Bajaj Allianz Health Insurance- a complete guide

Bajaj Allianz General Insurance Company Limited (IRDA Reg. No 113) is one of the most trusted and sought after names in the insurance industry in India.

Bajaj Allianz Health Insurance is a result of a joint venture between Bajaj Finserv Limited and Allianz SE. Both the companies are respected insurance vendors and are known for their integrity, professionalism, vision and expertise in the health insurance domain.

Bajaj is an established and a well-known brand in India, synonymous with trust and high quality services. Allianz SE is a global brand, and it very well-known for their technical expertise and ground-breaking visions and initiatives. Bajaj Allianz has been a vendor on the insurance circuit for quite some time and has acquired more than its fair share happy and loyal customers. Us offers two of the most popular Bajaj Allianz health insurance plans. Read on to know more.

Features

1. of members- The plan covers maximum 6 members of your family with up to 2 children and 4 adults.
2. Lifelong Renewal – The plans offered are lifelong renewable hence it saves you from the financial burden and stress caused by a medical emergency and keeps you well prepared to handle any situation.
3. Pre & Post hospitalization cover– The plan covers medical expenses for 60 days prior to hospitalization and 90 days post hospitalization only for related medical expenses.
4. Health Check-ups – Offers health checkup after 4 claim free years only at the networked diagnostic centres.
5. Pre-existing diseases– Pre-existing diseases are covered after 4 years of waiting period
6. Room rent- No sub-limits on room rent

 

Benefits of Bajaj Allianz Health Insurance

• Offers discounts and VAS for their loyal customers
• Offers no-claim bonus, which is 10% for every claim- free year, up to 50%
• Strong network of affiliated hospitals for cashless settlement
• 24/7 customer service

Products offered by Bajaj Allianz Health Insurance

At Us you get – Same Products. Same Prices. Additional Free Services.

Health Guard

Individual Coverage

This is the most basic health insurance plan which offers coverage as follows:

This policy offers basic coverage in range of Rs.1 lakh and Rs.10 lakh for individuals between age 3 months and 65 years.

Pre and post hospitalization expenses, No-claim bonus, cashless benefit, hospital expense cover, ambulance cover, etc., are provided in the plan.

Family Floater

In case you wish to buy this plan for coverage of your entire family on a shared basis. Here are some of details of coverage offered:

This is a basic family floater plan which covers health costs of the entire family in the range of Rs.2 lakh and Rs.10 lakh.

A maximum of 2 adults and 4 children in the family of any age above 3 months can be covered under this policy.

The plan offers hospital expense cover, ambulance cover, pre and post hospitalization expenses, No-claim bonus, etc., are provided in the plan. Along with these, the policy distinctly offers cashless health insurance facility (the hospitalization bill is directly settled with the health insurer).

Health Care Supreme

Individual Coverage

This is a health insurance plan with coverage for maternity expenses and daily cash allowance. Here are some of the details of this plan:

This health insurance plan offers coverage in range of Rs.5 lakh and Rs.50 lakh for individuals of any age above 3 months.

Along with basic coverage the policy has pre and post hospitalization expenses, No-claim bonus, maternity coverage, out-patient benefit, cashless benefit, etc. the policy also has restore benefits.

There are three variations of this plan available each of which has different coverage range.

Vital- Coverage range Rs.5 lakh to Rs.10 lakh

Smart- Coverage range Rs.15 lakh to Rs.30 lakh

Ultimo- Coverage range Rs.35 lakh to Rs.50 lakh

Ancillary treatment cover (e.g. Daily allowance), personal accident cover, critical illness cover, can be covered under this policy with additional premium rates.

Family Floater Coverage

This is a family floater plan which covers health costs of the entire family in the range Rs.5 lakh to Rs.50 lakh

A maximum of 2 adults and 3 children in the family of any age above 3 months can be covered under this policy.

Along with basic coverage the policy has pre and post hospitalization expenses, No-claim bonus, maternity coverage, out-patient benefit, cashless benefit, etc. the policy also has restore benefits.

There are three variations of this plan available each of which has different coverage range.

Vital- Coverage range Rs.5 lakh to Rs.10 lakh

Smart- Coverage range Rs.15 lakh to Rs.30 lakh.

*Ultimo- Coverage range Rs.35 lakh to Rs.50 lakh.

Ancillary treatment cover (e.g. Daily allowance), personal accident cover, critical illness cover, can be covered under this policy with additional premium rates.

Health Ensure

This is a plan which considers difference in medical expenses with respect to geographical distance. Here are brief details of coverage offered;

This policy offers coverage in range of Rs.50,000 and Rs.1 lakh for individuals of between age 18 years and 65 years and dependent child between age 3 months and 25 years.

The premium rate in this plan is different in different geographical areas (zones).

Sub-limits are applicable in all the case of hospitalizations (e.g. room rent limit, ICU rent limit, limited ambulance charges, etc.).

Pre and post hospitalization expenses, No-claim bonus, delivery and new born coverage, cashless facility, etc., are provided in the plan.

If you want to know more about this plan, contact Us.

