Max Bupa Health Premia


Max Bupa Health Insurance

HEALTH PREMIA FAMILY FLOATER

Max Bupa’s Health Premia is an all-inclusive plan, made-to-fit you and your loved ones. It not only understands your changing health needs due to your changing lifestyle, but also gives you the flexibility to change & choose the right cover basis your needs. In addition, you also get to choose from a comprehensive list of benefits and rewards basis your requirements.

Now, your health is truly in your hands with the all-new Health Premia.

Gold version

FEATURES

In-Patient Care (Hospitalisation)

We cover cost of medical treatment when you or your insured family members are hospitalised for treatment.

Hospital Accommodation

No limit on the hospital room rent. Room rent is covered up to Sum Insured except suite and above room category. ICU charges are covered up to Sum Insured.

Pre & Post Hospitalisation Medical Expenses

We reimbursepre & post hospitalisationmedical expenses incurred due to illness/injury. The period of the treatment covered is90 days before you get admitted to the hospital and 180 days after you get discharged from the hospital. This is subject to Max Bupa accepting the In-patient Carehospitalisation, Day Care or Domiciliary hospitalisation claim.

Day Care Treatments Covered

We cover day care treatments under the product. Please refer to Annexure III of the policy document to know the day care procedures covered under the product.

Domiciliary Hospitalisation

In case a bed in the hospital is unavailable or on advice of the attending medical practitioner, treatment is administered at home; we pay for medical treatment taken at home, which would otherwise have required hospitalisation. Such treatment shouldcontinue for at least 3 consecutive days and confirmation from treating medical practitioner/insured that insured person could not be transferred to the hospital or hospital bed was unavailable, as the case may be.

Alternative Treatments

We will indemnify the medical expenses incurred on the insured person’s hospitalization for Inpatient Care on treatment taken under Ayurveda, Unani, Siddha and Homeopathy.

Organ Transplant

Medical expenses for an organ donor’s In-patient treatment for the harvesting of the organ donated is also covered provided the organ is for the use of the insured person.

Emergency Ambulance

We also cover the road ambulance expenses to transfer the insured following an emergency to the nearest hospital. We also provide ambulance coverage if the medical condition requires immediate ambulance services from the existing Hospital to another Hospital with advanced facilities for management of the current Hospitalization.These expenses are paid up to Sum Insured (network hospitals) or up to Rs2,000 (non-network hospitals) only if we have accepted the In-patient claim.

E-Consultation

Unlimited tele / online consultations available under this product.

Maternity Benefit

The plan provides you maternity benefits for up to two deliveries. This benefit is available after both you and your spouse have been covered under the policy for two continuous years.

Newborn Baby

The new born baby will be covered as an insured person from birth without additional premium, till the next policy year, if the maternity claim is admissible under the policy. We also cover vaccination expenses of the new born baby for the first year if you add the baby in the policy for the next policy year.

Health Checkup

You can avail health checkup for Diagnostic Tests purposes from Day 1 for any insured person (including children), so that you live a healthier and happier life. You can undergo a health checkup through our service provider on cashless basis. You can choose tests of your choice up to a sub-limit as per the plan chosen.

Refill Benefit

In case you have exhausted your Base Sum Insured and Loyalty Additions / Enhanced Loyalty Additions (if any) partially or completely, you are entitled for an additional sum insured equal to the base sum insured for a subsequent claim in the same year. This benefit can be availed for both same and different illnesses.

Premium Waiver

Automatic free of charge extension for 1 year if the Policy holder (who should also be an Insured Person) dies or is diagnosed or undergoes treatment for the first time, with any of the Specified Illness during the Policy. (Not available for individual cover)

Pharmacy And Diagnostic Services

You may purchase medicines and diagnostic services from the empanelled service provider through our mobile application or website. The cost for the purchase of the medicines or diagnostic services shall be borne by you.

Loyalty Additions

Irrespective of your claim history, you will get an increase of 10% of expiring base Sum Insured every year, subject to maximum of 100% of base Sum Insured.

