Go Active Training

What comes to your mind when
you think about health insurance?
What are customer’s expectations

from health insurance these days?
©Max SkillFirst V1.0_2017 1

How many of you have heard these lines…
I will not fall Only for those

ill soon, I 04 01 who are sick
will buy it later
Illness
Works, only Health
if you are insurance
hospitalized does not keep
you healthy
03 02
Traditionally, Health Insurance revolves around Illnesses only

What if a health insurance talks about…
Rewarding you for

keeping yourself
01 healthy
Wellness
Cost advantage,
if you are
buying early
03 02
Care for
your daily health
needs
Need of the hour –
A plan which has both: Protection against Illnesses & Wellness Benefits
Presenting
Presenting

GoActive - Coverage options
As per Individual Family

member Floater
4 Lac, 5 Lac, 4 Lac, 5 Lac,

As per
7.5 Lac,10 Lac, 7.5 Lac,10 Lac,
sum insured 15 Lac & 25 Lac 15 Lac & 25 Lac

GoActive - Eligibility criteria
Self- individual plan Self & spouse, up to 4 kids family floater plan
Entry Age:- Adult:- 18 yrs to 65 yrs (last birthday), Child:- 91 Day to 21 yrs (Dependent)
Family Floater Plan

a) Can include: Husband / Wife / Kids
b) Maximum of 2 Adults & 4 Kids
Lifetime renewability c) Standalone policy not allowed for kids
Family combination allowed:-
2A , 2A+1C , 2A+2C , 2A+3C , 2A+4C, 1A+1C, 1A+2C
A= Adult, C= Child
In case of family floater, after 22 years, insured child need to take separate policy & continuity
benefits will be given.
.
GoActive - A Comprehensive Coverage against
Illnesses along with Wellness Benefits
GoActive Plan
Coverage against
Wellness benefits
Illnesses
Non
Hospitalization Health Coach
hospitalization
Inpatient Behavioral
OPD (More than 24 hrs) assistance
Daycare Preventive
Medicine (Less than 24 hrs) health check-up
.
GoActive Product Design :
New
Differentiators
(11 points)
GoActive
Traditional
Benefits
(10 points)
.
GoActive - Traditional Benefits
Inpatient Emergency
1 Treatment Ambulance 6
Hospital Refill
2 Accommodation 7
Benefit
Alternative Organ Donor

3 Treatment Coverage 8
Traditional
Pre-Post
Benefits
4 Deductible 9
Hospitalization
Domiciliary
5 Day Care 10
Hospitalization
.
GoActive - New Differentiators
Health
1 OPD Checkup 6
Behavioral
2 AdvantAge
Assistance 7
Second Medical
3 Health Coach Opinion 8
New
Differentiators
Cost Reduction Homecare
4 Option Facility 9
Personal Accident
5 I - Protect 10
Cover
Pharmacy &
Diagnostic services
11
.
Section 1 New Differentiators
.
1. OPD consultation
OPD
AdvantAge Search & visit Upload the

(Industry’s first) Now get coverage bills on
even for consulting to
a doctor in your Max Bupa website
Health coach a Doctor. or
location
mobile app
Cost
reduction option
I – Protect Base Sum Insured (SI) per Policy Year

(Industry’s first) Go Active 4 lacs 5 lacs
7.5
10 lacs 15 lacs
25
lacs lacs
Health checkup OPD consultations ( 1A, 1A+ 1C, 1A+2C) ,
(Consultations limits per policy per year)
3 4 4 6 6 6
Behavioral OPD Consultations (for 2A and more)
assistance (Consultations limits per policy per year)
5 6 8 10 10 10
Second •A separate network of doctors will provide OPD consultations for both reimbursement &
medical opinion cashless
•Reimbursement for zone 1 is up to Rs. 600 and for zone 2 is 500Rs
Homecare facility
(MBHI’s first) •The number of consultations can be availed by any Insured Person during the Policy
Year as per chosen SI.
Personal •Cashless services will be available in phase 2
accident cover
City covered as on Jan 2018 ( Bangalore, Delhi NCR, Mumbai, Chennai, Hyderabad, Kolkata, Pune,
Nasik, Surat, Jaipur, Nagpur, Lucknow, Coimbatore, Ahmedabad)
Pharmacy
Any Unutilized amount can‟t be carry forward to next year.
& diagnostic
.
2. AdvantAge – Discount for entry at early age
OPD
Industry’s
AdvantAge First
(Industry’s first) Applicable, if age of
10% discount on
eldest member is
base premium
Health coach <= 35 yrs
Cost
reduction option
I – Protect
(Industry’s first)
Pay for
Health checkup 9 years Discount for
& Lifetime
Behavioral Enjoy coverage for
assistance 10 years
Second
medical opinion
Homecare facility
(MBHI’s first) In case of member addition at the time of Renewal, the discount under this benefit shall continue only if
one of the following conditions is fulfilled:
Personal
accident cover
• The Insured Persons added in the Family Floater Policy are younger than the existing Insured Person;
Pharmacy OR
& diagnostic • The Insured Person(s) added in the Family Floater Policy are less than Age 35 years;
.
3. Health coach - Benefit (1/3)
OPD
Personalized
AdvantAge
coaching as
per
individual’s
Health coach life style Up to 20%
discount on
Cost renewal premium
reduction option basis health score.
Human
I – Protect Get rewards interaction,
(Industry’s first) for healthy Health no artificial
living Coach intelligence
Health checkup
Behavioral
assistance
Second
medical opinion Activity Helps to live
tracking healthy life
Homecare facility through through
(MBHI’s first) mobile app. continuous
engagement
Personal
accident cover
Pharmacy
& diagnostic
.
3. Health coach – Score assessment (2/3)
OPD Half
Onetime Weekly Monthly Quarterly
Yearly
AdvantAge
Continuity
Health coach
Create account
Coach interaction
Cost
reduction option Tele
consultation
I – Protect Complete Health Habit tracking Achieve Goal with Doctor
(Industry’s first) assessment
Weekly steps
Health checkup
Coach
Behavioral interaction
Finish Intro Call Review calls
assistance
Second Share your test

reports
medical opinion Daily food logs
Upload your first Health
Homecare facility health record assessment
(MBHI’s first)
Personal Health score 0-9999 10000-69999 70000-79999 80000-89999 90000-100000

accident cover Discount on
Pharmacy base product 0% 5% 10% 15% 20%
& diagnostic premium
.
3. Health coach – How it works (3/3)
OPD
AdvantAge Get personal

