Max Bupa Health Insurance

Max Bupa Health Insurance
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About Max Bupa Health Insurance

Max Bupa Health Insurance Company Ltd. (Max Bupa) is a joint venture between True North, an Indian private equity firm, and the UK based healthcare services expert, Bupa. It provides comprehensive health insurance plans that cover all hospitalization expenses, critical care, and accident care needs. It also provides other benefits that cover all the needs of Indian joint and nuclear families. Following are the different plans offered by the company:

Max Bupa Health Insurance Plans

1. Health Premia Family Floater Health Insurance

Health Premia is a comprehensive 360-degree health insurance plan that covers all the health needs of an individual in India as well as abroad. This policy covers the health insurance cover at the individual and family level. The plan provides the following covers:

PLAN TYPESILVERGOLDPLATINUM
Cover availableRs. 5 lakh - Rs. 7.5 lakhRs. 10 lakh - Rs. 50 lakhRs. 1 crore - Rs. 3 crore
Health Check-upUp to Rs.1,875 per personUp to Rs.7,500 per personUp to Rs.10, 000 per person

Table Data updated on 23-03-2020

Max Bupa Health Insurance Highlight

Features

  • All the expenses that come under hospitalization care are covered under this policy, including Ayurvedic, Homeopathy, Siddha, and Unani treatments. It also provides cover for treatments that just need one day stay in hospitals. All the expenses incurred 90 days before and 180 days after hospitalization are also covered.
  • The policy provides worldwide maternity benefits along with benefits for the newborn baby for its health and vaccination needs.
  • The plan also covers treatments that need modern technology like, Bariatric, Laser, Robotics, and Organ transplants.
  • The policy provides travel and international cover that covers medical procedures done abroad and for emergencies that arise during international travel. It has an inbuilt cover of 1 crore per family member that includes all the hospitalization needs.
  • Apart from the above features, it also provides:
  1. Personal Accident and Critical Care cover
  2. Loyalty addition in the sum assured after every year
  3. Option to increase international healthcare cover

2. Health Companion Plan

Health Companion Plan is a comprehensive health insurance plan that caters to all the medical needs of an Indian joint family with up to 19 relationships. Like the Health Premia policy, it provides individual as well as the family cover. The individual and family plan provides the following covers:

PLAN TYPEVARIANT 1VARIANT 2VARIANT 3
Cover AvailableRs. 3 lakh - Rs. 4 lakhRs. 5 lakh - Rs. 12.5 lakhRs. 15 lakh - Rs. 1 crore
Health Check-UpOnce in 2 yearsAnnual check-upAnnual check-up

Table Data updated on 23-03-2020

Apart from the individual and family plan, the company also provides a Family floater plan which is suitable for a nuclear family, and which depends on the age of the oldest person in the family.

Features

  • The policy covers all types of hospitalization charges without any room capping rent charges (except for suite or above that category). It also covers expenses that are incurred 30 days before being admitted to the hospital to 60 days after discharge.
  • Alternative treatments such as Ayurvedic, Homeopathy, Siddha, and Unani are also covered.
  • Expenses related to emergency ambulance, organ donor's treatment and daycare procedures are also covered under the policy.
  • Apart from the medical expenses, the policyholder also gets a Fitness Band, a 6-month gym membership, and a digital coach through GoQuii App.
  • If the policyholder has exhausted the basic sum assured, then a refill benefit is given where the insured party gets the basic sum assured.
  • If the policyholder renews the policy, the company provides a 20% increase in the sum assured every year as a loyalty bonus.

3. GoActive Family Floater Plan

The GoActive family floater plan that provides cover for daily health needs like doctor visits, medical tests, along with hospitalization expenses.

Eligibility Criteria

Entry AgeChild: 91 Days to 21 Years
Adult: 18 Years to 65 Years
Policy Term1 Year
Base Sum Assured4 Lacs - 25 Lacs

Table Data updated on 23-03-2020

Features

  • The policy offers comprehensive protection that includes hospitalization expenses coverage, OPD consultations, day-care treatments, home treatment services like nursing care, and annual health check-ups. Expenses incurred 90 days before hospitalization and 180 days after discharge is covered by the policy.
  • Based on the size of the family and the sum assured, the policy also covers 3-10 OPD consultations. It can be redeemed via cashless mode or through reimbursement.
  • Along with the policy, the plan also provides a lifetime discount of 10% if the policy is purchased before 35 years of age.
  • It also provides an I-Protect option that increases the cover by 10% every year. It also offers three telephonic counseling sessions under the behavioral assistance program.
  • As added benefits, it also provides a second medical opinion, a personal accident cover of 25 - 50 lacs, Emergency ambulance cover up to Rs. 3,000 per hospitalization, and health coaching through the GoActive App.