HIV / AIDS

Expenses incurred for hospitalization (including day care treatment) due to condition caused by or associated with HIV / AIDS are covered under the policy subject to sub-limit as specified in the policy contract. This benefit is provided subject to a waiting period of 48 months from inception of the cover with Us, with HIV / AIDS covered as a benefit.

Emergency Assistance Services

Coverage for Medical referral, Emergency medical evacuation, Medical repatriation, Compassionate visit, Care and/or transportation of minor children & Return of mortal remains. The services are provided when Insured Person(s) is/are traveling within India to a place which is at a minimum distance of 150 kilometers from the residential address, and the travel is for less than 90 days period.

Mental Disorder Treatment

Expenses incurred for inpatient treatment for mental illness are covered under the policy subject to sub-limit for specific conditions as specified in the policy contract.This benefit is provided subject to a waiting period of 36 months from inception of the cover with Us, with Mental illness covered as a benefit.

Weight Loss (Bariatric) Surgery

Expenses incurred for undergoing medically necessary bariatric surgery where the insured person’s MBI is greater than 35 are covered under the policy subject to sub-limit as specified in the policy contract.This benefit is provided subject to a waiting period of 36 months from inception of the cover with Us, with bariatric surgery covered as a benefit. Surgeries which are cosmetic in nature are not covered under this benefit.

Cyber Knife/ Robotics Surgery

Expenses incurred for inpatient treatment for the removal and/or treatment of a malignant tumor through cyber knife or robotic Surgery are covered under the policy.A co-payment of 50% is applicable for this benefit.

LASER Surgery Cover

Expenses incurred for undergoing LASER assisted surgeries are covered under the policy subject to sub-limit as specified in the policy contract. This benefit is provided subject to a waiting period of 36 months from inception of the cover with Us. Lasik surgery for correction of refractive error would be covered if the Insured Person has a refractive index of plus/minus 8 or more and is prescribed by an ophthalmologist.

International Coverage

One Single trip of up to Rs. 30 Lacs per insured for maximum 15 days per insured outside India except USA & Canada is covered under this benefit. Coverage is provided for Emergency Hospitalization, Emergency Medical Evacuation, OPD cover (with a co-payment of 20%), Compassionate visit, Loss of Passport, Care and/or transportation of minor children, Loss of checked-in baggage, Return of mortal remains, Trip Cancellation & Interruption, Trip Delay, Delay of Checked-in Baggage, Medical Referral and Medical Repatriation; subject to sub-limits as specified in the Policy. For activating this benefit, You have to get the Policy Schedule issued by Us at least 7 days prior to your trip.

Personal Accident Cover (Optional)

Personal Accident coverage can be opted for any adult insured against accidental death, permanent total and partial disability.

Critical Illness Cover (Optional)

Critical illness coverage for any adult insured against major illnesses like cancer, CABG, open heart replacement, kidney failure, stroke, major organ/bone marrow transplant etc.

Enhanced Loyalty Additions (Optional)

Irrespective of your claim history, enhanced cumulative bonus of 20% of expiring base Sum Insured every year, subject to maximum of 200% of base Sum Insured.

Hospital Cash (Optional)

Daily hospital cash benefit for an amount of Rs. 5,000 per day in case of hospitalization. Minimum 48 hours of continuous hospitalization required, however claim would be paid from day one subject to hospitalization claim being admissible. Maximum coverage offered for 30 days/policy year/insured person.

International Coverage Extension (Optional)

With the help of this benefit, You can double the sum insured of international coverage benefit and/ or opt for additional single trips of maximum 30 days.

Health Coach (Optional)

Keeping in mind that the present age customers are fitness conscious, you have an option to choose a personal health coach who will guide and motivate to achieve personal health goals. This facility can be opted by any adult insured persons for 90 calendar days in a policy year.

Enhanced Geographical Scope For International Coverage (Optional)

Would like to inform you that by adding this benefit that you would be entitled to avail international coverage in USA & Canada also.

