Max Heartbeat (Version 3) - Prospectus PDF

Heartbeat Health Insurance Plan (UIN: IRDA/NL-HLT/MBHI/P-H/V.
II/19/13-14) Prospectus and Sales Literature
HEARTBEAT HEALTH INSURANCE PLAN
Your search for high quality health insurance stops here.
Introducing Max Bupa Health Insurance Company Limited, a joint venture between Max India Limited and
Bupa Finance Plc., U.K. We believe in nurturing long-term relationships with our customers by providing
the highest levels of quality in service.
Our Parent Companies
Max India Limited: A reputation for excellence
Max Group brings expertise in insurance and healthcare with a strong presence in Life Insurance
(through Max New York Life Insurance Company Limited), Healthcare (through Max Healthcare Institute
Ltd.) and Clinical Research (through Max Neeman Medical International Limited).
A Rs 8500 crore group, it has over 500 offices across 400 locations in India with more than 57,000
employees, all focused on delivering customer satisfaction to more than 5 million customers(Source Max
st
India website as on March 31 , 2012)
Bupa: 65 years of Care
Established in 1947 as the British United Provident Association, Bupa today has group revenue of
£8.0billion, 10.84 million customers in over 190 countries and employs over 52,000 people.(Source –
Bupa Annual Report published in March 2011)
Bupa Group brings in a wealth of experience in serving customers directly in the health insurance sector
across the world. In addition, Bupa also runs care homes for older people, operates hospitals, provides
chronic disease management services and offers out of hospital care.
Recognition and Rewards
Max India Limited:

rd
• Max New York Life was declared a “Superbrand” by Superbrands India in the 3 edition of
Consumer Superbrands 2008‟
• CII-Exim Bank Award for for Business Excellence awarded to Max New York Life in 2008
• CIO 100 Award for technology implementation
Bupa:
 The Health Insurance Company of the Year Award -awarded at the U.K. Health Insurance
Awards 2009
 Best International Private Medical Insurance provider 2008 - awarded at the U.K. Health
Insurance Awards
 Best Medical Insurer Company (2008, Bupa Arabia) - awarded at the Jeddah Chamber of
Commerce and Industry Health Committee Awards
 Best Healthcare Provider of the Year - awarded at the U.K. Corporate Adviser Awards 2009
 Best Individual Private Medical Insurance Provider - awarded at the U.K Money Marketing
Awards 2009
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Heartbeat Health Insurance Plan (UIN: IRDA/NL-HLT/MBHI/P-H/V.II/19/13-14) Prospectus and Sales Literature
Heartbeat Health Insurance Plan
Start a healthy relationship
Heartbeat Health Insurance Plan from Max Bupa is the most comprehensive health insurance cover for
you and your family. It gives you the flexibility to choose just the right cover for your needs. Apart from
giving you a comprehensive health insurance cover to suit your needs, we are also committed to provide
you the best quality service when you need it the most.
Which is why Max Bupa is the Healthier Health Insurance for you and your family:
 You talk to us directly, not through any third parties. We will be there for you when you need us.
Because you should concentrate on getting better, not chasing your claims.
 We are with you at every step of the way in your life. For a happy occasion like the delivery of
your baby, to your child‟s vaccinations, or at other times when there is an illness in the family- we
have it covered. New born babies are automatically covered till the next renewal of the policy.
 You can access our cashless facility at quality hospitals of your city, with the best medical
facilities included in our partner network.
 We cover families across life stages – from newborns to senior citizens of any age, covering up to
13 relationships in one policy.
 Our health relationship programme helps you to nurture and improve your and your family‟s
health.
 You can call us anytime for help on our 24/7 health line for easy and friendly access to health
advice when you need it.
 Managing our relationship - As a customer, you can access your own page on the Max Bupa
website to keep track of your policy details and benefits.
 To build a relationship that lasts a lifetime, we make all efforts to understand your health profile
during enrollment, so that when you need us, we can provide speedy and efficient support.
 We assure you renewability of your policy for lifetime, if you pay renewal premium within the
grace period of 30 days of expiry of your previous policy. You should renew on or before the
renewal date of the policy to ensure you have continued medical insurance cover even during the
grace period.
 As with all health insurance policies, you may save tax under Section 80D of the Income Tax Act
when you buy a Max Bupa health insurance policy. (Tax benefits are subject to changes in the
tax laws, please consult your tax advisor for more details)
Policy Design
 Max Bupa Heartbeat Health Insurance plan can be issued to an individual customer, a family
and/or extended family.
 The family floater policy may be available in any of the following combinations:
o 1 Adult + 1Child
o 1 Adult + 2 Children
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o 2 Adults
o 2 Adults + 1Child
o 2 Adults + 2Children
 The family includes spouse and dependent children and can comprise up to a unit of 6
insureds of which up to 4 can be children. .
 The premium for family floater policies depends on the age of the eldest insured customer.
 The Family First may be available in any of the below relationships with the Proposer
a. Legally married spouse as long as he or she continues to be married to You; b. Son;
c. Daughter-in-law; d. Daughter; e. Son-in-Law; f. Father; g. Mother; h. Father-in-law as long
as Your spouse continues to be married to You; i. Mother-in-law as long as Your spouse
continues to be married to You.; j. Grandfather; k. Grandmother; l. Grandson;
m. Granddaughter
 The premium for Family First policies depends on the individual age of each insured
customer in the Extended Family.
 This policy covers persons of any age. There is no maximum entry age for the insured.
 The maximum entry age of any dependent as a child in the policy is less than 21 years on the
date of commencement of the initial cover under the Policy.
Please note all the children whose age exceeds the maximum entry age would be given an
option to migrate to our retail health insurance offering (for e.g. Heartbeat Health Insurance
Plan, Health Companion Health Insurance Plan, Health Assurance) under individual plans.
 There is no maximum cover ceasing age in this policy.

 The default policy term for all plans is one year. A two year policy term option is also
available for Heartbeat Individual, Family Floater and Family First plans. Avail 12.5% discount
on second year premium when you opt for 2 year policy.
 You can also choose an optional aggregate annual deductible (top-up cover) along with
Silver Sum Insured options of Individual and Family Floater plans.
Sum Insured
 The sum insured options:

o In case of Individual or Family Floater - range from Rs. 2 lacs to Rs. 1 cr
depending on the plan you choose. The details of the plans are available in the
product benefits table.
o In case of Family First:

Flexible sum insured per person (one amount chosen for all family members) as well
as a floating amount that can be utilised once the sum assured per person is
consumed. This provides flexibility for families to decide their optimal cover:
Choose individual cover from options given below:
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 Individual Base Sum Insured Options for Silver are - Rs 1L, 2L, Rs 3L, Rs 4L,
& Rs 5L
 Individual Base Sum Insured Options for Gold - Rs 1L, Rs 2L, Rs 3L, Rs 4L,
Rs 5L, Rs10L and Rs 15L
 Individual Cover Sum Insured Options (for Platinum)- Rs5L, 10L and Rs 15L
Within the Sum Insured, there is an individual insurance cover for each Insured
Person which shall be up to the amount specified in the Schedule for that Insured
Person. Our maximum liability for all claims in respect of an Insured Person under the
Policy during the Policy Period shall be limited to the Individual Cover amount
specified in the Schedule for that Insured Person.
Choose family floater cover from options given below:

Family Floater Cover Sum Insured
 For Silver – Rs. 3L, Rs. 4L, Rs. 5L, Rs. 10L & Rs. 15L
 For Gold – Rs. 3L, Rs. 4L, Rs. 5L, Rs. 10L, Rs. 15L, Rs.20L, Rs.30L and Rs.50L
 For Platinum- Rs. 15L, Rs 20L, Rs. 30L and Rs. 50L
Within the Sum Insured, there is a floater insurance cover up to the amount specified
in the Schedule. This floater cover may be utilized only if the Individual Cover amount
of an Insured Person is fully exhausted and there is a further claim under the Policy.
Our maximum, total and cumulative liability for any and all such further claims in
respect of all Insured Persons under the Policy during the Policy Period shall be
limited to the Floater Cover amount specified in the Schedule.
Illustration for Family First Policy:
Family Members Age Individual Sum Insured (in lacs)

Father 66 2
Mother 65 2
Son 40 2
Daughter-in law 39 2
Total Individual Sum Insured 8 lacs
Family Floater Sum Insured 5 lacs
Total Sum Insured 13 lacs
The details of the plans are available in the product benefits table for Family First Policy.
Product Features and Benefits – Key Highlights
The policy covers reasonable charges incurred towards medical treatment taken during the Policy Period
for an Illness or an Accident. We cover the following expenses
1. Inpatient Care: Medical Expenses for:
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(i) Medical Practitioners‟ fees, Diagnostics procedures, Medicines, drugs

and consumables, Operation theatre charges, Intensive Care Unit,
Intravenous fluids, blood transfusion, injection administration charges
(ii) The cost of prosthetics and other devices or equipment if implanted
internally during a Surgical Procedure.
2. Hospital Accommodation: Reasonable charges for Room Rent for Hospital

