EBH Complete Health Solutions - Overview

EBH Complete Health Solution is an all-inclusive tailor-made plan that offers a well-structured compilation of advanced health features designed to cater to your medical needs. This plan offers you to get the best health advice from a network of expert doctors anywhere across India.

 

The plan offers you a seamless digital experience through their Health app that provides appointment reminders, helps you to search and book the doctor of your choice, easy access to your overall health records & prescriptions. This plan offers you to claim covid-19 lab test expenses done at any government-approved lab in India. Make health needs of you and your family your top priority by being a part of the Bajaj Finserv health family and exploring our Complete health solution plan!

  • Key Features & Benefits

  • HealthRx App

    This plan offers you a seamless digital experience through its healthrx app where you can book appointments for covid -19 lab tests and search for the best doctors anywhere in India. This also helps you to set reminders for medicine intake.

  • Doctor Consultation

    Get the consultation from your preferred doctor anywhere in Indian either through in-clinic visits or via teleconsultation facility.

  • Covid -19 Lab test:

    Get the consultation from your preferred doctor anywhere in Indian either through in-clinic visits or via teleconsultation facility.

  • In-patient Hospitalisation Expenses:

     

    EBH Complete Health Solution offers inpatient hospital expenses which include:

    • Room Rent/Boarding and Nursing Expenses
    • ICU Rent/ Boarding and Nursing Expenses
    • Fees of Medical Practitioner, Surgeon, Anesthetist, Nurses and Specialist Doctor
    • Operation theatre charges, Anesthesia, surgical appliances, diagnostic tests, medicines, blood, oxygen and cost of prosthetic and other devices or equipment if implanted internally like pacemaker during a surgical process

  • Pre-Hospitalisation Expenses:

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

  • Post-Hospitalisation Expenses:

    EBH Complete Health Solution pays for the medical costs incurred due to an illness or injury 90 days immediately after hospitalisation.

  • Day Care Procedures:

    Covers medical expenses under in-patient hospitalisation treatment cover for day-care procedures/surgeries taken as an inpatient in a hospital or day-care centre.

  • Organ Donor Expenses:

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

  • Sum Reinstatement Benefit:

    Through this plan, the insured will get their sum insured amount restored if they have used it completely within the single policy period.

  • Emergency Road Ambulance Cover:

    The insured under this policy get the benefit of ambulance expenses being covered to a maximum of Rs. 3000 for accidents or emergencies between Hospitals in the Hospital’s ambulance or an ambulance provided by any ambulance service provider.

  • Tax Benefits:

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

Policy Details

EBH Complete Health Solution
Policy Type Individual/Family Floater
Entry Age Minimum Entry age for proposer/ spouse/ dependent parents: 21 years
Maximum Entry Age for proposer/ spouse/ dependent parents: 55 years 4
Renewal Lifetime Renewable
Tenure One, two and three years
Sum Insured Rs. 5 lakh - Rs. 10 lakh
Number of members covered 6 (2A+4C)

Plans Available

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.3899, with maximum coverage of Rs. 25 lakh, to know more about the premium rates in detail please click

How to buy the policy

  • To apply the EBH Complete Health Solution, 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 centres.
  • 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.

List of documents to buy the policy

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


  • Photograph of the Applicant
  • Age proof such as birth certificate, Voter’s ID, PAN card, passport etc.
  • Identity proof such as passport, Aadhaar card, PAN card, Voter’s ID, etc.
  • Income Proof such as Form 16, salary slips, employment certificate etc.
  • Address proof such as telephone bill, electricity bill, passport, bank statement, Voter’s ID, etc.
  • Medical Test that the insurer requires you to undergo

How to process the claims

Cashless Claims
Cashless treatment is only available at a network hospital registered with the insurance provider. 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-authorization form to the insurer.
  • The insurer will verify the pre-authorization request and convey the policy coverage and other details to the hospital.

Planned Hospitalization

  • Insured member should intimate such admission at least 72 hours before the planned admission.
  • Emergency Hospitalization- Insured member or his representative should intimate such admission within 24 hours of such admission.
  • The insurer will send you or the network hospital, a pre-authorization letter. The pre-authorization 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-authorization 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 claim

If pre-authorization 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 postmortem report (if any) within 30 days.
  • The insurer shall not indemnify you for any period of hospitalisation of fewer than 24 hrs, except for daycare procedures.
  • The insurer shall make claim payment in Indian rupees only.

List of Documents Required for Claim:

  • A consultation letter from the doctor
  • Duly completed claim form and NEFT form signed by the claimant
  • Original hospital discharge card
  • Original hospital bill giving a detailed break up of all expense heads mentioned in the bill with clear break-ups for OT charges, doctor’s consultation and visit charges, OT consumables, transfusions, room rent, etc.
  • Original money receipt duly signed with a revenue stamp.
  • Original laboratory and diagnostic test reports. E.g. X-ray, E.C.G, USG, MRI scan, haemogram etc.
  • In case of a cataract operation, IOL sticker will have to be enclosed.
  • Claim settlement letter from any other insurer (if any) in case of partial settlement
  • In cases of suspected fraud/misrepresentation, the insurer may call for any additional document(s) in addition to the documents listed above.
  • Aaadhar Card & PAN card Copies (Not mandatory if the same is linked with the policy while issuance or in the previous claim)

Major Policy Exclusions

  1. All pre-existing diseases waiting period of 3 years and any type gastrointestinal ulcers, Cataracts,
  2. fistula, hernia, sinuses, piles, surgery on all internal or external tumours/cysts/ nodules/polyps of any
  3. kind including breast lumps, Gout and rheumatism, Tonsillitis, Alzheimer’s Disease etc.
  4. Cosmetic, dental, Aesthetic, or optical treatment
  5. Pregnancy or childbirth, HIV / AIDS, Drink and Drive, Treatment for any mental or psychiatric illness,
  6. Intentional self-injury or suicide, War, invasion, acts of foreign enemies, hostilities, civil war,
  7. commotion, unrest, rebellion, revolution, insurrection, military or usurped power or confiscation or nationalization or requisition of or damage by or under the order of any government or public local authority.
  8. Refer to the policy brochure to know further exclusions in detail.

Claim/Assistance Contact Details

Toll free number –  08698010101/1800-209-0144 /1800-209-5858

E-mail –  wecare@bajajfinserv.in

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

 

*For claim related issues please refer your policy document or certificate of insurance (COI).