Magma HDI One Health

Let’s Get To Know The Plan Better

Magma HDI One Health is a health insurance plan from Magma HDI General Insurance Company Limited. This plan comes with a range of features, benefits, and add-ons that can be tailored to your specific needs. You get the flexibility to customise it according to what suits you best. The plan also offers various discounts, making it cost-effective. The plan has five variants: Support, Secure, Support Plus, Shield, and Premium.
 

Who is Eligible to Get The Magma HDI One Health Plan?

• For adults, the entry age is 18 years.
• For dependent children, the entry age is 5 years for an individual plan and 91 days for a floater plan.
   

Benefits and Limits Explained

The Magma HDI One Health Plan provides coverage for more than just inpatient hospitalisation expenses that includes costs for staying in a hospital for over 24 hours. This includes room and board expenses, nursing charges, medical practitioner fees, prescribed medicines, drugs, ICU charges, and all other related expenses. Let's take a quick look at some of the expenses covered by the plan –

• Pre & Post Hospitalisation Expenses
  If the doctor needs to conduct diagnostic tests before or after your hospital stay, the insurer has got you covered. The policy includes coverage for both pre and post-hospitalisation expenses, up to the sum insured. The duration of coverage depends on the plan variant you choose.

You should keep in mind that for the insurer to cover these expenses, they must be directly related to the medical condition/disease that led to your hospitalisation. Approval for these expenses is dependent upon them being part of the inpatient hospitalisation coverage.

• Daycare Treatment Coverage
  Daycare treatment involves medical procedures or surgeries that used to require an extended hospital stay but can now be completed within 24 hours, because of advancements in medical technology. The Magma HDI One Health Plan covers 541 daycare procedures across all its five variants. There is no limit on these treatments – this means that the insurance company will provide coverage for the expenses up to the sum insured.
   
• Domiciliary Treatment Coverage
  Domiciliary treatments are medical interventions for injuries or illnesses that need immediate attention in a hospital but are given at home due to the unavailability of hospital beds nearby or the patient's severe condition. The Magma HDI One Health Plan provides cover for domiciliary treatment costs up to the sum insured in all its five variants.
   
• Organ Donor Coverage
  The Magma HDI One Health Plan includes coverage for organ donor expenses when you are the recipient. It covers all inpatient costs related to organ transplantation. The expenses are covered up to the sum insured you choose under the policy. The coverage is applicable across all five variants.
   
• Modern Treatment Coverage
  Healthcare is evolving fast due to technological progress, bringing forth modern treatments that were once thought impossible. The Magma HDI One Health Plan is crafted to keep up with these changes and ensures coverage for the expenses linked to modern treatments. This coverage extends up to the sum insured you select under all five variants.
   
• Cumulative Bonus
  If you stay healthy and do not make any claims during a policy year, the insurer gives you a special reward. For each year without a claim, your sum insured will increase by a certain percentage, but only up to a set limit, depending on the variant you choose. Even if you do need to make a claim, the bonus you have earned will not decrease. Listed below is the available bonus percentage -

• Recharge Of Sum Insured
  This feature ensures that if your sum insured is used up during a policy year, it gets replenished. The restoration benefit kicks in when you have completely or partially used up your base sum insured and any cumulative bonus. You can then use this benefit for subsequent claims throughout the policy year, up to 5 times, but only for unrelated illnesses or complications. It is important to remember that this benefit is not available if you have chosen the Support variant under the plan.
   
• Room Rent Limit
  The maximum amount your insurer covers for the room you stay in during hospitalisation is called the room rent limit. If you opt for a room within this limit, you will not have to pay anything extra. But, if you choose a room with a higher rent, then there will be a proportionate deduction. This means that you will need to cover a share of the total bill and not just the extra room rent. The room rent limit under the Magma HDI One Health Plan varies based on the variant you choose. With Support Plus, Shield, or Premium variants, you have the freedom to choose any room you prefer, unlike the Support and Secure variants. Here are the room rent capping details –

Additional Product Features

Here are some of the important features of the product –

• Psychiatric Treatment Cover
• This feature acknowledges the importance of mental health and ensures that you can get treatment for various mental health disorders. Across all Magma HDI One Health variants, inpatient expenses related to mental health will be covered up to the sum insured. However, there is a sub-limit of Rs.50,000 for certain mental disorders or conditions. For such listed conditions, you might have to go through a waiting period of 36 months. You should  keep in mind that this coverage has some limitations.
   
• Bariatric Surgery Cover
  The Magma HDI One Health Plan (across all 5 variants) includes coverage for expenses related to bariatric surgery for weight loss, up to Rs.1 Lakh. This coverage is available for individuals aged 18 years or older and is subject to a waiting period of 36 months. Additional conditions related to coverage may also apply.
   
• Fitness Rewards and Wellness Services
  The Magma HDI One Health Plan (across all 5 variants) offers a fascinating feature where you can earn fitness points by getting medical checkups at the insurer’s network providers or participating in physical activities like marathons, professional sports events, gym or yoga memberships, etc. These earned fitness points can be redeemed as discounts, up to 10% of the premiums you have paid. Additionally, there are wellness services like specialists' e-opinions, nutritional e-counselling, etc. This  coverage, however, is subject to certain terms and conditions.
   

Waiting Period

After you buy a health insurance policy, there is a time when certain illnesses and diseases may not be covered. This is called the waiting period. Once this time is over, you can start making claims for these conditions. There are different types of waiting periods, like –

• Initial Waiting Period: There is an initial waiting period of 30 days for all medical conditions except accidents. This means that you cannot make a claim for hospitalisation during the first 30 days, except in the case of accidents.
   
