CignaTTK Health Insurance Company Limited

Corporate Office: 10th Floor, Commerz, International Business Park, Oberoi Garden City, Off Western Express Highway,
Goregaon (East), Mumbai - 400 063. IRDA Registration No. 151
Call (Toll Free): 1-800-10-24462 Visit: www.cignattkinsurance.in E-mail: customercare@cignattk.in

ANNEXURE: ILLUSTRATION OF BENEFITS

Restoration of Sum Insured (Available once in a Policy Year)
Illustration:
If there are 2 Insured members with Sum Insured 10 Lacs each, lets understand how restoration benefit will apply to each under
different circumstances.
Sum Insured

1st Claim

2nd Claim

3rd Claim

Basic Sum Insured

Insured 1

Insured 2

` 10,00,000

` 10,00,000

No claims Bonus (if any)

` 50,000 (Assuming a claim free year)

Total Sum Insured

` 10,00,000

` 10,50,000

Reason

Due to planned Surgery

Due to an accident

1st Claim payable amount

` 5,00,000

` 5,00,000

Balance Sum Insured

` 5,00,000

` 5,50,000

Reason

Due to a Knee Surgery

Due to Meningitis

2nd Claim payable amount

` 3,00,000

` 7,00,000

Available Sum Insured

` 5,00,000

` 5,50,000

Will the Restoration kick in?

No

Yes, Restored to `10,00,000

Why - Since the available

Sum Insured is enough to
pay for the claim, restoration
will not kick in.

Why - The available Sum Insured

is not enough to pay the claim.
The claimed amount (` 7,00,000)
is greater than the available
Sum Inured (` 5,50,000)

Balance Sum Insured

` 2,00,000

` 8,50,000

Reason

Due to heart attack

NA

3rd Claim payable amount

` 11,00,000

Available Sum Insured

` 2,00,000

Will the Restoration kick in?

Yes,
Restored to `10,00,000
Why - The available Sum Insured
is not enough to pay the claim.

Balance Sum Insured

` 2,00,000

For any claim the maximum

amount payable will be limited
upto the sum insured.
4th Claim

Reason

Due to heart attack

4th claim payable amount

` 6,00,000

Will the Restoration kick in?

No,
Why - Sum Insured will not be
restored for the same ailment

Deductible
Illustration:
If two Insured's with a ` 3.5 Lac and ` 7.5 Lac Sum Insured opt for a deductible, lets understand how deductible will be applied.
1st Policy year

Insured 1

Insured 2

` 3,50,000

` 7,50,000

Opted Deductible

` 1,00,000

` 2,00,000

What does opting for

a deductible mean?

Coverage will start once the Insured person incurs a single claim or
multiple claims that add up to the deductible.

Sum Insured

1st Claim

` 40,000 (Not paid by Us)

` 2,00,000 (Not paid by Us)

2nd Claim

` 60,000 (Not paid by Us)

` 1,00,000 (Paid by Us)

Since you have already exhausted your

deductible limit of ` 2, 00,000 we will pay the claim.
3rd claim

` 80,000 (Paid by Us)

Since ` 40,000 + ` 60,000 =

` 1 Lac, was paid out of your
pocket, your deductible limit
of ` 1 Lac was exhausted.

NA

Co-payment - I
Illustration:

Mandatory Co-payment
A 67 year old Insured person
buys an ` 4.5 Lacs policy, then
a mandatory Co-pay of 20%
will apply on all his claims.

Sum Insured
Claim Payable Amt.
Co-payment
Amount paid by Us

` 4,50,000
` 1,00,000
` 20,000 (20% of ` 1,00,000)

80,000

Voluntary Co-payment
A 45 year old Insured buys a `7.5
Lac Sum Insured and chooses to
opt for a Co-payment of 10%, then
a 10% Co-payment will apply on
all his Claims.
` 7,50,000
` 3,00,000
` 30,000 (10% of ` 3,00,000)
` 2,70,000

Out of Zone Co-payment

An Insured living in Lucknow (Zone III)
wants to get treated in Mumbai (Zone
I), then a Co-payment of 20% will be
applicable on his Claim.
` 4,50,000
` 3,00,000
` 60,000 (20% of ` 3,00,000)
` 2,40,000

Co-payment - II
Illustration for - Mandatory + Voluntary + Zonal Co-payment:
A 66 years old Insured person from Lucknow, has opted for an Optional cover of Voluntary Co-payment of 10% and wants to get
treated in Delhi, let us understand the Co-payment applicable in this scenario
Sum Insured
` 10,00,000
Claim payable amount
` 3,50,000
Applicable Co-pays Mandatory Co-payment for person above 65
20%
Voluntary Co-payment
10%
Zonal Co-payment
20% (Insured from zone III opting to get treated in Zone I)
Total Co-pay Applicable
50% (50% of ` 3,50,000 = ` 1,75,000)
Claim payable to the Insured
` 1,75,000 (50% of ` 3,50,000)

HEALTHY REWARD PROGRAMME

a. What is the objective of Healthy Rewards programme: The objective of our programme is to encourage our customer's to
demonstrate healthy behaviour.
In order to achieve this we have introduced online assessment programmes that evaluate your health status and aid in improving
your overall well-being.
b. How are the Rewards points calculated: From the premium that you pay, 1% of the premium value each year gets accumulated as
Reward points.
If you pay a premium of ` 5000 in the first year, 1% of ` 5000 ( ` 50) will be accumulated as points. Each earned Reward point will be
valued at 1 Rupee.
c. How are the Reward points Redeemed: Accumulated reward points can be redeemed in the following ways 1. Through additional Health Maintenance Benefit :
We will provide additional Sum Insured towards Health Maintenance Benefit equivalent to the number of points earned.
E.g. if you have 2000 points, you will be eligible to get additional Sum Insured of ` 2000. (1 point = 1 Rupee)
This benefit can be used to avail coverage under the Health Maintenance Benefit .
2. As a discount in premium:
If you wish to avail a discount in the premium, points accumulated in the policy can be utilized from the time you pay your 3rd
annual premium towards a discount.
Policy Year
1
2
3

Premium Paid
` 10,000
` 11,000
` 12,000

Accumulated rewards
100
110
120

` 13,000

130

Available to redeem
No
No
Yes
(330 points, which can be redeemed on 3rd annual premium to
avail a discount of ` 330) (100 + 110 + 120 = 330)
460 points (if 330 points are not redeemed in previous year)
(330 + 130 = 460)

a. How can you Accumulate more points: By opting for Our Online Wellness Programs that help you to assess your health status
and aid in improving your overall well-being you can add up more points.
Each program can be opted once by a particular insured person and a maximum of 5 such online programmes can be availed to earn
rewards during a policy year
Online Programs
Health Risk Assessment (HRA)
Targeted Risk Assessment (TRA)
Online Lifestyle Management Program (LMP)

Your Health Relationship Manager Has The Answer

Be it claims assistance or guidance, contact your Health RM anytime.

Points Earned
Protect Plan
25
50
50

1-800-10-24462

Plus Plan
40
80
80

Preferred Plan
80
160
160

customercare@cignattk.in

Premier Plan
120
240
240

www.cignattkinsurance.in

Corporate Office: CignaTTK Health Insurance Company Limited,10th Floor, Commerz, International Business Park, Oberoi Garden City, Goregaon (East), Mumbai - 400 063.
IRDA Registration No. 151
ProHealth UIN Number: IRDA/NL-HLT/CTTK/P-HA/-I/390/13-14 Critical illness UIN Number: IRDA/NL-HLT/CTTK/P-HA/-l/390/Addon(CI)13-14 Version Number: V1/Feb14