Max Bupa Heartbeat Health Insurance

Quote on
Request

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)



WHY MAX BUPA HEARTBEAT?

  • Our families are the center of our existence.
  •  We all aspire to give them the best life possible. A good health insurance policy is a step in this direction. Not only does it ensure access to the best medical care in times of need, it also safeguards our financial savings. 
  •  In Heartbeat, you have a plan that understands your family’s healthcare needs and takes care of them just like you would.
  •  It comes with a plethora of unmatched features so that your family enjoys the most comprehensive protection at all times.
  •  Simple, easy-to-understand and with unbeatable service, this is the one of the best plans available.

WHY HEARTBEAT IS THE RIGHT HEALTH COVER FOR YOUR FAMILY

1. Comprehensive Protection*
 Covers ranging from 5 lacs to 1 crore
 Up to 19 relationships covered in one policy
 Pre & post hospitalization coverage 
 No room rent capping for Gold/ Platinum Plans
 Maternity benefits 
 All day care treatments covered
 Alternative treatments like Ayurveda & Unani covered 

 2. Cashless Facility 
We process cashless claims at over 3500 quality hospitals in our network.

 3. Hospitalization Expenses 
We take care of your room rental expenses up to the sum insured for Gold (except for Suite or above room category) and Platinum Plans (No Limit). Pre and post hospitalization expenses are covered up to the sum insured, 60 days prior and 90 days post hospitalization. 

 4. Maternity and Newborn Child Benefits 
Heartbeat provides you maternity benefits for up to two deliveries. The benefit is available to the insured after two years of continuous coverage. 
 The newborn baby is automatically covered from day 1 up to sum insured until the next renewal of the plan. First year vaccinations for the newborn are covered as well. These benefits cannot be availed under an individual policy. 
 
 5. Health Check up 
We provide health check-up to our customers as per the applicable plan as specified in the Product Benefits Table. For Gold and Platinum plans, customers can choose the diagnostic tests they want to undergo up to the limit applicable as specified in the Product Benefits Table. 
 The Policy needs to be renewed with us without a break or the Policy needs to be in force for the second Policy Year in the 2 year Policy Period (if applicable). 

 6. Loyalty Benefits 
Increase Sum Insured 
 • You will get 10% of expiring base sum insured each policy year 
 • The additional sum insured can be accumulated maximum up to 100% of base Sum Insured for Gold and Platinum plan and 50% of base Sum Insured for Silver plan. This benefit is applicable irrespective of claim status.

 Example: Mr. Ravi buys a Heartbeat Gold cover for 5 lacs in year 1. In year 2, his sum insured will increase to 5.5 lacs, even if he makes a claim in year 1. Likewise, his cover would keep on increasing by 10%, year on year (6 lacs in year 3, 6.5 lacs in year 4) till 100% of base sum insured.

 7. Hospital Cash A trip to the hospital involves more than merely using the doctor’s services and hospital facilities. You are bound to run up numerous ‘non-medical’ expenses such as transportation, attendant’s cost and other daily expenses that you may not be able to foresee. To meet these expenses we have now introduced this benefit as an option for you.

 8. Discount On Two Year Plan When you take a policy for two years, you get 12.5% discount on the second year premium.

 9. Optional Co-payment To make your premium more affordable you can avail co-payment options of 10% and 20%. 

 10. Room Rent Capping For Gold and Platinum plan there is no capping on the room rent and it is covered up to the Sum Insured. You can choose any room type/category except suite or above.

HEARTBEAT SUM INSURED OPTION

                                             

AGE LIMIT


                                           

  1.  Family floater plan covers entire family under single sum insured.
  2. Family First is the combination of both Individual and Family Floater.                                             

POLICY COMBINATION

                          

PLANS

Choose Your Plan 
Your Heartbeat plan can be customized according to your needs. It allows you to choose between an individual and family cover. The family cover is further available in two options - Family Floater and Family First. 


Family Floater 

This option is suitable for a nuclear family and is available in the following combinations: 1 Adult +1 Child, 1 Adult +2 Children, 1 Adult +3 Children, 1 Adult +4 Children, 2 Adult, 2 Adult +1 Child, 2 Adult +2 Children, 2 Adult +3 Children, 2 Adult +4 Children. The premium for Family Floater plan depends on the age of the eldest insured member.

