Health Insurance Policy provides complete financial protection for you and your family against hospitalization expenses.

1. Health Insurance
Bharti
AXA Smart Health
Insurance Policy

2. Agenda
Product
Guidelines & Processes
Need for Health Insurance
Smart Health Insurance
Underwriting Guidelines
Basic Covers
Claims Process
Value-added Benefits
Important Guidelines
Additional Features
Exclusions
Plan and Premium
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080-49010200

3. Does this sound familiar?
Need for Health Insurance
You pay a visit to
the doctor..
You buy the
medicines the
doctor prescribed
You are still
unwell…so
you get
hospitalised
You undergo
medical tests…
You get
hospitalised for a
surgery
You take some
medicines for
faster recovery..
All these involve a lot of money…
You are well
again…
You suddenly
feel unwell…
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4. And the result….
You might feel like doing this….
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5. Multi-dimensional Impact
Potential Loss
of income
Family’s
Health
Hospitalisation
expenses
Ad-hoc
expenses
Depleted
savings
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080-49010200

6. What are the expenses related to hospitalisation?
Before Hospitalisation
During Hospitalisation
Post Hospitalisation
Doctor fees
Room Charges
Doctor fees
Cost of medicines
Operation Theater
Charges
Cost of medicines
Cost towards
medical tests
Covered
under basic
covers
Cost towards
medical tests
Surgery/Operation/
Treatment Costs
Cost of medicines.
Blood, oxygen etc
Doctor/Specialist/
Surgeon fees
Nursing Charges
Associated Costs:
Loss of income
Expenses towards food of accompanying persons/visitors
Transport expenses for accompanying persons/visitors
Ambulance charges etc
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080-49010200
Covered as
value-added
benefits

7. Smart Health for Smart People
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Your Smart Health Insurance Policy
provides complete financial
protection for you and your family
against Hospitalization Expenses
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080-49010200

8. Coverage
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The Smart Health Insurance Policy covers:
 Hospitalisation Benefit
 Domiciliary Hospitalisation
 Day Care Treatment
 Pre and Post Hospitalisation Expenses
 Critical Illness
- Dread Disease Recuperation
- Transplantation of Organs
Please refer the plan details for the Sum Insured options with respect to
these benefits
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9. Hospitalisation Benefit
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Covers expenses incurred by Insured Person as an in-patient in a
hospital
 In relation to treatment of disease or injury.
This includes:
 Hospital (Room & Boarding and Operation theatre) charges
 Fees of Surgeon, Anesthetist, Nurses, Specialists
 Cost of diagnostic tests, medicines, blood, oxygen
 Cost of appliances like pacemaker, artificial limbs and organs
This is applicable only if the period of hospitalisation exceeds 24
hours.
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080-49010200

10. Domiciliary Hospitalisation
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Reimbursement of expenses involving medical treatment for
disease/injury at the Insured Person’s home in India
The treatment would have in normal course, done in a
hospital/nursing home, but is taking place at Insured Person’s
home only because
i.
the condition of the patient is such that he / she cannot be moved to
Hospital / Nursing Home, or
ii.
the patient cannot be admitted to Hospital/Nursing Home for lack of
accommodation therein.
This is applicable only if the treatment is done at home for a period
exceeding 3 days
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080-49010200

11. Day Care Treatment
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Payment or reimbursement of hospitalisation expenses incurred in case of
treatment, where 24 hours of hospitalisation is not required due to technologically
advanced treatment protocol
This includes:
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Dialysis - Kidney
Chemotherapy - Cancer
Radiotherapy - Cancer
Eye surgery - Eye
Dental surgery - Dental
Lithotripsy (Kidney stone
removal)
Tonsillectomy - Tonsils
Dilatation & Curettage
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Cardiac Catheterization
Hydrocele surgery
Hernia repair surgery
TURP (Prostate Surgery)
Surgeries/procedures that
require less than 24 hours
hospitalisation due to
medical/technological
advancement and infrastructural
facilities.
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080-49010200

12. Pre and post hospitalisation
expenses
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Pre-hospitalisation Expenses  Post Hospitalisation Expenses
 Payment or reimbursement of  Payment or reimbursement of
expenses incurred for specified
expenses incurred for
days post discharge from Hospital
specified days prior to
hospitalisation
Optimum
60 days
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Optimum
90 days
Hospitalisation
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080-49010200

