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Health Insurance 513 views May 22, 2021
Bharti AXA advantEDGE Insurance Plan covers the medical expenses up to the extent of the sum insured as specified in the policy schedule. The policy shall cover all the reasonable and customary charges incurred during your medical treatment. Read this page further and know more about the coverage of Bharti AXA advantEDGE Insurance Plan.
Table of Contents
Under this policy, the insurer shall cover the following medical expenses incurred during the policy period –
Under in-patient treatment, the policy shall cover the following –
You can avail of the policy in-patent treatment cover if you are hospitalized for a minimum of 24 hours. This policy shall also cover the donor expenses that include screening expenses, post-donation fitness tests and medical expenses arising due to its complications. Organ donor benefit is applicable for six months or the policy end date, whichever is earlier, from the date of organ harvesting.
The coverage under this benefit is restricted up to the limits as specified in the policy schedule However, the amount payable under this benefit shall be a part of the overall sum insured.
Restore Benefit: The sum insured shall be regained to 100% if a claim is made under the policy, provided the base sum insured and guaranteed cumulative bonus exhausted for the particular policy year. This benefit shall be available after the first claim during the policy year.
Note: You can use the regained sum insured for any accident, disease, illness, injury claim for which the claim has already been admitted partially or fully during that policy year. This benefit shall be allowed once during a policy year and it is not applicable for optional benefits. If the regain sum insured is not utilized in a policy year, it shall not be carried forward to the subsequent policy year.
Animal Bite (Vaccination): OPD Treatment for vaccinations or immunizations for treatment post an animal bite will be covered under this policy, but only on a reimbursement basis.
Guaranteed Cumulative Bonus (GCB): For each claim-free year, the company will offer a GCB of 20% of the sum insured, up to 100% on the expiring policy sum insured if the policy is renewed continuously. GCB will be available only for base cover benefits and it shall remain guaranteed for the life and won’t be reduced in case of a claim or attaining the maximum value of GCB.
Note: GCB is calculated based upon the sum insured of the last completed policy year.
Surface Ambulance Charges: You’ll get ambulance services to the hospital or between hospitals & diagnostic centers for the treatment of illness/injury under this cover. This benefit is applicable irrespective of the number of hospitalizations during the policy period and is subject to the overall sum insured.
Health Check-up: The insurer will cover the cost of a health checkup per policy, provided the insured age is at least 18 years at the time of first policy year or renewal.
Convalescence Benefit: If you are hospitalized for a continuous period of 10 days or more, this benefit provides a fixed allowance. The convalescence benefit is available once per policy year.
Bariatric Surgery Cover: If the doctor advises you to undergo Bariatric Surgery, the insurer shall pay the reasonable and customary expenses related to it.
Domiciliary Hospitalization: In case the treatment of an illness/injury is taken at home due to the patient’s condition, non-availability of room in the hospital, etc, the coverage for medical expenses shall be provided if the treatment period is more than 3 days.
The following are the optional benefits that you can add to this policy by paying an additional premium.
Domestic Air Ambulance: Under this optional cover, an airplane or helicopter service will be provided as an ambulance for emergency transportation to the nearest hospital. This benefit is available only where the required medical treatment is not available at any hospital in your city. Return transportation expenses are excluded under this cover.
Maternity Cover: You’ll get coverage for maternity expenses, including the delivery of a baby and lawful termination of pregnancy, after a waiting period of 9 months. The coverage benefit is limited to a maximum of three deliveries or terminations during the lifetime. This optional benefit is applicable if the insured chooses a policy term of 3 years.
Note: Ectopic Pregnancy is not covered under maternity benefit. And if the maternity benefit is not claimed, the next 3 years’ premium for this optional cover shall be waived off.
New Born Baby Cover: The newborn baby shall be covered under this policy within the first 90 days of the birth. This benefit is applicable if you have opted for the Maternity Cover and have made a claim under the same. Under this benefit, vaccinations for newborns till the age of one year shall be covered during the policy period.
OPD for Medical and Dental: Under this optional cover, you will get OPD benefits like –
This benefit is available to you at network hospitals/diagnostic centers.
Hospital Cash Benefit: A daily cash amount is payable to you for each continuous and completed period of 24 hours of hospitalization. And if the hospitalization is for more than 24 hours, the first continuous and completed period of 48 hours will act as deferment, which means a minimum hospitalization of 48 hours is required for claims to be payable from the time of hospitalization. Hospital Cash Benefit is payable up to 45 days in a policy.
Personal Accident Cover: Under this optional cover, you’ll get coverage against –
The insurer shall pay 100% of the sum insured or a percentage of the sum insured as specified in the policy schedule if any of -death, PTD, PPD – occurs due to an accident within twelve calendar months from the date of the accident.
Critical Illness: A lump sum amount will be payable to you in case you are diagnosed with any of the following –
However, in case of diagnosis of multiple illnesses, the payment of compensation shall be up to the limit as specified in the policy schedule.
There is a free look period of 15 days in this policy that starts from the date of receipt of the policy document. During this period, you can review the terms and conditions of the policy and return the same if not acceptable. If you haven’t made any claims during the free look period, you’ll get a refund of the paid premium after the deduction of medical examination and stamp duty charges. Whereas if the risk has already commenced and the option of return of the policy is exercised by you, a deduction will be made towards the proportionate risk premium for the period of cover. If only a part of the insurance coverage has commenced, such proportionate premium commensurates with the insurance coverage.
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