• Waiting Period for Pre-existing Diseases: A pre-existing disease is any medical condition or illness you had in the 48 months before getting the health insurance policy. During this time, the policy will not cover expenses related to your pre-existing diseases. For the Magma HDI One Health Plan, here are the waiting periods for pre-existing conditions under different variants –

• Waiting Period for Specific Diseases: Insurers have a list of medical conditions or illnesses, aside from your pre-existing conditions that come with a waiting period. It does not matter if you have had those diseases before or not; the waiting period is set by the insurer and is not linked to your current health. In the Magma HDI One Health Plan,), the waiting period for specific diseases is 24 months under all 5 variants.
   

Exclusions

Exclusions refer to situations not covered by your health insurance policy. They include:

• Standard Permanent Exclusions: The IRDAI mandates 'standard permanent exclusions' that have to be followed by all insurance companies. Some of these are –
  • Investigation and Evaluation: Hospital admission solely for observation or monitoring.
  • Rest Cure, Rehabilitation, and Respite Care: Admission for bed rest without active treatment.
  • Obesity/Weight Control: Treatment or surgery for weight control or obesity.
  • Change of Gender Treatment: Altering the body's characteristics to the opposite sex.
  • Plastic/Cosmetic Surgery: Procedures to modify the body’s appearance or characteristics.
  • Profession in Hazardous or Adventure Sports: Treatment expenses while participating professionally in activities like rafting, mountaineering, scuba diving, horse racing, etc.
  • Breach of Law: Expenses related to treating a person attempting a breach of law with criminal intent.
  • Excluded Providers: Treatment from a practitioner or hospital excluded by the insurance company.
  • Narcotics: Treatment for addictive conditions like alcohol or drug addiction.
  • Treatments in Establishments for Domestic Purposes: Expenses for treatment in health spas, nursing homes, or similar places arranged for domestic reasons.
  • Dietary Supplements, Unprescribed Substances: Vitamins, minerals, etc., not prescribed by a medical practitioner.
  • Refractive Error: Costs for correcting refractive errors up to 7.5 diopters for improved eyesight.
  • Unproven Treatments: Surgeries, medical procedures, or treatments not proven effective.
  • Expenses related to Birth Control, Sterility, Infertility: Contraception, sterilisation, artificial insemination, advanced reproductive technologies like GIFT, ICSI, IVF, ZIFT, gestational surrogacy, etc.
  • Maternity Expenses: Pre/post-natal costs, childbirth-related hospitalisation expenses, etc.
     
• Additional Permanent Exclusions: Other than the standard permanent exclusions mentioned earlier, insurers may add more exclusions for specific situations or medical conditions. If you have certain diseases or severe medical conditions that insurers view too risky to cover, they might permanently exclude them from your policy. It is, however,  essential to note that insurers can only apply permanent exclusions for illnesses listed by the Insurance Regulatory and Development Authority of India (IRDAI).
   
• Non-Standard Exclusions (Specific Exclusions): These are specific exclusions that go beyond the standard permanent exclusions set by the IRDAI. These exclusions may vary among insurance companies and depend on the terms and conditions of the policy. Here are some notable specific exclusions under the Magma HDI One Health Plan –
  • Any alternative treatment except for the benefits under AYUSH Treatment.
  • Expenses for artificial life maintenance, including life support machines used to sustain a person in a vegetative state, confirmed by the treating doctor.
  • Circumcision unless necessary for treating an illness or disease or required due to an accident.
  • Treatment for any illness or injury resulting from nuclear or chemical contamination, war, riot, revolution, or acts of terrorism (excluding natural disasters).
  • Treatment for any external congenital anomaly.
  • Private nursing/attendant’s charges incurred during pre-hospitalization or post-hospitalization.
  • Issuance of fitness certificates and fitness examinations.
  • External and/or durable medical/non-medical equipment used for diagnosis and/or treatment, CPAP, CAPD, infusion pump.
  • Ambulatory devices, walkers, crutches, belts, collars, caps, splints, slings, braces, stockings of any kind, diabetic footwear, glucometer/thermometer, and any medical equipment subsequently used at home.
  • Treatment for any sexual problem, including impotence (regardless of the cause) or erectile dysfunction.
  • Treatment for sleep apnea, snoring, or any other sleep-related breathing problem.

Summary

Brochure and Policy Wording Links

• Brochure:https://www.magmahdi.com/documents/20127/0/OneHealth+Web+Brochure_0919.pdf/c34a605f-d4f0-ed72-5657-d39e0abb98ef

• Policy Wording: https://www.magmahdi.com/documents/20127/291040/Policy+Wordings+-+OneHealth.PDF

FAQs

1. How much coverage can I get under the Magma HDI One Health Plan?
   The maximum coverage you can choose depends on the plan variant –

2. Does Magma HDI One Health include AYUSH treatments?
   Yes, the Magma HDI One Health Plan covers AYUSH Treatment, with limits outlined in the policy document –

3. Does Magma HDI One Health provide restoration benefits?
   Yes, the Magma HDI One Health restores 100% of the sum insured if it gets partially or completely used up during a policy year. This can be utilised for unrelated illnesses (including complications), and you can avail of it up to a maximum of 5 times in a policy year. This is applicable to all plan variants except for the Support variant.
    
4. Are consumables covered in the Magma HDI One Health Plan?
   Unfortunately, no. The Magma HDI One Health Plan does not cover costs related to consumables like gloves, masks, syringes, etc., under any of its variants.
    
5. Does Magma HDI One Health Plan cover health check-up costs?
   Yes, the Magma HDI One Health Plan includes the expenses for an annual health check-up. The coverage, however, is subject to the terms and conditions of the insurer.