Alumni Benefit Guide

MNITJAA
Super Top-up Health Insurance Program ,
OPD Benefit program and
Group Personal Accident Insurance Program

Offered by: MNIT Jaipur Alumni Association

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MNITJAA Super Top-up Health Insurance Program Benefit Manual

Insurance Broker

Zopper Insurance Brokers Pvt Ltd.

Insurance Company

Care Health Insurance Limited

Third-Party Administrator

Direct Claim Servicing by Care

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Health Insurance - A primer

Basic health plan Top-Up Plan Super Top-Up Plan

It is the basic health insurance cover that provides A top-up insurance policy provides you with extra A super-top up insurance plan is like a Top-up plan but
for recoupment of expenditure made on resolving coverage above a predetermined "threshold limit". It considers the entire amount of all the bills you have in

smaller health issues more so in cases which means that if you exhaust the coverage of your base an entire year, and not just every individual case.

warrant short duration hospitalization insurance policy, then the coverage of the top-up policy
begins. This is typically used to cover for unforeseen Typically upwards of 20 lacs all the way up to 1Cr or
large medical expenses (Like hospitalization due to above – combined with low premiums and high
Typically in the range of Rs. 3-5 lacs
COVID) threshold
Most people have it from their employers

Larger sums with relatively low premiums and high

threshold Proposed Scheme for MNIT Jaipur Alumni Association

TOP-UP PLAN SUPER TOP-UP PLAN

• If you run the risk of being hospitalized more than once a year from chronic diseases, it is best
to pay for a super top-up plan.
Which one to The premium amount would pinch much less when you save on a hugely draining amount as
If you do not suffer from a chronic ailment, or run the risk of a terminal
prefer? hospitalization charges.
illness, a top-up plan would be suitable to your needs.
• In the long run, a super top-up plan is a cost-saver and offers coverage for wide range of
illnesses.
• It is especially beneficial for senior citizens who have frequent medical expenses that can be
covered due to cumulative coverage.

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Health Insurance - A primer

TOP-UP PLAN SUPER TOP-UP PLAN

Mr. Sharma has a base health insurance of ₹5 lakhs sum assured.

Scenario
example
Top-up plan of ₹10 lakhs with ₹5 lakhs as the deductible Super top-up of ₹10 lakhs with ₹5 lakhs as the deductible

Case 1: Single Expense coverage: Expense coverage:

claim of ₹12 ● Base plan will cover ₹5 lakhs. ● Base plan will cover ₹5 lakhs.
lakhs ● Top-up plan will cover the remaining ₹7 lakhs as it exceeds deductible. ● Top-up plan will cover the remaining ₹7 lakhs as it exceeds deductible.

Expense coverage:
● Base plan will cover ₹4 lakhs on first claim Expense coverage:
Case 2: Two
● Base plan will cover ₹1 lakhs on second claim ● Base plan will cover ₹4 lakhs on first claim
claims of ₹4
● Patient to pay balance ₹3 lakhs on second claim ● Base plan will cover ₹1 lakhs on second claim
lakhs each
There will be no claim pay-out from Top-up Plan, as the individual amount of ● Super Top-up will cover balance ₹3 lakhs on second claim
the claim does not exceed ₹5 lakhs.

Expense coverage:
Expense coverage:
Case 3: Claim ● Base plan will cover ₹5 lakhs on first claim
● Base plan will cover ₹5 lakhs on first claim
of ₹7 lakhs ● Top-up plan will cover ₹2 lakhs on first claim
● Super Top-up will cover ₹2 lakhs on first claim
and ₹4 lakhs ● Patient to pay ₹4 lakhs on second claim
● Super Top-up will cover balance ₹4 lakhs on second claim
No claim is payable for second claim as it does not exceed the deductible limit.

