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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.
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.
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.
|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
|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|
|Organ Donor expenses||Up to Rs.2500||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|
|Age at entry (in completed years)||Children – 91 days
Adults – no bar
|Plan tenure||1 year||2 years|
|Premium paying options||Single pay|
|Sum Assured||Rs.1 lakh||Rs.50 lakhs|
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.
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.