Health insurance covers you and your family against expenses that you may incur on hospitalization as an in-patient in a hospital or nursing home in India for treatment. With the rising incidence of diseases including life-style related ailments and cost of treatment, any incident of hospitalization can mean substantial financial outgo for you and your family. Health insurance allows you to plan for such events without feeling the financial burden of treatment. It also allows tax saving since the premium that you pay on your health insurance policy is eligible for tax deduction up to Rs.15000 under Section 80 D of the Income Tax Act.
Health Insurance - FAQ
The chief benefits offered under Bharti AXA GI’s health policy are the following:
- Hospitalisation Expenses including hospital charges (room & boarding and operation theatre), fees of surgeon, anesthetist, nurses, specialists, the cost of diagnostic tests, medicines, blood, oxygen, appliances like pacemaker, artificial limbs and organs, etc.
- Domiciliary Hospitalisation covers payment of expenses towards medical treatment for a period exceeding three days for disease, illness or injury, which in the normal course, would require hospitalization, but is actually taken at home in India.
- Day Care Treatment wherein 24 hours hospitalization is not required, due to advanced technological treatments/procedures being available
- Pre and Post Hospitalisation expenses covers relevant medical expenses for a specified period incurred before & after hospitalisation for disease / illness / injury sustained and considered a part of a claim admissible under the Policy.
- Pre-existing diseases are covered from the 5th year onwards, after four years of continuous coverage with us.
- Critical Illness where a separate and additional Sum Insured is available, exclusively for treatment of defined critical illnesses. We cover a total 20 critical illnesses. The customer has the choice of opting for coverage either on reimbursement basis or on lumpsum benefit basis.
In addition to the above, our policy offers a host of value-added benefits such as:
- Hospital Cash Allowance
- Home Nursing
- Ambulance Charges
- In-patient Physiotherapy Charges
- Recovery Grant
- Accompanying Person's Expenses
- Parent Accommodation as Companion for Child
- Out-patient Dental Emergency Treatment arising out of accidents.
- Out-patient Emergency treatment for accidents
- Children Education Fund
- Transportation of Mortal Remains
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.
The premium payable on your policy is based on the following factors:
- 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)
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.
A family floater policy covers all family members (Insured, his/her spouse and two dependent children upto 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.
e.g.: Mr. Sharma, his wife and his two children are covered under a traditional individual health insurance plan - Mr. Sharma has Rs. 2 lac, his wife Rs. 1 lac, their son and daughter Rs.50,000 each and they have paid premium for all these 4 policies. In an unforeseen situation, wherein surgery and post hospitalisation bill of their son amounts to Rs. 1.30 lac. The existing policy will cover only Rs. 50,000, while Mr. Sharma will have to bear the balance Rs. 80,000 from his pocket.
Suppose Mr. Sharma chooses to instead take a Smart Health Insurance Policy for Rs. 34 lac.
This Family Floater will cover entire Rs. 1.30 lac medical expenses of Mr. Prakash's son
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.
We cover self, spouse and two dependent children below the age of twenty one years under one policy.
The minimum amount of sum insured is Rs. 2 lakhs and the maximum amount is Rs. 5 lakhs.
Medical emergencies can severely impact your existing lifestyle due to large and unexpected financial outlays. A prolonged hospitalization will result in hefty medical bills, and with the rising incidence of diseases and cost of treatment, any illness can mean substantial financial outgo for you and your family. In case you suffer from a major illness or injury and are unable to work for a while , it can also affect your financial liabilities such as loan repayments, expenses towards children’s education and household expenses, among others.
Our lifestyle protection solution consisting of health and personal accident 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 all such expenses and liabilities.
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.
You can choose from a wide arrange of our products -
• Smart Health Insurance Policy (Optimum Plans)
This product offers comprehensive health coverage with 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.
• Smart Health Insurance Policy (Basic and Premium Plans)
If you wish to take a basic hospitalization cover, the basic and premium plans under smart health insurance policy are your best bet. These plans provide coverage for hospitalization expenses with cashless facility in over 3500 hospitals. With the basic and premium plans, you can get your medical expenses covered at an affordable price.
