Literature Sales Prospectus: Heartbeat Health Insurance Plan

HEARTBEAT HEALTH INSURANCE PLAN
&
PROSPECTUS
SALES
LITERATURE

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
Recognition and Rewards

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 India website as on March 31st, 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.
Max India Group:

Max New York Life was declared a Superbrand by
Superbrands India in the 3rd 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
Heartbeat Health Insurance Plan

Start a healthy relationship
Heartbeat Health Insurance Plan from Max Bupa is
*(Source: www.maxindia.com)
#(Source - Bupa Annual Report published in March 2012)
the most comprehensive health insurance cover for you
grace period of 30 days of expiry of your previous
and your family. It gives you the flexibility to choose just
policy. You should renew on or before the renewal
the right cover for your needs. Apart from giving you a
date of the policy to ensure you have continued
comprehensive health insurance cover to suit your
medical insurance cover even during the grace period.
needs, we are also committed to provide you the best
As with all health insurance policies, you may save
quality service when you need it the most.
tax under Section 80D of the Income Tax Act
Which is why Max Bupa is the Healthier Health
when you buy a Max Bupa health insurance
Insurance for you and your family:
policy. (Tax benefits are subject to changes in the
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 childs 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 familys
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 onthe 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
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
1 Adult + 2 Children
2 Adults
2 Adults + 1Child
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
Individual Base Sum Insured Options for Gold - Rs
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
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:
plan you choose. The details of the plans are
Family Members
available in the product benefits table.
Father
66
In case of Family First:
Mother
65
Son
40
Flexible sum insured per person (one amount
Daughter-in law
39
chosen for all family members) as well as a
Total Individual Sum Insured
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:
Age
Individual Sum Insured (in lacs)
Family Floater Sum Insured

Total Sum Insured
2
8 lacs
5 lacs
13 lacs
The details of the plans are available in the product

benefits table for Family First Policy.Product
Product Features and Benefits Key Highlights
Individual Base Sum Insured Options for Silver are Rs 1L, 2L, Rs 3L, Rs 4L, & Rs 5L
The policy covers reasonable charges incurred towards
medical treatment taken during the Policy Period for an
be covered. Under Day Care Procedures we
Illness or an Accident. We cover the following expenses
will also cover Chemotherapy, Radiotherapy,
1. Inpatient Care: Medical Expenses for:

(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,
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:
at the time of hospitalisation. For Silver Family
(i) In-case of Family Floater: This benefit is
First plans, the insured persons can opt for Rs
available only to you or your spouse under
3,000 or a shared room, depending on their
family floater policy, only when you and your
preference.
spouse, are both covered under the same
3. Pre & Post hospitalization Medical Expenses:
policy. We pay Medical Expenses for the
Medical Expenses incurred due to Illness up to
delivery of a child, only after 24 months of
30 days period immediately before an Insured
continuous coverage since the inception of the
Persons admission to a Hospital and 60 days
first Policy with Us. There is a sub-limit on
immediately after an Insured Persons
maternity expenses as shown in the Product
discharge from a Hospital. These are payable
Benefit Table. Maternity benefits are paid only
for the same illness or treatment as long as we
twice during the lifetime of the Policy including
have accepted an inpatient hospitalization
any of its renewals. We will also cover medically
claim for that treatment or illness. These can
necessary termination of pregnancy. We will
be claimed only as reimbursements. .
cover the pre-natal & post-natal Medical
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
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 theinception 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 Persons
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:
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.
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
Medical Expenses for an organ donors treatment for
within our partner hospital network if the customer wishes
harvesting of the organ provided that the Insured
to avail of the same, of the equivalent value.
Person has been medically advised to undergo an
a. If the Policy Period is one year, we offer
organ transplant and the donation conforms to The
vouchers, in either electronic or physical form, worth
Transplantation of Human Organs Act 1994 and the
10% of your last premium received
organ is for the use of the Insured Person;
b. If the Policy Period is two years, we offer
We will not cover:
vouchers, in either electronic or physical form, worth 5% of
(a) Pre-hospitalisation or post-hospitalization Medical
the last premium received on the commencement of each
Expenses or screening expenses of the donor or any
Policy Year commencing from the second Policy Year.
other medical expenses as a result of the harvesting
The Insured Person may avail of the services and
from the donor;
products specified within the period specified in or
(b) Costs directly or indirectly associated with the
along with the voucher, provided that:
acquisition of the donors 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:
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
total Loyalty Additional Sum Insured allowed will be
of 50% of his base sum insured. The customer will not
calculated based on the new sum Insured of Rs.
have an option of opting for Earn n redeem as
200,000 and the customer cannot avail of the higher
mentioned above once he has opted for increasing his
amounts earned earlier.
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
Current Base
Sum Insured
200,000
200,000
1,000,000
1,000,000
1,000,000
200,000
200,000
1
2
3
4
5
6
7
Loyalty Additional
Sum Insured Amount
20,000
20,000
100,000
100,000
100,000
20,000
Cumulative Loyalty
Additional Sum Insured
20,000
40,000
Rs.140,000
240,000
100,000
100,000
Total Sum Insured

200,000
220,000
1,040,000
1,140,000
1,240,000
300,000
300,000
(All Figures in INR)
We offer a 10% increase on the expiring Base Sum

Insured on each Policy Year up to a maximum of 50% of
12. Consultation and Diagnostic Tests Carry Forward
Base Sum Insured of that Policy Year provided the Policy
(for Platinum Policyholders only): We will cover
is renewed continuously
reasonable charges for Insured Persons medically
Illustration:
necessary consultation with a Medical Practitioner, as
The Loyalty additional Sum Insured is calculated as 10% of

the expiring policys 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 Insured for the
an OPD Treatment to assess the Insured Persons

