Critical Illness

Acquiring critical illnesses is a life changing event which can disrupt dreams and goals for family and wipe out savings. Critical illness mediclaim policy is the only solution to these problems. It provides a lump sum money on diagnosis of the specified critical illness.
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  • Covers 20 Critical Illness

    1. Cancer of Specified Severity
    2. First Heart Attack of Specified Severity
    3. Open Chest CABG
    4. Open Heart Replacement or Repair of Heart Valves
    5. Coma of Specified Severity
    6. Kidney Failure Requiring Regular Dialysis
    7. Stroke Resulting in Permanent Symptoms
    8. Major Organ/Bone Marrow Transplant
    9. Permanent Paralysis of Limbs
    10. Motor Neurone Disease with Permanent Symptoms
    11. Multiple Sclerosis Persisting Symptoms
    12. Aplastic Anaemia
    13. Bacterial Meningitis
    14. Loss of Speech
    15. End Stage Liver Disease
    16. Deafness
    17. End-stage Lung Disease
    18. Fulminant Viral Hepatitis
    19. Major Burns
    20. Muscular Dystrophy
    For more details Click Here.

  • Plan Coverage (Individual/Family)

    • Individual - 100% of sum assured
    • Family Floater - 100% of sum assured (Applicable only for 2 Adults, No coverage for children)

    Entry Age for Adults - 18 to 65 years

  • Guaranteed Cash Benefit

    Plan offers a guaranteed cash benefit subject to claim being admissible under policy.

  • 2 year Policy Tenure Option

    You can opt for 2 year policy tenure & avail discount.

  • Direct Claim Settlement

    We believe you should focus on the treatment of your loved ones rather than running after claim settlement. Therefore, all claims are processed directly by our own customer services team

  • Assured Plan Renewal for Life

    We assure you renewability for life. Once insured with us, you will always remain our customers.

  • Renewal Bonus

    If the Policy is renewed, the Sum Assured will be increased by 5% of the Sum Assured for every claim free year upto a cumulative maximum of 25% of the Sum Assured.

  • Free Look Period

    We endeavor for transparency and complete satisfaction and therefore, our policies are transparent and easy to understand. If you are not satisfied, we provide a 15 day free look period within which you can cancel your plan stating the reason.

  • Tax Benefit

    You will save tax under Section 80D of the Income Tax Act when you buy a Max Bupa health insurance policy. Tax benefits are subject to changes in the tax laws, please consult your tax advisor for more details.

  • UAN No. : MB/BR/2012-2013/154

  • • We will not cover any critical illness occurring during the first 90 days of the policy. This waiting period does not apply for renewal Policy.

  • • Benefits will not be available for Pre-existing Diseases until 48 months of continuous coverage from first policy start date.

  • • Insured person need to survive for 30 days from the date of diagnosis of critical illness for claim to be admissible

  • • Cover ceases for insured person if claim has been paid under the policy & policy cannot be renewed.

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  • Permanent Exclusion Specific to Hospital Cash