Login to app Set your own goals Earn points
(Industry’s first) coaching
Health coach
Cost
reduction option
I – Protect
Health checkup
Behavioral
assistance
Second
medical opinion
Homecare facility
(MBHI’s first)
Personal
accident cover
Pharmacy
& diagnostic
.
4. Cost saving option
OPD
Zone 1 All India coverage
All India coverage ( 20% co-payment applicable for
AdvantAge treatment in Mumbai (Mumbai, Navi Mumbai, Thane),
(Industry’s first) Zone 2
Delhi NCR( Ghaziabad, Gurgaon, Noida,
Faridabad) Kolkata & Gujarat State)
Health coach
Co-payment option can be chosen at inception and can be

Cost Mr. Ram Khanna Mr. Raju Reddy
dropped at renewal.
reduction option
I – Protect Note:- Zone choice is independent of customer’s

Lives in Delhi Lives in Chennai
(Industry’s first) address, Anyone can opt for any zone coverage
Health checkup This Zone-wise Co-payment shall not be applicable on

I am a businessman I am a state Govt OPD Consultation, Emergency Ambulance, Health Checkup
and need to travel college professor. / Diagnostic Tests, Second Medical Opinion, Behavioral
Behavioral
across India for my Chennai has best of Assistance Program and Personal Accident Cover.
assistance
work. hospitals and
Second doctors.
medical opinion Premium is not a Example:- 2A, 10 Lac SI, eldest member age 35 yrs
concern for me. I may not go
Homecare facility anywhere outside for
(MBHI’s first) I need a plan which treatment. Zone Premium (Exclusive of
can provide me best Tax)
Personal of coverage. But I want to
accident cover Zone 1 18,096
reduce my
Pharmacy
premium. Zone 2 13,653
& diagnostic
.
Industry’s
5. Inflation – Protect (1/2) First
Guaranteed No Capping / Provides

OPD Get 10% increase
Increase, Lifetime increase protection against
in sum insured
Irrespective in Sum insured medical inflation
AdvantAge for lifetime
(Industry’s first) of claim
Health coach Increasing trend in medical cost @ 10%

1800000 1608587
Cost
1600000
reduction option
1400000
I – Protect 1200000
1000000 908005
(Industry’s first) 829187
743807
800000
563800
600000 468054 419859
Health checkup 400000 290625 260700
200000
Behavioral 0
assistance Average cost 2017 Expected Average cost 2022 Expected Average cost 2030
Second CABG ( Heart Bypass Surgery) Kidney transplant Total knee replacement (B/L)
medical opinion Data:- * Health risk management team
Homecare facility
(MBHI’s first) Inflation protection @ 10% against rising medical cost
Personal 10 Lac SI 15 Lac SI 20 Lac SI
Lifetime
accident cover today after after 10
increase…..
5 years years
Pharmacy
& diagnostic Benefit will continue for respective insured, if policy converted from floater to individual & vice-versa. I-protect
sum insured will change proportionately, if base
. sum insured changes.
Industry’s
5. Inflation – Protect (2/2) First
OPD This benefit is not applicable for Re-fill Benefit, OPD Consultation, Health check-up /
Diagnostic Tests, Second Medical Opinion, Behavioral Assistance Program and Optional
AdvantAge Benefits (if opted for) such as Health Coach and Personal Accident Cover.
This option can be opted only at inception, not at the time of renewal.
Health coach
On renewal of the policy, customer can opt out of this option, post which this benefit can‟t
be availed again.
Cost
I-Protect Sum Insured
reduction option
Policy Year Base Sum Insured (as %age of Base Sum
I – Protect Insured)
(Industry’s first) 1 500000 0%
Opt out scenarios 2 500000 10%
3 500000 20%
Health checkup
4 500000 30%
Do not increase further and remain 5 500000 40%
Behavioral constant, if You pay the same
At renewal after 5th policy year, customer has chosen an opt
assistance additional percentage of premium out option of not increasing the I-Protect further
Second
as paid in the preceding Policy 6 500000 40%
medical opinion Year for this benefit. 7 500000 40%
8 500000 40%
Homecare facility Or 9 500000 40%
(MBHI’s first) 10 500000 40%
Be reduced to zero, if you do not At renewal after 10th policy year, customer has chosen an opt
Personal out option of reducing I-Protect to zero
accident cover pay any additional premium for this
11 500000 0%
benefit. 12 500000 0%
Pharmacy
& diagnostic XX 500000 0%
.
6. Health checkups / Diagnostic tests (From Ist year itself) (1/2)
OPD
Option 1 OR Option 2
(Annexure III)
AdvantAge 4 5 7.5 10 15 25
Tests / Sum
(Industry’s first) Insured
Lac Lac Lac Lac Lac Lac
Urine Routine
Yes Yes Yes
Health coach Analysis
Get annual CBC Yes Yes Yes
Cost health TSH
Cashless NA Yes Yes
reduction option checkup for Ultrasensitive
facility Phosphorous NA Yes Yes
all adults from
I – Protect day 1 of policy Calcium NA Yes Yes
(Industry’s first) Alkaline
NA Yes Yes
Phosphate
SGPT NA Yes Yes
Health checkup SGOT NA Yes Yes
Through our
Total Cholestrol Yes Yes Yes
empanelled List of pre
Behavioral HbA1C Yes NA NA
assistance service defined test
Uric Acid NA Yes Yes
provider Sugar (F) NA Yes Yes
Second Liver function test
medical opinion Kidney function NA NA Yes
test
Homecare facility
(MBHI’s first)
Phase 1 - Health Check-up can be arranged by calling Max Bupa
Personal
accident cover Phase 2 – Can be arranged through mobile App and website as well
.
Pharmacy
& diagnostic Benefit limit will start afresh after renewal, so you can utilize it fully in current year. .
.
6. Health checkups / Diagnostic tests - From Ist year itself (2/2)
OPD Option 1 OR Option 2

AdvantAge
Book them
Health coach Multiple tests
through
Tests of your can be taken
Max Bupa
Cost own choice within available
website or
reduction option amount
mobile App
I – Protect
Base Sum Insured (SI) per Policy Year
Go Active 4 lacs 5 lacs 7.5 lacs 10 lacs 15 lacs 25 lacs
Health checkup
Diagnostic test worth rupees Not
Rs. 1000 Rs. 1500 Rs. 2500
for family with 1A available
Behavioral
assistance Diagnostic test worth rupees Not
Rs. 2000 Rs. 3000 Rs. 5000
for family with 2A available
Second
medical opinion • Any insured person (including dependent children covered) can avail diagnostics
• Benefit limit will start afresh after renewal, so you can utilize it fully in current year. ..
Homecare facility • Diagnostics can be availed on cashless basis through a service provider or reimbursement (any
(MBHI’s first) diagnostic centre)
Personal • Phase 1 – Cashless diagnostics can be arranged by calling Max Bupa
accident cover • Phase 2 – Cashless diagnostics can be arranged through mobile App and website as well
Pharmacy
• Reimbursement claims can be uploaded on website (phase 1) and through App (phase 2)
& diagnostic
.
7. Behavioral assistance program
OPD
AdvantAge
(Industry’s first) Complexity in
Lack of support & Work life
managing
guidance imbalance
Health coach relationship
Cost
reduction option
I – Protect
Covers 3 free counseling sessions per adult per
(Industry’s first) policy year through telephonic mode
Health checkup •Pre-marital counseling