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 Practitioners prescription up
to the sub-limits shown in the product benefits table.
next year to 220,000. Like this the Total Loyalty

additional Sum Insured can be accumulated till 50%(Rs
If the Policy is renewed with us without any break and
100,000) of the base sum insured of Rs 200,000, if the
there is a unutilized amount (not used by the Insured
customer renews the policy for 200,000 continuously.
Person) under the applicable sub-limit (as specified in

the product benefit table) in a Policy Year, then we will
However, If at the next renewal he increases his base
carry forward 80% of this unutilized amount to the
Sum Insured to Rs 10,00,000 from Rs. 200,000, he
immediate succeeding Policy Year. The total amount
gets Rs. 20,000 Loyalty additional Sum Insured, which
(including the unutilized amount available under this
is10% of the expiring base Sum Insured Rs. 200,000.
benefit) should not exceed 2.5 times the amount of
This takes his total loyalty additional Sum Insured to
the entitlement in respect of this benefit under the
40,000 and his total Sum Insured for that policy to Rs.
plan applicable to the Insured Person as per the
10,40,000. The Loyalty additional Sum Insured earned
Product Benefits Table.
at renewal does not become a part of the base Sum

Insured for any current year. At next renewal the Loyalty
Illustration of how the above carry forward works as

follows (All figures in INR):
additional Sum Insured is calculated as 10% of expiring
Illustration 1: Sum Insured:
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
15 lacs, Out-patient benefits sub-limit Rs. 10,000/Yr
Fresh
OPD sublimit for
the year
Maximum
allowed (2.5
times sublimit)
Sub-limit
available
for the year
OPD
claims
made in
the year
Unutilized
limit at the
end of the
year
Sub-limit
carried
forward from
previous
year
-
10,000
25,000
10,000
10,000
Sub-limit
carried
forward to
the next
year
8,000
2
3
8,000
14,400
10,000
10,000
25,000
25,000
18,000
24,400
2,500
18,000
21,900
14,400
17,520
4
5
17,520
20,000
10,000
10,000
25,000
25,000
25,000
25,000
3,000
25,000
22,000
20,000
17,600
17,600
10,000
25,000
25,000
25,000
20,000
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
Illustration 2 (All Figures in INR): Sum Insured: 50 lacs,
once the insured person is 65 years or age or older.
Out-patient benefits sub-limit Rs. 20,000/-
The reduction in co-pay is a benefit being given to
Year
Fresh
OPD
sub-limit
for the
year
Maximum
allowed (2.5
times sublimit)
Sub-limit
available
for the
year
OPD
claims
made in
the year
Unutilized
limit at the
end of the
year
Sub-limit
carried
forward to
the next
year
Sub-limit
carried
forward
from
previous
year
-
20,000
50,000
20,000
20,000
16,000
16,000
20,000
50,000
36,000
36,000
28,800
28,800
20,000
50,000
48,800
48,800
39,040
39,040
20,000
50,000
50,000
50,000
40,000
40,000
20,000
50,000
50,000
50,000
40,000
40,000
20,000
50,000
50,000
17,500
32,500
26,000
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
13. Co-Payment
Customers who opt for the Platinum plan of the
If any insured person is 65 years of age or over on the
Heartbeat with Sum Insured ranging from 15 lacs to 1
date of commencement of current policy year, then we
cr on Individual policies and Family Floater, and Family
will pay the percentage provided in the table below of
First Platinum Plans get additional benefits ranging
any assessed claim amount
from preventive health care, alternative therapies and

outpatient treatments, treatment outside of India,
Co-payment contribution table:
making it an exhaustive and best quality health cover

for the entire family providing the best quality
No of Years of Continuous renewal at or later

than the age of 65 years
Percentage of any assessed claim amount

payable by Us
0 year
80%
healthcare options available. These benefits are
1yr
85%
offered within the geographical and sum-insured
2 yrs
90%
sub-limits presented in the Product Benefit table.
3 yrs
95%
4 yrs or more
100% (No Co-payment)
The above Co-pay grid means that the Percentage of

any assessed claim amount payable by Us increases by
5% for every continuous renewal.
of the first Policy Inception then the Co-pay that would

have applied at the age of 65 years would reduce as
of
Age
of
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
per the table below,

Years
medically necessary consultation as an outpatient with

outpatient treatment will also include alternative
If the insured person is of the age 63 years at the time
of
Policyholders only): Reasonable charges towards

a doctor to assess the Insured Persons condition. The
Illustration of how the above co-pay works:
No
14. Consultation and Diagnostic Tests (for Platinum
Benefit Table.
the
Insured
Percentage of any assessed claim amount
Continuous renewal
person
payable by Us when the insured person 65

years of age or older
0 yrs
Year)
63 yrs
100% (no co-pay in this policy year)
15. Child Care Benefits (for Platinum Policyholders
1 yr
64 yrs
100% (no co-pay in this policy year)
only): We will cover reasonable charges for specified
2 yrs
65 yrs
90% (co-pay starts at the age of 65 yrs,
(First
Policy
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%)

4 yrs
68 yrs
th
100% (co-pay reduces to zero after 4

th
Continuous renewal or in other words in the 5
year of Continuous coverage)
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
It should be noted that the Co-pay is applicable only
Hospitalization(for Platinum Policyholders only)
(i) Emergency Medical Evacuation and

