Bajaj Allianz Individual Health Guard

Product Description:

Bajaj Allianz offers its Health Insurance plan ‘Health Guard’ to Indian market under two forms – Individual & Family floater Health insurance. People between the age group of 3 months and 65 yrs can enter into this plan (subject to acceptance of risk by the Insurer) while the maximum renewal age is upto 80 yrs. For children the age band is 3 months to 5 yrs, provided both parents are insured under the policy. The Insured has the option of picking the total Sum Assured from many options ranging from 1.5 lacs to 10 lacs (max SA available for people > 56 yrs is 5 lacs with a co-pay of 20% for first timers). No medical test is required for people upto 45 yrs, subject to clean proposal form. For those above 45 yrs, the Insurer requires a mandatory health check up, the cost of which is reimbursed by Bajaj Allianz if the policy is issued. The Insured is required to serve a waiting period of 4 yrs for any pre-existing diseases while some specific diseases have time bound exclusions of 2 yrs under Health Guard (please refer to the Product brochure for complete details). There is also a provision of 5% bonus on SA for every claim free year, extendable to a max cumulative bonus of 50%.

Know more about your Insurance

Key features: Availability, Benefits and Exclusions

Minimum Age at Entry : 90 days
Maximum Age at Entry : 65 years
Maximum Age at Renewal : 80 years
Minimum Sum Assured : Rs 1.5 lacs
Maximum Sum Assured : Rs 10 lacs
No claim Bonus – Annual : 5%
No claim Bonus – cumulative : max of 50%
Maternity Benefits : N/A
Pre-Existing Disease cover : after 4 years
Waiting Period : 30 Days

Product pricing (Incl. S/Tax)   (Rs)
Age SA 1.5 lacs SA 2 lacs SA 3 lacs SA 4 lacs SA 5 lacs SA 7.5 lacs SA 10 lacs
90d - 25 yrs 1882 2338 3306 4332 5244 6688 8160
26 – 40 yrs 2532 3283 4430 5130 6156 8945 10913
41 – 45 yrs 3272 4309 6065 7820 9576 11683 14252
46 – 55 yrs 5028 6703 8380 12499 15236 18588 23708
56 – 60 yrs 7696 10260 12826 14999 17879 NA NA
61 – 65 yrs 8849 11800 14749 17249 20561 NA NA

Claim procedure

  1. Intimation & Assistance - Immediately intimate (with in 24 hrs) Bajaj Allianz about your illness and/or hospitalization at their helpline no 1800 233 3355 or through e-mail quoting your customer ID. For planned hospitalization, it is advisable to intimate the Insurer 7 days in advance of admission.

  2. Reimbursement of medical expenses – For treatment at ‘out of network hospitals’, please pay the hospital bill upfront and claim it later from the Insurer. Please note there is a co-pay of 10% for treatment at ‘non-network’ hospitals (co-pay waiver is available upon payment of extra premium). Intimate the Insurer about your claim situation no later than 7 days from the time of completion of such treatment. Follow this up with a duly filled claim form submission supported with required documents (originals and not photocopies) within 15 days. After cross-verification of documents, the Insurer will send a cheque in the name of the Proposer within 15 days of receipt of claims form.

  3. Availing the Cashless facility – The cashless facility can be availed at the network hospitals. In case of emergency hospitalization, intimate the Insurer no later than 24 hrs of admission to the hospital (network hospitals). For planned hospitalization though, kindly seek cashless authorization from the Insurer at least 48 hrs before admission. The Insurer will check your coverage and eligibility and send an authorization letter to the provider. In case of non-coverage of an ailment under the policy, a rejection letter will be sent to the provider soon after the receipt of your documents.

Some key statistics for Bajaj Allianz

Claims Pending Ratio : To be Announced soon
Complaints Resolved Ratio : To be Announced soon
Provider Network (cashless) : To be Announced soon

General Health Insurance Tips

Understand the cost of healthcare in your city/area before deciding the total cover (Sum Assured)

If your family includes a young bride, it is important to ensure the coverage of maternity benefits

Ask about the coverage of pre-existing diseases

Look at the waiting period

Satisfy yourself about the specific disease’s coverage under the Critical Illness cover

Inquire about the availability of cashless facility at the Network hospitals

Always compare before buying

Disclaimer: This is only an illustrative document to serve as a quick guide for aide in decision making.

Information Source: Bajaj Allianz website as on 28th Dec’2011
IRDAI annual report’2010