Bharti AXA Smart Super Health Assure health insurance

Bharti AXA Smart Super Health Assure health insurance

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Bharti AXA Smart Super Health Program provides cover for hospitalization costs incurred in treating disease, accident or illness. The scheme includes hospitalization expenses, daycare services, hospitalization expenses at home, ambulance costs, animal bite (vaccination), pre- and post-hospitalization expenses, domestic air ambulance and restoration of guaranteed amounts, among others.

Bharti AXA Smart Super Health Assure health insurance benefits

  • Eligibility
  • Coverages
  • Exclusions

Eligibility of Bharti AXA Smart Super Health Assure health insurance

  • 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.
  • The age at entry for Individual ranges between 5 year and 65 Yrs.
  • There is no maximum cover ceasing age on renewals.
  • This Policy can be issued to an individual and/or family.
  • The family means maximum of five persons including self, spouse and three dependent children up to the age of 23 years.

Sum Insured

Sum Insured that can be opted upto the age at entry of 65 years on Individual and/or Floater basisare as follows:
Plan Sum Insured (₹ INR)
Economy 1,00,000 / 2,00,000 / 3,00,000 / 4,00,000

This is the over all limit of Sum insured inclusive of all benefits under all sections except for Addon benefits referred under Section C.

Coverages of Bharti AXA Smart Super Health Assure health insurance

A. Basic cover upto the Sum Insured limit applicable to all plans
In-patient treatment In-patient treatment covers hospitalization expenses which are reasonable and customary charges incurred for treatment of Disease, Illness contracted or Injury sustained. This 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-hospitalization Covers relevant medical expenses incurred upto 60 days before hospitalization or day care treatment for treatment of Disease, Illness contracted or Injury sustained.
Post Hospitalization Covers relevant medical expenses incurred upto 90 days after discharge from Hospital / Day Care treatment for continuous and follow up treatment of the Disease, Illness contracted or Injury sustained for which the Insured/ Insured Person was hospitalized.
Organ Donor Expenses Covers hospitalization expenses for Medical treatment of the organ donor for harvesting the organ.
Day Care Treatment Medical treatment, and/or surgical procedure which is undertaken under General or Local Anaesthesia in a Hospital/ Day Care centre in less than 24 hours because of technological advancement, which would have otherwise required a hospitalization of more than 24 hours, In respect of listed treatments as given in the Appendix I at the end of this document.
AYUSH Treatment Medical expenses for in-patient treatment taken under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems in a government Hospital or in any institute recognized by government and/ or accredited by Quality Council of India/ National Accreditation Board on Health.
Domiciliary Hospitalization Medical treatment for an Illness/Disease/Injury which in the normal course would require care and treatment at a Hospital but is actually taken while confined at home under any of the following circumstances:
  • The condition of the Patient is such that he/she is not in a condition to be removed to a Hospital or,
  • The Patient takes treatment at home on account of non-availability of room in a Hospital.