•Nutrition
Behavioral •Stress
assistance •Child and parenting etc.
Second
medical opinion This benefit can only be availed through our world class
Homecare facility service providers by calling a dedicated number.
(MBHI’s first) (+91 72900-44777)
Personal
accident cover
Pharmacy Benefit limit will start afresh after renewal, so you can utilize it fully in current year.
& diagnostic Permanent Exclusions shall not apply to the extent this Benefit is applicable.
.
8. Second medical opinion
OPD
AdvantAge Get a free second

(Industry’s first) Just contact us on Take a right
medical
Max Bupa web or decision for your
opinion from our
Health coach mobile app loved ones
specialist
Cost
reduction option
I – Protect
• This benefit can be availed only once by an
insured person during a policy year for the
Health checkup
same specified illness or planned surgery.
Behavioral
assistance
• The insured person is free to choose
Second whether or not to obtain the second medical
medical opinion
opinion, and if obtained then whether or not to
Homecare facility act on it in whole or in part.
(MBHI’s first)
Personal
Second Medical Opinion
a. Cancer, b. Myocardial Infarction (Heart Attack), c. Coronary
accident cover Artery Bypass Graft (CABG), d. Major Organ Transplant, smo@maxbupa.com
e. Stroke, f. Surgery of Aorta, g. Coronary Angioplasty,
Pharmacy h. Primary Pulmonary Arterial Hypertension, i. Brain Surgery
& diagnostic
.
9. Home health care services MBHI’s
First
OPD Best in
Get our extended industry
AdvantAge Provided through Expenses
care at home after
(Industry’s first) our world class covered up to
discharge from
service partners sum insured
hospital
Health coach
Cost
reduction option
Home Health Care is a range of health care
I – Protect services and Medically Necessary treatment that
(Industry’s first) can be given at home for an Illness or Injury.
Health checkup These shall include services such as :-
Behavioral nursing care, investigations, medication

assistance
(including oral and
Second intravenous), chemotherapy, dialysis, transfu
medical opinion sions, physiotherapy and postsurgical care.
Homecare facility
(MBHI’s first) These will not be provided by network hospitals. Hence, separate pre-auth request to be submitted to
Max Bupa by the customer
Personal
accident cover Home health care services are covered only if we have accepted a cashless inpatient claim &
services are availed immediately after that hospitalization.
Pharmacy
Service available as on Jan 2018, in Delhi NCR, Mumbai, Bangalore, Hyderabad, Kolkata, Ludhiana, Jaipur.
& diagnostic
.
10. Personal accident cover
OPD
~ 4 cr**. People are

AdvantAge
17* death per hour pushed towards
in road accident in poverty due to
Health coach India treatment
bills
Cost
reduction option
Personal Accident Cover will be for either primary insured or primary insured with spouse
I – Protect covered under 2A+XC plan.
(Industry’s first) Base Sum Insured (SI) per Policy Year
Go Active 15
Health checkup 4 lacs 5 lacs 7.5 lacs 10 lacs 25 lacs
lacs
Personal Accident cover
Behavioral
- Accident Death (100% of Sum assured)
assistance
- Accident Permanent Total Disability(
25 lacs 25 lacs / 50 lacs
Second 125% of SA)
medical opinion - Accident Permanent Partial Disability
Homecare facility
(As per grid)
(MBHI’s first) Premium for 1A Rs. 2,226 Rs. 2,226 / Rs. 4,452
Premium for 2 A Rs. 4,452 Rs. 4,452 / Rs. 8,904
Personal
accident cover * Exclusive of service tax
Lower premium than HA, No separate underwriting for PA
Pharmacy
& diagnostic *Indian Express Sept 2017 **Credit health June 2016
.
11. Pharmacy and diagnostic services
OPD
AdvantAge Services
(Industry’s first) Ease of
available on
experience
click of a button
Health coach
Cost
reduction option
One window Avail special
I – Protect for different discount offer
(Industry’s first) services time to time
Health checkup
Behavioral
assistance
Second
medical opinion
Homecare facility
(MBHI’s first)
Personal
accident cover
Pharmacy
& diagnostic
.
India’s first digitally enabled wellness ecosystem
Services
available on
click of a
button
OPD
GoActive
offers you Drugs
Health &
Coach Diagnostic
Seamless
Everyday
utilization in
& convenient
comparison to
use
market
Section 2 Traditional Benefits
.
GoActive - Traditional Benefits
Inpatient Emergency
1 Treatment Ambulance 6
Hospital Refill
2 Accommodation 7
Benefit
Alternative Organ Donor

3 Treatment Coverage 8
Traditional
Pre-Post
Benefits
4 Deductible 9
Hospitalization
Domiciliary
5 Day Care 10
Hospitalization
.
1 & 2. Inpatient treatment & hospital accommodation
Inpatient Base Sum Insured (SI) per Policy Year
treatment Go-Active
4 lacs 5 lacs 7.5 lacs 10 lacs 15 lacs 25 lacs
Hospital
accommodation
Nursing charges for Hospitalization
Alternative as an inpatient excluding Private
treatment Nursing charges
Medical Practitioners‟ fees,
Pre-post excluding any charges or fees for
hospitalization Standby Services
Physiotherapy, investigation and
diagnostics procedures directly
Daycare related to the current admission
Medicines, drugs and consumables
as prescribed by the treating Covered up to Sum Insured
Emergency
Medical Practitioner
ambulance
Intravenous fluids, blood
Refill transfusion, injection administration
Benefit charges and /or consumables
Operation theatre charges