Co-Payment

There will be no co-payment if you choose Zone 1 coverage. If you chooseZone 2 coverage, you will be entitled for a premium discount but will have to bear a 20% co-payment for treatment in Mumbai (including Navi Mumbai and Thane), Delhi NCR, Kolkata & Gujarat state.

Entry Age And Family Coverage

The entry age for adults under this policy can be from 18 to 65 years. The entry age for dependent children is from 91 days to 30 years in a family floater policy. The policy can be taken individually or for the family. The family floater policy is available for husband, wife and a maximum of 4 children.

Tax Benefit

Save tax under Section 80D of the Income Tax Act when you buya Max Bupa health insurance policy. Tax benefits are subject to changes in the tax laws, please consult your tax advisor for more details.

Assured Policy Renewal For Life

Once insured with us, you will always remain our customers subject to continued payment of premium. We assure you renewability for life with no extra loadings based on your claim history.

Direct Claim Settlement

We believe you should focus on the treatment of your loved ones rather than running after claim settlement. Therefore, all claims are processed directly by our customer service team.

Cashless Facility

Cashless Facility can be availed only at our Network Providers or Service Providers. Please contact us for more details.

Free Look Period

We endeavor for transparency and complete satisfaction and therefore, our policies are transparent and easy to understand. If you are not satisfied, we provide a 15-day free look period (30 days if the policy has been sold through distance marketing)within which you can cancel your plan stating the reason.

Information At Your Fingertips

Get quick and easy access to your claims history, your health information, your health profile, including records of tests and other details on our website.

POLICY TERMS

The policy term is one or two or three years.

WAITING PERIODS

  • Pre-existing disease waiting period of 24 months since inception of the policy and continuous renewal. For Critical Illness cover, pre-existing disease waiting period would be 48 months along with a Survival Period exclusion of 30 days for all conditions.
  • Initial waiting period of 30 days unless the treatment needed is the result of an Accident. For Critical Illness cover, initial waiting period would be 90 days.
  • Specific waiting period of 12 months, since the inception of the first policy with us, for some listed illnesses, unless the condition is directly caused by Cancer (covered after Initial Waiting Period of 30 days) or an Accident (covered from day 1).
  • The following benefits will have a waiting period of 36 months since inception of the Policy and subject to continuous renewal:
    1. OWeight loss (Bariatric) surgery
    2. OMental disorder treatment
    3. OLASER surgery cover
  • For HIV / AIDS cover, there will be a waiting period of 48 months since inception of the Policy and subject to continuous renewal.

Please do read more about the common exclusions in the policy terms & conditions.

