Max Bupa Health Plus - Insurance Policy
COVID 19 CORONA
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COVERED COVERED
Policy Details
Sum Insured Premium (Incl Premium per Policy Tenure Plan Age Limit
GST) day
Rs 100,000 1,150 Rs.3.15 1 year Self Individual plan for BFL Customer Min 18 years – Max 60 years
Rs 500,000 2525 Rs.6.91 1 year Self Individual plan for BFL Customer Min 18 years – Max 60 years
Rs 10,00,000 3215 Rs.8.80 1 year Self Individual plan for BFL Customer Min 18 years – Max 60 years1
Hospital Accommodation :
• Per day - Upto 2% of Sum Insured
Per day coverage on
Sum Insured hospital accommodation
Rs 1,00,000 Rs 2,000
Rs 5,00,000 Rs 10,000
Rs 10,00,000 Rs 20,000
Intensive Care Unit charges :
• Per day - Upto 4% of Sum Insured
Per day coverage on
Sum Insured intensive care unit charges
Rs 1,00,000 Rs 4,000
Rs 5,00,000 Rs 20,000
Rs 10,00,000 Rs 40,000
Pre and Post Hospitalization Expenses :
Covered up to Sum Insured
• Expenses up to 30 days immediately before and up to 60 days immediately
after hospitalization including doctor's consultation, diagnostics tests,
medicines, drugs and consumables.
• Pre and post hospitalization expenses can be claimed as reimbursement
only.
All Day Care Treatment :
Covered up to Sum Insured (Rs 1 lakh to 10 lakh)
Organ Transplant when medically necessary:
Covered up to Sum Insured (1lakh to 10 lakh)
Emergency Ground Ambulance :
Covered up to Rs 1000 per hospitalization
Waiting Period:
Initial Waiting Period – 30 days
Accidental case covered from Day 1
Coronavirus cases covered from Day 15
Pre-Existing Disease Waiting Period – 48 Months
• Waiting period is the time gap post which insurance coverage is available from policy
issuance date
Co-payment:
20% co-payment per hospitalization for all age
Ex: If the claim amount is Rs 1 lac, then insurance company would pay up to Rs 80000,
while the balance (Rs 20000) would be paid by customer
Ex: If the claim amount is Rs 5 lac, then insurance company would pay up to Rs
400000,
while the balance (Rs 100000) would be paid by customer
Ex: If the claim amount is Rs 1 lac, then insurance company would pay up to Rs 800000,
while the balance (Rs 200000) would be paid by customer
Few Basic Definitions :
Term Definition
Sum Assured Max amount of money customer will receive, as per insurance policy. Total amount for
which an individual is insured.
Premium Amount of money paid by customer to buy insurance policy
Policy Tenure Tenure for which policy is valid and applicable
Health Insurance This covers expenses on health treatment. Sum Assured is paid by insurance company to
Life Insurance This covers death benefit for the insured. Nominee gets claim on death of insured person
IPD In patient department- in patient care / treatment. Customer is admitted in hospital for
treatment
OPD Out patient department. Customer is diagnosed and treatment is done without admission
in the hospital
Pre Hospitalization Expenses incurred on treatment done, before patient is admitted in the hospital
Expenses
Post Hospitalization Expenses incurred on treatment done, after patient is discharged from the hospital
Expenses
Sourcing Process - Sales Executive
Two methods to source Health Insurance
Leads allocated in Sales force : Exotel Calling
1. Leads will show in “My Health Insurance/Cards Leads” queue (Till the time leads are specifically allocated for
insurance, health cards leads can be used)
2. Click on “Click to Call” tab to initiate call in Exotel
3. Once call is connected, pitch customer for insurance
4. To send payment link for Health Insurance, click on “Send SMS Health Insurance”
Direct Link (Every FOS is assigned a unique link)
1. Pitch Health Insurance to existing customer
2. Share unique payment link allocated to FOS with customer for payment
Note : Every FOS has a unique payment link and is an identifier for incentive pay-out. Please use link, given to you only
Select “My Health Card Leads” from “Lead Management Tab”
My Health Card Leads
Leads allocated under Health card section can be used
for sourcing Health Insurance also
Click on “Lead name”, which needs to be connected to open the lead details page
My Health Card Leads
On lead details page, click on “Click to Call” tab to initiate the call.
• When “Click to Call” tab is pressed,
first tele-caller (who ever is
mapped) will receive a call and will
get connected
• As tele-caller call is connected, ring
will go to customer’s number and
connection will be made online
To send payment link for Health Card, click on “Send SMS Health Insurance”
CLICK HERE
MOBILE NUMBER OF CLICK AFTER ENTERING
CUSTOMER MOBILE NUMBER
CUSTOMER WILL RECEIVE THIS
SMS WITH PAYMENT LINK
Payment process –
Customer Mobile Screens
Rs. 1150
Rs. 1150
Rs. 1150
Enter registered “Mobile No.” and Enter “OTP received” and
click on “Generate OTP” click on “Submit OTP”
Rs. 1150
Confirm the details and Select Payment Mode and
click on “Make Payment” click on “Pay Now”
Customer will also able to see Features, Conditions and Major Exclusions if he scrolls the payment screen
Payment process –
Customer Desktop
Screens
Customer to enter registered “Mobile No.” and click on “Generate OTP”
Rs. 1150
Enter “OTP received” and click on “Submit OTP”
Rs. 1150
Confirm the details and click on “Make Payment”
Rs. 1150
Select Payment Mode and click on “Pay Now”
Rs. 1150
Bottom of the payment page, Features, Conditions and Major Exclusion is available
Major Exclusions :
• Addictive conditions and disorders,
• Ageing and puberty,
• Artificial life maintenance,
• Ayurvedic and Homeopathic treatment
• Circumcision,
• Conflict an d disaster,
• Convalescence and Rehabilitation,
• Cosmetic Surgery,
• Dental/Oral treatment,
• Drugs and dressings for OPD Treatment or take-home use,
• External Congenital Anomaly,
• Eyesight,
• Unproven / Experimental treatment,
• Unani, Yoga and Siddha treatment,
• Health hydros, nature cure, wellness clinics etc.,
• HIV and AIDS,
• Hereditary conditions,
• Items of personal comfort and convenience, including but not limited to the items as mentioned in the policy wording,
• Psychiatric and Psychosomatic Conditions, Obesity, OPD Treatment,
• Reproductive medicine - Birth control & Assisted reproduction,
• Self-inflicted injuries, Sexual disorder and gender issues,
• Sexually transmitted diseases, Sleep disorders, Speech disorders,
• Treatment for developmental problems, Treatment received outside India, Unrecognized physician or Hospital, Unlawful Activity, Genetic
disorders,
• Any expenses as mentioned under the List of Generally Excluded under Hospitalization Cover’
Cashless Claim Procedure:
Reimbursement Claim Procedure:
Frequently Asked Questions:
1: Can I source Max Bupa Insurance along with Health EMI card ?
Ans: Yes, Sales executive can source both Max Bupa Insurance and Health EMI card together.
2: Can I source Max Bupa Insurance to New Customer ?
Ans: No, this insurance can be sourced only to existing customers of BFL.
3: Can I source insurance for tenure more than 1 year ?
Ans: No, this insurance can be sourced only for one year.
4: Is insurance holder’s family is covered under this
policy ?
Ans: No, this insurance only covers the individual policy
holder.
5: What if customer does not receive SMS Link ?
Ans: Sales executive can share the payment link
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