Bajaj Allianz

1. Individual health guard

2. Bajaj Allianz's Individual Health Guard plan is designed to suit all your health care

needs. It takes care of the expensive medical treatment incurred during

hospitalization resulting from serious illness or accident.

3. Your health is precious to you - it enables you to live your life the way you please.

But a sudden illness or accident can put a stop to your way of living and empty your

savings. Protect yourself with the Bajaj Allianz Individual Health Guard - an all-round

policy that covers you against medical expenses including hospitalization, in the

event that you fall ill or have an accident. Now you don't ever have to worry about

not having enough money for treatment in case things go wrong.

Features

The policy covers hospitalization expenses for you.

You will have access to cashless facility at over 3000 empanelled hospitals across

India.(subject to exclusions and conditions)

Pre and post hospitalization expenses covers relevant medical expenses incurred 60

days prior to and 90 days after hospitalization.

Covers ambulance charges in an emergency subject to a limit of Rs 1000.

130 daycare procedures are covered subject to terms & conditions.

Benefits

Family discount of 10% is applicable.

5% cumulative bonus benefit for each claim free year, maximum up to 50%. cumulative

bonus would be passed for sum insured Rs.2,00,000/- and above continuously renewed

with us.

No medical tests upto 45 years, subject to clean proposal form.

Medical tests (pre-policy check-up) are mandatory for members aged 46 years and

above.

The pre-policy check up would be arranged at our empanelled diagnostic centers.

100% cost of pre-policy check-up would be refunded if the proposal is accepted and

policy is issued.

In case the member opts for hospitals besides the empanelled ones, the expenses

incurred by him shall be reimbursed within 14 working days from submission of all

documents.

Health check-up at designated Bajaj Allianz diagnostic centers or reimbursement upto

Rs.1000/- at the end of 4 continuous claim-free years. This benefit can be availed by

only one member of the family.

Income tax benefit on the premium paid as per Section 80D of the Income Tax Act.

Eligibility

Entry age for proposer is 18 years to 65 years. The policy can be renewed upto 80

years*.

Children aged 3 months to 25 years can be covered under this policy.

Exclusions

A waiting period of 4 years will be applicable in the case of pre-existing diseases.

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

excluded from coverage.

Certain diseases such as hernia, piles (liability restricted upto 10% of SI, max. upto

Rs.35,000) and sinusitis shall be covered after a waiting period of 2 years.

Treatment consisting of non-allopathic medicine will not be covered.

Congenital diseases are also excluded from coverage, as are all expenses arising from

AIDS and other related diseases.

Cosmetic, aesthetic or related treatments will not be covered.

Treatment will not be covered for use of intoxicating and/or addictive substances like

alcohol, drugs etc.

Joint replacement surgery (other than due to accidents) shall have a waiting period of 4

years before it is covered.

2.

Health Ensure - Health Insurance Protection Plan

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Brochure

The Health Ensure policy is the perfect health protection for you and your family. It

takes care of medical treatment costs incurred during hospitalization due to serious

accident or illness.

Features

Advantages

Coverage

Claim Procedure

My Premium Cost

FAQ

Features

Pre-existing diseases covered after 2 yrs continuous renewals with us.

A flat benefit of 2% of admissible hospitalization expenses are paid towards pre &

post hospitalization expenses.

Access to 2400 hospitals for Cashless facility

In case of admission in non network hospitals the expenses incurred would be

reimbursed within 14 days from the date of submission of all documents

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Advantages

No tests required up to the age of 55 yrs*

Health Check up at the end of continuous four claim free year

130 day care procedures covered

In case of emergency ambulance charges covered subject to a maximum of Rs.

1000 /- per policy period.

Hassle free claim settlement due to in house claims administration team

Family discount of 5 % is applicable

http://www.bajajallianz.com/Corp/content/Health%20Pdfs/health_ensure.pdf

Income tax benefit on the premium paid as per section 80-D of the income Tax

Act.

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Coverage

Policy can be taken from 3 months to 55 yrs *

Renewal up to 75 yrs*

SI - 50,000, 75000, and 1 lac.

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Claim Procedure

1. The illness / claim should be reported to BAJAJ ALLIANZ GENERAL INSURANCE

COMPANY LTD. with an immediate notice by telephone or in Writing (email / Letter)

2. On receipt of claim intimation, BAJAJ ALLIANZ GENERAL INSURANCE COMPANY

LTD will forward a claim form and check list for the documents to be submitted by the

claimant.

3. After receiving the claim form the claimant should submit the completed claim Form

mentioning the following mandatory details:

Insured details (Name / Address / Age / Sex / Contact No. )

ID card number and the current policy number

Hospitalization details (Date and time of admission and discharge).

Details of the other mediclaim policies in force.

Signature of the claimant.

4. The other relevant documents to be submitted along with the claim form are as

below:

A photocopy of your previous policy details prior to taking your Health Ensure policy

from Bajaj Allianz (if applicable)

A photocopy of your present policy document with Bajaj Allianz

First Prescription from the Doctor.

The Claim Form duly signed by the claimant or family member.

The Hospital Discharge Card

The Hospital Bill giving detailed break up of all expense heads mentioned in the bill.

E.g. if Rs.1,000/- has been charged towards medicines in the bill, the names of the

medicines, the unit price and the quantity used should be mentioned. Similarly e.g. If

Rs.2,000/- has been charged towards Laboratory Investigations, then the names of

the investigations, the number of times each investigation has been performed and

the rate should mentioned. In this way clear break ups have to be mentioned for OT

Charges, Doctor's Consultation and Visit Charges, OTConsumables, Transfusions,

Room Rent, etc.

