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Group Health Insurance

Max Bupa's Group Health Insurance is a one-of-its-kind offering that provides you the dual advantage of-

  • Customization of your plan so that you can choose up to 32 combinations of Base Benefits that suit your organization's needs and budget.
  • Most comprehensive health insurance plan for your group members and their family.

With this Group Health Insurance policy you ensure the well being and health of your group members.

6 Reasons to Choose Max Bupa Group Health Insurance

At Max Bupa, our solutions are based on understanding your needs and we offer you the flexibility to choose your group health cover as per your requirement. By signing up with us, your group members can avail the following advantages.

Group Health Insurance 
Comprehensive Suite of Health Covers

We provide you with the most comprehensive suite of health insurance that includes Hospitalization, OPD Treatment, Critical Illness, Health Checkup, Hospital Cash Cover and Named Illness so that your group members and their families stay well prepared against untimely health conditions.

Group Indemnity Cover

Our utmost concern is to provide proper health care facilities for your group members whenever required. For that, we provide the following coverage in case of hospitalisation for medical uncertainties:

  • Cashless facility:

    Your group members can access our cashless facility at quality hospitals, thanks to our relationship with them as part of our partner network.

  • Flexible Options for Room Accommodations:

    You can choose a plan which allows your group members accommodation without any sub-limits or single/shared room accommodation with room rent capping.

  • Pre and post Hospitalization Medical Expenses:

    Reimbursement of medical expenses incurred due to illness immediately before admission and after discharge from a hospital.

  • All Day-care Procedures Covered:

    As an In-patient in a hospital for a period of less than 24 hours, your group members are covered for medical expenses for all Day-Care Procedures. However the cover does not extend to treatment in the out-patient department of the hospital.

  • Organ Transplant:

    Reimbursement of medical expenses for organ transplant for the insured group member.

  • Emergency ground ambulance:

    Reimbursement of expenses incurred towards Ambulance facility to transfer the insured person following an emergency to the nearest hospital.

  • Large Sum Insured Range from Rs 10,000 to Rs 50 Lacs:

    Comprehensive cover for access to best-in-class medical advice and treatment.

    You can also provide your group members an additional floater sum insured for Parents and In-laws under Extended Family Cover

Group Hospital Cash Cover

Whenever a person is hospitalized, apart from the hospitalisation and medical expenses, the family spends a lot of money on out of pocket expenses like travel, refreshments and medicine bills. These are also covered as part of our Group Hospital Cash cover. For a nominal premium, your group members will get a daily allowance that they can avail for taking care of non-medical expenses during hospitalisation. Daily allowance will be paid to the group member for every completed continuous 24 hours of hospitalisation provided that he is hospitalized for a minimum of 2 days.

The sum insured options of Rs 1,000/day to Rs 5,000/day (in increments of Rs 500) are available under this cover.

Group Critical Illness Cover

For the first time in India, Max Bupa introduces Critical Illness cover for Groups. If you opt for this cover, we pay a lump sum cash payout on diagnosis of any of the below mentioned critical illnesses provided the insured has survived for minimum period of 30 days post diagnosis.

This will help your group members in financial planning & supporting their family in difficult period, apart from paying for their treatment costs.

The Critical Illnesses covered under this plan include:

  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 Neuron Disease with permanent symptoms
  11. Multiple Sclerosis with persisting symptoms

The sum insured options available are Rs 1Lac, Rs 2Lacs, Rs 3Lacs, Rs 4Lacs and Rs 5Lacs.

Group OPD Treatment Cover

While incidences of hospitalization are few and far between, most people have a significant amount of money spent on day-to-day consultations for themselves and their family. Our OPD Treatment cover covers any OPD expenses incurred by your group members or their families like doctor's consultations, dental treatment, pharmacy expenses and even Ayurvedic and Homeopathic treatments. The coverage also includes the option for co-payment upto 50% under this benefit to make the premium affordable.

The sum insured options of Rs 1,000 to Rs 30,000 (in increments of Rs 500) are available under this cover.

