Health Insurance - FAQ

Visit our website www.bharti-axagi.co.in to buy online. If you would like any assistance, please call 080-49123900.

If you are aged 45 years or less and do not suffer from any pre-existing conditions/diseases/injuries, you are not required to undergo any medical tests and will be able to get a free online quote and policy instantly. You can get a free quote online, fill the proposal form and pay the premium amount with credit card or net banking. You will receive the policy documents through email and post.

You can decide the amount of 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.

We cover individuals from 3 months to 65 years of age. Lifelong renewal is offered under our policies.

If your child is between 3 months and 5 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 21 years of age, you can choose between continuing the family floater policy or taking a separate policy for the child.

The minimum amount of sum insured is Rs. 2 lakhs and the maximum amount is Rs. 5 lakhs.

Normally, mediclaim policies covers expenses related to treatment and hospitalization, but do not offer protection for other unbillable expenses. Our range of products will provide you with 360 degree protection for hospital bills and incidental expenses and also offers lumpsum compensation, in case of major illness or accidental injury, to take care of loan repayments and other liabilities. Our comprehensive health cover, Smart Health insurance Policy provides cashless facility in over 3500 hospitals and also provides 11 different value-added benefits including a separate and additional Sum Insured on diagnosis of 20 critical illnesses, hospital cash allowance, recovery grant, nursing allowance etc.  In case you already have a health insurance cover, you can also opt to take a Smart Health Critical Illness policy or Smart Individual Personal Accident Policy on a stand alone basis.

What’s more, we help you pick the cover that’s best suited for your needs based on the information provided by you on your lifestyle .Through our comprehensive solutions, you can be rest assured that your medical expenses are covered and your lifestyle is also protected.

For comprehensive insurance protection, we would recommend that you should have both Health and Personal Accident policies which will ensure that you are covered both for hospitalisation expenses as well as providing a lumpsum benefit in the event of accidental death or permanent disablement.

Cashless claims facility is available in our network of tied-up hospital where we settle claims directly with the hospital / nursing home without you having to pay any amount to the hospital. In the case of pre-planned hospitalization, if the chosen hospital is included in our network of cashless hospitals, all that you would need to do is to send us a claim form along with certification from the doctor about the nature of illness and treatment. Once our Third Party Administrator receives the information, and if the claim is admissible, the TPA sends you a pre-authorization, in a matter of few hours, for the cashless claim. We have an extensive network of more than 3,900 network hospitals all over India where you can avail this facility.

The major exclusions under this Policy are:

• Pre-existing diseases / illness / injury / conditions. Benefits will not be available for any condition(s) as defined in the policy, until 48 months of continuous coverage have elapsed, since inception of the first policy with the Company
• Personal exclusions if any mentioned in respect of any one or more specific insured persons covered. It is understood that provisions of this exclusion shall not be applicable in case policy is renewed with the company for a continuous period of 48 months.
• Any benefit under Critical illness within 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 this Policy. This exclusion doesn't apply for subsequent renewals with the Company without a break.
• Treatment of 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, 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 and Joint Replacement surgeries unless necessitated by accident during the first two years of the operation of the Policy. However, 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, issue of medical certificates and examinations as to suitability for employment or travel.
• Vitamins and tonics unless forming part of treatment for 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 hospitalised
• 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.

For a list of all the exclusions under the policy, please refer to policy wordings.

We will send you a Health Card along with the policy schedule and 80D certificate, once you take your policy with us. This card can be produced at the time of admission into a hospital for using the cashless facility. The health card provides the contact details of the TPA. In case of a medical emergency, you can call Paramount Health Services at 1800-22-6655 or Emeditek Solutions at 1800-102-3242 for queries, clarifications and for seeking any kind of assistance. You would need to provide your health card at the time of admission into the hospital.

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

Your hospitalization expenses are covered only if you have been hospitalized for a minimum period of 24 hours. However, certain day care treatments, which do not require 24 hour hospitalization, are also covered under our Health Insurance policy. The treatments included are

• Dialysis
• Chemotherapy
• Radiotherapy
• Eye surgery
• Dental surgery
• Lithotripsy (kidney stone removal)
• Tonsillectomy
• Dilatation & Curettage
• Cardiac Catherization
• Hydrocele surgery
• Herniarepair surgery

Surgeries/procedures that require less than 24 hours hospitalisation due to advancement in technology.

The critical illness cover takes care of expenses incurred for treatment of any of the 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 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.
The following critical illnesses are covered under the Smart Health Insurance POlicy

• Cancer
• First Heart Attack
• Coronary Artery Disease
• Coronary Artery Bypass surgery
• Heart Valve Surgery
• Surgery to Aorta
• Stroke
• Kidney Failure
• Aplastic Anaemia
• End Stage Lung Disease
• End Stage Liver Failure
• Coma
• Major Burns
• Major Organ/Bone Marrow Transplantation
• Multiple Sclerosis
• Fulminant Hepatitis
• Motor Neurone Disease
• Primary Pulmonary Hypertension
• Terminal Illness
• Bacterial Meningitis

In case of Emergency Hospitalization in Network Hospitals:

• Patient takes admission in hospital by showing Health ID card
• Cashless claim request form to be filled by the hospital and faxed to TPA at the fax number given in the form or submitted to insurance help desk at the hospital
• TPA will review the claim
• TPA will inform the insured and the hospital with the status via SMS/email notification/fax usually within 6 hours of submission of request
• TPA will approve only the medical expenses covered under the policy. Expenses not covered by the policy are to be borne by the insured
• The hospital bill will be settled by Bharti AXA General Insurance directly.