13. Critical Illness
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Covers expenses incurred for treatment of any of the specified
critical illnesses
Coverage is available in either of the following options:
 Payment of lump sum benefit amount if the Insured Person is being
diagnosed as contracting any of specified Critical Illnesses and
surviving for more than 30 days post such diagnosis.
 Payment /reimbursement of expenses incurred for treatment of such
specified Critical Illness in a Hospital / Nursing Home
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This benefit is available after a waiting period of 60 days from the
date of inception of the first year Policy
The SI available under this benefit is separate and additional to the
SI available under the Hospitalisation benefit Section of the Policy.
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080-49010200

14. Critical Illnesses
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6.
7.
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10.
Cancer
First Heart Attack - Heart
Coronary Artery Disease Heart
Coronary Artery Bypass
surgery - Heart
Heart Valve Surgery - Heart
Surgery to Aorta – Heart
Stroke - Brain
Kidney Failure
Aplastic Anaemia - Blood
End Stage Lung Disease
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20.
End Stage Liver Failure
Coma - Brain
Major Burns - Burns
Major Organ/Bone Marrow
Transplantation - Bone
Multiple Sclerosis - Cancer
Fulminant Hepatitis - Liver
Motor Neurone Disease - Brain
Primary Pulmonary
Hypertension - Heart
Terminal Illness – Last stage of
any illness
Bacterial Meningitis - Brain
First product
in India to cover
20 critical illnesses
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080-49010200

15. SmartHealth Value Added Benefits
SmartHealth Benefits  Out-patient Dental Emergency
 Hospital Cash Allowance
 Home Nursing
Treatment (arising out of Accident only)
 Ambulance Charges
 The SmartHealth Insurance Policy  Out-patient Emergency treatment for
also offers these benefits:
 In-patient Physiotherapy Charges
accidents
 Hospital Cash Allowance
 Recovery Grant
 Home Nursing
 Children Education Fund
 Ambulance Charges
 Accompanying Person’s Expenses  Mortal Remains
 In-patient Physiotherapy Charges
 Parent Accommodation as
 Recovery Grant
 Accompanying Person’s Expenses
Companion for Childas Companion for Child
 Parent Accommodation
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Out-patient Dental Emergency Treatment
(arising out of Accident only)
 Out-patient Emergency treatment for accidents
 Children Education Fund
 Mortal Remains
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Please refer the plan details for the applicability and Sum Insured
options with respect to these benefits
For more détails please visit at www.bharti-axagi.co.in or call us at 080-49010200

16. Hospital Cash Allowance
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Payment of a daily hospitalisation expenses up to the applicable
limits
 In case the Insured is hospitalized for treatment of any disease/injury / critical
illness for which a valid claim is admissible under the Policy and
 if the hospitalisation exceeds the applicable number of days
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This benefit is applicable irrespective of the number of
occurrences during the Policy period subject to overall Sum
Insured.
For more détails please visit at www.bharti-axagi.co.in or call us at
080-49010200

17. Home Nursing
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Payment of an allowance for medical care services of a nurse at
the residence of the Insured
 following discharge from Hospital after a treatment for a disease /
illness / injury / critical illness for which a valid claim under this Policy
is admissible
 provided such medical care services are confirmed as being
necessary by the attending Medical Practitioner and
 the treatment relates directly to the disease/ injury / critical illness for
which the Insured has undertaken treatment during the
hospitalisation,
This benefit is applicable irrespective of the number of
occurrences during the Policy period subject to the overall Sum
Insured.
For more détails please visit at www.bharti-axagi.co.in or call us at
080-49010200

18. Ambulance Charges
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Reimbursement of expenses incurred for the transportation of
the Insured Person by ambulance to and from the Hospital
 for treatment of disease, illness or injury in a Hospital as an inpatient for which a valid claim under this Policy is admissible.
This benefit is applicable irrespective of the number of
occurrences during the Policy period and is subject to the
applicable limits.
For more détails please visit at www.bharti-axagi.co.in or call us at
080-49010200

19. In-patient Physiotherapy Charges
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Reimbursement of charges incurred towards physiotherapy in the
Hospital as an in-patient
 that is confirmed as being necessary by the attending Medical
Practitioner and
 the same relates directly to the disease, illness or injury for which the
Insured Person has undertaken treatment in the Hospital for which a
valid claim is admissible under this Policy.
This benefit is applicable irrespective of the number of
occurrences during the Policy period and is subject to the
applicable limits.
For more détails please visit at www.bharti-axagi.co.in or call us at
080-49010200

20. Recovery Grant
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Payment of a fixed allowance/grant
 in case the Insured Person is hospitalized for a period of 8
consecutive days or more for treatment of any disease/injury for
which a valid claim is admissible under the Policy
This benefit is available upto the applicable limits under the
Optimum Plan
For more détails please visit at www.bharti-axagi.co.in or call us at
080-49010200

