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Bajaj Allianz Silver Health (Health Cover for Seniors)

Objective

While most of the health insurance plans cap the entry age at 60 years, this is a special policy which aims at covering senior citizens against cost of inpatient hospitalisation.


Suited for

Any individual between age group of 46 and 70 years is eligible to take this policy.


What does it do?

A special policy meant to serve health insurance needs of elderly persons who are usually not allowed to enter general health insurance policies at that age. It covers expenses related to inpatient care including diagnostic procedures, medical consumables, boarding expenses and nursing care. Pre and post hospitalisation are covered with a ceiling on the benefits. Certain treatments that do not require a 24-hour stay in hospital such as radiotherapy and chemotherapy are covered under day care procedures. Besides these, health check up at the end of four continuous claim-free years and emergency ambulance are provided. The total coverage during lifetime of the policy however is capped up to three times the initial sum insured bought which means it will not cover any expenses beyond that limit anytime during lifetime of the policyholder.


Pros

Family discount of 5 per cent is available.
A bonus of 5 per cent on each claim-free year is available.
Premium paid towards this policy is eligible for tax benefit under section 80D of Income Tax Act.


Cons

Co-payment clause of 20 per cent in case treatment taken in non-network hospital is applicable.
There is a ceiling on pre and post hospitalisation benefits.
It does not allow policy renewal for lifetime.


Our View

This is the age when probability of falling ill increases resulting in higher medical costs. Anyone seeking a senior citizen cover must go for a plan that covers up to lifetime or up to a higher age. Do not get boggled by the capping on different benefits under senior citizens policy. Concentrate on lifetime and adequate insurance cover. Along with a basic health insurance policy, an add on cover for critical illness is a must, especially as you approach your golden years.
The policy though asserts to cover senior citizens, the cover ceases at 75 years of age itself. Co-payment clause applies if insured member gets treated in a non-network hospital. Above all, the capping on Lifetime Limit of Indemnity acts as a deterrent.

Eligibility
Entry Age (years) 
Minimum46
Maximum70
Maximum Policy Renewal Age (years)75
Coverage TypeSenior Citizens
Sum Insured (Rs) 
Maximum5 lakh
Minimum50000
Policy Term (years)1
Tax BenefitPremium paid is eligible for tax benefit under section 80D of the Income Tax Act
DiscountFamily discount of 5% is applicable
No Claim Bonus5% on each claim free year
Pre Policy Medical Check UpRequired; reimbursement by insurer in case of acceptance of proposal
Co Payment Clause20% of admissible claim to be borne by policyholder in case of treatment in a non empanelled hospital. Waiver of co payment clause is possible on payment of extra payment.
Policy TerminationBoth insurance company and Policyholder are 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 22 5858(BSNL/ MTNL); 1800 209 5858 (Any 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 empanelled hospital , expenses are re-imbursed within 14 working days from date of submission of all records with a Co-payment clause of 20%.
In-patient treatmentCovered
Pre-hospitalisation and post hospitalisationCovered; upto 3% of admissible hospitalisation expenses
Day Care Procedures130 day care procedures are covered
Emergency AmbulanceCovered; subject to maximum limit of Rs 1,000
Out-patient TreatmentNot Covered
Cataract SurgeryCovered after a waiting period of 1 year; restricted to 10% of limit of indemnity for each and every claim subject to minimum of Rs 12000 and maximum of Rs 25000
Health Check UpCovered; at the end of 4 continuous claim free years
Maximum Lifetime Liability3 times the limit of indemnity (insurance cover) specified in earliest senior citizen plan on continuous renewal.
E-Opinion (Second opinion) in respect of a Critical IllnessNot Covered
Exclusions and Waiting period
Pre-existing diseaseCovered upto 50% from second policy years and onwards
No claim periodAny disease contracted during the first 30 days of commencement of the policy
Waiting PeriodCertain diseases such as hernia, cataract ,sinusitis shall be covered after a waiting period of 1 year.Joint replacement surgery (unless initiated by an accident) and certain other diseases have a waiting period of 4 years.
General ExclusionsNon allopathic treatmentAIDS and other related diseasesCosmetic, beauty, weight reduction and other likely treatments.Use of alcohol or other addictive substancesWar, participation in any criminal activity or any other related conditionTreatment of any mental or related disease
Annual Premium
Age (in years)Sum Insured (in Rs)
500001 lakh1.5 lakh
46-50199529933741
51-55249537424677
56-60382457367170
61-65478071708963
66-7071701075513444
Indicative premiums; exclusive of service tax