GO-ACTIVE

BSE-NSE-web Portlet

Go Active

Healthy living is happy living. To ensure you lead a healthy life, we bring you GoActive, a comprehensive health insurance cover that ensures overall wellness and complete happiness for you and your family.

GoActive goes beyond the coverage of your hospitalisation expenses as it takes care of your overall health. It gives you the flexibility to choose the perfect cover for your needs, gives you the option to choose from a varied list of benefits and what’s more, it rewards you for being healthy!

Go Active not only cares for your health but your wealth too. It is a pocket-friendly health insurance plan that is designed keeping you and your family (your spouse and up to 4 children) in mind. Some of the key benefits include OPD Consultations, I-Protect, Health Coach and more.

  • Features
  • Policy Term
  • Waiting Periods
  • Exclusions (Permanent Exclusion)
  • Claim Process
  • FAQs
  • Buy Online

In-patient Care (Hospitalisation)

We cover cost of medical treatment when you or your insured family members are hospitalised for treatment.

Hospital Accommodation

We cover cost of all types of hospital accommodation (except suite or above room category) without any capping on room rent charges (for Sum Insured of Rs.5 lacs and above).

Pre & Post Hospitalisation Medical Expenses

We  reimburse pre & post hospitalisation medical expenses incurred due to illness/injury. The period of the treatment covered is 90 days before you get admitted to the hospital and 180 days after you get discharged from the hospital. This is subject to Max Bupa accepting the In-patient Care hospitalisation, Day Care or Domiciliary hospitalisation claim.

Day care treatments covered

We cover day care treatments under the product. Please refer to Annexure VI of the policy document to know the day care procedures covered under the product..

Home Health Care Services

Home Health Care is a range of health care services and medically necessary treatment that can be given at home for an illness or injury. These shall include services such as nursing care, investigations, medication (including oral and intravenous), chemotherapy, dialysis, transfusions, physiotherapy and postsurgical care.

The Home Health Care Services are covered only if we have accepted an In-patient Care hospitalisation claim and Home Health Care Services are availed immediately after that hospitalisation. The Home Health Care Services are provided through empaneled service provider in selected cities only.

Domiciliary Hospitalisation

In case a bed in the hospital is unavailable or on advice of the attending medical practitioner, treatment is administered at home; we pay for medical treatment taken at home, which would otherwise have required hospitalisation. Such treatment should continue for at least 3 consecutive days and confirmation from treating medical practitioner/insured that insured person could not be transferred to the hospital or hospital bed was unavailable, as the case may be.

Organ Transplant

Medical expenses for an organ donor’s In-patient treatment for the harvesting of the organ donated is also covered provided the organ is for the use of the insured person.

Emergency Ambulance

We also cover the ambulance expenses to transfer the insured following an emergency to the nearest hospital. These expenses are paid up to Rs3,000 per hospitalisation only if we have accepted the In-patient claim.

Health Checkup / Diagnostic Tests

You can avail health check-up for yourself and your spouse (if insured under the policy) annually so that you live a healthier and happier life. You can undergo a Health Checkup through  service provider on cashless basis. There shall be a pre-defined list of tests basis the Sum Insured chosen as specified in Annexure III of Policy terms and conditions. 

Instead of undergoing the pre-defined list of tests under health checkup for Sum Insured of Rs5 lacs and above, you can undergo the diagnostic tests of your choice up to a fixed amount depending upon your Sum Insured either on cashless or reimbursement basis. The cashless facility will only be available through empanelled  service provider.

Please note that only one of either Health Checkup or Diagnostic Tests can be availed.

Refill Benefit

In case you have exhausted your Base Sum Insured and Increased Sum Insured under I-Protect (if any) partially or completely, you are entitled for an additional sum insured equal to the base sum insured for a subsequent claim in the same year, provided it is for an unrelated illness.

Second Medical Opinion

You can obtain second medical opinion for specified illness / planned surgery / surgical procedure.

OPD Consultation

Avail OPD consultations within a network either on cashless or reimbursement basis. In case of reimbursement, the maximum amount payable per OPD consultation is Rs.600 (for Zone 1) and Rs.500 (for Zone 2). The number of consultations will depend on the Sum Insured chosen.  

Behavioral Assistance Program

You can avail consultation/counseling from a psychotherapist/counselor over a call to provide support on pre-marital counseling, nutrition, stress, child, parenting, etc.

Pharmacy and Diagnostic Services

You may purchase medicines and diagnostic services from the empanelled service provider through our mobile application or website. The cost for the purchase of the medicines or diagnostic services shall be borne by you.

Advantage

You will get a discount of 10% in the first policy year Base Premium and all subsequent renewal Base Premiums, if age of the eldest insured person at the time of inception of the first policy is less than or equal to 35 years.