Family First
A first of its kind plan, which has been designed keeping in mind the health insurance needs of the Indian joint family. It covers not just you but up to 19 relationships in your family. Your family is covered at two levels:

1. Individual Sum Insured: 
This cover provides an individual Sum Insured for each member of the family. The Individual Sum Insured is the same for each of the family members.

2. Floater Sum Insured: 
This cover is available as a pool for all family members and can be used by any member once his Individual Sum Insured is exhausted.

This provides flexibility for families to decide their optimal cover, and get comprehensive coverage for each member. Any of the following relationships can be covered in this plan.

Grandfather, Grandmother, Father-in-law, Mother-in-law, Father, Mother, Spouse, Son, Daughter, Son-in-law, Daughter-in-law, Grandson, Granddaughter, Brother, Sister, Sister-in-law, Brother-in-law, Nephew and Niece.



IN-PATIENT TREATMENT

In HEART BEAT  the Inpatient Treatment covers hospitalization expenses up to Sum Insured

Medical expenses for in-patient treatment :
  • Nursing charges for Hospitalization as an inpatient excluding Private Nursing charges.
  • Medical Practitioners’ fees, excluding any charges or fees for Standby Services.
  • Medicines, drugs and consumables.
  • Physiotherapy, investigation and diagnostics procedures directly related to the current admission.
  • Medicines, drugs as prescribed by the Medical Practitioner.
  • Intravenous fluids, blood transfusion, injection administration charges and /or consumables.
  • Operation theater charges.
  • The cost of prosthetics and other devices or equipment if implanted internally during Surgery.
  • intensive Care Unit charges.



PRE& POST HOSPITALIZATION EXPENSES

Expenses up to 60 days before and 90 days after an Insured person’s admission to a Hospital for the same illness.


                                          

DAY-CARE PROCEDURES

HEART BEAT covers the Medical Expenses incurred for various Surgeries that do not require a minimum of 24 hours of hospitalization under the Day Care Treatment Benefits.
  • Medical Expenses for all day-care procedures (< 24 hours). 
  • We also cover Chemotherapy, Radiotherapy, Hemodialysis, or any procedure which needs a period of specialized observation or care after completion of the procedure.
  • Heartbeat covers all day-care procedures not just a list of procedures.
  •  Stereotactic radiotherapy, radiotherapy, chemotherapy and immunotherapy for cancer (approved immunosuppressant drugs will be payable only if administered as a part of these procedures)  
  • Renal dialysis (Erythropoietin for chronic renal failure will be payable only if administered as a part of this procedure) d.
  •  Company  will not cover any OPD Treatment and Diagnostic Services under this Benefit.

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.

MATERNITY BENEFITS – PLATINUM PLAN


  • Medical Expenses for the delivery of a child and/or related to a Medically Necessary termination of pregnancy.
  • Above may be claimed twice during the lifetime of the Policy.
  • Maternity Benefit can be availed after 2 years of taking the policy
  • Maximum liability per pregnancy will be within the sub-limit:
          

For Platinum Policyholders only:
We will cover Pre or Post Hospitalization Medical Expenses.

Exclusions:
Following expenses are not covered under maternity benefits:
  • Expenses in respect of harvesting and storage of stem cells when carried out as a preventive measure against possible future Illnesses 
  • Medical Expenses for ectopic pregnancy are not covered under Maternity Benefit; however, these expenses are covered under the In-patient benefit.
We will not cover any claim under maternity benefit during the first 24 months of the coverage.

NEW BORN BABY COVER -PLATINUM PLAN

  • Expenses towards the medical treatment of the Insured Person’s new born baby while the Insured Person is Hospitalized as an In-patient for delivery.
  • Cover the new born baby as an Insured Person until the expiry of the Policy  Year in which the baby is born without the payment of any additional premium.
  • Expenses for WHO recommended vaccinations of the new born baby until the new born baby completes one year.

VACCINATION BENEFITS – PLATINUM PLAN

For Platinum Policyholders only.
  • Covers Reasonable and Customary expenses for the specified vaccinations for Insured children until they have completed 12 years of age
  • We will also cover expenses towards one consultation for nutrition and growth provided to the child during a visit for vaccination

LIST OF VACCINATIONS –PLATINUM PLAN

        

 

MATERNITY BENEFITS – GOLD PLAN

  • Medical Expenses for for the delivery of a child and/or related to a Medically Necessary termination of pregnancy ,Above may be claimed twice during the lifetime of the Policy.
  • Maternity Benefit after 2 years of taking the policy.
  • Maximum liability per pregnancy will be within the sub-limit.
            
