1
Policy wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: customer.service@bhartiaxa.com
Policy wordings – Bharti AXA Smart Super Health Assure
PREAMBLE:
The insurance cover provided under this Policy to the Insured / Insured Person up to the applicable limits
shall be subject to (a) The terms and conditions of this Policy (b) The receipt of premium (c) Disclosure to
Information Norm (including by way of the Proposal or Information Summary Sheet) and (d) Schedule of
Benefits.
OPERATIVE CLAUSE:
The Company hereby agrees subject to the terms and conditions contained herein or endorsed or otherwise
expressed hereon, to indemnify, compensate, pay and/or reimburse the Insured / Insured Person, his/her
nominee or the legal representatives, as the case may be, in respect of insured events occurring during the
period of insurance stated in the Schedule, in the manner and to the extent set forth in this Policy.
SECTION 1 - DEFINITIONS:
Any word or expression to which a specific meaning has been assigned in any part of this Policy or the
Schedule shall bear the same meaning wherever it appears. For purposes of this Policy, the terms specified
below shall have the meaning set forth:
1.1) "Accident" is a sudden, unforeseen and involuntary event caused by external, visible and violent
means.
1.2) "Any one Illness" means continuous period of Illness and it includes a relapse within 45 days from
the date of last consultation with the Hospital/Nursing Home where treatment may have been taken.
1.3) "Ayush Treatment" refers to the medical and / or hospitalization treatments given under ‘Ayurveda,
Yoga and Naturopathy, Unani, Siddha and Homeopathy systems.
1.4) "Cashless facility" means a facility extended by the Insurer to the Insured where, the payments of
the costs of treatment undergone by the Insured in accordance with the Policy terms and conditions
are directly made to the network provider by the Insurer to the extent of pre-authorization approved.
1.5) "Company" means Bharti AXA General Insurance Company Limited.
1.6) "Condition Precedent" shall mean a Policy term or condition upon which the Insurer's liability under
the Policy is conditional upon.
1.7) "Congenital Anomaly" refers to a condition(s) which is present since birth, and which is abnormal
with reference to form, structure or position.
1.7.1) Internal Congenital Anomaly - Congenital Anomaly which is not in the visible and
accessible parts of the body is called Internal Congenital Anomaly.
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
1.7.2) External Congenital Anomaly - Congenital Anomaly which is in the visible and
accessible parts of the body is called External Congenital Anomaly.
1.8) Co-payment (Co-pay) means a cost sharing requirement under a health insurance policy that
provides that the policyholder/insured will bear a specified percentage of the admissible claims
amount. A co-payment does not reduce the Sum Insured.
1.9) "Cumulative Bonus" shall mean any increase in the Sum Insured granted by the Insurer without an
associated increase in the premium.
1.10) "Day Care treatment" means medical treatment, and / or surgical procedure which is:
1.10.1) undertaken under general or local anesthesia in a hospital/day care centre in less than 24
hours because of technological advancement, and
1.10.2) which would have otherwise required a hospitalization of more than 24 hours.
Treatment normally taken on an out-patient basis is not included in the scope of this definition.
1.11) “Day care Centre" means any institution established for day care treatment of Illness and / or
injuries or a medical setup within a hospital and which has been registered with the local authorities,
wherever applicable, and is under the supervision of a registered and qualified medical practitioner
and must comply with all minimum criteria as under:
i. has qualified nursing staff under its employment
ii. has qualified medical practitioner/s in charge;
iii. has a fully equipped operation theatre of its own where surgical procedures are carried out
iv. maintains daily records of patients and will make these accessible to the Insurance
Company’s authorized personnel.
1.12) "Dependent Child" means a child (natural or legally adopted), who is unmarried, aged between 91
days and 23 years, financially dependent on the Insured and does not have his / her independent
sources of income.
1.13) "Deductible" is a cost-sharing requirement applicable per event/claim under a health insurance
Policy that provides, the Insurer will not be liable for a specified rupee amount in case of indemnity
policies and/or for a specified number of days/hours in case of hospital cash benefit which will apply
before any benefits are payable by the Insurer. A deductible does not reduce the Sum Insured.
1.14) "Disclosure to information norm" means the Policy shall be void and all premium paid hereon
shall be forfeited to the Company, in the event of misrepresentation, mis-description or non-
disclosure of any material fact.
1.15) "Disease" means an alteration in the state of the body or of some of its organs, interrupting or
disturbing the performance of the functions, and causing or threatening pain and weakness or
physical or mental disorder and certified by a Medical Practitioner.
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
1.16) "Domiciliary hospitalization" means medical treatment for an Illness/Disease/Injury which in the
normal course would require care and treatment at a hospital but is actually taken while confined at
home under any of the following circumstances:
i. the condition of the patient is such that he/she is not in a condition to be removed to a
hospital, or
ii. the patient takes treatment at home on account of non-availability of room in a hospital.
Domiciliary hospitalization benefits shall be subject to the limits as specified in the Schedule to this
Policy, and shall, in no case, cover expenses incurred for:
a) Pre and post Hospital treatment,
b) Treatment of any of the following Diseases:
i. Asthma;
ii. Bronchitis;
iii. Chronic nephritis and nephritic syndrome;
iv. Diarrhoea and all types of dysenteries including gastroenteritis;
v. Diabetes mellitus and insipidus;
vi. Epilepsy;
vii. Hypertension;
viii. Influenza, cough and cold;
ix. All psychiatric or psychosomatic disorders;
x. Pyrexia of unknown origin for less than 10 days;
xi. Tonsillitis and upper respiratory tract infection including aryngitis and pharyngitis;
xii. Arthritis, gout and rheumatism.
1.17) "Diagnostic Tests" Investigations, such as X-Ray or blood tests, to find the cause of your
symptoms and medical condition.
1.18) "Emergency care" means management for a severe Illness or Injury which results in symptoms
which occur suddenly and unexpectedly, and requires immediate care by a medical practitioner to
prevent death or serious long term impairment of the Insured person's health.
1.19) "Family" means the Insured, his/her lawful spouse and maximum of three dependent children up to
the age of 23 years who are specifically covered under the Policy with their name, age, gender etc.
1.20) "Family Floater Policy" means a Policy in terms of which, two or more persons of a Family are
named in the Schedule of Insurance Certificate as Insured Persons. In a Family Floater Policy,
Family means a unit comprising of up to five members who are related to each other in the following
manner:
i) Legally married husband and wife as long as they continue to be married; and/or
ii) Up-to three of their children who are less than 23 years on the date of commencement of
the cover under the Policy.
1.21) "Grace Period" means the specified period of time immediately following the premium due date
during which a payment can be made to renew or continue a Policy in force without loss of continuity
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
benefits such as waiting periods and coverage of pre-existing diseases. Coverage is not available for
the period for which no premium is received.
1.22) "Hospital" - A hospital means any institution established for in-patient care and day care treatment
of Illness and/ or injuries and which has been registered as a hospital with the local authorities under
the Clinical Establishments (Registration and Regulation) Act, 2010 or under the enactments
specified under the Schedule of Section 56(1) of the said Act or complies with all minimum criteria as
under:
1. 22.1) has qualified nursing staff under its employment round the clock;
1.22.2) has at least 10 in-patient beds in towns having a population of less than 10,00,000 and at
least 15 in-patient beds in all other places;
1.22.3) has qualified medical practitioner(s) in charge round the clock;
1.22.4) has a fully equipped operation theatre of its own where surgical procedures are carried
out;
1.22.5) maintains daily records of patients and makes these accessible to the insurance
company's authorized personnel.
1.23) "Hospitalization" means admission in a hospital for a minimum period of 24 in-patient care
consecutive hours except for specified procedures/ treatments, where such admission could be for a
period of less than 24 consecutive hours.
1.24) "Illness" means a sickness or a disease or pathological condition leading to the impairment of
normal physiological function which manifests itself during the Policy Period and requires medical
treatment.
1.24.1) Acute condition - Acute condition is a disease, Illness or Injury that is likely to respond
quickly to treatment which aims to return the person to his or her state of health immediately
before suffering the disease/ Illness/ Injury which leads to full recovery.
1.24.2) Chronic condition - A chronic condition is defined as a disease, Illness, or Injury that
has one or more of the following characteristics:
i. it needs ongoing or long-term monitoring through consultations, examinations, check-
ups, and / or tests;
ii. it needs ongoing or long-term control or relief of symptoms;
iii. it requires your/Insured person’s rehabilitation or for you/Insured member to be
specially trained to cope with it;
iv. it continues indefinitely;
v. it comes back or is likely to come back.
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
1.25) "Injury" means accidental physical bodily harm excluding Illness or disease solely and directly
caused by external, violent and visible and evident means which is verified and certified by a Medical
Practitioner.
1.26) "Inpatient care" means treatment for which the Insured person has to stay in a hospital for more
than 24 hours for a covered event.
1.27) "Insured" means the primary Insured who has the highest age amongst other person named in
the Schedule of the Policy in case of family floater Policy. In case of an Individual Policy the only
member mentioned in the schedule of the Policy shall be referred as "Insured".
1.28) "Insured Person" means the person named in the Schedule to the Policy and for whose benefit the
insurance is proposed and appropriate premium paid. I.
1.29) "Intensive Care Unit" means an identified section, ward or wing of a Hospital which is under the
constant supervision of a dedicated Medical Practitioner(s), and which is specially equipped for the
continuous monitoring and treatment of patients who are in a critical condition, or require life support
facilities and where the level of care and supervision is considerably more sophisticated and
intensive than in the ordinary and other wards.
1.30) "Information Summary Sheet" means the record and confirmation of information provided to
Company or Company’s representatives over the telephone for the purposes of applying for this
Policy.
1.31) "Maternity expense" shall include
I. Medical treatment expenses traceable to childbirth (including complicated deliveries and
caesarean sections incurred during hospitalization).
II. Expenses towards lawful medical termination of pregnancy during the Policy period.
1.32) "Medical Practitioner" is a person who holds a valid registration from the Medical Council of any
State or Medical Council of India or Council for Indian Medicine or for Homeopathy set up by the
Government of India or a State Government and is thereby entitled to practice medicine within its
jurisdiction and is acting within the scope and jurisdiction of license. The term Medical Practitioner
includes a physician, specialist and surgeon, provided that this person is not a member of the
Insured/ Insured Person's family who includes Father, Mother, Father-in-law, Mother-in-law, Son,
Daughter, Son-in-law, Daughter-in-law, Brother or Sister.
1.33) "Medical expenses" means those expenses that an Insured Person has necessarily and actually
incurred for medical treatment on account of Illness or Accident on the advice of a Medical
Practitioner, as long as these are no more than would have been payable if the Insured Person had
not been Insured and no more than other hospitals or doctors in the same locality would have
charged for the same medical treatment.
1.34) "Medically Necessary" treatment is defined as any treatment, tests, medication, or stay in hospital
or part of a stay in hospital which:
1.34.1) is required for the medical management of the Illness or Injury suffered by the Insured;
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
1.34.2) must not exceed the level of care necessary to provide safe, adequate and appropriate
medical care in scope, duration, or intensity;
1. 34.3) must have been prescribed by a medical practitioner,
1. 34.4) must conform to the professional standards widely accepted in international medical practice
or by the medical community in India.
1.35) “Medical Advise” means any consultation or advice from a Medical Practitioner including the issue
of any prescription or repeat prescription.
1.36) “New Born Baby” means baby born during the Policy Period and is aged between 1 day and 90
days, both days inclusive.
1.37) "Network Provider" means hospitals or health care providers enlisted by an Insurer or by a TPA
and Insurer together to provide medical services to an Insured on payment by a cashless facility.
1.38) "Non- Network" means any hospital, day care centre or other provider that is not part of the
network.
1.39) "Notification of claim" is the process of notifying a claim to the Insurer or TPA by specifying the
timelines as well as the address / telephone number to which it should be notified
1.40) “OPD treatment” is one in which the Insured visits a clinic / hospital or associated facility like a
consultation room for diagnosis and treatment based on the advice of a Medical Practitioner. The
Insured is not admitted as a day care or in-patient.
1.41) "Policy period" means the period between the inception date and the expiry date as specified in the
Schedule to this Policy or the cancellation of this insurance, whichever is earlier.
1.42) "Policy" means this document of Policy describing the terms and conditions of this contract of
insurance (basis the statements in the Proposal Form and the Information Summary Sheet), any
annexure thereto, including the company's covering letter to the Insured / Insured person if any, the
Schedule attached to and forming part of this Policy and any applicable endorsement thereon. The
Policy contains details of the scope and extent of cover available to the Insured/Insured Person, the
exclusions from the scope of cover and the terms and conditions of the issue of the Policy.
1.43) "Policy Year" means the period of one year commencing on the date of commencement specified
in the Schedule of Insurance Certificate or any anniversary thereof.
