Bajaj Allianz Health Guard Policy

Bajaj Allianz's Health Guard is a holistic health insurance plan that covers the treatment expenses incurred during hospitalisation resulting from serious illness or accident. The plan offers comprehensive benefits at an affordable price suitable for your needs. The policy plan makes you financially independent and puts you in charge to handle hospital bills for your family members during medical emergencies. There are two plans covered in this policy, the silver and gold plan.

Key Features and Benefits

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  In-patient hospitalisation expenses

  Bajaj Allianz’s Health Guard 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 60 days immediately before hospitalisation.

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  Post-hospitalisation expenses

  Bajaj Allianz's Health Guard covers for the medical costs incurred due to an illness or injury 90 days immediately after hospitalisation.

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  Daily cash benefit for accompanying an insured child

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

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  Day care procedures

  Covers 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 enjoy Rs. 5000 per policy year in the event of insured hospitalised for a disease/ illness/ injury for a continuous period exceeding 10 days provided the hospitalization claim is accepted under In-Patient

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

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  Maternity and new-born baby cover

  The plan covers maternity and medical expenses of a new-born baby.

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  Tax benefits

  This plan offers Income Tax Benefit as per Section 80D of the IT Act on the premiums paid for this policy.

Health Insurance helps you to be stress-free while dealing with medical contingencies due to sickness and accidental injuries. The plans are available starting from Rs.2973, with maximum coverage of Rs. 50 lakh.

• Adults must be minimum of 18 years and a maximum of 65 years of age to avail this insurance policy.
• Dependent children must be minimum of 3 months and a max of 30 years to avail this health insurance policy.

• To apply the Bajaj Allianz Health Guard Plan, click on the 'Apply Now' button and fill in your basic and health details. Our representative will get in touch with you to provide further assistance.
• Ensure that the information given in the form is complete and accurate.
• You may be required to undergo a pre-policy medical examination at our network diagnostic centers.
• 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.

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.

• Insured member should intimate such admission at least 72 hours before the planned admission.
• Emergency Hospitalisation- Insured member or his representative should intimate within 24 hours of admission.
• The insurer will send you or the network hospital, a pre-authorisation letter. The pre-authorisation letter, the id card issued to you along with this policy and any other information or documentation that the insurer has specified must be produced to the network hospital identified in the pre-authorisation letter at the time of your admission to the same.
• If the procedure above 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.

Reimbursement Claims:

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

• You or someone claiming on your behalf must inform us in writing immediately within 48 hours of hospitalisation
• The hospital all the documents to the insurer.
• In the event of the death of the insured person, someone claiming on his 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 hrs, except for daycare procedures.
• The insurer shall make claim payment in Indian rupees only.

The following mandatory documents will be needed to claim the policy:

• Claim form with NEFT details & cancelled cheque duly signed by insured
• Original/attested copies of discharge summary /discharge certificate/death summary with surgical & 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 & sticker.
• Aadhaar card & pan card copies (not mandatory if the same is linked with the policy while issuance or in the previous claim)

1. Ailments requiring treatment 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 and or any syndrome or 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.
7. Waiting Period:
• Bariatric Surgery Cover subject to a waiting period of 36 months from the date of first commencement of this policy.
• Maternity Expenses: Waiting period of 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 have elapsed, after the date of inception of the first Health Guard policy

8. Refer to the policy brochure to know further exclusions in detail.

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.