Organ donor
coverage The cost of prosthetics and other
devices or equipment if implanted
internally during Surgery
Deductible
Up to 1% of Base Sum No restriction (except suite or above room category)
Room Rent (per day)
Insured per day (Limit included in Inpatient Care SI)
Domiciliary Intensive Care Unit/Critical Care Up to 2% of Base Sum
hospitalization Covered up to Sum Insured
Unit charges (per day) Insured per day
.
3. Alternative treatment
Inpatient
treatment
Coverage:
Hospital Reimbursement of medical expenses for in-patient
accommodation alternative treatment taken under AYUSH (covering
ayurvedic, unani, sidha & homeopathy) provided
Alternative the treatment has been undergone in:
treatment
• A government hospital or in any institute
Pre-post
hospitalization
recognized by government and/or accredited by
quality council of India/national accreditation board
on health.
Daycare
• Covered up to sum insured
Emergency 90 days pre & 180 days post hospitalization is also
ambulance covered under alternative treatment.
Permanent exclusions (except yoga) shall not
Refill
apply to the extent this benefit is applicable
Benefit
Organ donor
coverage
Deductible
Domiciliary
hospitalization
.
4. Pre & Post hospitalization expenses
Inpatient Coverage:
treatment
• Medical expenses (doctor fee, diagnostic test, medicines ) up to 90 days immediately before
Hospital insured person‟s admission and 180 days immediately after insured person‟s discharge for the
accommodation same illness.
Alternative • Pre and post hospitalization expenses can be claimed as reimbursement only.
treatment
• Covered up to sum insured
Pre-post • Expenses will be covered, only if main claim under in-patient care / Day care / domiciliary
hospitalization treatment has been accepted.
Daycare
• Physiotherapy (under pre & post hospitalization medical expenses) will also be payable provided
that such physiotherapy is medically necessary and advised by the treating medical practitioner
and is directly related to current event that led to Hospitalization or Day Care Treatment.
Emergency
ambulance
Base Sum Insured (SI) per Policy Year
Refill
Go Active
4 lacs 5 lacs 7.5 lacs 10 lacs 15 lacs 25 lacs
Benefit
Organ donor
Pre-hospitalization Medical
coverage Covered up to Sum Insured
Expenses (90 days)
Deductible
Post-hospitalization Medical
Covered up to Sum Insured
Domiciliary Expenses (180 days)
hospitalization
.
5. Day care treatment
Inpatient
treatment Coverage:
Hospital
accommodation
• On written advice of medical practitioner & medical necessary expenses for 536 major
Alternative day-care procedures (< 24 hours) will be covered.
treatment
• Any procedure undertaken on an out-patient basis or diagnostic services will not
Pre-post
hospitalization
be covered under this benefit.
Daycare • Covered up to sum insured.
Emergency
ambulance
Refill
Benefit
Organ donor
coverage
Deductible
Domiciliary
hospitalization
.
6. Emergency ambulance
Inpatient
treatment
Coverage
Hospital
accommodation Reasonable and customary ambulance(surface transport) expenses following an
emergency to a hospital or from existing hospital to another as per the advise of treating
Alternative
doctor.
treatment
• The ambulance service is offered by a healthcare or ambulance service provider.
Pre-post
hospitalization • The company has accepted an in-patient claim for the same illness or accident.
• Max. Liability for irrespective of network = Up to Rs. 3,000 per hospitalization
Daycare
This benefit is available for one transfer per Hospitalization
Emergency • We will not make any payment under this benefit if the insured person is transferred to
ambulance
any hospital or diagnostic centre for evaluation purposes only.
Refill
Benefit
Organ donor
coverage
Deductible
Domiciliary
hospitalization
.
7. Refill benefit for new illness or person (1/2)
Inpatient
treatment
If the Base Sum Insured and I-Protect Sum Insured (if
available) is exhausted,
Hospital
accommodation • we will provide Refill Sum Insured up to 100% of Base
Sum Insured,
Alternative
treatment • only once a year,
CLAIM
• For claim of a un-related illness
Pre-post
For Ex: Fever due to Malaria and Fever due to Typhoid
hospitalization
are un-related although both are fever; Refill can get
triggered
Daycare
• OR for another insured person covered in family floater
policy
Emergency
ambulance The maximum liability for a single claim after applying
Re-fill benefit shall not be more than Base Sum Insured
Refill and Increased Sum Insured under I-Protect (if any).
Benefit
REFILL
Organ donor Most of the competitors offer Refill only on complete
coverage utilization of SI and NCB; we offer Refill even on Partial
utilization of SI or I protect* (refer next slide for
illustration)
Deductible
Domiciliary
hospitalization * I protect is automatic increase in base sum insured by 10% on each renewal (if opted)
.
7. GoActive - Refill illustration (2/2)
Inpatient
treatment
Hospital Apollo Optima

accommodation Individual/Floater Max Bupa Restore
Alternative
treatment Sum Insured 500,000 500,000
Pre-post First claim received during the year 200,000 200,000

hospitalization
First claim settlement amount 200,000 200,000
Daycare
Available base Sum Insured for future claim in same year 300,000 300,000
Emergency
ambulance Refill Trigger Yes No
Refill Second claim received during the year
(for unrelated illness)
5,00,000 5,00,000
Benefit
5,00,000
Organ donor 3,00,000
Second claim settlement amount for a different illness / (3L from
coverage (only remaining
injury / insured remaining SI, 2L
SI)
from refill)
Deductible
Domiciliary
hospitalization
.
8. Living organ donor transplant
Inpatient
treatment Coverage:
Hospital Expenses for an organ donor’s treatment for the harvesting of the organ donated.
accommodation
• Provided donation conforms to the transplantation of human organs act 1994 and the
Alternative organ is for the use of the insured person;
treatment
• The insured person has been medically advised to undergo an organ transplant;
Pre-post • Covered up to sum insured
hospitalization
What’s not covered:
• Pre or post medical expenses for the Organ Donor
Daycare
• Stem cell donation except for Bone Marrow Transplant
• Screening expenses for the organ donor which are not incurred during the duration of Insured
Emergency Person‟s hospitalization for organ transplant.
ambulance • Experimental or investigational transplant
• Any other medical treatment or complication in respect of the donor, consequent to
Refill harvesting.
Benefit
Organ donor
coverage
Deductible
Domiciliary
hospitalization
.
9. Annual aggregate deductible
Inpatient
treatment Deductible option available for individual
and family floater Example
Hospital
accommodation Annual Aggregate deductible option of
value: Sum Insured
Alternative 3L
treatment • Rs.25K, 50K, 1 Lac, 2 Lac, 3 Lac, 5 Lac
& 10 Lac for any sum insured.
Pre-post
hospitalization • Customer receives a discount 2L
• Deductible will not apply to any claim Existing Plan/
Daycare Borne by
Deductible
under Health Checkup / Diagnostic
customer
Tests, Second Medical Opinion, OPD 1L
Emergency Consultation, Behavioral Assistance
ambulance
Program & Personal Accident Cover.
Refill • Co-payment (if applicable) on amount
Benefit payable by us will apply after deductible
limit has exhausted.
Organ donor
coverage
Deductible
Domiciliary
hospitalization
.
10. Domiciliary hospitalization
Inpatient
treatment
Medical expenses for medical treatment for domiciliary treatment taken at home if this
Hospital
accommodation continues for at least 3 consecutive days as long as either:
Alternative
treatment • The attending doctor confirms in writing
Pre-post
that the insured person could not be
hospitalization
transferred to a hospital or
Daycare • The customer satisfies the company that a

hospital bed was unavailable.
Emergency
ambulance • Covered up to Sum insured
Refill
Benefit
Organ donor
coverage
Deductible
Domiciliary
hospitalization
.
Waiting period and exclusions
Initial waiting period: 30 days
Personal waiting period: 24 months
Pre-existing waiting period: 36 months
Specific waiting period: 24 months
Waiting periods shall not apply to health checkup/diagnostic tests, second medical opinion, OPD
consultation, Behavioral assistance, Health coach & Personal accident cover.
•Pancreatitis and Stones in biliary and urinary System

