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Health Insurance Policy

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Health Insurance Policy provides complete financial protection for you and your family against hospitalization expenses.
40
Health Insurance Bharti AXA Smart Health Insurance Policy
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Page 1: Health Insurance Policy

Health Insurance

Bharti AXA Smart Health

Insurance Policy

Page 2: Health Insurance Policy

For more détails please visit at www.bharti-axagi.co.in or call us at 080-490102002

Agenda

Product Guidelines & Processes

Need for Health Insurance

Smart Health Insurance

Basic Covers

Value-added Benefits

Additional Features

Plan and Premium

Exclusions

Underwriting Guidelines

Claims Process

Important Guidelines

Page 3: Health Insurance Policy

For more détails please visit at www.bharti-axagi.co.in or call us at 080-490102003

Does this sound familiar?Need for Health Insurance

You suddenly

feel unwell…

You pay a visit to

the doctor..

You buy the

medicines the

doctor prescribed

You are still

unwell…so

you get

hospitalised

You get

hospitalised for a

surgery

You undergo

medical tests…

You take some

medicines for

faster recovery..

You are well

again…

All these involve a lot of money…

Page 4: Health Insurance Policy

For more détails please visit at www.bharti-axagi.co.in or call us at 080-490102004

And the result….

You might feel like doing this….

Page 5: Health Insurance Policy

For more détails please visit at www.bharti-axagi.co.in or call us at 080-490102005

Multi-dimensional Impact

Hospitalisation

expenses

Ad-hoc

expenses

Potential Loss

of income

Depleted

savings

Family’s

Health

Page 6: Health Insurance Policy

For more détails please visit at www.bharti-axagi.co.in or call us at 080-490102006

What are the expenses related to hospitalisation?

Before Hospitalisation During Hospitalisation Post Hospitalisation

Doctor fees

Cost of medicines

Cost towards

medical tests

Room Charges

Operation Theater

Charges

Surgery/Operation/

Treatment Costs

Cost of medicines.

Blood, oxygen etc

Doctor/Specialist/

Surgeon fees

Nursing Charges

Doctor fees

Cost of medicines

Cost towards

medical tests

Associated Costs:

Loss of income

Expenses towards food of accompanying persons/visitors

Transport expenses for accompanying persons/visitors

Ambulance charges etc

Covered

under basic

covers

Covered as

value-added

benefits

Page 7: Health Insurance Policy

For more détails please visit at www.bharti-axagi.co.in or call us at 080-490102007

Smart Health for Smart People

Your Smart Health Insurance Policy

provides complete financial

protection for you and your family

against Hospitalization Expenses

Page 8: Health Insurance Policy

For more détails please visit at www.bharti-axagi.co.in or call us at 080-490102008

Coverage

The Smart Health Insurance Policy covers:

Hospitalisation Benefit

Domiciliary Hospitalisation

Day Care Treatment

Pre and Post Hospitalisation Expenses

Critical Illness

- Dread Disease Recuperation

- Transplantation of Organs

Please refer the plan details for the Sum Insured options with respect to

these benefits

Page 9: Health Insurance Policy

For more détails please visit at www.bharti-axagi.co.in or call us at 080-490102009

Hospitalisation Benefit

Covers expenses incurred by Insured Person as an in-patient in a hospital In relation to treatment of disease or injury.

This includes: Hospital (Room & Boarding and Operation theatre) charges Fees of Surgeon, Anesthetist, Nurses, Specialists Cost of diagnostic tests, medicines, blood, oxygen Cost of appliances like pacemaker, artificial limbs and organs

This is applicable only if the period of hospitalisation exceeds 24 hours.

Page 10: Health Insurance Policy

For more détails please visit at www.bharti-axagi.co.in or call us at 080-4901020010

Domiciliary Hospitalisation

Reimbursement of expenses involving medical treatment for

disease/injury at the Insured Person’s home in India

The treatment would have in normal course, done in a

hospital/nursing home, but is taking place at Insured Person’s

home only because

i. the condition of the patient is such that he / she cannot be moved to

Hospital / Nursing Home, or

ii. the patient cannot be admitted to Hospital/Nursing Home for lack of

accommodation therein.