Hospitalization (Outside India) In case of a medical
a) Claims for Emergency Medical Evacuation

(i) In the event of an Emergency, Our Service
emergency outside India we will provide assistance in
Provider shall be contacted immediately on the
medical evacuation of the Insured Person and cover the
helpline number specified in the Insured Persons
reasonable charges for transportation of the Insured
health card.
Person (and an attending Doctor if this is medically

necessary) following an emergency, to the nearest
(ii) Our Service Provider will evaluate the
Hospital which is prepared to admit the Insured Person
necessity for evacuation of the Insured Person and if
provided that: Necessary medical treatment cannot be
the request for Medical Evacuation is approved, the
provided at a Hospital where the Insured Person is
Service Provider shall pre-authorise the type of travel
situated at the time of emergency; and our service
that can be utilized to transport the Insured Person
provider has approved the request for Medical
and provide information on the nearest Hospital that
Evacuation. The medical evacuation has been prescribed
may be approached for medical treatment of the
by a Medical Practitioner and is medically necessary.
Insured Person.
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
(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.
The Medical Emergency Evacuation service is on best

efforts basis and Max Bupa does not make any
b) Cashless Hospitalization in Emergency at Network
guarantee and/or assume the responsibility for the
Hospitals:
appropriateness, quality or effectiveness of the
The health card We provide will enable the Insured
treatment/facilities sought or provided by, or arranged
Person to access medical treatment at any
by the Service Provider while approving the
Network Hospital outside India, but within those
pre-authorization or providing the evacuation service.
regions specified in the Schedule of Insurance
For details refer to the Terms and Conditions of the
Certificate, on a cashless basis only by the production
Policy Document.
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 Persons 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 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.
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
same is payable only if the procedure is done

subsequent to Myocardial infarction or Anginal attack.
of inadequate blood supply to the relevant area.

vii. Primary Pulmonary Arterial Hypertension
iii. Coronary Artery Bypass Graft (CABG)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.
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.
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.
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.
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
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;
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.
10
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
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.
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,
treatment is being taken.
Deductible Option
(top-up) in INR
1 lac Deductible
d.
2 lac Deductible
2 lacs & 3 lacs
33.0%
3 lac Deductible
2 lacs & 3 lacs
45.0%
Any costs or expenses incurred in relation to
accommodation or stay or transportation in the

overseas location where treatment is being taken.
Available for Sum Insured

(INR)
2 lacs & 3 lacs
Applicable discount in premium

calculation
25.0%
If an annual aggregate deductible is chosen then the

Insured Person shall bear all assessed claim amounts
e.
Any pre-Hospitalization or post-Hospitalization
payable under the policy up to the deductible amount,
costs or expenses incurred by or on behalf of the
under his(her) policy for any Policy Year. Our liability
Insured Person.
to make payment under the Policy in respect of any

claim made in that Policy Year will only commence
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 .
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)
Other optional benefits (Only one of the co-pays or
By accepting this condition you will agree to pay
the deductibles can be chosen for any single policy)
yourself or from another health insurance policy the

first 2 lac of the total claim amount assessed for
18. Co-payment discount options(optional benefit)
11
payment in one policy year. All claims will be assessed

by Us as per the Terms and Conditions of this policy.
If you are aged less than 65 years you can avail a
Max Bupa will start paying claims as per the policy
discount in premium calculation by opting for any one
Terms and Conditions once the total claim amount
of the below co-pay options. This will allow you to
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.
company Sum Insured: 3 Lacs

In this case there is an overlap of coverage with the
Please find below the two illustrations for the working
other insurance policy. So in this case customer has an
of the aggregate annual deductible(top-up option)
option to choose the insurance company from which

claim to be settled.
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
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
Health Insurance Policy from any other insurance
deductible, if the customer chooses Max Bupa to settle
company Sum Insured: 2 Lacs
the claim, no contribution clause will be applied
Rules:
For aggregate claim amounts above the annual
Balance
Deductible
Available
Sum
Available
Sum
Claim
amount paid
Claim
Amount
(INR)
(INR)
Insured
in
Heartbeat
policy
by the other
insurance
policy or the
customer
(INR)
-
paid
Us
(INR)
At
Inception
Claim 1
200,000
(INR)
300,000
20,000
20,000
1,80,000
300,000
300,000
20,000
Claim 2
Claim 3
1,80,000
2,40,000
1,80,000
0
0
0
300,000
300,000
2,80,000
1,00,000
1,80,000
0
0
2,40,000
of Contribution clause. So the first 2 lacs of aggregate

other insurer's policy.
Deductible
Exhaustion
Assessed
by
Us
(INR)
Insured in
Other
Insurer's
policy
(INR)
300,000
Deductible exhaustion will be calculated without use

annual claims in this example will be paid for by the
Claim
Amount
by
deductible,
Additional Services
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
24/7 Healthline. This facility has been put in place
to offer you access to health advice when you need it

the most.
lacs, Max Bupa will pay 100% of the assessed claim
Relationship Managers (For Gold and Platinum
amount above Rs 2 lacs up to the Sum Insured.
Policyholders): We may assign at our discretion, our

representative who will personally attend to your claims
Claim
Amount
Assessed
by Us
Deductible
Exhaustion
Balance
Deductible
Available
Sum Insured
in Heartbeat
policy
Claim
amount paid
by the other
insurance
policy or the
Claim
Amount
paid by Us
customer
-
At
Inception
Claim 1
200,000
300,000
20,000
20,000
1,80,000
300,000
20,000
Claim 2
Claim 3
1,90,000
3,60,000
1,80,000
0
0
0
300,000
290,000
1,80,000
0
10,000
2,90,0000
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.
Illustration 2: When there is an overlap of Sum
by our own customer services team.
Direct Servicing All claims are processed directly
Insured between the Max Bupa policy and another

