Bharti AXA Smart Health Critical illness plan offers coverage to an individual after first diagnosis of critical illness. Under this plan there are two Sections- Section I provides reimbursement benefit or medical expense cover (like in case of any Mediclaim policy) up to sum insured after diagnosis while Section II provides lump sum payment up to sum insured (irrespective of hospitalization expenses) after first diagnosis. The individual opting this policy has an option to choose benefit under either Section I or Section II.
Note: Under this plan, in case of multiple diagnosis the benefit can be availed only once. Also, in case of a family floater, once the claim is made by any one of the family members the plan cannot be further renewed for other members on floater basis.
Plan variants –
Main highlights of the plan –
The benefits offered under Bharti AXA Health Insurance's Smart Health Critical illness plan are:
It gives an individual option to choose reimbursement (under Section I) or lump sum benefit (under Section II) as critical illness benefit.
It has an option to opt for individual or family floater cover.
Discount of 5% on the premium is provided up to a maximum of 25% is provided after every claim free year.
20 critical illnesses are covered under this plan.
Scope of cover –
- The individual between age 3 months up to 55 years can be covered in the plan.
- The plan is available for proposer, lawful spouse and a maximum of two dependent children up to age 23 years.
- Sum insured– There are three sum insured options of INR 2,00,000; INR 3,00,000 and INR 5,00,000 available in this plan. NUMBER OF AILMENTS– The Bharti AXA Smart Health Critical illness policy offers coverage for 20 critical illnesses.
LIST OF CRITICAL ILLNESSES COVERED –
- Cancer of specified severity
- First heart attack
- Coronary artery disease
- Open chest Coronary Artery Bypass Graft (CABG)
- Open Heart Replacement of Heart Valves
- Surgery to Aorta
- Stroke resulting in permanent symptoms
- Kidney failure which requires regular dialysis
- Aplastic Anemia
- End stage Lung disease
- End stage Liver failure
- Coma of specified severity
- Major burns
- Major organ/ bone marrow transplant
- Multiple sclerosis with recurring symptoms
- Fulminant hepatitis
- Motor neurone disease exhibiting permanent symptoms
- Primary permanent hypertension
- Terminal illness
- Bacterial meningitis
Individual and Family floater
Coverage and benefits –
The Section I of the Bharti AXA Smart Health Critical illness policy offers following benefits in case of hospitalization:
ROOM RENT/ ROOM CATEGORY –
This plan does not have limit over room expense cover.
This plan does not have co-pay option.
NO-CLAIM BENEFITS – This plan offers 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
For claim under Section I of this policy, the pre hospitalization expense for a maximum of 30 days and post hospitalization for a maximum of 60 days is covered in this policy.
This plan does not offer restore benefit.
This plan reimburses 50% of the amount spend on pre-policy health check-up.
AMBULANCE CHARGES -
This benefit is applicable under Section I of this policy. With this benefit, the insured would get coverage for ambulance charges up to INR 2,500 for transportation to and from the hospital. One can avail this benefit more than once in a single policy year.
DAILY CASH –
This plan provides daily cash benefit for claims under Section I of the policy. With this benefit the insured is eligible for daily cash as follows:
Dread disease recuperation cover- With this cover the individual diagnosed with any critical illness listed under this policy a daily cash of INR 500 per day up to a maximum of 45 days would be provided.
Hospital Daily cash allowance- An additional benefit under Section I includes hospital daily cash allowance benefit which entitles you with an allowance of INR 750 per day for a maximum of 30 days, after the hospitalization exceeds 3 days. This benefit is not restricted to the number of occurrences.
Accompanying insured person- Another additional benefit provided under Section I of this policy is coverage to the person accompanying the insured. With this benefit, INR 250 for a maximum of 10 days is provided to cover the person accompanying the insured.
HOME NURSING EXPENSE –
This benefit is applicable under Section I of this plan. With this benefit insured would get a daily cash of-
- INR 350 per day for a maximum of 10 days after hospitalization exceeds 3 days is provided for sum insured INR 2,00,000.
- INR 500 per day for a maximum of 10 days after hospitalization exceeds 3 days is provided for sum insured INR 3,00,000 and INR 5,00,000.
ORGAN DONOR COVER – This benefit is applicable under Section I of this policy. With this benefit, the cost of treatment for the organ in case of major organ transplant for the insured is covered up to sum insured.
CONVALESCENCE BENEFIT –
This benefit is applicable for claims under Section I of this policy. With this benefit the insured would get convalescence benefit up to INR 12,500 after hospitalization exceeds 8 days.
PHYSIOTHERAPY – This benefit is provided under Section I of this health insurance plan. With this benefit the insured gets coverage for in-patient physiotherapy up to 2% of sum insured.
CHILDREN EDUCATION FUND –
This benefit is provided under Section I of Smart Health Critical illness plan in the event of death of the insured as a result of critical illness covered under this policy. Under this benefit, a maximum of two dependent children up to age 23 years pursuing education are provided allowance up to INR 5,000.
MORTAL EXPENSE COVER -
This benefit is provided under Section I of Smart Health Critical illness plan in the event of death of the insured as a result of critical illness covered under this policy. Under this benefit, an allowance of –
INR 1,000 is provided after the death of insured covered for sum insured INR 2,00,000.
INR 2,000 is provided after the death of insured covered for sum insured INR 3,00,000 and INR 5,00,000.
All the benefits mentioned above talk about benefits applicable under Section I of the policy. For Section II the policy provides compensation amount equal to 100% of sum insured after diagnosis of critical illness and irrespective of hospitalization expenses.
Note- For benefit under any one of the above Sections it is mandatory that the illness should fall under the critical illness category as defined by the insurance company. For more details on the categories defined please refer the policy wordings.
Survival period –
Waiting Period –
To claim for benefits under any Section (Sec. I or Sec. II), a waiting period of 60 days after commencement of policy is applicable. However, this period is waivered off after timely renewal.
Pre-existing conditions are covered only after 4 years of continuous coverage.
Specified illnesses have a waiting period of 2 years applicable in this plan.
Note: In case you are porting from policy A to this policy the terms and conditions under this section would differ. Please refer the policy wording or contact Coverfox for more details.
Permanent Exclusions –
- All the dental treatments unless recommended for treatment of any critical illness.
- Birth control procedures, AIDS and related diseases and illnesses.
- Treatment of mental illnesses.
Note: For detail list of exclusions, please refer the policy wording.