This is applicable only if the treatment is done at home for a period

exceeding 3 days

Page 11: Health Insurance Policy

For more détails please visit at www.bharti-axagi.co.in or call us at 080-4901020011

Day Care Treatment

Payment or reimbursement of hospitalisation expenses incurred in case of

treatment, where 24 hours of hospitalisation is not required due to technologically

advanced treatment protocol

This includes:

Cardiac Catheterization

Hydrocele surgery

Hernia repair surgery

TURP (Prostate Surgery)

Surgeries/procedures that

require less than 24 hours

hospitalisation due to

medical/technological

advancement and infrastructural

facilities.

Dialysis - Kidney

Chemotherapy - Cancer

Radiotherapy - Cancer

Eye surgery - Eye

Dental surgery - Dental

Lithotripsy (Kidney stone

removal)

Tonsillectomy - Tonsils

Dilatation & Curettage

Page 12: Health Insurance Policy

For more détails please visit at www.bharti-axagi.co.in or call us at 080-4901020012

Pre and post hospitalisation

expenses

Pre-hospitalisation Expenses

Payment or reimbursement of

expenses incurred for

specified days prior to

hospitalisation

Post Hospitalisation Expenses

Payment or reimbursement of

expenses incurred for specified

days post discharge from Hospital

Hospitalisation90 days60 days

Optimum Optimum

Page 13: Health Insurance Policy

For more détails please visit at www.bharti-axagi.co.in or call us at 080-4901020013

Critical Illness

Covers expenses incurred for treatment of any of the specified critical illnesses

Coverage is available in either of the following options: Payment of lump sum benefit amount if the Insured Person is being

diagnosed as contracting any of specified Critical Illnesses and surviving for more than 30 days post such diagnosis.

Payment /reimbursement of expenses incurred for treatment of such specified Critical Illness in a Hospital / Nursing Home

This benefit is available after a waiting period of 60 days from the date of inception of the first year Policy

The SI available under this benefit is separate and additional to the SI available under the Hospitalisation benefit Section of the Policy.

Page 14: Health Insurance Policy

For more détails please visit at www.bharti-axagi.co.in or call us at 080-4901020014

Critical Illnesses

1. Cancer 2. First Heart Attack - Heart3. Coronary Artery Disease -

Heart4. Coronary Artery Bypass

surgery - Heart5. Heart Valve Surgery - Heart6. Surgery to Aorta – Heart7. Stroke - Brain8. Kidney Failure 9. Aplastic Anaemia - Blood10. End Stage Lung Disease

11. End Stage Liver Failure12. Coma - Brain13. Major Burns - Burns14. Major Organ/Bone Marrow

Transplantation - Bone15. Multiple Sclerosis - Cancer16. Fulminant Hepatitis - Liver17. Motor Neurone Disease - Brain18. Primary Pulmonary

Hypertension - Heart19. Terminal Illness – Last stage of

any illness20. Bacterial Meningitis - Brain

First product

in India to cover

20 critical illnesses

Page 15: Health Insurance Policy

For more détails please visit at www.bharti-axagi.co.in or call us at 080-4901020015

SmartHealth Benefits

The SmartHealth Insurance Policy also offers these benefits: Hospital Cash Allowance Home Nursing Ambulance Charges In-patient Physiotherapy Charges Recovery Grant Accompanying Person’s Expenses Parent Accommodation as Companion for Child Out-patient Dental Emergency Treatment

(arising out of Accident only) Out-patient Emergency treatment for accidents Children Education Fund Mortal Remains

Please refer the plan details for the applicability and Sum Insured

options with respect to these benefits

Hospital Cash Allowance

Home Nursing

Ambulance Charges

In-patient Physiotherapy Charges

Recovery Grant

Accompanying Person’s Expenses

Parent Accommodation as

Companion for Child

Out-patient Dental Emergency

Treatment (arising out of Accident only)

Out-patient Emergency treatment for

accidents

Children Education Fund

Mortal Remains

SmartHealth Value Added Benefits

Page 16: Health Insurance Policy

For more détails please visit at www.bharti-axagi.co.in or call us at 080-4901020016

Hospital Cash Allowance

Payment of a daily hospitalisation expenses up to the applicable

limits In case the Insured is hospitalized for treatment of any disease/injury / critical

illness for which a valid claim is admissible under the Policy and

if the hospitalisation exceeds the applicable number of days

This benefit is applicable irrespective of the number of

occurrences during the Policy period subject to overall Sum

Insured.

