Max Bupa Criticare- Types, Eligibility & Exclusions

To ensure that pains don’t take up too much of our financial strength we buy insurance to help us gain protection against risks. Critical illness means all the disease which may have fatal consequences to an individual. To acquire protection against such conditions, Max Bupa Insurance provides Max Bupa Criticare. This policy helps in preparing an individual to face critical illness head-on.

Types of Max Bupa Criticare

The Max Bupa Criticare health insurance plan is provided to the policyholders under two options

• Benefit Option-1=Sum insured payable as a lump sum
• Benefit Option-2=Sum insured payable as a lump sum with an additional 10% of sum insured amount which is payable annually for the subsequent period of five years.

Eligibility Criteria

Parameters	Details
Entry Age	Min: 18 years Max: 65 Years
Sum Insured	Rs 3 lacs to Rs 2 crores.
Policy Tenure	1 year and opting for a 2-3 year tenure is supported under this policy
Policy Renewal Period	Lifelong Renewal Possible
Individuals that can be covered under this Policy	Provides two adult family options

Features

Features	Particulars
Claim Type [In house or TPA]	Direct Claim Settlement is provided under this claim.
Pre-Hospitalization	Provided with respect to sum insured for a period of 30 days
Network Hospitals Count	4000+
Post-Hospitalization	Provided with respect to sum insured for a period of 90 days
Room Eligibility	Subject to sum insured
Worldwide Coverage	No
Maternity Cover	No
Hospitalization at Home	No
Day-Care Treatment	No
Non-Allopathic Treatment Charge	No

Points to consider before buying a plan

1. Lifetime Renewal

It is advised to choose a policy which offers Lifetime Renewal as an individual’s health tends to deteriorate more when they get older. Thus Lifetime Renewal is beneficial in that aspect.

2. Claim Process

Claim process needs to be considered before buying an insurance policy. The simpler the claim process, the more it will benefit the policyholder. Also, the claim procedure should be hassle-free so as to avoid any mistakes or frauds. Even the brochure, prospectus and policy clause needs to be referred so as to know which documents will be required.

3. Offers

Before buying an insurance plan, it is recommended that you go through the brochures, prospectus along with the prospectus form to see if any offers are available. There exist several offers on the policy tenure options and the way one buys an insurance policy.

4. Network Hospitals

One should check the network and non-network hospitals available under the respective policy before buying an insurance plan. This will help the insured know about the hospitals which provide cashless basis or remuneration basis.

5. Waiting Periods

The policyholder should check the respective waiting periods before purchasing an insurance plan. It is favorable to buy the policy in youth as there exist fewer chances of filing a claim and the waiting periods can be covered easily.

6. Medical Check-ups

The policyholder should consider medical check-ups before buying an insurance plan. They should check the relevant terms and conditions associated with the medical check-up involved in the policy. The insured should also check whether the policy supports free medical check-ups.

Filing claims with Max Bupa Criticare

The Claim procedure under this particular Insurance plan is as follows:

1. For Cashless Basis

• The first step is to get admitted into a hospital. Check which hospitals are network and which are non-network on maxbupa.com.
• Use your Max Bupa Health card or share details such as policy number, passport details, and voter id details.
• Identification needs to be done by submitting the pre-authorisation request form. It will be validated at the network hospital.
• The verification process will be conveyed by the network hospital via fax or e-mail. Text message and E-mail will also be conveyed within a span of 30 minutes.
• As per policy terms, the claims will be settled with the adequate formalities.

2. For Remuneration basis

• In the case of hospitalization, inform the Insurance Company within a period of 48 hours of admission in the non-network hospitals.
• After getting admitted, the payment needs to be made directly to the hospital themselves.
• On discharge collect all the documents, invoices and medical reports which are needed in the claim filing.
• Send the respective documents along with the filled claim form and a valid id proof.
• The insurance company will review your respective documents for the claim procedure.
• As per the policy terms, the claim will be settled along with the formalities.

Documents Required

The documents that need to be submitted under Max Bupa Criticare health insurance plan are as follows:

• Claim form which is duly filled and signed.
• All the respective KYC documents.
• The original hospital discharge summary [final] or all the self-attested copy [if the originals are already submitted with the insurer respectively].
• The original final hospital bill or the self-attested copy [[if the originals are already submitted with the insurer respectively].
• All the consultation notes issued
• Investigation reports from outside the hospital  before hospitalization.
• The first consultation note along with the medical records since the onset of complaint.
• Copy of FIR/ Panchnama Duty attested in the respective police station [ for claims with respect to critical illness due to accidents]
• The copy of the medico-legal certificate duly attested to the concerned hospital.

Exclusions under Max Bupa Criticare

• AIDS and HIV are excluded under this policy.
• All attempts of suicide or any intentional self-injuries by the policyholder are excluded.
• In a scenario of failure to seek or follow the medical advice.
• Breach of law
• Any activities which the insured participates under criminal intent are also excluded under this policy.
• Nuclear contamination is also excluded under this policy.
• All involvement in hazardous activities or sports is excluded under this policy.
• Participation in aviation/marine activities other than as a crew and fare passenger is excluded under this policy.
• Involvement in Narcotics unless medically prescribed
• All acts of the foreign enemy are excluded under this policy.
• Involvement in civil wars, riots or strikes is excluded under this policy.

How long does the claim procedure take place?

The claim procedure will take the time as per the terms and conditions in the policy clause along with the formalities associated with it.

Advantages of Max Bupa Criticare

• This policy covers 20 critical care illnesses such as Cancer of specified severity, Loss of speech, Deafness, Open Chest CABG, Kidney failure which may require regular dialysis, End Stage Lung as well as Liver diseases, Major burns, First heart attack with respect to specified severity, Open Heart replacement/Repairing the heart values, Stroke associated with symptoms of permanent nature, Limb permanent paralysis, Transplant associated with bone marrow or major organ. Motor Neurone disease with permanent symptoms, Muscular dystrophy, Aplastic Anaemia, Bacterial Meningitis, Fulminant viral hepatitis and Multiple Sclerosis with persisting symptoms.
• Benefits won’t be available for pre-existing diseases until 48 months of continuous coverage has been elapsed since the commencement of the respective policy.
• Discounts are available if the policy tenure is selected for a period of 2-3 years.

Also Read: Max Bupa GoActive Family Floater- Types, Features & Exclusions

FAQs

Q1. Is there a free-look period provided under this respective Criticare health insurance plan?

Under this policy, free-look period [15 days] is provided under Max Bupa Criticare health insurance plan.

Q2. Is the policy subject to tax benefits?

Yes, the respective policy is subject to income tax benefits under section 80D of The Income Tax Act, 1961.

Q3. How can a policyholder buy this CritiCare health insurance plan?

There are various ways of buying this plan. The policyholder can buy this plan online, by a visit to the nearest branch office or by telephone communication.

Q4. Is it mandatory to do a pre-medical test screening before availing this policy?

A pre-medical test screening is only required at the time of joining a policy. It is not subject to renewals.

Q5. What is the respective premium calculated on?

The premium is calculated on your age and the city of residence and not on the claim history of the insured.

Also Read: Max Bupa Health Insurance Premium Calculator

Q6. Are there any Third Party Associations [TPAs] for settling the claims under this particular insurance policy?

No, there exists no TPAs under Max Bupa Insurance. All our claim settlements are done via direct claim settlement.