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Bharti AXA Smart Health Insurance Plan

  • There are three variants of this plan with different sum insured option.
  • This plan has both reimbursement and lump sum benefit for listed critical illnesses is provided in this plan depending option chosen.
  • This plan also provides benefit of daily cash during recovery period in case of critical illness.

Bharti AXA Smart Health Insurance Plan - Coverage

Plan

Entry Age

Maximum Number of Members

Sum Insured Range

Basic

Children- Above age 2 years for individual plan

and between age 3 months to age 23 years for floater plan

Adults up to age 65 years for sum insured INR 2,00,00 and 55 years for sum insured above INR 2,00,000

Adults 2

Children 2

INR 2,00,000; INR 3,00,000 and INR 5,00,000

Premium

Children- Above age 2 years for individual plan

and between age 3 months to age 23 years for floater plan

Adults up to age 55 years

Adults 2

Children 2

INR 3,00,000

Optimum

Children- Above age 2 years for individual plan

and between age 3 months to age 23 years for floater plan

Adults up to age 45 years

Adults 2

Children 2

INR 4,00,000 and INR 5,00,000

Note: For Basic variant, pre-policy medical test will be required above age 55 years for sum insured INR 2,00,000 and above age 45 years for sum insured above INR 2,00,000.

For Premium plan, pre-policy medical test is required above age 45 years.

Room Rent/Room Category

The room rent limits for the plan is as follows:

  • In case of Basic plan, sum insured INR 2,00,000 and INR 3,00,000; the room-rent limit of INR 2,000 and INR 3,000 per day is applicable for normal hospitalization room while limit of INR 3,000 and INR 4,500 per day is applicable for ICU room.
  • In case of Premium plan, room-rent limit of INR 3,000 is applicable normal hospitalization room and INR 4,500 is for ICU room.
  • In case of sum insured INR 5,00,000 for Basic plan and Optimum plan which has sum insured INR 4,00,000 and INR 5,00,000 there is no limit applicable on room rent.

Co-Payment

  • There is no co-pay option for this product.

No-Claim Benefits

  • This plan has premium discount of 5% up to a maximum of 25% for each unclaimed year. However, this cumulative discount is reduced to zero once claim is made.

Good to have

PRE/POST HOSPITALIZATION-The variants of this plan covers pre and post hospitalization expense as follows:
  • Under Basic plan pre hospitalization expense is covered up to 30 days and post hospitalization is covered up to 60 days.
  • Under Premium plan pre hospitalization expense is covered up to 45 days and post hospitalization is covered up to 60 days.
  • Under Basic plan pre hospitalization expense is covered up to 60 days and post hospitalization is covered up to 90 days.

Restore Benefits:

  • This plan does not offer restore benefit.

Health Check-up

  • This plan offers health check-up benefit up to 1% of sum insured after every 4 claim free years.

Value Adds

Ambulance Charges

All the variants of this plan provides coverage for ambulance charges as follows:

  • Up to INR 1,500 for Basic plan
  • Up to INR 2,000 for Premium plan
  • Up to INR 2,500 for Optimum plan

Eye Cover

  • This plan does not provide coverage for eye treatment expenses.

Domiciliary Hospitalization

All the variants of this plan covers domiciliary hospitalization up to 10% of the sum insured.

  • Home nursing allowance of INR 200 and INR 500 per day for a maximum of 10 days after 3 days is provided in the Premium and Optimum variant respectively.
  • Note: The list of diseases in the policy wording are not covered under this policy.

Outpatient Benefits

  • This plan does not have any outpatient benefits.

Critical Illness Coverage

This plan has an option to opt for both reimbursement and lump sum benefit in case of critical illness.

  • For the Basic variant of this plan additional coverage up to sum insured is available for coverage above INR 2,00,00 on reimbursement basis.
  • For the Optimum variant of this plan provide addition lump sum benefit in case of critical illnesses listed in the document.
  • Note: The Premium variant of this plan does not have any additional cover for critical illnesses.
  • Dread Disease Recuperation: In addition to all of the above benefits, for critical illnesses, this plan has dread disease recuperation. In case of basic plan with sum insured above INR 2,00,000; INR 200 would be provided for maximum of 45 days. The Premium variant of this plan does not have this benefit while for Optimum variant, this benefit is included in the lump sum benefit.

Alternative Practice

  • This plan does not cover medical expenses for alternative practices like Ayurveda, Unani, etc.

Dental Cover

  • This plan does not offer coverage for out-patient dental expenses.

Daily Cash

All the variants of this plan offers daily cash benefit after 3 days of hospitalization, as follows-
Under Basic plan, daily cash in the range of INR 200 to INR 350 per day for a maximum of 10 days is provided.
  • Under Premium plan, daily cash of INR 250 per day for a maximum of 15 days is provided.
  • Under Optimum plan, daily cash of INR 1000 for a maximum of 30 days is provided.
  • For accompanying an insured person daily cash benefit is provided as follows:
  • INR 250 per day for 5 days after first 3 days for the Basic and the Premium variant
  • INR 250 per day for 10 days after first 3 days for the Optimum variant.
  • Note: The Premium and the Optimum variant of this plan offer INR 250 per day for 10 and 30 days respectively, after first 3 days for parent accommodation for accompanying an insured child.

Organ Donor Cover

  • The Basic variant of this plan offers additional coverage for INR 30,000 and INR 50,000 depending on the sum insured. In case of Optimum variant the organ donor cover is included in the lump sum benefit offered.

Convalescence Benefit

  • The Optimum variant of this plan offers convalescence benefit up to INR 12,500.

Maternity Cover

  • This plan does not cover maternity related expenses.

Physiotherapy

Coverage for in-patient physiotherapy is provided in this plan as follows:

  • Up to INR 3,000 for the Premium variant.
  • Up to INR 8,000 and INR 10,000 for the Optimum variant.

Exclusions

A cooling off period of 30 days is applicable on buying heath insurance policy for the first year. No claims (other than claims related to an accident) can be made in this cooling off period. There is no cooling off period applicable on renewal of this policy.

Waiting period of 2 years is applicable for specified ailments. Refer to the policy wordings for the list of these specified ailments.

Waiting period of 4 years is applicable for pre-existing diseases.

Waiting period of 60 days is applicable for claims under critical illness.

Permanent Exclusions

  • Cosmetic surgery, Lasik eye treatments, drugs or alcohol abuse, genetic disorders, self inflicted injuries, war related injuries, etc. are some of the exclusions. For the detailed list of please refer the policy document.

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