Axis Max Life Group Smart Health Insurance Plan

1

Fixed Daily Hospitalization Cash Benefit (FDHCB)

Fixed Daily Hospitalization Cash Benefit shall be payable after the completion of each medically necessary continuous hospitalization for more than 24 hours as a result of injury, sickness or disease.

In case of Hospitalization, the Member shall receive 1% of FDHCB Sum Insured per day in case admitted in a non-ICU room or 2% of FDHCB Sum Insured per day in case admitted in an ICU room for each day of hospitalization beginning from the first day. The applicable amount payable on a per-day basis under the FDHCB benefit shall be referred to as the ‘Per Day FDHCB Sum Insured’.

Flexibility to allocate part of the daily benefit as Fixed Recuperation Cash Support Benefit. The Fixed Recuperation Cash Support Benefit is part of the Per Day FDHCB Sum Insured and is not payable in addition to it.

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2

Fixed Surgical Care Benefit (FSCB)

The FSCB Sum Insured is payable on hospitalization for undergoing any medically necessary surgery in India for a minimum period for 24 hours and actually undergoing that surgery.  The surgery must be for medically necessary treatment of any illness or injury due to an accident and should have been advised in writing by a Medical Professional/Medical Practitioner.

In case the Member has undergone any of the specified surgeries, a fixed percentage of FSCB Sum Insured shall be payable on the basis of the surgery type as shown below:

3

Accidental Total Permanent Disability

In the event of ATPD of a member during the Member Cover Term, 100% of the applicable ATPD Sum Insured shall be payable to the Member, based on the Sum Insured cover opted at inception of the policy.

4

Critical Illness Benefit (29 CI  Covered)

An amount equal to 100% of the applicable CI Benefit Sum Insured is payable on diagnosis of any of the covered CI conditions, as applicable.

5

Cancer Cover

The following benefit as Lump sum is payable as per applicable Cancer Cover Sum Insured:

The list of Cancer conditions covered, and their category is as below:

6

Cardiac Cover

The following benefit as Lump sum is payable as per applicable Cardiac Cover Sum Insured:

The list of Cardiac conditions covered, and their categorization is as below:

^If a claim is made for this condition, in addition to satisfying the definitions and exclusion criteria, the procedure or surgery must be determined to be medically necessary by a Consultant Cardiologist / Surgeon and must be supported by relevant imaging findings & evidenced by established diagnostic reports.