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)

Minimum

18; 3 Months for Children

Maximum

65; 5 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

1.5 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

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

There is no need to go through medical check up below 46 years of entry age

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

Network Hospitals

Https://general.bajajallianz.com/BagicNxt/hm/hmSearchState.do

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

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 period is applicable for Pre-existing diseases

No claim period

Any disease contracted during the first 30 days of commencement of the policy will not be covered

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, laser treatment for correction of eye sight due to refractive error and certain other conditions will have a waiting period of 4 years.

General Exclusions

Non 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.