Bajaj Allianz Health Insurance

Bajaj Allianz Health Guard Product Page

Bajaj Allianz Health Guard Product Page

Bajaj Allianz Health Guard Plan

What The Plan Is All About

The Bajaj Allianz Health Guard Plan is a comprehensive health insurance policy provided by Bajaj Allianz General Insurance Company. It consists of three variants: Silver, Gold, and Platinum, each offering different levels of coverage. The Health Guard Plan is designed to provide a well-rounded solution by combining extensive features and numerous benefits. It ensures that you have access to quality healthcare without worrying about the financial burden that may arise from medical expenses.

Check Out The Eligibility Requirements

Minimum Entry Age

  • Adults: 18 years
  • Children: 3 months

Maximum Eligibility

  • Adults: 65 years
  • Dependent Children: 30 years

A Sneak-Peek Into The Plan’s Benefits and Limits

The Bajaj Allianz Health Guard Plan covers expenses related to inpatient hospitalisation. This includes costs incurred when you are hospitalised for more than 24 hours, such as room and boarding fees, nursing charges, fees for medical practitioners, expenses for prescribed medicines and drugs, charges for intensive care units (ICU), and other relevant costs.

Besides these, it also covers the following expenses -

  • Pre & Post Hospitalisation Expenses Coverage

    If the doctor needs to perform multiple diagnostic tests before or after your discharge, the Bajaj Alliance Health Guard Plan has got you covered. Your insurer will handle the costs for these tests and other pre- and post-hospitalization costs, up to the sum insured mentioned in your policy, for a reasonable duration - 60 days before your hospitalisation and within 90 days after your discharge. It is crucial to understand that the insurer will only cover these expenses if they are directly associated with the medical condition for which you are hospitalised. And, your claim must also be approved as part of your inpatient hospitalisation coverage.

  • Daycare Treatment Coverage

    These are medical procedures or surgeries that used to require a prolonged hospital stay in the past. However, due to cool advances in medical technology, these procedures can now be done within 24 hours - allowing for shorter recovery time. The Bajaj Allianz Health Guard Plan provides coverage for a comprehensive list of 399 different daycare procedures. Importantly, this plan does not impose any limit on the coverage for these treatments. This means that all costs associated with these treatments will be completely taken care of up to the sum insured.

  • Organ Donor Coverage

    The Bajaj Allianz Health Guard Plan offers coverage for expenses incurred by organ donors up to the sum insured. This includes the costs of harvesting the organ from the donor for transplantation (where the insured is the recipient).

  • Modern Treatments Coverage

    The healthcare industry is constantly changing and improving due to technological advancements, allowing for the development of modern treatments. The Bajaj Allianz Health Guard Plan is tailored to adapt to the latest innovations, ensuring coverage for expenses related to such treatments, up to the specified sum insured.

  • Cumulative Bonus

    The Cumulative Bonus benefit allows you to receive a bonus if you refrain from making any claims in a policy year. With Health Guard by Bajaj Allianz, this benefit is exclusively available with the gold or silver plans. By selecting one of these plans, your sum insured will increase by 10% for each claim-free year for 10 years and up to a maximum of 100% of your base sum insured. However, if you file a claim in the future, the accumulated cumulative bonus will be reduced by 10%.

  • Sum Insured Reinstatement Benefit

    This benefit is activated when your sum insured, along with any accumulated Cumulative Bonus or Super Cumulative Bonus, is depleted due to unexpected medical costs. This benefit ensures that 100% of your base sum insured is reinstated, providing you with an extra layer of protection for the remaining policy year. Please note that this benefit can only be used once per policy year, and it is applicable only if the entire sum insured and any applicable bonus have been fully utilised.

  • Room Rent Limit

    The room rent limit refers to the maximum amount covered by your insurance company for the hospital room where you are admitted. If you choose a room that is within the limit set by your insurance plan, you will not have to pay any additional costs. However, if you decide to stay in a room that has a higher rent than what is allowed under your plan, you will face a proportional deduction. This means that you will be required to pay a proportionate portion of the total bill, rather than just the difference in the cost of the room.

    However, with Bajaj Allianz Health Guard, you have the freedom to choose any type of room you prefer, whether it's a shared room, single private AC room, premium room, suite, or any other available option. Since the insurer does not impose any restrictions on the cost of the room, you can select based on your personal preference without any concerns.