Group Named Illness Cover

Under this cover you have the freedom to insure your group members against specific illness of your choice. In case an insured person suffers the illness for which cover is taken, we will provide a lump sum payout as per the terms of the policy. This benefit can be availed after the specified waiting periods and cannot be chosen as part of any other combinations available under this plan.

The named Illnesses covered under this plan include:

  1. Typhoid
  2. Malaria
  3. Dengue Fever
  4. Tuberculosis
  5. Impacted Wisdom Tooth
  6. Maternity Complications - Gestational Diabetes
  7. Maternity Complications - Ectopic Pregnancy
  8. Kidney Stones
  9. Tetanus
  10. Meningitis

The sum insured options of Rs 1,000 to Rs 50,000 (in increments of Rs 500) are available under this cover.

Group Health Checkup Cover

In today's uncertain times, even young and healthy people can be diagnosed for serious ailments. To ensure the health of your group members at all times, Max Bupa provides you the option of choosing Group Health Checkup Cover. This will ensure that the health of your group members is monitored at all times and ensure early diagnosis of any illness. To make this more cost effective for your group you can also opt for an option of co-payment upto 50% by your group members.

Health checkups covered under this cover include:

  1. Complete Blood Count and Erythrocyte Sedimentation Rate (ESR) Test
  2. Urine Routine and Microscopic
  3. Fasting Blood Sugar Test and Post Prandial (lunch)
  4. Lipid Profile
  5. ECG
  6. Chest X ray
  7. Blood Test for average plasma sugar concentration in past 90 days (Hba1c)
  8. Ultrasound whole abdomen
  9. Liver Function Test (LFT)
  10. Kidney Function Test (KFT)
  11. Hepatitis B surface antigen (HbsAg or Australia Antigen Test)
  12. Tread Mill Test (TMT) or Stress Test
  13. Thyroid Function Test (TFT)
  14. Prostrate Exam (males only)
  15. Mammography (females only)
  16. HIV
  17. Blood Grouping and Rh factor
  18. Uric Acid
  19. Pap Smear for Cervix (females)
  20. Pulmonary Function Test (PFT)

The sum insured options of Rs 1,000 to Rs 10,000 (in increments of Rs 1,000) are available under this cover.

6 Covers. 32 Combinations

Each group has different requirements and welfare budgets for its group members. At Max Bupa we understand that one size may not fit all, which is why we give you the option to create the most ideal health cover that ensures the health of your group members and gives them the freedom from worrying about hospital bills.

With this plan you can put together the most ideal combination of covers that suit your group's needs. You can make up to 32 combinations as per your group member's and organisation's requirements. The following illustration shows some health cover options that you can design keeping in mind your needs.

You can choose upto 32 unique combinations by combining these benefits to best suit your needs.

6 Covers 32 Combinations 

Waivers & Discounts

To make our Group Health policy even more group member friendly, we provide you the option to opt for the following waivers on certain waiting periods on payment of additional premium.

  • Forty Eight months for Pre Existing Diseases
  • Thirty days initial waiting period
  • Twenty four months for specific exclusions

To further customize and make your plan more effective we provide you the following options.

  • In-patient Care treatment under Alternative Treatments

    Group members have the option to be covered for any Alternative treatment that they may undergo

  • Co-Payment & Sub-Limit options

    These options help you make health insurance cover much more affordable.

  • Sub-Limit on Specified Illness/Conditions

    We also provide the sub-limit options on specified illness/conditions that your group members can opt for and lower the premium

  • Claim Settlement on Reimbursement basis only

    By opting for reimbursement only mode of claim settlement you can avail a discount in your policy premium. Under reimbursement mode the group member pays the hospital bills on his own and files for reimbursement for those bills with us. This is applicable only for Group Indemnity cover and Top Up options.

  • Restriction of Cashless Treatment in Specified Provider Network

    Under this benefit You will have the flexibility to chose a provider network (from Max Bupa's existing hospital network), for cashless treatment, at the time of policy issuance. Claims would be settled on reimbursement basis with co-payment of 20% for treatment in any hospital outside the specified network.

Riders Available

For further customisation of your Group Health Cover, after choosing your ideal combination (if you have opted for Group Indemnity Cover) you can include below mentioned riders to your plan by payment of additional premium.

