Bharti AXA Smart Health Insurance Plan: Coverage, Claim Process & Eligibility

Updated: 07-02-2019 07:10:14 AM

 

Living in a high- risk environment all the time, it makes perfect sense to get ourselves insured for that financial shock that may drop anytime. But most of us stop at life insurances while health insurance is just as important. Medical costs are always on the shoot and getting a health plan will only make your stance stronger in monetary terms with something like Bharti AXA Smart Health Insurance Plan.

What is Bharti AXA Smart Health Insurance Plan?

Bharti AXA offers a range of health insurance policies with attractive coverage and added benefits to take care of the policyholder and his/her family’s health care requirements. Its Smart Health Insurance Plan is available in three variants viz. Basic, Premium, and Optimum.

Eligibility Criteria

Particulars	Details
Entry Age	Min: 18 years Max: No limits
Age of children covered (Provided either of the parents is covered)	Min: 91 days Max: 5 years
Policy Tenure	1 year/ 2 years
Sum Assured	Rs. 2 lakhs to Rs. 5 lakhs
Maximum Members	4

 

What all Bharti AXA Smart Health Insurance Plan covers?

• Expenses incurred while availing any daycare procedures provided the patient is hospitalized for less than 24 hours
• Inbuilt Critical Illness Cover
• Pre-hospitalization expenses for consultation, medication, etc. for up to 30-40 days
• Post-hospitalization expenses for consultation, medication, etc. for up to 60 days
• Organ transplantation charges
• Home nursing
• Covers critical illnesses like cancer, heart attack (first), kidney failure, bypass surgery, etc.
• Cashless hospitalization facility provided with over 4300 hospitals across India

Claim Process of Bharti AXA Smart Health Insurance Plan

At the time of hospitalization in the network of 4000+ hospitals spread across the country, you can ask the network hospital to fill the cashless claim form. The insurance company will settle the claims with the hospital, and you can leave the hospital without paying a penny. You can also choose to get reimbursement of the expenses incurred during the treatment.

• Cashless Claim
  • This facility is only available if you avail treatment in any of the network hospitals of Bharti AXA.
  • The insured individual needs to provide the network hospital with the policy details and ask them to fill up the cashless claim form. If the treatment is predetermined, the insurance company needs to be intimated about the same 4 days prior to the bill payment.
  • This form has to be submitted to the insurance helpdesk in the network hospital.
  • After the completion of the procedure, the insurance company will directly settle the bill with the hospital.
• Reimbursement Claim
  • The prerequisite to avail this facility is that Bharti AXA should be intimated about the hospitalization within 48 hours of the admission.
  • The insured needs to pay the bills to the hospital and get all the original documents for the same.
  • You need to submit the documents required for the reimbursement. Once Bharti AXA receives and verifies all the required documents, the total amount spent will be reimbursed within 21 days of the request.
• Documents Required to Claim for Reimbursement with Bharti AX
  • Duly filled claim form.
  • First prescription
  • Copy of police file in case of accidental injury.
  • Certificate from the treating doctor.
  • Doctor advising for hospitalization
  • Medical fitness certificate
  • Medical bills
  • Test reports
  • Copy of all the medical documents and the discharge documents.
  • The Policyholder’s identity proof and age proof of the assured life.

Cases where you can’t claim Bharti AXA Smart Health Insurance Plan

The Smart Health Insurance Plan from Bharti AXA will not cover any treatments induced due to the following conditions:

• Consumption of drug or alcohol
• Congenital diseases
• AIDS
• Suicide attempt
• Circumcision unless necessary for treatment of a disease
• Hospitalization due to war or warlike situation
• Birth control procedures, hormone replacement therapy
• Pre-existing conditions for the first four policy years. Dental treatment or surgery of any kind unless requiring hospitalization

How long does it take to settle claims?

The claim settlement time taken by Bharti AXA is dependent on the submission of the required documents for the same. If you submit all the necessary documents for the claim, upon verification, your claim will be settled within 7 working days from the date of last document submission.

Advantages of buying Bharti AXA Smart Health Insurance Plan

• A free-look period of 15 days is provided in which the policyholder, if unsatisfied, can choose to return the policy within the 15 days
• Domiciliary hospitalization is covered under this policy
• Emergency ambulance service expenses are covered up to a certain limit for each hospitalization
• You can avail a complimentary health check up to 1% of the sum insured after every four claim free policy years
• The expenses of the accompanying person are compensated up to the minimum sum insured of the previous policy year
• You can avail daily cash allowance with Bharti AXA Smart Health Insurance Plan based on the coverage you have opted for
• Bharti AXA Smart Health Insurance Plan tax benefits include deductions in the premium paid as per Section 80(D) of the Indian Income Tax Act
• If you wish to switch your health insurance plan from other providers to Bharti AXA, you can do that without losing your sum accrued in the previous plan
• Renewal Discount of 5% (up to 25% ) as No -Claim bonus

Important Aspects

• Choose the required amount, i.e. the sum insured for your health insurance plan
• Also make sure the plan has a lifetime renewability facility for ease of use
• Look for benefits like top-up facility, discounts, bonuses, etc. from your health insurance plan
• Check for the waiting period applicable for your health insurance plan to avoid claim rejection in the future
• Make sure to check the applicable sub-limits for the health insurance plan you wish to purchase

FAQs

Q1. Will my hospitalization expenses be covered if I am hospitalized outside India?

No. If you are hospitalized outside the Indian boundaries, no covers will be applicable as per the terms and conditions of Bharti AXA Health Insurance policies.

Q2. Can I cancel my policy if I have made claim but it has been just 10 days from the date of commencement of the policy?

No. As per the terms and conditions of the policy, you can cancel the policy within 15 days only if there have been no claims made. Therefore, in your case, your cancellation options ceases to exist.