Max Bupa Health Companion

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ABOUT MAX BUPA


Max India & BUPA an international health insurance company, has joined hands together to bring to India – Max BUPA health Insurance Company Ltd. world class provider of health insurance.

Vision:To become India's most admired Health Insurance Company. And to make this vision a reality, we have brought together our vast and varied experience as the experts in healthcare.

RECOGNITION

 Awarded for the Best Product Innovation for Heart Beat, Family First plan
               (By India Insurance Award -2011, Dated: June -07-2011)
Heart Beat was Awarded Golden Peacock for its innovation            
               (Dated: April-22-2015)

SUM INSURED OPTION (LACS)

                                             

PLAN COMBINATIONS

                                     

AGE LIMITS

                                           
  • There is no maximum cover ceasing age.
  • Policy tenure: One year or two years.

PRODUCT DESIGN

                                 

IN-PATIENT TREATMENT

In HEALTH COMPANION  the Inpatient Treatment covers hospitalization expenses up to Sum Insured

Medical expenses for in-patient treatment :
  • Medical Practitioners’ fees.
  • Diagnostics Tests.
  • Medicines, drugs and consumables.
  • Nursing Charges .
  • Intravenous fluids, blood transfusion, injection administration charges.
  • Operation theater charges.
  • The cost of prosthetic and other devices or equipment if implanted internally during a Surgical Procedure.
  • Intensive Care Unit charge.
  • Covered up to Base Sum  Insured; Sum Insured (Individual + Floater) in case of Family First .

HOSPITAL ACCOMMODATION


  • Reasonable and customary charges for hospital accommodation.
  • Reasonable and Customary charges means the charges for services or supplies, which are the standard charges for the specific provider and consistent with the prevailing charges in the geographical area for identical or similar services among comparable providers, taking into account the nature of the Illness / injury involved.
  • Covered up to Base Sum  Insured; Sum Insured (Individual + Floater) in case of Family First.

PRE & POST HOSPITALIZATION EXPENSES

  • Expenses  up to 30 days immediately before and 60 days immediately after an Insured Person’s admission to a Hospital for the same Illness.
  • Pre and post hospitalization expenses can be claimed as reimbursement only. 
  • Covered up to Base Sum Insured; Sum Insured (Individual + Floater) in case of Family First.

ALL DAY-CARE PROCEDURES

  • Medical Expenses for all day-care procedures (< 24 hours). 
  • Including Chemotherapy, Radiotherapy, Hemodialysis, or any procedure which needs a period of specialized observation or care after completion of the procedure.
  • Any procedure undertaken on an out-patient basis will not be covered.
  • Covers all day-care procedures not just a list of procedures.
Covered up to Base Sum  Insured; Sum Insured (Individual + Floater) in case of Family First.

ORGAN DONOR

Expenses for an organ donor’s treatment for the harvesting of the organ donated.
Provided donation conforms to The Transplantation of Human Organs Act 1994 and the organ is for the use of the Insured Person.
The Insured Person has been medically advised to undergo an organ transplant.

What’s not covered:
  • Pre or post Medical Expenses or screening expenses.
  • Any other costs directly or indirectly associated with the acquisition.
Covered up to Base Sum Insured; Sum Insured (Individual + Floater) in case of Family First.

EMERGENCY AMBULANCE

Reasonable and customary ambulance expenses following an Emergency to the nearest Hospital if:
  • The ambulance service is offered by a healthcare or ambulance service provider.
  • The Company has accepted an in-patient claim for the same illness or accident. 
  • Covered up to Rs. 3,000 per hospitalization for all hospitalization (network/out of network).

DOMICILIARY TREATMENT

Medical Expenses for medical treatment taken at home if this continues for an uninterrupted period of 3 days as long as either:
  • The attending Doctor confirms that the Insured Person could not be transferred to a Hospital or 
  • The customer satisfies the company that a Hospital bed was unavailable.
  • Covered up to Base Sum Insured; Sum Insured (Individual + Floater) in case of Family First

FREE HEATH CHECK-UP AT RENEWALS

  • We will only cover health checkups arranged by Us through Our empanelled service providers.
  • Insured Person who has attained minimum age of 18 years at the time of Renewal shall be eligible for a health check-up. 
  • Only available at Renewal for Policies that are renewed without any break.
                                                        

NO CLAIM BONUS (NCB)

If no claim has been made in a Policy Year by any Insured Person: 
  • 20% increase on the expiring Base Sum Insured up to a maximum of 100% of the Base Sum Insured of that Policy Year.
  • Sub-limits applicable to various benefits will remain the same and shall not increase proportionately,Provided that the Policy is renewed continuously.
  • NCB once accrued does not get reduced in case of claim. 
  • In competition, in case of a claim, the NCB gets reduced.
  • In case of Family First, NCB gets accrued on Individual Base Sum Insured. 
                                      
                                                   

REFILL BENEFIT FOR NEW ILLNESS (Individual/Family Floater Only)

  • If  the base sum insured and No Claim Bonus is partially or completely exhausted (in case of Individual and Floater)
  • We will provide Refill Sum Insured up to 100% of Base Sum Insured, only once a year, for a subsequent/future claim of an UN-related illness only for the same member or any subsequent claim of a different member.
  • For Ex: Fever due to Malaria and Fever due to Typhoid are UN-related although both are fever; Refill can get triggered
  • However, refill would not trigger for a customer who has already been paid a claim for angioplasty and then we get a second claim for Bypass surgery.
  • Max Bupa’s maximum liability under a policy would be (2 X Base Sum Insured + Accrued NCB)  i.e. Base Sum Insured + Accrued NCB + Refill Sum Insured.
  • Refill benefit is not available in Family First variant.
  • Family first construct has Floater Sum Insured which takes care of the Refill feature.
  • Most of the competitors offer Refill only on complete utilization of SI and NCB,we offer Refill even on Partial utilization of Sum Insured or NCB (refer the illustration).