Page 17: Health Insurance Policy

For more détails please visit at www.bharti-axagi.co.in or call us at 080-4901020017

Home Nursing

Payment of an allowance for medical care services of a nurse at

the residence of the Insured

following discharge from Hospital after a treatment for a disease /

illness / injury / critical illness for which a valid claim under this Policy

is admissible

provided such medical care services are confirmed as being

necessary by the attending Medical Practitioner and

the treatment relates directly to the disease/ injury / critical illness for

which the Insured has undertaken treatment during the

hospitalisation,

This benefit is applicable irrespective of the number of

occurrences during the Policy period subject to the overall Sum

Insured.

Page 18: Health Insurance Policy

For more détails please visit at www.bharti-axagi.co.in or call us at 080-4901020018

Ambulance Charges

Reimbursement of expenses incurred for the transportation of

the Insured Person by ambulance to and from the Hospital

for treatment of disease, illness or injury in a Hospital as an in-

patient for which a valid claim under this Policy is admissible.

This benefit is applicable irrespective of the number of

occurrences during the Policy period and is subject to the

applicable limits.

Page 19: Health Insurance Policy

For more détails please visit at www.bharti-axagi.co.in or call us at 080-4901020019

In-patient Physiotherapy Charges

Reimbursement of charges incurred towards physiotherapy in the

Hospital as an in-patient

that is confirmed as being necessary by the attending Medical

Practitioner and

the same relates directly to the disease, illness or injury for which the

Insured Person has undertaken treatment in the Hospital for which a

valid claim is admissible under this Policy.

This benefit is applicable irrespective of the number of

occurrences during the Policy period and is subject to the

applicable limits.

Page 20: Health Insurance Policy

For more détails please visit at www.bharti-axagi.co.in or call us at 080-4901020020

Recovery Grant

Payment of a fixed allowance/grant

in case the Insured Person is hospitalized for a period of 8

consecutive days or more for treatment of any disease/injury for

which a valid claim is admissible under the Policy

This benefit is available upto the applicable limits under the

Optimum Plan

Page 21: Health Insurance Policy

For more détails please visit at www.bharti-axagi.co.in or call us at 080-4901020021

Accompanying Person’s Expenses

Payment an allowance towards expenses incurred on the

accompanying person at the Hospital

during hospitalisation treatment of the Insured Person for the disease,

illness or injury for which a valid claim is admissible under the Policy.

This benefit is applicable irrespective of the number of

occurrences during the Policy period and is subject to the

applicable limits

Page 22: Health Insurance Policy

For more détails please visit at www.bharti-axagi.co.in or call us at 080-4901020022

Parent Accommodation as Companion

for Child

Payment of a fixed daily allowance towards meeting the expenses

for the stay of one of the parents at the Hospital when a child

below the age of 12 years is hospitalized.

This benefit is applicable irrespective of the number of

occurrences during the Policy period and is subject to the

applicable limits.

Page 23: Health Insurance Policy

For more détails please visit at www.bharti-axagi.co.in or call us at 080-4901020023

Out-patient Dental Emergency Treatment

(arising out of Accident only)

Reimbursement of medical expenses incurred towards emergency

treatment by a Dentist following an accident where the Insured Person suffers injuries or damage to

his natural teeth and/or gums.

This benefit further provides cover for medical expenses incurred for

follow up treatment for the same accidental dental injury up to a

maximum of 15 days by the same Dentist.

This benefit is applicable irrespective of the number of occurrences

during the Policy period and is subject to the applicable limits.

Page 24: Health Insurance Policy

For more détails please visit at www.bharti-axagi.co.in or call us at 080-4901020024

Out-patient Emergency treatment for

accidents Reimbursement of medical expenses incurred towards

emergency treatment by a Medical Practitioner

following an accidental injury to the Insured Person and

such Emergency Treatment administered within 24 hours

following the accident.