1.44) "Portability" means transfer by an individual health insurance Policyholder (including family cover)
of the credit gained for pre-existing conditions and time-bound exclusions if he/she chooses to
switch from one Insurer to another.
1.45) "Post-hospitalization Medical Expenses" means Medical Expenses incurred immediately after the
Insured Person is discharged from the hospital provided that:
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
1.45.1) Such Medical Expenses are incurred for the same condition for which the Insured Person's
Hospitalization was required, and
1.45.2) The In-patient Hospitalization claim for such Hospitalization is admissible by the Insurance
Company.
1.46) "Pre-Existing Disease" means any condition, ailment or Injury or related condition(s) for which
you/Insured member had signs or symptoms, and / or were diagnosed, and / or received medical
advice / treatment within 48 months prior to the first Policy issued by the Insurer.
1.47) "Pre-hospitalization Medical Expenses" means medical expenses incurred immediately before
the Insured Person is Hospitalized, provided that:
1.47.1) Such Medical Expenses are incurred for the same condition for which the Insured Person's
Hospitalization was required, and
1.47.2) The In-patient Hospitalization claim for such Hospitalization is admissible by the Insurance
Company.
1.48) “Qualified Nurse” is a person who holds a valid registration from the Nursing Council of India or the
Nursing Council of any state in India.
1.49) "Renewal" defines the terms on which the contract of insurance can be renewed on mutual consent
with a provision of grace period for treating the renewal continuous for the purpose of all waiting
periods.
1.50) "Reasonable and Customary charges" means the charges for services or supplies, which are the
standard charges for the specific provider and consistent with the prevailing charges in the
geographical area for identical or similar services, taking into account the nature of the Illness / Injury
involved.
1.51) "Restoration of Sum Insured" means re-instatement of hundred percent of the Sum Insured.
1.52) "Room rent" means the amount charged by a hospital for the occupancy of a bed on per day (24
hours) basis and shall include associated medical expenses.
1.53) "Schedule" means Schedule attached to and forming part of this Policy mentioning the details of
the Insured/ Insured Persons, the Sum Insured, the period and the limits to which benefits under the
Policy are subject to.
1.54) "Schedule of Benefits" means the Product Benefits Table issued by the Company and
accompanying this Policy and annexures thereto.
1.55) "Subrogation" means the right of the insurer to assume the rights of the Insured person to recover
expenses paid out under the Policy that may be recovered from any other source.
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
1.56) "Sum Insured" means the sum as specified in the Schedule to this Policy against the name of
Insured / each Insured Person at the inception of a Policy Year and in the event of Policy is
upgraded or downgraded on any continuous Renewal, then exclusive of Cumulative Bonus, if any,
the Sum Insured for which premium is paid at the commencement of the Policy Year for which the
prevalent upgrade or downgrade is sought.
1.57) "Surgery or Surgical Procedure" means manual and / or operative procedure (s) required for
treatment of an Illness or Injury, correction of deformities and defects, diagnosis and cure of
diseases, relief of suffering or prolongation of life, performed in a hospital or day care centre by a
medical practitioner.
1.58) "Terrorism/Terrorist Incident" means any actual or threatened use of force or violence directed at
or causing damage, Injury, harm or disruption, or the commission of an act dangerous to human life
or property or government, with the stated or unstated objective of pursuing economic, ethnic,
nationalistic, political, racial or religious interests, whether such interests are declared or not.
Robberies or other criminal acts, primarily committed for personal gain and acts arising primarily
from prior personal relationships between perpetrator(s) and victim(s) shall not be considered
terrorist activity. Terrorism shall also include any act, which is verified or recognized by the relevant
Government as an act of terrorism.
1.59) "Third Party Administrator (TPA)" means any organization or institution that is licensed by the
IRDA as a TPA and is engaged by the Company for a fee or remuneration for providing Policy and
claims facilitation services to the Insured/ Insured Person as well as to the Company for an insurable
event.
1.60) "Unproven/Experimental treatment" is treatment, including drug Experimental therapy, which is
not based on established medical practice in India, is treatment experimental or unproven.
SECTION 2 - SALIENT FEATURES & BENEFITS:
Basic cover upto the Sum Insured limit applicable to all plans:
The Company hereby agrees subject to the terms, conditions and exclusions herein contained or otherwise
expressed, to pay cashless and/or reimburse the following benefits in manner, for the period and to the
extent of the Sum Insured as specified in the Schedule to this Policy.
The Policy covers Reasonable and Customary Charges incurred towards medical treatment taken during the
Policy Period for an Illness, Accident or condition described below if this is contracted or sustained by an
Insured Person during the Policy Period and subject always to the Sum Insured, any subsidiary limit
specified in the schedule of Benefits, the terms, conditions, limitations and exclusions mentioned in the
Policy and eligibility as per the insurance plan opted for in the schedule of Benefits and as shown in the
Schedule of Insurance Certificate.
2.1) In-patient Treatment:
This benefit provides cover for reimbursement / payment of cashless hospitalization expenses which are
reasonably and necessarily incurred by the Insured / Insured Person for treatment of Disease, Illness
contracted or Injury sustained by the Insured / Insured Person during the Policy period as specified in the
Schedule to this Policy, in a Hospital in India as in- patient which among other things, includes, Hospital
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
room rent or boarding expenses, nursing, Intensive Care Unit charges, Operation Theatre charges, Medical
Practitioner’s charges, fees of Surgeon, Anesthetist, Qualified Nurse, Specialists, the cost of diagnostic
tests, medicines, drugs, blood, oxygen, the cost of prosthetics and other devices or equipment if implanted
internally during a Surgical Procedure.
The Insured/Insured Person should have been hospitalized as an in-patient for a minimum period of 24
consecutive hours. The benefit under this Section is limited to the Sum Insured specified for this Section in
the Schedule of Benefits to this Policy.
2.2) Pre-hospitalization:
This benefit covers relevant medical expenses incurred during a period up to the number of days as
specified in the Schedule of benefits forming part of this Policy, prior to hospitalization or day care treatment
for treatment of Disease, Illness contracted or Injury sustained for which the Insured / Insured Person was
hospitalized, giving rise to an admissible claim under this Policy. This benefit is a part of benefit available
under Section 2.1 above and is limited to the available Sum Insured under Section 2.1. Pre-hospitalization
Medical Expenses can be claimed as reimbursement only.
2.3) Post-hospitalization:
This benefit covers relevant medical expenses incurred during a period up to the number of days as
specified in the Schedule of benefits forming part of this Policy, after discharge from Hospital / day care
treatment for continuous and follow up treatment of the Disease, Illness contracted or Injury sustained for
which the Insured/Insured Person was hospitalized, giving rise to an admissible claim under this Policy. This
benefit is a part of benefit available under Section 2.1 above and is limited to the available Sum Insured
under Section 2.1. Post-hospitalization Medical Expenses can be claimed as reimbursement only.
2.4) Organ Donor:
Where the Insured/Insured Person contracts any of the Illness or Injury requiring major Organ
Transplantation surgery and undergoes surgery and treatment in a Hospital as an in-patient for which a valid
claim under this Policy is admissible, the hospitalization expenses incurred for harvesting the organ donated
for the Insured / Insured Person for this treatment is covered under this benefit, provided the donation
conforms to The Transplantation of Human Organs Act 1994. This benefit is a part of benefit available under
Section 2.1 above and is limited to the available Sum Insured under Section 2.1.
This benefit does not cover pre or post hospitalization medical expenses or screening expenses of the donor
or any other medical expenses as a result of harvesting from the donor. This benefit also does not cover
costs directly or indirectly associated with the acquisition of the donor’s organ.
2.5) Day Care Treatment:
This benefit covers hospitalization expenses towards medical treatment, and/or procedure incurred by the
Insured / Insured Person which is undertaken under General or Local Anesthesia in a Hospital/day care
centre (where 24 hours of hospitalization is not required due to technologically advanced treatment) which
shall be payable, in respect of listed treatments as given in the Appendix I at the end of this document. The
benefit under this Section is limited to the available Sum Insured under Section 2.1 of this Policy as
mentioned in the Schedule to this Policy.
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
2.6 Ayush Treatment:
This benefit provides reimbursement to the Insured/ Insured Person of Medical Expenses incurred for In-
patient treatment taken under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems
provided that:
I. The treatment is undertaken in a government Hospital or in any institute recognized by government
and/ or accredited by Quality Council of India/ National Accreditation Board on Health,
Ayush Treatment is also covered provided the treatment has been undergone in
i. Teaching hospitals of AYUSH colleges recognised by Central Council of Indian Medicine (CCIM) and
Central Council of Homeopathy (CCH)
ii. AYUSH Hospitals having registration with a Government authority under appropriate Act in the State/UT
and complies with the following as minimum criteria:
a. has at least fifteen in-patient beds;
b. has minimum five qualified and registered AYUSH doctors;
c. has qualified paramedical staff under its employment round the clock;
d. has dedicated AYUSH therapy sections;
e. maintains daily records of patients and makes these accessible to the insurance company’s authorized
personnel
Note:
a) The reimbursement under Ayush benefit will be applicable for inpatient hospitalization claims only;
b) The Insured/ Insured person will not be entitled for Domiciliary Hospitalization;
c) Cashless facility is not available.
The benefit under this Section is available upto the Sum Insured under Section 2.1 of this Policy as
mentioned in the Schedule to this Policy.
2.7) Domiciliary Hospitalization:
Medical treatment for an Illness/Disease/Injury which in the normal course would require care and treatment
at a Hospital but is actually taken while confined at home under any of the following circumstances:
1. The condition of the Patient is such that he/she is not in a condition to be removed to a Hospital
or,
2. The Patient takes treatment at home on account of non-availability of room in a Hospital.
However, this does not cover
1. Treatment of less than 3 days. (Coverage will be provided for expenses incurred in first three
days however this benefit will be applicable if treatment period is greater than 3 days);
2. Post-Hospitalization expenses;
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
3. The following medical conditions:
a. Asthma, Bronchitis, Tonsillitis and Upper Respiratory Tract infection including Laryngitis
and Pharyngitis, Cough and Cold, Influenza,
b. Arthritis, Gout and Rheumatism,
c. Chronic Nephritis and Nephritic Syndrome,
d. Diarrhoea and all type of Dysenteries including Gastroenteritis,
e. Diabetes Mellitus and Insupidus,
f. Epilepsy,
g. Hypertension,
h. Psychiatric or Psychosomatic Disorders of all kinds,
i. Pyrexia of unknown origin.
Domiciliary hospitalization benefits also cover expenses on Qualified nurses engaged on the
recommendation of the attending Medical Practitioner.
The benefit under this Section is limited to the available Sum Insured under Section 2.1 of this Policy as
mentioned in the Schedule to this Policy.
SECTION 3 – OTHER BENEFITS:
Benefits under this Section are payable as additional benefits / in-built benefits upto the limits specified in
the Schedule to this Policy. A valid claim should have been admitted under the Hospitalization Section of the
Policy, for admission of liability under this Section.
3.1 Restoration of Sum Insured:
In case of a situation where the Sum Insured and No claim bonus are exhausted due to claims made and
paid during the Policy Year, and the Insured/Insured Persons have to subsequently, incur any hospitalization
expenses due to any Disease/ Illness / Injury for which a valid claim is admissible under the Policy, then the
Sum Insured shall be restored which is equal to 100% of sum insured for the particular Policy year for all
members in the Policy, provided that;
I. The Restored Sum Insured will be enforceable only after the Sum Insured and No claim bonus (if
any) have been completely exhausted in that year; and the Restored Sum Insured can be used for
claims made by the Insured Person in respect of the benefits stated in Section 2 and 3.
II. The Restored Sum Insured shall be available only for fresh/ any new Disease / Illness / Injury and
not in relation to any Illness/ Injury for which a Claim has already been admitted partially or fully for
that Insured person during that Policy Year.
III. The Restored Sum Insured will only be allowed once during a Policy Year;
IV. Restoration of Sum Insured is not applicable for add-on benefits.
If the Restored Sum Insured is not utilized in a Policy Year, it shall not be carried forward to any subsequent
Policy Year.
3.2 Emergency Surface Ambulance Charges:
This benefit provides for cashless / reimbursement to the Insured/Insured Person of expenses incurred for
his/her surface transport by ambulance to hospital or between hospitals and/or diagnostic centre for
treatment of Disease, Illness or Injury in a Hospital as an in-patient for which a valid claim under this Policy
is admissible.
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
This benefit is subject to sub limits (per hospitalization claim) as mentioned in Schedule of benefit but within
overall limit of the Sum Insured as specified in the Schedule to this Policy.
This benefit is applicable irrespective of the number of occurrences during the Policy period subject to the
overall Sum Insured and forms a part of Section 2.1.
SECTION 4 – OPTIONAL ADD-ON BENEFIT:
Benefits under this Section are payable as add-on benefits on payment of additional premium, up to the
limits specified in the Schedule to this Policy unless specified otherwise.