The Money Receipt duly signed with a Revenue Stamp.

All Original Laboratory & Diagnostic Test Reports. E.g. X-Ray, E.C.G, USG,MRI

Scan, Haemogram etc.(Please note that it is not mandatory to enclose the films or

plates, a printed report for each investigation is sufficient)

If the medicines have been purchased in cash and if this has not been reflected in

the hospital bill, a prescription from the doctor and the supporting medicine bill from

the Chemist has to be enclosed.

If the insured has paid in cash for Diagnostic or Radiology tests and it has not been

reflected in the hospital bill, it is mandatory to enclose a prescription from the doctor

advising the tests, the actual test reports and the bill from the diagnostic centre for

the tests.

In case of a Cataract Operation, Please enclose the IOL Sticker.

PLEASE NOTE THAT ONLY ORIGINAL DOCUMENTS SHOULD BE ENCLOSED

(EXCEPT FOR POLICY COPY), DUPLICATES OR PHOTOCOPIES WILL NOT BE

ENTERTAINED

Pre & Post Hospital Expenses:

Medicines: Mandatory to provide doctor's prescription advising medicines and the

relevant chemist bill.

Doctor's Consultation Charges: Mandatory to provide the Doctor's prescription and

the doctor's bill and receipt.

Diagnostic Tests: Mandatory to provide the Doctor's prescription advising tests, the

actual test reports and the bill and receipt from the diagnostic centre.

The claims team would assess the claim for completeness of documentation and

Admissibility. A written communication would be sent to the insured regarding

Requirement of documents if any or if the claim is deemed to be inadmissible as per

Policy terms and conditions.

In case the claim is determined to be admissible a pay order and discharge voucher

would be sent to the insured address as mentioned on the policy document.

3. Extra Care

If the sum insured of your existing health insurance plan does not suffice for

expenses due to illness or accidents, the Extra Care health insurance policy

takes care of the additional hospitalization expenses.

As health expenses increase, you may find that your base health insurance is no

longer sufficient for your needs. A serious illness or accident can require long

term care and complicated treatment that can quickly become expensive and

exhaust your health cover. What do you do then? Bajaj Allianz Extra Care is a

top-up cover that ensures you do not run short of money if your health insurance

policy runs out. Secure yourself with Extra Care and never worry about medical

expenses again.

Coverage

Medical Expenses: Covered upto the sum insured.

Ambulance Charges: Up to Rs.3000/-.

Pre and Post Hospitalisation: Upto 60 and 90 days respectively.

Waiver for Pre-existing Diseases: After 4 years of continuous policy.

Floater Policy (upto 3 Children): Single sum insured for the whole family.

Continuity: Continuity for waiting periods will be given for any policy at any sum insured.

Pre-Acceptance Medical Test: No test till 55 years of age for clean proposals.

Entry Age 3 months-70 years: Renewable up to 80 years.

Affordable Premium: Starting at Rs.2500/-.

Benefits

Can be taken as an add-on policy with any health insurance policy.

Income tax benefit on the premium paid as per section 80-D of Income Tax Act as per

existing IT law.

Premium starting at Rs.2500 p.a with sum insured options of Rs.10, 12 or 15 lakhs.

This is a floater policy; thus there will be a single sum insured and single premium for

the whole family.

Competitive premium rates.

No medical tests up to 55 years of age, subject to a clean proposal form.

Tax Exemption

Tax exemption under Section 80D on premium paid upto Rs.15000/- p.a.

Eligibility

Age of entry for proposer is 18 years to 70 Years; Renewable upto 80 years.

Children from 3 months to 5 years can be covered if both the parents are insured with

us.

Children from 6 years to 18 years can be covered if either of the parents is covered with

us.

Children from 18 years to 25 years can be covered as self-proposer or as dependents.

The primary member or the proposer can cover self, spouse and 3 children under this

policy.

The premium would be calculated as per the highest age of the family member.

Members covered under medical expenses (hospitalization) policy. This policy covers

the medical expenses in excess of the specified deductible amount.

Members who do not have any health policy can also opt for this policy; the expenses

up to the deductible limit (per hospitalization) would have to be borne by the member.

Exclusions

All diseases/illnesses existing prior to or at the time of proposing this insurance for a

period of 4 years.

Any diseases contracted during the first 30 days of inception of the policy.

Congenital diseases and disorders.

Non-allopathic medicine.

Joint replacement surgeries other than due to accident would have a waiting period of 4

years.

All expenses arising out of AIDS and related diseases.

Cosmetic and aesthetic treatments.

Use of intoxicating drugs or alcohol.

Any fertility, sub-fertility, impotence, assisted conception operation, or sterilization

procedure.

Deductible

Deductible means the amount stated in the schedule which shall be borne by the

insured with respect to each and every hospitalization claim incurred within the policy

period. The company's liability to make any payment for each and every claim under the

policy is in excess of the deductible. Each and every hospitalization would be

considered as a separate claim. (Except relapse within 45 days, which will be treated as

the same claim.)

4. Family floater health guard

5. In these times of rising medical costs, Bajaj Allianz's Family Floater Health Guard

Policy is the perfect health protection for you and your family. It takes care of the

expensive medical treatment incurred during hospitalization resulting from serious

illness or accident.

