Features  

• Covers Hospital Cash, Health Guard, Critical Illness, Personal accident, Education Grant, Householders contents, Traveling Baggage & Public liability.
• Family floater can be opted by paying 50% & 25% of self premium for spouse & children respectively.
• Add-on covers can be opted under Health Guard.
• 12 Dreaded diseases are covered under Critical illness.
• The policy can be taken for maximum 3 years to avoid yearly renewal.
• 10-15% section discount can be availed if 4 or more sections are opted.
• 10-15% Long term discount can be availed if the policy is taken for 2 or more years.

What are the benefits of this policy?  

• Wide coverage from Health to Home.
• Access to over 2400 hospitals all overIndiafor cashless facility.
• No sub-limits applicable on room rent and other expenses.
• Hassle-free claim settlement due to In-house claim administration.
• Income tax benefit on the premium paid as per section 80-D of Income Tax Act* as per existing IT law.

Coverage  

• Age – 3 Months – 55 years.
• Wide range of Sum Insured is available under different cover.

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Features

• A single family floater policy to cover hospitalization expenses & personal accident benefit.
• Hassle free policy, Health & PA cover for Healthy individuals without any history of pre-existing diseases.
• The cover starts once the KIT is activated by generating the authentication number.
• Entry age restricted upto 45 yrs and no medical underwriting (Subject to clean proposal)
• Policy can be renewed till proposer attains an age of 70 yrs.
• Access to over 2400 hospitals for cashless facility.

Benefits

• Complete protection to the family for hospitalization expenses.
• All the family members can be covered under a single SI for a single premium (Floater Cover).
• Death cover for the proposer.
• Hassle free policy issuance without medical tests.
• Income tax benefit on the premium paid as per section 80D.
• Covers emergency ambulance charges.

Coverage

• 1 lac family floater cover towards hospitalization expenses & 1 lac death cover for the proposer
• The policy covers ambulance charges in case of emergency subject to a maximum of Rs 1000
• Care procedure for 130 days, subject to terms and conditions
• Pre-existing diseases covered after 4 years’ continuous renewals with us
• A flat benefit of 2% of admissible hospitalization expenses towards pre and post hospitalization medical expenses

Eligibility

• Age of proposer 18 years to 45 years
• Age of entry 3 months to 45 years
• Policy renewed continuously upto age 70 years
• No pre existing ailment

Premium

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Features

• Pre-existing diseases covered upto 50% from the second year of the policy
• A flat benefit of 3% on admissible hospitalization expenses are paid towards pre & post hospitalization expenses
• Cashless facility: With Silver Health plan, the member has access to cashless facility at wide network of 2400 hospitals acrossIndia(subject to exclusions and conditions)
• Incase of admission in non-network hospitals, the expenses incurred would be reimbursed within 14 days from the submission of all documents
• 20% of co-payment of the admissible claim to be paid by the member if treatment is taken in a hospital other than a network hospital
• Waiver of co-payment is available on payment of additional premium

Advantages

• Cumulative bonus of 5 % added to your sum assured for every claim free year
• Health Check up at the end of continuous four claim-free years
• Family discount of 5 % is applicable
• Income tax benefit on the premium paid as per section 80-D of the Income Tax Act as per existing IT law

Coverage

• Policy can be taken form 46-70yrs *
• Renewal up to 75 yrs*
• SI can be opted from 50,000 – 5, 00,000.

Silver Health: Annual Premium Rate

* Premium excludes Service Tax

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Coverage

1. Whom all does the policy cover?   Hospital Cash offers complete health protection for you, your spouse as well as children.

2. How can the Hospital Cash Policy work best for me?   It is recommended that the Hospital Cash Policy be taken as an add on policy along with our Health Guard / Critical illness policies so as to be assured of peace of mind.

3. What are the exclusions under the policy?   Hospitalization with in 30 days from the commencement of the policy, pre-existing diseases, dental treatment or surgery, treatment related to pregnancy, childbirth, natural perils like avalanche, earthquake, volcanic eruptions etc., accidents resulting from drunken driving are some exclusions.

Premium Table

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Features  

• OPD & Hospitalisation expenses covered under a single policy on floater basis
• Access to over 2400 hospitals all overIndiafor cashless facility.
• Covers ambulance charges in case of an emergency up to Rs 1000/-
• 130 day care procedures subject to terms & conditions
• 10% co-payment of the admissible claim amount applicable if treatment is taken in non-network hospital, waiver of co-payment is available on payment of additional premium.
• Provides benefit of Health check-up at the end of each four (Hospitalization) claim free policy periods. Tests as specified in the schedule. This benefit can be opted by any one insured member

Benefits  

• A single policy or cover can be continued till a person reaches 75 yrs!
• The premium slabs remain same from 18 yrs -55 yrs & 56- 75 yrs
• No restrictions of waiting periods to claim under Out patient expenses
• You can claim for dental procedures & treatment under OPD section!
• Cost of Spectacles, dentures, crutches can also be claimed under OPD Section!
• Provides Tax benefit under section 80 D of Income Tax Act
• In house claims settlement without hassles of going through a TPA.

