health rider

Who do I rely on
when I encounter
medical emergencies?

Bharti AXA Life

Hospi Cash Benefit Rider
A solution that ensures lumpsum
payout on surgery, fixed payout
for each day of hospitalization,
and ICU payout
Why Bharti AXA Life Hospi Cash
Benefit Rider?

When it comes to medical emergencies, you need a partner who

you can rely upon.

We at Bharti AXA Life bring to you a unique solution that

ensures you receive a fixed amount in case of hospitalization or
surgery.

About us:
Bharti AXA Life Insurance is a joint venture between Bharti, one of India’s
leading business groups with interests in telecom, agri business and
retail, and AXA, one of the world’s leading organisations with interests in
financial protection and wealth management. The joint venture company
has a 51% stake from Bharti and 49% stake of AXA.

As we further expand our presence across the country with a large

network of distributors, we continue to provide innovative products and
service offerings to cater to specific insurance and wealth management
needs of customers. Whatever your plans in life, you can be confident
that Bharti AXA Life will offer the right financial solutions to help you
achieve them.
Bharti AXA Life Hospi Cash Benefit Rider is a non-linked and regular pay
hospital and surgery cash insurance rider product that provides a fixed
benefit for per day of hospitalization, ICU benefits and a lumpsum benefit
on undergoing a surgery on an individual policy.

Benefits Payable
Daily Hospital Cash Benefit (DHCB):
Daily Hospital Cash Benefit is a fixed per day benefit paid to the
Policyholder for each day of hospitalization. For this benefit to be payable
the hospitalization should be for minimum periods of 48 hours while the
Policy is in force. This is a fixed amount and not linked to the actual
expenses incurred during Hospitalization.

Intensive Care Unit Benefit (ICU):

Intensive Care Unit Benefit is a fixed per day benefit equal to the DHCB
amount, paid to the Policyholder for each day of hospitalization in Intensive
Care Unit, if the hospitalization lasts 48 hours or more while Policy is in
force. This is a fixed amount and not linked to the actual expenses
incurred during Hospitalization.

Surgical Hospitalization Benefit (SCB):

In the event of Hospitalization (min 48 hours) for undergoing any valid and
medically necessary surgery as specified in this document, in India and
actually undergoing that Surgery, a lump sum benefit will be paid. In the
event of undergoing more than one surgical procedure during a single
admission to hospital a lump sum in respect of the surgical procedure
attracting the highest benefit will be paid

Tax Benefits
You may be eligible for tax benefits under Section 80D of the Income Tax
Act 1961. The tax benefits are subject to change as per change in Tax laws
from time to time.

Lump sum payout on valid surgery after 48 hours

of hospitalization.
Benefit Schedule
The policyholder, at any point, during the term of the policy, cannot switch
between the levels, as mentioned below:

Benefit** Silver Gold Diamond

Hospital Cash Benefit

Daily Hospital Cash Benefit: DHCB 1,000 2,000 3,000

Intensive Care Unit Benefit: ICU + 100% of DHCB + 100% of DHCB + 100% of DHCB

Surgical Hospitalization Benefit

Major Surgeries - For surgeries

directly involving the brain, heart 20 x DHCB 20 x DHCB 20 x DHCB
(including coronary arteries),
liver & lung

Minor Surgeries - All Other 5 x DHCB 5 x DHCB 5 x DHCB

Valid Surgeries

The maximum Surgical Hospitalization Benefit available in one policy year is capped to
90 times the DHCB

Day Limits for Hospital Cash Benefit

Daily Hospital Cash Benefit Maximum of 40 days of Hospital Stay in one

policy year.

Intensive Care Unit Benefit Maximum of 10 days of Intensive Care unit stay
in one policy year.

**The aggregate of all benefits payable in any one policy year under this policy will not
exceed an amount equivalent to 150 times the DHCB under the plan opted for by the
policyholder.

Fixed benefits for each day of hospitalization and

ICU benefits
Eligibility Criteria
Parameter Eligibility Criteria
Minimum /Maximum 91 days - 65 years (age last birthday)
Age at Entry

Maximum Maturity Age 85 years

Policy Term 5,7,10,15,20 & To Age 75 years

Premium Payment Frequency Annual, Semi- Annual, Quarterly and Monthly*

Premium Payment Term Regular Premium

Maturity / Death Benefit No Maturity/ Death Benefit is Payable

No Claim Bonus Not Available

Renewal Guaranteed Renewal till the end of premium

payment term of the base policy- No
medicals at the time of renewal.