HI policy, along with the annual aggregate
Deductible (top-up) option
Waiting Periods and Exclusions:
Heartbeat Policy Plan opted for Sum Insured: 3 Lacs
Claims for the following are not covered:
with an annual aggregate Deductible: 2 lacs
Health Insurance Policy from any other insurance
available for Pre-existing Conditions for Gold and
Pre-Existing Conditions: Benefits will not be
12
Platinum plans until 24 months and for all Silver plans
until 48 months of continuous coverage have elapsed
disorders; Ageing and puberty; Artificial life
since the inception of the first Policy with Us.
maintenance; Circumcision; Conflict and disaster;
Congenital conditions; Convalescence and
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:
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
Stones in the urinary system (eg kidney/bladder); *
India(except for treatment undertaken under
Stones in billiary system (eg gallstones);* Cataract;
Emergency Medical Evacuation and Hospitalization (for
*BPH - Benign prostatic hypertrophy; *
Platinum Policyholders only) or Specified Illness Cover
Mennoraghia, * Fibromyoma, *Uterine prolapse
for treatment abroad (For Platinum Policyholders only)
including any condition requiring Hysterectomy; *
of the Policy Document); Unlawful activity;
Piles (Haemorrhoids); * Hernia (Inguinal/umbilical
Unrecognised physician or Hospital, Genetic disorders;
and gastric); * Degenerative disorders of knee/hip;
any other such permanent exclusions as may be
* Chronicrenal failure or end stage renal failure; *
specified in the Schedule, any expenses as mentioned
Retinopathy; * Diabetes and related treatments
below for hospitalization treatment.
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
conducting an ECG if the report is not normal than a
personal waiting period for heart disease will be
applied post risk assessment.
13
Permanent Exclusions: Addictive conditions and
LIST OF GENERALLY EXCLUDED IN HOSPITALISATION POLICY

S.No. List of Expenses Generally
SUGGESTIONS
Excluded ("Non-Medical") in
Hospital Indemnity Policy TOILETRIES / COSMETICS / PERSONAL COMFORT OR
CONVENIENCE ITEMS
1
HAIR REMOVAL CREAM
Not Payable
2
BABY CHARGES
Not Payable
(UNLESS SPECIFIED/INDICATED)
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
MOISTURIZER PASTE BRUSH
Not Payable
11
POWDER
Not Payable
12
RAZOR
Payable
13
SHOE COVER
Not Payable
14
BEAUTY SERVICES
Not Payable
15
BELTS/ BRACES
Essential and may
be paid specifically
for cases who have
undergone surgery of
thoracic or lumbar
spine.
16
BUDS
Not Payable
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
23
DISPOSABLES RAZORS CHARGES Payable
(for site preparations)
24
EAU-DE-COLOGNE /
Not Payable
ROOM FRESHNERS
25
EYE PAD
Not Payable
26
EYE SHEILD
Not Payable
27
EMAIL / INTERNET CHARGES
Not Payable
28
FOOD CHARGES (OTHER THAN
Not Payable
PATIENT'S DIET PROVIDED
BY HOSPITAL)
29
FOOT COVER
Not Payable
30
GOWN
Not Payable
31
LEGGINGS
Essential in bariatric
and varicose vein
surgery and should be
considered for these
conditions 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
44
45
46
BED UNDER PAD CHARGES

CAMERA COVER
CLINIPLAST
CREPE BANDAGE
47
48
49
CURAPORE
DIAPER OF ANY TYPE
DVD, CD CHARGES
50
51
52
53
54
55
56
EYELET COLLAR
FACE MASK
FLEXI MASK
GAUSE SOFT
GAUZE
HAND HOLDER
HANSAPLAST/ADHESIVE
BANDAGES
INFANT FOOD
SLINGS
57
58
59
60
61
62
63
64
65
66
67
68
69
70
Not Payable
Not Payable
Not Payable
Not Payable / Payable
by the patient
Not Payable
Not Payable
Not Payable
(However if CD is
specifically sought by
Insurer / TPA then
payable)
Not Payable
Not Payable
Not Payable
Not Payable
Not Payable
Not Payable
Not Payable
Not Payable
Reasonable costs for
one sling in case of
upper arm fractures
should be considered
ITEMS SPECIFICALLY EXCLUDED IN THE POLICIES
WEIGHT CONTROL PROGRAMS/ Exclusion in policy
SUPPLIES/ SERVICES
unless otherwise
specified
COST OF SPECTACLES/ CONTACT Exclusion in policy
LENSES/ HEARING AIDS ETC.,
unless otherwise
specified
DENTAL TREATMENT EXPENSES Exclusion in policy
THAT DO NOT REQUIRE
unless otherwise
HOSPITALISATION
specified
HORMONE REPLACEMENT
Exclusion in policy
THERAPY
unless otherwise
specified
HOME VISIT CHARGES
Exclusion in policy
unless otherwise
specified
INFERTILITY/ SUBFERTILITY/
Exclusion in policy
ASSISTED CONCEPTION
unless otherwise
PROCEDURE
specified
OBESITY (INCLUDING MORBID
Exclusion in policy
OBESITY) TREATMENT IF
unless otherwise
EXCLUDED IN POLICY
specified
PSYCHIATRIC &
Exclusion in policy
PSYCHOSOMATIC DISORDERS
unless otherwise
specified
CORRECTIVE SURGERY FOR
Exclusion in policy
REFRACTIVE ERROR
unless otherwise
specified
TREATMENT OF SEXUALLY
Exclusion in policy
TRANSMITTED DISEASES
unless otherwise
specified
DONOR SCREENING CHARGES
Exclusion in policy
unless otherwise
specified
ADMISSION/REGISTRATION
Exclusion in policy
CHARGES
unless otherwise
specified
14
71
HOSPITALISATION FOR EVALUATION/ Exclusion in policy