6. You want to protect your family, but rising medical expenses mean that an

unforeseen accident or illness can put your savings - and their future - in jeopardy.

Protect your family with the Bajaj Allianz Family Floater Health Guard. This all-round

health insurance policy covers you and your family against medical expenses such

as hospitalization, doctor's consultation, diagnostic tests, medicines, ambulance, etc.

Now you never have to worry about running out of cash when it comes to your

family's treatment.

Coverage1. Medical expenses2. Pre and post hospitalization3. Emergency ambulance charges4. Cashless treatment5. Family floater cover6. 130 day care procedure

Benefit

Cumulative bonus of 5% to your Limit of Indemnity for every claim free year.

5% cumulative bonus benefit for each claim free year, maximum up to 50%. cumulative

bonus would be passed for sum insured Rs.2,00,000/- and above continuously renewed

with us.

No medical tests upto 45 years, subject to clean proposal form.

Medical tests (pre-policy check-up) are mandatory for members aged 46 years and

above.

The pre-policy check up would be arranged at our empanelled diagnostic centers.

100% cost of pre-policy check-up would be refunded if the proposal is accepted and

policy is issued.

In case the member opts for hospitals besides the empanelled ones, the expenses

incurred by him shall be reimbursed within 14 working days from submission of all

documents.

Health check-up at designated Bajaj Allianz diagnostic centers or reimbursement upto

Rs.1000/- at the end of 4 continuous claim-free years. This benefit can be availed by

only one member of the family.

Income tax benefit on the premium paid as per Section 80D of the Income Tax Act.

Eligibility

Entry age for proposer is 18 years to 65 years. The policy can be renewed upto 80

years*.

Children aged 3 months to 25 years can be covered under this policy.

There shall be a waiting period of 4 years for pre-existing diseases.

All diseases/injuries existing at the time of proposing this insurance.

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

Certain diseases such as hernia, piles, cataract (liability restricted upto 10% of SI, max.

upto Rs. 35,000), sinusitis shall be covered after a waiting period of 2 years.


Congenital diseases.

All expenses arising from AIDS and related diseases.

Cosmetic, aesthetic or related treatment.

Use of intoxicating drugs and alcohol.

Joint replacement surgery (other than due to accident shall have a waiting period of four

years).

Exemptions

There shall be a waiting period of 4 years for pre-existing diseases.

All diseases/injuries existing at the time of proposing this insurance.

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

Certain diseases such as hernia, piles, cataract (liability restricted upto 10% of SI, max.

upto Rs. 35,000), sinusitis shall be covered after a waiting period of 2 years.


Congenital diseases.

All expenses arising from AIDS and related diseases.

Cosmetic, aesthetic or related treatment.

Use of intoxicating drugs and alcohol.

Joint replacement surgery (other than due to accident shall have a waiting period of four

years).

Tax Exemption

Tax exemption under Section 80D on premium paid upto Rs.15000

5. Crritical illness for women coverage

This is a women-specific Critical Illness Insurance scheme that provides you protection against the risk of 8 critical illnesses.It gives you the security of knowing that a guaranteed cash sum will be paid in case you are diagnosed with a life-threatening illness.

1. Overian cancer2. Vaginal cancer3. Uterin endowmetrial cancer4. Fallopian tube cancer5. Paralysis6. Burns7. Cervical cancer8. Breast cancer

Benefits

A. Congenital Disability Benefit (50% of Sum insured)

An amount equal to 50% of the sum assured will be payable under the plan on the birth

of the child with any one or more of the Congenital Disabilities listed below and the child

survives 30 days from the date of diagnosis. This benefit will be available for first two

children only and will not be available if the birth of the child occurs after the proposer

attains the age of 40 years.

List Of the Congenital diseases /defects

o Down's syndrome:

o Congenital cyanotic heart disease:

o Tracheo-esophageal fistula:

o Cleft Palate with or without cleft lip:

o Spina bifida:

Down's syndrome:

o Oblique eye fissures with skin folds on the inner corner of the eyes

o muscle hypo-tonia (poor muscle tone)

o a single palmar fold

o a protruding tongue (due to small oral cavity, and an enlarged tongue near the

tonsils)

o Most individuals with Down syndrome have mental retardation in the mild to

moderate range

o In addition, individuals with Down syndrome can have serious abnormalities affecting

any body system. They also may have a broad head and a very round face

Congenital cyanotic heart disease:

o A hole between the two bottom chambers (ventricles) of the heart Ventricular septal

Defect.

o A narrowing of the right ventricular outflow tract and can occur at the pulmonary

valve (valvular stenosis).

o An aortic valve with biventricular connection, that is, it is situated above the

ventricular septal defect and connected to both the right and the left ventricle.

o The right ventricular wall increases in size causing a characteristic boot-shaped

(coeur-en-sabot) appearance as seen by chest X-ray.

o It is the most common cyanotic heart defect, representing 55-70%, and the most

common cause of blue baby syndrome

Tracheo-esophageal fistula

o An abnormal connection (fistula) between the esophagus (food pipe) and the trachea

(wind pipe).

o Tracheoesophageal fistula is suggested in a newborn by copious salivation

associated with choking, coughing, and cyanosis coincident with the onset of feeding.

o Once diagnosed, prompt surgery is required to allow the baby to take in food.