Extra Care

This is a health insurance top-up plan which gets activated after the deductible value is met. Here are details of the coverage offered:

This is a top-up plan with deductible (amount to be paid by the policy holder before claiming insurance) and which offers coverage for higher hospital expense at minimum premium rates for anyone between age 18 years and 65 years and dependent child between age 3 months and 25 years.

The coverage amount for this plan is in the range of Rs.10 lakh and Rs.15 lakh and the deductible amount is in the range of Rs.3 lakh and Rs.5 lakh.

To know more about the coverage and benefits offered under Extra Care plan, contact Us.

Premium Personal Guard

Individual coverage

This is personal accident disability plan for occupation risk class I individuals. The details of the plan are as follows:

This policy offers coverage in case of accidents in range of Rs.10 lakh and Rs.25 lakh for risk class I individuals (Administrative/ managing functions, accountants, doctors, lawyers, architects, teachers and similar occupations) between age 18 years and 65 years and dependent children between age 5 years to 21 years.

The plan covers permanent total disability, permanent partial disability, temporary total disability & death. Education allowance is also offered to the policy holder’s child after his/her death.

Family Coverage

For family coverage under this plan the details are as follows:

This is a family plan which covers the entire family against any accident. Coverage offered is in the range of Rs.10 lakh and Rs.25 lakh for family members in risk class I (Administrative / managing functions, accountants, doctors, lawyers, architects, teachers and similar occupations).

A maximum of 2 adults (proposer and spouse) and 4 children in the family between age 18 years and 65 years and dependent children between ages 5 years to 21 years. Additional member A and additional member B would include spouse and children respectively.

The plan covers permanent total disability, permanent partial disability, temporary total disability & death. Education allowance is also offered to the policy holder’s child after his/her death.

Personal Accident/ Personal Guard

This personal accident disability plan is available for all the three occupation risk class viz. I, II and III. The details of the coverage offered is as follows:

This policy offers accidental coverage based on the occupational risk class.

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

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

Risk class III- Workers in underground mines, electric installations with high tension supply, jockey, circus performers, big game hunters, mountaineers, professional river rafters and similar occupations.

The coverage offered is further classified as:

Basic- Covers only death, Children’s education, medical expenses and does not cover permanent total or partial disability and temporary total disability.

Wider- From the covers mentioned in basic coverage wider additionally covers permanent total or partial disability.

Comprehensive- It covers all the conditions mentioned in basic.

Sankat Mochan

This is a personal accident disability plan with 16 variants. Here are some of the details of the coverage offered:

This policy offers accidental coverage to individuals.

There 16 plans under this plan which offers different type of coverage to both risk group I and risk group II mentioned above. The coverage can be distinguished as:

Basic- The basic cover would cover only death.

Wider- Wider cover would cover death, permanent total and partial disability.

Comprehensive- In addition to wider coverage comprehensive plan covers temporary total disability.

For Spouse and Children

The Sankat Mochan Plan is also available for Family coverage of spouse and children. The details are as follows:

This plan will offer accidental coverage.

For spouse only 5 plans and for children only 3 plans can be availed. Under which offer different type of coverage is offered to both risk group I and risk group II mentioned above. The distinguished coverage type are:

Basic- Covers only death.

Wider- Covers death, permanent total and partial disability.

Comprehensive- In addition to wider coverage this plan covers temporary total disability.

Accidental Hospitalization- Provides reimbursement of actual expenses.

Note: For children only 3 plans of Sankat Mochan can be availed.

Hospital Cash Daily Allowance

This is a benefit plan which as the name suggests offers compensation in the form of daily cash during hospitalization of the insured. The benefits offered are:

This policy offers daily cash for as long as one or two months of hospitalization.

Per day cover offered by the policy is in range of Rs.500 and Rs.2500

Adults between age 18 years and 65 years, and dependent child between age 3 months and 21 years can be covered under this policy.

To know more about this benefit plan, contact Us.

Critical Illness

This is a benefit plan offered by Bajaj which is designed to cover expenses other than hospitalization expenses by offering a lump sum amount after diagnosis of any of the critical conditions listed in the policy wording.

This policy offers coverage in range of Rs.1 lakh and Rs.10 lakh for individuals between age 18 years and 65 years dependent child between age 3 months and 21 years.

The plan offers lump sum amount to the policy holder after being diagnosed with critical illness.

If you want to buy a plan which will take care of your financial burden after diagnosis of critical conditions, know more about Critical illness Plan, contact Us.

Surgical Protection Plan

This is a unique plan which is designed only to cover surgical expenses. Here are some of the benefits offered:

This plan offers coverage in the range of Rs.1 lakh and Rs.10 lakh.

Minor surgery, day care, major surgery, sub-major surgery and supra major surgery are categories in which the surgeries are divided.

Other benefits like hospital daily cash allowance and critical illness cover are optional in this plan.

The plan is grouped such that it covers some specific group of surgeries. It provides a fixed amount in case of the surgeries mentioned.

There is variation in waiting period for coverage offered. Details are as follows:

3 months- It will provide benefits like surgical benefit, hospital daily cash and critical illness cover.

2 years or 4 years- Both of these would provide surgical benefit and hospital daily cash only.