•Cataract, Glaucoma and other disorders of lens, disorders of retina
•Hyperplasia of prostate, hydrocele and spermatocele
•Abnormal utero-vaginal bleeding, female genital prolapse, endometriosis/adenomyosis, fibroids, PCOD, or any condition requiring
dilation and curettage or hysterectomy
•Hemorrhoids, fissure or fistula or abscess of anal and rectal region
•Hernia of all sites,
•Osteoarthritis, Systemic Connective Tissue disorders, Dorsopathies, Spondylopathies, inflammatory Polyarthropathies, Arthrosis
such as RA, Gout, Intervertebral Disc disorders
•Chronic kidney disease and failure
•Diabetes and its related complications
•Varicose veins of lower extremities
•Disease of middle ear and mastoid including Otitis Media, Cholesteatoma, Perforation of Tympanic Membrane
•All internal or external benign or In Situ Neoplasms/Tumours, Cyst, Sinus, Polyp, Nodules, Swelling, Mass or Lump
•Ulcer, Erosion and Varices of Upper Gastro Intestinal Tract
•Tonsils and Adenoids, Nasal Septum and Nasal Sinuses
•Internal Congenital Anomaly
.
Section 3 Cost Benefit Analysis
.
Cost benefit analysis – with optional benefits (1/2)
Cost Benefit Analysis (Zone 1) Year 1 Year 2

Sum Insured 10 Lac 10 Lac Remarks
Premium rate for 2A+2C, Delhi, Eldest age 35 yrs 26,969 27,815 Zone 1
Less Advantage benefit 10% 2,697 2,782 example
Less Premium after advantage 24,272 25,034
Less Health score based discount 0 5,007 Assumed 20% discount at renewal
= Base premium to be paid 24,272 20,027
Add Health coach 2,368 2,368 Assumed taken for 1 adult
3% increase considered on base
Add I - Protect 0 751
premium after AdvantAGE
Add Personal accident cover 4,452 4,452 Accident cover for 2 adults, 25 lac
= Total of add on covers 6,820 7,571
Premium without tax 31,092 27,598
Add Tax (18%) 5,597 4,968
= Premium to be paid inclusive of tax 36,689 32,565
Less OPD benefit 6,000 6,000 Rs. 600* 10 consultation
Less Health checkup cost for All adults 3,000 3,000 1500 * 2
considering max deductible limit of
Less Tax Benefit Assuming 30% slab 7,500 7,500
rs. 25000
= Benefit worth (F+G+H) 16,500 16,500
Net cost to customer (Annually) 20,189 16,065
Per member cost monthly (Annual premium/ 4 / 12) 421 335
Per member cost daily (Monthly premium / 30) 14 11
.
Cost benefit analysis – with optional benefits (2/2)
Cost Benefit Analysis (Zone 2) Year 1 Year 2

Sum Insured 10 Lac 10 Lac Remarks
Premium rate for 2A+2C, Delhi, Eldest age 35 yrs 20,034 20,655 Zone 2
Less Advantage benefit 10% 2,003 2,066 example
Less Premium after advantage 18,031 18,590
Less Health score based discount 0 3,718 Assumed 20% discount at renewal
= Base premium to be paid 18,031 14,872
Add Health coach 2,368 2,368 Assumed taken for 1 adult
3% increase considered on base
Add I - Protect 0 558
premium after AdvantAGE
Add Personal accident cover 4,452 4,452 Accident cover for 2 adults, 25 lac
= Total of add on covers 6,820 7,378
Premium without tax 24,851 22,249
Add Tax (18%) 4,473 4,005
= Premium to be paid inclusive of tax 29,324 26,254
Less OPD benefit 5,000 5,000 Rs. 500 * 10 consultation
Less Health checkup cost for All adults 3,000 3,000 Rs. 1500 * 2 adults
considering max deductible limit of rs.
Less Tax Benefit Assuming 30% slab 7,500 7,500
25000
= Benefit worth (F+G+H) 15,500 15,500
Net cost to customer (Annually) 13,824 10,754
Per member cost monthly (Annual premium/ 4 / 12) 288 224
Per member cost daily (Monthly premium / 30) 10 7
.
Cost benefit analysis – without optional benefits (1/2)
Cost Benefit Analysis (Zone 1)
Zone 1
A Sum Insured 10 Lac
B Premium rate for 2A+2C, Delhi, Eldest age 35 yrs 26,969
example
C Less Advantage benefit 10% 2,697
D = Actual premium before tax 24,272

E Premium to be paid inclusive of tax 28,641 Premium including service tax(18%)
F Less OPD benefit 6,000 Rs. 600 *10 consultation per year
G Less Health checkup cost for All adults 3,000 Irrespective of claim, AHC – from Day 1
Customer can be on any tax slab.. For
H Less Tax Benefit Assuming 30% slab 7,500 calculation purpose taking 30%,
(deductible limit- 25000 premium)
I = Benefit worth (F+G+H) 16,500
J Net cost to customer ( E - I ) (Annually) 12,141
K Per member cost monthly (J / 4 / 12) 252 Example of 2A+2C i.e 4 members
L Per member cost daily (K / 30) 8
At renewal customer can get up to 20% extra discount basis health score
.
Cost benefit analysis – without optional benefits (2/2)
Cost Benefit Analysis (Zone 2)
Zone 2
A Sum Insured 10 Lac
B Premium rate for 2A+2C, Chennai, Eldest age 35 yrs 20,034
example
C Less Advantage benefit 10% 2,003
D = Actual premium before tax 18,031

E Premium to be paid inclusive of tax 21,276 Premium including service tax(18%)
F Less OPD benefit 5,000 Rs. 500 *10 consultation per year
G Less Health checkup cost for All adults 3,000 Irrespective of claim, AHC – from Day 1
Customer can be on any tax slab.. For

H Less Tax Benefit Assuming 30% slab 6,382 calculation purpose taking 30%,
(deductible limit- 25000 premium)
I = Benefit worth (F+G+H) 14,382
J Net cost to customer ( E - I ) (Annually) 6,894

