A closer look at Max Bupa Health Insurance

Max Bupa Health Insurance Company Ltd. (IRDA Reg. No 145) regularly known as Max Bupa is a strategic collaboration between Max India Limited and Bupa – a pioneer in healthcare services from UK.

Max India Group is considered to be a forerunner in the Indian health and insurance segment. Their repertoire includes life insurance, hospitals, and health related clinical research. On the other hand, Bupa boasts of over 6 decades experience in the healthcare industry and it has over 11.3 million customers spread across 190 countries. Max Bupa health insurance envisions of being India’s most preferred health insurance company by being committed to their esteemed customers.

Features

of members- The plan covers maximum 4 members of your family with up to 2 children and 2 adults.
Lifelong Renewal – The plans offered are lifelong renewable hence it saves you from the financial burden and stress caused by a medical emergency and keeps you well prepared to handle any situation.
Pre & Post hospitalization cover– The plan covers medical expenses for 30 days prior to hospitalization and 60 days post hospitalization only for related medical expenses.
Health Check-ups – Offers free health check-up every second year for insured.
Pre-existing diseases– Pre-existing diseases are covered after 4 years of waiting period
Room-rent– There are zero or no sub-limits on room rent

Benefits of Max Bupa Health Insurance

With no involvement of the TPA, direct liaison with the company initiates quicker resolutions
No age restriction for enrolment in the policy
Maternity and New Born Child benefits

Products offered by Max Bupa Health Insurance

Health @ Companion

The Health @ Companion plan offers the most basic coverage when compared to all the other plans by Max Bupa. It has option of individual or family floater coverage. There are two variants of this plan. Given below are the details of coverage offered on individual or family floater basis under both the variants:

Health @ Companion – Silver

Individual Coverage

This policy offers basic coverage in the range of Rs.2 lakh and Rs.4 lakh for individuals of between age 18 years and 65 years.
Pre and post hospitalization expenses, day care procedures, etc., are benefits provided in this plan.
Co-payment of 20% (amount to be paid by the policy holder before claiming for the policy) is applicable for individuals above age 65 years.

Family Floater Coverage

This is a basic family floater plan, which covers health costs of the entire family in the range of Rs.2 lakh and Rs.4 lakh.
A maximum of 2 adults (proposer & spouse) in the family between age 18 years and 60 years and 4 children between age 3 months and 23 years can be covered under this policy.
Pre and post hospitalization expenses, day care procedures, etc., are benefits provided in this plan.
Co-payment of 20 % (amount to be paid by the policy holder before claiming for the policy) is applicable for individuals above age 65 years.

Health @ Companion- Gold

Individual Coverage

This policy offers basic coverage of Rs.5 lakh for individuals between age 18 years and 65 years.
Pre and post hospitalization expenses, day care procedures, etc., are benefits provided in this plan. This plan offers higher expense cover than Health Companion @ Silver.
Co-payment of 20 % (amount to be paid by the policy holder before claiming for the policy) is applicable for individuals above age 65 years.

Family Coverage

This is a basic family floater plan which covers health costs of the entire family in the range of Rs.5 lakh.
A maximum of 2 adults (proposer & spouse) and 4 children in the family between age 18 years and 60 years and dependent children between age 3 months and 23 years can be covered under this health insurance policy.
Pre and post hospitalization expenses, day care procedures, etc., are benefits provided in this plan. This plan offers higher expense cover than Health Companion @ Silver.
Co-payment of 20 % (amount to be paid by the policy holder before claiming for the policy) is applicable for individuals above age 65 years.

Heartbeat

Heartbeat is covers basic medical expenses along with offering a loyalty benefit for its customers. There are three variants under which different benefits offered. Given below are details of each variant of individual and family floater basis.

Heartbeat- Gold Policy

Individual Coverage

This policy offers coverage in the range of Rs.5 lakh and Rs.50 lakh for individuals of any age above 18 years.
Pre and post hospitalization expenses, day care procedures, health check-up (every year), etc. are covered under this policy.
Under loyalty program, the plan offers additional sum insured or earn and redeem benefit on every renewal irrespective of claims made.
10% or 20% co-payment is applicable above age 65 years.

Family Floater Coverage

This is a family floater plan which covers health costs of the entire family in the range of Rs.5 lakh and Rs.50 lakh.
A maximum of 2 adults and 4 children of any age in the family can be covered under this plan.
Pre and post hospitalization expenses, day care procedures, health checkup (every year), etc. are covered under the policy.
Under loyalty program, the plan offers additional sum insured or earn and redeem benefit on every renewal irrespective of claims made.
10% or 20% co-payment is applicable above age 65 years.

Heartbeat- Platinum Policy

Individual Coverage

This policy offers coverage in the range of Rs.15 lakh and Rs.1 crore for individuals of any individual above age 18 years.
Pre and post hospitalization expenses, day care procedures, health checkup (every year), etc. are covered for higher expenses than gold under this policy. Additionally, this policy also has international coverage for 9 treatments specified in the document.
Under loyalty program, the plan offers additional sum insured or earn and redeem benefit on every renewal irrespective of claims made.
10 % or 20 % co-payment is applicable above age 65 years.