VACCINATION AND IMMUNIZATION POST ANNIMAL BITE

Medical Expenses of OPD Treatment for vaccinations or immunizations.

                                                                         

AYUSH BENEFIT

Reimbursement of medical expenses for alternative treatment taken under AYUSH provided the treatment has been undergone in:
  • A Government hospital or in any institute recognized by government and/or accredited by Quality Council of India/National Accreditation Board on Health.
  • Does not include pre and post hospitalization expenses.
  • List of Hospitals where one can avail AYUSH treatment.

HIGH DEDUCTIBLE TOP-UP OPTION DISCOUNT


  • High Deductible Option available across all sum insured including Family First.
Annual Aggregate deductible option of value.
  •  Rs.1, 2, 3, 4, 5 and 10 lac for any sum insured and receive a discount.

HOSPITAL CASH OPTION

Payable for each continuous and completed period of 24 hours of Hospitalization provided that:
  • Minimum 48 hrs of continuous hospitalization required.
  • Maximum coverage offered for 30 days/policy year.
  • NOT paid for diagnosis or treatment arising from or related to pregnancy.
  • Not subject to sum-insured.
                                                                               

DISCOUNT FOR 2 YEAR POLICY

  • 12.5% flat discount on second year premium.
  • Cancellation refund available up to 545 days in two year policy.

WAITING PERIODS

  • 30 days  Waiting Period except accidents.
  • 48 months  Pre-Existing Disease (PED) in Variant 1.  
  • 36 months  PED in Variant 2, 3 & Family First.
  • 24 months Specific and personal Waiting Period.

SPECIFIC ILLNESS COVERED   
  1. Stones in biliary and urinary systems.
  2. Lumps / cysts / nodules / polyps / internal tumors.
  3. Gastric and Duodenal Ulcers.
  4. Surgery on tonsils / adenoids.
  5. Osteoarthritis / Arthritis / Gout / Rheumatism / Spondylosis / Spondylitis / Inter vertebral Disc Prolapse. 
  6. Cataract.
  7. Fissure / Fistula / Hemorrhoids.
  8. Hernia / Hydrocele.
  9. Chronic Renal Failure or end stage Renal Failure.
  10. Sinusitis / Deviated Nasal Septum / Tympanoplasty / Chronic Suppurative Otitis Media.
  11. Benign Pro static Hypertrophy.
  12. Knee/Hip Joint replacement.
  13. Dilatation and Curettage.
  14. Varicose veins.
  15. Dysfunctional Uterine Bleeding / Fibroid / Prolapse Uterus / Endometriosis.
  16. Diabetes and related complications.
  17. Hysterectomy for any benign disorder .

PERMANENT EXCLUSION

  • Addictive conditions and disorders.
  • Ageing and puberty.
  • Artificial life maintenance.
  • Circumcision.
  • Dental /oral treatment.
  • Conflict and disaster.
  • Congenital conditions.
  • Convalescence and Rehabilitation.
  • Cosmetic surgery.
  • Drugs and dressings for OPD Treatment or take-home use.
  • Eyesight.
  • Unproven/ Experimental treatment.
  • Health hydro's, nature cure, wellness clinics etc.
  • HIV and AIDS; Obesity.
  • Hereditary conditions (specified).
  • Items of personal comfort and convenience.
  • Alternative treatment; Psychiatric and Psychosomatic Conditions.
  • OPD Treatment.
  • Stem cell implantation, Ancillary Hospital Charges.
  • Preventive care.
  • Treatment for Alopecia.
  • Unrelated diagnostic, x-ray or laboratory examinations.
  • Charges for medical papers.
  • Reproductive medicine.
  • Self-inflicted injuries.
  • Sexual problems and gender issues.
  • Sexually transmitted diseases.
  • Unrecognized physician or Hospital.
  • Sleep disorders.
  • Speech disorders.
  • Treatment for developmental problems.
  • Treatment received outside India.
  • Hospitalization undertaken for observation or for investigations only and where no medical  treatment is provided Active participation in adventure or hazardous sports including but not limited to para-jumping, rock climbing, mountaineering, motor racing, horse racing or deep-sea diving.
  • Unlawful Activity.
  • Any costs or expenses specified in the List of Expenses Generally Excluded at Annexure I.

HIGHLIGHTS

1)ROOM RENT ,ICU CHARGES :-  No Capping on room rent and ICU Charges in Health Companion. 
2)PRE-POST HOSPITALIZATION :- 30 days before and  60 days after the hospitalization expenditure are covered for same illness.
3)EMERGENCY AMBULANCE :-Covered up to Rs. 3,000 per hospitalization for all (network/out of network). 
4)SUB LIMITS:- Disease wise sub-limit is Not applicable on Health companion.
5)PRE-EXISTING WAITING PERIOD:-
Variant 1- 4 years waiting period for Pre-existing diseases.
Variant 2- 3 years waiting period for pre existing disease.
6)CO-PAYMENT:- No Co-pay in case of Health Companion 
7)SPECIFIC DISEASES WAITING PERIOD:- 2 years of waiting period for specific diseases.
8)DAY CARE PROCEDURES:-  All day care procedures are covered.
9)PREMIUM LOADING :-   There is a Loading on Premium.

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