4.1 Hospital Cash Allowance:
Daily cash amount will be payable per day up to the specified limits as mentioned in the Schedule to this
Policy if the Insured Person is Hospitalized for treatment of any Disease / Illness / Injury for which a valid
claim is admissible under the Policy for each continuous and completed period of 24 hours and if the
Hospitalization exceeds for more than 24 hours. First continuous and completed period of 24 hours will act
as deductible.
This is paid up to a maximum of 30 days including all the members & all claims for the entire Policy Year.
This benefit is subject to the specified limits as mentioned in Schedule over and above the Sum Insured.
4.2 Maternity Benefit:
This benefit covers the medical expenses including (after a waiting period of 9 months with the company) up
to limits specified in the schedule (over and above Sum Insured mentioned in the Schedule) for the delivery
of a baby and / or expenses related to medically recommended lawful termination of pregnancy but only in
life threatening situation under the advice of Medical Practitioner, limited to maximum of two deliveries or
terminations as said herein during the lifetime of an Insured/Insured Person between the ages of 18 years to
45 years(being the age of eldest member in the Policy).
This benefit may be opted subject to the following:
(a) This benefit is available only under a Family Floater Policy.
(b) This benefit is available for Insured / Insured’s spouse provided both are covered under the
same Policy.
This benefit is applicable only for the Insured person who has opted for 3 years Policy term. This benefit can
be opted only on renewals for female Insured/ Insured Person.
In case, insured has taken three year policy without maternity add-on and would like to opt for maternity
add-on, then this can be availed at the time of renewal.
Ectopic Pregnancy is not covered under Section 4.2. However the same is covered under Section 2.1.
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
New Born Baby Cover:
Medical Expenses for any medically necessary treatment described under Section 2.1 while the Newborn
baby is hospitalized during the Policy Period within first 90 days of birth, as an inpatient under this benefit.
The coverage is subject to the Policy exclusions, terms and conditions. This Benefit is applicable if Maternity
benefit is opted and the Company has accepted a maternity claim under this Policy.
This benefit is subject to the specified limits as mentioned in Schedule however over and above the Sum
Insured and the Maternity Benefit limit as specified in the Schedule.
Well Baby Charges are not covered under the Maternity and/or New Born Baby cover.
4.3 Lump sum benefit for critical Illnesses (over and above S.I)
If, 60 days after the inception of this Policy, the Insured / Insured Person is at any time during the Policy
period (after the above waiting period of 60 days), being diagnosed as contracting any Critical Illness as
specified below and surviving for more than 30 days post such diagnosis, the specified limits as mentioned
in Schedule (over and above the Sum Insured mentioned in the Schedule) for this benefit shall be payable to
the Insured/Insured Person as Lump Sum benefit. This benefit shall be paid over and above the
hospitalization benefit if any.
However, in case of diagnosis of multiple illnesses qualified as Critical Illness under the Policy, the payment
of compensation shall be limited to the limit specified in the schedule and shall be payable only once in the
lifetime of Insured/Insured person. Critical Illness benefit will lapse after reporting of and payment of one
claim for the claiming Insured/Insured person. Critical Illness limit opted cannot be more than Sum Insured
opted under Section 2.1. The illnesses qualified as Critical Illnesses and covered in this section are as
follows:
1. Cancer of Specified Severity
2. First Heart Attack of Specified Severity
3. Coronary Artery Disease
4. Open Chest CABG
5. Open Heart Replacement or Repair of Heart Valves
6. Surgery to Aorta
7. Stroke resulting in Permanent Symptoms
8. Kidney Failure requiring Regular Dialysis
9. Aplastic Anaemia
10. End Stage Lung Disease
11. End Stage Liver Failure
12. Coma of Specified Severity
13. Major Burns
14. Major organ /bone marrow transplant
15. Multiple Sclerosis with Persisting Symptoms
16. Fulminant Hepatitis
17. Motor Neurone Disease with Permanent Symptoms
18. Primary Pulmonary Hypertension
19. Terminal Illness
20. Bacterial Meningitis
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
1. Cancer of Specified Severity
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
The following are excluded -
1. All tumors which are histologically described as carcinoma in situ, benign, pre-malignant, borderline
malignant, low malignant potential,neoplasm of unknown behavior, or non-invasive, including but not
limited to: Carcinoma in situ of breasts, Cervical dysplasia CIN-1, CIN -2 and CIN-3
2. Any non-melanoma skin carcinoma unless there is evidence of metastases to lymph nodes or
beyond;
3. Malignant melanoma that has not caused invasion beyond the epidermis;
4. All tumors of the prostate unless histologically classified as having a Gleason score greater than 6 or
having progressed to at least clinical TNM classification T2N0M0
5. All Thyroid cancers histologically classified as T1N0M0 (TNM Classification) or below;
6. Chronic lymphocytic leukaemia less than RAI stage 3
7. Non-invasive papillary cancer of the bladder histologically described as TaN0M0 or of a lesser
classification,
8. All Gastro-Intestinal Stromal Tumors histologically classified as T1N0M0 (TNM Classification) or
below and with mitotic count of less than or equal to 5/50 HPFs;
9. All tumors in the presence of HIV infection.
2. Myocardial Infarction (First Heart Attack of specified severity):
I. The first occurrence of heart attack or myocardial infarction, which means the death of a portion of the
heart muscle as a result of inadequate blood supply to the relevant area. The diagnosis for Myocardial
Infarction should be evidenced by all of the following criteria:
i. A History of typical clinical symptoms consistent with the diagnosis of Acute Myocardial Infarction
(for e.g. typical chest pain)
ii. New characteristic electrocardiogram changes
iii. Elevation of infarction specific enzymes, Troponins or other specific biochemical markers
II. The following are excluded:
i. Other acute Coronary Syndromes
ii. Any type of angina pectoris
iii. A rise in cardiac biomarkers or Troponin T or I in absence of overt ischemic heart disease OR following
an intra-arterial cardiac procedure.
3. Coronary Artery Disease
The narrowing of the lumen of at least one coronary artery by a minimum of 75% and of two others by a
minimum of 60%, as proven by coronary arteriography, regardless of whether or not any form of coronary
artery surgery has been performed. Coronary arteries herein refer to left main stem, left anterior descending
circumflex and right coronary artery.
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
4. Open Chest CABG (Coronary Artery By-pass Graft) surgery
I. The actual undergoing of heart surgery to correct blockage or narrowing in one or more coronary artery(s),
by coronary artery bypass grafting done via a sternotomy (cutting through the breast bone) or minimally
invasive keyhole coronary artery bypass procedures. The diagnosis must be supported by a coronary
angiography and the realization of surgery has to be confirmed by a cardiologist.
II. The following are excluded:
1. Angioplasty and/or any other intra-arterial procedures
5. Open heart replacement or repair of heart valves
The actual undergoing of open-heart valve surgery is to replace or repair one or more heart valves, as a
consequence of defects in, abnormalities of, or disease-affected cardiac valve(s). The diagnosis of the valve
abnormality must be supported by an echocardiography and the realization of surgery has to be confirmed
by a specialist medical practitioner. Catheter based techniques including but not limited to, balloon
valvotomy/ valvuloplasty are excluded.
6. Surgery to Aorta
The actual undergoing of major surgery to repair or correct aneurysm, narrowing, obstruction or dissection of
the aorta through surgical opening of the chest or abdomen. For the purpose of this definition aorta shall
mean the thoracic and abdominal aorta but not its branches.
Surgery performed using only minimally invasive or intra-arterial techniques are excluded.
Angioplasty and all other intra-arterial, catheter based techniques, "keyhole" or laser procedures are
excluded.
7. Stroke resulting in permanent symptoms
I. Any cerebrovascular incident producing permanent neurological sequelae. This includes infarction of brain
tissue, thrombosis in an intra-cranial vessel, haemorrhage and embolisation from an extracranial source.
Diagnosis has to be confirmed by a specialist medical practitioner and evidenced by typical clinical
symptoms as well as typical findings in CT scan or MRI of the brain. Evidence of permanent neurological
deficit lasting for at least 3 months has to be produced.
II. The following are excluded:
1. Transient ischemic attacks (TIA)
2. Traumatic injury of the brain
3. Vascular disease affecting only the eye or optic nerve or vestibular functions.
8. Kidney failure requiring regular dialysis
I. End stage renal disease presenting as chronic irreversible failure of both kidneys to function, as a result of
which either regular renal dialysis (haemodialysis or peritoneal dialysis) is instituted or renal transplantation is
carried out. Diagnosis has to be confirmed by a specialist medical practitioner.
9. Aplastic Anaemia
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
Chronic persistent bone marrow failure which results in anaemia, neutropenia and thrombocytopenia
requiring treatment with at least one of the following:
I. Blood product transfusion;
II. Marrow stimulating agents;
III. Immunosuppressive agents; or
IV. Bone marrow transplantation
The diagnosis must be confirmed by a haematologist.
10. End Stage Lung Failure
End Stage Lung Disease, causing chronic respiratory failure. This diagnosis must be supported by evidence
of all of the following:
I. FEVI test results which are consistently less than one litre;
II. Permanent supplementary oxygen therapy for hypoxemia;
III. Arterial blood gas analyses with partial oxygen pressures of 55mm Hg or less (PaO2 <- 55 mm Hg);
and
IV. Dyspnea at rest.
The diagnosis must be confirmed by a respiratory physician
11. End Stage Liver Failure
I. Permanent and irreversible failure of liver function that has resulted in all three of the following:
i. Permanent jaundice; and
ii. Ascites; and
iii. Hepatic encephalopathy.
II. Liver failure secondary to drug or alcohol abuse is excluded.
12. Coma of specified severity
I. A state of unconsciousness with no reaction or response to external stimuli or internal needs. This
diagnosis must be supported by evidence of all of the following:
i. no response to external stimuli continuously for at least 96 hours;
(ii) life support measures are necessary to sustain life; and
(iii) permanent neurological deficit which must be assessed at least 30 days after the onset of the
coma.
II. The condition has to be confirmed by a specialist medical practitioner. Coma resulting directly from
alcohol or drug abuse is excluded.
13. Third Degree Burns
There must be third-degree burns with scarring that cover at least 20% of the body’s surface area. The
diagnosis must confirm the total area involved using standardized, clinically accepted, body surface area
charts covering 20% of the body surface area.
14. Major organ /bone marrow transplant
I. The actual undergoing of a transplant of –
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
i. One of the following human organs: heart, lung, liver, kidney, pancreas, that resulted from irreversible
end-stage failure of the relevant organ, or
ii. Human bone marrow using haematopoietic stem cells. The undergoing of a transplant has to be
confirmed by a specialist medical practitioner.
II. The following are excluded:
a. Other stem-cell transplants
b. Where only islets of langerhans are transplanted
15. Multiple Sclerosis with persistent symptoms
I. The unequivocal diagnosis of Definite Multiple Sclerosis confirmed and evidenced by all of the
following:
i. investigations including typical MRI findings which unequivocally confirm the diagnosis to be
multiple sclerosis and
ii. there must be current clinical impairment of motor or sensory function, which must have
persisted for a continuous period of at least 6 months.
II. Other causes of neurological damage such as SLE and HIV are excluded.
16. Fulminant Hepatitis
A sub-massive to massive necrosis of the liver by the Hepatitis virus, leading precipitously to liver failure.
This diagnosis must be supported by all of the following:
I. Rapid decreasing of liver size;
II. Necrosis involving entire lobules, leaving only a collapsed reticular framework;
III. Rapid deterioration of liver function tests;
IV. Deepening jaundice; and
V. Hepatic encephalopathy.
17. Motor Neurone Disease with permanent symptoms
Motor neurone disease diagnosed by a specialist medical practitioner as spinal muscular atrophy,
progressive bulbar palsy, amyotrophic lateral sclerosis or primary lateral sclerosis. There must be
progressive degeneration of corticospinal tracts and anterior horn cells or bulbar efferent neurons. There
must be current significant and permanent functional neurological impairment with objective evidence of
motor dysfunction that has persisted for a continuous period of at least 3 months
18. Primary (Idiopathic) Pulmonary Hypertension
I. An unequivocal diagnosis of Primary (Idiopathic) Pulmonary Hypertension by a Cardiologist or specialist in
respiratory medicine with evidence of right ventricular enlargement and the pulmonary artery pressure above
30 mm of Hg on Cardiac Cauterization. There must be permanent irreversible physical impairment to the
degree of at least Class IV of the New York Heart Association Classification of cardiac impairment.
II. The NYHA Classification of Cardiac Impairment are as follows:
i. Class III: Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity
causes symptoms.
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
ii. Class IV: Unable to engage in any physical activity without discomfort. Symptoms may be present
even at rest.
III. Pulmonary hypertension associated with lung disease, chronic hypoventilation, pulmonary
thromboembolic disease, drugs and toxins, diseases of the left side of the heart, congenital heart disease
and any secondary cause are specifically excluded.
