Bharti AXA India health insurance

Bharti Axa General health insurance - review

• Key features of Bharti Axa General Health Assure Health insurance plan

  • This Policy covers persons in the age group 91 days to 65 years. The maximum entry age is restricted to 65 years.Children between 91 days and 5 years can be covered provided either parent is getting insured under this Policy.
  • In-patient treatment includes Hospital room rent or boarding expenses, nursing, Intensive Care Unit charges Operation Theatre charges, Medical Practitioner’s charges, fees of Surgeon, Anaesthetist, Qualified Nurse, Specialists, the cost of diagnostic tests, medicines, drugs, blood, oxygen, the cost of prosthetics and other devices or equipment if implanted internally during a Surgical Procedure. A minimum period of 24 consecutive hours hospitalization as in-patient is must.
  • Pre & Post Hospitalization Cover : Covers relevant medical expenses incurred upto 60 days before hospitalization or day care treatment and 90 days post hospitalization for treatment of Disease, Illness contracted or Injury sustained.
  • Organ Donor Expenses : Covers hospitalization expenses for Medical treatment of the organ donor for harvesting the organ
  • AYUSH Treatment Expenses
  • Automatic Restoration of Sum Insured upto 100% of Base Sum insured
  • Optional Benefit - Optional benefits are additional benefits which chosen by Insured by paying additional premium, however optional benefits cannot be opted without Base Hospitalization cover
    • a. Critical Illness
      i. Critical Illness Sum Insured opted should not be more than the Sum Insured of base hospitalisation Policy.
      ii. Critical illness cover is available for Insured/Insured person(s) selected, with each member having Individual limit of coverage, however limits for Insured/Insured person(s) cannot be different from each other.
    • b. Hospital Cash
      i. Hospital Cash allowance if opted has to be opted for all Insured / Insured person(s) in a Policy with common limit for Insured/Insured person(s).
    • c. Maternity with New Born Baby Cover
      i. This benefit is available only under a Family Floater Policy.
      ii. This benefit is available for Insured / Insured’s spouse provided both are covered under the same Policy.
      iii. This benefit can be opted only with a 3 year term of base coverwhere both base hospitaliZation coverand add-on cover term is 3 years only.

  Pre Policy Medical Grid – Base Product

  Pre Policy Medical Grid –Smart Health Insurance Policy
  Age Band
  18-45	Nil*
  >45	Level 1

  Level 1	FMR, RUA, HbA1c, ECG,CBC, Total Cholesterol, FBS, S Creat
  Level 2	FMR, RUA, HbA1c, ECG, Lipid profile, CBC, FBS, Serum Creatinine
  Level 3	FMR, RUA, HbA1c, ECG, Lipid profile, CBC, FBS, Serum Creatinine, SGOT, SGPT

• Claim notification - Multi model intimation :

  It is the endeavor of Company to give multiple options to the Insured/covered person/patient’s care taker to intimate the claim to the Third party administrator (TPA)/Company. The intimation can be given in following ways:

  • Toll Free call Centre of the Insurance Company(24x7) - 1800-103-2292
  • Login to the website of the Insurance Company and intimate the claim – Contact Us
  • Send an email to the TPA/Company - Customer service
  • Post/courier to TPA/Company - Bharti AXA General Insurance Company Limited, Spectrum Tower, 3rd flr, Chincholi Bunder Rd, Rajan Pada, Mindspace, Malad West, Mumbai, Maharashtra 400064 - replace with malad office Telephone: + 91 8049123900; Bharti AXA General insurance
  • Directly Contacting our Company office but in writing. - Bharti AXA General Insurance Company Limited, Spectrum Tower, 3rd flr, Chincholi Bunder Rd, Rajan Pada, Mindspace, Malad West, Mumbai, Maharashtra 400064 Replace with malad officeTelephone: + 91 8049123900; Bharti AXA General insurance, Dial :+ 91 80 49123900

  
  In all the above, the intimations are directed to a central team for prompt and immediate action.

