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)

Minimum

46

Maximum

70

Maximum Policy Renewal Age (years)

75

Coverage Type

Senior Citizens

Policy Term (years)

1

Sum Insured (Rs)

Maximum

5 lakh

Minimum

50000

Tax Benefit

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

Discount

Family discount of 5% is applicable

No Claim Bonus

5% on each claim free year

Pre Policy Medical Check Up

Required; reimbursement by insurer in case of acceptance of proposal

Co Payment Clause

20% 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 Termination

Both 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

Address

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

Mail to

customercare@bajajallianz.co.in

Call to

1800 22 5858(BSNL/ MTNL); 1800 209 5858 (Any mobile/ landline) or 020 30305858

Scope of Cover

Cashless facility

Available at empanelled hospitals in India

Re-imbursement

In 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 treatment

Covered

Pre-hospitalisation and post hospitalisation

Covered; upto 3% of admissible hospitalisation expenses

Day Care Procedures

130 day care procedures are covered

Emergency Ambulance

Covered; subject to maximum limit of Rs 1,000

Out-patient Treatment

Not Covered

Cataract Surgery

Covered 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 Up

Covered; at the end of 4 continuous claim free years

Maximum Lifetime Liability

3 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 Illness

Not Covered

Exclusions and Waiting period

Pre-existing disease

Covered upto 50% from second policy years and onwards

No claim period

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

Waiting Period

Certain 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 Exclusions

Non 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