It also provides cover for medical expenses incurred for

follow-up treatment by the same Medical Practitioner in

respect of the same accidental injury up to 30 days from the

date of accident.

This including expenses incurred for medication prescribed on a

written basis by the attending Medical Practitioner for that same

treatment or consultation.

This benefit is applicable irrespective of the number of

occurrences during the Policy period and is subject to the

applicable limits

Page 25: Health Insurance Policy

For more détails please visit at www.bharti-axagi.co.in or call us at 080-4901020025

Children Education Fund

Payment of a fixed amount per dependent child

in the event of death of the Insured Person whilst under treatment in a

Hospital as an in-patient for a disease/injury and/or critical illness for

which a valid claim is payable under the Policy.

This is available for a maximum of two dependant children who

pursue studies and are below the age of 23 years

The benefit is subject to the applicable limits as per the plan

chosen.

Page 26: Health Insurance Policy

For more détails please visit at www.bharti-axagi.co.in or call us at 080-4901020026

Mortal Remains

Reimbursement of expenses incurred for transportation of the

mortal remains of the deceased Insured Person from Hospital to

his/her place of residence

in the event of death at the Hospital as an in-patient whilst under

treatment of a disease / illness / injury and/or critical illness for which

a valid claim is payable under the Policy

This benefit is subject to the applicable limits as per the plan

chosen.

Page 27: Health Insurance Policy

For more détails please visit at www.bharti-axagi.co.in or call us at 080-4901020027

Additional FeaturesAdditional Features

Family Floater Feature

Renewal Discount

Income Tax Benefit

Cost of Medical Check-up

Page 28: Health Insurance Policy

For more détails please visit at www.bharti-axagi.co.in or call us at 080-4901020028

Family Floater

Policy can be issued on a Floater basis covering the family

members of the Insured comprising the Insured, spouse and two

dependant children (upto the age limit of 23 years).

What is floater, how does it benefit?

All members of the family (Self, Spouse, 2 Kids)

can be covered under one single policy

Single premium payable for the entire family

The amount of Sum Insured “floats”

over the entire family

No need to insure individual members separately

No hassles of tracking renewals for different members

Page 29: Health Insurance Policy

For more détails please visit at www.bharti-axagi.co.in or call us at 080-4901020029

Renewal Discount

Discount equivalent to 5% of renewal premium every year on a

progressive scale will be given back to the Insured as Renewal

Discount at the time of renewal,

This is applicable where the Policy which is renewed is claim free in the

expiring year.

This renewal discount on a progressive scale will be allowed upto a

maxumum of 25%.

In case of renewal of a Policy where there is a loss, the Insured will lose

the entire Renewal Discount accumulated.

Page 30: Health Insurance Policy

For more détails please visit at www.bharti-axagi.co.in or call us at 080-4901020030

Income Tax Benefit

Premium paid under the Policy shall be eligible for income tax

deduction benefit under Sec 80 D as per the Income tax Act.

Page 31: Health Insurance Policy

For more détails please visit at www.bharti-axagi.co.in or call us at 080-4901020031

Cost of Medical Check-up

Reimbursement of cost of medical check-up once at the end of a block

of every four continuous underwriting years provided there were no

claims reported /made under the Policy during the block.

This benefit is limited to 1% of the average Sum Insured per person

during the block of four underwriting years.

This additional benefit is available on the policies taken and renewed

with our Company for four continuous years without any claim.