Exclusions:

Following expenses are not covered under maternity benefits:
  • Expenses in respect of harvesting and storage of stem cells when carried out as a preventive measure against possible future Illnesses 
  • Medical Expenses for ectopic pregnancy are not covered under Maternity Benefit; however, these expenses are covered under the In-patient benefit.
We will not cover any claim under maternity benefit during the first 24 months of the coverage

NEW BORN BABY COVER – GOLD PLAN

  • Expenses towards the medical treatment of the Insured Person’s new born baby while the Insured Person is Hospitalized as an In-patient for delivery.
  • Cover the new born baby as an Insured Person until the expiry of the Policy  Year in which the baby is born without the payment of any additional premium. 
  • Expenses for WHO recommended vaccinations of the new born baby until the new born baby completes one year. 

MATERNITY BENEFITS - SILVER PLAN

  • Medical Expenses for for the delivery of a child and/or related to a Medically Necessary termination of pregnancy ,Above may be claimed twice during the lifetime of the Policy.
  • Maternity Benefit after 2 years of taking the policy
  • Maximum liability per pregnancy will be within the sub-limits
                       

Exclusions:

Following expenses are not covered under maternity benefits:
  • Expenses in respect of harvesting and storage of stem cells when carried out as a preventive measure against possible future Illnesses 
  • Medical Expenses for ectopic pregnancy are not covered under Maternity Benefit; however, these expenses are covered under the In-patient benefit.
We will not cover any claim under maternity benefit during the first 24 months of the coverage.

NEW BORN BABY COVER – SILVER PLAN

  • Expenses towards the medical treatment of the Insured Person’s new born baby while the Insured Person is Hospitalized as an In-patient for delivery.
  • Cover the new born baby as an Insured Person until the expiry of the Policy  Year in which the baby is born without the payment of any additional premium. 
  • Expenses for WHO recommended vaccinations of the new born baby until the new born baby completes one year. 

DOMICILIARY TREATMENT


Medical Expenses for medical treatment for domiciliary 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 Sum Insured in Platinum, Gold and Silver Plan for individual, family floater and family first.

EMERGENCY AMBULANCE

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 sum-insured in network
* Max. liability for out-of-network is 2,000/event

ALTERNATIVE TREATMENT (AYUSH)

Expenses incurred on the Insured Person’s Medically Necessary and Medically Advised Inpatient Hospitalization during the Policy Period on treatment taken under Ayurveda, Unani, Sidha and Homeopathy are covered and it has to under go in :-

  • A Government hospital 
  • In any Institute recognized by Government and/or Accredited by Quality Council of India/National Accreditation Board on Health.
  • It includes Pre 60 days and Post 90 days of  Hospitalization Expenses.

LOYALTY ADDITIONS

Increase in base sum insured :10% increase on the expiring Base Sum Insured each policy year. The additional sum insured can be accumulated maximum up to 100% of the base sum insured for GOLD and PLATINUM PLAN’S and 50% of the base sum inured for SILVER PLAN’S. 

This benefit is applicable irrespective of claim status. 

OPTIONAL CO-PAY

To make your premium more affordable you can avail co payment options of 10% and 20%. 



DISCOUNT FOR 2 YEAR POLICY

The Insured will get 12.5% discount on premium for the second year.

ANNUAL HEALTH CHECK-UP AT RENEWALS

We provide annual health check-up to our GOLD and PLATINUM customers as per the applicable plan as specified in the Product Benefits Table. 

For Gold and Platinum plans, customers can choose the diagnostic tests they want to undergo up to the limit applicable as specified in the Product Benefits Table. 

The Policy needs to be renewed with us without a break. 

We will cover the cost of a health check-up arranged by Us through Our em paneled service providers.

 Any unutilized test or amount cannot be carry forwarded to the next Policy Year.

In case of the Silver Plan a pre defined set of tests can be availed by the insured once in 2 years.

