Max Bupa CritiCare - Critical Illness Plan

The critical illness can be contagious to life as well as to the financial security of the family. To protect your finances in such times, Max Bupa has come up with a Critical Illness plan: CritiCare. The plan is designed with a motive to eliminate the risk of confronting financial crises due to critical illness/diseases. The plan 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)

Eligibility

**Last Updated on 06-05-2021

Benefit Options

1. Option 1

   If an individual Criticare plan has been chosen, then the facility of lump sum 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.

2. 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 a lump-sum payment. While the coverage will terminate for that member and the policy continue for the other insured.

   In the 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 the lump sum amount. The rule of the policy is that in one particular year only one member can avail of the benefit option. The other insured person will get the benefit amount in the next year or when the issue of critical illness detected but not in the same year.

Features of Criticare Plan

**Last Updated on 06-05-2021

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

Discounts offered

• Long Term Discount: On purchasing a plan of 2 or 3 years, the insured will receive a 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.

Sample Premium Rates

This graph illustrates the premium payable by an individual at the different sum insured options ranging from Rs 3 lakh to Rs. 60 lakhs. Let's understand the premium price on the basis of the graph:

Premium Payable by an individual at a different sum insured under Criticare Plan

We have seen above that how the premium varies on the basis of the sum insured. With the increase in age, the premium amount increases due to lifestyle changes, smoking habits, pre-existed illnesses, and other factors. For your better understanding, we have prepared a graph:

Premium Payable by an individual at different ages under Criticare Plan

Let's understand this with the help of an example,

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 to 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 the 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 a lump-sum payment.

*The premium paid was after the 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.

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 law.
• Illness arising due to consumption of alcohol, drugs, narcotics, sedatives, or poison.

Claim Process of Max Bupa Criticare

In order to process a smooth and hassle-free claim process under the Max Bupa CritiCare plan. Follow the below steps,

Cashless Claims

• Get admitted to any one of the network hospitals associated with Max Bupa. You can check the list of network hospitals on the company's website.
• Use your Max Bupa Health Card and show them your identification proof.
• After validating your identity, the network hospital will submit the pre-authorization request form to the company.
• The company will review your request and provide the confirmation to the network hospital by fax or email and share the same with you via text or email.
• The company will settle the claim with the hospital after the completion of all formalities.

For Reimbursement claims

• If admitted to a non-network hospital, notify Max Bupa within 48 hours of hospitalization. In emergency cases, inform them within 24 hours of hospitalization.
• You need to pay the treatment expenses to the hospital. During discharge, collect all the necessary documents, invoices, medical reports, and discharge certificates from the hospital.
• Send the completed claim form (available on Max Bupa's website) along with the required documents to Max Bupa.
• Max Bupa Health Insurance will review the documents and settle the claim (if approved) by reimbursing you for the amount.

Documents Required for the Claim process

• Valid ID proof.
• The claim application form that is duly signed along with KYC documents
• Summary of final hospital discharge documents
• Consultation notes and/or reports of investigation outside the hospital.
• All medical records since the start of the complaint.
• Copy of Medico Legal Certicificate. The certificate is duly attested by the concerned hospital.
• FIR i.e., First Information Report.
• Original reports of diagnostic tests, radiology reports, and payment receipts.
• Original hospital bills and discharge certificate signed by the medical practitioner.
• Others requested by the company