DIAGNOSTIC PURPOSE
unless otherwise
specified
72
EXPENSES FOR INVESTIGATION/ Not payable TREATMENT IRRELEVANT TO THE Exclusion in
DISEASE FOR WHICH ADMITTED policy unless
OR DIAGNOSED
otherwise specified
ANY EXPENSES WHEN THE PATIENT Not payable as
73
IS DIAGNOSED WITH RETRO
HIV/AIDS per
VIRUS + OR SUFFERING FROM
exclusion
/HIV/AIDS ETC IS DETECTED/
DIRECTLY OR INDIRECTLY
STEM CELL IMPLANTATION/ SURGERY Not Payable except
74
and storage
Bone Marrow
Transplantation where
covered by policy
ITEMS WHICH FORM PART OF HOSPITAL SERVICES WHERE
SEPARATE CONSUMABLES ARE NOT PAYABLE BUT THE
SERVICE IS
75
WARD AND THEATRE BOOKING Payable under OT
CHARGES
Charges, not payable
separately
76
ARTHROSCOPY & ENDOSCOPY
Rental charged by the
INSTRUMENTS
hospital payable.
Purchase of
Instruments not
payable.
77
MICROSCOPE COVER
Payable under OT
separately
78
SURGICAL BLADES, HARMONIC Payable under OT
SCALPEL, SHAVER
separately
79
SURGICAL DRILL
Payable under OT
separately
80
EYE KIT
Payable under OT
separately
81
EYE DRAPE
Payable under OT
separately
82
X-RAY FILM
Payable under
Radiology Charges,
not as consumable
83
SPUTUM CUP
Payable under
Investigation Charges,
not as consumable
84
BOYLES APPARATUS CHARGES
Part of OT Charges,
not seperately
85
BLOOD GROUPING AND CROSS Part of Cost of Blood,
MATCHING OF DONORS SAMPLES not payable
86
Antiseptic or disinfectant lotions Not Payable -Part of
Dressing Charges
BAND AIDS, BANDAGES, STERLILE Not Payable -Part of
87
INJECTIONS, NEEDLES, SYRINGES Dressing Charges
88
COTTON
Not Payable -Part of
Dressing Charges
89
COTTON BANDAGE
Dressing Charges
90
MICROPORE/ SURGICAL TAPE
Not Payable-Payable
by the patient when
prescribed, otherwise
included as Dressing
Charges
91
BLADE
Not Payable
15
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
APRON

Hospital Services /
Disposable linen to be
part of OT/ICU charges
TORNIQUET
Not Payable (service is
charged by hospitals,
consumables cannot
be separately charged)
ORTHOBUNDLE,
Part of Dressing
GYNAEC BUNDLE
Charges
URINE CONTAINER
Not Payable
ELEMENTS OF ROOM CHARGE
LUXURY TAX
Actual tax levied by
government is
payable. Part of room
charge for sub limits
HVAC
Part of room charge
not payable separately
HOUSE KEEPING CHARGES
Part of room charge
SERVICE CHARGES WHERE
Part of room charge
NURSING CHARGE ALSO
CHARGED
TELEVISION & AIR CONDITIONER Payable under room
CHARGES
charges not if
separately levied
SURCHARGES
Part of room charge
ATTENDANT CHARGES
Not Payable - Part of
Room Charges
IM IV INJECTION CHARGES
Part of nursing
charges, not payable
CLEAN SHEET ^
Part of Laundry /
Housekeeping not
payable separately
EXTRA DIET OF PATIENT
Patient Diet provided
(OTHER THAN THAT WHICH
by hospital is payable
FORMS PART OF BED CHARGE)
BLANKET/WARMER BLANKET
Not Payable- part of
ADMINISTRATIVE OR
room charges
NON-MEDICAL CHARGES
ADMISSION KIT
Not Payable
BIRTH CERTIFICATE
Not Payable
BLOOD RESERVATION CHARGES Not Payable
AND ANTE NATAL BOOKING
CHARGES
CERTIFICATE CHARGES
Not Payable
COURIER CHARGES
Not Payable
CONVENYANCE CHARGES
Not Payable
DIABETIC CHART CHARGES
Not Payable
DOCUMENTATION CHARGES /
Not Payable
ADMINISTRATIVE EXPENSES
DISCHARGE PROCEDURE
Not Payable
CHARGES
DAILY CHART CHARGES
Not Payable
ENTRANCE PASS / VISITORS
Not Payable
PASS CHARGES
EXPENSES RELATED TO
To be claimed by
PRESCRIPTION ON DISCHARGE
patient under Post
Hosp where admissible
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
FILE OPENING CHARGES

INCIDENTAL EXPENSES / MISC.
CHARGES (NOT EXPLAINED)
MEDICAL CERTIFICATE
MAINTENANCE CHARGES
MEDICAL RECORDS
PREPARATION CHARGES
PHOTOCOPIES CHARGES
PATIENT IDENTIFICATION BAND /
NAME TAG
WASHING CHARGES
MEDICINE BOX
MORTUARY CHARGES
Not Payable
Not Payable
Not Payable
Not Payable
Not Payable
Not Payable
Not Payable
Not Payable
Not Payable
Not Payable
Payable upto 24 hrs,
shifting charges not
payable
Not Payable
MEDICO LEGAL CASE CHARGES