Heartbeat Individual and Family Floater – Platinum  Plan


Heartbeat Individual and Family Floater - Gold Plan

HEALTH CHECK-UP TESTS FOR GOLD AND SILVER  PLAN**

TREATMENT ABROAD**

  • Our platinum customers can avail treatment abroad for 9 specified illnesses.
  • They are covered if detected in India by a Medical practitioner within the policy period on cashless basis.
  • Expenses toward inpatient treatment and hospital accommodation.
                                         
                                                                                                                   

EMERGENCY MEDICAL EVACUATION &HOSPITALIZATION OUTSIDE INDIA**

We also cover evacuation and hospitalization for medical emergencies outside India as per terms  and conditions.

Assistance in Medical Evacuation and costs of transportation of the Insured Person following an Emergency, to the nearest Hospital.

Our Service Provider has must pre-approve the request for Medical Evacuation. 

Also, Medical Expenses in an Emergency towards medical treatment until the Insured Person reaches a Medically Stable Condition.

Should be prescribed by a Doctor and is Medically Necessary.

Benefit shall not be available after the first 180 cumulative days of travel outside India. 

Covered up to SUM INSURED For individual, family floater and family first in Platinum Plan .


OPD CONSULTATION, DIAGNOSTIC TESTS & MEDICINES**

We also cover evacuation and hospitalization for medical emergencies outside India as per terms  and conditions.
For Platinum policyholders only:-
  • Consultation expenses, diagnostic tests and and medicines purchased as prescribed.
  • Includes Homeopathy and Ayurveda  treatments.
  • Carry forward 80% of unutilized amount provided the total does not exceed 2.5 times of the entitlement.

Covered up to sub-limits:

            

SECOND MEDICAL OPINION**

  • If the Insured Person is diagnosed with a Specified Illness is planning to undergo a planned Surgery or a Surgical Procedure for any Illness or Injury, the Insured Person can, obtain a Second Medical Opinion.
  • The Second Medical Opinion will be arranged by the Service Provider and will be based only on the information and documentation provided by the Insured Person that will be shared with the Medical Practitioner.
  • This benefit can be availed only once by an Insured Person during a Policy Year for the same Specified Illness or planned Surgery.
  • By seeking the Second Medical Opinion under this Benefit the Insured Person is not prohibited or advised against visiting or consulting with any other independent Medical Practitioner or commencing or continuing any treatment advised by such Medical Practitioner. 



OPTIONAL BENEFIT (HOSPITAL CASH)

Company will pay the Hospital Cash to a maximum of 30 days of Hospitalization during the Policy Year for the Insured Person for a period of  24 hours of Hospitalization provided that:

 a). The Insured Person has been admitted in a Hospital for a minimum period of 48 hours continuously. 
company  will not make any payment under this option Domiciliary Hospitalization, Maternity Benefit and New Born Baby.

 

ENHANCED GEOGRAPHICAL SCOPE FOR INTERNATIONAL COVERAGE

  • The terms and conditions specified there in, geographic coverage for the benefits set out in (emergency medical evacuation Out side the geographical boundaries of India),
  • (Emergency Hospitalization – outside the geographical boundaries of India), 
  • (Specified Illness cover – outside the geographical boundaries of India) is extended to include USA & Canada.

CO-PAYMENT:

The Insured Person will bear a predetermined percentage of the admissible claim amounts subject to the Co-payment option chosen irrespective of the Age of the Insured Person and the number of claims made.

Co-payment will not apply to any claim under  (Second Medical Opinion), (Health Checkup) and(Hospital Cash). 

WHAT IS NOT COVERED ?

 Pre-Existing Conditions:
Benefits will not be available for preexisting conditions as per your policy plan. 
Gold & Platinum plan: until 24 months of continuous coverage from first policy start date. 
Silver plan: until 48 months of continuous coverage from first policy start date.

30 days initial waiting period:
We will not cover treatment during the first 30 days of the plan, unless the treatment needed is a result of an accident. This waiting period does not apply for renewal policies. 

Specific Waiting Period:
There is no specific waiting period for people aged 45 years and below. For persons above 45 years of age, some conditions will be subject to a waiting period of 24 months. 

