Objective

This is a top-up health insurance policy where insurance company pays medical expenses in excess of a certain limit up to maximum sum insured. The limit is the deductible i.e. the amount which has to be borne by the policyholder or by his existing cover, before the insurance benefit actually kicks in. Deductible limit is applicable on each hospitalisation taken by insured person which means that deductible limit refreshes every time insured person is hospitalized as an inpatient within the policy term.

Suited for

This policy is suitable for any person who believes that existing insurance cover is inadequate to cover the rising costs of medical treatments. A person who does not have any medical insurance policy may also take this policy. The initial expenses up to threshold limit in this case will have to be borne by the insured person.

What does it do?

This health insurance plan covers hospitalisation expenses if treatment is taken as an inpatient. It covers medical expenses, room rent, boarding, nursing care, surgeon, anesthetist and specialist fees up to the sum insured. This policy also provides for ambulance charges upto maximum of Rs 3,000 per hospitalisation for transporting insured person from residence or place of accident to hospital and from hospital to residence.

Pros

It covers relevant medical expenses from 60 days prior and 90 days post hospitalisation.
This policy can be purchased online.

Cons

The deductible limit applies each time hospitalisation services are accessed.

Our View

This policy is suitable only if the chances of contracting a major illness, which would otherwise dent your financial resources, in future are high. Though this policy is meant to increase the existing insurance cover, the catch here is that deductible applies to every single claim. It will not come in picture till single claim crosses the threshold limit.

Eligibility

Entry Age (years)

Minimum

18; 3 Months for Children

Maximum

70; 25 for Children

Maximum Policy Renewal Age (years)

80

Coverage Type

Individual/ Family floater

Policy Term (years)

1

Sum Insured (Rs)

Maximum

15 lakh

Minimum

10 lakh

Tax Benefit

Premium paid is eligible for tax benefit under section 80D of the Income Tax Act

Pre Policy Medical Check Up

Not required below 55 years of age. 50% reimbursement of medical check up costs on acceptance of proposal in case where medical tests have been conducted.

Grace Period for Policy Renewal

15 days grace period is allowed to policyholder for payment of premium. If policyholder fails to make payment within the grace period, the applicable waiting period(s) shall start afresh

Policy Termination

Policyholder 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

Address

Bajaj Allianz General Insurance Company Limited. GE Plaza, Airport Road, Yerawad, Pune - 411006

Mail to

customercare@bajajallianz.co.in

Call to

1800 225858(BSNL/ MTNL); 1800 1025858 (Bharti users- mobile/ landline) or 020 30305858

SMS

Extra' to 56070

Scope Of Cover

Cashless facility

Available at empanelled hospitals in India

Re-imbursement

In case policyholder opts for non empaneled hosiptal , expenses are re-imbursed withing 14 working days from date of submission of all records.

Pre-post hospitalisation

Relevant medical expenses covered from 60 days prior and 90 days post hospitalisation

In-patient treatment

Covered

Emergency Ambulance

Covered; subject to maximum limit of Rs 3000

Exclusions and Waiting Period

Deductible per hospitalisation

3 lakh for Sum insured 10 lakh4 lakh for Sum insured 12 lakh5 lakh for Sum insured 15 lakh

Pre-existing disease

4 years waiting periods applicable for Pre-existing diseases

No claim period

Any disease contracted during the first 30 days of commencement of the policy

Waiting Period

4 years waiting perod on enhanced Sum Insured in case of change in plan to a high cover.Certain diseases such as joint replacement surgery (unless necessitated due to accident )will have a waiting period of 4 years.

General Exclusions

Non 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.