* Through ECS only

The Premium pertaining to health related or critical illness riders shall not
exceed 100% of premium under the Base Policy, the Premiums under all
other life insurance Riders put together shall not exceed 30% of premiums
under the Base Policy and any benefit arising under each of the above
mentioned Riders shall not exceed the Sum Assured under the Base Policy.
Case Study
Ajay is 35 years old. He is married and has a 1 year old son. His wife is a
homemaker.

Concerns:
■ He is concerned about the expenses he will incur incase he is
hospitalized.
■ He is looking at meeting his daily hospitalization expenses over and
above his mediclaim/ health insurance policies.

Proposed Solution:
Name: Ajay. Age: 35 years. Gender: Male. Daily Hospital Cash Benefit
Chosen: 1,000. (Silver) Policy Term: 5 years. Regular premium payable:
929 (exclusive of applicable taxes).

Scenario:
Ajay is admitted to a hospital for Heart surgery for which he requires 20
days of hospital stay. He is admitted in the ICU for the initial 5 days and
spends the next 15 days in general ward.
Benefit paid out:

Daily Hospital Cash Benefit 15 days x 1000 per day 15,000

(DHCB):

Intensive Care Unit Benefit: 5 days x 2000 per day 10,000

Surgical Hospitalization 20 x DHCB 20,000

Benefit – Major Surgery
(related to heart):

Total Payout 45,000

Needs Met:
■ Ajay’s daily hospital bills, ICU stay and Surgery charges are covered upto
predefined daily limits.
■ Ajay can claim the balance unutilized benefits available under the rider
incase of him being readmitted in the hospital, subject to overall annual
limits permissible.

Lapsation
In case you do not pay the premiums within the grace period, your Policy will
lapse and no benefits will be paid under this policy. This policy will expire in
case the base policy lapses.
Grace Period
Grace period is the time extended by the Company to facilitate the Policyholder
to pay the unpaid premium, in case the premium/s had not been paid as on
the due date. The Policyholder gets Grace Period (30 days for annual/
semi-annual/quarterly premium payment modes and 15 days for monthly
mode) to pay the unpaid premium due under the Policy and the benefits under
the Policy will remain unaltered during this period.
Revival
The Rider may be revived subject to the following conditions;
• The application for Revival of the Rider benefit is made within five (5) years
from the date of first unpaid premium and before the termination of base Policy
or Expiry Date of Rider ,whichever is earlier;
• Satisfactory evidence of insurability of the Life Insured;
• An amount equal to all unpaid premiums together with interest at such rate
as the Company may charge for such revival, as decided by the Company from
time to time is paid in full; subject to prior approval from IRDAI. The revival
interest rate will be calculated on the 1st of April every year and will be derived
as average of last six months 10 year G.Sec* yield of the immediate last
financial year plus 0.5%. The revival rate of interest for FY 20-21 is 7.12% p.a..
• The Company has not discontinued the Rider Benefits based on the intima-
tion by the Policyholder to discontinue the Rider.
• “Declaration of Good Health” or the Policy holder needs to undergo medical
examination (at his/her own expense) in the manner prescribed / to be
prescribed by the Company as part of the process for revival.
The charges for medical examination, if any, for re-instatement of the Rider
shall be borne by the Policyholder.

Premium Review & Guarantee

• The premium rates are guaranteed for period of three years from the date of
issuance of the policy and are subject to revision after every three years
based on our experience.
• The revised Rider Premium will be based on the then attained age of the
Life Insured and the premium rates applicable for this Rider at that point of
time. Such Premium is guaranteed to remain unchanged for a further period
of 3 years from that date. This process shall continue till the Expiry of the Rider.
• For new business, the rates may be revised based on the experience every
year and the rates shall be guaranteed for a period of 3 years.
• All such revision of premium is subject to IRDA approval.
• Please note that the premiums applicable will be different for standard and
substandard lives.
Terms and Conditions
Waiting Period:

The Company shall not be liable to make any payment if claims are made
due to any treatment of illness/ailment/disease diagnosed or
hospitalization taking place during the first 60 days of the policy
commencement date or date of revival. This waiting period will not apply to
valid hospitalization events arising out of accidents.

