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Health Insurance & Medical Insurance India
Plans > Health Insurance Plans > Individual > Maxima

More often than not we visit hospitals for small health problems like sore throat, fever stomach ache etc than big ones, yet very few plan cover these small illnesses. Our Maxima plan offers unique out-patient benefits to take care of your regular illnesses and little niggles.


         
Eligibility
  • This policy covers persons in the age group 91 days onwards. The maximum entry age is 65 years.
  • There is no maximum cover ceasing age in this policy.
  • The policy will be issued for a period of 1 year.
  • This policy can be issued to an individual and/or family. The family coverage in on floater basis and the coverage will be available for two members & two adults + upto 2 children.
  • The family includes spouse, dependent children and dependent parents.
  • The premium under floater coverage will be charged on the age of the eldest insured member
Benefit

Outpatient Benefits

  • Doctor Consultation - 4/6/8 consultations as per plan opted for you and your family.
  • Pharmacy Expenses - Your pharmacy bills are covered.
  • Diagnostics - Cost of diagnostic tests taken by you or any of your covered family members is covered.
  • Specialist Services - Coverage for specific dental treatments, spectacles & contact lenses upto a certain limit
  • Health Check-up Benefit - Any person above the age of 18 years can undergo an annual health check-up (Person above 45 years can avail this benefit from second year)

Plan Benefits

  • In-Patient Hospitalisation - The medical expenses for coverage for hospitalization of more than 24 hrs.
  • Pre-Hospitalisation - The medical expenses that you incur due to illness during 30 days immediately before you are hospitalised.
  • Post-Hospitalisation - The medical expenses you incur in the 60 days immediately after you are discharged from hospital.
  • Day-Care Procedures - The medical expenses for enlisted 140 day-care procedures, which do not require 24 hours hospitalization due to technological advancement, are covered.
  • Domiciliary Treatment - The treatment expenses involved in getting a treatment done at home which otherwise would need hospitalization.
  • Organ Donor - Treatment expenses for the organ donor at the time of organ transplant.
  • Daily Cash for Choosing Shared Accommodation - A lump sum amount given for selecting a shared room in a network hospital.
  • Emergency Ambulance - Expenses incurred if ambulance service is used on the way to hospital for hospitalization (up to Rs. 2000).
  • Daily Cash for Accompanying An Insured Child (less than 12 years) - A lump sum amount paid if an adult accompanies an insured child during hospitalization.
  • New Born Baby - An option is given to the policy holder to cover a new born baby (from Age 1-90 days)
  • Maternity Expenses - The maternity expenses incurred both before and after child birth procedures are covered after a waiting period of 4 years.
  • Additional Cover for Critical Illness (optional) - You can opt for an additional cover for Critical Illness which covers for Cancer of specified severity, Open Chest CABG, First Heart Attack of specified severity, Kidney Failure requiring regular dialysis, Major Organ/Bone Marrow Transplant, Multiple Sclerosis with Persisting Symptoms, Permanent Paralysis of Limbs, Stroke resulting in Permanent Symptoms. This benefit if opted is applicable to all family members on Individual Sum Insured Basis equivalent to Rs.300,000/

Other Benefits

  • Renewal Benefits for Inpatient Treatment - Maxima offers a cumulative bonus of 10% for every claim free year accumulating to a maximum of 50% of your in-patient sum insured. In the event of a claim, the cumulative bonus is reduced by 10% on the next renewal.
  • Renewal Benefit for Out-Patient Treatment - Maxima offers the advantage of carrying forward 50% of any unutilized entitlement certificates to the next policy year. This excludes the Annual Health Check-up.
  • Cashless Service - You need to obtain a pre-authorization for all planned admissions atleast 48 hours prior to actual admission or regularize any ‘emergency’ admission within 24 hours post the admission. The details of the process and the documentation requirements are given in the guide-book sent along with the policy.
  • Portability - If you are insured with some other company’s health insurance and you want to shift to us on renewal, you can. Our portability policy is customer friendly and aims to achieve the transfer of most of the accrued benefits and makes due allowances for waiting periods etc.
  • Tax Benefits - With our Maxima Plan you can presently avail tax benefits for the premium amount under Section 80D of the Income Tax Act.
Stay Healthy Package

With increasing stress levels and work pressure, we help you take care of your wealth by managing your health! We bring to you our “Stay Healthy” Program that offers

  • Online health assessment.
  • Customized diet & exercise plan from our experts.
  • E- storage facilities to store your medical reports for 24X7 access.
  • Great offers & discounts on heath products & services.
  • Set alerts to track your health appointments and medicinal intake.
  • Exclusive health newsletter & helpline services.

And lots more…

In addition, Health Line Services & Discounts at our listed partner’s network are provided in all sum insured – You just need to call us and quote your customer ID to reach our experts and avail their help in primary consultation, health-related counseling, individual referrals, health information, nutrition and diet.

Renewal Policies
  • Our Maxima policy offers lifelong renewability i.e there is no maximum cover ceasing age in this policy
  • Grace Period of 30 days for renewing the policy is provided under this policy.
  • Waiting periods as mentioned in the policy wording gets reduced by 1 year on every continuous renewal of your Maxima Insurance policy.
  • Renewal premium are subject to change with prior approval from IRDA. Any change in benefits or premium (other than due to change in age) will be done with the approval of the IRDA and will be intimated atleast 3 months in advance.
Exclusions
  • All treatments within the first 30 days of cover except any accidental injury.
  • Any pre-existing condition will be covered after a waiting period of 3 years.
  • 2 years waiting period for specific diseases like cataract, hernia, joint replacement surgeries, surgery of hydrocele etc.
  • Expenses arising from HIV or AIDS and related diseases.
  • Congenital diseases, mental disorder or insanity, cosmetic surgery and weight control treatments.
  • Abuse of intoxicant or hallucinogenic substances like intoxicating drugs and alcohol.
  • Hospitalization due to war or an act of war or due to a nuclear, chemical or biological weapon and radiation of any kind.
  • Items of personal comfort and convenience.
  • Experimental, investigative and unproven treatment devices and pharmacological regimens

Please refer to the Policy Wording for the complete list of exclusions.


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