19. Terminal Illness
The conclusive diagnosis of an Illness that is expected to result in the death of the insured person within 12
months. This diagnosis must be supported by a specialist and confirmed by the Company's appointed
Doctor.
Terminal Illness in the presence of HIV infection is excluded.
20. Bacterial Meningitis
Bacterial infection resulting in severe inflammation of the membranes of the brain or spinal cord resulting in
significant, irreversible and permanent neurological deficit. The neurological deficit must persist for at least 6
weeks. This diagnosis must be confirmed by:
I. The presence of bacterial infection in cerebrospinal fluid by lumbar puncture; and
II. A consultant neurologist.
Bacterial Meningitis in the presence of HIV infection is excluded.
SECTION 5 - RENEWAL INCENTIVE:
5.1. Health Check-up:
The Company will cover the cost of a health checkup as per plan eligibility as defined in the Schedule of
Benefits provided that Insured / Insured Person has applied for the same. Only that Insured / Insured
Person who has attained minimum age of 18 years at the time of Renewal, shall be eligible for a health
check-up. The Company will only cover health checkups arranged by the Company through their
empaneled service providers. Insured / Insured Person further understands and agrees that this benefit is
only available at Renewal for Policies that are renewed without any break.
The list of tests conducted for the plan opted shall be as per Appendix II.
5.2. No Claim Bonus:
If no claim has been made in a Policy Year by any Insured / Insured Person, then for each such Policy year
irrespective of the policy term whether 1 year, 2 years or 3 years, the Company will offer a no claim bonus
as specified below.
No claim bonus will be provided on the expiring Policy Sum Insured, provided that the Policy is renewed
continuously.
The sub-limits applicable to various benefits will remain the same and shall not increase proportionately with
the increase in Cumulative Bonus.
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
No Claim Bonus will be calculated on the basis of Sum Insured of the last completed Policy Year. The rate
of accrual shall be based on the age at which the policy was bought (age at inception). The same rate shall
be applicable in all the policy years as long as the policy is renewed.
No Claim Bonus – Accrual Rate
Age at the inception of 1st Policy year
<=45 yrs.
50% of expiring Policy S.I per annum not exceeding Cumulative
Bonus of 100% of current Policy S.I
Age at the inception of 1st Policy year
>45 yrs. and <=65 yrs.
20% of expiring Policy S.I per annum not exceeding Cumulative
Bonus of 100% of current Policy S.I
The rate of accrual or reduction for each applicable policy year shall remain the same even for a policy
term of 2 years or 3 years.
In case of a claim, the no claim bonus earned shall be automatically reduced in the same proportion in the
following renewal of the Policy. However, in cases where the insured has availed health checkup, the same
shall not be considered as claim and the policy shall be eligible for No Claim Bonus provided there is no
claim in the respective policy year. This will not affect the Sum Insured of the Policy.
5.3. Portability:
i. From another company to Bharti AXA Policy
(i) If the proposed Insured Person was insured continuously and without a break under another Indian retail
health insurance Policy with any other Indian General Insurance company or stand-alone Health Insurance
Company, it is understood and agreed that:
(1) If Insured person wish to exercise the Portability Benefit, The Company should have received the
application for portability and the completed Portability Form with complete documentation at least 45
days before the expiry of the existing insurance Policy.
(2) This benefit is available only at the time of renewal of the existing health insurance Policy.
(3) Portability benefit is available only up to the existing cover. If the proposed Sum Insured is higher than
the Sum Insured under the expiring policy, waiting periods would be applied on the amount of
proposed increase in Sum Insured only, in accordance with the existing guidelines of the Insurance
Regulatory and Development Authority.
(4) Waiting period credits would be extended to Pre-existing Diseases and time bound exclusions /
waiting periods in accordance with the existing guidelines of the Insurance Regulatory and
Development Authority.
(5) The Portability Benefit shall be applied by the Company within 15 days of receiving the completed
Application and Portability Form from the proposer subject to the following:
(a) Proposer shall provide the Company all additional documentation and/or information requested;
(b) The proposer shall pay the Company the applicable premium in full;
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
(c) The Company may, subject to medical underwriting, restrict the terms upon which the Company
may offer cover, the decision as to which shall be in the Company sole and absolute discretion;
This is subject to Company’s Board approved Underwriting policy filed with Authority.
(d) There is no obligation on the Company to insure all Insured Persons or to insure all Insured
Persons on the proposed terms, even if the proposer have given all documentation to the
Company; This is subject to Company’s Board approved Underwriting policy filed with Authority.
(e) The Company shall be received necessary details of medical history and claim history from the
previous insurance company for the Insured Person's previous health insurance Policy through
the IRDA's web portal.
(ii). No additional loading or charges shall be applied by the Company exclusively for porting the Policy.
ii. From the Company’s existing health insurance policies to this Policy
(i) If the proposed Insured Person was insured continuously and without a break under another health
insurance Policy with the Company, it is understood and agreed that:
(1) If the Insured wish to exercise the Portability Benefit, the Company should have received the
Insured’s application and completed Portability Form before the expiry of the existing insurance
Policy;
(2) This benefit is available only at the time of renewal of existing health insurance Policy.
(3) Portability benefit is available only up to the existing cover. If the proposed Sum Insured is higher
than the Sum Insured under the expiring Policy, waiting periods would be applied on the amount of
proposed increase in Sum Insured only, in accordance with the existing guidelines of the Insurance
Regulatory and Development Authority.
(4) Waiting period credits would be extended to Pre-existing Diseases and time bound
exclusions/waiting periods in accordance with the existing guidelines of the Insurance Regulatory
and Development Authority.
(5) The Portability Benefit shall be applied by the Company within 15 days of receiving Insured’s
completed Application and Portability Form subject to the following:
(a) Insured / Insured Person shall give the Company all additional documentation and/or information
request’s;
(b) Insured / Insured Person pay the Company the applicable premium in full;
(c) The Company may, subject to medical underwriting, restrict the terms upon which the company
may offer cover, the decision as to which shall be in Company’s sole and absolute discretion; This is
subject to Company’s Board approved Underwriting policy filed with Authority.
(d) There is no obligation on Company to insure all Insured Persons or to insure all Insured Persons
on the proposed terms, even if Insured/ Insured person have given
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
all documentation. This is subject to Company’s Board approved Underwriting policy filed with
Authority.
(e) No additional loading or charges shall be applied by Company exclusively for porting the Policy.
The Company reserves the right to modify or amend the terms and the applicability of the Portability Benefit
in accordance with the provisions of the regulations and guidance issued by the Insurance Regulatory and
Development Authority as amended from time to time.
SECTION 6 - EXCLUSIONS:
6.1 Waiting Period:
1. 30 days waiting period:
Expenses incurred for treatment undertaken for Disease or Illness within 30 days of the inception date of
first / initial Policy. This exclusion, however, doesn't apply in case of
Subsequent renewals with the Company without a break.
Expenses due to Accident occurring after the Policy inception date.
Portability to the extent of waiting period and Sum Insured waived off in the Schedule of the Policy.
2. Specific waiting period:
Hospitalization Expenses incurred on treatment of following Diseases or Illness or procedures/surgeries
within the first two years (continuously renewed without any break) from the inception of initial / first Policy:
1. Any types of gastric or duodenal ulcers
2. Benign prostatic hypertrophy
3. All types of sinuses
4. Hemorrhoids
5. Dysfunctional uterine bleeding
6. Endometriosis
7. Stones in the urinary and biliary systems
8. Surgery on ears/tonsils/adenoids/ paranasal sinuses
9. Cataracts,
10. Hernia of all types and Hydrocele
11. Fistulae in anus
12. Fissure in anus
13. Fibromyoma
14. Hysterectomy
15. Surgery for any skin ailment
16. Surgery on all internal or external tumours/ cysts/ nodules/polyps of any kind including breast lumps with
exception of Malignancy
17. Dialysis required for Chronic Renal Failure.
18. Joint Replacement Surgeries unless necessitated by Accident happening after the Policy risk inception
date.
19. Dilatation and curettage
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
20. Varicose Veins and Varicose Ulcers
21. Non Infective Arthritis and other form arthritis
22) Gout and Rheumatism
23) Prolapse inter Vertebral Disc and Spinal Diseases including spondylitis/spondylosis unless arising from
Accident
This exclusion, however, doesn't apply in case of
Subsequent renewals with the Company without a break post the first 2 years of the Policy
Portability to the extent of waiting period and Sum Insured waived off in the Schedule of the Policy.
In the event that the above listed Illness/diseases arise on account of a pre-existing condition, they shall be
covered under this policy only upon completion of 48 months of continuous coverage
3. Pre-existing Diseases / Illness / Injury / conditions:
The benefits will not be available for any condition(s) as defined in the Policy, until 48 months of continuous
coverage have elapsed, since inception of the first Policy with the Company.
Disclosure of any Pre-existing Diseases with details must be done at the time of application for this Policy/
addition of member in existing Policy, in the Proposal Form and shall be classified as pre-existing Disease
post acceptance of such application by the company.
4. Maternity expenses where maternity cover is opted:
The benefits will not be available for any condition(s) as defined in the Policy, until 9 months since inception
of the first Policy with the Company. In all other cases where maternity benefit cover is not opted, all claims
directly or indirectly related to maternity stands excluded always.
6. Internal Congenital Anomalies are covered after a waiting period of 48 months.
7. Genetic disorders are covered after a waiting period of 48 months.
6.2 The Company shall not be liable to make any payment for any claim directly or indirectly
caused by or, based on or, arising out of or howsoever attributable to any of the following:
1. War (whether declared or not) and war like occurrence or invasion, acts of foreign enemies, hostilities,
civil war, rebellion, revolutions, insurrections, mutiny, military or usurped power, seizure, capture, arrest,
restraints and detainment of all kinds.
2. Any Illness or Injury directly or indirectly resulting or arising from or occurring during commission of any
breach of any law by the Insured Person with criminal intent.
3. Disease/ Illness/ Injury whilst performing duties as a serving member of a military or a police force.
4. Any loss, Injury/Illness, directly or indirectly caused due to an act of terrorism or terrorist incident,
regardless of any contributory causes (if the Company alleges that by reason of this exclusion any loss
is not covered by this insurance, the burden of proving the contrary shall be upon the Insured / Insured
Person).
5. Expenses following Ionizing radiation or contamination by radioactivity from any nuclear fuel or from any
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
nuclear waste from the combustion of nuclear fuel.
6. Medical Treatment in respect of the Illness / Injury / Disease caused whilst engaging in speed contest or
racing of any kind (other than on foot), bungee jumping, parasailing, ballooning, parachuting, skydiving,
paragliding, hang gliding, mountain or rock climbing, potholing, abseiling, deep sea diving, polo, snow
and ice sports.
7. Medical treatment in respect of the Injury caused whilst flying or taking part in aerial activities (including
cabin crew) except as a fare-paying passenger in a regular Scheduled commercial airline
8. Circumcision unless necessary for treatment of Disease, Illness or Injury not excluded hereunder, or, as
may be necessitated due to an Accident.
9. Dental treatment or surgery of any kind unless requiring hospitalization or in case of out-patient Dental
Emergency Treatment (unless arising out of Accident only as specified under the scope of the Policy).
10. Birth control procedures, hormone replacement therapy, contraceptive supplies or services including
complications arising due to supplying services or Assisted Reproductive Technology, treatment arising
from or traceable to pregnancy, childbirth including caesarean section and voluntary medical termination
of pregnancy during the first 12 weeks from the date of conception. However, this exclusion will not
apply to Ectopic Pregnancy proved by diagnostic means and certified to be life threatening by the
attending Medical Practitioner.
11. Any treatment arising from or traceable to any fertility, infertility, sub-fertility or assisted conception
procedure or sterilization.
12. Charges incurred in connection with cost of spectacles and/or contact lenses, hearing aids, routine eye
and ear examinations, laser surgery for correction of refractory errors, dentures, artificial teeth and or all
other similar external appliances and/or devices whether for diagnosis or treatment, Issue of medical
certificates and examinations as to suitability for employment or travel.
13. Any condition directly or indirectly caused by or associated with venereal Disease, sexually transmitted
Disease, including Genital Warts, Syphilis, Gonorrhea, Genital Herpes, Chlamydia, Pubic Lice and
Trichomoniasis, whether or not arising out of HIV, Human T-Cell Lymphtropic Virus Type III (HTLV–III or
IITLB-III) or Lymphadenopathy Associated Virus (LAV) or the mutants derivative or Variations Deficiency
Syndrome or any Syndrome or condition of a similar kind
14. Vitamins and tonics unless forming part of treatment for Disease, Illness or Injury as certified by the
Medical Practitioner.
