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Max Bupa Heartbeat Health Insurance

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  • Individual/Family
  • Features
  • Exclusions
Benefits Silver Policy Gold Policy Platinum Policy
Sum Insured 2 Lakhs & 3 Lakhs 5 Lakhs, 7.5 Lakhs, 10 Lakhs, 15 Lakhs, 20 Lakhs & 50 Lakhs 15 Lakhs, 20 Lakhs, 50 Lakhs & 1 Crore
In-patient treatment
Medical Practitioner's fees Covered Covered Covered
Diagnostic procedures Covered Covered Covered
Medicines, drugs and consumables Covered Covered Covered
Intravenous fluids, blood transfusion, injection Covered Covered Covered
The cost of prosthetics and other devices or equipment if implanted internally during a Surgical Operation Covered Covered Covered
Intensive Care Unit Charges Covered Covered Covered
Hospital accommodation Shared room or 1% of the Base Sum Insured Single Private Room Covered
Pre and Post hospitalization expenses including doctor's consultation, diagnostics tests, intravenous fluid, blood transfusion, medicines, drugs and consumables. Covered up to 15% of Base Sum Insured Covered up to 20% of Base Sum Insured Covered
All day care treatment Covered Covered Covered
Maternity Cover for up to 2 deliveries
Maternity Cover for up to 2 deliveries Covered up to Rs 20,000, Rs 30,000 for 2 Lakhs & 3 Lakhs respectively Covered up to Rs 40,000, Rs 45,500, Rs 50,000, Rs 55,000, Rs 65,000 & Rs 80,000 for 5 Lakhs, 7.5 Lakhs,10 Lakhs, 15 Lakhs, 20 Lakhs & 50 Lakhs respectively Covered up to Rs 60,000, Rs 75,000, Rs 1,00,000 & Rs 150,000 for 15 Lakhs, 20 Lakhs, 50 Lakhs & 1 Cr respectively
New Born Baby Cover until the end of current policy year Covered Covered Covered
Vaccinations for children up to 12 years and nutrition and diet consulting Covered Covered Covered
Further benefits
Health check up at the time of renewal Once in 2 years Annual Annual tests
Organ transplant when medically necessary Covered Covered Covered
Emergency ambulance Covered at actual costs in Network Hospitals up to Sum Insured Covered at actual costs in Network Hospitals up to Sum Insured Covered at actual cost in Network Hospitals up to Sum Insured
Domiciliary treatment Covered up to Rs 10,000, Rs 15,000 for 2 Lakhs & 3 Lakhs respectively Covered up to Rs 25,000, Rs 37,500, Rs 50,000, Rs 60,000, Rs 80,000 & Rs 200,000 for 5 Lakhs, 7.5 Lakhs,10 Lakhs, 15 Lakhs, 20 Lakhs & 50 Lakhs respectively Covered up to Rs 75,000, Rs 1,00,000, Rs 2,50,000 & Rs 400,000 for 15 Lakhs, 20 Lakhs, 50 Lakhs & 1 Cr respectively
Health Relationship Loyalty Program 10% equivalent redeemable points of the Last Paid Annual Premium OR Additional 10% sum insured of expiring Base sum insured up to a maximum of 50% of base sum insured 10% equivalent redeemable points of the Last Paid Annual Premium OR Additional 10% sum insured of expiring Base sum insured up to a maximum of 50% of base sum insured 10% of the Last Paid Premium OR Additional 10% base sum insured up to at any time maximum of 50% of base sum insured
OPD benefits
Outpatient benefits covering specialist consultation and costs of diagnostics tests prescribed by them Not Applicable Not Applicable Covered up to Rs 10,000, Rs 15,000, Rs 20,000 & Rs 40,000 for 15 Lakhs, 20 Lakhs, 50 Lakhs & 1 Crore respectively
International Medical treatment & Assistance
Emergency Medical Evacuation and Hospitalization outside India Not Applicable Not Applicable Covered up to Rs 15,000, Rs 200,000, Rs 500,000 & Rs 10,00,000 for 15 Lakhs, 20 Lakhs, 50 Lakhs & 1 Crore respectively
Specified Illness Cover for treatment abroad Not Applicable Not Applicable Covered Worldwide excluding USA and Canada
Optional benefit/feature
Annual aggregate Deductible Covered up to 1 lakh/2 lakhs/3 lakhs for 2 Lakhs & 3 Lakhs Not Applicable Not Applicable
Co-payment for insured less than 65 year old Options of 10% and 20% co-payment Options of 10% and 20% co-payment Options of 10% and 20% co-payment
  1. In-patient treatment - (Up to Sum Insured)
