Smart Health Insurance Policy

8/12/2019 Smart Health Insurance Policy

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Health Insurance

Bharti AXA SmartHealthInsurance Policy


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For more dtails 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 thedoctor prescribed

You are still

unwellso

you gethospitalised

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
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And the result.

You might feel like doing this.


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Multi-dimensional Impact

Hospitalisation

expenses

Ad-hoc

expenses

Potential Loss

of income

Depleted

savings

FamilysHealth


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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 CostsCost 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


7/40For more dtails please visit at www.bharti-axagi.co.in or call us at 080-490102007

Smart Health for Smart People

Your Smart HealthInsurance Policyprovides complete financial

protection for you and your family

against Hospitalization Expenses



Coverage

The SmartHealth

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



Hospitalisation Benefit

Covers expenses incurred by Insured Person as an in-patient in ahospital 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 24hours.


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Domiciliary Hospitalisation

Reimbursement of expenses involving medical treatment fordisease/injury at the Insured Persons home in India

The treatment would have in normal course, done in a

hospital/nursing home, but is taking place at Insured Persons

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


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Day Care Treatment

Payment or reimbursement of hospitalisation expenses incurred in case of

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

This includes:

Cardiac Catheterization

Hydrocele surgery Hernia repair surgery

TURP (Prostate Surgery)

Surgeries/procedures that

require less than 24 hours

hospitalisation due tomedical/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


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Pre and post hospitalisation

expenses

Pre-hospitalisation Expenses Payment or reimbursement of

expenses incurred for

specified days priorto

hospitalisation

Post Hospitalisation Expenses

Payment or reimbursement of

expenses incurred for specified

days post discharge from Hospital

Hospitalisation

90 days60 days

Optimum Optimum


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Critical Illness

Covers expenses incurred for treatment of any of the specifiedcritical 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 andsurviving 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.


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Critical Illnesses

1. Cancer2. First Heart Attack - Heart3. Coronary Artery Disease -

Heart4. Coronary Artery Bypass

surgery - Heart

5. Heart Valve Surgery - Heart6. Surgery to Aorta Heart7. Stroke - Brain8. Kidney Failure9. Aplastic Anaemia - Blood10. End Stage Lung Disease

11.End Stage Liver Failure12. Coma - Brain

13. Major Burns - Burns14. Major Organ/Bone Marrow

Transplantation - Bone15. Multiple Sclerosis - Cancer

16. 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


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SmartHealth Benefits

The SmartHealth Insurance Policy

also offers these benefits: Hospital Cash Allowance Home Nursing Ambulance Charges In-patient Physiotherapy Charges Recovery Grant Accompanying Persons 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 Persons 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


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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.


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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,


occurrences during the Policy period subject to the overall SumInsured.


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Ambulance Charges

Reimbursement of expenses incurred for the transportation ofthe 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.


occurrences during the Policy period and is subject to the

applicable limits.


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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


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Accompanying Persons 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.


occurrences during the Policy period and is subject to theapplicable limits


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Parent Accommodation as Companion

for Child

Payment of a fixed daily allowance towards meeting the expensesfor the stay of one of the parents at the Hospital when a child

below the age of 12 years is hospitalized.



applicable limits.


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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.


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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 inrespect 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.



applicable limits


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Children Education Fund

Payment of a fixed amount per dependent child

in the event of death of the Insured Person whilst under treatment in aHospital 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.


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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 planchosen.


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Additional FeaturesAdditional Features

Family Floater Feature

Renewal Discount

Income Tax Benefit

Cost of Medical Check-up


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Family Floater

Policy can be issued on a Floater basis covering the familymembers 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


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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.


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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.


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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.


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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


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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 Emedi tek Solut ions

L td


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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 fromthe website of the TPA/Insurance company, benefit guide, branchoffices of TPA/Insurance company)

For emergency hospitalization, forward your request letter within24 hours of hospitalization in the prescribed format(format availablefrom the website of the TPA/Insurance company, benefit guide, branchoffices of TPA/Insurance company)

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

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

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

Step 5 :At the time of discharge insured leaves back all the documentsand 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


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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 hospitalizationand 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


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For more dtails 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 doctors

prescription. Copy of the policy document


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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


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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 ofdiagnosis of any of the covered critical illnesse

Three different plan variants - each with five different Sum Insuredoptions to choose from

Instant, Hassle Free Policy Delivery for customers aged 45 years orbelow.

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

network hospitals


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Plan Options

39 Please Visit us at www.bharti-axagi.co.in for more dtails orcall on 080-49010200 for more options


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Thank you
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