Compare Max Bupa Heartbeat Gold Plan

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Max Bupa Heartbeat Gold Plan

Max Bupa Heartbeat Gold is a health insurance plan which covers 19 relations in its family floater variant. The plan provides all necessary coverage features including maternity cover and allows Sum Insured levels up to Rs.50 lakhs. Premium discounts are also allowed and the plan has optional coverage features too which can be taken to enhance the scope of coverage.

Key features of the plan

  • The plan has no sub-limits on room rents.
  • 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.
  • There are no limitations on Day Care Treatments. All treatments are covered by the plan.
  • There is no restriction on the entry age.

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

Vihan, aged 30 years bought an individual Heartbeat Plan for a Sum Insured of Rs.10 lakhs and a policy term of 1 year.

Option 1 – Vihan undergoes tonsillitis treatment which is a day care procedure. Since the plan covers day care procedures, Vihan’s bill of Rs.45, 000 is paid by the plan.

Option 2 – if the plan matures and Vihan 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:
    For Family Floater and Individual Plans
    Coverages Sum Insured Rs.5 lakhs Sum Insured Rs.7.5 lakhs Sum Insured Rs.10 lakhs Sum Insured Rs.15 lakhs Sum Insured Rs.20 lakhs Sum Insured Rs.30 lakhs Sum Insured Rs.50 lakhs
    In-patient hospitalization Covered Covered Covered Covered Covered Covered Covered
    Day care treatments Covered Covered Covered Covered Covered Covered Covered
    Pre-hospitalization 60 days 60 days 60 days 60 days 60 days 60 days 60 days
    Post hospitalization 90 days 90 days 90 days 90 days 90 days 90 days 90 days
    Domiciliary hospitalization Covered Covered Covered Covered Covered Covered Covered
    Organ Donor expenses Covered Covered Covered Covered Covered Covered Covered
    AYUSH Coverage Covered Covered Covered 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 Up to Rs.80,000 Up to Rs.1 lakh Up to Rs.1 lakh
    New born baby cover Covered up to Sum Insured Covered up to Sum Insured Covered up to Sum Insured Covered up to Sum Insured Covered up to Sum Insured Covered up to Sum Insured Covered up to Sum Insured
    Vaccination for newborn baby Covered for 1st year vaccinations Covered for 1st year vaccinations Covered for 1st year vaccinations Covered for 1st year vaccinations Covered for 1st year vaccinations Covered for 1st year vaccinations Covered for 1st year vaccinations
    Ambulance cover Network hospital – up to Sum Insured
    Non-network hospital – Up to Rs.2000
    Network hospital – up to Sum Insured
    Non-network hospital – Up to Rs.2000
    Network hospital – up to Sum Insured
    Non-network hospital – Up to Rs.2000
    Network hospital – up to Sum Insured
    Non-network hospital – Up to Rs.2000
    Network hospital – up to Sum Insured
    Non-network hospital – Up to Rs.2000
    Network hospital – up to Sum Insured
    Non-network hospital – Up to Rs.2000
    Network hospital – up to Sum Insured
    Non-network hospital – Up to Rs.2000
    Hospital Cash Rs.3000/day Rs.3000/day Rs.3000/day Rs.3000/day Rs.3000/day Rs.3000/day Rs.3000/day
    Health check-ups Annually. Up to Rs.1250 per insured member Annually. Up to Rs.1875 per insured member Annually. Up to Rs.2500 per insured member Annually. Up to Rs.2500 per insured member Annually. Up to Rs.2500 per insured member Annually. Up to Rs.2500 per insured member Annually. Up to Rs.2500 per insured member
    For Family First Gold Plan

    Coverages
    Sum Insured Rs.1 lakh to Rs.15 lakhs on individual basis or Rs.3 lakhs to Rs.50 lakhs on floater basis
    In-patient hospitalization Covered
    Day care treatments Covered
    Pre-hospitalization Covered
    Post hospitalization Covered
    Domiciliary hospitalization Covered
    Organ Donor expenses Covered
    AYUSH Coverage Covered
    Maternity benefit Up to Rs.50,000
    New born baby cover Covered up to Sum Insured
    Vaccination for newborn baby Covered for 1st year vaccinations
    Ambulance cover Network hospital – up to Sum Insured
    Non-network hospital – Up to Rs.2000
    Hospital Cash Rs.3000/day
    Health check-ups Annually. Up to Rs.2500 per insured member
  • No Claim Bonus – if the policyholder does not make a claim in any policy year he earns a cumulative bonus of 10% increase in the Sun Insured subject to a maximum of 100% for family floater and individual plans. For Family First plan, the maximum allowable increase in Sum Insured is 50%.
  • 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 Cover – the policyholder can choose a co-payment of 10% or 20% to get further premium discounts.

Eligibility Criteria

  Minimum Maximum
Age at entry (in completed years) Individuals of any age can be covered
Plan tenure 1 year 2 years
Premium paying options Single pay
Sum Assured Rs.1 lakh Rs.50 lakhs

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 2 years of the policy

Maternity related benefits have a waiting period of 2 years.

Specific illnesses are not covered in the first two years of the plan if the insured is aged 45 years or above. For individuals aged below 45 years, there is no waiting period for such specific illnesses

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.

Max-Bupa-Heartbeat-Gold

FAQs

What is the coverage provided under organ donor feature?

The organ donor feature covers the in-patient hospitalization cost incurred in harvesting an organ from a living individual. This coverage is available up to the Sum Insured.

When is domiciliary hospitalization covered?

Domiciliary hospitalization is covered up to the Sum Insured if the treatment continues for at least 3 continuous days at the insured’s home.

When is hospital cash available?

Hospital cash is payable only if hospitalization exceeds at least 48 hours of continuous hospitalization.

When should the company be intimated in case of a cashless claim?

For a planned hospitalization, the insurance company should be informed at least 72 hours prior to hospitalization. For emergency hospitalization, the time period is within 48 hours of hospitalization.

What is the free-look period in the policy?

The free-look period in the policy is for 15 days.

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