accommodation. All Gold and Platinum Policies can utilise Single Private rooms during
hospitalization.
For Silver sum insured options of Individual and Family Floater plans, the Insured
Persons can choose between a shared room category or 1% of their Sum Insured, at the
time of hospitalisation. For Silver Family First plans, the insured persons can opt for Rs
3,000 or a shared room, depending on their preference.
3. Pre & Post hospitalization Medical Expenses: Medical Expenses incurred due to
Illness up to 30 days period immediately before an Insured Person‟s admission to a
Hospital and 60 days immediately after an Insured Person‟s discharge from a Hospital.
These are payable for the same illness or treatment as long as we have accepted an
inpatient hospitalization claim for that treatment or illness. These can be claimed only as
reimbursements. .
4. Day Care Treatment: Medical Expenses for Day Care procedures/ Treatment where
such treatment are undertaken by an Insured Person for a continuous period of less than
24 hours, in a Hospital/day care centre, will be covered. Any procedure undertaken at the
out-patient department of a Hospital will not be covered. Under Day Care Procedures we
will also cover Chemotherapy, Radiotherapy, Hemodialysis, or any procedure which
needs a period of specialized observation or care after completion of the procedure,
where such procedure is undertaken by an Insured Person as an In-patient in a Hospital
for a continuous period of less than 24 hours. Any OPD Treatment undertaken in a
Hospital will not be covered.
5. Domiciliary Treatment: Medical Expenses for treatment taken at home if the treatment
continues for an uninterrupted period of 3 days and the condition for which treatment is
taken would otherwise have necessitated hospitalization as long as either (i) the
attending Medical Practitioner confirms that the Insured Person could not be transferred
to a Hospital or (ii) Insured Person satisfies us that a Hospital bed was unavailable.
6. Maternity Benefits:
(i) „In-case of Family Floater: This benefit is available only to you or your spouse
under family floater policy, only when you and your spouse, are both covered
under the same policy. We pay Medical Expenses for the delivery of a child, only
after 24 months of continuous coverage since the inception of the first Policy with
Us. There is a sub-limit on maternity expenses as shown in the Product Benefit
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Table. Maternity benefits are paid only twice during the lifetime of the Policy
including any of its renewals. We will also cover medically necessary termination
of pregnancy. We will cover the pre-natal & post-natal Medical Expenses for any
covered delivery and termination. However, expenses in respect of harvesting
and storage of stem cells are not covered.
(ii) In-case of Family First: This benefit is available only to adult females covered
under Family First Policy. We pay Medical Expenses for the delivery of a child,
only after 24 months of continuous coverage since the inception of the first Policy
with Us. There is a sub-limit on maternity expenses as shown in the Product
Benefit Table for Family First Policy. Maternity benefits are paid only twice during
the lifetime of the Policy including any renewal thereof. We will also cover
medically necessary termination of pregnancy. We will cover the pre-natal &
post-natal Medical Expenses for any covered delivery and termination. However,
expenses in respect of harvesting and storage of stem cells are not covered.
7. New Born Baby: The new born baby will be covered as an insured person from birth. We
will cover medical expenses towards the medical treatment of the Insured Person‟s new
born baby while the Insured Person is Hospitalized as an Inpatient for delivery. We also
cover Reasonable Charges for vaccination of the new born baby until the new born baby
completes one year. If the policy ends before the baby completes one year, then we will
cover the vaccinations only if the baby has been added as an insured person at the time
of renewal.
8. Organ Donor: Medical Expenses for an organ donor‟s treatment for harvesting of the
organ provided that the Insured Person has been medically advised to undergo an organ
transplant and the donation conforms to The Transplantation of Human Organs Act 1994
and the organ is for the use of the Insured Person;
We will not cover:

(a) Pre-hospitalisation or post-hospitalization Medical Expenses or screening expenses of
the donor or any other medical expenses as a result of the harvesting from the donor;
(b) Costs directly or indirectly associated with the acquisition of the donor‟s organ.
9. Health Checkup: We will cover the cost of Health Check-Up arranged by us through our
empanelled service providers as per your plan eligibility defined in the product benefit
table.
10. Emergency ambulance: Reasonable charges for ambulance expenses (by surface
transport only) incurred to transfer the Insured Person following an Emergency, while in
India, to the nearest Hospital, if we accept the in-patient claim. For Out Of Network
Hospitalization our maximum liability for ambulance expenses is limited to Rs.2,000/- per
event.
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11. Benefits on Annual Renewals
 Health Relationship Loyalty Program

If the Policy is renewed with us without any break, each Insured Person will become
eligible to participate in the Health Relationship Loyalty Program announced by us from
time to time. It is a first-of-its kind rewards program, which rewards customers for their
relationship with Max Bupa and the trust they have reposed in the brand, irrespective of
their claim history. The program is also designed in a way that the customers can choose
the benefits that are most relevant to them. Under this program, customers can opt for
either of the following:
1. Earn and Redeem: Customers can earn points worth a percentage of their last
paid premium which can be redeemed against various products and services.
These products and services can be vouchers from various partner brands. It
also includes vouchers for OPD services within our partner hospital network if the
customer wishes to avail of the same, of the equivalent value.
a. If the Policy Period is one year, we offer vouchers, in either electronic or
physical form, worth 10% of your last premium received
b. If the Policy Period is two years, we offer vouchers, in either electronic or
physical form, worth 5% of the last premium received on the commencement
of each Policy Year commencing from the second Policy Year.
The Insured Person may avail of the services and products specified within the
period specified in or along with the voucher, provided that:
 The vouchers are used for health services and benefits communicated from time
to time;
 The conditions or limitations specified in the vouchers are adhered to;
 The Policy is continuously renewed.
2 . Increase Sum Insured: The customer also has the option to opt-for increasing his
Sum insured up to a cap of 50% of his base sum insured. The customer will not have an
option of opting for „Earn n redeem‟ as mentioned above once he has opted for
increasing his Sum insured on further renewals
 The option of higher Sum Insured is applicable for (a) individual Policy on Base
Sum Insured, (b) Family Floater Policy on Base Plan Sum Insured, and (c)
Family First Policy on individual Base Sum Insured
 We offer a 10% increase on the expiring Base Sum Insured on each Policy Year
up to a maximum of 50% of Base Sum Insured of that Policy Year provided the
Policy is renewed continuously
Illustration:
The Loyalty additional Sum Insured is calculated as 10% of the expiring policy‟s Sum
Insured at the time of renewal. So if a customer has a base Sum Insured of Rs.
200,000 in the beginning, he earns a 10% Loyalty additional Sum Insured of Rs.
20,000 at renewal which is added with his base Sum Insured to take his total Sum
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Insured for the next year to 220,000. Like this the Total Loyalty additional Sum
Insured can be accumulated till 50%(Rs 100,000) of the base sum insured of Rs
200,000, if the customer renews the policy for 200,000 continuously.
However, If at the next renewal he increases his base Sum Insured to Rs 10,00,000
from Rs. 200,000, he gets Rs. 20,000 Loyalty additional Sum Insured, which is10% of
the expiring base Sum Insured Rs. 200,000. This takes his total loyalty additional
Sum Insured to 40,000 and his total Sum Insured for that policy to Rs. 10,40,000.
The Loyalty additional Sum Insured earned at renewal does not become a part of the
base Sum Insured for any current year. At next renewal the Loyalty additional Sum
Insured is calculated as 10% of expiring Base Sum Insured of Rs. 10,00,000. The
maximum allowed total Loyalty additional Sum Insured can now be 50% (Rs
500,000) of Rs. 10,00,000 if the customer renews the policy for Rs. 10,00,000
continuously
Next, If the customer reduces his base Sum Insured back to Rs. 200,000 at next
renewal, the maximum total Loyalty Additional Sum Insured allowed will be calculated
based on the new sum Insured of Rs. 200,000 and the customer cannot avail of the
higher amounts earned earlier.
Current Base Loyalty Additional Cumulative Loyalty

Sum Insured Sum Insured Amount Additional Sum Insured Total Sum Insured
1 200,000 - - 200,000
2 200,000 20,000 20,000 220,000
3 1,000,000 20,000 40,000 1,040,000
4 1,000,000 100,000 Rs.140,000 1,140,000
5 1,000,000 100,000 240,000 1,240,000
6 200,000 100,000 100,000 300,000
7 200,000 20,000 100,000 300,000
(All Figures in INR)
12. Consultation and Diagnostic Tests Carry Forward (for Platinum Policyholders
only): We will cover reasonable charges for Insured Person‟s medically necessary
consultation with a Medical Practitioner, as an OPD Treatment to assess the Insured
Person‟s health condition for any illness. We will also pay for any diagnostic tests
prescribed by the medical practitioner and medicines purchased under and supported
with a Medical Practitioner‟s prescription up to the sub-limits shown in the product
benefits table.
If the Policy is renewed with us without any break and there is a unutilized amount (not
used by the Insured Person) under the applicable sub-limit (as specified in the product
benefit table) in a Policy Year, then we will carry forward 80% of this unutilized amount to
the immediate succeeding Policy Year. The total amount (including the unutilized amount
available under this benefit) should not exceed 2.5 times the amount of the entitlement in
respect of this benefit under the plan applicable to the Insured Person as per the Product
Benefits Table.
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Illustration of how the above carry forward works as follows (All figures in INR):
Illustration 1: Sum Insured: 15 lacs, Out-patient benefits sub-limit Rs. 10,000/-
Yr
Sub-limit Fresh Maximum Sub-limit OPD Unutilized Sub-limit
carried OPD sub- allowed (2.5 available claims limit at the carried
forward from limit for times sub- for the year made in end of the forward to
previous year the year limit) the year year the next
year
1 - 10,000 25,000 10,000 - 10,000 8,000
2 8,000 10,000 25,000 18,000 - 18,000 14,400
3 14,400 10,000 25,000 24,400 2,500 21,900 17,520
4 17,520 10,000 25,000 25,000 - 25,000 20,000
5 20,000 10,000 25,000 25,000 3,000 22,000 17,600
6 17,600 10,000 25,000 25,000 25,000 20,000
Illustration 2 (All Figures in INR): Sum Insured: 50 lacs, Out-patient benefits sub-limit Rs. 20,000/-
Year Sub-limit Fresh Maximum Sub-limit OPD Unutilized Sub-limit