15. Weight management services and or treatment, services and supplies including treatment of
obesity(including morbid obesity),
16. Any treatments related to sleep disorder, sleep apnea syndrome, general debility, treatment received in
convalescent homes, cure, rundown condition or rest cure, congenital external Diseases / Illness or
defects or anomalies, sterility, venereal Disease or intentional self-Injury
17. Any treatment received in convalescent homes, convalescent Hospitals, health hydros, nature cure
clinics or similar establishments.
18. Medical Treatment following use/abuse of intoxicating drugs or alcohol or drug abuse, solvent abuse or
any addiction or medical condition resulting from or relating to such abuse or addiction.
19. Sex change or treatment, which results from, or is in any way related to, sex change.
20. All preventive care vaccination including inoculation or immunization of any kind unless forming a part of
post animal bite treatment.
21. Treatment by a family member (Father, Mother, Father-in-law, Mother-in-law, Son, Daughter, Son-in-
law, Daughter-in-law, Brother or Sister) and or self-medication or any treatment except AYUSH that is
not scientifically recognized.
22. Medical treatment required following involvement in any criminal act of the Insured / Insured Person.
23. Prostheses, corrective devices and medical appliances, which are not, required intra-operatively.
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
24. Any stay in Hospital without undertaking any treatment or where there is no active regular treatment by
the Medical Practitioner.
25. Aesthetic treatment, cosmetic surgery or plastic surgery unless necessitated due to Accident
26. Experimental and unproven treatment.
27. Charges incurred primarily for diagnostic, X-ray or laboratory examinations or other diagnostic studies
not consistent with or incidental to the diagnosis and treatment of the positive existence or presence of
any Disease, Illness or Injury.
28. Cost incurred for medicines which are not under the advice of the Medical Practitioner.
29. Any treatment which is taken as an out-patient without any admission as an in-patient at the Hospital
except those that are specifically mentioned as covered specifically in the this Policy.
30. Costs of donor screening or treatment, unless specifically covered and specified in this Policy.
31. Any treatment received outside India.
32. Treatment taken from persons not registered as Medical Practitioners under respective medical councils.
33. Stem cell implantation / Surgery or Growth Hormone Therapy.
34. Acupressure, acupuncture, magnetic therapies.
35. Treatment for Age Related Macular Degeneration (ARMD) , treatments such as Rotational Field
Quantum Magnetic Resonance (RFQMR), External Counter Pulsation (ECP), Enhanced External
Counter Pulsation (EECP), Hyperbaric Oxygen Therapy and Robotic surgery.
36. Any kind of Service charges, Surcharges, Luxury Tax and similar charges levied by the Hospital. (other
than government taxes).
37. External medical equipment of any kind used at home as post hospitalization care including cost of
instrument used in the treatment of Sleep Apnea Syndrome (C.P.A.P), Continuous Peritoneal
Ambulatory Dialysis (C.P.A.D) and Oxygen concentrator for Bronchial Asthmatic condition.
SECTION 7 - GENERAL CONDITIONS:
7.1) Duty of Disclosure:
The Policy shall be null and void and no benefit shall be payable in the event of untrue or incorrect
statements, misrepresentation, mis-description or non-disclosure of any material facts in the Proposal Form,
personal statement, declaration and connected documents, or any material information having been
withheld, or a claim being fraudulent or any fraudulent` means or device being used by the Insured/Insured
Person or any one acting on their behalf to obtain a benefit under this Policy.
7.2) Floater Policy:
Where the Policy is obtained on floater basis covering the family members, the Sum Insured as specified in
the Schedule to this Policy, shall be available to the Insured and all other Insured members. However, the
Sum Insured shall be the overall limit including add-on Sum Insured unless otherwise specified, if opted and
no claim bonus, if any for the entire period of Insurance/Policy period including all members/Insured persons
and all claims.
7.4) Observance of terms and conditions:
The due observance and fulfillment of the terms, conditions and endorsements of this Policy in so far as they
relate to anything to be done or complied with by the Insured / Insured Person, shall be a condition
precedent to any liability of the Company to make any payment under this Policy.
7.5) Material Change:
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
The Insured / Insured Person shall immediately notify the Company in writing of any material change in the
risk on account of change in nature of occupation or business, partial disclosure of the medical history at
Insured / Insured person own expense. The Company may, adjust the scope of cover and / or the premium,
if necessary, accordingly.
7.6) Fraudulent Claims:
If any claim is in any respect fraudulent, or if any false statement or declaration is made or used in support
thereof or if any fraudulent means or devices are used by the Insured / Insured Person or anyone acting on
his/her behalf to obtain any benefits under the Policy, all benefits under this Policy shall be forfeited. The
Company will have the right to reclaim all benefits paid in respect of a claim which is fraudulent as
mentioned above under this condition as well as condition No. 7.1 of this Policy.
7.7) No Constructive Notice:
The Company shall not take notice of any information relating to the Insured person unless such information
is submitted in writing by the Insured, even if such information was available with the Company.
7.8) Notice of Charge:
The Company is not under obligation to take note of any trust, assignment, lien or similar charge on or
relating to the Policy. However, any payment by the Company to Insured or legal representative or bank
shall be binding on all concerned and shall be considered as complete discharge by the Company.
7.9) Special Provisions:
Any special provisions subject to which this Policy has been entered into and endorsed on the Policy or in
any separate instrument shall be deemed to be part of this Policy and shall have effect accordingly.
7.11) Electronic Transaction:
The Insured / Insured Person agrees to adhere to and comply with all such terms and conditions as the
Company may prescribe from time to time and hereby agrees and confirm that all transactions effected by or
through facilities for conducting remote transactions including the internet, world wide web, electronic data
interchange, call centres, tele service operations (whether voice, video, data or combination thereof) or by
means of electronic, computer, automated machines network or through other means of telecommunication
established by or on behalf of the Company for and in respect of the Policy or its terms, shall constitute
legally binding and valid transactions when done in adherence to and in compliance with the Company's
terms and conditions for such facilities, as may be prescribed from time to time. However, the terms of this
condition shall not override provisions of any law(s) or statutory regulations including provisions of IRDA
regulations for protection of Policy holder's interests.
7.12) Duty of the Insured on occurrence of loss/event leading to claim
On the occurrence of loss/event/claim within the scope of cover under the Policy resulting in a claim, the
Insured / Insured Person shall:
a) Forthwith file/submit a claim form in accordance with "Claim Procedure" clause.
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
b) Allow the Medical Practitioner or any agent of the Company to inspect the medical and hospitalization
records and to examine the Insured / Insured Person
c) Assist and not hinder or prevent the Company or any of its agents in pursuance of their duties
In case the Insured / Insured Person does not comply with the provisions of this clause or other obligations
cast upon the Insured / Insured Person under this Policy or in any of the Policy documents, all benefit under
the Policy shall be forfeited, at the option of the Company.
7.13) Right to Inspect:
If required by the Company, an agent/representative of the Company including a physician appointed in that
behalf in case of any loss/event/claim or any circumstances that have given rise to a claim to the Insured /
Insured Person, be permitted at all reasonable times to examine into the circumstances of such loss/event
leading to claim. The Insured / Insured Person shall on being required so to do by the Company produce all
relevant documents relating to or containing reference relating to the loss/event or such circumstance in
his/her possession including presenting himself/herself for examination and furnish copies of or extracts
from such of them as may be required by the Company so far as they relate to such claims or shall assist
the Company to ascertain the correctness thereof or the liability of the Company under this Policy.
The Company shall bear all cost of examination required under this section.
7.14) Position after a claim:
As from the day of receipt of the claim amount by the Insured / Insured Person, the Sum Insured for the
remainder of the Policy year of insurance shall stand reduced by a corresponding amount.
.
7.15) Multiple policies
If two or more policies are taken by an insured during a period from one or more insurers to
indemnify treatment costs, the policyholder shall have the right to require a settlement of his/her
claim in terms of any of his/her policies.
1. In all such cases the insurer who has issued the chosen policy shall be obliged to settle the
claim as long as the claim is within the limits of and according to the terms of the chosen policy.
2. Claims under other policy/ies may be made after exhaustion of Sum Insured in the earlier
chosen policy / policies.
3. If the amount to be claimed exceeds the sum insured under a single policy after considering
the deductibles or co-pay, the policyholder shall have the right to choose insurers from whom
he/she wants to claim the balance amount.
4. Where an insured has policies from more than one insurer to cover the same risk on
indemnity basis, the insured shall only be indemnified the hospitalization costs in accordance
with the terms and conditions of the chosen policy.
7.16) Forfeiture of claims:
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
If any claim is made and rejected and no court action or suit is commenced within 12 months after such
rejection or, in case of arbitration taking place as provided therein, within 12 calendar months after the
arbitrator or arbitrators have made their award, all benefits under this Policy shall be forfeited and will not
have any rights whatsoever.
7.17) Free Look Period:
Insured has a period of 15 days from the date of receipt of the Policy document to review the terms and
conditions of this Policy. If the Insured has any objections to any of the terms and conditions, he / she have
the option of cancelling the Policy stating the reasons for cancellation and in such a case, the Company will
refund premium subject to
A deduction of the expenses incurred on any medical check-up, stamp duty charges, if the risk has
not commenced.
A deduction of the expenses incurred on any medical check-up, stamp duty charges and
proportionate risk premium for period on cover, if the risk has commenced.
A deduction of such proportionate risk premium commensurating with the risk covered during such
period, where only a part of risk has commenced.
The Policy can be cancelled only if Insured has not made any claims under the Policy.
Free look provision is not applicable and/or available at the time of renewal of the Policy.
7.18) Grace Period:
All applications for renewal of the Policy must be received by us before the end of the Policy. A Grace
Period of 30 days for renewing the Policy is provided under this Policy.
However, there is no coverage provided during the break period.
7.19) Cancellation/Termination:
The Company may cancel this Policy, by giving 15 days’ notice in writing by registered post
acknowledgment due to the Insured at his / their last known address. The Company shall exercise its right to
cancel only on grounds of mis-representation, fraud, non-disclosure of material facts or non-cooperation of
the Insured / Insured Person in implementing the terms and conditions of this Policy, in which case the
Company shall be liable to repay on demand a ratable proportion of the premium for the unexpired term
from the date of the cancellation. The Insured may also give 15 days’ notice in writing, to the Company, for
the cancellation of this Policy, in which case the Company shall from the date of receipt of notice, cancel the
Policy and retain the premium for the period this Policy has been in force at the Company's short period
scales given below. Provided that, refund on cancellation of Policy by the Insured shall be made only if no
claim has/is occurred/reported up to the date of cancellation of this Policy / Policy riders.
Period on Risk
Rate of Premium
to be retained by
Company for 1
year Policy
Rate of Premium
to be retained by
Company for 2
years Policy
Rate of
Premium to
be retained
by Company
for 3 years
Policy
Up to 1 month 25% 15% 10%
Exceeding 1 month Up to 3 months 50% 25% 15%
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
Exceeding 3 months Up to 6 months 75% 50% 25%
Exceeding 6 months Up to 12 months 100% 75% 50%
Exceeding 12 months Up to 18 months N.A 85% 75%
Exceeding 18 months Up to 24 months N.A 100% 85%
Exceeding 24 months Up to 30 months N.A N.A 90%
Beyond 30 months N.A N.A 100%
7.20) Cause of action/Currency of payment:
No claim shall be payable under this Policy unless the cause of action arises in India. All claims shall be
payable in India in Indian Rupees only.
7.21) Policy Disputes:
The parties to this Policy expressly agree that the laws of the Republic of India shall govern the validity,
construction, interpretation and effect of this Policy. Any dispute concerning the interpretation of the terms
and conditions, limitations and/or exclusions contained herein is understood and agreed to by both the
Insured and the Company to be subject to Indian law. All matters arising hereunder shall be determined in
accordance with the law and practice of such court with in Indian Territory.
7.22) Arbitration:
If any dispute or difference shall arise as to the quantum to be paid under this Policy (liability being
otherwise admitted) such difference shall independently of all other questions be referred to the decision of a
sole arbitrator to be appointed in writing by the parties to the dispute/difference, or if they cannot agree upon
a single arbitrator within 30 days of any party invoking arbitration, the same shall be referred to a panel of 3
arbitrators, comprising of 2 arbitrators - 1 to be appointed by each of the parties to the dispute/difference and
the third arbitrator to be appointed by such 2 arbitrators.
Arbitration shall be conducted under and in accordance with the provisions of the Arbitration and Conciliation
Act 1996.
It is hereby agreed and understood that no dispute or difference shall be referred to arbitration, as herein
before provided, if the Company has disputed or not accepted liability under or in respect of this Policy.
It is expressly stipulated and declared that it shall be a condition precedent to any right of action or suit upon
this Policy that the award by such arbitrator/arbitrators of the amount of the loss shall be first obtained.
7.23) Terms of renewal:
• The Company offers life-long renewal unless the Insured/ Insured Person or any one acting on behalf of
an Insured/ Insured Person has acted in an improper, dishonest or fraudulent manner or has made
misrepresentation in relation to this Policy or the Policy poses a moral hazard.