(MLC CHARGES)
EXTERNAL DURABLE DEVICES
WALKING AIDS CHARGES
Not Payable
BIPAP MACHINE
Not Payable
COMMODE
Not Payable
CPAP/ CAPD EQUIPMENTS Device Not Payable
INFUSION PUMP - COST Device
Not Payable
OXYGEN CYLINDER (FOR USAGE Not Payable
OUTSIDE THE HOSPITAL)
PULSEOXYMETER CHARGES Device Not Payable
SPACER
Not Payable
SPIROMETRE Device
Not Payable
SP0 2PROB E
Not Payable
NEBULIZER KIT
Not Payable
STEAM INHALER
Not Payable
ARMSLING
Not Payable
THERMOMETER
Not Payable (paid by
patient)
CERVICAL COLLAR
Not Payable
SPLINT
Not Payable
DIABETIC FOOT WEAR
Not Payable
KNEE BRACES ( LONG/ SHORT/
Not Payable
HINGED)
KNEE IMMOBILIZER/SHOULDER Not Payable
MMOBILIZER
LUMBOSACRAL BELT
Essential and should
be paid specifically for
cases who have
undergone surgery of
lumbar spine.
NIMBUS BED OR WATER OR
Payable for any ICU
AIR BED CHARGES
patient requiring
more than 3 days in
ICU, all patients with
paraplegia /quadriplegia
for any reason and at
reasonable cost of
approximately
Rs. 200/- day
AMBULANCE COLLAR
Not Payable
AMBULANCE EQUIPMENT
Not Payable
MICROSHEILD
Not Payable
Essential and should
ABDOMINAL BINDER
be paid in post
surgery patients of
major abdominal
surgery including TAH,
LSCS, incisional hernia

repair, exploratory
laparotomy for
intestinal obstruction,
liver transplant etc.
ITEMS PAYABLE IF SUPPORTED BY A PRESCRIPTION
BETADINE\HYDROGEN PEROXIDE\ May be payable when
156
SPIRIT\DISINFECTANTS ETC
prescribed for patient,
not payable for
hospital use in OT or
ward or for dressings
in hospital
157
PRIVATE NURSES CHARGESPost hospitalization
SPECIAL NURSING CHARGES
nursing charges not
Payable
NUTRITION PLANNING CHARGES- Patient Diet provided
158
DIETICIAN CHARGES DIET
by hospital is payable
CHARGES
159
SUGAR FREE Tablets
Payable -Sugar free
variants of admissable
medicines are not
excluded
160
CREAMS POWDERS LOTIONS
Payable when
prescribed (Toileteries
are not payable, only
prescribed medical
pharmaceuticals
payable)
161
Digestion gels
Payable when
prescribed
162
ECG ELECTRODES
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 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
Payable when
MOUTHWASH
prescribed
166
LOZENGES
Payable when
prescribed
167
MOUTH PAINT
Payable when
prescribed
168
NEBULISATION KIT
If used during
hospitalization
is payable reasonably
169
NOVARAPID
Payable when
prescribed
170
VOLINI GEL/ ANALGESIC GEL
Payable when
prescribed
171
ZYTEE GEL
Payable when
prescribed
172
VACCINATION CHARGES
Routine Vaccination
not Payable / Post
Bite Vaccination
Payable
PART OF HOSPITAL'S OWN COSTS AND NOT PAYABLE
173
AHD
Hospital's internal
Cost
174
ALCOHOL SWABES
16
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
17
SCRUB SOLUTION/STERILLIUM
OTHERS
VACCINE CHARGES FOR BABY
AESTHETIC TREATMENT/SURGERY
TPA CHARGES
VISCO BELT CHARGES
ANY KIT WITH NO DETAILS
MENTIONED [DELIVERY KIT,
ORTHOKIT, RECOVERY KIT, ETC]
EXAMINATION GLOVES
KIDNEY TRAY
MASK
OUNCE GLASS
OUTSTATION CONSULTANT'S/
SURGEON'S FEES
Hospital's internal
Cost
Hospital's internal
Cost
Payable as per plan
Not Payable
Not Payable
Not Payable
Not Payable
Not Payable
Not Payable
Not Payable
Not Payable
Not payable, except
for telemedicine
consultations where
covered by policy
OXYGEN MASK
Not Payable
PAPER GLOVES
Not Payable
PELVIC TRACTION BELT
Should be payable in
case of PIVI) requiring
traction as this is
generally not reused
REFERAL DOCTOR'S FEES
Not Payable
ACCU CHECK (Glucometery / Strips) Not payable pre
hospitilasation
or post hospitalisation
/ Reports and Charts
required / Device not
payable
PAN CAN
SOFNET
TROLLY COVER
UROMETER, URINE JUG
AMBULANCE
TEGADERM / VASOFIX SAFETY