A specific waiting period of 2 years for any hospitalization for treatment of

any of the following diseases or surgeries or procedures and any
complications arising out of them from the date of commencement of policy
or date of revival shall apply,

■ Fibroids, menorrhagia, Dysfunctional Uterine Bleeding, Uterine Prolapse.

■ Removal of uterus, fallopian tubes and/or ovaries, except for

malignancy.

■ Hernia (Inguinal / Ventral / Umbilical / Incisional).

■ Hydrocoele / Varicocoele / Spermatocoele.

■ Benign Enlargement of Prostrate.

■ Thyroidectomy for Nodular / Multi Nodular Goitre.

■ Calculus / Calculi in Kidney / Ureter / Bladder / Urethra.

■ Deviated Nasal Septum / Sinusitis.

■ Piles / Anal Fissure / Fistula-in-ano / Rectal prolapse.

■ Cholecystitis / Gall stones.

■ Breast Lumps, except for malignancy.

■ Heart valve and Coronary Artery diseases.

■ Arthroscopy unless post-accident.

■ Disorders of the spine.

Exclusions for the Hospitalisation Benefit
The Company shall not be liable to make any payment if hospitalization or
claims are attributable to, or based on, or arise out of, or are directly or
indirectly connected to any of the following:
■ Pre Existing Disease means any condition, ailment, injury or disease: a)
That is/are diagnosed by a physician within 48 months prior to the
effective date of the policy issued by the insurer or its reinstatement or (b)
For which medical advice treatment was recommended by, or received
from, a physician within 48 months Prior to the effective date of the policy
issued by the insurer or its reinstatement.
■ Hospitalisation not in accordance with the diagnosis and treatment of
the condition for which the hospital confinement was required;
■ Hospitalisation and/or treatment within the waiting period and
hospitalisation and/or treatment following the diagnosis within the
waiting period;
■ 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; Study and treatment of sleep apnoea;
■ Any dental care or surgery of cosmetic nature, extraction of impacted
tooth/teeth, or thodontics 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;
■ Hospitalisation for treatment arising from pregnancy and it’s
complications which shall include child birth or miscarriage;
■ Stay in hospital where no active regular treatment is given by specialist
medical practitioner;
■ Experimental or unproven procedures or treatments, devices or
pharmacological regimens of any description (not recognized by Indian
Medical Council) or hospitalisation for treatment under any system other
than allopathy;
■ 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 unless
related to the treatment of an acute medical condition;
■ 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,
invasion, acts of foreign enemies, hostilities (whether war be declared or
not), civil war, terrorism, 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;
■ Sexually transmitted diseases or Acquired Immune Deficiency Syndrome
(AIDS) and all illnesses or diseases caused by or related to the Human
Immuno-deficiency Virus;
■ 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; circumcision
unless necessary for treatment of a disease or necessitated due to an
accident;
■ 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; or
deliberate exposure to exceptional danger (except in an attempt to save
human life);
■ 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;
■ Hospitalization where the insured is a donor for any organ transplant;
■ Any hospitalisation outside of Republic of India.
■ No benefits are payable on surrender of the Rider.
■ If the Life Insured, whether medically sane or insane, commits suicide,
within one year of the Issue Date/ Revival Date, the Rider shall be void
and The Company will not be liable to pay any Rider Benefit to the
Policyholder/nominee
Free Look Period
If policyholder disagrees with any of the terms and conditions of the policy,
policyholder has the option to return the original policy bond along with a letter
stating reasons for the objection within 15 days of receipt of the Policy Bond in
case of offline Policy and within 30 days of receipt of the Policy in case of Policy
sourced through distance marketing (i.e. online sales). The Policy will
accordingly be cancelled and the Policyholder will be refunded an amount equal
to the Premium paid subject to a deduction of a proportionate risk premium for
the period on cover, the expenses incurred by the Company on medical
examination (if any) and stamp duty charges. All rights under this Policy shall
stand extinguished immediately on the cancellation of the Policy under the free
look option.
Definitions

Day: “Day” in Hospital means a period of a full 24 hours during a period of

confinement. The first Day of confinement shall commence at the time of
admission to the Hospital and each subsequent Day shall commence 24
hours after the commencement of the previous Day. In the event of the time
of discharge of the life insured from the Hospital being more than 12 hours,
but less than 24 hours from the end of the previous Day, then the day of
discharge shall also be regarded as a Day.

