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Bajaj Allianz Health Guard- Individual

Objective

This is an online health insurance policy and aims to provide for medical expenses incurred if the insured person gets hospitalized. It covers pre and post hospitalisation expenses as well.  USP of the policy is that it covers Lasik eye surgery after a waiting period of four years. It comes along with a voluntary deductible option that gives a pre-specified discount on premium.


Suited for

This policy is suitable for anyone who wants to insure against hospitalisation cost.


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 insurance company will be liable to pay only 90 per cent of 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.
Besides these, there is a voluntary Deductible option where if policyholder agrees to bear a certain initial amount of each admissible claim, insurance company offers him a discount on premium.


Pros

It covers lasik 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 an useful option.
The policy gives a discount if two or more family members are covered under the same policy.
Discount on premium is available if opted for a deductible.
It gives a special bonus of 5 per cent for each claim-free year upto maximum of 50 per cent.
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, bonus has been passed and a claim arises during that year, bonus would be reduced by 10 per cent in the subsequent year.


Our View

This is a decent policy that covers hospitalisation expenses of insured. A unique benefit is that it covers lasik eye surgery though after a waiting period of four years. As far as top up option in this policy is concerned, do not go for it. The simple reason is because the deductible limit applies to each claim amount.

Eligibility
Entry Age (years) 
Minimum18; 3 Months for Children
Maximum65; 5 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
Minimum1.5 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
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 UpThere is no need to go through medical check up below 46 years of entry age
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
Network HospitalsHttps://general.bajajallianz.com/BagicNxt/hm/hmSearchState.do
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
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 period is applicable for Pre-existing diseases
No claim periodAny disease contracted during the first 30 days of commencement of the policy will not be covered
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, laser treatment for correction of eye sight due to refractive error and certain other conditions will have a waiting period of 4 years.
General ExclusionsNon allopathic treatment.Expenses related to AIDS and other related diseases.Cosmetic, beauty, weight reduction and other likely treatments.Any illness or deisease contracted due to intake 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
Age (in years)Sum Insured (in Rs)
1.5 lakh2 lakh3 lakh4 lakh5 lakh7.5 lakh10 lakh
90 day- 251882233833064332524466888160
26 - 4025323283443051306156894510913
41 - 45327243096065782095761168314252
46 - 5550286703838012499152361858823708
56 - 60769610260128261499917879NANA
61 - 65884911800147491724920561NANA
Figures are indicative premium for appropriate sum insured for each age band excluding service tax
Deductible Discount
Deductible Amount (in Rs)Discount (%)
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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