carried OPD sub- allowed (2.5 available claims limit at the carried
forward from limit for times sub- for the year made in end of the forward to
previous the year limit) the year year the next
year year
1 - 20,000 50,000 20,000 - 20,000 16,000
2 16,000 20,000 50,000 36,000 - 36,000 28,800
3 28,800 20,000 50,000 48,800 - 48,800 39,040
4 39,040 20,000 50,000 50,000 - 50,000 40,000
5 40,000 20,000 50,000 50,000 - 50,000 40,000
6 40,000 20,000 50,000 50,000 17,500 32,500 26,000
13. Co-Payment
If any insured person is 65 years of age or over on the date of commencement of current policy
year, then we will pay the percentage provided in the table below of any assessed claim amount
Co-payment contribution table:
No of Years of Continuous renewal at or later than Percentage of any assessed claim amount payable
the age of 65 years by Us
0 year 80%
1yr 85%
2 yrs 90%
3 yrs 95%
4 yrs or more 100% (No Co-payment)
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The above Co-pay grid means that the Percentage of any assessed claim amount payable by Us
increases by 5% for every continuous renewal.
Illustration of how the above co-pay works:
If the insured person is of the age 63 years at the time of the first Policy Inception then the Co-pay that
would have applied at the age of 65 years would reduce as per the table below,
No of Years of Age of the Insured person Percentage of any assessed claim amount
Continuous renewal payable by Us when the insured person 65 years
of age or older
0 yrs (First Policy Year) 63 yrs 100% (no co-pay in this policy year)
1 yr 64 yrs 100% (no co-pay in this policy year)
2 yrs 65 yrs 90% (co-pay starts at the age of 65 yrs, applicable

percentage payable by Us is 80% plus the
cumulative benefit of 10% for 2 Continuous
renewals)
3 yrs 67 yrs 95% (co-pay keeps reducing at each Continuous

renewal by 5%)
th
4 yrs 68 yrs 100% (co-pay reduces to zero after 4
th
Continuous renewal or in other words in the 5
year of Continuous coverage)
It should be noted that the Co-pay is applicable only once the insured person is 65 years or age or older.
The reduction in co-pay is a benefit being given to customers for enrolling before the age of 65 years.
Even after turning 65 the Co-pay continues to reduce by 5% for every Continuous renewal. So for any
customer Continuously renewing the same plan with Us for 4 policy years the Co-pay reduces to zero.
Special Benefits to Platinum Customers

Customers who opt for the Platinum plan of the Heartbeat with Sum Insured ranging from 15 lacs to 1 cr
on Individual policies and Family Floater, and Family First Platinum Plans get additional benefits ranging
from preventive health care, alternative therapies and outpatient treatments, treatment outside of India,
making it an exhaustive and best quality health cover for the entire family providing the best quality
healthcare options available. These benefits are offered within the geographical and sum-insured sub-
limits presented in the Product Benefit table.
14. Consultation and Diagnostic Tests (for Platinum Policyholders only): Reasonable
charges towards medically necessary consultation as an outpatient with a doctor to
assess the Insured Person‟s condition. The outpatient treatment will also include
alternative treatment like Homeopathy and Ayurveda, within the same, up to the sub-
limits prescribed. We will also pay for any diagnostic tests and medicines prescribed by
the doctor up to the sub-limits shown in the Product Benefit Table.
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15. Child Care Benefits (for Platinum Policyholders only): We will cover reasonable
charges for specified vaccination expenses for children who are included as insured
persons until they have completed 12 years are covered. We will also cover expenses
towards one consultation for nutrition and growth provided to the child during a visit for
vaccination.
16. Emergency Medical Evacuation and Hospitalization(for Platinum Policyholders

only)
(i) Emergency Medical Evacuation and Hospitalization (Outside India) In

case of a medical emergency outside India we will provide assistance in
medical evacuation of the Insured Person and cover the reasonable charges
for transportation of the Insured Person (and an attending Doctor if this is
medically necessary) following an emergency, to the nearest Hospital which
is prepared to admit the Insured Person provided that:
Necessary medical treatment cannot be provided at a Hospital where the
Insured Person is situated at the time of emergency; and our service provider
has approved the request for Medical Evacuation.
The medical evacuation has been prescribed by a Medical Practitioner and is
medically necessary.
Further, if the Insured Person is required to be Hospitalized in an emergency

when the Insured Person is outside India, but within those regions specified
in the Schedule of Insurance Certificate, We will cover the following medical
expenses towards medical treatment until the Insured Person reaches a
medically stable condition:
(1) Medical Practitioner‟ fees

(2) Diagnostics procedures
(3) Medicines, drugs and consumables
(4) Intravenous fluids, blood transfusion, injection administration charges
(5) Operation theatre charges
(6) The cost of prosthetics and other devices or equipment if implanted internally
during a Surgical Operation.
(7) Intensive Care Unit charges
(8) Reasonable charges for room rent for Hospital accommodation
(ii) Specific Exclusions
I. We will not cover any treatment or claims falling under any exclusions or
waiting period
II. The benefit will also not be available after the first 180 cumulative days
of travel outside India during the Policy Year.
Claims Procedure applicable to Emergency Medical Evacuation and Hospitalization
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a) Claims for Emergency Medical Evacuation

(i) In the event of an Emergency, Our Service Provider shall be contacted immediately on
the helpline number specified in the Insured Person‟s health card.
(ii) Our Service Provider will evaluate the necessity for evacuation of the Insured Person and
if the request for Medical Evacuation is approved, the Service Provider shall pre-
authorise the type of travel that can be utilized to transport the Insured Person and
provide information on the nearest Hospital that may be approached for medical
treatment of the Insured Person.
(iii) If the Service Provider pre-authorises the Medical Evacuation of the Insured Person
through an air ambulance, the Service Provider shall also arrange for the same to be
provided to the Insured Person unless there are any logistical constraints or the medical
condition of the Insured prevents Emergency Medical Evacuation.
(iv) If the Service Provider pre-authorises the Medical Evacuation of the Insured Person
through air travel and if the condition of the Insured Person permits travel by commercial
airline as certified by the treating Medical Practitioner, the Service Provider shall arrange
one-way economy class air tickets or equivalent by the most direct route from the place
of evacuation to the place to where the Insured Person is being evacuated.
(v) It is agreed and understood that We shall not cover:
a. Any claims for reimbursement of the costs incurred in the evacuation or

transportation of the Insured Person while outside India or any claims which are not
pre-authorized by Our Service Provider;
b. Any costs or expenses incurred in relation to any persons accompanying the Insured
Person, even if such persons are also Insured Persons.
b) Cashless Hospitalization in Emergency at Network Hospitals:

The health card We provide will enable the Insured Person to access medical treatment at any
Network Hospital outside India, but within those regions specified in the Schedule of Insurance
Certificate, on a cashless basis only by the production of the card to the Network Hospital prior to
admission, subject to the following:
(i) In the event of an Emergency, the Insured Person or Network Hospital shall call Our
Service Provider immediately, on the helpline number specified in the Insured Person‟s
health card, requesting for a pre-authorization for the medical treatment required.
(ii) Our Service Provider will evaluate the request and the eligibility of the Insured Person
under the Policy and call for more information or details, if required.
(iii) Our Service Provider will communicate directly to the Hospital whether the request for
pre-authorization has been approved or denied.
(iv) If the pre-authorization request is approved, Our Service Provider will directly settle the
claim with the Hospital. Any additional costs or expenses incurred by or on behalf of the
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Insured Person beyond the limits pre-authorized by the Service Provider shall be borne
by the Insured Person.
(v) This benefit is available only as cashless facility through pre-authorization by Our Service
Provider. It is agreed and understood that We shall not cover:
a. Any claims for reimbursement of the costs incurred in relation to the Hospitalization
of the Insured Person while inside or outside India or any claims which are not pre-
authorized by Our Service Provider;
b. Any costs or expenses incurred in relation any persons accompanying the Insured
Person during the period of Hospitalization, even if such persons are also Insured
Persons.
The Medical Emergency Evacuation service is on best efforts basis and Max Bupa does
not make any guarantee and/or assume the responsibility for the appropriateness, quality
or effectiveness of the treatment/facilities sought or provided by, or arranged by the
Service Provider while approving the pre-authorization or providing the evacuation
service. For details refer to the Terms and Conditions of the Policy Document.
17. International Treatment support for Specified Illnesses (For Platinum Policy
Holders Only)
If an Insured Person suffers a specified illness during the Policy Period, we will cover
reasonable expenses incurred towards the treatment of the same, provided the
symptoms first occur and are diagnosed by a doctor within India during the Policy Period
after the completion of the 90 day waiting period. The customers can undergo treatment
on a pre-authorisation basis outside of India. The base coverage provided under all
Platinum Plans covers treatment outside India excluding treatment in USA and Canada.
All Platinum Plan customers can enhance their coverage to include USA and Canada by
paying an additional premium amount.
The specified illnesses covered are listed below:
i. Cancer
A malignant tumor characterized by the uncontrolled growth and spread of

malignant cells with invasion and destruction of normal tissues. This diagnosis
must be supported by histological evidence of malignancy. The term cancer
includes leukemia, lymphoma and sarcoma.
Specific Exclusion: All tumors in the presence of HIV infection are excluded.
ii. Myocardial Infarction (Heart Attack)
The death of a portion of the heart muscle as a result of inadequate blood supply
to the relevant area.
iii. Coronary Artery Bypass Graft (CABG)
Page 13 of 36
The actual undergoing of open / keyhole chest surgery for the correction of one
or more coronary arteries, which is/are narrowed or blocked. The diagnosis must
be supported by relevant diagnostic tests and confirmed by a cardiologist.
iv. Major Organ Transplant
The actual undergoing of a transplant of:

