Max Bupa Health Assurance – Personal Accident

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.

 

The Health Assurance policy provides high flexibility to customers to choose this plan for themselves or their entire family, with an option to choose all or any of the three covers. The customers also have the option of choosing their own sum insured for the guaranteed cash payment ranging from Rs. 3 lakh to Rs. 2 crore in case of Critical Illness cover, Rs. 5 lakh to Rs. 25 lakhs for Personal Accident cover and Rs. 1, 000 to Rs. 4, 000 per day as daily cash benefit under Hospital Cash. This plan proves to be the major support in times of accidental and irreparable crisis.

 

Key Features and Benefits


The key features covered under Max Bupa Health Assurance 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.

  • Accident hospitalization*

    The Accident Hospitalization benefit shall be available only for hospitalization in India following an accident. If the insured person is hospitalised during the policy period solely and directly due to an injury sustained arising from an accident occurring during the policy period.

  • Worldwide coverage

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

  • Customizable cover

    The insured has the flexibility to choose from the three plan options available under the heath assurance policy

  • CritiCare Cover

    • If the insured suffers a critical illness during the policy period and while the policy is in force, they will be paid the sum insured provided that:

    • Critical illness first occurs or manifests itself during the policy period

    • The signs and symptoms of such Critical Illness commence after 90 days from the date of commencement of the Policy i.e. the benefit would not be payable if the signs or symptoms occurred during the first 90 days or earlier from the date of commencement of coverage, as specified in the Schedule of Insurance Certificate

    • The insured person survives for a minimum period of at least 30 days from the date of diagnosis of such critical illness for the claim to be admissible

    • The top 20 critical illness are covered under CritiCare are as follows:
     

    1. Cancer of Specified Severity 2. Multiple Sclerosis with Persisting Symptoms
    3. Myocardial Infarction 4. Aplastic Anaemia
    5. Open Chest CABG 6. Bacterial Meningitis
    7. Open Heart Replacement or Repair of Heart Valves 8. Loss of Speech
    9. Coma of Specified Severity 10. End-Stage Liver Disease
    11. Kidney Failure Requiring Regular Dialysis 12. Deafness
    13. Stroke Resulting in Permanent Symptoms 14. End-stage Lung Disease
    15. Major Organ/Bone Marrow Transplant 16. Fulminant Viral Hepatitis
    17. Permanent Paralysis of Limbs 18. Third Degree Burns
    19. Motor Neurone Disease with Permanent Symptoms 20. Muscular Dystrophy

Policy Details

Max Bupa Health Assurance Plan
  Accident Care CritiCare HospiCash
Insurer Name Max Bupa Health Insurance Company Limited
Policy Type Individual/Family Floater Individual Individual/Family Floater
Entry Age Adults: 18 to 65 years Dependent Children – 2 years to 21 years Adults: 18 to 65 years Adults: 18 to 65 years Dependent Children – 1 day to 21 years
Renewal Lifetime Renewable Lifetime Renewable Lifetime Renewable
Policy Tenure One, two or three years One, two or three years ​ One, two or three years ​

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.

How to Purchase the Policy

In order to purchase the policy, follow these steps:

  • To apply for the product, click on 'Apply Now' and fill in the necessary details
  • Make the fee payment online using your preferred mode of payment
  • Fill in your name and mobile number
  • Complete the process by clicking 'Buy Now', you can also request a call back

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 5000+ 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. Initial Waiting Period
  8. • Criticare: Benefits will not become payable if the signs or symptoms of any of the listed critical illnesses commence within 90 days from the date of commencement of CritiCare coverage of the first policy.
    • HospiCash: Benefits will not become payable if the signs or symptoms and/or Treatment fall within 30 days from the date of commencement of HospiCash coverage except accidents.
  9. Pre-Existing Diseases:For CritiCare and HospiCash, benefits will not be available for pre-existing diseases until 48 months of continuous coverage have elapsed since the inception of the policy.
  10. Refer to the policy brochure to know further exclusions in detail.

Claim/Assistance Contact Details

BFL Helpline Number: –  08698010101

Max Bupa Helpline Number:– 1860-500-1000

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).

Disclaimer

Bajaj Finance Limited (‘BFL’) is a registered corporate agent of third party insurance products of Bajaj Allianz Life Insurance Company Limited, HDFC Life Insurance Company Limited, Future Generali Life Insurance Company Limited, Bajaj Allianz General Insurance Company Limited, Tata AIG General Insurance Company Limited, Oriental Insurance Company Limited, Max Bupa Health Insurance Company Limited, Aditya Birla Health Insurance Company Limited, and Manipal Cigna Health Insurance Company Limited under the IRDAI composite registration number CA0101.

Please note that BFL does not underwrite the risk or act as an insurer. Your purchase of an insurance product is purely voluntary after you exercise independent due diligence on the suitability, viability of any insurance product. Any decision to purchase an insurance product is solely at your own risk and responsibility and BFL shall not be liable for any loss or damage that any person may suffer, whether directly or indirectly This product provides insurance coverage under MaxBupa Health Assurance insurance policy UIN no: IRDAI/HLT/MBHI/P-H/V. II/175/2016-17. Please refer insurer's website for Policy Wordings. For more details on risk factors, terms and conditions, and exclusions please read the product sales brochure carefully before concluding a sale.

Tax benefits applicable if any will be as per the prevailing tax laws. Tax laws are subject to change. BFL does NOT provide Tax/Investment advisory services. Please consult your advisors before proceeding to purchase an insurance product.