Family Floater Coverage

This is a family floater plan which covers health costs of the entire family in the range of Rs.15 lakh and Rs.1 crore.
A maximum of 2 adults (proposer & spouse) and 4 children of any age in the family can be covered under this plan.
Pre and post hospitalization expenses, health checkup (every year), out-patient, maternity benefits and new born cover, etc. Are covered under this policy. Additionally, this policy also has international coverage for 9 treatments specified in the document.
Under loyalty program, the plan offers additional sum insured or earn and redeem benefit on every renewal irrespective of claims made.
10% or 20% co-payment is applicable above age 65 years.

Heartbeat- Silver Plan

Individual Coverage

This is a top plan (these plans have an agreed upon deductible amount to be paid at the time of claim) for any individual above age 18 years.
The coverage amount for this plan is Rs.2 lakh and Rs.3 lakh and the deductible amount for the plan is Rs.1 lakh and Rs.3 lakh.
Pre and post hospitalization expenses, day care procedures, health checkup (every two years), etc. are covered under this policy.
Under loyalty program, the plan offers additional sum insured or earn and redeem benefit on every renewal irrespective of claims made.
10% or 20% co-payment is applicable above age 65 years.

Family Floater Coverage

This is a top-up plan (these plans have an agreed upon deductible amount to be paid at the time of claim) which offers coverage of Rs. and INR 3,00,000 for all the family members.
A maximum of 2 adults (proposer & spouse) and 4 children of any age in the family can be covered under this plan.
Pre and post hospitalization expenses, day care procedures, health check up (every two years), maternity benefit and newborn cover, etc. are covered under the policy.
Under loyalty program, the plan offers additional sum insured or earn and redeem benefit on every renewal irrespective of claims made.
10% or 20% co-payment is applicable above age 65 years.

Health Assurance

This is a unique plan which offers coverage for critical illness, hospital cash and personal accident at 4 different range/ levels of sum assured. It is available as individual and family floater coverage. Given below are the details:

Individual Coverage

Critical illness benefit- The policy would provide lump sum amount in case of critical illness and coverage in the range of Rs.3 lakh and Rs.10 lakh between age 18 years and 65 years.
Hospital cash- This would additionally to cover miscellaneous expenses required on daily basis during hospitalization. It provides coverage in the range of Rs.1000 per day to INR 4000 per day between age 18 years and 65 years.
Personal accident- It would provide lump sum amount in case of accidents. The coverage offered would be in the range Rs.5 lakh and Rs.25 lakh between age 18 years and 65 years.
The plan also has 7 options having different combinations of benefits in it.
Option I- Will have critical illness cover, Hospital cash benefit and personal accident cover.
Option II- Will have critical illness cover and hospital cash benefit.
Option III- Will have critical illness and personal accident cover.
Option IV- Will have hospital cash benefits and personal accident cover.
Option V- Will have critical illness cover only.
Option VI- Will have hospital cash benefit only.
Option VII- Will have personal accident cover only.

Family Floater Coverage

Critical illness benefit- It would provide lump sum amount in case of critical illness and coverage in the range of Rs.3 lakh and Rs.10 lakh between age 18 years and 65 years.
A maximum of 2 adults can be covered for this benefit. Hospital cash- This would additionally cover miscellaneous expenses required on daily basis during hospitalization. It provides coverage in the range of Rs.1000 per day to Rs.4000 per day between age 18 years and 65 years.
Proposer, spouse and 2 children can be covered for this benefit. Personal accident- It would provide lump sum amount in case of accidents. The coverage offered would be in the range of Rs.5 lakh to Rs.25 lakh between age 18 years and 65 years.
Proposer, spouse and 2 children can be covered for this benefit.
The plan also has 7 options having different combinations of benefits in it.
Option I- Will have critical illness cover, Hospital cash benefit and personal accident cover
Option II- Will have critical illness cover and hospital cash benefit
Option III- Will have critical illness and personal accident cover
Option IV- Will have hospital cash benefits and personal accident cover
Option V- Will have critical illness cover only
Option VI- Will have hospital cash benefit only
Option VII- Will have personal accident cover only

In case Health Assurance provides all the benefits that you are looking out for know more about the plan, contact.

Family First- Silver Policy

Max Bupa has some very unique family floater options Family First is one such plan. There are three variants under this plan. Given below are the details of the coverage offered.

Family First- Silver Policy

This is a unique family health insurance plan specially designed for joint families which covers any number of family members from defined 14 family relations.
The base sum insured is divided into two insured values such that all the members are covered on an individual as well as floater basis under same plan.
The individual Sum insured value is the range of Rs.1 lakh and Rs.5 lakh.
The family Sum insured value is in the range of Rs.3 lakh and Rs.15 lakh.
The policy offers basic coverage like pre and post hospitalization expenses, day care procedures, health check-up (every two years), maternity benefit and newborn cover, etc.
Under loyalty program, the plan offers additional sum insured or earn and redeem benefit on every renewal irrespective of claims made.
10 % or 20 % co-payment is applicable above age 65 years.

