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)

Minimum

18; 3 Months for Children

Maximum

65; 25 for Children

Maximum Policy Renewal Age (years)

80

Policy Term (years)

1

Sum Insured (Rs)

Maximum

10 lakh for entry age upto 55 years and 5 lakh for higher age group

Minimum

2 lakh

Tax Benefit

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

Discount

Family discount of 10% is applicable .
Premium discount on choosing voluntary deductible.

No Claim Bonus

5% 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 Up

Not 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 Renewal

15 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 Clause

10% 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 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

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. Moreover, insurance company will bear the expenses in excess of 10% of total claim amount

Pre-post hospitalisation

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

In-patient treatment

Covered

Pre-hospitalisation

Covered

Post-hospitalisation

Covered

Day Care Procedures

130 day care procedures are covered subject to conditions

Emergency Ambulance

Covered; subject to maximum limit of Rs 1,000

E-Opinion (Second opinion) in respect of a Critical Illness

Covered, for Sum Insured of Rs 5 lakh, Rs 7.5 lakh and Rs 10 lakh

Health Check Up

Covered; for a maximum amount of Rs 1000 at the end of 4 continuous claim free years

Exclusions and Waiting Period

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

Certain 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

Deductible

10000 to 2.5 lakh

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.