Bajaj Allianz Health Guard Policy

Bajaj Allianz's Health Guard is a holistic health insurance policy that covers the treatment expenses incurred during hospitalisation resulting from serious illness or accident. The policy offers comprehensive benefits at an affordable price that suits all your needs. It helps you stay financially prepared for any medical emergencies. There are two plans covered in this policy, the silver and gold plan.

Key Features And Benefits

Here are the key features and benefits under the policy:

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  In-patient hospitalisation expenses

  The policy covers in-patient hospitalisation expenses if you are hospitalised on the advice of a doctor, as defined under the policy. The need for hospitalisation is because of illness or accidental bodily injury sustained or contracted during the policy period.

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  Pre-hospitalisation expenses

  The insurance policy covers medical costs incurred due to an illness or injury from 60 days immediately before hospitalisation.

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  Post-hospitalisation expenses

  The policy covers the medical costs incurred due to an illness or injury for 90 days immediately after hospitalisation.

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  Daily cash benefit for accompanying an insured child

  Avail of daily cash benefit of Rs. 500 for up to 10 days as accommodation charges, under each policy year. The coverage is offered for in-patient hospitalisation treatment. It is applicable on policies with a term of more than one year.

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  Sum insured reinstatement benefit

  The policy offers 100% reinstatement on the sum insured if the in-patient hospitalisation treatment cover gets exhausted during the policy term.

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  Preventive health check-up

  The policy offers free health check-up after the completion of three policy years. The insurer will reimburse the amount equal to 1% of the sum insured of up to Rs. 2,000 for each member in the individual policy, during the block of three years. You may call the insurer on the toll-free numbers: 08698010101/1800-209-0144/1800-209-5858 for the arrangement of the health check-up.

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  Ayurvedic/homeopathic hospitalisation expenses

  The policy covers ayurvedic/homeopathic hospitalisation treatment expenses for more than 24-hour in-patient hospitalisation to a maximum of Rs. 20,000 per policy term.

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  Day care procedures

  Get coverage for medical expenses as listed in the policy brochure under in-patient hospitalisation treatment cover for day-care procedures/surgeries taken as an inpatient in a hospital or day care centre but not in the outpatient department.

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  Convalescence benefit

  The insured can avail of Rs. 5,000 per policy year in the event of hospitalisation for treatment of a disease/illness/injury. The coverage is given for hospitalisation of a continuous period that exceeds 10 days, provided the hospitalisation claim is accepted under inpatient.

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  Organ donor expenses

  The policy covers an organ donor's treatment up to the sum insured.

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  Emergency road ambulance cover

  The policy offers ambulance expenses up to Rs. 20,000 during the policy period.

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  Maternity and new-born baby cover

  Get coverage for maternity and medical expenses of a new-born baby.

• 

  Tax benefits

  Get income tax benefit as per section 80D of the Income Tax Act for the premium paid towards this policy.

Here are the details of the policy:

The plans are available starting from Rs. 2,973 and offers a maximum coverage of Rs. 50 lakh.

Here are the steps to purchase the policy:

• To apply for the policy, click on the 'Apply Now' button and fill in your basic and health details. The insurer’s representative will get in touch with you to provide further assistance.
• Ensure that the information given in the form is complete and accurate.
• Make the fee payment online using your preferred mode of payment
• Complete the process by clicking 'Buy Now', you can also request for a call back

• You may be required to undergo a pre-policy medical examination at the insurer’s network diagnostic centre.
• 100% of the cost of the pre-policy medical examination will be refunded if the policy is issued.
• Policy schedule, policy wordings, cashless cards and health guide will be sent to your mailing address.

Here how you can process a claim:

Cashless claims

Cashless treatment is only available at a network hospital registered with Bajaj Allianz. To avail of the cashless treatment, the following procedure must be followed:

• Approach the network hospital with your policy details.
• The hospital will verify the details provided by you and send a pre-authorisation form to the insurer.
• The insurer will verify the pre-authorisation request and convey the policy coverage and other details to the hospital.

Planned hospitalisation

• Insured member should intimate the insurer at least 72 hours before the planned admission to a hospital.
• In case of emergency hospitalisation, the insured or his/her representative should intimate the insurer within 24 hours of admission.
• The insurer will send you or the network hospital a pre-authorisation letter. The pre-authorisation letter, ID card issued to you along with this policy and any other information or documentation specified by the insurer must be produced to the network hospital identified in the pre-authorisation letter at the time of your admission.
• If the above procedure is followed, you will not be required to directly pay for the medical expenses above the aggregate deductible in the network hospital.
• Original bills and evidence of treatment in respect of the same shall be left with the network hospital, until the claim is settled.

Reimbursement claims

If pre-authorisation under cashless claim procedure mentioned above is denied by the insurer or if treatment at a non-network hospital or if you do not wish to avail of the cashless facility, then the following procedure must be followed:

• You or someone claiming on your behalf must inform the insurer in writing immediately within 48 hours of hospitalisation.
• Provide all the hospital documents to the insurer.
• In the event of insured person’s death, someone claiming on his/her behalf must inform the insurer in writing immediately and send a copy of the post-mortem report (if any) within 30 days.
• The insurer will not compensate for any period of hospitalisation which is less than 24 hours, except for daycare procedures.
• The insurer shall make the claim payment in Indian rupees only.

Here are the mandatory documents required to raise a claim:

• Claim form with NEFT details and cancelled cheque duly signed by the insured
• Original/attested copies of discharge summary/discharge certificate/death summary with surgical and anaesthetics notes
• Attested copies of indoor case papers
• Original/attested copies of final hospital bill with the breakup of surgical charges, surgeon's fees, or charges etc.
• Original paid receipt against the final hospital bill
• Original bills towards investigations done/laboratory bills
• Original/attested copies of investigation reports against investigations done
• Original bills and receipts paid for transportation from the registered ambulance service provider
• Treating doctor certificate to transfer the injured person to a higher medical centre for further treatment (if applicable)
• First consultation letter for the current ailment
• In case of implant surgery, invoice and sticker
• Aadhaar card and PAN card copies (not mandatory if the same is linked with the policy while issuance or in the previous claim)

Here are some of the exclusions under the policy:

1. Treatment for ailments suffered due to use or abuse of any substance, drug or alcohol and treatment for de-addiction
2. Dental treatments and cosmetic surgeries
3. Human Immunodeficiency Virus (HIV) or variant/mutant viruses or any syndrome/condition of a similar kind also known as AIDS
4. Plastic surgery unless necessary for the treatment of cancer, burns or accidental bodily injury
5. Treatment for any mental illness or psychiatric illness, Parkinson's disease
6. Vaccination or inoculation unless forming a part of post-bite treatment or if medically necessary and forming a part of the treatment recommended by the treating doctor
Waiting Period

Here’s the waiting period to seek benefits for the following conditions:

• Bariatric surgery cover is subject to a waiting period of 36 months from the date of first commencement of this policy
• For maternity expenses, the waiting period is 72 months from the date of issuance of the first policy
• Pre-existing condition, ailment or injury have a waiting period of 36 months of continuous coverage, after the date of inception of the first health guard policy


Note: Refer to the policy brochure to know further exclusions in detail.

For claim/assistance, you can contact the insurer/us through one of the following ways:

BFL Helpline Number: 08698010101

Bajaj Allianz General Insurance Helpline Number:  1800-209-0144/1800-209-5858

E-mail:–  wecare@bajajfinserv.in

Mailing address: Ground Floor, Bajaj Finserv Corporate Office, Off Pune-Ahmednagar Road, Viman Nagar, Pune – 411014.