  1. Maternity Benefit Options
    1. Maternity cover *

      Under this plan medical expenses will be covered for the delivery of the child. We also provide coverage for mother and child care treatment till the time of discharge with separate coverage limit for normal and caesarean delivery. You also have the option to get the nine month waiting period waived off.

    2. New born baby cover

      This covers medical treatment expenses for the new-born baby till policy renewal.

    3. Vaccination cover *

      Under this option, your group members have the flexibility to reimburse certain vaccines like measles, Hepatitis B-1, Typhoid etc. for their new born baby until the baby completes one year. The list of vaccines are:

      1. BCG
      2. OPV+IPV-B1/OPV
      3. Hepatitis B-1
      4. DTPw booster-1 or DTPa booster-1
      5. Hib
      6. Measles
      7. MMR-1
      8. Typhoid
      9. Meningococcal
      10. Tetanus Toxoid
      11. HPV (only girls)
  2. Domiciliary treatment

    In case your group member requires hospitalization and a medical bed is unavailable or he is in no condition to be transferred to a hospital, we will provide cover for medical treatment taken from home.

  3. Corporate floater

    Corporate Floater benefit for a group member is available as an additional sum insured to the insured in case the base sum insured is exhausted. The two options available are:

    • Option 1: Corporate Floater is restricted to 11 named critical illness & rail/road accidents.
    • Option 2: No restriction to any illness or accidents
Exclusions and Waiting Periods

The following exclusions and waiting periods apply for our group covers.
However, you can purchase waivers for certain waiting periods for your group members.

Pre-existing Conditions:

Benefits will not be available for Pre-existing Conditions until 48 months of continuous coverage.

30 Days Waiting Period:

We will not cover any treatment taken during the first 30 days since the commencement of the Policy, unless the treatment needed is a result of an Accident or Emergency.

Specific Waiting Periods:

For all Insured Persons, the following conditions will be covered subject to a waiting period of 24 months from the date of commencement of coverage.

Stones in the urinary system; Stones in billiary system; Surgery on tonsils / adenoids; Uterine Polyps; Any type of breast lumps; Treatment of Spondylosis /Spondylitis - any type; Inter Vertebral Disc Prolapse (IVDP) and such other degenerative disorders; Cataract; Benign prostatic hypertrophy; Hysterectomy / Myomectomy done due to Menorrhagia / fibroids; Fistula in ano; Fissure in ano; Piles; Hernia; Hydrocele; Sinusitis; Knee / hip joint replacement; Chronic Renal Failure(CRF) or end stage renal failure; Any type of Carcinoma / sarcoma / blood cancer; Osteo Arthritis of any joint; Gastric and duodenal Ulcers; Varicocele; Spermatocele; Dilatation and Curettage (D&C); Diabetic Nephropathy and Retinopathy; Mastoidectomy (operation to remove piece of bone behind the ear); Tympanoplasty (Surgery to repair tympanic membrane i.e. eardrum); Gout; Rheumatism; Varicose veins & Varicose ulcers; Internal congenital anomaly

Permanent Exclusions:

Certain permanent exclusions will still apply including addictive conditions and disorders; ageing and puberty; artificial life maintenance; conflict and disaster, convalescence and rehabilitation, cosmetic surgery, dental/oral treatment, external congenital conditions, eyesight, unproven/experimental treatment, health hydros, nature cure, wellness clinics etc., HIV and AIDS, hereditary conditions, items of personal comfort and convenience, neurological and psychiatric conditions, obesity, reproductive medicine - birth control & assisted reproduction, self-inflicted injuries, sexual problems and gender issues, sexually transmitted diseases, sleep disorders, speech disorders, treatment for developmental problems, treatment received outside India, unrecognized physician or facility, unlawful activity, genetic disorders, any expenses mentioned under the list of expenses generally excluded under Hospitalisation cover.

Disclaimer

This is only a summary of the product features and is for reference purpose only. For more details on terms and conditions, exclusions and waiting period, please read sales brochure and Policy Documents of Group Health Insurance cover carefully before concluding a sale.

* Terms and Conditions apply

UAN no MB/WP/2013-2014/204

 
 
 
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