*Flat Premium (Rs) inclusive of Service Tax
All Sums Insured for Hospitalisation and OPD benefit in Indian Rupees.

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What are the benefits of this policy?  

• Highest compensation of 125% of the sum insured incase of permanent total disability.
• Medical Expenses arising out of accident.
• Children’s education bonus / in case of death or permanent total disability.
• Cumulative bonus @5% per claim free year to a maximum of 50% (reduced by 10% if claim is lodged).
• Family discount of 10%.

In case of permanent partial disablement, we will pay the percentage, of sum assured as applicable given in the table below:-

Premium Rate:

The premium differs in case of different risk levels determined by your occupation.  

Risk Level I: Administrative / managing functions, accountants, doctors, lawyers, architects, teachers and similar occupations.  .

Risk Level II:   Manual labour, garage mechanic, machine operator paid driver (car / truck / heavy vehicles) cash carrying employee, builder, contractor, veterinary doctor and similar occupations.    

Risk Level III:   Workers in underground mines, electric installations with high tension supply, jockey, circus performers, big game hunters, mountaineers, professional river rafters and similar occupations.
(For occupations not specified above, please enquire with us).      

Annual Premium Rate  

Who is eligible for this policy?  

1. How do I submit my claim?  

• If you meet with an accident and injure any part of your body that may result in a claim, you or someone claiming on your behalf must inform us in writing immediately and in any event within 14 days.
• Incase of death due to accident, the same must be informed to us in writing immediately and a copy of the post mortem report should be sent to us within 14 days.

      2. What are the steps to be taken?  

• You must immediately consult a Doctor and follow the advice and treatment that he recommends.
• You must get yourself examined by our medical advisors if we ask for this, and as often as we consider this to be necessary.
• You or someone claiming on your behalf must promptly provide us the documentation and other information we ask for in order to investigate the claim or to carry out our obligation to make payment for it.

      3. How soon can I get my compensation? What is the mode of payment?  

• Bajaj Allianz believes in quick processing. Claims are processed within seven working days from the date of fulfilling all the requirements.
• You must get yourself examined by our medical advisors if we ask for this, and as often as we consider this to be necessary.

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Advantages of Critical Illness Health Insurance Plan   The Critical Illness health insurance plan has the following advantages:-

• The benefit amount is payable once the disease is diagnosed meeting specific criteria and the insured survives 30 days after the diagnosis.
• The insured receives the amount as lumpsum so that he can plan the treatment accordingly.
• Expenses like donor expenses in a transplant surgery, which are not covered under normal health insurance policy, can be paid out of the amount received under this cover both inIndia& abroad.

Key Features

• The product is offered from 6 to 59 years.
• Medical examination may be required in some cases based on the age and the benefit amount opted by the proposer.
• Very competitive premium rates.
• Insured can opt for Sum Assured from 1,00,000 to Rs. 50,00,000.

Illness Covered   1) Cancer:-   A claim can be made if the assured is diagnosed as suffering from a malignant tumour, which has invaded surrounding tissue. A microscopic examination of the cells will be required to confirm the claim.

2) Coronary Artery Bypass Surgery:-   When coronary arteries become narrowed or blocked they cannot supply enough blood to the heart muscle. To correct this and prevent risk of death, a coronary artery bypass surgery is performed in which two sections of artery on either side of the blockage are connected together. With our health insurance plan – Critical Illness, you can insure yourself against this serious illness in much the same
way as you insure your car and your house. You will be able to claim if you undergo this surgery for blockage of 2 or more coronary arteries.

3) First Heart Attack:- (Myocardial Infarction)   First heart attack, also known as myocardial infarction, occurs when part of the heart muscle dies from lack of oxygenated blood. Chest pain is usually felt at the time of the attack, ECG (electrocardiogram) changes will confirm the diagnosis. A damaged heart also releases enzymes into the bloodstream and a blood test will show that the heart attack is recent.

4) Kidney Failure:-   The kidneys act as filters and remove waste from the blood. When the kidneys fail to do this, waste builds up in the blood and leads to severe complications. Although it is possible to manage with one kidney; if both kidneys fail completely, one will need long-term dialysis or a transplant.

5) Major Organ Transplant:-   Sometimes a major internal organ is so seriously diseased or damaged that the only effective treatment is replacement with a healthy one. Kidney transplants are covered under a separate section.

6) Multiple Sclerosis:-   This is a progressive disease of the central nervous system where the protective covering (myelin) of the nerve fibers in the brain and spinal cord is destroyed. The severity of the disease and symptoms will depend on the areas of the brain or spinal cord affected. Periods of remission which may last many years between acute phases are characteristic of the disease.