I-Protect (Optional)

Get an increase in Sum Insured by 10% of the Base Sum Insured for every renewal. The benefit will be provided for every policy year as long as the policy is renewed or until you request for opting out of this benefit.

Health Coach (Optional)

You can opt for personalised health coaching services to keep yourself fit and healthy. Based on your health score, a premium discount of maximum up to 20% of the base premium may apply at the time of renewal.

Personal Accident Cover (Optional)

Personal Accident coverage against accident death, permanent total and partialdisability.

Zonal coverage

You can opt for one of the following two zones.

Zone 1: All India coverage

Zone 2: All India coverage (Co-payment applicable for Mumbai, Delhi NCR, Kolkata & Gujarat)

If You select Zone 2, then 20% co-payment will apply for Inpatient treatment in Mumbai, Delhi NCR, Kolkata & Gujarat. This Zone-wise co-payment shall not be applicable on OPD Consultation, Emergency Ambulance, Health Checkup / Diagnostic Tests, Second Medical Opinion, Behavioral Assistance Program and Personal Accident Cover.

Entry Age and family coverage

The entry age for adults under this policy can be from 18 to 65 years. The entry age for dependent children is from 91 days to 21 years.

The policy can be taken individually or for the family. The family floater policy is available in any of the following combinations:

1 Adult + 1 Child

1 Adult + 2 Children

2 Adults

2 Adults + 1 Child

2 Adults + 2 Children

2 Adults + 3 Children

2 Adults + 4 Children

Tax Benefit

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.

Assured Policy Renewal for Life

Once insured with us, you will always remain our customers subject to continued payment of premium. We assure you renewability for life with no extra loadings based on your claim history.

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 customer service team.

Cashless Facility

Cashless Facility can be availed only at our Network Providers or Service Providers. Please contact us for more details.

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.

Information at your fingertips

Get quick and easy access to your claims history, your health information, your health profile, including records of tests and other details on our website.

UAN no.: MB/BR/2014-2015/398

The policy term is one year.

Pre-existing Disease waiting period of 36 months since inception of the policy and continuous renewal.

Initial Waiting Period of 30 days unless the treatment needed is the result of an accident.

Specific Waiting Period of 24 months for some listed illnesses, unless the condition is directly caused by cancer (covered after initial Waiting Period of 30 days) or an accident (covered from day 1).

Please note that Waiting Periods shall not apply to annual health checkup or diagnostic tests, second medical opinion, out-patient consultations, counseling sessions and optional benefits if opted for.

Please do read more about the common exclusions in the policy terms & conditions.

Ancillary hospital charges

Hazardous activities

Artificial life maintenance

Behavioral, Neurodevelopmental and Neurodegenerative Disorders

Circumcision

AYUSH treatments

Conflict & disaster

External congenital anomaly

Convalescence & rehabilitation

Cosmetic and reconstructive surgery

Dental/oral treatment

Eyesight & optical services

Experimental or unproven treatment

HIV, AIDS, and related complex

Hospitalisation not justified

Inconsistent, irrelevant or incidental diagnostic procedures

Mental and psychiatric conditions

Non-medical expenses

Obesity and weight control programs

Off- label drug or treatment

Puberty and menopause related disorders

Reproductive medicine & other maternity expenses

Robotic assisted surgery, light amplification by stimulated emission of radiation (LASER) & light based treatment

Sexually transmitted infections & diseases

Sleep disorders

Substance related and addictive disorders:

Unlawful activity

Treatment received outside India

Unrecognized physician or hospital

Generally, excluded expenses - Any costs or expenses specified in the list of expenses generally excluded at Annexure II of the Policy Document.

Permanent Exclusion for Personal Accident Cover (if opted)

We shall not be liable to make any payment under any benefits under the Personal Accident Cover if the claim is attributable to, or based on, or arise out of, or are directly or indirectly connected to any of the following:

  • Suicide or self-inflicted injury, whether the insured person is medically sane or insane.
  • Treatment for any injury or illness resulting directly or indirectly from nuclear, radiological emissions, war or war like situations (whether war is declared or not), rebellion (act of armed resistance to an established government or leader), acts of terrorism.
  • Service in the armed forces, or any police organisation, 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.
  • 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 policy schedule.
  • Committing an assault, a criminal offence or any breach of law with criminal intent.
  • Taking or absorbing, accidentally or otherwise, any intoxicating liquor, drug, narcotic, medicine, sedative or poison, except as prescribed by a medical practitioner other than the policyholder or an insured person.
  • Participation in aviation/marine including crew other than as a passenger in an aircraft/water craft that is authorised by the relevant regulations to carry such passengers between established airports or ports.
  • Engaging in or taking part in professional/adventure sports or any hazardous pursuits, such as speed contest or racing of any kind (other than on foot), bungee jumping, parasailing, ballooning, parachuting, skydiving, paragliding, hang gliding, mountain or rock climbing necessitating the use of guides or ropes, potholing, abseiling, deep sea diving using hard helmet and breathing apparatus, polo, snow, ice sports, hunting, etc.
  • 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 Permanent Partial Disability benefit.