One or more of the following human organs: heart, lung, liver, kidney, pancreas,
that resulted from irreversible end-stage failure of the relevant organ, or human
bone marrow using haematopoietic stem cells.
Specific Exclusions: The following are excluded:
(a) Other stem-cell transplants
(b) Where only islets of langerhans are transplanted
iv. Stroke
Any cerebrovascular incident including infarction of brain tissue, thrombosis in an

intracranial vessel, hemorrhage and embolisation from an extra cranial source,
which would result in neurological sequelae. Transient Ischemic Attacks (TIA) are
excluded. Treatment of the neurological sequelae is excluded from the cover if
the primary condition is not covered.
v. Surgery of Aorta:
Surgery of aorta including graft, insertion of stents or endovascular repair.
Specific Exclusion: Wherein the surgery is required due to underlying congenital

condition.
vi. Coronary Angioplasty
Procedures done for widening a narrowed or obstructed blood vessel of the heart
wherein a stent may or may not be inserted into the blood vessel. The same is
payable only if the procedure is done subsequent to Myocardial infarction or
Anginal attack.
vii. Primary Pulmonary Arterial Hypertension
An abnormal elevation in pulmonary artery pressure with or without any known

cause. The disease has to be confirmed through cardiac catheter.
viii. Brain Surgery

Any brain (intracranial) surgery required of brain due to traumatic or non
traumatic reasons.
Exclusion: Surgery for treating neurocysticercosis
In addition to the exclusions mentioned specifically for particular specific illness, all other
exclusions and/or waiting periods specified elsewhere in the Policy Document shall apply.
Claims procedure for specified illness treatment
Cashless Hospitalization facility for network Hospitals:
i. In the event of specified illness, the Insured Person should call Our service provider on the
helpline number mentioned in their health card, requesting for a pre-authorization for the
treatment prior to commencement of travel abroad for treatment;
Page 14 of 36
ii. After verification of eligibility as per the Policy, our service provider will evaluate the request and
call for more information, if required.
iii. After evaluation of all information, our service provider will communicate the decision and details
of the Hospitals where the treatment can be undertaken to the Insured Person. This could either
be an approval or a denial.
iv. Any additional costs or expenses incurred by or on behalf of the Insured Person beyond the
limits pre-authorized by the Service Provider or at any non-Network Hospital shall be borne by the
Insured Person.
v. If the pre-authorization request is approved, our service provider will directly settle the claim with
the Hospital.
vi. This benefit is available only as cashless facility. It is agreed and understood that We shall not
cover:
a. Any claims for reimbursement of the costs incurred in relation to the treatment of
the Specified Illness outside India or any claims which are not pre-authorized by
Our Service Provider;
b. Any costs or expenses incurred in relation to any persons accompanying the

Insured Person during any period of treatment, even if such persons are also
Insured Persons.
c. Any costs or expenses incurred in relation to the travel to or from the overseas
location where treatment is being taken.
d. Any costs or expenses incurred in relation to accommodation or stay or

transportation in the overseas location where treatment is being taken.
e. Any pre-Hospitalization or post-Hospitalization costs or expenses incurred by or

on behalf of the Insured Person.
f. Any costs or expenses incurred in relation to transportation of repatriation of the

mortal remains of the Insured Person.
g. Any costs or expenses incurred by any organ donor in relation to harvesting of

organs.
h. Any OPD Treatment taken outside India .
Other optional benefits (Only one of the co-pays or the deductibles can be chosen for any single policy)
18. Co-payment discount options(optional benefit)
If you are aged less than 65 years you can avail a discount in premium calculation by opting for
any one of the below co-pay options. This will allow you to manage your premium costs better.
i. 10% co-pay by the insured for all claims that you submit to us, cashless or
reimbursement.(Applicable only for Individual and Family Floater)
ii. 20% co-pay by the insured for all claims that you submit to us, cashless or
reimbursement.
Page 15 of 36
19. Optional Aggregate Annual Deductibles(top-up option):

You can choose from one of three optional deductibles of Rs 1 lac, Rs 2 Lacs and Rs 3 lacs. By doing so
you will receive a discount in the premium calculation of your policy as per the table below,
Deductible Option Available for Sum Insured Applicable discount in premium

(top-up) in INR (INR) calculation
1 lac Deductible 2 lacs & 3 lacs 25.0%
If an annual aggregate deductible is chosen then the Insured Person shall bear all assessed claim
amounts payable under the policy up to the deductible amount, under his(her) policy for any Policy Year.
Our liability to make payment under the Policy in respect of any claim made in that Policy Year will only
commence once the Deductible has been exhausted.
Any claim amount that is assessed to be payable by Max Bupa under this policy and is borne by the
customer (even if paid for through another Health Insurance Policy) will be accepted as reason of
deductible exhaustion.
Description (using 2 lacs deductible with 3 Lacs Sum Insured as example)

By accepting this condition you will agree to pay yourself or from another health insurance policy the first
2 lac of the total claim amount assessed for payment in one policy year. All claims will be assessed by Us
as per the Terms and Conditions of this policy. Max Bupa will start paying claims as per the policy Terms
and Conditions once the total claim amount assessed for payment for your policy goes above 2 lacs. We
will cover you for a Sum Insured of 3 lacs over and above the 2 lacs deductible.
Please find below the two illustrations for the working of the aggregate annual deductible(top-up
option)
Illustration 1: When a customer already has an health insurance policy and opts for another
policy from Max Bupa along with the annual aggregate Deductible (top-up) Option
Heartbeat Health Insurance Plan Opted for Sum Insured: 3 Lacs, with an annual aggregate
Deductible: 2 lacs
Health Insurance Policy from any other insurance company Sum Insured: 2 Lacs
Rules:
Deductible exhaustion will be calculated without use of Contribution clause. So the first 2 lacs of
aggregate annual claims in this example will be paid for by the other insurer's policy.
For aggregate claim amounts above the annual deductible,
Page 16 of 36
Contribution ratio will be calculated as per the ratio of the Sum Insured above the annual deductible in
both policies. So if the other insurers' policy has Sum Insured Rs 2 Lacs and the deductible in Max
Bupa policy is Rs 2 lacs, Max Bupa will pay 100% of the assessed claim amount above Rs 2 lacs up to
the Sum Insured.
Claim Deductible Balance Available Claim Claim

Amount Exhaustion Deductible Sum Insured amount paid Amount
Assessed in Heartbeat by the other paid by Us
by Us policy insurance
policy or the
customer
At - - 200,000 300,000 - -
Inception
Claim 1 20,000 20,000 1,80,000 300,000 20,000 0
Claim 2 1,90,000 1,80,000 0 300,000 1,80,000 10,000
Claim 3 3,60,000 0 0 290,000 0 2,90,0000
Illustration 2: When there is an overlap of Sum Insured between the Max Bupa policy and
another HI policy, along with the annual aggregate Deductible (top-up) option
Heartbeat Policy Plan opted for Sum Insured: 3 Lacs with an annual aggregate Deductible: 2 lacs
Health Insurance Policy from any other insurance company Sum Insured: 3 Lacs
In this case there is an overlap of coverage with the other insurance policy. So in this case customer
has an option to choose the insurance company from which claim to be settled.
Rules:
Deductible exhaustion will be calculated without use of Contribution clause. So the first 2 lacs of
aggregate annual claims in this example will be paid for by the other insurer's policy.
For aggregate claim amounts above the annual deductible, if the customer chooses Max Bupa to
settle the claim, no contribution clause will be applied
Claim Deductible Balance Available Available Claim Claim
Amount Exhaustion Deductible Sum Sum amount paid Amount
Assessed (INR) (INR) Insured Insured in by the other paid by
by Us in Other insurance Us
(INR) Heartbeat Insurer's policy or the (INR)
policy policy customer
(INR) (INR) (INR)
At - - 200,000 300,000 300,000 - -
Inception
Claim 1 20,000 20,000 1,80,000 300,000 300,000 20,000 0
Claim 2 1,80,000 1,80,000 0 300,000 2,80,000 1,80,000 0
Claim 3 2,40,000 0 0 300,000 1,00,000 0 2,40,000
Page 17 of 36
Additional Services
 24/7 Healthline. This facility has been put in place to offer you access to health advice when you
need it the most.
 Relationship Managers(For Gold and Platinum Policyholders): We may assign at our

discretion, our representative who will personally attend to your claims settlement, leaving you
free to concentrate on getting better or looking after your loved ones.
 Second E-Opinion (For Platinum Policyholders) for a life threatening medical condition.
 Direct Servicing – All claims are processed directly by our own customer services team.
Waiting Periods and Exclusions:
Claims for the following are not covered:
 Pre-Existing Conditions: Benefits will not be available for Pre-existing Conditions for
Gold and Platinum plans until 24 months and for all Silver plans until 48 months of
continuous coverage have elapsed since the inception of the first Policy with Us.
 90 Days Waiting Period: We will not cover any treatment taken during the first 90 days
since the commencement of the Policy, unless the treatment needed is a result of an
Accident or Emergency. This waiting period does not apply for any subsequent and
continuous renewals of Your Policy.
 Specific Waiting Periods: For all Insured Persons who are above 60 years of age as
on the date of commencement of the first Policy Period, the conditions listed
below will be subject to a waiting period of 24 months and will be covered in the
third Policy Year as long as the Insured Person has been insured continuously
under the Policy without any break:
- Stones in the urinary system (eg kidney/bladder); * Stones in billiary system

(eg gallstones);* Cataract; *BPH - Benign prostatic hypertrophy; *
Mennoraghia, * Fibromyoma, *Uterine prolapse including any condition
requiring Hysterectomy; * Piles (Haemorrhoids); * Hernia (Inguinal/umbilical
and gastric); * Degenerative disorders of knee/hip; * Chronicrenal failure or end
stage renal failure; * Retinopathy; * Diabetes and related treatments
 Personal Waiting Periods: There are certain conditions mentioned in the Schedule of
insurance certificate. These will be subject to a waiting period of 24 months and will be
covered in the third Policy Year as long as the Insured Person has been insured
continuously under the Policy without any break.
These will be applied only on select Insured Person(s) basis their health condition
which is determined only after conducting medical tests. For example, after
Page 18 of 36
conducting an ECG if the report is not normal than a personal waiting period for
heart disease will be applied post risk assessment.
 Permanent Exclusions: Addictive conditions and disorders; Ageing and puberty;