Cleft Palate

o Cleft palate is a condition in which the two plates of the skull that form the hard palate

(roof of the mouth) are not completely joined.

o The hole in the roof of the mouth caused by a cleft connects the mouth directly to the

nasal cavity.

o A cleft lip or palate can be successfully treated with surgery soon after birth.

Spina Bifida

o "split spine" is a developmental birth defect involving the incomplete closure of the

neural tube in developmental stage which results in an incompletely formed spinal

cord.

o The most common location of the malformations is the lumbar and sacral areas of

the spinal cord.

o Myelomeningocele is the most significant form and it is this that leads to disability in

most affected individuals.

o Spina bifida can be surgically closed after birth, but nerve damage is permanent and

this does not restore normal function to the affected part of the spinal cord.

B. Children Education Bonus In the event of a Claim being admissible under Section I

(Critical Illness) the policy will pay Children's Education Bonus for future education of

the children (one or more). The amount payable under this section would be restricted

to Rs 25000/- for one or more child put together.

C. Loss of Job: In the event of the insured person losing her job within a period of 3

months of the date of diagnosis of any of the Critical Illness as covered in the policy, the

policy will pay an amount of Rs 25000/- towards loss of employment. For a claim to be

admissible under this section the claim under Section. I should be admissible.

o Specific Exclusions for loss of Job: Loss of Job due to voluntary resignation from

service is excluded.

Cast

The details furnished above do not constitute the entire terms and conditions, Please

refer the policy wordings for definitions, exclusions, terms and conditions. Premium

Table:

SUM INSURED Upto 25 Yrs 26-35 36-40 41-45 46-50 51-55

50000 250 375 688 1000 1500 2188

100000 375 563 1031 1500 2250 3281

150000 500 750 1375 2000 3000 4375

200000 625 938 1719 2500 3750 5469

Service Tax Extra

*Additional Inbuilt Benefits:

Children Education Bonus - Rs 25000/- payable if the claim is paid under Critical Illness

Section

Loss of Job - Rs 25000/- payable if the claim is admissible under Critical Illness section

* Subject to terms & conditions as specified under the policy

Medical Tests Required

SUM

INSURED

21-

25yr

26-

35

36-

4041-45 46-50 51-55

50000 nil nil nil nil nil nil

100000 nil nil nil nil FMR,USG FMR,USG

150000 nil nil nilFMR,US

G

FMR,USG,PA

P

FMR,USG,PA

P

200000 nil nil nilFMR,US

G

FMR,USG,PA

P

FMR,USG,PA

P

Tests:

FMR: Full Medical Report as per Bajaj Allianz Format

USG: Ultrasonography of Abdomen and Pelvis

PAP: PAP Smear Test

Note: We regret that expecting mothers cannot purchase this policy at this time.

However, this policy can be bought three months post delivery.

Medicals are to be done by the customer. Bajaj Allianz can also arrange medical

test with our network clinics but the cost will have to be borne by the customer.

Exclusions

Despite the extensive coverage offered by this policy, there are a few exclusions that you need to know about. We suggest you read this section carefully before making your purchase decision. If you have any queries, please call us at: 020-66495000. Our female representatives will help you understand the terminologies better. Our team of female doctors will answer any in-depth queries you may have.

Exclusions for Breast Cancer

Tumours that are histologically (the study of the structure of cells and tissues)

described as pre-malignant (A precancerous condition) and Ductal /Lobular

carcinoma in situ (location) of the breast.

Breast Lumps e.g. fibro adenoma, fibrocystic diseases of breast etc.

All hyperkeratoses or basal cells carcinomas, melanomas, squamous cell carcinoma,

Kaposi’s sarcoma and other tumors associated with HIV infections or AIDS of the

skin

Learn more about the technical terms listed above

Ductal carcinoma in situ (DCIS), or inter-aductal carcinoma, is breast cancer in the

lining of the milk ducts that has not yet invaded nearby tissues. It may progress to

invasive cancer if untreated.

Lobular carcinoma in situ (LCIS) is a marker for an increased risk of invasive

cancer in the same or both breasts.

Fibro adenoma, fibrocystic diseases of breast - Fibrocystic changes (formerly

called fibrocystic breast disease) include breast pain, cysts, and lumpiness that are

not due to cancer.

Hyperkeratoses or basal cells carcinomas, melanomas, squamous cell carcinoma,

Kaposi’s sarcoma are types of Skin Cancers and not breast cancers.

6. Tax gain plan

Tax Gain Plan - Health Insurance Policy

Download Brochure

YES! You can save tax and gain OPD benefits also!

Bajaj Allianz has designed a unique product - The Tax Gain plan, a Family floater

health policy which covers out patient (OPD) expenses & hospitalization expenses

under a single policy and helps you in your tax management also.

Features

Policy Benefits

Premium Table

1. Features

OPD & Hospitalisation expenses covered under a single policy on floater basis

Access to over 2400 hospitals all over India for cashless facility.

Covers ambulance charges in case of an emergency up to Rs 1000/-

130 day care procedures subject to terms & conditions

10% co-payment of the admissible claim amount applicable if treatment is taken in

non-network hospital, waiver of co-payment is available on payment of additional

premium.

Provides benefit of Health check-up at the end of each four (Hospitalization) claim free

policy periods. Tests as specified in the schedule. This benefit can be opted by any

one insured member

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http://www.bajajallianz.com/Corp/health/tax-gain.jsp#top

http://www.bajajallianz.com/Corp/content/Health%20Pdfs/opd_tax_Gain_new_ver1.pdf

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2. Benefits

A single policy or cover can be continued till a person reaches 75 yrs!