Treatment of less than 3 days is not covered. (Coverage will be provided for expenses incurred in first three days however this benefit will be applicable if treatment period is greater than 3 days)
B. Other Benefits available on the basis the selected plan.
Restoration of Sum Insured In case of a situation where the Sum Insured and No claim bonus are exhausted due to claims made and paid during the Policy Year, and the Insured/ Insured Persons have to subsequently, incur any hospitalization expenses due to any Disease / Illness / Injury for which a valid claim is admissible under the Policy, then the Sum Insured shall be restored which is equal to 100% for the particular Policy year for all members in the Policy
Emergency Surface Ambulance charges Covers expenses incurred for surface transport by ambulance to Hospital or between Hospitals and/ or diagnostic centre for treatment of Disease, Illness or Injury in a Hospital as an in-patient, provided a valid claim under the Policy is admissible.
C. Optional Add-on benefits available to all plans on payment of extra premium
Hospital Cash Allowance Daily cash amount will be payable per day upto the specified limits opted, if the Insured Person is Hospitalized for treatment of any Disease/Illness / Injury for which a valid claim is admissible under the Policy for each continuous and completed period of 24 hours and if the Hospitalisation exceeds for more than 24 hours. First continuous and completed period of 24 hours will act as deductible. This is paid upto a maximum of 30 days including all the members & all claims for the entire Policy year.
Maternity Benefit New Born Baby Cover This benefit covers the medical expenses including (after a waiting period of 9 months with the company) up to limits specified in the schedule (over and above Sum Insured mentioned in the Schedule) for the delivery of a baby and / or expenses related to medically recommended lawful termination of pregnancy but only in life threatening situation under the advice of Medical Practitioner, limited to maximum of two deliveries or terminations as said herein during the lifetime of an Insured Person between the ages of 18 years to 45 years (being the age of eldest member in the Policy).
Lump sum benefit for critical Illnesses If, 60 days after the inception of this Policy, the Insured / Insured Person is at any time during the Policy period (after the above waiting period of 60 days), being diagnosed as contracting any Critical Illness as specified below and surviving for more than 30 days post such diagnosis, the specified limits as mentioned in Schedule (over and above the Sum Insured mentioned in the Schedule) for this benefit shall be payable to the Insured/Insured Person as Lump Sum benefit.
The illnesses qualified as Critical Illnesses and covered in this section are as follows:
  1. Cancer of Specified Severity
  2. First Heart Attack of Specified Severity
  3. Coronary Artery Disease
  4. Open Chest CABG
  5. Open Heart Replacement or Repair of Heart Valves
  6. Surgery to Aorta
  7. Stroke resulting in Permanent Symptoms
  8. Kidney Failure requiring Regular Dialysis
  9. Aplastic Anaemia
  10. End Stage Lung Disease
  11. End Stage Liver Failure
  12. Coma of Specified Severity
  13. Major Burns
  14. Major organ /bone marrow transplant
  15. Multiple Sclerosis with Persisting Symptoms
  16. Fulminant Hepatitis
  17. Motor Neurone Disease with Permanent Symptoms
  18. Primary Pulmonary Hypertension
  19. Terminal Illness
  20. Bacterial Meningitis