Proposed Scheme for MNIT Jaipur Alumni Association

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Comparison on Coverages of Super Top-up program

United India Insurance Company

Offerings MNITJAA<>Care Niva Bupa Royal Sundaram TATA AIG ACKO
Limited
Self 18 to 85 years 18 to 65 Years 18 to 65 Years 18-65 years 18-65 years No Limit
Spouse 18 to 85 years 18 to 65 Years 18 to 65 Years 18-65 years 18-65 years No Limit

between the age of 3 months and 18 between the age of 3 months and 18
Children 91 Days to 30 years 91 days to 25 yrs 91 days to 25 yrs No Limit
year year

Entry age upto 85 years Not covered ( Covered Incase, if they have already
Parents Not Covered Not Covered Not Covered Covered up to 65 years
Covered for life a base policy with Parent coverages from Acko )

Not covered ( Covered Incase, if they have already

Entry age upto 85 years
Parent-in-law Not Covered Not Covered Not Covered Not Covered a base policy with Parent in law coverages from
Covered for life
Acko )
Age Band upto 85 Years upto 65 Years Only upto 65 Years Only upto 65 Years Only upto 65 Years Only Not Covered
Medical checkup required before buying
No Yes Yes Yes Yes Yes
policy??
Policy Tenure 1 Year 1 year 1 year 1 Year 1 Year 1 year
Cashless Yes Yes Yes Yes Yes Yes
Reimbursement Yes Yes Yes Yes Yes Yes
10 Lakh / 15 Lakh / 20 Lakh / 25
SUM Insured Options Available Lakh / 30 Lakh 3 /5/7/15/ 10/20/45/40/70 Lakhs 7.5 /10/15/25 Lakhs Yes 10/15/25/50 Lakhs 10L/25L/50L/1Cr/Unlimited
/ 50 Lakh / 75 Lakh/ 1 Crore

Deductible 3/5/7/10 Lakhs 2/3/5 /10/15/20/25 Lakhs 3 Lacs/4 Lacs and 5 Lacs 5/10/15/20/25 Lacs 3/5/10/15 Lakhs 75K to 25L
Normal - Any kind of Room except
1% of base SI for Normal and Single 1% of base SI for Normal and Single 1% of base SI for Normal and
Room Rent Suite No Capping No Capping
Private room for ICU Private room for ICU Single Private room for ICU
ICU - On Actuals
Day Care Treatment Covered Yes Yes Yes Yes Yes Yes
In-Patient Hospitalisation Covered Yes Yes Yes Yes Yes Yes
Pre & Post Hospitalisation Expenses
Pre- 60 , Post 90 Days Pre- 30 , Post 60 Days Covered 60 and 90 days respectively 60 and 90 Days 60 and 90 Days Pre- 60 , Post 120 Days
Covered
Yes, if it continues for a period
Hospitalisation at Home Yes , maximum 30,000 per policy Yes Up to 50,000 Yes upto SI
exceeding 3 consecutive days
Yes, for up to ₹5,000 per 2500 per event/ Max 5000 per policy
Ambulance Covered upto Rs 1500 per hospitalization Up to 3000 per event Up to 3000 per event No Limit
hospitalisation period
Donor Expenses Covered up to opted S.I Not Covered Covered Covered Covered Covered
Initial waiting period - 30 Days
(except for
injury/accident) Specific disease
Waiting Period in The Policy ( Initial / Pre 36 Months, specific illness-24 36 Months, specific illness-24
waiting period 4 Years for Pre Existing Diseases 4 Years for Pre Existing Diseases Covered from Day 1
Existing Disease) months months
- 12 Months Pre-existing disease
waiting period
- 12 Months

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 Key Differentiator of Super Top-up program

United India Insurance Company ACKO (only if base policy is with

Offerings MNITJAA<>Care Niva Bupa Royal Sundaram TATA AIG
Limited ACKO)

Entry age upto 85 years

Entry Age for Parents Covered for life
Not Covered Not Covered Not Covered Covered up to 65 years Covered upto any age limit

Entry age upto 85 years

Entry Age for Parents in Laws Covered for life
Not Covered Not Covered Not Covered Not Covered Covered upto any age limit
Entry age upto 85 years
Entry Age for Self & Spouse Covered for life
upto 65 Years Only upto 65 Years Only upto 65 Years Only upto 65 Years Only No Limit

