Max Bupa CritiCare Plan

Max Bupa Critical illness Plan

The CritiCare Plan plan was instituted by Max Bupa with the motive to eliminate the risk of confronting financial crisis due to critical illness/diseases. The critical illness can be contagious to life as well to the financial security of the family. Max Bupa CritiCare organizes your saving in such a manner that does not let your savings drain away in an event of critical illness.

The CritiCare Plan provides two coverage options-

1. Individual plan
2. Family Floater option (maximum 2 adults)

Benefit Options

• Option 1
  If an individual Criticare plan has been chosen, then the facility of lumpsum payment is available to the insured on the sum insured. This means at the time of critical illness claims the insured will get the whole sum insured amount.
• Option 2
  A lump sum payment would be made on a claim based on the detection of critical illness during the policy tenure. In addition, 10% of the sum insured will be paid to the beneficiary for a continuous 5 years from the date of lumpsum payment. While the coverage will terminate for that member and the policy continue for the other insured.

In case of a family floater, the benefit chosen is applicable to both the adults. In case, insured 1 is detected with critical illness, then the company will pay lumpsum amount. The rule of the policy is that in one particular year only one member can avail the benefit option. The other insured person will get benefit amount in next year or when the issue of critical illness detected but not in the same year.

Features of CritiCare Plan

Illnesses Covered

The Criticare plan provides financial assistance for 20 ailments listed below-

1. Cancer of specified Severity
2. Open Chest CABG
3. Myocardial Infarction
4. Open Heart Replacement Or Repair Of Heart Valves
5. Stroke Resulting In Permanent Symptoms
6. Permanent Paralysis of limbs
7. Coma of specified Severity
8. Kidney failure requiring regular dialysis
9. Major Organ/Bone Marrow Transplant
10. Motor Neurone Disease with permanent Symptoms
11. Multiple sclerosis
12. End-stage Liver Disease
13. End-stage Lung Disease
14. Loss of speech
15. Deafness
16. Third-degree Burns
17. Aplastic Anaemia
18. Bacterial Meningitis
19. Viral Hepatitis
20. Muscular Dystrophy

Discount offered

• Long Term Discount: On purchasing a plan of 2 or 3 years, insured will receive 12.5% and 15% discount on the premium paid for the year.
• Online Purchase Discount: If the online medium is selected for the purchase of the policy, then a discount of 10% off will be credited to the insured’s total amount of premium.

Exclusions

• Self-inflicted injuries or suicides
• Involvement in Adventure sports like climbing, parasailing, skydiving etc
• HIV/AIDS transmitted due to sexual interaction
• Injuries due to involvement in the naval, military, air force, war, radioactivities, or nuclear bombing, an act of terrorism etc
• Injuries sustained due to criminal acts, or breach of a law.
• Illness arising due to consumption of alcohol, drugs, narcotics, sedatives or poison.

Case Study

Ashutosh took a CritiCare plan of Rs 50 lakhs for him and her spouse. Ashutosh is of 35 years and his wife is 33 years. The annual income of primary inured i.e Ashutosh is 10 lakhs.

The policy was taken for two years and the premium decided was 38626*. The couple opted for Benefit Option 2 (please refer above in the Benefit Options).

Ashutosh was detected with a critical illness after 10 years from the inception of the policy. He claimed for the hospitalization expenses incurred on the treatment of the disease which was accepted by the company. He received a lump sum payment of sum insured and his share of benefit will terminate. Now, his wife is the only beneficiary of the policy and will receive 10% of 50 lakhs every year for 5 continuous years counting from the date of lump sum payment.

*The premium paid was after online discount (10%) and 2 years policy discount (12.5%).

Please Note: The sum insured taken must not cross 12 times of the income, if you are salaried class and 15 times, if self-employed.

FAQs

1. Will Insurance company pay for the Pre-Policy Medical Check-up (PPMC)?

The insurance company will pay for the same with respect to various conditions-

• 50% of PPMC would be payable by the insurer for a sum insured of 10 lakhs or less.
• The insurer would pay the whole cost if the sum insured us more than 10 lakhs and the proposal is approved.
• Whole amount of PPMC will be borne by the insurer only if the policy is taken for 2 or 3 years.

If the proposal is not approved by the insurer, the whole cost will be carried by insured.

2. Is medical check-up is required to buy the CritiCare plan?

The necessity for a medical check-up before buying policy depends on the age and the sum insured selected by an individual.

3. What is the list of documents required to make claim?

1. Claim form duly attested and filled along with KYC documents like ID proof.
2. Original/photocopy of Hospital Discharge summary
3. Final Hospital Bills
4. Investigation Reports/ Consultation Notes
5. Photocopies of First Information Report (FIR) /Panchnama, in case of admissible injuries due to accidents.
6. Photocopy of Medico Claim Legal Certificate verified by the concerned hospital.

The insured must keep the original as well as attested photocopies with them as a proof for further communication of claim.

4. What is the notification period to make a claim?

When you have opted for CritiCare plan, you are responsible to inform the insurer within a period 30 days after the illness has been investigated.

5. What is the process to make claim?

1. Inform the insurer.
2. Accurate submission of documents after the proposal of claim or date of discharge.
3. If the claim is accepted, the insured will receive a payment within 30 days of time limit. Any delay in payment will be compensated with a payment of 2% interest rate.

6. How much refund is received when policyholder cancel the policy after 30 days or more?

The refund will be given by the insurer but after some deduction of applicable cess and service tax. Look at the table for more information-

7. What are the waiting periods in the policy?

• Initial waiting: The insured has to wait for 90 days starting from the date of policy activation.
• Pre-existing waiting: Any pre-existing diseases at the time of purchasing the policy will get coverage after a time lag of 48 months after the inception of the policy with a condition of timely renewal.