Bajaj Allianz Health Guard

Bajaj Allianz Health Guard:

With the sky-rocketing medical expenses, one should be covered with a health insurance policy. Having health insurance helps you get cashless medical treatment or reimburse your medical expenses up to the covered amount. It makes sure that proper medical care is available to a person without exhausting their savings and affecting their financial condition.

Hence, it becomes imperative to have a health cover in today’s time. Under this plan, each family member can avail an individual sum insured. The individual health insurance plan covers the expenses incurred due to hospitalization, doctor’s consultation, ambulance services, treatment charges, and pre and post-hospitalization expenses. One of the key aspects of Bajaj Allianz health insurance is the extensive network of more than 6000+ network hospitals where policyholders can avail cashless treatment. Bajaj Allianz Health Guard does not require the pre-medical test up to the age of 45. Policyholders can also avail free health check-ups after 3 claim free years.

 Individual Health Insurance Policy Covers:

• 1.Sum insured options ranging from Rs. 1.5 lacs up to Rs. 50 lacs
• 2. The policy covers pre and posts hospitalization expenses, which would have occurred 60 days prior to hospitalization or 90 days after hospitalization.
• 3. Access to the cashless facility at over 6000+ empanelled hospitals across India(subject to exclusions and conditions)
• 4. Extended family coverage: Now you can cover your parents, parents in law, grandparents, grandchildren, as well as dependent siblings
• 5. Covers ambulance charges subject to a limit of Rs. 20000 in a policy year
• 6. Sum insured reinstatement (For similar illness as well)
• 7. Covers expenses for all day care treatments
• 8. Policy term option of 1, 2 and 3 years
• 9. Lifelong renewal option

Zone wise Premium

Zone A	Zone B
Delhi / NCR, Mumbai including (Navi Mumbai, Thane, and Kalyan), Hyderabad and Secunderabad, Bangalore, Kolkata, Ahmedabad, Vadodara, and Surat	Rest of India apart from Zone A cities are classified as Zone B.
Health insurance policyholders paying Zone A premium rates can avail treatment all over India without any co-payment	Policyholders paying zone B premium rates and availing treatment in Zone A city will have to pay 20% copayment on admissible claim amount. This co-payment will not be applicable for accidental hospitalization. Those residing in Zone B can choose to pay the premium for Zone A and avail treatment all over India without any co-payment

Individual Health Insurance Plans - Features and Benefits:

1. 1.Family discount of 10% up to 2 members, 15% for 3 members
2. 2.Long-term policy discount of 4% for 2 yrs, 8% for 3 yrs
3. 3.Discount of up to 20% for co-payment option
4. 4. Organ donor expenses covered up to the sum insured
5. 5.10% cumulative bonus benefit for each claim free year up to 100%
6. 6.Tax saving up to Rs. 100,000 under Sec 80D*
7. 7. No medical tests up to 45 years, subject to the clean proposal form
8. 8. Bariatric surgery cover
9. 9. Convalescence benefits up to Rs. 7500 per year
10. 10. Ayurvedic and Homeopathic hospitalization cover
11. 11. Free preventive health checkup every 3 years, irrespective of a claim
12. 12. Maternity and newborn baby expenses cover
13. 13. Daily Cash Benefit for Accompanying an Insured Child (Rs. 500 per day                    maximum up to 10 days, up to age 12yrs)
14. 14. Health CDC benefit – quick claim settlement through the app**.

* On the health insurance premium paid for self, spouse, children, and parents, the deduction can be availed up to Rs 25,000 per annum, provided the age of the individual is not above 60. If the premium paid by an individual is towards health insurance policy for his or her parent who is a senior citizen of age 60 or more, the maximum is capped at Rs 50,000. A taxpayer may, therefore, maximize tax benefit under section 80D to a total of Rs 75,000 if his age is below 60 If parents age is above 60. For those taxpayer individuals who are of age 60 or more and are also paying health insurance premium for their parents, the maximum tax benefit under section 80D would, therefore, be a total of Rs 100,000.

**Health CDC (Claim by Direct Click) is a feature in the Bajaj Allianz Insurance Wallet App which enables you to raise claim requests up to Rs. 20000/- through the app. This is the easiest way to make claim requests as you upload all the required documents on the app and get regular updates of your claim status. The entire process is paper-less, hence it helps you save both time and money.

Exclusions:

• Certain diseases/medical conditions are not covered under the policy.
• Any pre-existing disease or illness until the completion of 36 months of the policy term.
• Certain medical conditions such as hemorrhoids, cataract, fistula, endometriosis, etc. until the completion of 24 months of the policy term.
• Certain surgeries like joint replacement, correction of the deviated nasal septum, and congenital internal diseases/anomalies until completion of 36 months of the policy term, are not covered.
• Any medical expenses incurred in the first 30 days of the policy unless caused by an accident.
• Any treatment traceable to pregnancy, childbirth, etc. A waiting period of 72 months is specified for the Gold Plan.
• Any dental treatment unless necessitated by an acute injury requiring hospitalization.
• Medical expenses for which hospitalization is not required.
• Any injury caused by war, invasion, or terrorism.
• Circumcision unless necessitated by an accidental injury.
• Any cosmetic or aesthetic surgery.
• Any plastic surgery unless the injury that required treatment was caused by an accident.
• Cost of spectacles, contact lenses, artificial limbs, and other appliances or devices.
• External medical equipment used for treatment post-hospitalization.
• Convalescence, rest cure and general debility.
• Congenital external diseases or anomalies.
• Genetic disorders, growth hormone therapy or stem cell implantation.
• Intentional self-injury.
• Illness caused by substance abuse.
• Treatment of AIDS and conditions directly or indirectly caused by HIV.
• Diagnostic or laboratory examinations.
• Vaccination or inoculation.
• Any fertility-related procedure.
• Vitamins, tonics or supplements unless required for the treatment.
• Non-standard, unproven, or experimental treatment.
• Treatment of psychiatric conditions.