Hospital: “Hospital” means any institution established for indoor or

in-patient care and day care treatment of sickness and/or injuries and which
has been registered either as a Hospital or Nursing Home with the local
authorities and is under the supervision of a registered and qualified
Medical Practitioner OR must comply with all minimum criteria as under:

■ Has at least 10 inpatient beds, in those towns having a population of

less than 10,00,000 and 15 inpatient beds in all other places;

■ Has fully qualified nursing staff under its employment round the clock;

■ Has fully qualified doctor(s) in charge round the clock;

■ Has a fully equipped operation theatre of its own where surgical

procedures are carried out; and

■ Maintains daily records of patients and will make these accessible to the
insurance company.

Hospital does not include any institution which is operated primarily as a

convalescent or rest home or a sanatorium, or a home for the aged, or a
place for rehabilitation of alcoholics or drug addicts, or for any similar
purpose.

Intensive Care Unit: “ICU” means a specially equipped and designated ward
in any Hospital that is used for the sole purpose of the treatment of patients
with a critical or exigent condition, and where the patient is under 48 hour
care and monitoring, by a Physician and specially trained nursing staff.
Medically Necessary: “Medically Necessary” refers to a procedure, a
treatment or a period of hospitalization which is ordered by a registered
medical practitioner and

■ Which is required for the treatment of a medical condition, and

■ Appropriate and consistent with the symptoms and findings or diagnosis

and treatment of the life insured medical condition, and

■ Provided in accordance with generally accepted medical practice on a

national basis, and

■ Not of an experimental nature, not of an investigative nature and not in

the nature of research

Pre-existing condition: “Pre-existing condition” means a condition (illness or

bodily injury) for which, prior to the effective date of the policy:

■ The life insured had signs or symptoms, or

■ Medical advice or treatment was recommended by or received from a

physician, or

■ The life insured had undergone medical tests or investigations.

■ Any complication arising out of or in connection with a pre-existing

medical condition shall be considered part of that pre-existing condition.
Any congenital disorder or deformity or physical defects present from
birth shall not be considered part of the Pre-existing Condition.

Surgery: “Surgery” means medically necessary procedure or intervention

performed by a qualified medical professional and carried out through either
a natural orifice or approached by the cutting or penetration of any part of
the body to treat a disease, deformity or injury. Procedures which are only
diagnostic or investigative in nature are excluded from the scope of this
definition.

Accident: A sudden, unintended and fortuitous external and visible event,

occurring independently of any other causes.
Prohibition of Rebate: Section 41 of the
Insurance Act, 1938
No person shall allow or offer to allow, either directly or indirectly, as an
inducement to any person to take or renew or continue an insurance in
respect of any kind of risk relating to lives or property in India, any rebate of
the whole or part of the commission payable or any rebate of the premium
shown on the policy, nor shall any person taking out or renewing or
continuing a policy accept any rebate, except such rebate as may be allowed
in accordance with the published prospectuses or tables of the insurer:
Any person making default in complying with the provisions of this section
shall be punishable with fine which may extend to ten lakh rupees.

Section 45 of the Insurance Act, 1938

Fraud, Misrepresentation and forfeiture would be dealt with in accordance with
provisions of Sec 45 of the Insurance Act 1938 as amended from time to time.
[A Leaflet containing the simplified version of the provisions of Section 45 is
enclosed in appendix – I for reference]
Appendix I: Section 45 – Policy shall not be called in question
on the ground of mis-statement after three years
Provisions regarding Policy not being called into question in terms of Section 45 of
the Insurance Act, 1938, as amended from time to time are as follows:

01. No Policy of Life Insurance shall be called in question on any ground whats ever
after expiry of 3 years from:
a. the date of issuance of Policy or
b. the date of commencement of risk or
c. the date of reinstatement of Policy or
d. the date of rider to the Policy whichever is later.