    • • Hospitalisation not in accordance with the diagnosis and treatment of the condition for which the hospital confinement was required;
    • • Elective surgery or treatment which is not medically necessary;
    • • Treatment for weight reduction or weight improvement regardless of whether the same is caused (directly or indirectly) by a medical condition;
    • • Any dental care or surgery of cosmetic nature, extraction of impacted tooth/teeth, orthodontics or orthognathic surgery, or tempero-mandibular joint disorder except as necessitated by an accidental injury
    • • Treatment for infertility or impotency, sex change or any treatment related to it, abortion, sterilization and contraception including any complications relating thereto;
    • • Treatment arising from pregnancy and it’s complications which shall include childbirth or abortion or threatened abortion excluding ectopic pregnancy;
    • • Treatment for Congenital Anomaly,
    • • Hospitalisation primarily for diagnosis, X-ray examinations, general physical or medical check-up not followed by active treatment during the hospitalisation period or hospitalization where no active treatment is given by the medical practitioner
    • • Unproven/Experimental treatments
    • • Alternative treatment;
    • • Treatment of any mental or psychiatric condition including but not limited to insanity, mental or nervous breakdown / disorder, depression, dementia, Alzheimer’s disease or rest cures;
    • • Admission to a nursing home or home for the care of the aged for rehabilitation, or convalescence.
    • • Treatment directly or indirectly arising from alcohol, drug or substance abuse and any illness or accidental physical injury which may be suffered after consumption of intoxicating substances, liquors or drugs;
    • • Treatment directly or indirectly arising from or consequent upon war (whether war be declared or not), invasion, acts of foreign enemies, hostilities, civil war, rebellion, active participation in strikes, riots or civil commotion, revolution, insurrection or military or usurped power, and full-time service in any of the armed forces;
    • • Acquired Immune Deficiency Syndrome (AIDS) and all illnesses or diseases caused by or related to the Human Immuno-deficiency Virus;
    • • Sexually transmitted diseases;
    • • Cosmetic or plastic surgery except to the extent that such surgery is necessary for the repair of damage caused solely by accidental injuries; treatment of xanthelesema, syringoma, acne and alopecia;
    • • Nuclear disaster, radioactive contamination and/or release of nuclear or atomic energy;
    • • Treatment for accidental physical injury or illness caused by intentionally self-inflicted injuries; or any attempts of suicide while sane or insane;
    • • Treatment for accidental physical injury or illness caused by violation or attempted violation of the law, or resistance to arrest;
    • • Treatment for accidental physical injury or illness caused by professional sports, racing of any kind, scuba diving, aerial sports, activities such as hand-gliding, ballooning, and any other hazardous activities or sports unless agreed by special endorsement;
    • • Circumcision unless necessary for treatment of a disease or necessitated due to an accident;
    • • Hospitalization where the Insured Person is a donor for any organ transplant;
    • • Any treatment outside of Republic of India
    • • Treatment to assist reproduction, including IVF treatment
    • • Hormone Replacement Therapy
    • • Ageing and Puberty: Treatment to relieve symptoms caused by ageing, puberty, or other natural physiological cause, such as menopause and hearing loss caused by maturing or ageing
    • • Artificial Life Maintenance: Artificial Life Maintenance, including life support machine use, where such treatment will not result in recovery or restoration of the previous state of health
    • • Hereditary conditions: Treatment for abnormalities, deformities illness present only because they have been passed down through generations of family
    • • Sleep disorders: Treatment for sleep apnea, snoring or any other sleep-related breathing problem
    • • Speech disorders: Treatment for speech disorders, including stammering
    • • Treatment for developmental problems: Treatment for, or related to developmental problems, including – learning difficulties (such as dyslexia), behavioral problems, including attention deficit hyperactivity disorder (ADHD)
    • Any costs or expenses specified in the List of Expenses Generally Excluded mentioned at Annexure II of policy wording

  • Permanent Exclusions Specific to Critical Illness

    • a. Acquired Immune Deficiency Syndrome (AIDS), AIDS-related complex or infection by Human Immunodeficiency Virus (HIV); or
    • b. the Insured’s attempted suicide or self-inflicted injuries while sane or insane; or
    • c. any Congenital Anomaly or inherited disorder or developmental conditions of the Insured; or
    • d. narcotics used by the Insured Person unless taken as prescribed by a registered doctor, or the Insured Person’s abuse of drugs and/or consumption of alcohol; or
    • e. Failure to seek or follow medical advice; or
    • f. War (whether war be declared or not), invasion, act of foreign enemy, hostilities, armed or unarmed truce, civil war, mutiny, rebellion, revolution, insurrection, military or usurped power, riot or civil commotion, strikes; or
    • g. taking part in any naval, military or air force operation during peace time; or
    • h. participation by the Insured Person in any flying activity, except as a bona fide, fare-paying passenger of a recognized airline on regular routes and on a scheduled timetable.
    • i. participation by the Insured Person in a criminal or a breach of law with criminal intent or
    • j. engaging in or taking part in professional sports or any hazardous pursuits, such as diving or riding or any kind of race; underwater activities involving the use of breathing apparatus or not; martial arts; hunting; mountaineering; parachuting; bungee-jumping; or
    • k. nuclear contamination; the radioactive, explosive or hazardous nature of nuclear fuel materials or property contaminated by nuclear fuel materials or accident arising from such nature.

  • Permanent Exclusions Specific to Personal Accident

    • i. Suicide or self inflicted injury, whether the Insured Person is medically sane or insane.
    • ii. War (whether declared or not), invasion, act of foreign enemy, hostilities, civil war, martial law, rebellion, revolution, insurrection, military or usurper power, riot or civil commotion..
    • iii. Service in the armed forces, or any police organization, of any country at war or at peace or service in any force of an international body or participation in any of the naval, military or air force operation during peace time.
    • iv. Any change of profession after inception of the Policy which results in the enhancement of Our risk, if not accepted and endorsed by Us on the Schedule of Insurance Certificate.
    • v. Committing an assault, a criminal offence or any breach of law with criminal intent.
    • vi. Taking or absorbing, accidentally or otherwise, any intoxicating liquor, drug, narcotic, medicine, sedative or poison, except as prescribed by a licensed doctor other than the Policyholder or an Insured Person.
    • vii. Inhaling any gas or fumes, accidentally or otherwise, except accidentally in the course of duty.
    • viii. Participation in aviation other than as a fare-paying passenger in an aircraft that is authorized by the relevant regulations to carry such passengers between established aerodromes
    • ix. engaging in or taking part in professional sports or any hazardous pursuits, such as diving or riding or any kind of race; underwater activities involving the use of breathing apparatus or not; martial arts; hunting; mountaineering; parachuting; bungee-jumping;
    • x. Any disability arising out of Pre-existing Conditions if not accepted and endorsed by Us.
    • xi. Body or mental infirmity or any disease except where such condition arises directly as a correspondence of an Accident during the Policy Period. However this exclusion is not applicable to claims made under the PPD benefit