Medical Check-up before buying

No Yes Yes Yes Yes Yes, Mandatorily
the Policy

10 Lakh / 15 Lakh / 20 Lakh / 25

Sum Insured Options Lakh / 30 Lakh 3 /5/7/15/ 10/20/45/40/70 Lakhs 7.5 /10/15/25 Lakhs Yes 10/15/25/50 Lakhs 10L/25L/50L/1Cr/Unlimited
/ 50 Lakh / 75 Lakh/ 1 Crore

Normal - Any Kind of Room Except

1% of base SI for Normal and Single 1% of base SI for Normal and Single 1% of base SI for Normal and Single
Room Rent Limit Suite No Capping No capping
Private room for ICU Private room for ICU Private room for ICU
ICU - On Actuals

Initial waiting period - 30 Days

(except for
injury/accident) Specific disease
Wait Period on the Pre Existing 36 Months, specific illness-24 36 Months, specific illness-24
waiting period 4 Years for Pre Existing Diseases 4 Years for Pre Existing Diseases No waiting period
Diseases (PEDs) months months
- 12 Months Pre-existing disease
waiting period
- 12 Months

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Coverages

Age Criteria

Self & Spouse 18 to 85 years

Child/Children 91 days to 30 years

Parents/Parents-in-law 41 to 85 years

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Coverages

Features of MNITJAA Super Top-up Health Insurance Program

Medical check-up No medicals required Hospitalisation at home Yes, if it continues for a period exceeding 3 consecutive days

Policy Tenure 1 Year Ambulance covered Yes, for up to Rs 5,000 per hospitalisation

Cashless facility Yes Donor expenses Covered up to opted Sum Insured

● Initial waiting period for new members - 30 Days from the first
date of enrolment (except for injury/accident)

● Specific disease waiting period for new members - 12 Months

Waiting period in policy
Reimbursement facility Yes from the first date of enrolment
(Initial/Pre-existing Disease)

● Pre-existing disease waiting period for new members -12

Months from the first date of enrolment

10 Lakh/15 Lakh/20 Lakh/25 Lakh/30 Lakh /50 Select different sum insured & deductible for immediate family, parents,
Available sum insured options Flexible Coverage
Lakh/75 Lakh/1 Cr & parents-in-law

Deductible 3 Lakh/5 Lakh/7 Lakh/10 Lakh Copayment No Copayment

Room rent Any Kind of room except Suite Capping on ailments/treatments None

Day care treatment covered Yes Jurisdiction of the program India

In-patient hospitalisation covered Yes

Pre-60 days
Pre & Post hospitalisation expenses covered
Post-90 days

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Negative List For Super Top-up Program

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List of Specific Diseases of Super Top-up

List of Specific Diseases/Procedure - Waiting Period of 12 Months

Any treatment related to

1. Arthritis (If Non-Infective) 6. Fissure / Fistula In Anus, Hemorrhoids / Piles , Pilonidal Sinus, Gastric And Duodenal Ulcers
A. Osteoarthritis And Osteoporosis, Gout 7. Surgery Of Genito-Urinary System Unless Necessitated By Malignancy
B. Rheumatism, Spinal Disorders(Unless Caused By Accident) 8. All Types Of Hernia & Hydrocele
C. Joint Replacement Surgery(Unless Caused By Accident) 9. Hysterectomy For Menorrhagia Or Fibromyoma Or Prolapse Of Uterus Unless
D. Arthroscopic Knee Surgeries/Acl Reconstruction/Meniscal Necessitated By Malignancy
And Ligament Repair 10. Internal Tumours, Skin Tumours, Cysts, Nodules, Polyps Including Breast Lumps (Each Of
2. Surgical Treatments For Benign Ear Any Kind) Unless Malignant
A. Nose And Throat (Ent) Disorders And Surgeries (Including But 11. Kidney Stone / Ureteric Stone
Not Limited To Adenoidectomy, Mastoidectomy) 12. Lithotripsy / Gall Bladder Stone
B. Tonsillec To My And Tympanoplasty 13. Myomectomy For Fibroids
C. Nasal Septum Deviation 14. Varicose Veins And Varicose Ulcers
D. Sinusitis And Related Disorders 15. Genetic Disorders
3. Benign Prostatic Hypertrophy 16. Parkinson's or Alzheimer's disease or Dementia
4. Cataract
5. Dilatation And Curettage

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Claim Process

Time limit for submission of Claim Documents:

Within 30 days from date of discharge.