Select and approach insurance/corporate/TPA helpdesk of our network hospital [recommended at least 72 hours before treatment].

For identification purpose, use passport, voter card, PAN card or driver's licence along with your Max Bupa health card or policy number.

Network hospital will check your identity for validation and submit a pre-authorisation form to us.

We provide our decision to the hospital within 4 hours, when no further document is required.

We may assign a relationship manager to make the hospitalisation simple for you.

Get admitted for treatment and sign all documents, forms and invoices on discharge.

We make payments to the hospital for pre-approved treatment and as per policy terms and conditions.

How can I buy this policy?

There are various ways in which you can purchase this policy: Online- On buying this plan online, your policy will be generated instantly along with your policy kit and card. This is applicable for cases which do not require further underwriting or medical checkup. If you wish to know more about Max Bupa’s Health Insurance Plans, feel free to get in touch with our 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 is Health Coach and how would I be eligible for discounts under this benefit?

Health Coach is an option benefit under GoActive product. This benefit is available either to the primary insured person or primary insured person along with his/her spouse (if covered in the policy). This benefit provides personalised health coaching services through a personal coach connected via a mobile application to guide and motivate you to achieve your health goals. The health coach feature makes you realise that lifestyle plays an important role in maintaining your health and suggests you ways to shift these habits into a positive direction that will improve your overall wellness. In order to get access to the health coach facility, you will have to download the mobile application and register your specified details through the mobile application. When your registration gets completed, your health coach will notify you through the mobile application to set up an introductory call where you can discuss your short and long term goals with the coach. Once these goals are recorded, the health coach will provide an on-going daily support, motivation and interpretation of your tracking data to help you stay on track and reach your goals. You can constantly be in touch with the health coach to review your progress and revise the existing goals or set new goals. The mobile application willalso keep a track of your steps taken, daily food logs, etc. which can be accessed by you, personal health coach and the empanelled medical practitioners under this benefit. A Health Score will be calculated as per the table below:

Health Score Model
One time
Sign up & Activation
Selecting your own goals
Taking your first Health assessment
Completing your first tele-consultation with Our empanelled Medical Practitioner
Uploading your first health record
500
500
750
500
750
Weekly
Coach engagement (>3 interactions / week)
Walking - Steps count (5000 steps /day --- 5 times /week)
Daily food logs (minimum 10 logs/ week)
250
300
250
Monthly
Habit tracking (minimum 15 check in)
Monthly Coach review - Call
500
500
Quarterly
Health Assessment
500
Half Yearly
Tele-consultation with Our empanelled Medical Practitioner
Sharing your test reports / records
1200
1500
Performance Based Parameters for performance review Score - based on your performance(Max points / review )
One time Health Assessment at the time of on boarding 2000
Monthly Monthly performance - Quality score by personal health coach 2000
Quarterly
On completion of goal set by personal health coach 500
Based on health assessment results 2000
Annual Health score (Task based points + Performance based points) Earn up to 1 lac points in a year

Based on your health score, you will get a discount in Renewal Base Premium under this benefit as per the following table:

Health Score Discount in Renewal Base Premium
0-9999 0%
10000-69999 5%
70000-79999 10%
80000-89999 15%
90000-100000 20%

The Health score of the primary insured person (higher of the health scores, if both primary insured person and spouse are covered under this benefit) will be considered for calculating the discount in Renewal Base Premium.For the first renewal, the Health Score at the end of nine policy months shall be considered and pro-rated to arrive at the twelve months’ score for calculating the discount in Renewal Base Premium. For subsequent renewals, Health Score for the next twelve policy months from the date of last annual Health Score calculation, will be considered for calculating the discount in Renewal Base Premium.

Is there any tax benefit that one can avail 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.25,000 from his/her taxable income for health insurance premium for self and dependants. For senior citizens, this amount is Rs.30,000. Please note: You will have to show the proof of payment of premium. (Section 80D benefit is different from the exemption of Rs1,50,000 under Section 80 C). These benefits are as per applicable tax laws, which can amend from time to time. 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, depending upon the age of the proposed to be insured and the sum insured opting for. In case your proposal gets rejected by us, we will deduct the full cost of medical tests from your premium and the balance premium would be refunded.

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. You can use your health insurance policy across India. For cashless hospitalisation, all you need to do is check for a Max Bupa network hospital near your place of residence. You can also present your claim for reimbursement if you get treated at a hospital which is not a Max Bupa network hospital.

 

Disclaimer
 
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