7) Stroke:-   A stroke is an incident, which affects the supply of blood to the brain causing permanent neurological damage such as paralysis or disturbance of speech or vision. Transient ischaemic attacks are excluded as they do not cause permanent damage and the symptoms do not last for more than few days.

Aorta Graft Surgery:-   The aorta is the main artery that supplies oxygenated blood to all other parts of the body. Sometimes, part of the aorta becomes blocked or weak and may need replacement. You will be able to claim if you need surgery to remove and replace part or the entire aorta.

9) Paralysis:-   Paralysis is usually caused by damage to the brain or spinal cord, affecting the transmission of messages through the nervous system or by physical injury to the limbs in question.

10) Primary Pulmonary Arterial Hypertension:-   Primary pulmonary hypertension a progressive disorder recommended or which was first manifested or contracted before characterized by high blood pressure (hypertension) of the main artery of the lungs (pulmonary artery). The pulmonary artery is the blood vessel that carries blood from the heart through the lungs.

Symptoms of primary pulmonary hypertension include shortness of breath (dyspnoea) especially during exercise, chest pain, and fainting episodes. The exact cause of primary pulmonary hypertension is unknown

Exclusions

• Any critical illness for which care, treatment, or advice was recommended or which was first manifested or contracted before
• Any critical illness diagnosed within the first 90 days
• Death with in 30 days following the diagnosis of the critical illness
• Presence of HIV/AIDS infection
• Treatment arising from or traceable to pregnancy or childbirth, including caesarean section and birth defects
• War, invasion, act of foreign enemy, terrorism, hostilities (whether war be declared or not), civil war, rebellion, revolution
• Naval or military operations of the armed forces or air force and participation in operations requiring the use of arms or which are ordered by military authorities for combating terrorists, rebels and the like, any natural peril
• Consequential losses of any kind, be they by way of loss of profit, loss of opportunity, loss of gain, business interruption etc.
  The details furnished above do not constitute the entire terms and conditions.

Coverage

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Features

• Pre-existing diseases covered after 2 yrs continuous renewals with us.
• A flat benefit of 2% of admissible hospitalization expenses are paid towards pre & post hospitalization expenses.
• Access to 2400 hospitals for Cashless facility
• In case of admission in non network hospitals the expenses incurred would be reimbursed within 14 days from the date of submission of all documents

Advantages

• No tests required up to the age of 55 yrs
• Health Check up at the end of continuous four claim free year
• 130 day care procedures covered
• In case of emergency ambulance charges covered subject to a maximum of Rs. 1000 /- per policy period.
• Hassle free claim settlement due to in house claims administration team
• Family discount of 5 % is applicable
• Income tax benefit on the premium paid as per section 80-D of the income Tax Act.

Coverage

• Policy can be taken from 3 months to 55 yrs 
• Renewal up to 75 yrs
• SI – 50,000, 75000, and 1 lac.

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Features

• This is a floater policy; thus there will be a single sum insured and single premium for the whole family.
• Competitive premium rates.
• High deductible health insurance product.
• No medical tests up to 55 years of age, subject to a clean proposal form.
• Pre-existing diseases will be covered after 4 years.
• Continuity for waiting periods would be given for any indemnity cover irrespective of sum insured in the earlier policy.
• The policy covers ambulance charges in case of emergency subject to a maximum of Rs.3000/-.

Benefits

• Can be taken as an add-on policy with any health insurance policy.
• Income tax benefit on the premium paid as per section 80-D of Income Tax Act as per existing IT law.
• Premium starting at Rs.2500 p.a with sum insured options of Rs.10, 12 or 15 lakhs.

Coverage

• · Medical Expenses: Covered up to the sum insured.
• · Ambulance Charges: Up to Rs.3000/-.
• · Pre and Post Hospitalisation: Up to 60 and 90 days respectively.
• · Waiver for Pre-existing Diseases: After 4 years of continuous policy.
• · Floater Policy (up to 3 children): Single sum insured for the whole family.
• · Continuity: Continuity for waiting periods will be given for any policy at any sum insured.
• · Pre-acceptance Medical Test: No test till 55 years of age for clean proposals.
• · Entry Age 3 months-70 years: Renewable up to 80 years.
• · Affordable Premium: Starting at Rs.2500/-.

Exclusions:

• Pre-existing diseases/injuries.
• Disease contracted during first 30 days of policy.
• Joint replacement surgery (except due to accidents) shall have a 4-year waiting period.
• War, invasion, acts of foreign enemies.
• Circumcision, cosmetic or aesthetic treatment.
• Any form of plastic surgery.
• The cost of spectacles, contact lenses, hearing aids, crutches, artificial limbs, dentures, artificial teeth and all other external appliances.
• Dental treatment.
• Convalescence, general debility or weakness.