  Customer Service – Senior Citizens

  In respect of Senior Citizens, both the Company and TPA have established a separate channel to address the grievances. Any concerns may be directly addressed to the Senior Citizen’s channel of the Company or TPA for faster attention or speedy disposal of grievance, if any.

  • Website :Bharti AXA General insurance
  • Email : customerservice
  • Phone : 080-49123900
  • Courier : Any of the Company’s Branch office or corporate office

  Insured/ Insured Person may also approach the grievance cell at any of the Company’s branches with the details of the grievance during working hours from Monday to Friday
  

  Important Points of Note
  For Cashless Claims	For Reimbursement Claims
  Avail the benefits of cashless service at Bharti Axa network hospital. Email : claims or Call Toll free number : 1800-103-2292	Mention correct and complete communication address with the pin code on the claim form. Email : claims or Call Toll free number : 1800-103-2292
  Kindly ensure that the pre-authorisation form is completely filled and signed by the Insured and the attending doctor within 6 hours once hospitalised.	Always keep a photocopy of the claim documents submitted to the insurance company
  Kindly ensure to mention the mobile number on the pre-authorisation form.	Kindly ensure that the claim form is completely filled and signed by the insured and the attending doctor
  In case of planned hospitalization, please send the pre-authorisation form in advance (not before 15 days of admission date).	Kindly ensure to mention the mobile number on the claim form.
  In case of emergency hospitalization, please send the pre-authorisation form within 24 hours from the time of hospitalization.	All claim documents are to be submitted in original within 30 days from the date of discharge.
  In case of cashless denial, insured to pay hospitalization expenses. Quote your cashless (pre-authorisation) number as reference in all the future correspondence with BHARTI AXA.	Quote your claim number as reference in all future correspondence with BHARTI AXA.
  Do not refer to the network list of any other service provider.	Insured to bear any inadmissible expenses, co-payments and or deductions.
  Do not wait until the discharge time to raise the enhancement request.
  Insured to bear any inadmissible expenses, co-payments and or deductions.

• Exclusions under Bharti Axa health plan

  The major exclusions under health insurance policy are :

  • Pre-existing diseases, illness, or injury. Health insurance benefits will not be available for any condition(s) as defined in the policy, until 48 months of continuous coverage have elapsed, since the inception of the first policy with the Company
  • Any benefit under critical illness within the first 30 days of inception of the policy for the first year. This exclusion doesn't apply for subsequent renewals with the Company without a break.
  • Medical expenses incurred for treatment undertaken for disease or illness and/or for critical illness within 30 days of the inception date of health insurance policy. This exclusion doesn't apply for subsequent renewals with the Company without a break.
  • Routine medical, eye and ear examinations, cost of spectacles, laser surgery, contact lenses or hearing aids, vaccinations and inoculation of any kind, issuing of medical certificates and examinations as to suitability for employment or travel.
  • Vitamins and tonics unless forming part of treatment for the disease, illness, or injury.
  • Any stay in Hospital without undertaking any treatment or where there is no active regular treatment by the Medical Practitioner
  • Prostheses, corrective devices, and medical appliances, which are not required intra-operatively or for the disease/ illness/ injury for which the Insured / Insured Person was hospitalized
  • Charges incurred primarily for diagnostic, X-ray or laboratory examinations or other diagnostic studies not consistent with or incidental to the diagnosis and treatment.
  • Costs of donor screening or treatment, unless specifically covered and specified in the Schedule to this Policy.
  • Naturopathy treatment.
  • Any treatment received outside India.

  And treatment of the following health conditions:

  • Cataract, Benign Prostatic Hypertrophy, Myomectomy, Hysterectomy or menorrhagia or fibromyoma unless because of malignancy, dilation, and curettage
  • Hernia, hydrocele, congenital internal disease, fistula in anus, and sinusitis
  • Skin and all internal tumors/ cysts/nodules/ polyps of any kind including breast lumps unless malignant, adenoids and hemorrhoids
  • Dialysis required for chronic renal failure, Gastric, and Duodenal ulcers
  • Joint Replacement surgeries unless necessitated by accident during the first two years of the operation of the Policy.