Group Health Insurance 728 views June 9, 2021

Bharti AXA Group Health Assure Plan

Bharti AXA Group Health Assure provides financial protection to the employees of an organization/company should they face any medical contingencies. What’s good is that they don’t have to pay premiums as their organization will do on their behalf. The insurer will pay for the hospital bills incurred due to an illness/injury during the policy term. Continue reading this page and learn about the policy coverage in detail.

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Bharti AXA Group Health Assure Base Cover

This policy shall cover the following medical expenses during the policy term –

In-Patient Care Expenses: If the insured member is admitted for a medical/surgical treatment of an illness/injury at any hospital in India on the advice of the medical practitioner, the insurer shall cover the following medical expenses incurred during the hospital stay:

  1. Room Rent/Boarding Expenses
  2. Nursing Expenses
  3. ICU Charges
  4. Fees of Medical Practitioners, Surgeons and Anaesthetists
  5. Cost of Anaesthesia, Blood, Oxygen, Operation Theatre Charges, Drugs, Medicines, X-ray & Diagnostic tests.
  6. Radiotherapy, Chemotherapy & Physiotherapy
  7. Cost of Prosthetic devices used intraoperatively during the surgical procedure
  8. Kidney Dialysis
  9. Computerized tomography, magnetic resonance imaging, x-rays and other such proven medical imaging techniques

Note: Any medical expenses related to 24 hours hospitalization for evaluation/investigation shall not be covered under this policy.

Day Care Treatment Expenses: Hospitalization expenses incurred towards specific medical treatments where the insured has taken treatment under General or Local Anesthesia in a Hospital/daycare center for less than 24 hours.

Domiciliary Hospitalization Expenses: Medical treatment for an illness/injury at home under any of the following circumstances:

  1. Condition of the patient is such that he/she couldn’t be moved to a Hospital
  2. Non-availability of room in a hospital.

Organ Donor Expenses: Expenses incurred towards organ donor’s treatment for organ harvesting shall be covered under this policy.

AYUSH: The insurer shall also cover medical expenses incurred for in-patient treatment taken under Ayurveda, Yoga, Unani, Siddha and Homeopathy systems in a Central and State Government Hospital.

Pre & Post-hospitalization Expenses: All the necessary & reasonable expenses incurred before the in-patient care/daycare treatment/domiciliary hospitalization shall be covered under this policy for a specific period as specified in the policy schedule.

Surface Ambulance Cost: Expenses incurred on an ambulance offered by a registered healthcare or ambulance service to transfer the insured person to the nearest Hospital shall be covered under this policy, provided the insurer has accepted the claim under in-patient care or day care treatment.

Newborn cover from Day 1: Under this policy, the insurer provides coverage to newborn babies from the date of birth of the baby until discharge from the hospital.

Bharti AXA Group Health Assure Extensions

Under this policy, you’ll get the option of following extensions by which you can enhance your policy coverage:

Non-Payable Items: The insurer agrees to pay for all the reasonable expenses incurred by the insured towards the cost of non-payable items including Hospital Registration Fees, Surcharges & Other Miscellaneous charges. But all these non-payable items shall be covered in case of an admissible claim under in-patient care or daycare treatment.

International Treatment Extension: The insured person can get a cashless or reimbursement facility for hospitalization expenses incurred outside India up to the amount as specified against this benefit. The coverage under this benefit is available for 45 continuous days from the date of travel in a single trip and 90 days on a cumulative basis in a policy year. However, worldwide treatment coverage shall not be provided in the United States of America.

Note: Medical expenses payable under this benefit shall be limited to in-patient care & daycare treatment. Pre and post-hospitalization expenses are not covered under this benefit.

The insurer shall cover the following critical illnesses under this benefit:

  1. Cancer of Specified Severity
  2. Kidney Failure Requiring Regular Dialysis
  3. Multiple Sclerosis with Persisting Symptoms
  4. Major Organ/Bone Marrow Transplant
  5. Open heart replacement or repair of heart valves
  6. Open chest CABG
  7. Stroke resulting in permanent symptoms
  8. Permanent paralysis of limbs
  9. First Heart Attack of specified severity
  10. Coma of specified severity
  11. Parkinson’s disease
  12. Benign Brain Tumor
  13. Alzheimer’s Disease
  14. End-Stage Liver Failure
  15. Surgery to Aorta
  16. Deafness
  17. Loss of speech
  18. Major burns
  19. Motor Neurone Disease with Persisting Symptoms
  20. Primary Pulmonary Hypertension
  21. Pulmonary Artery Graft Surgery
  22. Muscular Dystrophy
  23. Systemic Lupus Erythematosus (SLE):
  24. Pneumonectomy
  25. Medullary Cystic Disease

Outside Area Coverage Extension: The insurer shall pay or reimburse the medical expenses incurred for availing emergency medical assistance due to an illness/ injury sustained or contracted on a trip up to the limit of sum insured as specified in the policy schedule. This is an annual multi-trip cover applicable to business or leisure trips whose duration shouldn’t be more than 5 days.

Enhanced Sum Insured: If an insured person suffers accidental bodily injury/diagnosed with any named Critical Illnesses and requires treatment as an in-patient, the insurer shall enhance the in-patient care converge as stated in the policy schedule.

Corporate Floater: The insurance company agrees to provide a corporate floater during the policy period if the available sum insured is exhausted. However, the coverage under this benefit is restricted to 25 named Critical Illness and shall be available to the primary insured or his/her family members, except for dependent parents & parents-in-law.

Restricted Ailments Coverage: Expenses for the following restricted ailments shall be covered under this policy, provided the insured has been admitted as an in-patient.

  1. Cancer of Specified Severity
  2. Kidney Failure Requiring Regular Dialysis
  3. Multiple Sclerosis with Persisting Symptoms
  4. Major Organ/Bone Marrow Transplant
  5. Open heart replacement or repair of heart valves
  6. Open chest CABG
  7. Stroke resulting in permanent symptoms
  8. Permanent paralysis of limbs
  9. First Heart Attack or specified severity
  10. Coma of specified severity
  11. Parkinson’s disease
  12. Benign Brain Tumor
  13. Alzheimer’s Disease
  14. End-Stage Liver Failure
  15. Surgery to Aorta
  16. Deafness
  17. Loss of speech
  18. Major burns
  19. Motor Neurone Disease with Persisting Symptoms
  20. Primary Pulmonary Hypertension
  21. Pulmonary Artery Graft Surgery
  22. Muscular Dystrophy
  23. Systemic Lupus Erythematosus (SLE):
  24. Pneumonectomy
  25. Medullary Cystic Disease
  26. Tuberculosis
  27. Kidney Stones
  28. Tetanus
  29. Meningitis
  30. Typhoid
  31. Impacted Wisdom Teeth
  32. Maternity
  33. ICD 10 Category Specific

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