The premium slabs remain same from 18 yrs -55 yrs & 56- 75 yrs

No restrictions of waiting periods to claim under Out patient expenses

You can claim for dental procedures & treatment under OPD section!

Cost of Spectacles, dentures, crutches can also be claimed under OPD Section!

Provides Tax benefit under section 80 D of Income Tax Act

In house claims settlement without hassles of going through a TPA.

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PLANS AND PREMIUM CHART

Flat premium 4999 * 18-25

yrs

26-40

yrs

41-45

yrs

46-55

yrs.

Hospitalization cover - Floater Sum Insured

1 lac

OPD Benefits Self 3100 2900 2500 1600

PLAN-B Tax Gain9999


yrs

26-40

yrs

41-45

yrs 46-55 yrs

http://www.bajajallianz.com/Corp/health/tax-gain.jsp#top


2lacs


OPD benefits Self + spouse 5200 4800 3500 1000

PLAN-C Tax Gain 14999 1 ) C- 1


yrs

26-40

yrs

41-45

yrs 46-55 yrs


2 lacs



2 ) C-2


yrs

26-40

yrs

41-45

yrs 46-55 yrs


3 lacs



PLAN- D-FOR SENIOR CITIZENS - Tax Gain

19999


yrs

61-65

yrs

65-70

yrs 71-75 yrs

Hospitalization cover-Floater Sum Insured

1 lac

OPD Benefits -Self 13000 12500 12000 11000

OPD benefits- Self + spouse 11000 10000 9500 8000

*Flat Premium (Rs) inclusive of Service Tax

All Sums Insured for Hospitalisation and OPD benefit in Indian Rupees.

7.

Personal Guard - Accident Health Insurance

Download Brochure

Life is uncertain. Your future doesn't have to be. Accidental death or injury of a breadwinner can

create serious financial problems for the family. Our Personal Guard health insurance plan

ensures total security and peace of mind.

Personal Guard is a policy that covers the insured against bodily injury or death caused due to

accidents.

Policy Benefits

Exclusions

Claim Procedure

Premium Table

FAQ

Sl / Age Basic Wider Comprehensive

Death

Permanent Total

http://www.bajajallianz.com/Corp/content/Health%20Pdfs/Personal_Gard_brochure.pdf

Disability

Permanent Partial

Disability

Temporary Total

Disability

Children's Education

Bonus

Sum Insured

Medical Expenses +

Hospital Confinement

1. What are the benefits of this policy?

Highest compensation of 125% of the sum insured incase of permanent total disability.

Medical Expenses arising out of accident.

Children's education bonus / in case of death or permanent total disability.

Cumulative bonus @5% per claim free year to a maximum of 50% (reduced by 10% if

claim is lodged).

Family discount of 10%.

Benefit Compensation

Medical ExpensesReimbursement upto 40% of valid claim amount

or actual medical bills, whichever is less

Hospital Confinement Rs.1000/- per day for a maximum of 30 days hospitalization

Children's Education Bonus

Rs.5000/- for a child or Rs. 10,000/- maximum

for 2 children below the age of 19 or 10% of

capital sum insured, whichever is less

In case of permanent partial disablement, we will pay the percentage, of sum assured as

applicable given in the table below:-

Scale of benefits description Compensation as% of sum insured

An arm at the shoulder joint 70

An arm above the elbow joint 65

An arm beneath the elbow joint 60

A hand at the wrist 55

A thumb 20

An index finger 10

Any other finger 5

A leg above the mid-thigh 70

A leg upto mid-thigh 60

A leg upto beneath the knee 50

A leg upto mid-calf 45

A foot at the ankle 40

A large toe 5

Any other toe 2

An eye 50

Hearing loss in one ear 30

Hearing loss on both ears 75

Sense of smell 10

Sense of taste 5

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2. Premium Rate

The premium differs in case of different risk levels determined by your occupation.

Risk Level I: Administrative / managing functions, accountants, doctors, lawyers, architects,

teachers and similar occupations.

Risk Level II :

http://www.bajajallianz.com/Corp/health/personal-guard.jsp#top

Manual labour, garage mechanic, machine operator paid driver (car / truck / heavy vehicles)

cash carrying employee, builder, contractor, veterinary doctor and similar occupations.

Risk Level III:

Workers in underground mines, electric installations with high tension supply, jockey, circus

performers, big game hunters, mountaineers, professional river rafters and similar

occupations.

(For occupations not specified above, please enquire with us).

Annual Premium Rate

Premium rates given below (%) -Rs per 1000/-

Cover Risk Class

I II III

Basic 0.45 0.6 0.9

Wider 1.0 1.25 1.75

Comprehensive 1.5 2.0 Not available

Medical Expenses25% of above

premium

25% of above

premium

25% of above

premium

Hospital

ConfinementRs. 300 per person Rs. 300 per person Rs. 300 per person

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3. Who is eligible for this policy?

1. How do I submit my claim?

If you meet with an accident and injure any part of your body that may result in a claim,

you or someone claiming on your behalf must inform us in writing immediately, and in

any event within 14 days.

Incase of death due to accident, the same must be informed to us in writing immediately

and a copy of the post mortem report should be sent to us within 14 days.

2. What are the steps to be taken?

You must immediately consult a Doctor and follow the advice and treatment that he

recommends.

You must get yourself examined by our medical advisors if we ask for this, and as often

as we consider this to be necessary.