21. Accompanying Person’s Expenses
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Payment an allowance towards expenses incurred on the
accompanying person at the Hospital
 during hospitalisation treatment of the Insured Person for the disease,
illness or injury for which a valid claim is admissible under the Policy.
This benefit is applicable irrespective of the number of
occurrences during the Policy period and is subject to the
applicable limits
For more détails please visit at www.bharti-axagi.co.in or call us at
080-49010200

22. Parent Accommodation as Companion
for Child
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Payment of a fixed daily allowance towards meeting the expenses
for the stay of one of the parents at the Hospital when a child
below the age of 12 years is hospitalized.
This benefit is applicable irrespective of the number of
occurrences during the Policy period and is subject to the
applicable limits.
For more détails please visit at www.bharti-axagi.co.in or call us at
080-49010200

23. Out-patient Dental Emergency Treatment
(arising out of Accident only)
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Reimbursement of medical expenses incurred towards emergency
treatment by a Dentist
 following an accident where the Insured Person suffers injuries or damage to
his natural teeth and/or gums.
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This benefit further provides cover for medical expenses incurred for
follow up treatment for the same accidental dental injury up to a
maximum of 15 days by the same Dentist.
This benefit is applicable irrespective of the number of occurrences
during the Policy period and is subject to the applicable limits.
For more détails please visit at www.bharti-axagi.co.in or call us at
080-49010200

24. Out-patient Emergency treatment for
accidents
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Reimbursement of medical expenses incurred towards
emergency treatment by a Medical Practitioner
 following an accidental injury to the Insured Person and
 such Emergency Treatment administered within 24 hours
following the accident.
It also provides cover for medical expenses incurred for
follow-up treatment by the same Medical Practitioner in
respect of the same accidental injury up to 30 days from the
date of accident.
 This including expenses incurred for medication prescribed on a
written basis by the attending Medical Practitioner for that same
treatment or consultation.
This benefit is applicable irrespective of the number of
occurrences during the Policy period and is subject to the
applicable limits
For more détails please visit at www.bharti-axagi.co.in or call us at
080-49010200

25. Children Education Fund
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Payment of a fixed amount per dependent child
 in the event of death of the Insured Person whilst under treatment in a
Hospital as an in-patient for a disease/injury and/or critical illness for
which a valid claim is payable under the Policy.
This is available for a maximum of two dependant children who
pursue studies and are below the age of 23 years
The benefit is subject to the applicable limits as per the plan
chosen.
For more détails please visit at www.bharti-axagi.co.in or call us at
080-49010200

26. Mortal Remains
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Reimbursement of expenses incurred for transportation of the
mortal remains of the deceased Insured Person from Hospital to
his/her place of residence
 in the event of death at the Hospital as an in-patient whilst under
treatment of a disease / illness / injury and/or critical illness for which
a valid claim is payable under the Policy
This benefit is subject to the applicable limits as per the plan
chosen.
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080-49010200

27. Additional Features
Additional Features
 Family Floater Feature
 Renewal Discount
 Income Tax Benefit
 Cost of Medical Check-up
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080-49010200

28. Family Floater
Policy can be issued on a Floater basis covering the family
members of the Insured comprising the Insured, spouse and two
dependant children (upto the age limit of 23 years).
What is floater, how does it benefit?
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Single premium payable for the entire family
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The amount of Sum Insured “floats”
over the entire family
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No need to insure individual members separately
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All members of the family (Self, Spouse, 2 Kids)
can be covered under one single policy
No hassles of tracking renewals for different members
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080-49010200

29. Renewal Discount
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Discount equivalent to 5% of renewal premium every year on a
progressive scale will be given back to the Insured as Renewal
Discount at the time of renewal,
This is applicable where the Policy which is renewed is claim free in the
expiring year.
This renewal discount on a progressive scale will be allowed upto a
maxumum of 25%.
In case of renewal of a Policy where there is a loss, the Insured will lose
the entire Renewal Discount accumulated.
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080-49010200

30. Income Tax Benefit
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Premium paid under the Policy shall be eligible for income tax
deduction benefit under Sec 80 D as per the Income tax Act.
For more détails please visit at www.bharti-axagi.co.in or call us at
080-49010200

31. Cost of Medical Check-up
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This benefit is limited to 1% of the average Sum Insured per person
during the block of four underwriting years.
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Reimbursement of cost of medical check-up once at the end of a block
of every four continuous underwriting years provided there were no
claims reported /made under the Policy during the block.
This additional benefit is available on the policies taken and renewed
with our Company for four continuous years without any claim.
For more détails please visit at www.bharti-axagi.co.in or call us at
080-49010200