Exclusions of Bharti AXA Smart Super Health Assure health insurance

  • Smart Super Health Assure Initial waiting period: 30 days for all illnesses (not applicable on renewal or for accidents)24 months for the specific diseases or illness or procedures/surgeries (refer to the policy wordings for entire list)
  • Pre-existing diseases covered after 48 months
  • Maternity expenses: Where maternity cover is opted, waiting period until 9 months since the inception of the first Policy with the Company
  • Internal Congenital Anomalies are covered after a waiting period of 48 months
  • Genetic disorders are covered after a waiting period of 48 months
  • Critical Illness – 60 days waiting period and 30 days survival period
  • War (whether declared or not) and war like occurrence or invasion, acts of foreign enemies, hostilities, civil war, rebellion, revolutions, insurrections, mutiny, military or usurped power, seizure, capture, arrest, restraints and detainment of all kinds.
  • Disease/ illness/ injury while performing duties as a serving member of a military or a police force
  • Any illness or injury directly or indirectly resulting in or arising from or occurring during the commission of any breach of any law by the insured person with criminal intent.
  • Any Illness or Injury directly or indirectly resulting or arising from or occurring during commission of any breach of any law by the Insured Person with criminal intent.
  • Disease/ Illness/ Injury whilst performing duties as a serving member of a military or a police force.
  • Any loss, Injury/Illness, directly or indirectly caused due to an act of terrorism or terrorist incident, regardless of any contributory causes (if the Company alleges that by reason of this exclusion any loss is not covered by this insurance, the burden of proving the contrary shall be upon the Insured / Insured Person).
  • Expenses following Ionizing radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel.
  • Medical Treatment in respect of the Illness / Injury/ Disease caused whilst engaging in speed contest or racing of any kind (other than on foot), bungee jumping, parasailing, ballooning, parachuting, skydiving, paragliding, hang gliding, mountain or rock climbing, potholing, abseiling, deep sea diving, polo, snow and ice sports.
  • Medical treatment in respect of the Injury caused whilst flying or taking part in aerial activities (including cabin crew) except as a fare-paying passenger in a regular Scheduled commercial airline
  • Circumcision unless necessary for treatment of a Disease, Illness or Injury not excluded hereunder, or, as may be necessitated due to an Accident.
  • Dental treatment or surgery of any kind unless requiring hospitalization or in case of outpatient Dental Emergency Treatment (unless arising out of Accident only as specified under the scope of the Policy).
  • Birth control procedures, hormone replacement therapy, contraceptive supplies or services including complications arising due to supplying services or Assisted Reproductive Technology, treatment arising from or traceable to pregnancy, childbirth including caesarean section and voluntary medical termination of pregnancy during the first 12 weeks from the date of conception. However, this exclusion will not apply to Ectopic Pregnancy proved by diagnostic means and certified to be life threatening by the attending Medical Practitioner.
  • Any treatment arising from or traceable to any fertility, infertility, sub-fertility or assisted conception procedure or sterilization.
  • Charges incurred in connection with cost of spectacles and/or contact lenses, hearing aids,routine eye and ear examinations, laser surgery for correction of refractory errors, dentures, artificial teeth and or all other similar external appliances and/or devices whether for diagnosis or treatment, Issue of medical certificates and examinations as to suitability for employment or travel.
  • Any condition directly or indirectly caused by or associated with venereal Disease, sexually transmitted Disease, including Genital Warts, Syphilis, Gonorrhea, Genital Herpes, Chlamydia, Pubic Lice and Trichomoniasis, Human T-Cell Lymphtropic Virus Type III (HTLV–III or IITLB-III) or Lymphadenopathy Associated Virus (LAV) or the mutants derivative or Variations Deficiency Syndrome or any Syndrome or condition of a similar kind.
Disclaimer: “For the detailed list of exclusions under the policy, kindly refer to the same provided in your policy kit”

Bharti AXA Ergo Health Insurance FAQ’s

Claim Settlement ratio is the ratio of claims settled against claims reported during thce year. Bharti AXA health insurance claim settlement ratio is 92.37% for FY 2016-17.

Any number of claims can be made during the health insurance policy period subject to the sum insured mentioned under the policy.

Hospitalization expenses are covered in the health insurance policy. Hospitalization expenses are covered in the plan if you have been hospitalized for a minimum period of 24 hours. However, specific day care treatments, which do not require 24-hour hospitalization, are also covered under our health insurance policy. The treatments include:

  • Dialysis
  • Chemotherapy
  • Radiotherapy
  • Eye surgery
  • Dental surgery
  • Lithotripsy
  • Tonsillectomy
  • Dilatation and CurettageCardiac Cauterization
  • Hydrocele surgery
  • Hernia repair surgery

No, the health insurance policy is meant to cover hospitalization only in India

The critical illness cover takes care of expenses incurred for treatment of any of the below specified critical illnesses. The 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 and surviving 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 survival period of 30 days from the date of inception of the first year health insurance Policy. The SI available under this benefit is separate and is in addition to the SI available under the hospitalization benefit section of the Policy. The following critical illnesses are covered under the Smart Super Health Insurance Policy:
  • Cancer
  • First Heart Attack
  • Coronary Artery Disease
  • Coronary Artery Bypass surgery
  • Heart Valve Surgery
  • Surgery to Aorta
  • Stroke resulting in permanent symptoms
  • Kidney Failure requiring regular dialysis
  • Aplastic Anaemia
  • End Stage Lung Disease
  • End Stage Liver Failure
  • Coma of specified severity
  • Major Burns
  • Major Organ or Bone Marrow Transplantation
  • Multiple Sclerosis with persisting symptoms
  • Fulminant Hepatitis
  • Motor Neurone Disease
  • Primary Pulmonary Hypertension
  • Terminal Illness
  • Bacterial Meningitis

Domiciliary hospitalization means treatment done at home in India for a period exceeding three days for disease, illness, or injury, which in the normal course, would require hospitalization. This could happen if either the condition of the patient is such that he or she cannot be moved to hospital or nursing home, or due to lack of accommodation.