You or someone claiming on your behalf must promptly provide us the documentation

and other information we ask for in order to investigate the claim or to carry out our

obligation to make payment for it.

3. How soon can I get my compensation? What is the mode of payment?

Bajaj Allianz believes in quick processing. Claims are processed within seven working

days from the date of fulfilling all the requirements.

You must get yourself examined by our medical advisors if we ask for this, and as often

as we consider this to be necessary.

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http://www.bajajallianz.com/Corp/health/personal-guard.jsp#top

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4. Claim Procedure

1. The illness / claim should be reported to BAJAJ ALLIANZ GENERAL INSURANCE

COMPANY LTD. with an immediate notice by telephone or in Writing (email / letter).

2. On receipt of claim intimation, BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LTD will

forward a claim form and check list for the documents to be submitted by the claimant.

3. After receiving the claim form the claimant should submit the completed claim form

mentioning the following mandatory details:-

Insured details (Name / Address / Age / Sex / Contact No.)

Accident details (Date and circumstances of accident / injury).

Details of the other Personal Accident policies in force.


4. The other relevant documents to be submitted along with the claim form are as follows:-

A. Death

Claim form

Police Panchanama, FIR, Post mortem Report, Death Certificate

If admitted - the Admission history.

B. PTD (Permanent Total Disability) & PPD (Permanent Partial Disability)

Claim form

Disability Certificate from the treating doctor

Medical Examination.

C. Temporary Total Disablement (Weekly Benefit)

Claim form

Medical Certificate from the treating doctor

Leave certificate from the employer.

5. If there is a discrepancy / disagreement on the percentage of disability, the insured may be

referred to an independent orthopedic surgeon for an unbiased opinion.

6. The claims team would assess the claim for completeness of documentation and

admissibility. A written communication would be sent to the insured regarding requirement of

documents if any or if the claim is deemed to be inadmissible as per policy terms and

conditions.

7. In case the claim is determined to be admissible a pay order and discharge voucher would be

sent to the insured address as mentioned on the policy document.

8.

Critical Illness Download Brochure

A health insurance plan that covers critical illness means you can insure yourself against the

risk of serious illness in much the same way as you insure your car and your house. It will give

you the same security of knowing that a guaranteed cash amount will be paid if the unexpected

happens and you are diagnosed with a critical illness.

Advantages of Critical Illness health insurance plan

Illness Covered

Exclusions

Claim Procedure

Premium Table

FAQ

1. Advantages of Critical Illness Health Insurance Plan

The Critical Illness health insurance plan has the following advantages:-

The benefit amount is payable once the disease is diagnosed meeting specific criteria

and the insured survives 30 days after the diagnosis.

The insured receives the amount as lumpsum so that he can plan the treatment

accordingly.

Expenses like donor expenses in a transplant surgery, which are not covered under

http://www.bajajallianz.com/Corp/content/Health%20Pdfs/Critical_illness_brochure.pdf

normal health insurance policy, can be paid out of the amount received under this cover

both in India & abroad.

Key Features

The product is offered from 6 to 59 years.

Medical examination may be required in some cases based on the age and the benefit

amount opted by the proposer.

Very competitive premium rates.

Insured can opt for Sum Assured from 1,00,000 to Rs. 50,00,000.

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2. Illness Covered

1) Cancer:-

A claim can be made if the assured is diagnosed as suffering from a malignant tumour,

which has invaded surrounding tissue. A microscopic examination of the cells will be

required to confirm the claim.

2) Coronary Artery Bypass Surgery:-

When coronary arteries become narrowed or blocked they cannot supply enough blood to

the heart muscle. To correct this and prevent risk of death, a coronary artery bypass surgery

is performed in which two sections of artery on either side of the blockage are connected

together. With our health insurance plan - Critical Illness, you can insure yourself against

this serious illness in much the same

way as you insure your car and your house. You will be able to claim if you undergo this

surgery for blockage of 2 or more coronary arteries.

http://www.bajajallianz.com/Corp/health/critical-Illness.jsp#top

3) First Heart Attack:- (Myocardial Infarction)

First heart attack, also known as myocardial infarction, occurs when part of the heart muscle

dies from lack of oxygenated blood. Chest pain is usually felt at the time of the attack, ECG

(electrocardiogram) changes will confirm the diagnosis. A damaged heart also releases

enzymes into the bloodstream and a blood test will show that the heart attack is recent.

4) Kidney Failure:-

The kidneys act as filters and remove waste from the blood. When the kidneys fail to do this,

waste builds up in the blood and leads to severe complications. Although it is possible to

manage with one kidney; if both kidneys fail completely, one will need long-term dialysis or a

transplant.

5) Major Organ Transplant:-

Sometimes a major internal organ is so seriously diseased or damaged that the only

effective treatment is replacement with a healthy one. Kidney transplants are covered under

a separate section.

6) Multiple Sclerosis:-

This is a progressive disease of the central nervous system where the protective covering

(myelin) of the nerve fibers in the brain and spinal cord is destroyed. The severity of the

disease and symptoms will depend on the areas of the brain or spinal cord affected. Periods

of remission which may last many years between acute phases are characteristic of the

disease.

7) Stroke:-

A stroke is an incident, which affects the supply of blood to the brain causing permanent

neurological damage such as paralysis or disturbance of speech or vision. Transient

ischaemic attacks are excluded as they do not cause permanent damage and the symptoms

do not last for more than few days.

