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Bajaj Allianz Family Floater Health Guard

Objective

An online health insurance policy, the main objective of which is to provide for medical expenses incurred if any of the insured person gets hospitalized. It covers a family on a floater basis which means the sum insured can be utilized to pay hospitalisation or other allowed expenses for any of the insured member. It covers pre and post hospitalisation expenses as well.  It comes along with a voluntary deductible option that allows a certain percentage of discount on premiums.


Suited for

This policy fits those who want to insure against hospitalisation expenses.


What does it do?

Though this policy facilitates both cashless claim settlement for treatment in empanelled hospital and reimbursement of medical expenses incurred during treatment in a non-empanelled hospital, availing reimbursement facility should be avoided as there is a co- payment clause where 10 per cent of each claim has to be paid by the insured person. In this case, the insurance company will be liable to pay only 90 per cent of the admissible claim. To get rid off this clause, you need to shell out an additional premium.
It covers all relevant medical expenses where insured is admitted in a hospital for more than 24 hours. Apart from this, the policy covers 130 day care treatment which takes less than 24 hours to complete the treatment procedure due to technological advancement which would otherwise require admission to hospital. Emergency ambulance charges are also covered. It gives an advantage to policyholders covered for sum insured of Rs 5 lakh and above where, in case of critical illness, policyholder may ask for a second opinion from any doctor empanelled with insurance company. Health check-up at the end of four continuous claim-free years are also done.
It gives a cumulative bonus of 5 per cent for each claim-free year till a maximum of 50 per cent.
Besides these, there is a voluntary Deductible option where policyholder agrees to bear a certain initial amount of each admissible claim. Policyholders get a discount if this option is chosen.


Pros

It covers laser eye surgery after a waiting period of four years.
No sub-limits on room rent and boarding.
Second opinion in case of critical illness is a useful option.
Discount on premium is available if opted for a deductible.
It covers pre and post hospitalisation expenses.
This policy can be purchased online.
Premiums paid under this policy qualify for deduction under section 80D of Income Tax Act.


Cons

Co-payment clause of 10 per cent in case treatment is taken in a non-network hospital.
Co-payment clause where any insured person above 55 years of age has to bear 20 per cent of medical bills each time medical services are accessed.
In case, cumulative bonus has been passed and a claim arises during that year, cumulative bonus would be reduced by 10 per cent in the subsequent year.


Our View

This is a good policy that covers a family on a floating basis which means sum insured can be used to pay for hospitalisation expenses of any of the insured person. The major advantage of family floater policy is that it reduces paperwork and is relatively cheap. It may happen that after paying expenses for a family member's illness, the remaining unclaimed amount is insufficient to indemnify another claim. So, those willing to purchase this policy must ensure that they take an adequate coverage. As far as Deductible option is concerned, do not go for it as the deductible here applies to each claim which means the policy will become active only if the deductible limit is violated in a single claim.