Example of 2A+2C i.e 4 members
K Per member cost monthly (J / 4 / 12) 143
L Per member cost daily (K / 30) 5
At renewal customer can get up to 20% extra discount basis health score
.
Section 4 Sales Pitches
.
Sales pitch ( Go-Active)
AdvantAge Health Coach Behavior assistance
I - Protect Refill benefit AHC / Diagnostic
Home healthcare 2nd Medical Opinion OPD consultation

.
Sales pitch – AdvantAge
Sir, You would agree that buying insurance

protection at early age is always beneficial, as
chances of getting good coverage are high due to
comparatively low risk at young age.
Yes, I agree
Sir, we at Max Bupa are committed to Wow… really, this will

provide quality service to the save my 10%
clients, specially for people like you who are premium every
less than or equal to age 35 years. year…
We will provide 10% discount on your

premium for lifetime under our Go-active
AdvantAge benefit….
.
Sales Pitch – Behavioural Assistance Program & health
coaching
Dear Mr. Prospect, you will agree that, our health

can be affected anytime due to factors like Yes. Could be.
unhealthy lifestyle & habits.
Sir, you would also appreciate the need of Yes, I also feel so
someone who can guide us, counsel us and
support us for various situation of life where we
need behavioral assistance.
Very
Sir, Max Bupa Go-Active provide telephonic counseling innovative….
sessions on cashless basis, to any conditions like, pre-
marital counseling, nutrition, Stress, child and parenting...
It gives 3 consultations per adult per policy year…
Oh! That’s
really nice….
Sir, We will provide you a personal health coach Who will
help you to keep yourself fit and healthy, and based on
your health score you can get discount of 20% on your
renewal premium
.
Sales Pitch – I-Protect
Mr. Customer, You would also agree with the fact that
with passage of time, our health status changes and cost
of medical treatment will go higher.
So one should have plan which can compensate this

medical inflation and increase your coverage periodically
without any hurdle. Yes I agree.
This sounds
very good.
Sir, Max Bupa Go-Active provides customized solution to
beat Medical Expenses Inflation in the plan.. We add 10%
of base sum insured at the time of renewal a policy.
This will enable you to enhance your coverage without

additional underwriting.
.
Sales pitch – Refill benefit
Yes. That‟s True!!
Sir, you would agree with me that in today‟s

scenario the increased prevalence of Life
style diseases are leading to very high Well ! you are
right, but what‟s
medical expenses. Do you agree?
the solution ?
This clubbed with technological advancement

in the field of medicine, makes the medical How will it happen
treatment even more expensive. There are so
many cases, where in a single claim utilized
major part of the Sum Insured.
That‟s really
Sir, How about if, I offer you a solution which takes care
interesting
of all your medical expenses beyond your chosen SI,
even in the case of multiple hospitalization in a single
year.
Sir, we have this unique benefit under the Go-active plan with the
name of Refill Benefit , in which you pay less & get more out of
your Health Insurance. It gives you an additional Sum Insured
equal to the Base Sum Insured in the same year & that too
without any extra premium.
.
Sales pitch – AHC / Diagnostic test from day 1
Sir, this is just to share a fact with you, 60% of health

problems occur in 30-45 age, out of these 70% could be
averted if diagnosed well in time. Okay, that‟s
(www.Healthcareontime.Com) interesting
we will cover the cost (cashless) of a health check-up

arranged by us through our empanelled service providers This sounds
as per the plan eligibility after issuance of policy. very good.
You can also go for diagnostic test of your own choice on

cashless basis or get it reimbursed up to the maximum
limit as per plan eligibility
As well as if the amount is unutilized we can use for kids
too…
.
Sales pitch – Home health care services
Sir, you would agree, in busy daily life and changing

family structures, we may need care even after
discharge from hospital after treatment.
Yes we do need post

hospitalization care
Sir, we have offered a innovative benefit home health care
immediately after the In Patent treatment as per medical
advice…this is done on cashless basis through our
empanelled service provider
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,
This Seems
physiotherapy and postsurgical care. Customer
Centric…
.
Sales pitch – Second medical opinion
Sir, in the current scenario, we have found that sometimes

patients or their relative feel confused, whether to go for
any particular procedure immediately or not?
For example:- Many people are getting diagnosed with

blockage in heart and they found themselves in a dicey Oh!! That’s really
state to go for angioplasty or not. great…
We provide Second Opinion for specified illness per year, it

always help people to do right decision at the time of real
need.
.
Sales pitch – OPD coverage
Sir, you would agree, apart from big expenses for medical
treatment, sometimes daily routine outpatient consultations
with doctor becomes equally important. Yes! You are right.
Sir, Max Bupa Go-Active will provide Doctor consultations

as per Sum Insured selected by you. All these are
available through Cashless or Reimbursement basis and
you can save up to Rs 6000/- per year.
Oh! that’s really

good
.
Section 5 Objection handling
.
Objection handling – Plan only for nuclear family
I understand your concern ma‟am and I do

appreciate your care for parents.
But there are different policy for different

features.
Why your plan is covering only I would like to share with you that you can take a
nuclear family? Why parents are additional policy for your parents too.
not covered?
Benefits:-
•More number of OPD coverage

•Both you and parents will enjoy tax benefit.
•Overall risk coverage will be more.
.
Objection handling – Maternity not covered
I understand your concern ma‟am.
We have customized plans as per different

customer‟s priority.
For particular maternity coverage we have

Why you are not covering Heartbeat plan.
maternity expenses in this
policy? But With GoActive you can enjoy:-
•Health coaching
•Behavioral assistance
•OPD benefit
•Refill benefit
•Inflation protection benefit etc.
.
Objection handling – No carry forward of OPD limit
I appreciate your concern ma‟am.
We at Max Bupa want our customers to avail

best of benefits available in policy at time of real
need.
Why unused OPD expenses
balance does not carry forward We found in our study that people often use 6-10
to next year? OPD normally in a year, which will be available
for you.
Next year these benefits will start afresh to cover

you.
.
Objection handling – Why buy early
Ma‟am, we really appreciate that you take care of you

health.
& that‟s why have designed this product for customer

specially like you.
Ma‟am , getting insurance coverage is always easy

I am young, my chances of when we are young and healthy.
getting hospitalized at this age is
very less. Why should I buy now You will get the following benefit:-
• Health coach guidance