8) Aorta Graft Surgery:-

The aorta is the main artery that supplies oxygenated blood to all other parts of the body.

Sometimes, part of the aorta becomes blocked or weak and may need replacement. You

will be able to claim if you need surgery to remove and replace part or the entire aorta.

9) Paralysis:-

Paralysis is usually caused by damage to the brain or spinal cord, affecting the transmission

of messages through the nervous system or by physical injury to the limbs in question.

10) Primary Pulmonary Arterial Hypertension:-

Primary pulmonary hypertension a progressive disorder recommended or which was first

manifested or contracted before characterized by high blood pressure (hypertension) of the

main artery of the lungs (pulmonary artery). The pulmonary artery is the blood vessel that

carries blood from the heart through the lungs.

Symptoms of primary pulmonary hypertension include shortness of breath (dyspnoea)

especially during exercise, chest pain, and fainting episodes. The exact cause of primary

pulmonary hypertension is unknown.

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3. Exclusions

Any critical illness for which care, treatment, or advice was recommended or which was

first manifested or contracted before

Any critical illness diagnosed within the first 90 days

Death with in 30 days following the diagnosis of the critical illness

Presence of HIV/AIDS infection

Treatment arising from or traceable to pregnancy or childbirth, including caesarean

section and birth defects

War, invasion, act of foreign enemy, terrorism, hostilities (whether war be declared or

not), civil war, rebellion, revolution

Naval or military operations of the armed forces or air force and participation in

operations requiring the use of arms or which are ordered by military authorities for

combating terrorists, rebels and the like, any natural peril

Consequential losses of any kind, be they by way of loss of profit, loss of opportunity,

loss of gain, business interruption etc.

The details furnished above do not constitute the entire terms and conditions.

For more details on the policy, please visit our office nearest to you. Our executives will be

pleased to furnish further details.

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Coverage

SI available from 1,00,000 to Rs. 50,00,000

Age band - 6 yrs - 59 Years.

Premium Table


Sum

insured

AGE ( in years)

21- 25 26 - 35 36 - 40 41 - 45 46 - 50 51 - 55 56 - 60

100000 200 300 550 800 1200 1750 3000

300000 600 900 1650 2400 3600 5250 9000

500000 1000 1500 2750 4000 6000 8750 15000

1000000 2000 3000 5500 8000 12000 17500 30000

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4. Claim Procedure

1. The illness / claim should be reported to Bajaj Allianz General Insurance Company Ltd.

with an immediate notice by telephone or in Writing (email / letter).

2. On receipt of claim intimation, Bajaj Allianz General Insurance Company Ltd. will forward

a claim form and check list for the documents to be submitted by the claimant.





Details of the other hospital cash policies in force.




Discharge summary mentioning the diagnosis, date and time of admission and

discharge, past medical and surgical history with duration.

All supporting reports to prove diagnosis.

First consultation paper.


admissibility. A written communication would be sent to the insured regarding requirement

of documents if any or if the claim is deemed to be inadmissible as per policy terms and

conditions.

6. In case the claim is determined to be admissible a pay order and discharge voucher

would be sent to the insured address as mentioned on the policy document.

9.

Star Package - Family Floater Health Insurance

Download Brochure

Star Package policy is a unique family floater policy which protects your family against various

risks and contingencies. It provides a gamut of covers for various health risks, household

contents, education grant, travel baggage and public liability all under a single policy. It has 8

sections and you would have to opt for a minimum 3 sections to avail for this policy.

The death, Injury or sickness of a breadwinner or family member can create serious financial

problems for any family. Star package insures you against these circumstances.

Features

Policy Benefits

Coverage

Claim Procedure

Premium Table

1. Features

Covers Hospital Cash, Health Guard, Critical Illness, Personal accident, Education Grant,

http://www.bajajallianz.com/Corp/content/Health%20Pdfs/star_package.pdf

Householders contents, Traveling Baggage & Public liability.

Family floater can be opted by paying 50% & 25% of self premium for spouse & children

respectively.

Add-on covers can be opted under Health Guard.

12 Dreaded diseases are covered under Critical illness.

The policy can be taken for maximum 3 years to avoid yearly renewal.

10-15% section discount can be availed if 4 or more sections are opted.

10-15% Long term discount can be availed if the policy is taken for 2 or more years.

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2. What are the benefits of this policy?

Wide coverage from Health to Home.

Access to over 2400 hospitals all over India for cashless facility.

No sub-limits applicable on room rent and other expenses.

Hassle-free claim settlement due to In-house claim administration.

Income tax benefit on the premium paid as per section 80-D of Income Tax Act* as per

existing IT law.

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3. Coverage

Age - 3 Months - 55 years.

Wide range of Sum Insured is available under different cover.

Products Sum Insured

http://www.bajajallianz.com/Corp/health/insurance-star-package.jsp#top

http://www.bajajallianz.com/Corp/health/insurance-star-package.jsp#top

Hospital cash 500 to 2500

Health Guard 100000 to 500000

Critical illness 100000 to 300000

Personal Accident 200000 to 500000

Education Grant 200000 to 500000

House Holder Content 100000 to 400000

Traveling Baggage 10000 to 40000

Public Liability 200000 to 500000

Claim Procedure

1. The illness / claim should be reported to Bajaj Allianz General Insurance Company Ltd. with

an immediate notice by telephone or in Writing (email / letter).

2. On receipt of claim intimation, Bajaj Allianz General Insurance Company Ltd. will forward a

claim form and check list for the documents to be submitted by the claimant.