32. Major Exclusions
 No payment will be made for any pre-existing disease or condition until
48 months of continuous coverage have elapsed, since inception of the
first policy
 Any benefit under Critical Illness section within the first 60 days of policy
inception
 Hospitalisation expenses incurred for treatment within 30 days of the
inception date of this Policy
 Claims related to
 pregnancy, childbirth, fertility treatment etc
 Routine medical, eye/ear examinations, vitamins, tonics, cost of
spectacles, lenses, hearing aids etc
 Cosmetic or Plastic Surgery unless necessitated by accidents
 War, nuclear perils, radiation etc
 use of intoxicating drugs and alcohol or drug abuse etc
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080-49010200

33. Claims Procedure
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Claims can be either on:
 Cashless Basis
 Reimbursement Basis
Claims to be adminstered by Third Party Administrators(TPA)
Claims to be handled by the following TPAs as per the occurrence of
the claim:
 Location of Hospital: South & West Zone – Paramount Health
Services Pvt Ltd
 Location of Hospital: North & East Zone – Emeditek Solutions
Ltd
For more détails please visit at www.bharti-axagi.co.in or call us at
080-49010200

34. How to avail cashless service
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Step1 : For planned hospitalization, forward your request letter 3-4 days
prior to hospitalization in the prescribed format(format available from
the website of the TPA/Insurance company, benefit guide, branch
offices of TPA/Insurance company)
For emergency hospitalization, forward your request letter within
24 hours of hospitalization in the prescribed format(format available
from the website of the TPA/Insurance company, benefit guide, branch
offices of TPA/Insurance company)
Step 2 : TPA will issue an authorization letter for the coverage as per
the policy to network hospital
Step 3 : Insured approaches the network hospital with ID card and
authorization letter
Step 4: Network Hospital will extend cashless treatment to the insured
up to authorized amount
Step 5 : At the time of discharge insured leaves back all the documents
and sign the claim form
Step 7 : The Insured makes the payment in cash to network hospital for
the services that are not covered under the policy
For more détails please visit at www.bharti-axagi.co.in or call us at
080-49010200

35. How to avail reimbursment facility
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Step1 : Incase of hospitalization in non network hospital, the insured is
required to intimate the TPA 3-4 days prior to planned hospitalization
and within 24 hours of emergency hospitalization
Step 2 : Insured avails treatment from hospital and makes payment for
the entire amount
Step 3 : After discharge, the insured submits the necessary documents
to the TPA within 7 days.
Step 4: The Company to process the claim once all documents are
submitted
For more détails please visit at www.bharti-axagi.co.in or call us at
080-49010200

36. Indicative List of Documents
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First prescription regarding the current illness for which treatment
undergone in hospital/nursing home, in original
Medical advice for hospitalization
Discharge Summary of Hospital, in original
Medical Fitness certificate, in original
All test reports supported by medical prescription(pre & post
hospitalization), in original
All vouchers of the test report mentioned above, in original
All medicines purchased from outside the hospital at any point of time
to be supported by original prescription, in original
Complete and signed claim form with filled in attending doctor’s
prescription.
Copy of the policy document
Presentationdétails
For more title
please visit at www.bharti-axagi.co.in or call us at
080-49010200

37. Necessary Documentation
Important Guidelines
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Completed proposal form in all respects and duly signed by the
proposer
All details written in proposal should be clear, do not leave any “blanks”
or use any signs “-”
Necessary test reports shall be submitted in full
Premium in case of referral risks shall not be accepted without prior
approval of the underwriting team
Special condition/warranty if any incorporated by underwriting team
shall be clearly mentioned in the policy schedule
For more détails please visit at www.bharti-axagi.co.in or call us at
080-49010200

38. To summarize…
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One-stop solution to protect the health of the family members
Covers hospitalization expenses for treatment of diseases or injuries
Provides a host of value-added benefits such as Recovery Grant,
Dread Disease Recuperation,
Separate additional Sum Insured automatically available in case of
diagnosis of any of the covered critical illnesse
Three different plan variants - each with five different Sum Insured
options to choose from
Instant, Hassle Free Policy Delivery for customers aged 45 years or
below.
24 hour cashless treatment facility available at more than 4000 of our
network hospitals
For more détails please visit at www.bharti-axagi.co.in or call us at
080-49010200

39. Plan Options
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Please Visit us at www.bharti-axagi.co.in for more détails or
call on 080-49010200 for more options

40. Thank you…
40
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080-49010200