We cover the cost of the treatment as well as expenses, if any, on the employment of qualified nurses, employed on the recommendation of the attending medical practitioner. The cover is limited to a maximum of 10% of the sum insured and will be payable if the treatment exceeds three days.

The medical insurance cover provided by your employer is available to you only as long as you are an employee of the company. Moreover, the sum insured under your employer's health insurance plan may not be adequate for your needs. Hence it would be advisable to go for a separate health insurance policy.

Yes, we send you a health card along with the policy schedule and 80D certificate, once you take a health insurance plan with us. Health card is like an identity card issued by the insurer (insurance company) to the insured (individual). It is a useful card providing you the access to the network hospitals. You would need to provide your health card at the time of admission into the hospital. This card will be beneficial for availing cashless facility as well.

We issue health insurance policies for tenure of 1 year, 2 years, and 3 years, which can be renewed subsequently.

Health insurance covers you and your family against expenses incurred in a medical emergency. With medical bills on the rise, insurance helps in reducing the financial burden during hospitalization. Also, the cases of critical illnesses and lifestyle-related ailments have increased rapidly. Health insurance allows you to be better prepared for such events.

The premium that you pay for your health insurance is eligible for tax deduction under Section 80D of the Income Tax Act.

We cover self, spouse, and two dependent children under the age of 21 years under one policy.

We cover self, spouse, and two dependent children up to the age of 23 years. Lifelong renewal is offered under our health insurance policies.

If your child is between 3 months and five years of age, he/she can be covered as part of a family floater policy provided at least one parent is covered. If the child is between 5 years and 23 years of age, you can choose between continuing the family floater policy or taking a separate health insurance policy for the child.

A family floater health insurance policy covers all family members (insured, his or her spouse, and two dependent children up to the age of 23 years) under one single policy. The sum insured floats over the entire family, and a consolidated premium needs to be paid. You can cover your family member under comprehensive health insurance to get family floater advantage.

Sum insured is the maximum amount paid to the insured by the insurance company in the event of a claim as per the health insurance contract.

You can decide the amount of health insurance on your own. We have a variety of sum insured options for you to choose from. You can decide on the amount based on the number of family members to be covered under the policy, the age of family members, the expected costs of treatment and the amount of premium you are willing to pay.

The premium payable on your health insurance policy is based on the following factors:

  • Sum insured option is chosen
  • The number of family members to be covered
  • The age of the senior most person in the family to be covered
  • The type of policy you opt for - Basic, Premium, Optimum, Smart Super Health Insurance Policy

If you are suffering from any ailment at the time of buying a policy is termed as pre existing illness or disease. It’s important to declare pre existing disease at the time of policy issuance or else at the time of claim; if the insurer knows about your existing illness your claim may get denied.

Insurance Company gives you a chance to cancel your policy post payment if you have found a better plan and wish to take a different plan. This period is called free-look period.

Under cashless hospitalization, the insured person does not settle the hospitalization expenses at the time of discharge from hospital. The settlement is done directly by us for treatment that the insured person is eligible to receive under the terms of his/her policy. This is for your convenience. However, it is important to note here that prior approval is required from us before admission into the hospital. In some cases, you may have to pay for all or part of the treatment if it is not fully covered under the terms of the policy. However, in case of emergency hospitalization, you can obtain approval post-admission. Please note that the cashless facility is available only at our Network Hospitals.

Bharti Axa has an extensive network of 4,500+ network hospitals across India growing steadily over the years. One must get admitted to a network hospital in order to avail cashless treatment for their illness. One can get the hospital closest to them by going through the Bharti Axa network hospital list available on Smart Super Health Assure

The premium paid on a health insurance policy is eligible for deduction under Section 80D of the Income Tax Act. So save with your policy now!

Brochure

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