•10% discount in your premium for lifetime(age<=35 yrs)
• Up to 20% discount in your renewal premium basis
your health score.
• OPD benefits
• Behavioral assistance
• Tax benefits
.
Objection handling – Product seems expensive
I understand your concern. Ma‟am,
GoActive offers high coverage at a competitive per lac cost.
At age 35 yrs, daily premium for 10 lac S.I for 2A+2C is just
Rs. 8 per member
Plus you can avail up to 20% discount on your renewal

premium.
Your product seems
expensive, what is the
value benefit I am getting? Most important thing, you can talk directly to
Maxbupa- No Third party administrator (TPA )
involvement.
Cashless claim approval in just 30 minutes
24 * 7 in house customer care
But can you compare it with

your competitors? Sure ma‟am
.
Competition benchmarking (Features)
Aditya Birla Active Health
Company / Product Feature Max Bupa GoActive Apollo Munich Health Wallet
Enhanced
Lifetime discount of 10%
Early entry age discount
available Not Available Not Available
(AdvantAGE)
(for <=35 years age)
Available within closed network Not available
Wallet based amount – can be
OPD Consultations (based on plan – max 10 (Not selling OPD expense
utilized for multiple benefits
consults) optional benefit)
Wellness coach available
Optional benefit of Health Earn Health Returns basis the
Health Coaching for fitness Coach Activity level / fitness
Not Available
and well being (up to 20% discount on assessment, which can be
renewal) utilized against OPD and
uncovered expenses
Available from Day 1 of policy. Applicable on policy renewal Applicable every year for adult
Option of pre-defined list of only. members only – a predefined list
Health
tests OR Only diagnostic tests up to of tests (cashless or
Check-up / Diagnostics
Amount limit for any diagnostic certain amount available for reimbursement up to fixed
tests wallet benefit of 10k and above amount)
Optional I-Protect– 10%
NCB of 50% pa; NCB of 20% pa.
increase in SI (irrespective of
Renewal Bonus up to 100% up to 100%
claim) on each renewal with
(with decrease) (w/o decrease)
any upper limit
Second Medical Opinion Available Not available Available
No co-pay No co-pay
(option for 20% co-pay in Co-pay applicable only for
Co-Pay No co-pay
selected cities with reduction in treatment in higher zone / room
premium) category
.
Competition benchmarking (Premium)
Sum Insured 5Lac Sum Insured 10Lac
Sum Insured = 5L Sum Insured = 10L
MBHI GA Apollo Aditya Birla MBHI GA Apollo Aditya Birla
Age = 27 yrs (1A) Age = 27 yrs (1A)
Premium 8,546 12,024 6,661 Premium 10,990 19,414 8,517
Less OPD benefit / Wallet Less OPD benefit / Wallet 3,600 10,000 0
2,400 5,000 0
Less Less Health Check 1,500 1,500 1,000
Health Check 1,000 0 1,000
Net Premium 5,146 7,024 5,661 = Net Premium 5,890 7,914 7,517
=
Note - Health checkup is a renewal benefit in Apollo's Health
Sum Insured = 5L Wallet
MBHI GA Apollo Aditya Birla
Age = 32 yrs (2A)
Premium 13,138 15,293 10,714 Sum Insured = 10L
Less OPD benefit / Wallet 3,600 5,000 0 Age = 32 yrs (2A)
Less Health Check 2,000 0 2,000 Premium 17,312 23,501 14,269
Net Premium 7,538 10,293 8,714 Less OPD benefit / Wallet 6,000 10,000 0
=
Less Health Check 3,000 3,000 2,000
Sum Insured = 5L = Net Premium 8,312 10,501 12,269
Age = 37 yrs MBHI GA Apollo Aditya Birla Note - Health checkup is a renewal benefit in Apollo's Health
(2A+1C) Wallet
Premium 18,651 19,378 13,229
Less OPD benefit / Wallet 3,600 5,000 0 Sum Insured = 10L
Less Health Check 2,000 0 2,000 Age = 37 yrs (2A+1C)
= Net Premium 13,051 14,378 11,229 Premium 24,236 28,016 17,547
Note - The premium will be INR 16,786 (10% lower) if policy Less OPD benefit / Wallet 6,000 10,000 0
is purchased on or before 35 years of age and renewed Less Health Check 3,000 3,000 2,000
continuously. = Net Premium 15,236 15,016 15,547
Premium excluding taxes for Delhi / Mumbai without co-payment Note - The premium will be INR 21,812 (10% lower) if policy is
purchased on or before 35 years of age and renewed continuously.
Note - Health checkup is a renewal benefit in Apollo's Health Wallet
©Max SkillFirst .
V1.0_2017 63
Objection handling – No claim bonus not available
I understand your concern ma‟am,
In GoActive plan we also offer bonus as an optional benefit

through I-Protect feature.
moreover bonus in my plan is guaranteed, you will get a

guaranteed 10% increase in sum insured at time of
renewal irrespective of claims.
Other companies are
This is to give protection to you against medical inflation for
giving NCB, if I don’t
lifetime. & unlike other companies we have not capped it
claim, Why you are
to 100% only.
not giving it?
.
Section 6 Proposal form filling & underwriting
Click here to see sample filled proposal form
.
Important things to remember during form filling (1/4)
Now proposal form with auto generated bar code is available at click of a button
Path:- www.maxbupa.com
>> Customer Support >> Downloads >> Proposal Form >> {click on the proposal form}
INSTRUCTIONS:-
The scanning/Printing dimensions should be as follows:
Paper size to be : A4., Scanning in 200-300 DPI, Black and White Scanning, Multi Page TIFF format scan file to be produced.
All the pages should be scanned in the same configurations.
.
Mandatory fields to be filled in proposal form

•Title / First / last name of proposer
•Date of birth of proposer
•Gender: male / female / other
•Email id, Aadhar number, PAN no in case of premium more than 1 lac.
•Annual income
•Premium paid by
•Relationship with proposer
•Proposer‟s bank account details (irrespective of the premium)
•Details or e-insurance account
• Details of applicants for insurance ( Name, height, weight, gender, DOB & relationship with proposer like:- spouse of adult 1,
son/daughter of adult 1)
•Medical and habit information:
•Section A ( All 6 questions, pregnancy related question only for females(18 yrs to 50 yrs)
•Section B (Habits)
•Section C ( Only if, answer given as yes in section A)
• Past proposal details
• Declaration
• Vernacular declaration
• Additional detail of Bancassurance Channel
• Insurance advisor Report
• Please tick if not an Indian ( mandatory for Indian)
.
Non mandatory fields to be filled in proposal form

•Alternate number
•Waistline
•Date of birth of nominee
•Authorization for Electronic Policy Fulfillment and Service Communication (mandatory to
select yes or no)
•Renewal Payment Sign Up (mandatory to select yes or no)
Politically exposed person (PEP) questionnaire

•PEP question to be answered as „yes‟ or „no‟. If the customer has answered it as „yes‟ then
PEP questionnaire is required to be filled up by the customer.
•Pep questionnaire to be filled in for all members
.
Proof required
• Age proof is required for eldest member and aadhar of proposer.
• For NRI applications: copy of passport, copy of VISA and NRI questionnaire are mandatory
documents
Additional points (from underwriting prospective)