Artificial life maintenance; Circumcision; Conflict and disaster; Congenital conditions;
Convalescence and rehabilitation; Cosmetic surgery; Dental/oral treatment; Drugs and
dressings for OPD treatment or take-home use; Unproven/Experimental treatment;
Eyesight; Health hydros, nature cure, wellness clinics etc; Hereditary conditions
(specified); HIV and AIDS; Items of personal comfort and convenience; alternative
treatment(except for Consultation and Diagnostic Tests (For Platinum Policyholders
only)); Psychiatric and Psychosomatic conditions; Obesity; OPD treatment; Reproductive
medicine - Birth control and Assisted reproduction; Self-inflicted injuries; Sexual problems
and gender issues; Sexually transmitted diseases; Sleep disorders; Speech disorders;
Treatment for developmental problems; Treatment received outside India(except for
treatment undertaken under “Emergency Medical Evacuation and Hospitalization (for
Platinum Policyholders only)” or “Specified Illness Cover for treatment abroad (For
Platinum Policyholders only)” of the Policy Document); Unlawful activity; Unrecognised
physician or Hospital, Genetic disorders; any other such permanent exclusions as may
be specified in the Schedule, any expenses as mentioned below for hospitalization
treatment.
List of Generally excluded in Hospitalisation Policy

List of Expenses Generally Excluded ("Non-
SNO Medical")in Hospital Indemnity Policy - SUGGESTIONS
TOILETRIES/COSMETICS/ PERSONAL COMFORT OR CONVENIENCE ITEMS
1 HAIR REMOVAL CREAM Not Payable
2 BABY CHARGES (UNLESS SPECIFIED/INDICATED) Not Payable
3 BABY FOOD Not Payable
4 BABY UTILITES CHARGES Not Payable
5 BABY SET Not Payable
6 BABY BOTTLES Not Payable
7 BRUSH Not Payable
8 COSY TOWEL Not Payable
9 HAND WASH Not Payable
10 M01STUR1SER PASTE BRUSH Not Payable
11 POWDER Not Payable
12 RAZOR Payable
13 SHOE COVER Not Payable
14 BEAUTY SERVICES Not Payable
Essential and may be paid specifically for cases
who have undergone surgery of thoracic or
15 BELTS/ BRACES lumbar spine.
16 BUDS Not Payable
Page 19 of 36
17 BARBER CHARGES Not Payable

18 CAPS Not Payable
19 COLD PACK/HOT PACK Not Payable
20 CARRY BAGS Not Payable
21 CRADLE CHARGES Not Payable
22 COMB Not Payable
DISPOSABLES RAZORS CHARGES ( for site
23 preparations) Payable
24 EAU-DE-COLOGNE / ROOM FRESHNERS Not Payable
25 EYE PAD Not Payable
26 EYE SHEILD Not Payable
27 EMAIL / INTERNET CHARGES Not Payable
FOOD CHARGES (OTHER THAN PATIENT'S DIET
28 PROVIDED BY HOSPITAL) Not Payable
29 FOOT COVER Not Payable
30 GOWN Not Payable
Essential in bariatric and varicose vein surgery
and should be considered for these conditions
31 LEGGINGS where surgery itself is payable.
32 LAUNDRY CHARGES Not Payable
33 MINERAL WATER Not Payable
34 OIL CHARGES Not Payable
35 SANITARY PAD Not Payable
36 SLIPPERS Not Payable
37 TELEPHONE CHARGES Not Payable
38 TISSUE PAPER Not Payable
39 TOOTH PASTE Not Payable
40 TOOTH BRUSH Not Payable
41 GUEST SERVICES Not Payable
42 BED PAN Not Payable
43 BED UNDER PAD CHARGES Not Payable
44 CAMERA COVER Not Payable
45 CLINIPLAST Not Payable
46 CREPE BANDAGE Not Payable/ Payable by the patient
47 CURAPORE Not Payable
48 DIAPER OF ANY TYPE Not Payable
Not Payable ( However if CD is specifically
49 DVD, CD CHARGES sought by Insurer/T PA then payable)
50 EYELET COLLAR Not Payable
51 FACE MASK Not Payable
52 FLEXI MASK Not Payable
53 GAUSE SOFT Not Payable
Page 20 of 36
54 GAUZE Not Payable

55 HAND HOLDER Not Payable
56 HANSAPLAST/ADHESIVE BANDAGES Not Payable
57 INFANT FOOD Not Payable
Reasonable costs for one sling in case of upper
58 SLINGS arm fractures should be considered
ITEMS SPECIFIC ALL Y EXCLUDED IN THE POLICIES
WEIGHT CONTROL PROGRAMS/ SUPPLIES/
59 SERVICES Exclusion in policy unless otherwise specified
COST OF SPECTACLES/ CONTACT LENSES/
60 HEARING AIDS ETC., Exclusion in policy unless otherwise specified
DENTAL TREATMENT EXPENSES THAT DO NOT
61 REQUIRE HOSPITALISATION Exclusion in policy unless otherwise specified
62 HORMONE REPLACEMENT THERAPY Exclusion in policy unless otherwise specified
63 HOME VISIT CHARGES Exclusion in policy unless otherwise specified
INFERTILITY/ SUBFERTILITY/ ASSISTED
64 CONCEPTION PROCEDURE Exclusion in policy unless otherwise specified
OBESITY (INCLUDING MORBID OBESITY)
65 TREATMENT IF EXCLUDED IN POLICY Exclusion in policy unless otherwise specified
66 PSYCHIATRIC & PSYCHOSOMATIC DISORDERS Exclusion in policy unless otherwise specified
67 CORRECTIVE SURGERY FOR REFRACTIVE ERROR Exclusion in policy unless otherwise specified
TREATMENT OF SEXUALLY TRANSMITTED
68 DISEASES Exclusion in policy unless otherwise specified
69 DONOR SCREENING CHARGES Exclusion in policy unless otherwise specified
70 ADMISSION/REGISTRATION CHARGES Exclusion in policy unless otherwise specified
HOSPITALISATION FOR EVALUATION/
71 DIAGNOSTIC PURPOSE Exclusion in policy unless otherwise specified
EXPENSES FOR INVESTIGATION/ TREATMENT
IRRELEVANT TO THE DISEASE FOR WHICH Not payable - Exclusion in policy unless
72 ADMITTED OR DIAGNOSED otherwise specified
ANY EXPENSES WHEN THE PATIENT IS
DIAGNOSED WITH RETRO VIRUS + OR SUFFERING
FROM /HIV/ AIDS ETC IS DETECTED/ DIRECTLY OR
73 INDIRECTLY Not payable as per HIV/AIDS exclusion
Not Payable except Bone Marrow
74 STEM CELL IMPLANTATION/ SURGERY and storage Transplantation where covered by policy
ITEMS WHICH FORM PART OF HOSPITAL SERVICES WHERE SEPARATE CONSUMABLES ARE NOT PAYABLE
BUT THE SERVICE IS
Payable under OT Charges, not payable
75 WARD AND THEATRE BOOKING CHARGES separately
Rental charged by the hospital payable.
76 ARTHROSCOPY & ENDOSCOPY INSTRUMENTS Purchase of Instruments not payable.
Page 21 of 36

77 MICROSCOPE COVER separately
78 SURGICAL BLADES,HARMONIC SCALPEL,SHAVER separately
79 SURGICAL DRILL separately
80 EYE KIT separately
81 EYE DRAPE separately
Payable under Radiology Charge s, not as
82 X-RAY FILM consumable
Payable under Investigation Charges, not as
83 SPUTUM CUP consumable
84 BOYLES APPARATUS CHARGES Part of OT Charges, not seperately
BLOOD GROUPING AND CROSS MATCHING OF
85 DONORS SAMPLES Part of Cost of Blood, not payable
86 Antiseptic or disinfectant lotions Not Payable -Part of Dressing Charges
BAND AIDS, BANDAGES, STERLILE INJECTIONS,
87 NEEDLES,SYRINGES Not Payable -Part of Dressing Charges
88 COTTON Not Payable -Part of Dressing Charges
89 COTTON BANDAGE Not Payable -Part of Dressing Charges
Not Payable-Payable by the patient when
prescribed , otherwise included as Dressing
90 MICROPORE/ SURGICAL TAPE Charges
91 BLADE Not Payable
Not Payable -Part of Hospital
Services/Disposable linen to be part of OT/ICU
92 APRON charges
Not Payable (service is charged by hospitals,

93 TORNIQUET consumables cannot be separately charged)
94 ORTHOBUNDLE, GYNAEC BUNDLE Part of Dressing Charges
95 URINE CONTAINER Not Payable
ELEMENTS OF ROOM CHARGE
Actual tax levied by government is payable
96 LUXURY TAX .Part of room charge for sublimits
97 HVAC Part of room charge not payable separately
98 HOUSE KEEPING CHARGES Part of room charge not payable separately
SERVICE CHARGES WHERE NURSING CHARGE
99 ALSO CHARGED Part of room charge not payable separately
Payable under room charges not if separately
100 TELEVISION & AIR CONDITIONER CHARGES levied
Page 22 of 36
101 SURCHARGES Part of room charge not payable separately

102 ATTENDANT CHARGES Not Payable - P art of Room Charges
103 IM IV INJECTION CHARGES Part of nursing charges, not payable
Part of Laundry/Housekeeping not payable
104 CLEAN SHEET ^ separately
EXTRA DIET OF PATIENT(OTHER THAN THAT