• The premium for renewal will be applicable as per the premium chart based on age; Sum Insured;
geography.
• Company will not load the premium for any adverse claims experience of particular Insured/Insured
Person at the time of renewal if there is no change in the coverage of continuing Policy.
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
• The Company may change the renewal premium and/or benefits payable subject to approval from
regulator (IRDA) and inform the same to the Insured at least 3 months prior to the effective date of
revision and/ or modification or renewal
• In the likelihood of this Policy being withdrawn in future, the Company will inform the same to the Insured
at least 3 months prior to expiry of the Policy. Insured will have the option to migrate to other plan under
similar health insurance Policy at the time of renewal, provided the Policy is maintained without a break.
All applications for renewal of the Policy must be received by us before the expiry of current Policy. A Grace
Period of 30 days for renewing the Policy is provided under this Policy.
However, there is no coverage for Injury sustained or Disease contacted during this grace period/break
period.
7.24) Sum Insured Enhancement:
i. The Insured member can apply for enhancement of Sum Insured at the time of renewal by submitting a
duly filled fresh Proposal Form to the Company.
ii. The acceptance of enhancement of Sum Insured would be at the discretion of the Company, based on
the health condition of the Insured members, claim history and subject to acceptance by the Company post
underwriting.
All waiting periods as defined in the Policy shall apply afresh for this enhanced Sum Insured from the
effective date of enhancement of such Sum Insured considering such Policy Period as the first Policy in
respect of such increased Sum Insured.
7.25) Inclusion of Dependent members under the Policy:
New Person can be added to this Policy, either by way of endorsement in case of mid-term inclusion or at
the time of renewal. Mid-term inclusion is available only in case of such new person i.e. spouse and or new
born child post 90 days of birth subject to acceptance by underwriters.
The pre-existing Disease clause, exclusions and waiting periods will be applicable afresh in respect of such
newly added person,
7.26) Renewal:
The Company shall allow renewal of the Policy and accept renewal premium in all cases except in case of
noncooperation of the Insured/Insured Person in implementing the terms and conditions of this Policy..
7.27) Notices:
Any notice, direction or instruction given under this Policy shall be in writing and delivered by hand, post or
facsimile to
a) In case of the Insured, at the address given in the Schedule to the Policy.
b) In case of the Company, to the Policy issuing office/nearest office of the Company.
SECTION 8 – GRIEVANCES REDRESSAL PROCEDURE:
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
The Company is committed to extend the best possible services to its customers. However, If
Policyholder/Insured Person have a grievance that he/she wish us to redress, he/she may contact the
Company with the details of their grievance via:
•Website: www.bharti-axagi.co.in
•Email: customer.service@bhartiaxa.com
•Phone: 18001032292
•Courier: Any of the Company’s Branch office or corporate office
Policyholder/Insured/ Insured Person may also approach the grievance cell at any of the Company’s
branches with the details of the grievance during working hours from Monday to Friday.
Escalation Level 1
In case the Policyholder/Insured/Insured Person has not got his/her grievances redressed through one of
the above methods (After 5 days of intimating of your complaint), Policyholder/ Insured/ Insured Person may
contact the National Grievance Redressal Officer at :
Write to: Bharti AXA General Insurance, Spectrum Towers, 3rd floor, Malad Link Road, Malad (west),
Mumbai- 400064
Call: 022-48815939
Email: NGRO@bhartiaxa.com
3rd floor, Spectrum Tower, Rajan Pada
Mindspace, Malad (W), Mumbai - 400 064
Escalation Level 2
In case the Policyholder/ Insured/Insured Person has not got his/her grievances redressed through any of
the above methods (After 5 days of approaching National Grievance Redressal Officer), Policyholder/
Insured/ Insured Person may contact the Chief Grievance Redressal Officer at:
Email : CGRO@bhartiaxa.com
Escalation Level 3
In case the Policyholder/ Insured/Insured Person has not got his/her grievances redressed by the Company
within 14 days, or, If Policyholder/ Insured/Insured Person is not satisfied with Company’s redressal of the
grievance through one of the above methods, Policyholder/ Insured/ Insured Person may approach the
nearest Insurance Ombudsman for resolution of their grievance. The contact details of Ombudsman offices
are mentioned below. Policy holder may also obtain copy of IRDAI circular Ref No. F. No.
IRDAI/Reg/8/145/2017, notification on Insurance Regulatory and Development Authority (Protection of
Policy holders’ interests) Regulations, 2017 from any of our offices.
Grievance of Senior Citizens:
In respect of Senior Citizens, the Company has established a separate channel to address the grievances.
Any concerns may be directly addressed to the Senior Citizen’s channel of the Company for faster attention
or speedy disposal of grievance, if any.
•Website: www.bharti-axagi.co.in
•Email: customer.service@bhartiaxa.com
•Phone: 18001032292
•Courier: Any of the Company’s Branch office or corporate office
Insured/ Insured Person may also approach the grievance cell at any of the Company’s branches with the
details of the grievance during working hours from Monday to Friday.
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
Grievance Redressal Cell of the Consumer Affairs Department of IRDAI
The insurance company should resolve the complaint within a reasonable time. In case if it is not resolved
within 15 days or if the Insured/Insured Person is unhappy with their resolution you can approach the
Grievance Redressal Cell of the Consumer Affairs Department of IRDAI.
•Website: igms.irda.gov.in
•Email: complaints@irda.gov.in
•Toll Free Number 155255 (or) 1800 4254 732
LIST OF INSURANCE OMBUDSMEN
1.
Office Details
AHMEDABAD - Shri/Smt........
Office of the Insurance Ombudsman,
Jeevan Prakash Building, 6th floor,
Tilak Marg, Relief Road,
Ahmedabad – 380 001.
Tel.: 079 - 25501201/02/05/06
Email: bimalokpal.ahmedabad@ecoi.co.in
BENGALURU - Smt. Neerja Shah
Office of the Insurance Ombudsman,
Jeevan Soudha Building,PID No. 57-27-N-19
Ground Floor, 19/19, 24th Main Road,
JP Nagar, Ist Phase,
Bengaluru – 560 078.
Tel.: 080 - 26652048 / 26652049
Email: bimalokpal.bengaluru@ecoi.co.in
BHOPAL - Shri Guru Saran Shrivastava
Office of the Insurance Ombudsman,
Janak Vihar Complex, 2nd Floor,
6, Malviya Nagar, Opp. Airtel Office,
Near New Market,
Bhopal – 462 003.
Tel.: 0755 - 2769201 / 2769202
Fax: 0755 - 2769203
Email: bimalokpal.bho[email protected]
BHUBANESHWAR - Shri/Smt........
Office of the Insurance Ombudsman,
62, Forest park,
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
1.
Office Details
Bhubneshwar – 751 009.
Tel.: 0674 - 2596461 /2596455
Fax: 0674 - 2596429
Email: bimalokpal.bhubaneswar@ecoi.co.in
CHANDIGARH - Dr. Dinesh Kumar Verma
Office of the Insurance Ombudsman,
S.C.O. No. 101, 102 & 103, 2nd Floor,
Batra Building, Sector 17 – D,
Chandigarh – 160 017.
Tel.: 0172 - 2706196 / 2706468
Fax: 0172 - 2708274
Email: bimalokpal.chandigarh@ecoi.co.in
CHENNAI - Shri M. Vasantha Krishna
Office of the Insurance Ombudsman,
Fatima Akhtar Court, 4th Floor, 453,
Anna Salai, Teynampet,
CHENNAI – 600 018.
Tel.: 044 - 24333668 / 24335284
Fax: 044 - 24333664
Email: bimalokpal.chennai@ecoi.co.in
DELHI - Shri/Smt........
Office of the Insurance Ombudsman,
2/2 A, Universal Insurance Building,
Asaf Ali Road,
New Delhi – 110 002.
Tel.: 011 - 23232481/23213504
Email: bimalokpal.delhi@ecoi.co.in
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
1.
Office Details
GUWAHATI - Shri Kiriti .B. Saha
Office of the Insurance Ombudsman,
Jeevan Nivesh, 5th Floor,
Nr. Panbazar over bridge, S.S. Road,
Guwahati – 781001(ASSAM).
Tel.: 0361 - 2632204 / 2602205
Email: bimalokpal.guwahati@ecoi.co.in
HYDERABAD - Shri I. Suresh Babu
Office of the Insurance Ombudsman,
6-2-46, 1st floor, "Moin Court",
Lane Opp. Saleem Function Palace,
A. C. Guards, Lakdi-Ka-Pool,
Hyderabad - 500 004.
Tel.: 040 - 67504123 / 23312122
Fax: 040 - 23376599
Email: bimalokpal.hyderab[email protected]o.in
JAIPUR - Smt. Sandhya Baliga
Office of the Insurance Ombudsman,
Jeevan Nidhi – II Bldg., Gr. Floor,
Bhawani Singh Marg,
Jaipur - 302 005.
Tel.: 0141 - 2740363
Email: Bimalokpal.jaipu[email protected].in
ERNAKULAM - Ms. Poonam Bodra
Office of the Insurance Ombudsman,
2nd Floor, Pulinat Bldg.,
Opp. Cochin Shipyard, M. G. Road,
Ernakulam - 682 015.
Tel.: 0484 - 2358759 / 2359338
Fax: 0484 - 2359336
Email: bimalokpal.ernakul[email protected]o.in
KOLKATA - Shri/Smt........
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
1.
Office Details
Office of the Insurance Ombudsman,
Hindustan Bldg. Annexe, 4th Floor,
4, C.R. Avenue,
KOLKATA - 700 072.
Tel.: 033 - 22124339 / 22124340
Fax : 033 - 22124341
Email: bimalokpal.kolkata@ecoi.co.in
LUCKNOW -Shri/Smt........
Office of the Insurance Ombudsman,
6th Floor, Jeevan Bhawan, Phase-II,
Nawal Kishore Road, Hazratganj,
Lucknow - 226 001.
Tel.: 0522 - 2231330 / 2231331
Fax: 0522 - 2231310
Email: bimalokpal.lucknow@ecoi.co.in
MUMBAI - Shri Milind A. Kharat
Office of the Insurance Ombudsman,
3rd Floor, Jeevan Seva Annexe,
S. V. Road, Santacruz (W),
Mumbai - 400 054.
Tel.: 022 - 26106552 / 26106960
Fax: 022 - 26106052
Email: bimalokpal.mumbai@ecoi.co.in
NOIDA - Shri/Smt........
Office of the Insurance Ombudsman,
Bhagwan Sahai Palace
4th Floor, Main Road,
Naya Bans, Sector 15,
Distt: Gautam Buddh Nagar,
U.P-201301.
Tel.: 0120-2514250 / 2514252 / 2514253
Email: bimalokpal.noida@ecoi.co.in
PATNA - Shri/Smt........
Office of the Insurance Ombudsman,
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
1.
Office Details
1st Floor,Kalpana Arcade Building,,
Bazar Samiti Road,
Bahadurpur,
Patna 800 006.
Tel.: 0612-2680952
Email: bimalokpal.patn[email protected].in
PUNE - Shri/Smt........
Office of the Insurance Ombudsman,
Jeevan Darshan Bldg., 3rd Floor,
C.T.S. No.s. 195 to 198,
N.C. Kelkar Road, Narayan Peth,
Pune – 411 030.
Tel.: 020-41312555
Email: bimalokpal.pune@ecoi.co.in
SECTION 9: CLAIM SERVICING:
9.1 Claim Notification - Multi Model Intimation:
It is the endeavor of Company to give multiple options to the Insured/covered person/patient’s care taker to
intimate the claim to the Third party administrator (TPA)/Company. The intimation can be given in following
ways:
Toll Free call Centre of the Insurance Company(24x7) - 1800-103-2292
Login to the website of the Insurance Company and intimate the claim – http://www.bharti-
axagi.co.in/contact-us
Send an email to the TPA/Company- customer.service@bhartiaxa,.com
Post/courier to TPA/Company - Claims, Bharti AXA General Insurance Company Limited spectrum
Tower, 3rd flr, Chincholi Bunder Rd, Rajan Pada, Mindspace, Malad West, Mumbai, Maharashtra
400064
Directly Contacting our Company office but in writing. - Bharti AXA General Insurance Company
Limited, 19th Floor, Parinee Crescenzo, G-Block, Bandra Kurla Complex, Opposite MCA Club,
Bandra (E), Mumbai - 400051
In all the above, the intimations are directed to a central team for prompt and immediate action.
9.2 Information Details
When the Insured/covered person/patient’s care taker intimate the claim as mentioned above the following
information should be given for prompt services.
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
Policy number
Name of the Insured
Name of Covered person/Insured member making the claim
Contact details
Nature of the Disease, Illness or Injury
Name and address, phone number of the attending medical practitioner/hospital.