• Others Features of Health Guard Individual Policy:

The Health Guard Individual Policy offered by Bajaj Allianz is a comprehensive health insurance plan that offers a wide range of options and benefits that the policyholder can choose from as per his/her convenience.

• The plan is available in two variants- Silver Plan and Gold Plan.
• The sum insured options available for the Silver Plan is Rs.1.5 lakh and Rs.2 lakh.
• The sum insured options for the Gold Plan ranges from Rs.3 lakh to Rs.50 lakh.
• Individual and family floater options are available.
• The policy period options offered are 1 year, 2 years, and 3 years.
• The premium for the one-year policy is paid annually. The long-term policy comes with a one-time premium payment feature. The premium is paid at the time of inception of the policy and at the time of renewal.
• No pre-policy check-up is required for individuals up to the age of 45 years unless the individual suffers from any adverse medical condition.
• A waiting period of 36 months is specified for coverage of pre-existing diseases/illnesses.
• A waiting period of 72 months is specified to avail benefits for maternity expenses.
• A waiting period of 36 months is specified for coverage of bariatric surgery.
• The sum insured can be enhanced at the time of renewal.
• A 15-day free-look period is provided to review the policy. A refund of the premiums paid will be made in case the policy is returned during the free-look period.
• Policy portability is available.
• Terms of the policy can be revised/modified with approval from IRDAI.
• This policy can be ported. The premium applicable will be of the new product opted for.
• Discounts are offered to policyholders who include family members in the policy, voluntarily opt for co-pay, or opt for long-term policies.
• Policyholders can avail tax benefits for the premiums paid under Section 80D of the Income Tax Act, 1961.

Benefits of Health Guard Individual Policy:

The Silver Plan and the Gold Plan have varying benefits. Prospective policyholders can choose the plan that best suits their requirements.

Benefits	Silver Plan	Gold Plan
Room, boarding and nursing expenses	1% of sum insured per day	No sub-limit
Intensive care unit charges	Up to actual expenses
Ambulance charges	Maximum Rs.20,000
Pre-hospitalisation expenses	Expenses up to 60 days before admission to a hospital will be covered
Post-hospitalization expenses	Expenses up to 90 days after discharge from the hospital will be covered
Cumulative Bonus	If there is no claim in a policy year, 10% of the base sum insured is provided per annum
Cataract Eye	20% of sum insured per eye
Daycare procedures	Daycare procedures and surgeries are covered
Daily cash benefit for accompanying an insured child	Rs.500 per day for a maximum of 10 days will be provided to one parent/legal guardian for accommodation expenses to stay with an insured child under the age of 12
Organ donor expenses	Organ donor’s treatment is covered
Sum insured reinstatement benefit	If the sum insured and the cumulative bonus, if any, is exhausted during a policy year, 100% of the sum insured will be reinstated for the policy year
Convalescence bonus	If the hospitalization period exceeds 10 consecutive days, Rs.5,000 will be provided	If the hospitalization period exceeds 10 consecutive days, Rs.5,000 for Rs.5 lakh sum insured and Rs.7,500 for Rs.7.5 lakh and above sum insured will be provided
Preventive Health check-up expenses	At the end of a continuous period of 3 years, an amount equal to 1% of the sum insured not exceeding Rs.2,000 will be reimbursed for preventive health check-ups	At the end of a continuous period of 3 years, an amount equal to 1% of the sum insured not exceeding Rs.5,000 will be reimbursed for preventive health check-ups
Ayurvedic/Homoeopathic hospitalization expenses	Nil	Room rent, boarding expenses, nursing expenses, consultation fees, medicine and drug expenses, ayurvedic and homeopathic procedures are covered up to a maximum Rs.20,000
Maternity expenses	Nil	Expenses incurred for delivery of a baby (cesarean section included) is covered
Newborn baby cover	Nil	Expenses with respect to the newborn baby i.e. treatment while the mother is hospitalized, complications up to 90 days from the date of birth, mandatory vaccinations up to 90 days from the date of birth are covered
Bariatric surgery	Nil	Expenses related to Bariatric surgery is covered up to 50% of the sum insured not exceeding Rs.5 lakh

Eligibility for Health Guard Individual Policy:

Prospective policyholders are expected to meet certain eligibility criteria specified by the insurer.

• The entry age for the proposer, spouse, parents, and other family members is 18 years to 65 years.
• The entry age for dependent children or grandchildren is 3 months to 30 years.
• The plan comes with a lifetime renewability option.

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