105 WHICH FORMS PART OF BED CHARGE) Patient Diet provided by hospital is payable
BLANKET/WARMER BLANKET ADMINISTRATIVE

106 OR NON-MEDICAL CHARGES Not Payable- part of room charges
107 ADMISSION KIT Not Payable
108 BIRTH CERTIFICATE Not Payable
BLOOD RESERVATION CHARGES AND ANTE NATAL
109 BOOKING CHARGES Not Payable
110 CERTIFICATE CHARGES Not Payable
111 COURIER CHARGES Not Payable
112 CONVENYANCE CHARGES Not Payable
113 DIABETIC CHART CHARGES Not Payable
DOCUMENTATION CHARGES / ADMINISTRATIVE
114 EXPENSES Not Payable
115 DISCHARGE PROCEDURE CHARGES Not Payable
116 DAILY CHART CHARGES Not Payable
117 ENTRANCE PASS / VISITORS PASS CHARGES Not Payable

EXPENSES RELATED TO PRESCRIPTION ON To be claimed by patient under Post Hosp
118 DISCHARGE where admissible
119 FILE OPENING CHARGES Not Payable
INCIDENTAL EXPENSES / MISC. CHARGES (NOT
120 EXPLAINED) Not Payable
121 MEDICAL CERTIFICATE Not Payable
122 MAINTENANCE CHARGES Not Payable
123 MEDICAL RECORDS Not Payable
124 PREPARATION CHARGES Not Payable
125 PHOTOCOPIES CHARGES Not Payable
126 PATIENT IDENTIFICATION BAND / NAME TAG Not Payable

127 WASHING CHARGES Not Payable
128 MEDICINE BOX Not Payable
Payable up to 24 hrs, shifting charges not
129 MORTUARY CHARGES payable
Page 23 of 36
130 MEDICO LEGAL CASE CHARGES (MLC CHARGES) Not Payable

EXTERNAL DURABLE DEVICES
131 WALKING AIDS CHARGES Not Payable
132 BIPAP MACHINE Not Payable
133 COMMODE Not Payable
134 CPAP/ CAPD EQUIPMENTS Device Not Payable
135 INFUSION PUMP - COST Device Not Payable
OXYGEN CYLINDER (FOR USAGE OUTSIDE THE
136 HOSPITAL) Not Payable
137 PULSEOXYMETER CHARGES Device Not Payable
138 SPACER Not Payable
139 SPIROMETRE Device Not Payable
140 SP0 2PROB E Not Payable
141 NEBULIZER KIT Not Payable
142 STEAM INHALER Not Payable
143 ARMSLING Not Payable
144 THERMOMETER Not Payable (paid by patient)
145 CERVICAL COLLAR Not Payable
146 SPLINT Not Payable
147 DIABETIC FOOT WEAR Not Payable
148 KNEE BRACES ( LONG/ SHORT/ HINGED) Not Payable
149 KNEE IMMOBILIZER/SHOULDER IMMOBILIZER Not Payable

Essential and should be paid specifically for
cases who have undergone surgery of lumbar
150 LUMBOSACRAL BELT spine.
Payable for any ICU patient requiring more
than 3 days in ICU, all patients with paraplegia
/quadriplegia for any reason and at reasonable
151 NIMBUS BED OR WATER OR AIR BED CHARGES cost of approximately Rs 200/ day
152 AMBULANCE COLLAR Not Payable
153 AMBULANCE EQUIPMENT Not Payable
154 MICROSHEILD Not Payable
Essential and should be paid in post surgery

patients of major abdominal surgery including
TAH, LSCS, incisional hernia repair, exploratory
laparotomy for intestinal obstruction, liver
155 ABDOMINAL BINDER transplant etc.,
ITEMS PA YABLE IF SUPPORTED BY A PRESCRIPTION
Page 24 of 36
May be payable when prescribed for patient,

BETADINE \ HYDROGEN not payable for hospital use in OT or ward or
156 PEROXIDE\SPIRIT\DISINFECTANTS ETC for dressings in hospital
PRIVATE NURSES CHARGES- SPECIAL NURSING Post hospitalization nursing charges not
157 CHARGES Payable
NUTRITION PLANNING CHARGES - DIETICIAN
158 CHARGESDIET CHARGES Patient Diet provided by hospital is payable
Payable -Sugar free variants of admissable
159 SUGAR FREE Tablets medicines are not excluded
CREAMS POWDERS LOTIONS (Toileteries are not
payable,only prescribed medical pharmaceuticals
160 payable) Payable when prescribed
161 Digestion gels Payable when prescribed
Upto 5 electrodes are required for every case
visiting OT o r ICU. For longer stay in ICU, may
require a change and at least one set every
162 ECG ELECTRODES second day must be payable.
163 GLOVES Sterilized Gloves payable /unsterilized gloves not payable
164 HIV KIT Payable - payable Pre operative screening
165 LISTERINE/ ANTISEPTIC MOUTHWASH Payable when prescribed

166 LOZENGES Payable when prescribed
167 MOUTH PAINT Payable when prescribed
If used during hospitalization is payable
168 NEBULISATION KIT reasonably
169 NOVARAPID Payable when prescribed
170 VOLINI GEL/ ANALGESIC GEL Payable when prescribed
171 ZYTEE GEL Payable when prescribed
Routine Vaccination not Payable / Post Bite
172 VACCINATION CHARGES Vaccination Payable
PART OF HOSPITAL'S OWN COSTS AND NOT PA YA BLE
173 AHD Not Payable - Part of Hospital's internal Cost
174 ALCOHOL SWABES Not Payable - Part of Hospital's internal Cost
175 SCRUB SOLUTION/STERILLIUM Not Payable - Part of Hospital's internal Cost
OTHERS
176 VACCINE CHARGES FOR BABY PAYABLE AS PER PLAN
177 AESTHETIC TREATMENT / SURGERY Not Payable
178 TPA CHARGES Not Payable
179 VISCO BELT CHARGES Not Payable
ANY KIT WITH NO DETAILS MENTIONED

180 [DELIVERY KIT,ORTHOKIT, RECOVERY KIT, ETC] Not Payable
Page 25 of 36
181 EXAMINATION GLOVES Not Payable

182 KIDNEY TRAY Not Payable
183 MASK Not Payable
184 OUNCE GLASS Not Payable
Not payable, except for telemedicine
185 OUTSTATION CONSULTANT'S/ SURGEON'S FEES consultations w here covered by policy
186 186 OXYGEN MASK Not Payable
187 PAPER GLOVES Not Payable
Should be payable in case of PIVI) requiring
188 PELVIC TRACTION BELT traction as this is generally not reused
189 REFERAL DOCTOR'S FEES Not Payable
Not payable pre hospitilasation or post
hospitalisation / Reports and Charts required /
190 ACCU CHECK ( Glucometery/ Strips) Device not payable
191 PAN CAN Not Payable
192 SOFNET Not Payable
193 TROLLY COVER Not Payable
194 UROMETER, URINE JUG Not Payable
195 AMBULANCE PAYABLE AS PER PLAN

Payable - maximum o f 3 in 48 hrs an d then 1
196 TEGADERM / VASOFIX SAFETY in 24 hrs
Payable where medically necessary till a
197 URINE BAG P reasonable cost - maximum 1 per 24 hrs
198 SOFTOVAC Not Payable
Essential for case like CABG etc. where it
199 STOCKINGS should be paid.
Free Look & Cancellation:
1. Free Look Provision: You have a period of 15 days from the date of receipt of the Policy
document to review the terms and conditions of this Policy. If You have any objections to any of
the terms and conditions, You may cancel the Policy stating the reasons for cancellation and
provided that no claims have been made under the Policy, We will refund the premium paid by
You after deducting the amounts spent on stamp duty charges and proportionate risk premium for
the period on cover. All rights and benefits under this Policy shall immediately stand extinguished
on the free look cancellation of the Policy. The free look provision is not applicable and available
at the time of Renewal of the Policy.
2. Cancellation/Termination (other than Free Look cancellation): You may terminate this Policy
by giving 7 days‟ prior written notice to us. We shall cancel the Policy and refund the premium for
the balance of the Policy Period as per the table below, provided that no claim has been filed
under the Policy by or on behalf of any Insured Person:
Page 26 of 36
Length of time Policy in force Refund of premium
up to 30 days 75%
up to 90 days 50%
up to 180 days 25%
exceeding 180 days 0%
Without prejudice to the above, We may terminate this Policy during the Policy Period by sending 30 days
prior written notice to Your address shown in the Schedule of Insurance Certificate without refund of
premium if:
a) You or Any Insured Person or any person acting on behalf of either has acted in a dishonest and
fraudulent manner, under or in relation to this Policy
b) You or any Insured Person has not disclosed the material facts or misrepresented in relation to
the Policy; and/or
c) You or any Insured Person has not co-operated with Us.
For avoidance of doubt, it is clarified that no claims shall be admitted and/or paid during the
notice period by Us in relation to the Policy.
The Policy will be automatically terminated in the following circumstances:
a. Individual Policy:
The Policy shall automatically terminate in the event of death of the Insured Person.
b. Family Floater Policy:
The Policy shall automatically terminate in the event of death of all the Insured Persons.
c. Refund:
Refund as per table above under cancellation/termination shall be payable in case of an

automatic cancellation of the Policy provided that no claim has been filed under the
Policy by or on behalf of any Insured Person.
Portability Benefit
From another company to Our Policy