02. On the ground of fraud, a Policy of Life Insurance may be called in question within
3 years from:
a. the date of issuance of Policy or
b. the date of commencement of risk or
c. the date of reinstatement of Policy or
d. the date of rider to the Policy whichever is later.

For this, the insurer should communicate in writing to the insured or legal
representative or nominee or assignees of insured, as applicable, mentioning the
ground and materials on which such decision is based.

03. Fraud means any of the following acts committed by insured or by his agent, with
the intent to deceive the insurer or to induce the insurer to issue a life
insurance Policy:
a. The suggestion, as a fact of that which is not true and which the insured does not
believe to be true;
b. The active concealment of a fact by the insured having knowledge or belief of the fact;
c. Any other act fitted to deceive; and
d. Any such act or omission as the law specifically declares to be fraudulent.

04. Mere silence is not fraud unless, depending on circumstances of the case, it is
the duty of the insured or his agent keeping silence to speak or silence is in
itself equivalent to speak.

05. No Insurer shall repudiate a life insurance Policy on the ground of Fraud, if the
Insured/beneficiary can prove that the misstatement was true to the best of
his knowledge and there was no deliberate intention to suppress the fact or
that such mis-statement of or suppression of material fact are within the
knowledge of the insurer. Onus of disproving is upon the Policyholder, if alive,
or beneficiaries.
06. Life insurance Policy can be called in question within 3 years on the ground that
any statement of or suppression of a fact material to expectancy of life of the
insured was incorrectly made in the proposal or other document basis which Policy
was issued or revived or rider issued. For this, the insurer should communicate in
writing to the insured or legal representative or nominee or assignees of insured
as applicable, mentioning the ground and materials on which decision to repudiate
the Policy of life insurance is based.

07. In case repudiation is on ground of mis-statement and not on fraud, the premium
collected on Policy till the date of repudiation shall be paid to the insured or legal
representative or nominee or assignees of insured, within a period of 90 days from
the date of repudiation.

08. Fact shall not be considered material unless it has a direct bearing on the risk
undertaken by the insurer. The onus is on insurer to show that if the insurer had
been aware of the said fact, no life insurance Policy would have been issued to the
insured.

09. The insurer can call for proof of age at any time if he is entitled to do so and no
Policy shall be deemed to be called in question merely because the terms of the
Policy are adjusted on subsequent proof of age of life insured. So, this Section will
not be applicable for questioning age or adjustment based on proof of age submit-
ted subsequently.
[Disclaimer: This is not a comprehensive list of amendments of Insurance Laws
(Amendment) Ordinance, 2014 and only a simplified version prepared for general
information. Policyholders are advised to refer to Original Ordinance Gazette
Notification dated December 26, 2014 for complete and accurate details. ]
 Your Bharti AXA Life Advisor

For any further queries or feedback, please contact your Financial

Advisor or get in touch with us on:

24/7 Toll-free:

1800 102 4444

SURAKSHA 56677
SMS to
We will get in touch within 24 hours to address your query.

For locating a branch near you, please visit

www.bharti-axalife.com
BEWARE OF SPURIOUS/FRAUD PHONE CALLS!
IRDAI is not involved in activities like selling insurance policies,
announcing bonus or investment of premiums. Public receiving such phone
calls are requested to lodge a police complaint.

Trade Logos and used in the document belongs to the

Bharti Enterprises (Holdings) Private Ltd. and AXA SA respectively and are used by Bharti AXA Life under license.

The product brochure is indicative of the terms, conditions, warranties and exceptions contained in the
Insurance policy .
Riders are not mandatory and are available at an additional cost.
Bharti AXA Life Insurance Company is the name of the insurance company and Bharti AXA Life Hospi Cash
Benefit Rider is only the name of the rider. The name of the rider does not in any way indicate the quality
of the product and its future prospects.
Bharti AXA Life Insurance Company Ltd.
Regd. Office address: Bharti AXA Life Insurance Company Ltd. [IRDAI Regd. No. 130] Unit No. 1904,
19th Floor, Parinee Crescenzo, 'G' Block, Bandra Kurla Complex, BKC Road, Behind MCA Ground,
Bandra East, Mumbai - 400051, Maharashtra. UIN: 130B007V04
CIN: U66010MH2005PLC157108, Advt No.: II-May-2020-2184