    • Medical practitioners fees, Diagnostics tests, Medicines, Drugs and Consumables, Nursing charges, Intravenous fluids, Blood transfusion, Injection administration charges, Operation theatre charges, The cost of prosthetics and other devices or equipment if implanted internally during a Surgical procedure,Intensive Care Unit charges
  2. Hospital Accommodation
    • Reasonable and customary charges for hospital accommodation upto Sum Insured
  3. Pre & Post Hospitalization Expenses - (Up to Sum Insured)
    • Reimbursement of claim amount, 30 days for pre-hospitalization and 60 days for post-hospitalization
  4. All Day-care Procedures – (Up to Sum Insured)
    • Including Chemotherapy, Radiotherapy, Hemodialysis, or any procedure which needs a period of specialized observation or care after completion of the procedure
  5. Organ donor
    • Expenses for an organ donor’s treatment for the harvesting of the organ donated covered upto Sum Insured
  6. Emergency Ambulance
    • Covered upto Rs. 3,000 per hospitalization for all hospitalization (network/non-network)
  7. Domiciliary Treatment
    • Covered upto Sum Insured
  8. Free Heath Check-ups
    • Once in 2 years for 4 lakh coverage, once a year for others. Insured Person whos age is of 18 years at the time of Renewal shall be eligible for a health check-up.
  9. No Claim Bonus
    • 20% increase on the expiring Base Sum Insured up to a maximum of 100% of the Base Sum Insured of that Policy Year. NCB once accrued does not get reduced in case of claim
  10. Refill Benefit for New Illness (Individual/Family Floater Only)
    • If the base sum insured and No Claim Bonus is partially or completely exhausted (in case of Individual and Floater),We will provide Refill Sum Insured upto 100% of Base Sum Insured.
  11. Vaccination and Immunization Post an Animal Bite
  12. AYUSH Benefit
    • Reimbursement of medical expenses for alternative treatment taken under AYUSH provided the treatment has been undergone in a government hospital or in any institute recognized by government and/or accredited by Quality Council of India/National Accreditation Board on Health(Ayurvedic, Homeopathic, Sidda & Unani)
  13. No Copayment
    • No Mandatory or Optional Co-payment for any age
  14. High Deductible Top-up Option Discount
    • Customers can opt to start utilizing MAX Bupa Cover after exhausting their existing over with other company.
  15. Option Available with 10% Discount.
  16. Hospital Cash Option
    • Optional
  17. Discount for 2 year Policy
    • 12.5% on 2nd year premium
  18. Disease Based Risk Loading
    • Newly introduced
  19. Waiting Periods And Exclusions
    • 30 days waiting period except accidents. 48m Pre-Existing Diseasein Variant 1(upto 4 lac),36m PED in Variant 2, 3 & Family First
  20. Pricing
    • Best In the Industry.
    • Cashless facility is available across quality hospitals in our network.
  1. Addictive conditions and disorders
  2. Ageing and puberty
  3. Artificial life maintenance
  4. Circumcision
  5. Conflict and disaster
  6. Congenital conditions
  7. Convalescence and Rehabilitation
  8. Cosmetic surgery
  9. Dental/oral treatment
  10. Drugs and dressings for OPD Treatment or take-home use
  11. Eyesight
  12. Unproven/Experimental treatment
  13. Health hydros, nature cure, wellness clinics etc
  14. HIV and AIDS
  15. Hereditary conditions
  16. Alternative treatment
  17. Psychiatric and Psychosomatic Conditions
  18. Obesity
  19. OPD Treatment
  20. Reproductive medicine - Birth control & Assisted reproduction
  21. Self-inflicted injuries
  22. Sexual problems and gender issues
  23. Sexually transmitted diseases
  24. Sleep disorders
  25. Speech disorders
  26. Treatment for developmental problems
  27. Treatment received outside India
  28. Unrecognized physician or Hospital
  29. Unlawful Activity
  30. Policy will not cover any treatment during the first 30 days unless the treatment needed is a result of an accident.
  31. Pre-existing disease for a sum-insured upto 4 lakhs will be covered after 48 months and for 5 lakhs onwards pre-existing condition will cover after 36 months.

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