*conditions apply

Plan Details

For example, if you have Rs.3 lakhs health insurance cover from your employer and your hospitalisation bill is Rs.10 lakhs for a single hospitalisation, then you would use the insurance policy from your employer to pay the first Rs.3 lakhs of the expenses and then pay the remaining Rs.7 lakhs using the Extra Care policy. The expense paid by your existing insurance policy or by you is called the Deductible Amount. Extra Care specifies a Deductible Amount for each sum insured option. The 3 sum insured and the corresponding deductible amounts are listed here:

Voluntary Deductibles:

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Features –

• The member has cashless facility at over 2900 hospitals acrossIndia
• With Health Guard, the member has access to cashless facility at various empanelled hospitals acrossIndia.
• Pre and post – hospitalization expenses covers relevant medical expenses incurred 60 days prior to and 90 days after hospitalization
• Covers ambulance charges in an emergency subject to limit of Rs. 1000 /-
• No tests required up to 45 years up to SI 10 lacs*
• 10% co- payment applicable if treatment taken in non-network hospitals
• 20% co-payment applicable for members of age group 56 -65 years, opting this policy for first time
• Waiver on 10% co-payment is available on payment of additional premium
• Pre-existing diseases covered after 4 years continuous renewal with Bajaj Allianz

Benefits –

• In house Health Administration Team for hospitalisation claims to lower turn around time.
• Access to over 2900 hospitals all overIndiafor cashless facility.
• No Sub-limits applicable on room rent and other expenses.
• Hassle-free claim settlement due to In-house claim administration.
• Income tax benefit on the premium paid as per section 80-D of Income Tax Act as per existing IT law.
• Health Check up for maximum amount of Rs. 1000 /- at the end of continuous four claim free years.
• Family discount of 10% is applicable.

Coverage –

• Sum insured from Rs. 1lakh to Rs.10 lakhs can be opted from 3 months to 55 yrs.
• Sum insured from Rs. 1lakh to Rs.5 lakhs can be opted from 56 months to 65 yrs Policy can be renewed up to 80 years*
• In built E-opinion cover for SI 5 lacs & above.

Pre and Post Hospital Expenses:

• Medicines: Mandatory to provide doctor’s prescription advising medicines and the relevant chemist bill.
• Doctor’s Consultation Charges: Mandatory to provide the doctor’s prescription and the doctor’s bill and receipt.
• Diagnostic Tests: Mandatory to provide the Doctor’s prescription advising tests, the actual test reports and the bill and receipt from the diagnostic centre.
• The claims team would assess the claim for completeness of documentation and admissibility. A written communication would be sent to the insured regarding requirement of documents if any or if the claim is deemed to be inadmissible as per the policy’s terms and conditions.
• In case the claim is determined to be admissible a pay order and discharge voucher would be sent to the insured address as mentioned on the policy document.

Exclusions:

• A waiting period of 4 years will be applicable in the case of pre-existing diseases.
• Any disease contracted during the first 30 days of commencement of the policy will be excluded from coverage.
• Certain diseases such as hernia, piles, cataract (liability restricted upto 10% of SI, max. upto Rs. 35,000) and sinusitis shall be covered after a waiting period of 2 years.
• Treatments consisting of non-allopathic medicine will not be covered.
• Congenital diseases are also excluded from coverage, as are all expenses arising from AIDS and other related diseases.
• Cosmetic, aesthetic or related treatments will not be covered.
• Treatment will not be covered for use of intoxicating and/or addictive substances like alcohol, drugs, etc.
• Joint replacement surgery (other than due to accidents) shall have a waiting period of 4 years before it is covered.

*conditions apply

Plan Details –

Eligible Age:

• Entry age for proposer is 18-65 years. The policy can be renewed upto 80 years.*
• Children from 3 months to 25 years are eligible if both the parents are insured with Bajaj Allianz.

*conditions apply

Restrictions on the Value of the Sum Insured:

• Sum insured from Rs.2 lakh to Rs.10 lakh can be opted from 3 months to 55 years.
• Sum insured from Rs.2 lakh to RS.5 lakh can be opted from 56 years to 65 years.
• No tests are required for a sum insured of upto Rs.10 lakh till the age of 45 yrs (subject to a clean proposal form).

Pre-policy Check-ups:

• No medical tests are required upto the age of 45 years, subject to a clean proposal form.
• Medical tests (pre-policy check-ups) are mandatory for members aged 46 years and above.
• The pre-policy check-up is arranged at one of our empanelled diagnostic centres.
• The cost of the pre-policy check-up is refunded in full, if the proposal is accepted and the policy is issued.

Voluntary Deductibles:

This policy has an option of voluntary deductibles where discounts are applied, as given below:

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