Page 32: Health Insurance Policy

For more détails please visit at www.bharti-axagi.co.in or call us at 080-4901020032

Major Exclusions

No payment will be made for any pre-existing disease or condition until

48 months of continuous coverage have elapsed, since inception of the

first policy

Any benefit under Critical Illness section within the first 60 days of policy

inception

Hospitalisation expenses incurred for treatment within 30 days of the

inception date of this Policy

Claims related to

pregnancy, childbirth, fertility treatment etc

Routine medical, eye/ear examinations, vitamins, tonics, cost of

spectacles, lenses, hearing aids etc

Cosmetic or Plastic Surgery unless necessitated by accidents

War, nuclear perils, radiation etc

use of intoxicating drugs and alcohol or drug abuse etc

Page 33: Health Insurance Policy

For more détails please visit at www.bharti-axagi.co.in or call us at 080-4901020033

Claims Procedure

Claims can be either on:

Cashless Basis

Reimbursement Basis

Claims to be adminstered by Third Party Administrators(TPA)

Claims to be handled by the following TPAs as per the occurrence of

the claim:

Location of Hospital: South & West Zone – Paramount Health

Services Pvt Ltd

Location of Hospital: North & East Zone – Emeditek Solutions

Ltd

Page 34: Health Insurance Policy

For more détails please visit at www.bharti-axagi.co.in or call us at 080-4901020034

How to avail cashless service

Step1 : For planned hospitalization, forward your request letter 3-4 days prior to hospitalization in the prescribed format(format available from the website of the TPA/Insurance company, benefit guide, branch offices of TPA/Insurance company)

For emergency hospitalization, forward your request letter within 24 hours of hospitalization in the prescribed format(format available from the website of the TPA/Insurance company, benefit guide, branch offices of TPA/Insurance company)

Step 2 : TPA will issue an authorization letter for the coverage as per the policy to network hospital

Step 3 : Insured approaches the network hospital with ID card and authorization letter

Step 4: Network Hospital will extend cashless treatment to the insured up to authorized amount

Step 5 : At the time of discharge insured leaves back all the documents and sign the claim form

Step 7 : The Insured makes the payment in cash to network hospital for the services that are not covered under the policy

Page 35: Health Insurance Policy

For more détails please visit at www.bharti-axagi.co.in or call us at 080-4901020035

How to avail reimbursment facility

Step1 : Incase of hospitalization in non network hospital, the insured is

required to intimate the TPA 3-4 days prior to planned hospitalization

and within 24 hours of emergency hospitalization

Step 2 : Insured avails treatment from hospital and makes payment for

the entire amount

Step 3 : After discharge, the insured submits the necessary documents

to the TPA within 7 days.

Step 4: The Company to process the claim once all documents are

submitted

Page 36: Health Insurance Policy

For more détails please visit at www.bharti-axagi.co.in or call us at 080-4901020036 Presentation title

Indicative List of Documents

First prescription regarding the current illness for which treatment undergone in hospital/nursing home, in original

Medical advice for hospitalization Discharge Summary of Hospital, in original Medical Fitness certificate, in original All test reports supported by medical prescription(pre & post

hospitalization), in original All vouchers of the test report mentioned above, in original All medicines purchased from outside the hospital at any point of time

to be supported by original prescription, in original Complete and signed claim form with filled in attending doctor’s

prescription. Copy of the policy document

Page 37: Health Insurance Policy

For more détails please visit at www.bharti-axagi.co.in or call us at 080-4901020037

Necessary DocumentationImportant Guidelines

Completed proposal form in all respects and duly signed by the

proposer

All details written in proposal should be clear, do not leave any “blanks”

or use any signs “-”

Necessary test reports shall be submitted in full

Premium in case of referral risks shall not be accepted without prior

approval of the underwriting team

Special condition/warranty if any incorporated by underwriting team

shall be clearly mentioned in the policy schedule

Page 38: Health Insurance Policy

For more détails please visit at www.bharti-axagi.co.in or call us at 080-4901020038

To summarize…

One-stop solution to protect the health of the family members

Covers hospitalization expenses for treatment of diseases or injuries

Provides a host of value-added benefits such as Recovery Grant,

Dread Disease Recuperation,

Separate additional Sum Insured automatically available in case of

diagnosis of any of the covered critical illnesse

Three different plan variants - each with five different Sum Insured

options to choose from

Instant, Hassle Free Policy Delivery for customers aged 45 years or

below.

24 hour cashless treatment facility available at more than 4000 of our

network hospitals

Page 39: Health Insurance Policy

Plan Options

39

Please Visit us at www.bharti-axagi.co.in for more détails or

call on 080-49010200 for more options


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