  • Financial Limits On Treatments/Diseases

    Expenses associated with cataract treatment are limited to 20% of the sum insured per eye per policy year under Silver and Gold variants. There is a maximum limit of Rs 1 Lakh under the Gold variant for cataract surgery.

    Bariatric surgery is also subject to sub-limits.

    In the Silver plan, it is restricted to 25% of the sum insured.

    In the Gold and Platinum plans, it is limited to 50% of the sum insured up to a maximum of Rs 5 Lakhs.

A Few Noteworthy Features Of The Plan!

  • Preventive Health Check-ups For Early Detection

    Bajaj Allianz Health Guard provides a valuable advantage that promotes your well-being. You can receive a complimentary preventive health check-up. This benefit is offered once per policy year and the insurer will reimburse the cost of the check-up based on your specific plan, within certain limits specified in the plan.

  • Wellness Benefits To Keep Healthy

    This feature is provided as an incentive for you to maintain an active and healthy lifestyle. By meeting specific health criteria at each renewal, you can earn discounts on wellness-related services. Please note that this benefit is only available to individuals who are 25 years old or above.

    The below table is the range of the discounts offered based on certain parameters -

    Parameters Achieved Discount Offered
    4-5 out of 8 5%
    6-7 out of 8 7.5%
    8 out of 8 10%
  • Bariatric Surgery Cover To Combat Obesity

    Bariatric surgery, or weight loss surgery, is a collection of surgical procedures designed to assist people with severe obesity in reducing their weight. The Bajaj Allianz Health Guard Plan includes coverage for the costs associated with bariatric surgeries and treatments. The specific coverage details can be found in the terms and conditions of the plan.

Everything About Waiting Periods

It's important to keep in mind that there may be certain illnesses and diseases that are not covered immediately after the policy is issued. This period, referred to as the waiting period, is a specific time frame during which you are unable to make claims for particular conditions. However, once this waiting period comes to an end, you will be eligible to file claims for these conditions.

Waiting periods can vary in duration and can be categorised into different types based on various factors -

  1. Initial waiting period:There is a 30-day waiting period for all medical conditions, except accidents. This means that you cannot make a claim for medical treatments within the first 30 days unless it is due to an accident.

  2. Waiting period for pre-existing diseases: A pre-existing disease is defined as any medical condition or illness that you have had in the 48 months prior to the issuance of a health insurance policy. In the Bajaj Allianz Health Guard Plan, there is a waiting period of 36 months for pre-existing diseases. This means that during this period, the policy will not cover any expenses associated with your pre-existing conditions.

  3. Waiting period for specific diseases: Insurers typically have a predetermined list of medical conditions or illnesses, separate from your pre-existing conditions, that have a waiting period. It is important to note that this waiting period applies regardless of whether you have had these diseases before or not. Bajaj Allianz Health Guard Plan has a waiting period of 24 months for specific diseases.

What Does The Plan Not Include?

Exclusions refer to specific situations that are not covered by your health insurance policy. These situations can include -

  • Standard permanent exclusions: The Insurance Regulatory and Development Authority of India (IRDAI) has introduced a set of regulations known as 'standard permanent exclusions'. These exclusions are mandatory for all insurance companies to enforce. Here are some of these exclusions:

  1. Investigation and evaluation: Hospital admission primarily for the purpose of observation or monitoring the patient’s health.
  2. Rest cure, rehabilitation, and respite care: Admission to a bed rest facility, characterised by the absence of active medical intervention or treatment.
  3. Obesity/weight control: Treatment options for weight control or managing obesity.
  4. Change of gender treatment: Treatments focusing on modifying the physical attributes of individuals to align them with their identified gender.
  5. Plastic/cosmetic surgery: Treatment or surgical procedures that are designed to alter physical attributes or enhance one's appearance through various modifications.
  6. Profession in hazardous or adventure sports: Costs for medical care that arise due to the involvement in adventurous pursuits such as river rafting, mountain climbing, scuba diving, horse racing, etc. as a professional.
  7. Breach of law: Expenses incurred for the medical care of an individual who has engaged in or attempted to engage in unlawful activities with criminal intent.
  8. Excluded providers: Treatment provided by a medical practitioner or hospital not covered by the insurance company.
  9. Treatments in establishments arranged for domestic purposes: Expenses incurred for medical treatments received at health spas, nursing homes, etc. for domestic purposes.
  10. Dietary supplements, substances purchased without prescription: Nutritional supplements, such as vitamins and minerals, that are not recommended by a healthcare professional.
  11. Refractive error: Expenses related to the correction of refractive errors to enhance eyesight, up to a maximum of 7.5 diopters.
  12. Unproven treatments: Surgeries, medical procedures, or treatments that lack proven effectiveness.
  13. Expenses related to birth control, sterility infertility: Costs related to birth control, sterility infertility: Contraception, sterilisation, artificial insemination, advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc.
  14. Maternity expenses: Costs related to pre/post-natal care and other similar medical services associated with pregnancy and childbirth.
  • Additional Permanent ExclusionsInsurance companies have the power to impose additional limitations on coverage for certain situations or medical conditions. If you have specific diseases or severe medical conditions that are deemed high-risk by insurers, they may choose to permanently exclude them from your policy. It is worth noting that insurers are bound by a specific list of illnesses determined by the Insurance Regulatory & Development Authority of India (IRDAI) for which they can impose permanent exclusions.

  • Non-standard exclusions (Specific exclusions):These specific exclusions are additional to the standard permanent exclusions mentioned by the IRDAI. The specific exclusions can vary among insurance companies and are based on the terms and conditions of the policy.

    Below, you will find a compilation of some notable specific exclusions found in the Bajaj Allianz Health Guard Plan -

  1. Expenses resulting from events such as war, invasion, etc. caused due to government or local public authority orders.
  2. Circumcision, except to treat an illness or accidental injury.
  3. Vaccination or inoculation unless deemed medically necessary and recommended by your physician as part of any post-bite treatment.
  4. Self-harm that is deliberate. This includes self-harm due to mind-altering substances such as drugs or alcohol.
  5. Expenses associated with congenital external diseases/defects/anomalies, growth hormone therapy, stem cell implantation, or surgery (except for hematopoietic stem cells specifically used for bone marrow transplants in cases of haematological conditions).
  6. Any costs associated with treatments like C.P.A.D - Continuous Peritoneal Ambulatory Dialysis, oxygen concentrator for bronchial asthma, etc.
  7. External medical equipment, such as those used for post-hospitalisation care at home, including the cost of instruments used in the treatment of Sleep Apnea.
  8. Medical expenses that do not necessitate inpatient care or 24/7 supervision from qualified nursing staff and medical practitioners.
  9. Any dental procedure including cosmetic surgery, dentures, dental prosthesis, dental implants, orthodontics, or any kind of surgical intervention, except when it is necessitated due to accidental injury to natural teeth requiring hospitalisation.

Let’s Quickly Recall The Product Benefits And Their Limits

Product Benefits Coverage Limits
Pre-Hospitalisation Expenses

60 days up to the sum insured

Post-Hospitalisation Expenses

90 days up to the sum insured

Daycare Treatment Coverage Up to sum insured (399 procedures covered)
Organ Donor Coverage Harvesting expenses up to the sum insured
Modern Treatment Coverage Up to the sum insured
Cumulative Bonus 10% increase in sum insured every claim-free year, over 10 years. Up to a max of 100% of the base sum insured.
Sum Insured Reinstatement Benefit: Up to 100% of the sum insured
Room Rent Limit Limits set on the basis of your sum insured
Pre-existing disease Covered after a 36-month waiting period
Specific Diseases Covered after a 24-month waiting period
Questions about Car Insurance

Frequently Asked Questions (FAQs)

The Bajaj Allianz Health Guard Plan provides extensive health coverage of up to Rs 1 Crore, ensuring that you are protected against a wide range of medical expenses.

There are no limits. The Bajaj Allianz Health Guard Plan offers you the flexibility to choose from a range of hospital room options, including Single Private Room, Share Room, Deluxe Room, Suite, etc. ensuring your comfort and convenience during your hospital stay.

Certainly! The Bajaj Allianz Health Guard Plan provides coverage for a wide range of modern treatments up to the sum insured you’ve chosen.

Unfortunately, the Bajaj Allianz Health Guard Plan does not offer coverage for expenses that are not related to medical needs. It is important to carefully review the policy details to understand what is and isn't included in your coverage.

The Bajaj Allianz Health Guard Plan includes a waiting period of 36 months during which pre-existing diseases are not covered.