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-

Individual plan
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

Sum Insured	3L/ 5L/ 7.5L/ 10L/ 15L/ 20L/ 30L/ 35L/ 40L/ 45L/ 50L/ 60L/ 75L/ 100L/ 125L/ 150L/ 175L/ 200L/ 225L/ 250L/ 275L/ 300L
Tenure of the policy	One, two, or three years
Number of members can be included	Maximum 2 adults
Minimum and maximum age of entry	18 to 65 years
Renewability	Lifelong
Critical Illness	20 Critical Illness covered
Free Look Period	15 days to review the policy/30 days in case of 3-year policy
Tax Benefit	Save tax by paying the premiums under Section 80D of Income-tax Act
Claim Settlement	Direct settlement of a claim by Max Bupa without the involvement of the third party
Pre-existing Disease	Covered after 48 months
Pre-policy check up	Required for 46 years & above/ for sum insured more than 10 lakhs

Illnesses Covered

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

Cancer of specified Severity
Open Chest CABG
Myocardial Infarction
Open Heart Replacement Or Repair Of Heart Valves
Stroke Resulting In Permanent Symptoms
Permanent Paralysis of limbs
Coma of specified Severity
Kidney failure requiring regular dialysis
Major Organ/Bone Marrow Transplant
Motor Neurone Disease with permanent Symptoms
Multiple sclerosis
End-stage Liver Disease
End-stage Lung Disease
Loss of speech
Deafness
Third-degree Burns
Aplastic Anaemia
Bacterial Meningitis
Viral Hepatitis
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

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.

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

Age	Sum insured (up to 10 lakhs)	Sum insured more than 10 lakhs
18 to 45 years	Not required	Mandatory
46 to 65 years	Mandatory	Mandatory

Claim form duly attested and filled along with KYC documents like ID proof.
Original/photocopy of Hospital Discharge summary
Final Hospital Bills
Investigation Reports/ Consultation Notes
Photocopies of First Information Report (FIR) /Panchnama, in case of admissible injuries due to accidents.
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.

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.

Inform the insurer.
Accurate submission of documents after the proposal of claim or date of discharge.
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.

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-

Policy in-force up to	Refund (%)
Policy in-force up to	1 year	2 years	3 years
Up to 30 days	75%	87.5%	90%
31 to 90 days	50%	75%	87.5%
90 to 180 days	25%	62.5%	75%
180 to 365 days	0%	50%	60%
366 to 455 days	0%	25%	50%
456 to 545 days	0%	12%	25%
545 to 720 days	0%	0%	12%

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.

Last updated on 15-01-2021