URINE BAG P
SOFTOVAC
STOCKINGS
Not Payable
Not Payable
Not Payable
Not Payable
Payable-Ambulance
from home to
hospital or interhospital
shifts is payable/ RTA
as specific requirement
is payable
Payable - maximum
of 3 in 48 hrs and
then 1 in 24 hrs
Payable where
medicaly necessary till
a reasonable cost maximum 1 per 24hrs
Not Payable
Essential for case like
CABG etc. where it
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:
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
premium in full and case acceptance is subject to
Policy; and/or
medical underwriting. We would also need the
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:
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
The Policy shall automatically terminate in the event of
another policy at the time of renewal, provided the
death of the Insured Person.
application and completed Portability Form is received
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
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
cancellation/termination shall be payable in case of an
The portability benefit guidelines may be modified by
automatic cancellation of the Policy provided that no
us from time to time depending on the guidance
claim has been filed under the Policy by or on behalf of
issued by the Insurance Regulatory and Development
any Insured Person.
Authority as amended from time to time.
Portability Benefit
Notification
From another company to Our Policy
You will inform Us immediately of any change in the
If the proposed Insured Person was insured

continuously and without a break under another
Indian retail health insurance policy with any other
address, nature of job, state of health, or of any other

changes affecting You or any Insured Person through
the format Annexure A.
Indian Insurance company, the customer can avail the
We shall allow the enhancement in Sum Assured or
portability benefit provided they have submitted the
scope of cover only at the time of Renewal, provided
application with complete documentation 21 days
You intimate Us at the time of Renewal. The decision
before the expiry of their present period of Insurance,
of acceptance of enhancement of the sum insured or
at the time of renewal. The benefit will be available up
the scope of cover will be based on our underwriting
to the existing cover. If the Sum Insured is more than
policy and shall be subject to payment of applicable
that of the last issued policy, waiting periods will be
premium for such enhanced cover.
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
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
18
amount of premium is dependent on the age of the
and Family First policies, can be applied for at the time
Insured Person and the geographical locations. The
of renewal. These changes shall be accepted subject to
reference of age for calculating the premium for Family
the renewal terms and as per our underwriting policy.
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
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)
from any of the continuity benefits (for example for
Pre-Existing Conditions). Renewal of the Policy will not
Hospitals: We will provide cashless hospitalization
ordinarily be denied other than on grounds of moral
facility at our network hospitals. We pre-authorise all
hazard, misrepresentation and fraud. Please note that
cashless in-patient and day care procedure, if
coverage is not available for the period for which no
intimated to us in writing 72 hours before
premium is received.
hospitalization (andwithin 48 hours after
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.
Cashless Hospitalization Facility for Network
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
4. Maximum Age: There is no maximum coverage
necessary documents by the Insured Person. To claim
ceasing age in this policy
re-imbursements for any Illness or Accident or medical
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
19
Obligations in case of a minor
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
(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
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.
break-up and paid receipt.
Revision or Modification
(7) Original bills of medicines purchased, or of any
Max Bupa in future may revise or modify this product
other investigation done outside hospital with reports
post clearance of the authority basis the guidelines
and requisite prescriptions. .
issued by them. We will notify You of any such change
(8) Invoice of major accessories in case billed and

utilized during treatment (if not included in the final
atleast 3 months prior to the date when such revision

or modification will come into effect.
hospital bill).
Premium:
(9) For Medicolegal cases (MLC/FIR copy attested by
the concerned hospital / police station (if applicable).
and 3 geographical zones.
(10)
Original self-narration of incident in absence of
MLC / FIR.
(11)
Original first consultation paper (in case

Original Laboratory Investigation reports.
(13)
Original X-Ray/ MRI / Ultrasound films and
other Radiological investigations

(14)
Indoor case paper/OT notes (if required)
Annual premium in INR (excluding service tax
and applicable cess) as per rate tables.

Sum
Insured
(Rs)
disease is first time diagnosed).

(12)
Premium is dependent on age of the insured
200,000
(Min)
10000000
(Max)
Premiums applicable for different ages for a standard healthy life

(Rs. per annum)
For 25
For 30 For 40 For 50 For 60
For 65
For 70
years
years years
years
years
years
years
3,204
3,366
4,235
7,340
12,042
16,166
21,103
52,319
53,273
62,955
80,729
105,306
128,410
162,028
Disclosure:
All customers personal information collected
or held by Max Bupa may be used by Max Bupa for

-
Details of any other insurance policy that may
processing the claims and analysis related to
respond to the claim.
insurance / reinsurance business.
We might request for any other documents or
Product Benefits Tables
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).
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.
Nomination Facility: You are mandatorily required at

the inception of the Policy, to make a nomination for
20
1. Every Customer will be assigned a unique customer
If all questions are answered with NO the proposal
identification number on the Max Bupa system
form is processed accordingly with acceptance and
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?
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.
21
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
Member
pain, fatigue, weight loss, dizziness, joint pain, change
Individual Cover Sum

Insured (Lacs)
Total Rated up Sum Insured per

member for triggering medicals
(Lacs)
in bowel habit, shortness of breath, abdominal pain,
Proposer (Self)
rectal bleeding?
Spouse
Father
medicines, prescribed or otherwise?
Mother
Son
Are you or any prospective customer taking any

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
Family floater Cover Sum

Insured
5Lacs
health that has not been prompted by the questions
The table below indicates where a medical checkup is
listed above?
initially required with the proposal form.
If the answer to any of the above questions is YES

then further medical assessment and review may be
requested by the Underwriter.
Age (in Years)

Below 1
Upto 39
40-44
45-59
60 and above
Individual Plan
Decline*
No Check-up
Level 3
Level 3
Level 3
Family Floater Plan

