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Bharti AXA Smart Health Optimum Plan

Bharti AXA Smart Health Optimum Plan is a health plan which also has an inbuilt critical illness benefit paying an additional Sum Insured on diagnosis of any covered illness. The plan also provides other coverage features and comes at a competitive rate of premium.

Key features of the plan

  • 20 critical illnesses are covered under the plan.
  • Physiotherapy charges, OPD expenses, mortal remains, etc. are also covered under the plan.
  • The plan can be taken on an individual basis or on a family floater basis. A maximum of 2 adults and 2 children can be covered under family floater variant.
  • Tax benefits can be availed on the premium paid for the plan under Section 80D.

How does the plan work?

Step 1 – the policyholder chooses the Sum Insured and the members covered.

Step 2 – If the covered member (s) face any medical contingency and the related expenses are covered by the plan the expenses incurred are paid by the plan.

Step 3 – if the plan matures and no medical contingencies occur, no benefit is paid.

Example

Rohit bought a plan with a Sum Insured of Rs.5 lakhs covering himself and his wife.

Option 1 – His wife suffers from a covered critical illness. The plan pays the Sum Insured of Rs.5 lakhs for the illness suffered.

Option 2 – Rohit suffers hospitalization for appendicitis and the hospital bills amount to Rs.50, 000. The policy would pay for the expense as it is covered under the plan.

Option 3 – if the plan matures and Rohit or his wife doesn’t suffer any medical emergency, no benefit is paid.

Plan benefits

  • Medical benefits – the list of medical expenses covered by the plan and their extent is as follows:
  • Coverages Sum Insured Rs.3 lakhs Sum Insured Rs.4 lakhs Sum Insured Rs.5 lakhs
    Room rent, Boarding expenses, nursing charges 100% of Sum Insured 100% of Sum Insured 100% of Sum Insured
    In-patient hospitalization Normal hospitalization – Rs.3000/day
    ICU/CCU hospitalization – Rs.4500/day
    100% of Sum Insured 100% of Sum Insured
    Day care treatments Covered Covered Covered
    Pre-hospitalization 60 days 60 days 60 days
    Post hospitalization 90 days 90 days 90 days
    Domiciliary hospitalization Up to 10% of Sum Insured Up to 10% of Sum Insured Up to 10% of Sum Insured
    Hospital Cash Allowance Rs.700/day up to 30 days if hospitalization exceeds 3 days Rs.1000/day up to 30 days if hospitalization exceeds 3 days Rs.1000/day up to 30 days if hospitalization exceeds 3 days
    Home nursing Rs.500/day up to 10 days if hospitalization exceeds 3 days Rs.500/day up to 10 days if hospitalization exceeds 3 days Rs.500/day up to 10 days if hospitalization exceeds 3 days
    Second opinion for critical illness 100% of Sum Insured 100% of Sum Insured 100% of Sum Insured
    Critical illness benefit An additional 100% of Sum Insured is paid on diagnosis of any one of the 20 covered illnesses An additional 100% of Sum Insured is paid on diagnosis of any one of the 20 covered illnesses An additional 100% of Sum Insured is paid on diagnosis of any one of the 20 covered illnesses
    Ambulance cover Up to Rs.2500 Up to Rs.2500 Up to Rs.2500
    In-patient physiotherapy Up to 2% of Sum Insured Up to 2% of Sum Insured Up to 2% of Sum Insured
    Recovery Grant Rs.12,500 Rs.12,500 Rs.12,500
    Expenses on accompanying another person Rs.250/day up to 10 days if hospitalization exceeds 3 days Rs.250/day up to 10 days if hospitalization exceeds 3 days Rs.250/day up to 10 days if hospitalization exceeds 3 days
    Parent’s accommodation for accompanying a minor child Rs.250/day up to 30 days if hospitalization exceeds 3 days Rs.250/day up to 30 days if hospitalization exceeds 3 days Rs.250/day up to 30 days if hospitalization exceeds 3 days
    Outpatient dental treatments for accidental injury 1% of Sum Insured 1% of Sum Insured 1% of Sum Insured
    Mortal remains 1% of Sum Insured 1% of Sum Insured 1% of Sum Insured
    Children Education Fund 1% of Sum Insured 1% of Sum Insured 1% of Sum Insured
    Health check-ups Once every 4 years up to 1% of Sum Insured Once every 4 years up to 1% of Sum Insured Once every 4 years up to 1% of Sum Insured
  • No Claim Bonus – if the policyholder does not make a claim in any policy year he earns a premium discount of 5% in the renewal premium. The discount increases every year up to a maximum of 25%.

Eligibility Criteria

  Minimum Maximum
Age at entry (in completed years) Children - 3 months
Adults – 18 years
Adults - 65 years
Dependent children – 23 years
Plan tenure 1 year  
Premium paying options Single pay  
Sum Assured Rs.3 lakhs Rs.55 lakhs

What is not covered by the plan?

Illnesses suffered during the first 30 days of the plan commencement are not covered.

Critical Illnesses suffered during the first 90 days of the plan commencement are not covered.

Pre-existing illnesses or conditions are not covered by the plan in the first 4 years of the policy

Specific illnesses are not covered in the first two years of the plan.

Illnesses or accidents caused due to genetic disorder or stem cell surgery, substance abuse, participation in adventure sports or hazardous activities, criminal acts, attempted suicide, war and hazardous substances, etc. are not covered.

Treatments like dental treatments, cosmetic treatments, artificial life support, weight loss treatments, non-allopathic treatments or due to HIV/AIDS, etc. are not covered.

FAQs