If the proposed Insured Person was insured continuously and without a break under another
Indian retail health insurance policy with any other Indian Insurance company, the customer can
avail the portability benefit provided they have submitted the application with complete
documentation 21 days before the expiry of their present period of Insurance, at the time of
Page 27 of 36
renewal. The benefit will be available up to the existing cover. If the Sum Insured is more than
that of the last issued policy, waiting periods will be applied on the increased Sum Insured
amount.
This benefit shall be applied by Us within 45 days of receiving Your completed Application and
Portability Form and is is subject to submission of all information/documentation requested,
payment of premium in full and case acceptance is subject to medical underwriting. We would
also need the database and claim history from the previous insurance company for review. No
additional loading or charges shall be applied by Us exclusively for porting the policy.
From Our existing health insurance policies to this Policy
If the proposed Insured Person was insured continuously and without a break under another
health insurance policy with Us, they can port to another policy at the time of renewal, provided
the application and completed Portability Form is received before the expiry of the present period
of insurance. The benefit will be available only up to the existing sum insured, and waiting periods
will apply on any additional sum insured. The terms and conditions of acceptance of a portability
application remain the same as above
The portability benefit guidelines may be modified by us from time to time depending on the
guidance issued by the Insurance Regulatory and Development Authority as amended from time
to time.
Notification
You will inform Us immediately of any change in the address, nature of job, state of health, or of
any other changes affecting You or any Insured Person through the format Annexure A.
We shall allow the enhancement in Sum Assured or scope of cover only at the time of Renewal,
provided You intimate Us at the time of Renewal. The decision of acceptance of enhancement of
the sum insured or the scope of cover will be based on our underwriting policy and shall be
subject to payment of applicable premium for such enhanced cover.
Renewal Information:
Renewal Premium: The renewal premium is payable on or before the due date as shown in the
Schedule. The premium may change on renewal and will be notified by Us before completing the
Policy Period. The amount of premium is dependent on the age of the Insured Person and the
geographical locations. The reference of age for calculating the premium for Family Floater
Policies shall be the age of the eldest Insured Person, and for Family First policies it shall be the
individual age of each Insured Person of the Family. There will not be any loading at the time of
Renewal on individual claims experience of the Insured Person.
We will allow a grace period of 30 days from the due date of the renewal premium for payment to
us. If the Policy is not renewed within the grace period then we may issue a fresh policy subject to
Our underwriting criteria but any new policy issued shall not benefit from any of the continuity
benefits (for example for Pre-Existing Conditions). Renewal of the Policy will not ordinarily be
Page 28 of 36
denied other than on grounds of moral hazard, misrepresentation and fraud. Please note that
coverage is not available for the period for which no premium is received.
For avoidance of doubt, it is clarified that no claims shall be admitted and/or paid during the
Grace period by Us in relation to the Policy.
2. Waiting Period: The Waiting Periods mentioned in the policy wording will get reduced by 1 year
(2 years if the expiring policy has a 2 year policy tenure) with every continuous renewal of your
Heartbeat Health Insurance Policy.
3. This is a life-long renewal product unless the Insured Person or anyone acting on behalf of an
Insured Person has acted in a dishonest or fraudulent manner or has misrepresented under or in
relation to this policy or the Policy poses a moral hazard.
4. Maximum Age: There is no maximum coverage ceasing age in this policy
5. No underwriting on renewal: There will be no underwriting on policy renewal, without break.
The first year underwriting results will continue to apply and carry forward.
6. Change in the coverage of the policy including Sum Insured or additional members in Family
Floater and Family First policies, can be applied for at the time of renewal. These changes shall
be accepted subject to the renewal terms and as per our underwriting policy.
Obligations in case of a minor
If an Insured Person is less than 18 years of age, the proposer/adult Insured Person shall be
completely responsible for ensuring compliance with all the terms and conditions of this Policy on
behalf of that minor Insured Person.
Claims Procedure(Does not apply to Emergency Medical Evacuation and Hospitalization and
Specified Illness Cover for treatment abroad)
 Cashless Hospitalization Facility for Network Hospitals: We will provide cashless

hospitalization facility at our network hospitals. We pre-authorise all cashless in-patient
and day care procedure, if intimated to us in writing 72 hours before hospitalization
(andwithin 48 hours after hospitalization for emergency). Under cashless Hospitalization,
claims are paid directly to the Network Hospital and the treatment must take place within
15 days of pre-authorization.
 Out Of Network Hospitals & All Other Claims for Reimbursement: We will reimburse
expenses incurred outside network hospitals or cases where pre-authorisation has not
been done within the network hospitals. However, we must be notified in writing within 48
hours of admission to the hospital, ideally by the Policy holder/insured person or if
unable, by any immediate adult of the family. All claims will be adjudicated within 30 days
after the occurrence of the event and further submission of necessary documents by the
Insured Person. To claim re-imbursements for any Illness or Accident or medical
condition that requires Hospitalization, the Insured Person should provideus the
documents listed below, within 30 days of the Insured Person's discharge from Hospital:
(1) Claim form duly completed and signed by the Customer.
(2) Cancelled Cheque

Page 29 of 36
(3) Self attested copy of valid age proof (Passport / Driving License / PAN
card / class X certificate / Birth certificate)
(4) Self attested copy of identity proof (Passport / Driving License / PAN
card / Voters identity card)
(5) Original Discharge summary
(6) Original final bill from Hospital with detailed break-up and paid receipt.
(7) Original bills of medicines purchased, or of any other investigation done

outside hospital with reports and requisite prescriptions. .
(8) Invoice of major accessories in case billed and utilized during treatment
(if not included in the final hospital bill).
(9) For Medicolegal cases (MLC/FIR copy attested by the concerned

hospital / police station (if applicable).
(10) Original self-narration of incident in absence of MLC / FIR.
(11) Original first consultation paper (in case disease is first time diagnosed).
(12) Original Laboratory Investigation reports.
(13) Original X-Ray/ MRI / Ultrasound films and other Radiological

investigations
(14) Indoor case paper/OT notes (if required)
- Details of any other insurance policy that may respond to the claim.
We might request for any other documents or information that we believe may be
required;
 For any medical treatment taken from an Non-Network Hospital we will pay Reasonable
charges towards medical expenses.
 You are also advised to refer to the list of unrecognized hospitals, which is available at
our website (www.maxbupa.com).
Nomination Facility: You are mandatorily required at the inception of the Policy, to make a nomination
for the purpose of payment of claims.
Withdrawal of Product
This product may be withdrawn post receiving prior approval from Insurance Regulatory and
Development Authority or due to a change in regulations. In such a case We will provide You an option to
migrate to our other suitable retail product as available with Us.
Revision or Modification
Page 30 of 36
Max Bupa in future may revise or modify this product post clearance of the authority basis the guidelines
issued by them. We will notify You of any such change atleast 3 months prior to the date when such
revision or modification will come into effect.
Premium:
 Premium is dependent on age of the insured and 3 geographical zones.
 Annual premium in INR (excluding service tax and applicable cess) as per rate tables.
An illustrative premium table for individual policy for Rest of India zone (Rating Zone III):
Sum Premiums applicable for different ages for a standard healthy life
Insured (Rs. per annum)
(Rs) For 25 For 30 For 40 For 50 For 60 For 65 For 70
years years years years years years years
200,000 3,204 3,366 4,235 7,340 12,042 16,166 21,103
(Min)
10000000 52,319 53,273 62,955 80,729 105,306 128,410 162,028
(Max)
Disclosure:
 All customers’ personal information collected or held by Max Bupa may be used by Max
Bupa for processing the claims and analysis related to insurance / reinsurance business.
Product Benefits Tables
Attached as Annexure
How to Buy Max Bupa Policy
The Max Bupa policy is sold, through various channels like internal telesales team, Max Bupa direct sales
person or independent advisor, our website www.Maxbupa.com, licensed brokers, agents and any other
channels approved by IRDA.
1. Every Customer will be assigned a unique customer identification number on the Max Bupa system
2. A Max Bupa proposal form is completed. The Customer will be required to provide;
 Insureds‟ name, date of birth, and address, as well as proof of ID as necessary.

 As above for all dependants to be covered by the policy.
 Selection of Heartbeat product and sum insured
 Any existing health insurance policy details and claims history, if applicable.
 Disclosure of any pre-existing medical conditions with details.
 Medical history report for the proposed insured, if necessary.
 Height, weight and BMI for the proposed insured.
 Signature and date on application, wherever applicable.
 Premium payment collected and receipted
3. An underwriting process will be followed for every proposal form submitted, regardless of the
distribution channel.
Checks are made internally to ensure four key questions in the proposal form are completed, viz;
 Within the last 2 years have you consulted a doctor or healthcare professional?
Page 31 of 36
 Within the last 7 years have you been to a hospital for an operation and/or an investigation
(e.g. scan, x-ray, biopsy or blood tests)?
 Do you take tablets, medicines or drugs on a regular basis?
 Within the last 3 months have you experienced any health problems or medical conditions
which you have not seen a doctor for?
For telesales, the information about the customer is gathered on a telephone call instead of a
proposal form. The same four questions are asked on the telephone and call recorded.
If all questions are answered with “NO” the proposal form is processed accordingly with
acceptance and issuance of policy certificate.
If the applicant answers “YES” to any of these questions they will proceed to a further line of
enquiry directly with the Underwriter, providing answers to the following questions;
 Do you have circulatory disorders e.g. varicose veins, high cholesterol, deep vein thrombosis,
high blood pressure, venous ulcers?
 Do you have glandular disorders e.g. diabetes, thyroid, hormonal problems?
 Do you have breathing or respiratory disorders e.g. asthma, bronchitis, chest infections?
 Do you have ear, nose, throat or eye problems e.g. hay fever, tonsillitis, sinusitis, cataracts,
eye infections, deafness, ear infections?
 Do you have stomach, intestine, liver or gall bladder problems e.g. peptic ulcer, colitis,
indigestion, irritable bowel, hepatitis, piles, hernias?
 Do you have cancer, tumors growth, cysts or moles?
 Do you have skin problems e.g. eczema rashes, psoriasis, acne?
 Do you have brain or nervous system disorders e.g. migraines, headaches, multiples
sclerosis, epilepsy, nerve pain, fits?
 Do you have muscle or skeletal problems e.g. arthritis, cartilage and ligament problems, back
and neck problems, sprains, gout, sciatica?
 Do you have urinary problems e.g. bladder or prostate problems, urinary infections,
incontinence, cystitis?
 Do you have blood disorders e.g. anemia, abnormal blood tests, HIV/AIDS, leukemia?
 Do you have dental problems e.g. wisdom teeth problems, abscesses or gingivitis?
 Do you have allergies of any nature?
 Do you have undiagnosed symptoms e.g. chest pain, fatigue, weight loss, dizziness, joint
pain, change in bowel habit, shortness of breath, abdominal pain, rectal bleeding?
 Are you or any prospective customer taking any medicines, prescribed or otherwise?
 Has anyone to be covered ever had any past history of joint replacements, heart conditions
or strokes?
 Is there any other information relating to your health that has not been prompted by the
questions listed above?
If the answer to any of the above questions is “YES” then further medical assessment and review
may be requested by the Underwriter.
Upon full assessment of clinical and historical facts, the Underwriter, with possibly second opinion,
has discretion to decide if the proposal submitted presents a future risk.
Pre-policy health check-up requirements:
For specific ages and sum assured, a medical checkup is required as part of the underwriting process.
The table below indicates where a medical checkup is initially required with the proposal form:
Page 32 of 36
Total rated up Sum Insured to be calculated for all proposed individuals (Individual Sum Insured + Family
floater sum insured + Sum insured under previous or simultaneous similar product category) to ascertain
the exact medicals to be triggered as per the medical grid below.
For e.g. A Family First Policy has following members covered:
Total Rated up Sum Insured per