THE SPECIFIC ILLNESS : For person above 45 years of age, conditions will be subjected to  waiting period of 24 months and for 15 diseases.
  1. Pancreatitis and Stones in Biliary and Urinary System,
  2. Cataract, Glaucoma and other disorders of lens, disorders of Retina,  
  3.  Hyperplasia of Prostate, Hydrocele and spermatocele,  
  4.  Abnormal Utero-vaginal bleeding, female genital Prolapse, Endometriosis/Adenomyosis, Fibroids, PCOD, or any condition requiring dilation and curettage or Hysterectomy,
  5.  Hemorrhoids, Fissure or Fistula or Abscess of anal and rectal region,
  6. Hernia of all sites, 
  7.  Osteoarthritis, Systemic Connective Tissue disorders, Dorsopathies,Spondylopathies, inflammatory Polyarthropathies, Arthrosis such as RA, Gout, Intervertebral Disc disorders, 
  8. Chronic kidney disease and failure, 
  9. Diabetes and its related complications, 
  10.  Varicose veins of lower extremities, 
  11. Disease of middle ear and mastoid including Otitis Media, Cholesteatoma, Perforation of Tympanic Membrane,
  12.  All internal or external benign or In Situ Neoplasms/Tumours, Cyst, Sinus, Polyp, Nodules, Swelling, Mass or Lump, 
  13.  Ulcer, Erosion and Varices of Upper Gastro Intestinal Tract,
  14.   Tonsils and Adenoids, Nasal Septum and Nasal Sinuses,
  15.   Internal Congenital Anomaly

PERMANENT EXCLUSION

  1. Ancillary hospital charges;
  2.  Hazardous activities; artificial life maintenance; autoimmune disorders;
  3.  Behavioral, neurodevelopmental and neurodegenerative disorders;
  4.  Circumcision;
  5.  Complementary & alternative medicine; 
  6. Conflict & disaster related injury or     illness; 
  7. Screening, counseling or treatment related to external congenital anomaly; 
  8. Hereditary or genetic disorders; 
  9. Convalescence & rehabilitation; 
  10. Cosmetic and reconstructive surgery;
  11.  Dental/ oral treatment;
  12.  Eyesight & optical services;
  13.  Experimental/investigational or unproven treatment;
  14.  HIV, AIDS, and related complex; 
  15. Inconsistent, irrelevant or incidental diagnostic procedures; 
  16. Mental and psychiatric conditions; non-medical expenses;
  17.  Obesity and weight control programs; off label drug or treatment;
  18.  Puberty and menopause related disorders; 
  19. Reproductive medicine & other maternity expenses: birth control, assisted reproduction, sexual disorders and erectile disfunction;
  20.  Robotic assisted surgery; 
  21. Light amplification by stimulated emission of radiation (laser) & light based treatment;
  22.  Sexually transmitted infections & diseases; 
  23. Sleep disorders; substance related and addictive disorders; 
  24. Traffic offences & unlawful activity; 
  25. Treatment received outside India any treatment or medical services received outside India except for treatment undertaken under Emergency Medical Evacuation outside the geographical boundaries of India, emergency hospitalization outside the geographical boundaries of India and Specified Illness cover outside the geographical boundaries of India;
  26.  Treatment or medical advice by unrecognized physician or hospital;
  27.  Generally excluded expenses.
  28. Admission solely for the purpose of physiotherapy, evaluation, investigations, diagnosis or observation services or not consistent with standard treatment guidelines (as defined by clinical establishments (registration and regulation) act 2010 and amendments thereafter)or evidence based clinical practices;  

HIGHLIGHTS

1)ROOM RENT ,ICU CHARGES :-
  • Any Hospital Single Private Room in case of Gold , 
  • No Capping on room rent in Case of Platinum,
  • 3000 or twin sharing room in case of silver.
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 sum-insured in network hospital and 2000 for non network hospitals for all the plans .
4)SUB LIMITS:- Disease wise sub limit is Not applicable on  Heart Beat.
5)PRE-EXISTING WAITING PERIOD:-
  • 2 years waiting period for  Pre Existing Diseases in case of Gold and Platinum.
  • 4 years in case of Silver.
6)CO-PAYMENT:- Mandatory Reducing Co payment when you enter 65 years of age, starting with 20% the Co-Payment will becomes nil after 4 years of continuous renewal.
7)SPECIFIC DISEASES WAITING PERIOD:-
90 days if you are below the age of 60 
2 years of waiting Period for only 11 Specific disease for 60 and above at the time of entry.
8)DAY CARE PROCEDURES:-All day care procedures are covered.
9)PREMIUM LOADING :- There is no Loading on Premium.

Enquiry

Download