Claim Intimation - Within 7 days from date of admission

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Cashless Hospitalisation Process Flow Chart

Hospital intimates TPA & sends Pre-Authorisation request

Start Alumni Approaches Network Hospital with E-card
with approximate cost of the treatment for approval

Yes
At the time of discharge, hospital sends the final bill and TPA issues letter of credit (for cashless) with approval for
the discharge summary to TPA for the final approval partial/full amount as per eligibility and coverage to the hospital

TPA sends the final approval to hospital which allows the Yes
Hospital sends complete set of claims
Alumni to get discharged by paying all non-medical / non-
documents for processing to TPA
payable expenses

No No

Claims Processing by TPA & Insurer, release of

Follow reimbursement process
payments to the hospital

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Reimbursement Hospitalisation Process Flow Chart

Member intimates TPA Claim registered by TPA Insured admitted as per Insured admitted relevant
before or as soon as after receipt of claim hospital norms. All documents to the TPA within A
hospitalisation occurs intimation payments made by member 30 days of discharge

TPA performs medical Is document received within

Is claim payable?
scrutiny of the documents 30 days from discharge?

Claim Rejected

Payment will be done to Associated Bank

TPA checks documentation Is documentation complete
Claim processing done Account, The discharge voucher and copy
sufficiency as required?
of payment receipt to Associate

Receives mail about

deficiency and document A
requirement

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Communications Matrix for Super Topup
Program

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MNITJAA OPD Benefit program Benefit Manual

Insurance Broker

Zopper Insurance Brokers Pvt Ltd.

Insurance Company

Aditya Birla Health Insurance Co. Limited

Third-Party Administrator

Claim Servicing through VISIT app

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Unique Features Our Exclusive OPD Program

● One of it’s kind Voluntary OPD program where Alumni can enroll themselves, spouse, children & parents
or parents in law into the program

● Day 1 Coverage* (Once the account is activated in app, Alumni can start claiming)

● Completely cashless with more than 54000+ doctors across India

● No waiting period for Pre Existing Diseases

● Easy End 2 End Digital onboarding Journey

● No minimum participation % required in voluntary policy

Better than market benefits at a competitive premium
of the OPD Program

*All rates are exclusive of 18% GST

List of Exclusions of OPD Program
List of Exclusions of OPD Program
Communications Matrix for OPD Program

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Disclaimer

The information contained in this presentation is intended solely for the personal reference of the MNIT Jaipur Alumni
Association. Such information is subject to change without notice, its accuracy is not guaranteed and it may not
contain all material information concerning the proposal for seeking interest of the Alumni community to subscribe to
a group insurance super-top up plan (“proposed product”). The MNIT Jaipur Alumni Association makes no
representation regarding, and assumes no responsibility or liability for, the accuracy or completeness of, or any errors
or omissions in, any information contained herein. These views are based on current assumptions which are subject to
various risks and which may change over time. No assurance can be given that future events will occur, that
projections will be achieved, or that the assumptions are correct. It is not the intention to provide, and you may not
rely on this presentation as providing, a complete or comprehensive analysis of the proposed product. This
presentation does not constitute an offer or invitation to purchase or subscribe for the proposed product, and no part
of it shall form the basis of or be relied upon in connection with any contract, commitment or investment decision in
relation thereto.
This presentation is confidential and is intended, among other things, to present a general outline of the proposed
product. The contents are not to be reproduced or distributed to the public or press. Each person who has received a
copy of this presentation is deemed to have agreed: i) not to reproduce or distribute this presentation, in whole or in
part, ii) not to disclose any information contained in this presentation. All photos, logos etc. used in the presentation
are the property of their respective copyright owners and are used here for information purpose only within the closed
group of MNIT Jaipur Alumni Association.

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Let us keep you fit, healthy and well!

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