Date of hospitalization
The Insured / Insured Person must provide notification of claim within 48 hours of admission to the
Hospital or before discharge from the Hospital, whichever is earlier. The Notification of Claim should
be ideally provided by the Insured/Insured Person. In the event Insured / Insured Person is unwell,
then the Notification of Claim should be provided by any immediate adult member of the family.
9.3 Claim Form
Upon the notification of the claim, the TPA/Company will dispatch the claim form to the Insured/Covered
person. Claim forms will also be available with the network hospitals and Company offices and on its
website.
9.4 Claim Procedure
9.4.1 Cashless hospitalization:
Company will work with one or more TPAs for providing cashless facility to the Insured/Covered
person.
List of network hospitals will be available in the the website of the TPA/Company too.
Insured/covered person on admission (emergency) or willing to admit (planned admission) in the
network hospitals, a preauthorization request form has to be filled in by the treating doctor/hospital
and the same has to be sent through fax/e-mail to the TPA by the Insured/hospital. The TPA after
verifying the same will decide on the issuance of authorization after necessary discussion-
(approval) with insurance company. The action of pre-authorization will be done within 6 hours post
receiving all the documents and formalities for emergency admission and 48 hours for planned
admission.
The preauthorization request form will be available in the hospitals or can be downloaded from the
website of the TPA/Company or can request for the same to the TPA/Company via email or fax or
can be collected in person from the branches of the TPA/Company.
Denial of the cashless may not necessarily mean the claim has been rejected. Such claims may be
examined on merits and will be paid on reimbursement basis later if admissible.
The Insured/covered person can send the requisite claim documents to the TPA/Company seeking
reimbursement.
The Insured/covered person need not pay any amount to the hospital if he/she has received the
authorization letter except;
If the bill amount is in excess of the Sum Insured.
Non-medical expenses
Unrelated treatments
Excess/deductible, if any which has to be borne by Insured
The Insured/covered person may have to pay the difference amount to the network provider, in case
the authorized amount is less than estimated/actual bill amount.
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
9.4.2 Reimbursement claims
All reimbursement claims should be intimated to TPA/Insurance Company within 7 days from date of
discharge.
Insured/covered person admitted in a non-network hospital can send the claim documents the
TPA/Company for the reimbursement within 30 days from the date of discharge. However Pre and
post hospitalization bills can be sent within 15 days from the end of post hospitalization period as
specified in the Policy.
9.5 Claim Service Guarantee
9.5.1 Re-imbursement Claims
Notwithstanding the above, upon the receipt of all required documents and processing of the claim, the
claim will be settled within 30 days from the date of submission of the said documents. Settlement (payment)
of claim will be made within 7 days of receipt of acceptance in response to offer of settlement, failing which
penal interest (in compliance with applicable regulations) at a rate of 2% higher than bank rate (prevailing as
on the date of beginning of financial year in which the claim is reviewed) will be paid.
9.5.2 Cashless Claim:
In the event of delay in approval / rejection of cashless claim, a penalty of Rs.500/- for every delay of 6
hours beyond 6 hours in case of emergency hospitalization. For planned hospitalization, the Company shall
pay the penalty for every 6 hours beyond 48 hours. This penalty shall apply after receipt of all information /
documents and will be subject to a maximum amount of Rs.5000/-.
Checklist of documents for settling Claims
SL. NO CHECKLIST
TICK THE
BOXES
1 Claim form duly signed along with attending physician
2 Pre auth form-in case of cashless claim
3 Discharge summary
4 Hospital final bill
5 Attending Surgeon’s/Physician’s Prescription advising hospitalization
6 Surgery/consultation bills and receipts
7 Operation theatre and pharmacy bills
8 Medicines bill with doctor’s prescription
9 Pre hospitalization bills with receipts, prescriptions etc
10
Post hospitalization bills with prescriptions and receipts, Hospital payment
receipt in case of reimbursements
11 Diagnostic reports with doctor’s prescription
12 MLC Report & Police FIR
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
9.6 Documents
It is the Policy of the Company to seek documents in a single shot/request. Based on documents submitted,
if any further documentation is required then it will be sought promptly, at the earliest.
In cases where investigation is deemed necessary, the same will be conducted in all promptitude. Every
attempt will be made to keep the process transparent.
9.7 Repudiations
The power to repudiate claims is vested in the corporate office to ensure transparency and standardization
across the country.
Annexure I: Day Care Treatment
1. Suturing - CLW -under LA or GA
2. Surgical debridement of wound
3. Therapeutic Ascitic Tapping
4. Therapeutic Pleural Tapping
5. Therapeutic Joint Aspiration
6. Aspiration of an internal abscess under ultrasound guidance
7. Aspiration of hematoma
8. Incision and Drainage
9. Endoscopic Foreign Body Removal - Trachea /- pharynx-larynx/ bronchus
10. Endoscopic Foreign Body Removal -Oesophagus/stomach /rectum.
11. True cut Biopsy - breast/- liver/- kidney-Lymph Node/-Pleura/-lung/-Muscle biopsy/-Nerve biopsy/-
Synovial biopsy/-Bone trephine
biopsy/-Pericardial biopsy
12. Endoscopic ligation/banding
13. Sclerotherapy
14. Dilatation of digestive tract strictures
15. Endoscopic ultrasonography and biopsy
16. Nissen fundoplication for Hiatus Hernia /Gastro esophageal reflux disease
17. Endoscopic placement/removal of stents
18. Endoscopic Gastrostomy
19. Replacement of Gastrostomy tube
20. Endoscopic polypectomy
21. Endoscopic decompression of colon
22. Therapeutic ERCP
23. Brochoscopic treatment of bleeding lesion
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
24. Brochoscopic treatment of fistula /stenting
25. Bronchoalveolar lavage & biopsy
26. Tonsillectomy without Adenoidectomy
27. Tonsillectomy with Adenoidectomy
28. Excision and destruction of lingual tonsil
29. Foreign body removal from nose
30. Myringotomy
31. Myringotomy with Grommet insertion
32. Myringoplasty /Tympanoplasty
33. Antral wash under LA
34. Quinsy drainage
35. Direct Laryngoscopy with or w/o biopsy
36. Reduction of nasal fracture
37. Mastoidectomy
38. Removal of tympanic drain
39. Reconstruction of middle ear
40. Incision of mastoid process & middle ear
41. Excision of nose granuloma
42. Blood transfusion for recipient
43. Therapeutic Phlebotomy
44. Haemodialysis/Peritoneal Dialysis
45. Chemotherapy
46. Radiotherapy
47. Coronary Angioplasty (PTCA)
48. Pericardiocentesis
49. Insertion of filter in inferior vena cava
50. Insertion of gel foam in artery or vein
51. Carotid angioplasty
52. Renal angioplasty
53. Tumor embolization
54. TIPS procedure for portal hypertension
55. Endoscopic Drainage of Pseudopancreatic cyst
56. Lithotripsy
57. PCNS (Percutaneous nephrostomy)
58. PCNL (percutaneous nephrolithotomy)
59. Suprapubic cytostomy
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
60. Tran urethral resection of bladder tumor
61. Hydrocele surgery
62. Epididymectomy
63. Orchidectomy
64. Herniorrhaphy
65. Hernioplasty
66. Incision and excision of tissue in the perianal region
67. Surgical treatment of anal fistula
68. Surgical treatment of hemorrhoids
69. Sphincterotomy/Fissurectomy
70. Laparoscopic appendicectomy
71. Laparoscopic cholecystectomy
72. TURP (Resection prostate)
73. Varicose vein stripping or ligation
74. Excision of dupuytren’s contractureHG/V004/wef 1st Oct 2013 16
75. Carpal tunnel decompression
76. Excision of granuloma
77. Arthroscopic therapy
78. Surgery for ligament tear
79. Surgery for meniscus tear
80. Surgery for hemoarthrosis/pyoarthrosis
81. Removal of fracture pins/nails
82. Removal of metal wire
83. Incision of bone, septic and aseptic
84. Closed reduction on fracture, luxation or epiphyseolysis with osetosynthesis
85. Suture and other operations on tendons and tendon sheath
86. Reduction of dislocation under GA
87. Cataract surgery
88. Excision of lachrymal cyst
89. Excision of pterygium
90. Glaucoma Surgery
91. Surgery for retinal detachment
92. Chalazion removal (Eye)
93. Incision of lachrymal glands
94. Incision of diseased eye lids
95. Excision of eye lid granuloma
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
96. Operation on canthus & epicanthus
97. Corrective surgery for entropion & ectropion
98. Corrective surgery for blepharoptosis
99. Foreign body removal from conjunctiva
100. Foreign body removal from cornea
101. Incision of cornea
102. Foreign body removal from lens of the eye
103. Foreign body removal from posterior chamber of eye
104. Foreign body removal from orbit and eye ball
105. Excision of breast lump /Fibro adenoma
106. Operations on the nipple
107. Incision/Drainage of breast abscess
108. Incision of pilonidal sinus
109. Local excision of diseased tissue of skin and subcutaneous tissue
110. Simple restoration of surface continuity of the skin and subcutaneous tissue
111. Free skin transportation, donor site
112. Free skin transportation recipient site
113. Revision of skin plasty
114. Destruction of the diseases tissue of the skin and subcutaneous tissue
115. Incision, excision, destruction of the diseased tissue of the tongue
116. Glossectomy
117. Reconstruction of the tongue
118. Incision and lancing of the salivary gland and a salivary duct
119. Resection of a salivary duct
120. Reconstruction of a salivary gland and a salivary duct
121. External incision and drainage in the region of the mouth, jaw and face
122. Incision of hard and soft palate
123. Excision and destruction of the diseased hard and soft palate
124. Incision, excision and destruction in the mouth
125. Surgery to the floor of mouth
126. Palatoplasty
127. Transoral incision and drainage of pharyngeal abscess
128. Dilatation and curettage
129. Myomectomies
130. Simple Oophorectomies
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
Note: The standard exclusions and waiting periods are applicable to all of the above procedures depending on
the medical condition/disease under treatment. Only 24 hours hospitalization is not mandatory..
A
nnexure
I
I
-
Health Check
-
up tests on
Renewal
Age band <35 years
Complete Blood Count and ESR Tests
Pre and Post Fasting Blood Sugar Test
Urine Routine Analysis
Age band 36
-
5
0
years
Complete Blood Count and ESR Tests
Serum Cholesterol & Triglycerides
Urine Routine Analysis
ECG
Pre and Post Fasting Blood Sugar Test
Age band > 5
0
years
Complete Blood Count and ESR Tests
Lipid Profile
Urine Routine Analysis
ECG
Pre and Post Fasting Blood Sugar Test
Annexure III - No Claim Bonus
No Claim Bonus
Age at the inception of 1st Policy year <45 yrs.
50% of expiring Policy S.I per annum not
exceeding Cumulative Bonus of 100% of current
Policy S.I
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
Age at the inception of 1st Policy year >45 yrs. and
<65 yrs.