EXCLUSIONS

  1. Ancillary Hospital Charges
  2. Hazardous Activities
  3. Artificial life maintenance
  4. Circumcision
  5. AYUSH Treatments
  6. Conflict & Disaster
  7. External Congenital Anomaly
  8. Convalescence & Rehabilitation
  9. Cosmetic and Reconstructive Surgery
  10. Dental/oral treatment
  11. Eyesight & Optical Services
  12. Experimental or Unproven Treatment
  13. Hormone Replacement Therapy
  14. Hospitalization not justified
  15. Inconsistent, Irrelevant or Incidental Diagnostic procedures
  16. Non-Medical Expenses
  17. Obesity and Weight Control Programs
  18. Reproductive medicine & other Maternity Expenses
  19. Robotic Assisted Surgery, Specialized Light Amplification by Stimulated Emission of Radiation (LASER) & Cyber Knife Treatments
  20. Sexually transmitted Infections & diseases
  21. Sleep disorders
  22. Substance related and Addictive Disorders
  23. Unlawful Activity
  24. Treatment received outside India
  25. Unrecognized Physician or Hospital
  26. Generally Excluded Expenses
  27. Permanent Exclusions for Personal Accident Cover
    1. Suicide or self inflicted Injury, whether the Insured Person is medically sane or insane.
    2. Treatment for any Injury or Illness resulting directly or indirectly from nuclear, radiological emissions, war or war like situations (whether war is declared or not), rebellion (act of armed resistance to an established government or leader), acts of terrorism.
    3. Treatment for any Injury or Illness resulting directly or indirectly from nuclear, radiological emissions, war or war like situations (whether war is declared or not), rebellion (act of armed resistance to an established government or leader), acts of terrorism.
    4. Any change of profession after inception of the Policy or any Renewal which results in the enhancement of Our risk, if not accepted and endorsed by Us on the Policy Schedule.
    5. Any change of profession after inception of the Policy or any Renewal which results in the enhancement of Our risk, if not accepted and endorsed by Us on the Policy Schedule.
    6. Taking or absorbing, accidentally or otherwise, any intoxicating liquor, drug, narcotic, medicine, sedative or poison, except as prescribed by a Medical Practitioner other than the Policyholder or an Insured Person.
    7. Participation in aviation/marine activities (including crew) other than as a passenger in an aircraft/water craft that is authorized by the relevant regulations to carry such passengers between established airports or ports.
    8. Engaging in or taking part in professional/adventure sports or any hazardous pursuits, speed contest or racing of any kind (other than on foot), bungee jumping, parasailing, ballooning, parachuting, skydiving, paragliding, hang gliding, mountain or rock climbing necessitating the use of guides or ropes, potholing, abseiling, deep sea diving, polo, snow and ice sports, hunting.
    9. Body or mental infirmity or any Illness except where such condition arises directly as a result of an Accident during the Policy Period. However this exclusion is not applicable to claims made under Permanent Partial Disability.
  28. Permanent Exclusions for Critical Illness Cover
    1. AYUSH Treatment
    2. Conflict & Disaster
    3. External Congenital Anomaly
    4. Cosmetic and Reconstructive Surgery
    5. Experimental/ Investigational or Unproven Treatment
    6. Hazardous Activities
    7. Reproductive medicine & other Maternity Expenses
    8. Sexually transmitted Infections & Diseases
    9. Substance related and Addictive Disorders
    10. Traffic Offences & Unlawful Activity
    11. Unrecognized Physician or Hospital

CLAIM PROCESS

  • Select and approach insurance/corporate/TPA helpdesk of our network hospital [recommended at least 72 hours before treatment].
  • For identification purpose, use passport, voter card, PAN card, Aadhar Card or driver’s licence along with your Max Bupa health card or policy number.
  • Network hospital will check your identity for validation and submit a pre-authorisation form to us.
  • We provide our decision to the hospital within 4 hours, when no further document is required.
  • Get admitted for treatment and sign all documents, forms and invoices on discharge.
  • We make payments to the hospital for pre-approved treatment and as per policy terms and conditions.

FAQS

How Can I Buy This Policy?

There are various ways in which you can purchase this policy:

Online: On buying this plan online, your policy will be generated instantly along with your policy kit and card. This is applicable for cases which do not require further underwriting or medical checkup.

Is There Any Tax Benefit That One Can Availwhile Purchasing Health Insurance?

Yes,you may avail a tax benefit available under Section 80D of the Income Tax Act 1961 by buying a health insurance policy as per applicabletax laws, which can amend from time to time. We advise you to consult your tax advisor for further details or clarifications.

Is A Medical Checkup Necessary Before Buying A Policy?

A medical checkup may be necessary when you sign up for a new health insurance policy, depending upon the age of the proposed to be insured and the sum insured opting for. In case your proposal gets rejected by us, we will deduct the full cost of medical tests from your premium and the balance premium would be refunded.

My Wife And Children Are Residing At Chandigarh While I Am Here In Delhi. Can I Cover All Of Us In One Policy?

Of course,you can cover your family residing in India under one policy. You can use your health insurance policyacross India. For cashless hospitalisation, all you need to do is check for a Max Bupa network hospital near your place of residence. You can also present your claim for reimbursement if you get treated at a hospital which is not a Max Bupa network hospital