Max Bupa Health Companion Plan

Max Bupa Health Companion is a health insurance plan which comes in two variants of individual plan and family floater plan. Moreover, the family floater variant is further sub-divided into two sections. One section covers your immediate family while the other covers even your extended family under the plan. The coverage features are comprehensive and the premium rates are affordable.

Key features of the plan

• The family floater variant of the plan has two options. One is the simple family floater option which covers a maximum of 6 individuals. The other is a Family First option wherein 19 relations can be covered under the plan.
• The Family First variant offers Sum Insured individually for each member as well on a floater basis.
• The plan has a Smart Top-up option wherein the policyholder can choose to enhance the Sum Insured through a top-up plan. The top-up plan would have a deductible. Claims exceeding the deductible would be paid in any policy year.
• The plan allows an optimal level of coverage where the Sum Insured allowed is up to Rs.1 crore.
• There is a provision of an additional Sum Insured if your Sum Insured is exhausted in any policy year under the Refill benefit of the plan.

How does the plan work?

Step 1 – the policyholder chooses the Sum Assured, the plan variant, the term of the plan 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

Vinit, aged 35 years, buys a family floater plan covering himself, his wife and two children. He chooses a Sum Insured of Rs.5 lakhs and a top-up of Rs.5 lakhs with a deductible of Rs.2 lakhs.

Option 1 – Vinit’s wife is hospitalized and the claim incurred is Rs.4.5 lakhs. Since the claim is within the Sum Insured, the claim is paid in full

Option 2 – Vinit faces a further hospitalization in the same year and the bill comes to Rs.3.5 lakhs. In his health plan there is only a cover of Rs.1 lakh left which would be paid by the plan. Under the top-up option, since the deductible of Rs.2 lakhs is crossed, the remaining Rs.1.5 lakhs is paid by the top-up plan.

Option 3 – if the plan matures and Vinit 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.2,3,4 lakhs	Sum Insured Rs.5,7.5,10,12.5 lakhs	Sum Insured Rs.15,20,30,50,100 lakhs	Family First. Individual Sum Insured of Rs.1-10 lakhs Family floater Sum Insured of Rs.3-20 lakhs
In-patient hospitalization	Covered	Covered	Covered	Covered
Day care treatments	Covered	Covered	Covered	Covered
Pre-hospitalization	30 days	30 days	30 days	30 days
Post hospitalization	60 days	60 days	60 days	60 days
Domiciliary hospitalization	Covered	Covered	Covered	Covered
Organ Donor expenses	Up to Rs.2500	Covered	Covered	Covered
AYUSH Coverage	Covered	Covered	Covered	Covered
Maternity benefit	Up to Rs.40,000	Up to Rs.60,000	Up to Rs.70,000	Up to Rs.75,000
New born baby cover	Covered up to Sum Insured	Covered up to Sum Insured	Covered up to Sum Insured	Covered up to Sum Insured
Vaccination for animal bite	Up to Rs.2500	Up to Rs.5000	Up to Rs.7500	Up to Rs.5000
Ambulance cover	Up to Rs.3000	Up to Rs.3000	Up to Rs.3000	Up to Rs.3000
Refill benefit	Up to Sum Insured	Up to Sum Insured	Up to Sum Insured	Not available
Hospital Cash	Rs.1000/day	Rs.2000/day	Rs.4000/day	Rs.1000/day or Rs.2000/day
Health check-ups	Once in 2 policy years	Annually	Annually	Annually

• No Claim Bonus – if the policyholder does not make a claim in any policy year he earns a cumulative bonus of 20% increase in the Sun Insured subject to a maximum of 100% for family floater and individual plans
• Premium discounts – premium is discounted by 12.5% if a 2-year policy term is chosen. This discount is given in the second year’s premium.
• Optional benefits – hospital cash benefit is optional and can be chosen by paying an additional premium.

Eligibility Criteria

What is not covered by the plan?

Illnesses suffered during the first 30 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 if the Sum Insured is up to Rs.4 lakhs. If the Sum Insured is above Rs.4 lakhs, the waiting period for pre-existing illnesses is reduced to 3 years.

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

Premium Illustration

Below is the sample rates of premium payable by a non-smoking male living in Mumbai for different combinations of age, plan variants and members covered. The Sum Insured is Rs.10 lakhs and the policy is taken for 1 year. Under family first option, the Sum Insured is taken on a floater basis.