Max Bupa Health Assurance – Personal Accident - Overview

Max Bupa Health Assurance Policy offers a personal accidental plan that helps you in times of medical contingencies like sudden accidental death and disability. This policy provides the much-needed financial support that your family needs without having to shell out your years of savings.

 

This plan covers benefits like permanent total disability, permanent partial disability and temporary total disability, accidental death, thus being major support in times of accidental and irreparable crisis.

 

Key Features & Benefits



The key features covered under Max Bupa Health Companion Plan are as follows:

  • Accidental Death:

    Accidental death is covered under this plan. In the case of accidental death of any insured person, 100% of the sum assured is payable under the Max Bupa Health Assurance Plan.

  • Permanent Total Disability:

    In case the insured sustains a serious accidental bodily injury throughout the policy term which directly or independently causes permanent total disability within 12 months from the date of that accident, then the insurer will pay 125% of the sum insured.

  • Permanent Partial Disability

    If the insured sustains permanent partial disability due to accident, then the insurer will pay for these expenses of about 100% of the sum insured.

  • Children education benefit

    Children education benefit is an optional cover that is payable towards the cost of education of your dependent children, in case of death or permanent disability due to an accident.

  • Funeral Expenses Covered:

    The policy also covers the funeral expenses of about Rs. 5000 of all the persons insured under Max Bupa Health Assurance Plan.

  • Worldwide Coverage:

    The Max Bupa Health Assurance Plan covers all the accidental expenses for the insured in any part of the world.

  • Free Look Period

    Get a 15 days free look period from the date of receipt of the policy document to review the terms and conditions of this policy. You have the option of cancelling the policy stating the reasons for cancellation and will be refunded the premium paid by you.

Policy Details

Max Bupa Health Assurance Plan
Policy Type Individual/ Family Floater
Entry Age Individual plan:
Minimum entry age – 18 years
Maximum entry age – 65 years
Family Floater:
Dependent Children – 2 years to 21years
Renewal Lifetime Renewable
Tenure One, two and three years
Sum Insured Rs. 5 lakh – Rs. 25 lakh
No of members covered 4 members (2A+2C)

Plans Available

Health Insurance helps you to be stress-free while dealing with medical contingencies due to sickness and accidental injuries. The plans are available starting from Rs. 576, with maximum coverage of Rs. 25 lakh, to know more about the premium rates in detail please click

Eligibility Criteria

  • Minimum Entry Age: 18 years
  • Maximum Entry Age: 65 years
  • Dependent Children: 2 years to 21 years

How to buy the policy

  • To apply the Max Bupa Health Assurance Plan, you can buy it easily online by filling in your basic and health details.
  • Ensure that the information given in the form is complete and accurate.
  • You may be required to undergo a pre-policy medical examination at our network diagnostic centres.
  • 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 check-up.

List of documents to buy the policy

The following mandatory documents will be needed to purchase the policy:

  • Photograph of the Applicant
  • Age proof such as birth certificate, Voter’s ID, PAN card, passport etc.
  • Identity proof such as passport, Aadhaar card, PAN card, Voter’s ID, etc.
  • Income Proof such as Form 16, salary slips, employment certificate etc.
  • Address proof such as telephone bill, electricity bill, passport, bank statement, Voter’s ID, etc.
  • Medical Test that the insurer requires you to undergo

How to process the claims

Life is uncertain and so are medical emergencies and accidents. We are here to guide you in these tough times and complete your claim processing in a few simple steps:


Cashless Claims
  • With the Max Bupa Health Assurance Plan, you can avail the benefit of cashless treatment with our 3500+ network hospitals by following the following process:
  • Get admitted to any one of Max Bupa network hospitals.
  • Use your Max Bupa Health Card or share your policy number with the concerned team at a hospital along with your Passport/PAN card/ Voter’s ID as identification proof.
  • Now, the network hospital will verify your identity for validation and submit the pre-authorization request to the insurer
  • After validation, the insurer will review and provide their confirmation to the network hospital by fax and email. The insurer ensures you are also notified of the same through text message and email. The insurer will respond to your request within 30 minutes of filing of the claim request.
  • The only activity left to do now is the final settlement of your claim (as per policy terms & conditions) with the hospital after completion of all the necessary formalities

Reimbursement claim:

  • If you get hospitalized, notify the insurer within 48 hours of admission in our network or non-network hospital. After getting admitted pay the amount directly to the hospital you are in.
  • After you are discharged from the hospital, make sure you have all the relevant documents, invoices, medical reports and discharge certificate with you. The insurer would need the originals of all the mentioned documents to process your reimbursement.
  • Send all the documents to the insurer which should be filled and signed the claim form. Send your valid ID proof and age proof as well.
  • After receiving your documents, the insurer will review your claim request and accordingly will give our approval, raise a query or reject the same (as per policy terms & conditions)
  • Finally, the insurer will settle the claim (as per policy terms & conditions) and reimburse the approved amount.

Documents Required for Reimbursing Claims

Collect below mentioned relevant document in original from the hospital and submit them to us within 15 days of discharge from the hospital

 
  • Original investigation reports
  • Final hospital discharge summary FIR or post-mortem report if happened
  • Pharmacy bills along with the prescription
  • Cancelled cheque or NEFT details for payment
  • Original bills, receipts, and discharge report
  • Indoor case papers and duly filled claim form
  • Original hospital bills and a valid photo ID proof Treating doctor's report
  • Original consultation notes Nature of operation performed and surgeon's bill and receipt
  • Test reports along with attending doctor’s or surgeon’s report.

Major Policy Exclusions

  1. Engaging in or taking part in professional sports or any hazardous pursuits.
  2. Any disability arising out of Pre-existing Conditions if not accepted and endorsed by Max Bupa.
  3. Participation in a criminal or a breach of law with criminal intent
  4. Ailments requiring treatment due to use or abuse of any substance, drug or alcohol and treatment for de-addiction.
  5. War, the act of a foreign enemy, revolution, etc.
  6. Breach of law with Criminal Intent, intentional self-injury.
  7. Refer to the policy brochure to know further exclusions in detail.

Claim/Assistance Contact Details

Toll free number –  08698010101/1800-209-0144 /1800-209-5858

E-mail –  wecare@bajajfinserv.in

Mailing address: Ground Floor, Bajaj Finserv Corporate Office, Off Pune-Ahmednagar Road, Viman Nagar, Pune – 411014.

 

*For claim related issues please refer your policy document or certificate of insurance (COI).