of the policy. The alterations are allowed subject to minimum premium and term conditions which are mentioned in the plan brochure. The company may not allow any alterations in case any claim has been made under the policy which please note.

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What are the income tax benefits under the HDFC SurgiCare Plan?

Premium paid under the HDFC SurgiCare Plan is allowed as a deduction from gross taxable income under section 80D, of Income Tax Act 1961. This benefit is available only of the payment is made from taxable income and in a mode other than cash. This is as per the current tax laws. Please note that the tax provisions may change from time to time.
The maximum deduction that can be claimed currently is Rs 30000 (inclusive of Rs 15000 for insurance on the life of parent/parents)

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What are the unique benefits of the HDFC SurgiCare Plan?

HDFC SurgiCare Plan has the following unique benefits

• Valuable financial help in case of major surgical procedures
• Increasing health cover every year
• The lump sum benefit is paid out irrespective of actual medical costs
• Optional Hospital Cash benefit to cover major hospitalisation expenses
• Flexible premium payment options

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Will the benefit paid under HDFC SurgiCare Plan cover all costs related to the surgery?

The surgical benefit paid under the HDFC SurgiCare Plan is not linked to actual cost of the surgery. A lump sum benefit is paid on undergoing a listed for the first time in the lifetime of the life assured. The life assured can opt for a sum assured ranging from Rs 1 lakh to Rs 5 lakh as per your income and financial needs. While deciding the amount of cover, please ensure that you provide for direct and indirect costs associated with a major surgery. The hidden costs of major surgeries can be substantially high and need to be covered by a surgical benefit cover. Please request your financial consulant to evaluate your need and suggest an appropriate cover amount.
Please note that the surgical benefit under HDFC SurgiCare Plan is payable over and above any claim received under any other medical insurance plan. Cover available under exisiting insurance should also be taken into account while deciding the cover to be proposed under HDFC SurgiCare Plan.

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What benefit is paid on death under the HDFC SurgiCare Plan?

HDFC SurgiCare Plan covers the risk of major surgeries and hospitalisation as defined in the policy document. There is no death benefit under the plan and hence no benefit is paid in death of the life assured. In case there is any claim for surgery and/or hospitalisation which is outstanding at the time of death the claim will be paid to the nominee under the policy.

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Is there a waiting period for claims under the HDFC SurgiCare Plan?

Yes there is a waiting period of 90 days from the date of commencement and the date of revival. No claims will be considered during this waiting period which please note.

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Can hospital cash benefit be claimed for hospitalisation which does not involve surgery under HDFC SurgiCare plan?

Hospital Cash benefit is paid for any hospitalisation exceeding 48 hours. Surgery is not a precondition for payment of this benefit. Hospital Cash benefit can be claimed for hospitalisation exceeding 48 hours even when surgery is not performed during such hospital stay.

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What is cashless facility?

Cashless facility is a facility wherein the life assured can undergo surgery and/or hospitalisation without payment of cash to the hospital. When the life assured undergoes treatment at a network hospital he can choose to avail of the cashless facility provided the surgery/hospitalisation is covered under the HDFC SurgiCare Plan. To avail of the facility the life assured/hospital will have to make a preauthorization request to the TPA.

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Income Tax Section	Gross Annual Salary	How Much Tax Can You Save?	HDFC Standard Life Plans
Sec. 80C	Across all income slabs	Upto Rs. 30,900/- saved on investment of Rs. 1,00,000/-	All our Life Insurance Plans
Sec. 80CCC	Across all income slabs	Upto Rs. 30,900/- saved on Investment of Rs.1,00,000/-	All our Pension Plans
Sec. 80 D*	Across all income slabs	Upto Rs. 9,270/- saved on investment of Rs. 30,000/- (Inclusive of Rs.15,000/- towards health insurance of parents)	All our Health Insurance Plans All the health insurance riders available with our Conventional Plans
		Upto Rs. 10,815/- saved on investment of Rs.35,000/- (Inclusive of Rs. 20,000/- towards health insurance of parents who are senior citizens)
Total Savings Possible **	Rs. 41,715/- Rs. 30,900/- under Sec. 80C and Sec. 80CCC Rs. 9,270/- or Rs. 10,815/- under Sec. 80D Above figures calculated for a male with gross annual income exceeding Rs. 5,00,000/-
Sec. 10 (10)D	Under Sec. 10(10D), the benefits received by you are completely tax-free
Applicable to premiums paid for all Health Insurance Plans, Critical Illness Benefit, Accelerated Sum Assured and Waiver of Premium Benefit. ** These calculations are illustrative and based on our understanding of current tax legislations.   The above-mentioned tax benefits are subject to changes in the tax laws. Please contact your tax consultant for an exact calculation of your tax liabilities.

What is TPA?

TPA or the THIRD PARTY ADMINISTRATOR is a company licensed by IRDA (Insurance Regulatory and Development Authority) to offer health claim related services for the benefit of both the insured and the insurer. While the insured is benefited by quicker & better service, insurers are benefited by reduction in their administrative costs, fraudulent claims and control on claims.

In brief, the job of the TPA is to maintain databases of policyholders and issue them health identity cards with unique identification numbers and handle all claim related issues including claim settlements. In terms of infrastructure, the TPA will provide a 24-hour toll-free number, which can be accessed from anywhere in the country. TPA will have full-time medical practitioners under their employment who will immediately take a decision on whether the ailment is covered under the policy or not on receipt of a cashless preauthorization request.

Scope of TPA

The scope of services will include:

• Issue of Identity card to all policyholders.
• Provide information to policyholders about hospitals.
• Provide Cashless access in TPA network hospitals.
• Process claims.
• Provide 24 hours, 7 days a week customer service toll free number.

https://www.ttkhealthcareservices.com