The amount offered by the insurer would be after taking into consideration geographical location and the fixed amount which is required for the surgery.

Family Coverage

The plan mentioned above can also cover expenses for your entire family. Here are the details:

This is plan offers coverage in the range of Rs.1 lakh and Rs.10 lakh. Same policy can be used to cover proposer, spouse, dependent children and dependent parents.

It is specifically designed to provide coverage for surgeries with variation in waiting period. The waiting period option is as follows:

3 months- It will provide benefits like surgical benefit, hospital daily cash and critical illness cover.

2 years or 4 years- Both of these would provide surgical benefit and hospital daily cash only.

The amount offered by the insurer would be after taking into consideration geographical location and the fixed amount which is required for the surgery.

The plan is grouped such that it covers some specific group of surgeries. It provides a fixed amount in case of the surgeries mentioned.

Minor surgery, day care, major surgery, sub-major surgery and supra major surgery are categories in which the surgeries are divided. Other benefits like hospital daily cash allowance and critical illness cover are optional in this plan.

In case this plan is just what you were looking for, know more about this plan before you buy it for yourself or your family, contact Us to discuss about terms and conditions under this policy.

Tax Gain Plan

As the name suggest this health insurance plan is specifically for those looking for tax benefits in insurance. Here are the details of coverage offered.

This is a family floater plan which covers health costs of the all family members between age 18 years to 55 years for plan A, plan B and plan C and 56 years to 75 years for plan D.

The plans are divided as per the tax gain.

Plan A– Tax gain INR 4999.

Plan B– Tax gain INR 9999.

Plan C– Tax gain INR 14999.

Plan D– Tax gain INR 19999.

Co-pay of 10 % applicable when treatment is under non networked hospitals.

If you are okay to have a plan with co-pay on non-network treatment, know more about the terms and conditions under this plan, contact Us.

Critical illness for women

This is a unique critical illness benefit plan specifically for women. The details of coverage are as follows:

This policy is especially for women. Coverage offered is in the range of Rs.50,000 and Rs.2 lakh

The plan provides lump sum amount in case of critical illness coverage and also covers congenital disability benefits.

Additional benefit of this plan includes children education bonus (fund for children after claim for critical illness) and loss of job compensation (compensation in case critical illness resulting in loss of job).

If you are an independent women looking out for a plan just liked this one then know more about the details of coverage offered, contact Us.

Silver Health

A health insurance policy especially for senior citizens. Here are some of the benefits offered:

This policy offers coverage to senior individuals in range of Rs.50, 000 and Rs.5 lakh for individuals between age 46 years and 70 years.

The plan offers hospital expense cover, ambulance cover; pre-existing illness cover, etc. are provided in the plan. Along with these, the policy also has cashless facility.

Copay of 20 % is applicable before paying any plan.

To know more about terms and conditions under this plan, contact Us.

 

Claims process at Bajaj Allianz Health Insurance

There are two ways to make claim under a Health Insurance Policy: on cashless basis and on reimbursement basis. In simple terms, for making a claim on cashless basis, the treatment must be done only at a network hospital of the insurance company servicing your policy. For availing the treatment, you would have to first seek an authorization as per the procedures laid down and in the prescribed form. In case of claims on reimbursement basis, the insurance company has to be informed as per their prescribed procedures. The policyholder has to ensure that documents such as claim form, discharge summary, prescriptions and bills to be submitted for the claim on reimbursement are obtained after hospitalization.

Bajaj Allianz Health Insurance has a well-defined claim processing system.

Cashless Service: seeking Pre-Authorization

Complete the pre-authorization form available at the hospital’s insurance/TPA Desk.

Send the completed form via email or fax.

Approved letter will be sent by the claim management team. Remember that the claim management team could send an inquiry to the hospital or you before authorization.

In case the authorization is rejected, initiate the treatment and file for reimbursement claim.

Reimbursement Claim: Claim Submission

Complete the necessary form and submit along with required documents, as per the policy terms and conditions.

Necessary documents include discharge summary, prescriptions, bills etc.

Approved letter will be sent by the claim management team. Remember that you will be answerable to any queries raised by the claim management team before the letter is issued.

In case the claim is rejected, the reasons will be communicated by the team.

In case of any emergencies, you need to inform Bajaj Allianz within 24 hours of the admission. In case of planned emergencies, the notification has to reach the company 48 hours prior to the hospitalization. The claim intimation can be done via Bajaj Allianz’s toll free number 1800-209-5858. The same could also be emailed to customercare@bajajallianz.co.in .

Review of Bajaj Allianz Health Insurance

Bajaj Allianz offers an array of reasonably priced health insurance policies. Their health plans are made-to-measure to shield you against the mounting healthcare outlays. They boasts of a highest claim settlement ratio amongst private insurers. Their health insurance products like individual health insurance, family health insurance, health insurance for senior citizens, and top-up health insurance cover are premeditated to meet precise requirements. Hence, if you are scouting for an insurer who will deliver dependability, competence and brilliant post sales services in consort with the products specific to your requirements, Bajaj Allianz is a won over alternative.