4. Heartbeat Family Floater Health Insurance

Plan Details:

PLAN TYPESilver PlanGold PlanPlatinum Plan
Base sum assured1 Lac - 5 Lac5 Lacs - 50 Lacs15 Lacs - 1 Crore
Hospital CashUp to Rs. 1,500 per dayUp to Rs. 3,000 per dayUp to Rs. 6,000 per day
Maternity BenefitUp to Rs. 35,000 per yearUp to Rs. 50,000 per yearUp to Rs. 1,00,000 per year

Table Data updated on 23-03-2020

Features

  • Apart from covering regular hospitalization expenses, this plan also offers maternity benefits for two deliveries after two years of continuous coverage. The newborn baby is covered from the first day for the treatments and vaccinations.
  • The plan also covers expenses incurred 60 days before hospitalization and 90 days after discharge.
  • The plan offers a 10% addition to the sum assured each year as a loyalty benefit. For the gold plan, the sum accumulated would be 100% of the sum assured, and for the Silver plan, the sum would be 50% of the sum assured.
  • The additional benefits provided by the policy are hospital cash, personal accident cover, critical illness cover, e-consultation, Max Bupa Health Insurance premium waiver, and discount on premium if the policy is taken for two years.
  • Under the platinum policy, Max Bupa provides international coverage for specific illnesses, emergency medical and hospitalization expenses.

5. Max Bupa Health Recharge Super Top-up Plan

Plan Details:

PLAN TYPEe-SaverSuper Top-up
Base sum assured2 Lacs - 5 Lacs2 Lacs - 25 Lacs
Annual Aggregate DeductibleRs. 10,000 to Rs. 50,000Rs. 1 Lacs - Rs. 10 Lacs

Table Data updated on 23-03-2020

Features

  • Apart from covering hospitalization expenses and emergency ambulance services (up to Rs. 1,500 per hospitalization), the plan also provides cover for unlimited consultations by telephone and e-mail. It also provides pharmacy and diagnostic services through their independent service providers.
  • The policyholder can convert this policy to an indemnity policy after 5 years.
  • The plan also covers expenses occurring 60 days before admitting to the hospital and 90 days after discharge.
  • Some of the optional benefits provided by the policy include personal accident cover that is 5 times the sum assured, critical illness cover equal to the sum assured, and hospital room rent charges.

6. Max Bupa Health Plus

Plan Details:

PLAN TYPEType 1Type 2
Base sum assuredClassic- 3 Lacs - 4 Lacs
Enhanced - 3 Lacs - 4 Lacs
Classic- 5 Lacs - 10 Lacs
Enhanced - 5 Lacs - 25 Lacs
Hospitalization ExpensesUp to Rs. 1,500 per hospitalizationUp to 2,000 per hospitalization

Table Data updated on 23-03-2020

Features

  • The plan covers basic hospitalization expenses such as nursing charges, In-patient charges, Physiotherapy, medicine purchases, Intravenous fluids, transfusions, Operation Theatre charges, Annual health check-up, ICU charges, and Prosthetic or implants expenses.
  • The plan also covers room rent charges which should be 1% of the base sum assured or 1 single private room, depending upon the type of plan chosen.
  • Apart from hospitalization expenses, the plan also provides optional benefits such as Personal accident cover, critical illness cover, e-consultation cover, hospital cash, enhanced no claim bonus, and enhanced refill bonus.

7. Max Bupa Money Saver Plan

The Max Bupa Money Saver Plan combines the Health Recharge (HR) and Health Companion (HC) plans. The policyholder has the option to avail the benefits of both the plans by combining the policies and paying Max Bupa Health Insurance premiums according to the sum assured chosen.

Eligibility Criteria:

Age Limit25 years - 45 years
Sum Assured CombinationsHC 5 Lacs + HR 10 Lacs
HC 5 Lacs + HR 15 Lacs
HC 5 Lacs + HR 25 Lacs

Table Data updated on 23-03-2020

How is Max Bupa Health Insurance Premium Calculated?

Max Bupa calculates the premium on the following basis:

  • Type of plan chosen
  • The sum assured opted
  • Number of family members to be included in the plan
  • Age of the Insured members ( in some cases gender and the age of the eldest member in the plan)
  • Geographical location of the members

How To Buy Max Bupa Health Insurance Plans?

There are two ways of buying Max Bupa Health Insurance Plans - Online and Offline.