• Smart Health Critical Illness Insurance Policy:
In case you already have an existing health cover, it is imperative that you get yourself adequately protected when there is a major illness. If a major illness occurs, you may not be able to return to work immediately and it may affect your income which in turn would impact your ability to meet your financial liabilities such as loan repayments, fees towards your children’s education, expenses towards provisions etc. Our critical illness policy provides lumpsum compensation on diagnosis of any of the 20 covered critical illness (subject to survival and waiting period applicable), which can be used to cover your medical expenses as well as other incidental expenses. Even if you do not have a basic hospitalization policy, you can still opt for a stand-alone critical illness policy.
• Smart Health Essential Insurance Policy (Hospital Cash)
Our smart health essential insurance policy provides daily allowance in case of hospitalization – This can help you cover incidental expenses which is otherwise not part of hospital bills – It can complement and supplement your policy.
• Smart Individual Personal Accident Insurance Policy
Our smart individual personal accident insurance policy provides exhaustive coverage against accidental injury with value added benefits and 6 different plan variants. We offer the only PA product in the market to offer ‘double compensation’ feature if travelling in public transport and 150% compensation for permanent total disability.
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.
Pre and post hospitalization means the medical expenses incurred during a period before & after hospitalisation for any disease / illness / injury sustained which is covered under your Policy. The period before and after hospitalization that is covered depends on the type of plan opted for. We have three different plans to choose from – Basic, Premium and Optimum. Depending on the type of plan you opt for, pre and post hospitalization expenses are covered for periods as mentioned below:
|Pre Hospitalisation||Post Hospitalisation|
|Basic||up to 30 days||up to 60 days|
|Premium||up to 45 days||up to 60 days|
|Optimum||up to 60 days||up to 90 days|
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 premium paid on a health insurance policy is eligible for deduction under section 80D of the Income Tax Act. The amount of deduction available is up to Rs.15000.
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 issue policies for duration of 1 year and can be renewed subsequently.
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.
Our third party administrators are:
- E-meditek solutions for any claims in North and East Zones.
- Paramount Health Services for any claims in South and West Zones.
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.
No, the health insurance policy is meant to cover hospitalization only in India
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
- Eye surgery
- Dental surgery
- Lithotripsy (kidney stone removal)
- Dilatation & Curettage
- Cardiac Catherization
- Hydrocele surgery
- Herniarepair surgery
Surgeries/procedures that require less than 24 hours hospitalisation due to advancement in technology.
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/she cannot be moved to Hospital/Nursing Home, or the patient cannot be admitted to Hospital/Nursing Home for lack of accommodation. In such cases, we cover the cost of the treatment as well as expenses, if any, on 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 once the treatment exceeds 3 days and it has to be applied for at the time of taking the policy.
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
- First Heart Attack
- Coronary Artery Disease
- Coronary Artery Bypass surgery
- Heart Valve Surgery
- Surgery to Aorta
- Kidney Failure
- Aplastic Anaemia
- End Stage Lung Disease
- End Stage Liver Failure
- Major Burns
- Major Organ/Bone Marrow Transplantation
- Multiple Sclerosis
- Fulminant Hepatitis
- Motor Neurone Disease
- Primary Pulmonary Hypertension
- Terminal Illness
- Bacterial Meningitis
Bharti AXA General Insurance offers both Cashless services and Non Cashless (reimbursement) facilities for its customers. You can find our empanelled list of cashless hospitals where claims are managed by Third Party Administrators (TPAs) to offer claims service during hospitalization. To service your claims, reach out to the TPAs in your zone:
- Paramount Health Services: For locations of- Andhra Pradesh, Karnataka, Kerala, Tamil Nadu, Gujarat, Maharashtra, Goa, Madhya Pradesh, Dadra and Nagar Haveli, Daman and Diu, Pondicherry, Andaman and Nicobar Islands and Lakshadweep. Toll free no. – 1800-22-6655
- Emeditek Solutions: For locations of- Jammu & Kashmir, Himachal Pradesh, Punjab, Haryana, Uttar Pradesh, Bihar, West Bengal, Assam, Arunachal Pradesh, Nagaland, Manipur, Mizoram, Meghalaya, Orissa, Tripura, Jharkhand, Sikkim, Delhi, Chandigarh, Uttarakhand, Rajasthan and Chhattisgarh. Toll free no. – 1800-102-3242
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.
- Insured gets admitted to the hospital
- Takes treatment and pays hospital bills. Gets back all original documents from the hospital
- Submits all original and necessary documents to the TPA along with duly filled
- TPA will review the documents and effect payment within 21 days of receiving the complete documents. If the claim is
- rejected, a letter will be sent along with the reasons of rejection