Discharge Summary*
No Check-up
No Check-up
Level 3
Level 3
Family First Plan

No Check-up*
No Check-up
No Check-up
No Check-up
Level 3
* Individual plan Individual proposal where proposed

insured is below one year of age will be declined unless
Upon full assessment of clinical and historical facts,
the proposed insured is part of a family which is
the Underwriter, with possibly second opinion, has
insured with us.
discretion to decide if the proposal submitted presents

a future risk.
Family Floater and Family First plans Discharge

Summary and/or MER will be called for.
The medical check-up are spread in levels depending
Pre-policy health check-up requirements:

For specific ages and sum assured, a medical checkup
is required as part of the underwriting process. The
on the plan and Age

Category
Level 3
Tests
MER, RUA,Hba1c, TCHOL,GGT,HDL, SCREAT,SGOT,SGPT, ECG
table below indicates where a medical checkup is

initially required with the proposal form:
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
TMT will be triggered as per Underwriters 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.
the exact medicals to be triggered as per the medical
These tests will be valid for a period of 3 months (6
grid below.
months for sub-standard life). The tests can be
For e.g. A Family First Policy has following members

covered:
conducted only through a Max Bupa empanelled

provider. In case the proposal is accepted the costs of
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
22
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

Bupas Heartbeat Health Insurance plan and/or would like a
personal quote, speak to our specially trained sales team or
your local advisor. Theyll 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
23
Annexure A
Format to be filled up by the proposer for change in occupation of the Insured

Policy
Number
Name of
the
Insured
Date of
birth/Age
Relationship
with Primary
Insured
City of
residence
Previous Occupation or
Nature of Work
New Occupation or
Nature of Work
Place: _____________
Proposers Signature__________________
Date: ______________
Name:__________ Designation__________
(DD/MM/YYYY)
24
What to do next
If you wish to know more about Group Health Insurance plan and/or
would like a personal quote, speak to our specially trained sales team
or your local advisor. They will take time to fully understand your
requirements and help you select the right plan.
Web: www.maxbupa.com
Phone:1800 3010 3333 (Toll Free) or 011-3300 3333
Disclaimer: This is only a summary of the product features and is for reference purpose only. For more details on terms and
conditions, exclusions, waiting period and risk factors, please read sales brochure carefully before concluding a sale. The details
of benefits available shall be as described in the policy document, and will be subject to the policy terms, risk factors, conditions
and exclusions. Please call our customer service on the numbers / contact details as provided above if you require any further
information or clarification.
Insurance is a subject matter of solicitation Max, Max Logo are registered trademarks of Max India Limited Bupa and the
HEARTBEAT logo are the registered service marks of the The British United Provident Association Limited. All these marks are
being used under license by Max Bupa Health Insurance Company Limited. UAN No. MB/WB/2014-2015/304 and IRDA
Registration no. 145. For more details on terms and conditions, exclusions, waiting period and risk factors, please read sales
brochure carefully before concluding a sale.
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 publishable prospectus or the tables of the insurer. Any person making default
Registered Office : Max House, 1 Dr. Jha Marg, Okhla, New Delhi 110020
Corporate Office :Block B1/I-2, Mohan Cooperative Industrial Estate, Mathura Road, New Delhi -110044
www.maxbupa.com
HB/SP/0414/V3
in complying with the provision of this section shall be punishable with fine, which may extend to five hundred rupees.

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HEARTBEAT HEALTH INSURANCE PLAN

HEARTBEAT HEALTH INSURANCE PLAN

OUR PARENT COMPANIES

Recognition and Rewards

healthcare with a strong presence in Life Insurance

and Clinical Research (through Max Neeman

Medical International Limited).

satisfaction to more than 5 million customers(Source

Bupa - 65 years of Care

10.84 million customers in over 190

countries and employs over 52,000 people.(Source

Max India Group:

Heartbeat Health Insurance Plan

the most comprehensive health insurance cover for you

grace period of 30 days of expiry of your previous

and your family. It gives you the flexibility to choose just

policy. You should renew on or before the renewal

date of the policy to ensure you have continued

comprehensive health insurance cover to suit your

medical insurance cover even during the grace period.

needs, we are also committed to provide you the best

As with all health insurance policies, you may save

quality service when you need it the most.

tax under Section 80D of the Income Tax Act

Which is why Max Bupa is the Healthier Health

when you buy a Max Bupa health insurance

Insurance for you and your family:

policy. (Tax benefits are subject to changes in the

You talk to us directly, not through any third

tax laws, please consult your tax advisor for more

The family includes spouse and dependent

the individual age of each insured customer in the

Individual Base Sum Insured Options for Gold - Rs

In case of Individual or Family Floater - range

1L, Rs 2L, Rs 3L, Rs 4L, Rs 5L, Rs10L and Rs 15L

plan you choose. The details of the plans are

available in the product benefits table.

In case of Family First:

Flexible sum insured per person (one amount

chosen for all family members) as well as a

Total Individual Sum Insured

floating amount that can be utilised once the

Individual Sum Insured (in lacs)

Family Floater Sum Insured

The details of the plans are available in the product

Product Features and Benefits Key Highlights

The policy covers reasonable charges incurred towards

medical treatment taken during the Policy Period for an

be covered. Under Day Care Procedures we

Illness or an Accident. We cover the following expenses

will also cover Chemotherapy, Radiotherapy,

1. Inpatient Care: Medical Expenses for:

Hemodialysis, or any procedure which needs a period

at the time of hospitalisation. For Silver Family

(i) In-case of Family Floater: This benefit is

First plans, the insured persons can opt for Rs

available only to you or your spouse under

3,000 or a shared room, depending on their

family floater policy, only when you and your

spouse, are both covered under the same

3. Pre & Post hospitalization Medical Expenses:

policy. We pay Medical Expenses for the