Offline:

  • You can fill the form given on the top of this page and click “Proceed”
  • The next page will give you the details of all the health plans. Choose the plan which you need and click on 'Buy'.
  • On the payment page, make the payment and the policy will be emailed to you.

Offline:

Visit the nearest Max Bupa Health Insurance office and speak with a representative there, explain your needs to him and select the plan which he suggests. Submit the documents requested by the company and make the payment. The soft copy of the policy document will be sent within 48 hours and the hard copy within 15 days.

How To Renew a Max Bupa Health Insurance Policy?

  • Once an existing policy nears its expiry date, you will get a renewal notice with the premium amount. You need to login to the company website and go to the “My Account” section.
  • Under the option, “Renew Now”, the 14-digit policy number along with the date of birth of the eldest member in the policy needs to be entered.
  • If the same benefits are carried forward to the renewed policy, no medical test will be done, However, if the plan is being upgraded, then past medical history would need to be submitted and a medical test would be scheduled.
  • Once the details are entered, the premium payment needs to be done through debit card, credit card, or online payment wallets. If payment can't be done online, it can be done at Max Bupa branch.
  • Within 48 hours, Max Bupa will email you the soft copy of the new policy document and the hard copy will be sent in 15 days.

How is a Max Bupa Health Insurance Claim Processed?

If you are admitted to a network hospital:

  1. You need to submit your Max Bupa Health Card or share the Policy number and Passport / PAN card / voter's ID at the hospital for identity verification.
  2. Once the identity is verified, the hospital will submit the pre-authorization form to Max Bupa Health Insurance.
  3. Max Bupa will review and provide its confirmation to the network hospital through e-mail or fax. At the same time, you will also get a confirmation on your mobile through SMS.
  4. After all the formalities are completed, Max Bupa will communicate with the hospital and settle the claim.

If you are admitted to a non-network hospital:

  1. You need to pay the treatment expense to the hospital and notify Max Bupa within 48 hours of hospitalization.
  2. During discharge, you will need to collect all the necessary documents from the hospital that are needed for claim submission.
  3. You have to then send the completed claim form along with the documents, your ID and age proof to Max Bupa.
  4. Max Bupa will review the documents, claim form and will take the appropriate decision and settle the claim (if approved) by reimbursing the amount to you.

What Are The Major Exclusions in The Max Bupa Health Insurance Policies?

All the plans offered by Max Bupa Health Insurance have the following exclusions:

  • Any pre-existing conditions are excluded for the first 24 months of your policy.
  • Diseases diagnosed and any treatment done during the waiting period of the policy will not be covered.
  • Following diseases are also excluded:
  1. Sexually Transmitted Diseases,
  2. Diseases from hazardous activities,
  3. Dental/Oral treatment
  4. Circumcision
  5. Other diseases as specified in the policy document

Why Should You Choose Max Bupa Health Insurance Policy?

The Max Bupa Health Insurance company provides an easy claim settlement process by using in-house expert doctors. Cashless claims are processed within 30 minutes across 4,700 network hospitals. Even when the hospital doesn't come in the Max Bupa network, the company provides a reimbursement facility to ensure that illnesses don't come as a financial burden. Apart from these benefits, all the plans offered by the company provide loyalty or a no claim bonus that increases the cover every claim-free year. With the individual and floater plans, any Indian family, joint or nuclear, can be rest assured that their health and medical needs are fully taken care of.

Max Bupa Health Insurance: FAQs

1. If I take a policy from Max Bupa Health Insurance, would I be expected to undergo a medical check-up?

Yes. Based on the plan that has been chosen, you may be requested to undergo a pre-medical health check-up at our network hospital.

2. Does Max Bupa Health Insurance Company have any rules regarding the alternative treatments that I undertake and submit claims for?

Yes. Max Bupa only considers alternative treatments for claims if they have been treated at government hospitals or institutes accredited by the Quality Council Of India or the National Accreditation Board on Health.

3. Under the Max Bupa Health Insurance plans, how many hours of hospitalization is necessary for availing hospital cash?

The insured person should be hospitalized for 48 hours and depending upon the plan chosen, the hospital cash amount will be paid for a maximum of 30 hospitalized days.

4. What documents need to be submitted for availing Max Bupa's cashless facility?

The following documents need to be submitted:

  • Signed Claim form
  • Medical history record
  • Identity proofs
  • Canceled cheque
  • Original discharge summary
  • Hospital and pharmacy bills

5. Does Max Bupa Health Insurance allow porting of its insurance policies?

Yes, the insured can port his Max Bupa Health Insurance policy during renewal subject to the company's terms and conditions.

Page updated on 23-03-2020