Eligibility
Entry Age (years) 
Minimum18; 3 Months for Children
Maximum65; 25 for Children
Maximum Policy Renewal Age (years)80
Sum Insured (Rs) 
Maximum10 lakh for entry age upto 55 years and 5 lakh for higher age group
Minimum2 lakh
Policy Term (years)1
Tax BenefitPremium paid is eligible for tax benefit under section 80D of the Income Tax Act
DiscountFamily discount of 10% is applicable .
Premium discount on choosing voluntary deductible.
No Claim Bonus5% cumulative bonus benefit for each claim free year, maximum up to 50%. CB would be passed for Sum Insured Rs 2,00,000 and above when continuously renewed. In case of a claim during the year, the cumulative bonus will be reduced by 10%
Pre Policy Medical Check UpNot required below 46 years of age upto Sum Insured of Rs 10 lakh. Compulsory for 46 years and above. 100% reimbursement on acceptance of proposal.
Grace Period for Policy Renewal15 days grace period is allowed to policyholder for payment of premium. If policyholder fails to make payment within the grace period, the 2 year or 4 year waiting period shall start afresh
Co Payment Clause10% of the medical bills have to be borne by the policyholder himself for medical treatment in non empanelled hospital. Any applicant above 55 years of age will be required to pay 20% of medical bills each time medical services are accessed. Waiver of co payment clause is possible on payment of extra payment.
Policy TerminationPolicyholder is allowed to terminate the policy at anytime by giving a 15 day written notice. In case no claim has been made under the policy, percentage of premium will be refunded
Customer Service 
AddressBajaj Allianz General Insurance Company Limited. GE Plaza, Airport Road, Yerawad, Pune - 411006
Mail to[email protected]
Call to1800 225858(BSNL/ MTNL); 1800 1025858 (Bharti users- mobile/ landline) or 020 30305858
Additions to the Plan
Scope Of Cover
Cashless facilityAvailable at empanelled hospitals in India
Re-imbursementIn case policyholder opts for non empaneled hosiptal , expenses are re-imbursed withing 14 working days from date of submission of all records. Moreover, insurance company will bear the expenses in excess of 10% of total claim amount
Pre-post hospitalisationRelevant medical expenses covered from 60 days prior and 90 days post hospitalisation
In-patient treatmentCovered
Pre-hospitalisationCovered
Post-hospitalisationCovered
Day Care Procedures130 day care procedures are covered subject to conditions
Emergency AmbulanceCovered; subject to maximum limit of Rs 1,000
E-Opinion (Second opinion) in respect of a Critical IllnessCovered, for Sum Insured of Rs 5 lakh, Rs 7.5 lakh and Rs 10 lakh
Health Check UpCovered; for a maximum amount of Rs 1000 at the end of 4 continuous claim free years
Exclusions and Waiting Period
Pre-existing disease4 years waiting periods applicable for Pre-existing diseases
No claim periodAny disease contracted during the first 30 days of commencement of the policy
Waiting PeriodCertain diseases such as hernia, piles, cataract , sinusitis shall be covered after a waiting period of 2 years.Certain diseases such as joint replacement surgery , surgery for prolapsed inter vertebral disc (unless necessitated due to accident ), Surgery to correct deviated nasal septum and hypertrophied turbinate , congenital internal diseases or anomalies and laser treatment for correction of eye sight due to refractive error will have a waiting period of 4 years
Deductible10000 to 2.5 lakh
General ExclusionsNon allopathic treatment.AIDS and other related diseases.Cosmetic, beauty, weight reduction and other likely treatments.Use of alcohol or other addictive substances.War, participation in any criminal activity or any other related condition.Treatmenmt of any mental or related disease.
Annual Premium Option for 2 Adults
Age (in years)Sum Insured (in Rs)
2 lakh3 lakh4 lakh5 lakh7.5 lakh
upto 25350749596498786610032
26-40492566457695923413418
41-4564649098117301436417525
46-551005512570187492285427882
56-6015390192392249926819NA
61-6517700221242587430842NA
Figures are indicative premium for appropriate sum assured for each age band excluding service tax
Annual Premium Option for 2 Adults + 1 Child
Age (in years)Sum Insured (in Rs)
2 lakh3 lakh4 lakh5 lakh7.5 lakh10 lakh
upto 2540925786758191771170414280
26-40574577538978107731565419098
41-4575411061413685167582044524941
46-55117301466521873266633252941489
56-6017955224462624831288NANA
61-6520650258113018635982NANA
Figures are indicative premium for appropriate sum assured for each age band excluding service tax
Annual Premium Option for 2 Adults + 2 Children
Age (in years)Sum Insured (in Rs)
2 lakh3 lakh4 lakh5 lakh7.5 lakh10 lakh
upto 25467666128664104881337616320
26-406566886010260123121789021826
41-4586181213015640191522336628504
46-55134061676024998304723717647416
56-6020520256522999835758NANA
61-6523600294983449841122NANA
Figures are indicative premium for appropriate sum assured for each age band excluding service tax
Annual Premium Option for 2 Adults + 3 Children
Age (in years)Sum Insured (in Rs)
2 lakh3 lakh4 lakh5 lakh7.5 lakh10 lakh
upto 25526174399747117991504818360
26-407387996811543138512012624554
41-4596951364617595215462628732067
46-55150821885528123342814182353343
56-6023085288593374840228NANA
61-6526550331853881046262NANA
Figures are indicative premium for appropriate sum assured for each age band excluding service tax
Annual Premium Option for 2 Adults + 4 Children
Age (in years)Sum Insured (in Rs)
2 lakh3 lakh4 lakh5 lakh7.5 lakh10 lakh
upto 255845826510830131101672020400
26-4082081107512825153902236327283
41-45107731516319550239402920835630
46-55167582095031248380904647059270
56-6025650320653749844698NANA
61-6529500368734312351403NANA
Figures are indicative premium for appropriate sum assured for each age band excluding service tax
Deductible Discount
Deductible Amount (in Rs)Discount on premium (%)
1000010
1500015
2500017.5
5000020
7500022.5
10000025
15000027.5
20000030
25000032.5
Deductible is voluntary sum that a policyholder opts to pay when a claim is raised. In doing so, the policyholder agrees to bear the claims up to the deductible limit with the insurer paying for the claim above the deductible sum within the policy limits. This feature is used to reduce the premium.

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