Max Bupa GoActive™ Family Floater- Types, Features & Exclusions

Published: 23-01-2019 07:33:17 AM

The Max Bupa GoActive™ Family Floater plan is a health insurance policy for the everyday health requirements of the people. This comprehensive health insurance policy ensures protection for you as well as your entire family. This plan allows you to choose the perfect health cover as per your requirement, choose the benefits of the plan, as well as awards you for staying healthy. Moreover, this is a pocket-friendly health insurance plan that can include your spouse as well as your children (up to 4). In fact, some family health insurance policies also allow you to add your parents as well as parents-in-law in your family floater plan.

Types of Family Floater Plans

In India, there are two types of family floater plans, they are:

(a) Medical Insurance

The medical insurance covers the expenses incurred for the treatment of any diseases/ illnesses/ injuries that are defined under the terms and conditions of the policy. If you meet the eligibility criteria of the insurance company to make a claim, you can avail cashless treatment in the network hospitals, or you can claim for reimbursements from the insurer for the expenses incurred.

(b) Critical Illness Insurance

The insurance holder is financially protected against critical illnesses under this family health insurance policy. The insurance company provides the insurance money in a lump sum for the insured suffering from the critical illness defined in the policy terms and conditions. Many insurers also offer this as a cover that can be purchased in addition to the base health insurance policy so as to enhance the coverage. However, this plan cannot be purchased for multiple members of the family, and each member needs an individual critical illness cover to avail the benefits of the plan.

Eligibility Criteria

Parameters	Details
Entry Age	Min: 18 years Max: 65 years
Entry Age for Children in Family Floater Plan	Min: 3 months Max: 21 years
Policy Tenure	1 year
Sum Assured	Rs. 4 lakhs to Rs. 25 lakhs
Maximum Permitted Members	6 members including 2 adults and 4 children
Policy Renewal	Lifetime renewal

Features of the Max Bupa GoActive™ Family Floater

1. The expenses of inpatient hospitalization including OPD are covered.
2. The expenses of hospital accommodation are covered up to the sum insured. However, the charges of the hospital rooms that are of premium quality will not be covered.
3. The pre-hospitalization and post-hospitalization expenses for 90 days and 180 days respectively are covered under the Max Bupa GoActive™ Family Floater Plan. However, this facility will be available only if the claim for the insured is validated and accepted by the insurance company.
4. Daycare treatments are covered.
5. Domiciliary treatments are covered, provided the treatment is soon after the hospitalization of the insured and is accepted by the insurance company. You need to make sure whether this facility is available in your city or not. Also, the insured might need to submit medical reports as proof.
6. The organ transplantation expenses are, provided the insured is benefited from an organ transplant.
7. Emergency transportation charges for hospitalization of up to Rs. 3000 are offered under this health insurance plan.
8. You can avail tax deductions under the Indian Income Tax Act for the premiums paid for Max Bupa GoActive™ Family Floater Plan.

Points to Consider before Purchasing the Plan

1. Check the network hospitals of the insurance provider so that you can avail the cashless claim facility.
2. Check whether you have to make any co-payment for the policy.
3. Look for the available discounts and offers provided by the insurer.
4. Check out the availability of pre-hospitalization and post-hospitalization coverage.
5. Verify the claim settlement procedure of the insurance company.
6. Look for the coverage of the plan as per your requirement.

Filing claims with Max Bupa GoActive™ Family Floater

1. In case you are admitted to the network hospital, you need to approach the TPA desk at least 72 hours prior to the treatment.
2. Submit the necessary documents at the TPA desk.
3. The network hospital will verify the documents and contact the insurer for validation.
4. Within four hours of the intimation, the insurer will let the network hospital know the acceptance or rejection of the claim.
5. Upon acceptance of the claim, the bills are settled by the insurer, and you can move out of the hospital without paying money from your pocket up to the sum insured.
6. In case you are admitted to a non-network hospital, you need to pay the charges of the treatment and claim for reimbursement by contacting the insurance provider. You will require to submit the necessary documents as proof for your claim requirement. Upon verification of the documents, your expenses will be reimbursed within a few days.

Documents Required

Policyholders need to have below mentioned documents for filing claim:

1. Duly filled claim form
2. Doctor’s certificate
3. Hospital discharge summary and bills
4. FIR copy if needed
5. Original bills and prescription

Exclusions under Max Bupa GoActive™ Family Floater

Some of the major exclusions under the plan are as follows:

1. Any treatment mode other than Allopathy, Ayurveda, Siddha, Homeopathy, and Unani
2. Congenital diseases
3. Ancillary hospital expenses
4. Oral or dental treatments
5. Intentional injuries
6. Non-medical expenses
7. Maternity expenses
8. Treatment done outside India
9. Suicide attempt
10. Injury due to alcohol or drug intoxication
11. Cosmetic surgeries
12. Sexually transmitted diseases

What is the Time Required for Claim Settlement?

Max Bupa settles the reimbursement claim in a hassle-free manner. The quick procedure adopted by the company assures claim settlement within just 30 days from the initiation of the claim request. However, you got to make sure that the documents submitted for the same are original and valid.

Renewal Process with Max Bupa GoActive™ Family Floater

As this policy is renewable for lifetime, but company has the authority to automatically terminate at the end of the policy period or grace period.  However, the benefits under the policy can be availed even after the completion of the policy period only if the renewal request is made along with the applicable on timely basis.

Surrender of the policy

Policyholders can surrender the policy by providing at least 30 days notice to the company in written format. After this, company will cancel the policy and will refund the premium of the unexpired term.

Advantages of Max Bupa GoActive™ Family Floater

1. Enjoy annual health checkup for all the insured individual under the policy.
2. The health checkup in-network hospitals will be cashless.
3. You can either choose the determined tests for a health checkup or choose the tests as per your convenience up to the sum insured.
4. If your base sum insured is exhausted, you can avail additional sum insured up to the base sum for the following unrelated treatment in the same policy year.
5. You can avail second medical opinion if needed as well as get OPD consultation from the network hospitals.
6. You can get consultation or counseling for marriage, nutrition, stress, parenting, and such over a call from experts.
7. 10% discount is offered on the base sum insured for the first policy year as well as the subsequent policy years if the age of the policyholder will be equal to or below 35 years at the time of policy purchase.
8. With every policy renewal, you can avail 10% addition in the base sum insured. This benefit is optional and can be opted out at any point in time when the policy is active.
9. If you opt for health coaching facility for your insurance, you can avail 20% discount on the premiums at the time of policy renewal.
10. Optional personal accident coverage is offered.
11. Optional annual deductible between Rs. 25 lakhs and Rs. 10 lakhs are available.
12. The company offers direct claim settlement with the dedicated service team.
13. A 15 days free-look period is offered during which you can return the policy provided you haven’t made any claims during the period.

FAQs

Q1. Is there a waiting period to claim for pre-existing conditions under the Max Bupa GoActive™ Family Floater Plan?

Yes. There is a 36 months waiting period from the policy inception wherein you cannot make any claims, or your claim gets rejected.

Q2. Should I need to undergo a medical checkup to avail the Max Bupa GoActive™ Family Floater?

You would need to undergo a medical checkup while purchasing a new health plan. However, you would not require a health checkup for the subsequent policy renewals.

Q3. How can I purchase a health insurance policy from Max Bupa?

You can quickly purchase a health insurance policy from Max Bupa via three mediums, they are online, telephonic, and branch visit. You can apply for the policy online from the website or make direct calls through the number provided. You can also purchase a plan directly by visiting the nearest branch of Max Bupa.