Health Insurance Policy
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Transcript of Health Insurance Policy
Health Insurance
Bharti AXA Smart 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
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…
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….
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
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
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
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
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.
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
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
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
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.
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
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
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.
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.
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.
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.
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
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
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.
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.
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
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.
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.
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
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
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.
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.
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.
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
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
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
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
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
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
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
Plan Options
39
Please Visit us at www.bharti-axagi.co.in for more détails or
call on 080-49010200 for more options
For more détails please visit at www.bharti-axagi.co.in or call us at 080-4901020040
Thank you…