In-patient Care (Hospitalisation)
- We cover cost of medical treatment when you or your insured family members are hospitalised for treatment.
- We cover cost of all types of hospital accommodation (except suite or above room category) without any capping on room rent charges (for Sum Insured of Rs.5 lacs and above).
Pre & Post Hospitalisation Medical Expenses
- We reimburse pre & post hospitalisation medical expenses incurred due to illness/injury. The period of the treatment covered is 90 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 Care hospitalisation, Day Care or Domiciliary hospitalisation claim.
Day care treatments covered
- We cover day care treatments under the product. Please refer to Annexure VI of the policy document to know the day care procedures covered under the product..
Home Health Care Services
- Home Health Care is a range of health care services and medically necessary treatment that can be given at home for an illness or injury. These shall include services such as nursing care, investigations, medication (including oral and intravenous), chemotherapy, dialysis, transfusions, physiotherapy and postsurgical care.
- The Home Health Care Services are covered only if we have accepted an In-patient Care hospitalisation claim and Home Health Care Services are availed immediately after that hospitalisation. The Home Health Care Services are provided through empanelled service provider in selected cities only. Please contact us for updated list of cities where Home Health Care Services are provided.
- 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 should continue 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.
- 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.
- We also cover the ambulance expenses to transfer the insured following an emergency to the nearest hospital. These expenses are paid up to Rs 3,000 per hospitalisation only if we have accepted the In-patient claim.
Health Checkup / Diagnostic Tests
- You can avail health Checkup for yourself and your spouse (if insured under the policy) annually so that you live a healthier and happier life. You can undergo a Health Checkup through service provider on cashless basis. There shall be a pre-defined list of tests basis the Sum Insured chosen as specified in Annexure III of Policy terms and conditions.
- Instead of undergoing the pre-defined list of tests under health checkup for Sum Insured of Rs5 lacs and above, you can undergo the diagnostic tests of your choice up to a fixed amount depending upon your Sum Insured either on cashless or reimbursement basis. The cashless facility will only be available through empanelled service provider.
- Please note that only one of either Health Checkup or Diagnostic Tests can be availed.
- In case you have exhausted your Base Sum Insured and Increased Sum Insured under I-Protect (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, provided it is for an unrelated illness.
Second Medical Opinion
- You can obtain second medical opinion for specified illness / planned surgery / surgical procedure.
- Avail OPD consultations within a network either on cashless or reimbursement basis. In case of reimbursement, the maximum amount payable per OPD consultation is Rs.600 (for Zone 1) and Rs.500 (for Zone 2). The number of consultations will depend on the Sum Insured chosen.
Behavioral Assistance Program
- You can avail consultation/counseling from a psychotherapist/counselor over a call to provide support on pre-marital counseling, nutrition, stress, child, parenting, etc.
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.
- You will get a discount of 10% in the first policy year Base Premium and all subsequent renewal Base Premiums, if age of the eldest insured person at the time of inception of the first policy is less than or equal to 35 years.
- Get an increase in Sum Insured by 10% of the Base Sum Insured for every renewal. The benefit will be provided for every policy year as long as the policy is renewed or until you request for opting out of this benefit.
Health Coach (Optional)
- You can opt for personalized health coaching services to keep yourself fit and healthy. Based on your health score, a premium discount of maximum up to 20% of the base premium may apply at the time of renewal.
Personal Accident Cover (Optional)
- Personal Accident coverage against accident death, permanent total and partialdisability.
Annual Aggregate Deductible (Optional)
- Top Up with Annual Aggregate Deductible option of Rs 25,000, Rs 50,000, Rs 1 lac, Rs 2 lacs, Rs 3 lacs, Rs 5 lacs & Rs 10 lacs
You can opt for one of the following two zones.
- • Zone 1: All India coverage
- Zone 2: All India coverage (Co-payment applicable for Mumbai, Delhi NCR, Kolkata & Gujarat) If You select Zone 2, then 20% co-payment will apply for Inpatient treatment in Mumbai, Delhi NCR, Kolkata & Gujarat. This Zone-wise co-payment shall not be applicable on OPD Consultation, Emergency Ambulance, Health Checkup / Diagnostic Tests, Second Medical Opinion, Behavioral Assistance Program and Personal Accident Cover.
- Save tax under Section 80D of the Income Tax Act when you buy a 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 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 within which you can cancel your plan stating the reason.
- Pre-existing Disease waiting period of 36 months since inception of the policy and continuous renewal
- Initial Waiting Period of 30 days unless the treatment needed is the result of an accident.
- Specific Waiting Period of 24 months 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) Please note that Waiting Periods shall not apply to annual health checkup or diagnostic tests, second medical opinion, out-patient consultations, counseling sessions and optional benefits if opted for. Please do read more about the common exclusions in the policy terms & conditions.
- Ancillary hospital charges
- Hazardous activities
- Artificial life maintenance
- Behavioral, Neurodevelopmental and Neurodegenerative Disorders
- AYUSH treatments, except inpatient treatments taken under Ayurveda, Unani, Sidha and Homeopathy
- Conflict & disaster
- External congenital anomaly
- Convalescence & rehabilitation
- Cosmetic and reconstructive surgery
- Dental/oral treatment
- Eyesight & optical services
- Experimental or unproven treatment
- HIV, AIDS, and related complex
- Hospitalisation not justified
- Inconsistent, irrelevant or incidental diagnostic procedures
- Mental and psychiatric conditions
- Non-medical expenses
- Obesity and weight control programs
- Off- label drug or treatment
- Puberty and menopause related disorders
- Reproductive medicine & other maternity expenses
- Robotic assisted surgery, light amplification by stimulated emission of radiation (LASER) & light based treatment
- Sexually transmitted infections & diseases
- Sleep disorders
- Substance related and addictive disorders:
- Unlawful activity
- Treatment received outside India
- Unrecognized physician or hospital
- Generally, excluded expenses - Any costs or expenses specified in the list of expenses generally excluded at Annexure II of the Policy Document.
- Permanent Exclusion for Personal Accident Cover (if opted)
We shall not be liable to make any payment under any benefits under the Personal Accident Cover if the claim is attributable to, or based on, or arise out of, or are directly or indirectly connected to any of the following:
- Suicide or self-inflicted injury, whether the insured person is medically sane or insane.
- 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.
- Service in the armed forces, or any police organisation, of any country at war or at peace or service in any force of an international body or participation in any of the naval, military or air force operation during peace time.
- Any change of profession after inception of the policy which results in the enhancement of our risk, if not accepted and endorsed by us on the policy schedule.
- Committing an assault, a criminal offence or any breach of law with criminal intent.
- 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.
- Participation in aviation/marine including crew other than as a passenger in an aircraft/water craft that is authorised by the relevant regulations to carry such passengers between established airports or ports.
- Engaging in or taking part in professional/adventure sports or any hazardous pursuits, such as 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 using hard helmet and breathing apparatus, polo, snow, ice sports, hunting, etc.
- Body or mental infirmity or any disease except where such condition arises directly as a correspondence of an accident during the policy period. However, this exclusion is not applicable to claims made under the Permanent Partial Disability benefit.
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 21 years.
The policy can be taken individually or for the family. The family floater policy is available in any of the following combinations:
- 1 Adult + 1 Child
- 1 Adult + 2 Children
- 2 Adults
- 2 Adults + 1 Child
- 2 Adults + 2 Children
- 2 Adults + 3 Children
- 2 Adults + 4 Children