• Demographic details should be correctly filled (like Date of birth of, height, weight and
waistline of every insured)
• Health disclosure should be carefully captured for each insured in section A and B and details
should be provided in section C without fail.
• In case insured is PEP (get PEP questionnaire filled)
• In case of baby less than 1 year should take BDS prior to login.
• In case of NRI/ Other nationality and portability take relevant document
.
Pre policy medical checkup & premium loading
Underwriting Grid
Age Band (Completed years) Underwriting Assessment Tool Additional Considerations
Birth to < 1 Birth Discharge summary or/and MER # Medical underwriting may be triggered
1 to 44 Nil based on health declaration by the proposer
> 45 Pre-policy Medical Checkup (PPMC) or based on BMI or BMI for Age value*
 A health declaration will result in referral to the medical underwriter. Based on the assessment and information available,
the medical underwriter may trigger a PPMC
 All ported policies will be sent for medical underwriting and assessment
 *For less than 18 Years of Age, BMI for Age will be considered and for above 18 Years of age BMI will be considered
 # In case of non-availability of discharge summary or incomplete information therein, underwriter will exercise the discretion
to trigger appropriate medical test (s) or decline proposed life in view of potential medical risk (s).
The medical checkups are spread in levels depending on the age, type of plan and sum insured.
Standard Tests under PPMC may include tests such as (but not limited to): MER, RUA, T Cholesterol, LDL, HbA1c,
ECG, SGPT, SGOT, S Creatinine, GGT.
The underwriter may seek additional medical tests or past medical records if required for making an informed
underwriting assessment and decision
Accepted Proposal Decline Proposal
100 % to be borne by Max Bupa 100 % to be borne by Proposer
Diabetes, Hypertension, Ischemic Heart Diseases, High BMI. In addition to this, there will be a loading in
case of adverse test values indicating impact of DM, HTN, IHD and BMI on overall health
Loading range in Go active has been kept at reasonable levels ranging from 10-25% for DM & HTN, 10-50%
for IHD and 50% for adverse BMI. In addition to this, An additional 10% of loading may be levied for
each condition of Diabetes Mellitus, Hypertension and IHD in case of averse medical tests.
(except BMI) that are impacting overall health .
ACH
MBHI verifies Customer can fill ACH form at the time of
requisite details filling proposal form & any time after
issuance too.
The convenient method of ACH will

ensure that customers do not have to put
Details shared
reminders for their renewal payment or
with bank
visit our branches. On the due date of
policy renewal the authorized bank will
ACH mandate
Approved by customer‟s automatically deduct the amount of
bank & MBHI is now renewal premium from customer‟s bank
authorized to collect account.
premium from
customers' bank as
instructed It provides a robust, secure, and scalable
Customer fills
platform to customers to manage
ACH form
payments. It has best in class security
features ensuring that the financial details
of the customers are protected.
Request shared Customers have the choice to modify their

with customer‟s bank details or cancel the ACH registration
bank with us at any point in time.
.
Important contact details for claims & service
Customer care number 1860-3010-3333
Behavioral assistance 72900-44777
Second medical opinion 1860-3010-3333
AHC/Diagnostic 1860-3010-3333
Home Health Care 1860-3010-3333
.
Summary:
By the end of this module we have learnt about:
1 Policy design of “GoActive” product
2 Policy features and benefits of individual, family floater
3 Explain coverage, waiting period & exclusions
4 Cost benefit analysis, present powerful sales pitches, handle objection
5 Feature and premium benchmarking with close competitors
6 Form filling & underwriting process
.
Disclaimer
This document and contents thereof are proprietary material of Max Skill
First Limited. Any unauthorized copying, dissemination or use of the same is
strictly prohibited. The trademarks/ service marks as are used in the
documents are trademarks/ services marks of Max Bupa Health Insurance
and have been incorporated in this document on specific authorization of
Max Bupa Health Insurance.
.

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What comes to your mind when

you think about health insurance?

What are customer’s expectations

©Max SkillFirst V1.0_2017 1

I will not fall Only for those

Traditionally, Health Insurance revolves around Illnesses only

Rewarding you for

©Max SkillFirst V1.0_2017 4

As per Individual Family

4 Lac, 5 Lac, 4 Lac, 5 Lac,

©Max SkillFirst V1.0_2017 5

Family Floater Plan

Alternative Organ Donor

AdvantAge Search & visit Upload the

I – Protect Base Sum Insured (SI) per Policy Year

Second Share your test

Personal Health score 0-9999 10000-69999 70000-79999 80000-89999 90000-100000

AdvantAge Get personal

Co-payment option can be chosen at inception and can be

I – Protect Note:- Zone choice is independent of customer’s

Health checkup This Zone-wise Co-payment shall not be applicable on

Guaranteed No Capping / Provides

Health coach Increasing trend in medical cost @ 10%

OPD Option 1 OR Option 2

Health checkup •Pre-marital counseling

AdvantAge Get a free second

Health checkup These shall include services such as :-

Behavioral nursing care, investigations, medication

~ 4 cr**. People are

Alternative Organ Donor

Operation theatre charges

Daycare • Covered up to sum insured.

Hospital Apollo Optima

Pre-post First claim received during the year 200,000 200,000

Daycare • The customer satisfies the company that a

•Pancreatitis and Stones in biliary and urinary System

Cost Benefit Analysis (Zone 1) Year 1 Year 2

Cost Benefit Analysis (Zone 2) Year 1 Year 2

D = Actual premium before tax 24,272

J Net cost to customer ( E - I ) (Annually) 12,141

L Per member cost daily (K / 30) 8

D = Actual premium before tax 18,031

Customer can be on any tax slab.. For

J Net cost to customer ( E - I ) (Annually) 6,894

L Per member cost daily (K / 30) 5

AdvantAge Health Coach Behavior assistance

I - Protect Refill benefit AHC / Diagnostic

Home healthcare 2nd Medical Opinion OPD consultation

Sir, You would agree that buying insurance

Sir, we at Max Bupa are committed to Wow… really, this will

We will provide 10% discount on your

Dear Mr. Prospect, you will agree that, our health

So one should have plan which can compensate this

This will enable you to enhance your coverage without

Yes. That‟s True!!

Sir, you would agree with me that in today‟s

This clubbed with technological advancement

Sir, this is just to share a fact with you, 60% of health

we will cover the cost (cashless) of a health check-up

You can also go for diagnostic test of your own choice on

Sir, you would agree, in busy daily life and changing

Yes we do need post

Home Health Care is a range of health care services and

Sir, in the current scenario, we have found that sometimes