Individual Cover Sum
Member member for triggering medicals
Insured (Lacs)
(Lacs)
Proposer (Self) 2 7
Spouse 2 7
Father 2 7
Mother 2 7
Son 2 7
Family floater Cover Sum 5Lacs

Insured
The table below indicates where a medical checkup is initially required with the proposal form.
Age (in Years) Individual Plan Family Floater Plan Family First Plan
Below 1 Decline* Discharge Summary* No Check-up*
Upto 39 No Check-up No Check-up No Check-up
40-44 Level 3 No Check-up No Check-up
45-59 Level 3 Level 3 No Check-up
60 and above Level 3 Level 3 Level 3
* Individual plan – Individual proposal where proposed insured is below one year of age will be declined
unless the proposed insured is part of a family which is insured with us.
Family Floater and Family First plans – Discharge Summary and/or MER will be called for.
The medical check-up are spread in levels depending on the plan and Age
Category Tests
Level 3 MER, RUA,Hba1c, TCHOL,GGT,HDL, SCREAT,SGOT,SGPT, ECG
TMT will be triggered as per Underwriter‟s discretion on case to case basis depending upon the health
risk profile of proposed insured(s). We may require you to undertake further medical tests based on our
assessment of your health.
These tests will be valid for a period of 3 months (6 months for sub-standard life). The tests can be
conducted only through a Max Bupa empanelled provider. In case the proposal is accepted the costs of
Page 33 of 36
these tests will be borne by Us for gold and platinum variants; however for silver variant you will have to
bear 50% of the cost of these tests.
For High Deductible Policies,

For Pre-policy Medicals tests, Sum Insured would be considered as mentioned above i.e. the Sum
Insured applied for individual lives.
For e.g. If a proposer chooses Heartbeat Silver plan of Sum Insured Rs 3 lacs with a deductible option of
Rs 1 lac, then Sum Insured considered for triggering medicals (if any) is Rs 3 lacs (total rated up Sum
insured).
4. Three potential options will be determined by the Underwriter.
 No Risk - accept application with no condition exclusion(s)

 Potential Risk – accept application, but special conditions and exclusion(s) apply.
 Risk – decline policy cover. Max Bupa may decline policy cover where potential risk cannot
be quantified through the use of best knowledge and expertise. Max Bupa will consider past
medical history, pathological conditions, acquired disease conditions, deformity or disability,
terminal conditions, and/or a combination thereof to determine if a risk is uninsurable.
5. All proposals accepted by Max Bupa are internally processed and enrolled onto the Max Bupa
system, and premium payments are cleared.
6. Customer receives a welcome kit and a follow up welcome outbound customer service call where the
proposed risk has been accepted by Max Bupa
7. The welcome kit will be delivered direct to the Customers home.
8. Where proposals are not accepted due to unacceptable risk then they too receive communications
from Max Bupa advising of the same and specific reasons for the cover denied.
What to do next: If you wish to know more about Max Bupa‟s Heartbeat Health Insurance plan and/or
would like a personal quote, speak to our specially trained sales team or your local advisor. They‟ll take
time to fully understand your requirements and help you to select the right plan for you.
Phone 1800 3010 3333 (Toll Free) or 3300 3333
Disclaimer: This is only a summary of the product features and is for reference purpose only. The details
of benefits available shall be as described in the policy document, and will be subject to the policy terms,
conditions and exclusions. Please call our customer service if you require any further information or
clarification.
Statutory Warning: Prohibition of rebates (under section 41 of Insurance Act 1938); no person shall
allow or offer to allow either directly or indirectly as an inducement to any person to take out or renew or
continue an insurance in respect of any kind of risk relating to life or property, in India, any rebate of the
whole or part of the commission payable or any rebate of the premium shown on the policy, nor shall any
person taking out or renewing or continuing a policy accept any rebate, except such rebate as may be
allowed in accordance with the published prospectus or the tables of the insurer. Any person making
default in complying with the provision of this section shall be punished with fine, which may extend to five
hundred rupees.
Max Bupa Health Insurance Company Limited

Registered Office: Max House, 1 Dr. Jha Marg, Okhla, New Delhi 110020
Corporate Office: D-1, 2nd Floor, Salcon Ras Vilas, District Centre, Saket, New Delhi-110 017
Page 34 of 36
Insurance is the subject matter of solicitation
Unique Advertisement Number:XXXXXXXXXXXXX
„Max‟ and Max Logo are registered trademarks of Max India Limited and 'Bupa' and the HEARTBEAT
logo are the registered service marks of The British United Provident Association Limited. All these marks
are being used under license by Max Bupa Health Insurance Company Limited.
Page 35 of 36
Annexure A
Format to be filled up by the proposer for change in occupation of the Insured
Policy Name of Date of Relationship City of Previous Occupation or New Occupation or

Number the birth/Age with Primary residence Nature of Work Nature of Work
Insured Insured
Place: _____________ Proposer‟s Signature__________________
Date: ______________ Name:__________ Designation__________
(DD/MM/YYYY)
Page 36 of 36

Max Heartbeat (Version 3) - Prospectus PDF

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Heartbeat Health Insurance Plan (UIN: IRDA/NL-HLT/MBHI/P-H/V.

II/19/13-14) Prospectus and Sales Literature

HEARTBEAT HEALTH INSURANCE PLAN

Your search for high quality health insurance stops here.

Our Parent Companies

Max India Limited: A reputation for excellence

Bupa: 65 years of Care

Recognition and Rewards

Max India Limited:

Heartbeat Health Insurance Plan

Start a healthy relationship

 There is no maximum cover ceasing age in this policy.

 The sum insured options:

o In case of Family First:

Choose family floater cover from options given below:

Illustration for Family First Policy:

Family Members Age Individual Sum Insured (in lacs)

Product Features and Benefits – Key Highlights

1. Inpatient Care: Medical Expenses for:

(i) Medical Practitioners‟ fees, Diagnostics procedures, Medicines, drugs

2. Hospital Accommodation: Reasonable charges for Room Rent for Hospital

We will not cover:

11. Benefits on Annual Renewals

 Health Relationship Loyalty Program

 The conditions or limitations specified in the vouchers are adhered to;

 The Policy is continuously renewed.

Current Base Loyalty Additional Cumulative Loyalty

Year Sub-limit Fresh Maximum Sub-limit OPD Unutilized Sub-limit

4 yrs or more 100% (No Co-payment)

1 yr 64 yrs 100% (no co-pay in this policy year)

2 yrs 65 yrs 90% (co-pay starts at the age of 65 yrs, applicable

3 yrs 67 yrs 95% (co-pay keeps reducing at each Continuous

Special Benefits to Platinum Customers

16. Emergency Medical Evacuation and Hospitalization(for Platinum Policyholders

(i) Emergency Medical Evacuation and Hospitalization (Outside India) In

Further, if the Insured Person is required to be Hospitalized in an emergency

(1) Medical Practitioner‟ fees

Claims Procedure applicable to Emergency Medical Evacuation and Hospitalization

a) Claims for Emergency Medical Evacuation

(v) It is agreed and understood that We shall not cover:

a. Any claims for reimbursement of the costs incurred in the evacuation or

b) Cashless Hospitalization in Emergency at Network Hospitals:

The specified illnesses covered are listed below:

A malignant tumor characterized by the uncontrolled growth and spread of

ii. Myocardial Infarction (Heart Attack)

iii. Coronary Artery Bypass Graft (CABG)

iv. Major Organ Transplant

The actual undergoing of a transplant of:

Any cerebrovascular incident including infarction of brain tissue, thrombosis in an

Surgery of aorta including graft, insertion of stents or endovascular repair.

Specific Exclusion: Wherein the surgery is required due to underlying congenital

An abnormal elevation in pulmonary artery pressure with or without any known

viii. Brain Surgery

Claims procedure for specified illness treatment

Cashless Hospitalization facility for network Hospitals:

b. Any costs or expenses incurred in relation to any persons accompanying the

d. Any costs or expenses incurred in relation to accommodation or stay or

e. Any pre-Hospitalization or post-Hospitalization costs or expenses incurred by or

f. Any costs or expenses incurred in relation to transportation of repatriation of the

g. Any costs or expenses incurred by any organ donor in relation to harvesting of

h. Any OPD Treatment taken outside India .

18. Co-payment discount options(optional benefit)

19. Optional Aggregate Annual Deductibles(top-up option):

Place: _ Proposer‟s Signature______

Date: __ Name: Designation