Family First- Gold Policy

This is a unique family health plan specially designed for joint families which covers any number of family members from defined 14 family relations.
The base sum insured is divided into two insured values such that all the members are covered on an individual as well as floater basis under same plan.
The individual Sum insured value is the range of Rs.1 lakh and Rs.15 lakh.
The family Sum insured value is in the range of Rs.3 lakh and Rs.50 lakh.
The policy offers higher coverage values than the silver policy in case of pre and post hospitalization expenses, day care procedures, health check-up (every year), maternity benefit and newborn cover, etc.
Under loyalty program, the plan offers additional sum insured or earn and redeem benefit on every renewal irrespective of claims made.
10 % or 20 % co-payment is applicable above age 65 years.

Family First- Platinum Policy

This is a unique family health plan specially designed for a joint family, which covers any number of family members from defined 14 family relations.
The base sum insured is divided into two insured values such that all the members are covered on an individual as well as floater basis under same plan.
The individual Sum insured value is the range of Rs.5 lakh and Rs.15 lakh.
The family Sum insured value is in the range of Rs.15 lakh and Rs.50 lakh.
The policy offers higher coverage values than the gold policy in case of pre and post hospitalization expenses, health checkup (every year), maternity benefit and newborn cover, outpatient, etc. Additionally, this policy has international coverage for 9 treatments specified in the document.
Under loyalty program, the plan offers additional sum insured or earn and redeem benefit on every renewal irrespective of claims made.
10 % or 20 % co-payment is applicable above age 65 years.

If you have a big joint family and family first is suitable as per your requirement then, know more about the terms and conditions under the policy, contact us.

Employee First Health Insurance Plan

This is group health insurance plan suitable for business owners seeking health insurance policies for their employees. Given below are the details of coverage offered.

This plan provides comprehensive health coverage to group of employees of any age in the range of Rs.1 lakh and Rs.50 lakh.
The plan has benefit of opting for private room and health check-up to parents and parents in laws.
This plan also provides maternity benefits and new born coverage.

If you want to buy health insurance plan for your employees you might want to know all the terms and conditions under the policy please contact us for any details.

Employee First Classic Health Insurance Plan

This group health insurance policy is for employers who wish to cover entire family of their employees. The benefits under this policy are given below:

This plan provides group health insurance to employees of any age in the range of Rs. 50,000 and Rs.5 lakh.
This plan can be extended as corporate floater.
It provides coverage to parents, maternity benefits and new born coverage.

In case group family floater policy for employees was something that you were looking for know more about the coverage offered, contact.

Group Personal Accident

This is personal accident disability plan which offers compensation to entire group in case of an accident related death or disability. Given below are details of coverage offered:

This plan offers accidental coverage to the entire group and can be extended to cover family.
The plan has provides lump sum amount in case of accident, permanent total disability, etc. and option to have corporate floater, educational allowance, etc.

Before buying this policy for entire group know more about the terms and conditions, contact.

Network Hospitals

Claims process at Max Bupa Health Insurance

There are two ways to make claim under a Health Insurance Policy: on cashless basis and on reimbursement basis. In simple terms, for making a claim on cashless basis, the treatment must be done only at a network hospital of the insurance company servicing your policy. For availing the treatment, you would have to first seek an authorization as per the procedures laid down and in the prescribed form. In case of claims on reimbursement basis, the insurance company has to be informed as per their prescribed procedures. The policyholder has to ensure that documents such as claim form, discharge summary, prescriptions and bills to be submitted for the claim on reimbursement are obtained after hospitalization.

Max Bupa Health Insurance has a well-defined claim processing system.

Cashless Service: seeking Pre-Authorization

Complete the pre-authorization form available at the hospital’s insurance/TPA Desk.
Send the completed form via email or fax.
Approved letter will be sent by the claim management team. Remember that the claim management team could send an inquiry to the hospital or you before authorization.
In case the authorization is rejected, initiate the treatment and file for reimbursement claim.

Reimbursement Claim: Claim Submission

Complete the necessary form and submit along with required documents, as per the policy terms and conditions.
Necessary documents include discharge summary, prescriptions, bills etc.
Approved letter will be sent by the claim management team. Remember that you will be answerable to any queries raised by the claim management team before the letter is issued.
In case the claim is rejected, the reasons will be communicated by the team.

In case of any emergencies, you need to inform Max Bupa within 24 hours of the admission. In case of planned emergencies, the notification has to reach the company 48 hours prior to the hospitalization. The claim intimation can be done via Max Bupa’s toll free number 1800-3010-3333. The same could also be emailed to customercare@maxbupa.com .

Review of Max Bupa Health Insurance

If you are looking to invest in a plan that has no age restrictions, no sub-limits on room rent, offers a decent No Claim Bonus up to 100% and Maternity and New Born Child benefits, Max Bupa is one of the top 5 picks. With no involvement of TPA, they claim to have a quicker resolution process including claims handling. However, if you do not appreciate the element of co-payment, you may get disappointed.