Maxima Insurance

Maxima provides an in-patient cover along with hordes of other benefits with unique outpatient cover.


• Wide In-patient cover: Maxima offers 300,000 cover for in-patient treatment, pre and post hospitalisation, daycare procedures, domiciliary treatment, daily cash for choosing shared accommodation. We also pay for expenses for organ donor, emergency ambulance charges, daily cash for accompanying an insured child, maternity expenses and care for a new born.
• Wide Out-patient cover: An out-patient benefit up to the limit covering expenses for doctor consultations, pharmacy expenses, spectacles, health check-up and diagnostic tests. All these are available throughout the HDFC ERGO Health Formerly Apollo Munich network on cashless basis and on reimbursement basis anywhere else in India.
• Cashless Hospitalisation: Cashless transactions across the HDFC ERGO Health Formerly Apollo Munich network of over 4000 hospitals across 800 cities in case you need hospitalisation.
• Life Long Renewal benefit: The good thing is, once you are covered under Maxima, you can renew your cover life long. So there’s no cover ceasing age.
• Additional Critical Illness cover: You have the option to choose an additional critical illness cover as per your needs. This provides for additional coverage against 8 specified critical illnesses and is always paid as a lump sum benefit in addition to any medical expenses you may incur for hospitalisation.
• Renewal Benefits: For In-patient 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.

For Out-patient benefits : 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.

• Any treatment within first 30 days of cover except any accidental injury.
• 2 years exclusion for specific diseases.
• Pre-existing diseases exclusions for 3 years.
• Expenses arising from HIV or AIDS and related diseases.
• Abuse of intoxicant or hallucinogenic substance like drugs and alcohol.
• War or act of war, nuclear, chemical or biological weapon and radiation of any kind
• Non-allopathic treatment.

Benefits	1 Member	2 Members	2 Adults + Upto 2 Children
Sum Insured per Policy year	300,000	300,000	300,000
a) In-patient Hospitalisation	Covered	Covered	Covered
b) Pre-Hospitalisation	30 days	30 days	30 days
c) Post-Hospitalisation	60 days	60 days	60 days
d) Day Care Procedures	140 procedures covered	140 procedures covered	140 procedures covered
e) Domiciliary Treatment	Covered	Covered	Covered
f) Daily Cash for choosing shared accommodation	500 per day; maximum 3,000	500 per day; maximum 3,000	500 per day; maximum 3,000
g) Organ Donor	Covered	Covered	Covered
h) Emergency Ambulance	Up to 2,000 per hospitalisation	Up to 2,000 per hospitalisation	Up to 2,000 per hospitalisation
i) Daily Cash for accompanying an insured child	300 per day; maximum 9,000	300 per day; maximum 9,000	300 per day; maximum 9,000
j) Maternity Expenses** (Waiting Period 4 years)	Normal delivery- 15,000; Caesarean delivery- 25, 000 (Including Pre/Post Natal limit of 1,500 and infant baby limit of 2,000)	Normal delivery- 15,000; Caesarean delivery- 25, 000 (Including Pre/Post Natal limit of 1,500 and infant baby limit of 2,000)	Normal delivery- 15,000; Caesarean delivery- 25, 000 (Including Pre/Post Natal limit of 1,500 and infant baby limit of 2,000)
k) Newborn baby cover	Optional	Optional	Optional
Optional Benefit Critical Illness Rider** (Offered on Individual basis)	300,000	300,000	300,000

** Benefits do not dip into in-patient Sum Insured

Benefits per Policy year	1 Member	2 Members	2 Adults + Upto 2 Children
a) Doctor consultations*	4 consultations	6 consultations	8 consultations
b) Diagnostic tests# c) Pharmacy# d) Dental treatment# e) Spectacles, Contact lenses#	5,000	5,500	7,000
f) Annual Health Checkup within specified Network**	1 entitlement certificate	2 entitlement certificate	2 entitlement certificate

*The reimbursement against non-network out-patient consultation is restricted up to lower of actual expenses or Rs 400
#The reimbursement against Diagnostic tests, OPD Dental treatment, Spectacles, Contact lenses outside HDFC ERGO Health Formerly Apollo Munich network is restricted upto lower of actual expenses or the Sum Insured mentioned herein.
**Health check-up is available only within the specified network and not available on reimbursement basis.