20% of expiring Policy S.I per annum not
exceeding Cumulative Bonus of 100% of current
Policy S.I
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
Appendix IV - List of Generally excluded in Hospitalization Policy
List of Generally excluded in Hospitalization Policy
SNO
List of Expenses Generally Excluded
("Non-Medical")in Hospital Indemnity
Policy - SUGGESTIONS
TOILETRIES/COSMETICS/ PERSONAL COMFORT OR CONVENIENCE ITEMS
1 HAIR REMOVAL CREAM Not Payable
2
BABY CHARGES (UNLESS
SPECIFIED/INDICATED)
Not Payable
3 BABY FOOD Not Payable
4 BABY UTILITES CHARGES Not Payable
5 BABY SET Not Payable
6 BABY BOTTLES Not Payable
7 BRUSH Not Payable
8 COSY TOWEL Not Payable
9 HAND WASH Not Payable
10 MOISTUR1SER 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 ( for
site preparations)
Payable
24
EAU-DE-COLOGNE / ROOM
FRESHNERS
Not Payable
25 EYE PAD Not Payable
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
26 EYE SHEILD Not Payable
27 EMAIL / INTERNET CHARGES Not Payable
28
FOOD CHARGES (OTHER THAN
PATIENT'S DIET PROVIDED BY
HOSPITAL)
Not Payable
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 BED UNDER PAD CHARGES Not Payable
44 CAMERA COVER Not Payable
45 CLINIPLAST Not Payable
46 CREPE BANDAGE Not Payable/ Payable by the patient
47 CURAPORE Not Payable
48 DIAPER OF ANY TYPE Not Payable
49 DVD, CD CHARGES
Not Payable ( However if CD is specifically sought by
Insurer/TPA then payable)
50 EYELET COLLAR Not Payable
51 FACE MASK Not Payable
52 FLEXI MASK Not Payable
53 GAUSE SOFT Not Payable
54 GAUZE Not Payable
55 HAND HOLDER Not Payable
56 HANSAPLAST/ADHESIVE BANDAGES Not Payable
57 INFANT FOOD Not Payable
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
58 SLINGS
Reasonable costs for one sling in case of upper arm
fractures should be considered
ITEMS SPECIFIC ALL Y EXCLUDED IN THE POLICIES
59
WEIGHT CONTROL PROGRAMS/
SUPPLIES/ SERVICES
Exclusion in Policy unless otherwise specified
60
COST OF SPECTACLES/ CONTACT
LENSES/ HEARING AIDS ETC.,
Exclusion in Policy unless otherwise specified
61
DENTAL TREATMENT EXPENSES THAT
DO NOT REQUIRE HOSPITALIZATION
Exclusion in Policy unless otherwise specified
62 HORMONE REPLACEMENT THERAPY Exclusion in Policy unless otherwise specified
63 HOME VISIT CHARGES Exclusion in Policy unless otherwise specified
64
INFERTILITY/ SUBFERTILITY/ ASSISTED
CONCEPTION PROCEDURE
Exclusion in Policy unless otherwise specified
65
OBESITY (INCLUDING MORBID
OBESITY) TREATMENT IF EXCLUDED
IN POLICY
Exclusion in Policy unless otherwise specified
66
CORRECTIVE SURGERY FOR
REFRACTIVE ERROR
Exclusion in Policy unless otherwise specified
67
TREATMENT OF SEXUALLY
TRANSMITTED DISEASES
Exclusion in Policy unless otherwise specified
68 DONOR SCREENING CHARGES Exclusion in Policy unless otherwise specified
69 ADMISSION/REGISTRATION CHARGES Exclusion in Policy unless otherwise specified
70
HOSPITALISATION FOR EVALUATION/
DIAGNOSTIC PURPOSE
Exclusion in Policy unless otherwise specified
71
EXPENSES FOR INVESTIGATION/
TREATMENT IRRELEVANT TO THE
DISEASE FOR WHICH ADMITTED OR
DIAGNOSED
Not payable - Exclusion in Policy unless otherwise
specified
72
ANY EXPENSES WHEN THE PATIENT IS
DIAGNOSED WITH RETRO VIRUS + OR
SUFFERING FROM /HIV/ AIDS ETC IS
DETECTED/ DIRECTLY OR INDIRECTLY
Not payable as per HIV/AIDS exclusion
73
STEM CELL IMPLANTATION/ SURGERY
and storage
Not Payable except Bone Marrow Transplantation
where covered by Policy
ITEMS WHICH FORM PART OF HOSPITAL SERVICES WHERE SEPARATE CONSUMABLES ARE
NOT PAYABLE BUT THE SERVICE IS
74
WARD AND THEATRE BOOKING
CHARGES
Payable under OT Charges, not payable separately
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
75
ARTHROSCOPY & ENDOSCOPY
INSTRUMENTS
Rental charged by the hospital payable. Purchase of
Instruments not payable.
76 MICROSCOPE COVER Payable under OT Charges, not payable separately
77
SURGICAL BLADES,HARMONIC
SCALPEL,SHAVER
Payable under OT Charges, not payable separately
78 SURGICAL DRILL Payable under OT Charges, not payable separately
79 EYE KIT Payable under OT Charges, not payable separately
80 EYE DRAPE Payable under OT Charges, not payable separately
81 X-RAY FILM Payable under Radiology Charges, not as consumable
82 SPUTUM CUP
Payable under Investigation Charges, not as
consumable
83 BOYLES APPARATUS CHARGES Part of OT Charges, not separately
84
BLOOD GROUPING AND CROSS
MATCHING OF DONORS SAMPLES
Part of Cost of Blood, not payable
85 Antiseptic or disinfectant lotions Not Payable -Part of Dressing Charges
86
BAND AIDS, BANDAGES, STERLILE
INJECTIONS, NEEDLES,SYRINGES
Not Payable -Part of Dressing Charges
87 COTTON Not Payable -Part of Dressing Charges
88 COTTON BANDAGE Not Payable -Part of Dressing Charges
89 MICROPORE/ SURGICAL TAPE
Not Payable-Payable by the patient when prescribed ,
otherwise included as Dressing Charges
90 BLADE Not Payable
91 APRON
Not Payable -Part of Hospital Services/Disposable
linen to be part of OT/ICU charges
92 TORNIQUET
Not Payable (service is charged by
hospitals,consumables can not be separately charged)
93 ORTHOBUNDLE, GYNAEC BUNDLE Part of Dressing Charges
94 URINE CONTAINER Not Payable
ELEMENTS OF ROOM CHARGE
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
95 LUXURY TAX
Actual tax levied by government is payable .Part of
room charge for sub limits
96 HVAC Part of room charge not payable separately
97 HOUSE KEEPING CHARGES Part of room charge not payable separately
98
SERVICE CHARGES WHERE NURSING
CHARGE ALSO CHARGED
Part of room charge not payable separately
99
TELEVISION & AIR CONDITIONER
CHARGES
Payable under room charges not if separately levied
100 SURCHARGES Part of room charge not payable separately
101 ATTENDANT CHARGES Not Payable - Part of Room Charges
102 IM IV INJECTION CHARGES Part of nursing charges, not payable
103 CLEAN SHEET ^ Part of Laundry/Housekeeping not payable separately
104
EXTRA DIET OF PATIENT(OTHER THAN
THAT WHICH FORMS PART OF BED
CHARGE)
Patient Diet provided by hospital is payable
105
BLANKET/WARMER BLANKET
ADMINISTRATIVE OR NON-MEDICAL
CHARGES
Not Payable- part of room charges
106 ADMISSION KIT Not Payable
107 BIRTH CERTIFICATE Not Payable
108
BLOOD RESERVATION CHARGES AND
ANTE NATAL BOOKING CHARGES
Not Payable
109 CERTIFICATE CHARGES Not Payable
110 COURIER CHARGES Not Payable
111 CONVENYANCE CHARGES Not Payable
112 DIABETIC CHART CHARGES Not Payable
113
DOCUMENTATION CHARGES /
ADMINISTRATIVE EXPENSES
Not Payable
114 DISCHARGE PROCEDURE CHARGES Not Payable
115 DAILY CHART CHARGES Not Payable
116
ENTRANCE PASS / VISITORS PASS
CHARGES
Not Payable
117
EXPENSES RELATED TO
PRESCRIPTION ON DISCHARGE
To be claimed by patient under Post Hosp where
admissible
118 FILE OPENING CHARGES Not Payable
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
119
INCIDENTAL EXPENSES / MISC.
CHARGES (NOT EXPLAINED)
Not Payable
120 MEDICAL CERTIFICATE Not Payable
121 MAINTENANCE CHARGES Not Payable
122 MEDICAL RECORDS Not Payable
123 PREPARATION CHARGES Not Payable
124 PHOTOCOPIES CHARGES Not Payable
125
PATIENT IDENTIFICATION BAND /
NAME TAG
Not Payable
126 WASHING CHARGES Not Payable
127 MEDICINE BOX Not Payable
128 MORTUARY CHARGES Payable up to 24 hrs,shifting charges not payable
129
MEDICO LEGAL CASE CHARGES (MLC
CHARGES)
Not Payable
EXTERNAL DURABLE DEVICES
130 WALKING AIDS CHARGES Not Payable
131 BIPAP MACHINE Not Payable
132 COMMODE Not Payable
133 CPAP/ CAPD EQUIPMENTS Device Not Payable
134 INFUSION PUMP - COST Device Not Payable
135
OXYGEN CYLINDER (FOR USAGE
OUTSIDE THE HOSPITAL)
Not Payable
136 PULSEOXYMETER CHARGES Device Not Payable
137 SPACER Not Payable
138 SPIROMETRE Device Not Payable
139 SP0 2PROB E Not Payable
140 NEBULIZER KIT Not Payable
141 STEAM INHALER Not Payable
142 ARMSLING Not Payable
143 THERMOMETER Not Payable (paid by patient)
144 CERVICAL COLLAR Not Payable
145 SPLINT Not Payable
146 DIABETIC FOOT WEAR Not Payable
147
KNEE BRACES ( LONG/ SHORT/
HINGED)
Not Payable
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
148
KNEE IMMOBILIZER/SHOULDER
IMMOBILIZER
Not Payable
149 LUMBOSACRAL BELT
Essential and should be paid specifically for cases
who have undergone surgery of lumbar spine.
150
NIMBUS BED OR WATER OR AIR BED
CHARGES
Payable for any ICU patient requiring more than 3
days in ICU, all patients with paraplegia /quadripiegia
for any reason and at reasonable cost of
approximately Rs 200/ day
151 AMBULANCE COLLAR Not Payable
152 AMBULANCE EQUIPMENT Not Payable
153 MICROSHEILD Not Payable
154 ABDOMINAL BINDER
Essential and should be paid in post surgery patients
of major abdominal surgery including TAH,
LSCS,incisional hernia repair, exploratory laparotomy
for intestinal liver transplant etc.obstruction,
ITEMS PAYABLE IF SUPPORTED BY A PRESCRIPTION
155
BETADINE \ HYDROGEN
PEROXIDE\SPIRIT\DISINFECTANTS
ETC
May be payable when prescribed for patient , not
payable for hospital use in OT or ward or for dressings
in hospital
156
PRIVATE NURSES CHARGES- SPECIAL
NURSING CHARGES
Post hospitalization nursing charges not Payable
157
NUTRITION PLANNING CHARGES -
DIETICIAN CHARGESDIET CHARGES
Patient Diet provided by hospital is payable
158 SUGAR FREE Tablets
Payable -Sugar free variants of admissible medicines
are not excluded
159
CREAMS POWDERS LOTIONS (Toiletries
are not payable, only prescribed medical
pharmaceuticals payable)
Payable when prescribed
160 Digestion gels Payable when prescribed
161 ECG ELECTRODES
Up to 5 electrodes are required for every case visiting
OT or ICU. For longer stay in ICU, may require a
change and at least one set every second day must be
payable.
162 GLOVES Sterilized Gloves payable /unsterilized gloves not payable
163 HIV KIT Payable - payable Pre operative screening
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
164 LISTERINE/ ANTISEPTIC MOUTHWASH Payable when prescribed
165 LOZENGES Payable when prescribed
166 MOUTH PAINT Payable when prescribed
167 NEBULISATION KIT If used during hospitalization is payable reasonably
168 NOVARAPID Payable when prescribed
169 VOLINI GEL/ ANALGESIC GEL Payable when prescribed
170 ZYTEE GEL Payable when prescribed
171 VACCINATION CHARGES
Routine Vaccination not Payable / Post Bite
Vaccination Payable
PART OF HOSPITAL'S OWN COSTS AND NOT PA YA BLE
172 AHD Not Payable - Part of Hospital’s internal Cost
173 ALCOHOL SWABES Not Payable - Part of Hospital’s internal Cost
174 SCRUB SOLUTION/STERILLIUM Not Payable - Part of Hospital’s internal Cost
OTHERS
175 VACCINE CHARGES FOR BABY Payable as per Plan
176 AESTHETIC TREATMENT / SURGERY Not Payable
177 TPA CHARGES Not Payable
178 VISCO BELT CHARGES Not Payable
179
ANY KIT WITH NO DETAILS
MENTIONED [DELIVERY KIT,ORTHOKIT,
RECOVERY KIT, ETC]
Not Payable
180 EXAMINATION GLOVES Not Payable
181 KIDNEY TRAY Not Payable
182 MASK Not Payable
183 OUNCE GLASS Not Payable
184
OUTSTATION CONSULTANT'S/
SURGEON'S FEES
Not payable, except for telemedicine consultations w
here covered by Policy
185 186 OXYGEN MASK Not Payable
186 PAPER GLOVES Not Payable
187 PELVIC TRACTION BELT
Should be payable in case of PIVI) requiring traction
as this is generally not reused
188 REFERAL DOCTOR'S FEES Not Payable
189 ACCU CHECK ( Glucometery/ Strips)
Not payable pre-hospitilazation o r post hospitalization
/ Reports and Charts required / Device not payable
Policy Wordings – Bharti AXA Smart Super Health Assure Policy
UIN: BHAHLIP20108V011920
Bharti AXA General Insurance Company Limited, “HOSTO CENTER” 1st Floor No.43,Millers Road. Vasanth
Nagar, Bangalore -560052 Ph: 1800-103-2292, CIN : U66030KA2007PLC043362., IRDAI Reg No:- 139
Wesbite:www.bharti-axagi.co.in, Email: [email protected]m
190 PAN CAN Not Payable
191 SOFNET Not Payable
192 TROLLY COVER Not Payable
193 UROMETER, URINE JUG Not Payable
194 AMBULANCE Payable as per Plan
195 TEGADERM / VASOFIX SAFETY
Payable - maximum of 3 in 48 hrs an d then 1 in 24
hrs
196 URINE BAG P
Payable where medically necessary till a reasonable
cost - maximum 1 per 24 hrs
197 SOFTOVAC Not Payable
198 STOCKINGS
Essential for case like CABG etc. where it should be
paid.