  • Claim Process for Critical Illness


    No cashless facility will be available for the benefits of this product. All claims will be adjudicated after the occurrence of the event and further submission of documents by the Insured Person. Benefits will be paid out in line with the coverage in the plan and will be irrespective of the actual costs incurred by the Insured Person.
    We provide the best services to make claiming as simple and straightforward as it possibly can be. Just follow these simple steps below to claim:

    • 1. Duly filled and signed claim form
    • 2. Final Hospital Discharge Summary in original / self attested copies if the originals are submitted with another insurer.
    • 3. Final Hospital Bill in original / self attested copies if the originals are submitted with another insurer.
    • 4. Original consultation notes and / or investigation reports from outside the hospital prior to hospitalization
    • 5. Copy of First Information Report (FIR) / Panchnama duly attested by the concerned police station (if Critical Illness being claimed for is admissible in event of an Accident)
    • 6. Copy of Medico Legal Certificate duly attested by the concerned hospital. (if Critical Illness being claimed for is admissible in event of an Accident)
    Guidelines
    • 1. Initial Waiting Period of 90 days
    • 2. Survival Period of 30 days
    • 3. Admissibility of claim to be determined by compliance to the conditions specified in each critical illness separately.
    • 4. Policy expires for the particular member in the floater for whom a claim is admitted.

  • How can I buy this policy?

    There are various ways in which you can purchase this policy: Online: On purchase of this plan online your policy will be generated almost instantly along with your policy kit and card. This is applicable for cases which do not require further underwriting or medical checkup. While all our plans including Heartbeat and Health Assurance are available for purchase through this mode, our online special plan Health@Companion can be bought only through this mode. Telephone: If you wish to know more about Max Bupa’s Health Insurance Plans, please speak to our specially trained sales team or your local advisor. Call us on Phone 1800 3010 3333 (Toll Free) between 9 am and 6 pm India time (Monday to Saturday) or click on ‘Click to arrange a call’ to buy the policy over the phone or to fix up an appointment. Branch: Please visit our branch in your city. The complete list of branch locations is available in the Contact Us section of the website

  • What are the minimum and maximum policy durations?

    You have the option of buying a health insurance policy for a period of one year or two years. You will be able to get discounts on purchase of a policy for two years. This is applicable for Heartbeat and Health@Companion (Individual and Family Floater) plans on the premium for the second year only. At the end of your insurance period you need to renew your policy if you wish to continue being covered, without a break.

  • Is there any tax benefit that one can avail of while purchasing Health Insurance?

    Yes. You can avail a tax benefit available under Section 80D of the Income Tax Act 1961 by buying a health insurance policy. Every taxpayer can avail an annual deduction of Rs. 15,000 from his/her taxable income for health insurance premium for self and dependants. For senior citizens, this amount is Rs. 20,000. Please note that you will have to show the proof of payment of premium. (Section 80D benefit is different from the exemption of Rs 1,00,000 under Section 80 C). These benefits are as per prevalent applicable tax laws. We advise you to consult your tax advisor for further details or clarifications.

  • Is a medical checkup necessary before buying a policy?

    A medical checkup may be necessary when you sign up for a new health insurance policy. However, medical checkups are not usually needed for renewal of policies. It is in your best interests to undergo a medical check-up at the time of enrollment so that when you need us, we‘re there to provide speedy and efficient support and faster settlement of claims.

  • What is Annual Insurance Cover?

    The Annual Insurance Cover amount is the maximum amount payable during the year in the event of one or more claims. It is also known as ‘sum insured’ and ‘sum assured’. The premium of the policy is also dependent on the annual insurance amount that you choose.

  • My wife and children are residing at Chandigarh while I am here in Delhi. Can I cover all of us in one policy?

    Of course. You can cover your family residing in India under one policy. Your health insurance policy can be used by you all across India. For cashless facility, all you need to do is check for a Max Bupa network hospital near your place of residence. You can also get your claims reimbursed if you get treated at a hospital which is not in Max Bupa’s hospital network.

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