Insured details (Name / Address / Age / Sex / Contact No. )

ID card number and the current policy number


Details of the other mediclaim policies in force.



A photocopy of your previous policy details prior to taking your Health Guard policy from

Bajaj Allianz (if applicable).

A photocopy of your present policy document with Bajaj Allianz.

First Prescription from the Doctor.

The Claim Form duly signed by the claimant or family member.

The Hospital Discharge Card

The Hospital Bill giving detailed break up of all expense heads mentioned in the bill. E.g. if

Rs.1,000/- has been charged towards medicines in the bill, the names of the medicines, the

unit price and the quantity used should be mentioned. Similarly , for e.g., If Rs.2,000/- has

been charged towards Laboratory Investigations, then the names of the investigations, the

number of times each investigation has been performed and the rate should mentioned. In

this way clear break-ups have to be mentioned for OT Charges, Doctor's Consultation and

Visit Charges, OT Consumables, Transfusions, Room Rent etc.

The Money Receipt duly signed with a Revenue Stamp.

All Original Laboratory & Diagnostic Test Reports. E.g. X-Ray, E.C.G, USG,MRI Scan,

Haemogram etc.(Please note that it is not mandatory to enclose the films or plates, a printed

report for each investigation is sufficient).

If the medicines have been purchased in cash and if this has not been reflected in the

hospital bill, a prescription from the doctor and the supporting medicine bill from the Chemist

has to be enclosed.

If the insured has paid in cash for Diagnostic or Radiology tests and it has not been reflected

in the hospital bill, it is mandatory to enclose a prescription from the doctor advising the tests,

the actual test reports and the bill from the diagnostic centre for the tests.

In case of a Cataract Operation, please enclose the IOL Sticker. r

PLEASE NOTE THAT ONLY ORIGINAL DOCUMENTS SHOULD BE ENCLOSED (EXCEPT

FOR POLICY COPY), DUPLICATES OR PHOTOCOPIES WILL NOT BE ENTERTAINED

Pre & Post Hospitalization Expenses:-

Medicines: Mandatory to provide doctor's prescription advising medicines and the relevant

chemist bill.

Doctor's Consultation Charges: Mandatory to provide the doctor's prescription and the

doctor's bill and receipt.

Diagnostic Tests: Mandatory to provide the doctor's prescription advising tests, the actual

test reports and the bill and receipt from the diagnostic centre.

The claims team would assess the claim for completeness of documentation and

Admissibility. A written communication would be sent to the insured regarding Requirement

of documents if any or if the claim is deemed to be inadmissible as per Policy terms and

conditions

In case the claim is determined to be admissible a pay order and discharge voucher would

be sent to the insured address as mentioned on the policy document.

10.

Life Health Insurance for hospitalization

At Bajaj Allianz Life Insurance we offer unique hospitalisation-cum-insurance plan that

takes care of your hospitalization bills and also provides crucial financial support to your

dependents in case of your unfortunate death.

Our health insurance plans offer a sound protection to safe guard your family from any

medical emergencies and will make sure that financial problems are least of your

worries in trying to get yourself treated.

We offer cash less Mediclaim facility across 2000 hospitals in over 300 towns and

provide best treatment in the finest hospitals with our health insurance products.

1.

Health Care - A health insurance plan to help you fight medical costs

Download Brochure

http://www.bajajallianz.com/Corp/content/Health%20Pdfs/Helthcare.pdf

Health is Wealth...

particularly when health

care costs are getting

higher every year. The

emotional and financial

burden of a serious

accident, major illness or

surgery often lasts beyond

the immediate period of

the trauma. Bajaj Allianz

HealthCare protects you

and your family from the

high expenses associated

with medical care and

provides you with a

comprehensive financial

cushion against various

health hazards. The

benefits under this plan are

payable in addition to the

benefits under all other

plans that you may have,

including a Medi-claim

policy.

Following Benefits are available in the

Health Care Plan:-

Life Cover is payable on death of the life

assured.

Hospital Cash Benefit

Post Hospitalization Benefit

Surgical Benefit

Critical Illness Benefit

Accident Permanent Total/Partial Disability (APT/PD)

Multiple Claims:- Hospital Cash, Post Hospitalization Benefit & Surgical Benefit can

be claimed on multiple occasions as per the coverage selected (subject to the overall

limits) provided the policy is in force at the time of claim.

2. Family CareFirst - A health insurance plan for the entire family

Download Brochure

The health of your family is very important to

you. When faced with hospitalization or one or

more family members, the medical bills can

severely dent your savings. The cost associated

with hospitalization might be very high and you

need to be better prepared for such an

emergency.

Buying Medical Insurance for each individual

family member can be cumbersome and

expensive. What if there is a solution that gives

you a single tool to cover your entire family - all

in one? Bajaj Allianz Family CareFirst presents

an innovative yet practical health care plan for

everyone in your family including children and

parents. This unique hospitalization plan gives

you a 3-year health cover for your entire family

and allows you to renew the policy after every 3

years to keep your family covered till the age of

74 years. So no separate accounts, repetitive

paperwork or payment adjustments for each

member. Secure your entire family in one shot.

Download Brochure in Regional

Languages

http://www.bajajallianz.com/Corp/content/Health%20Pdfs/familycarefirst.pdf

Key Benefits

Coverage from 3 months to age 74 with guaranteed renewals

3 year premium guarantee for each policy term

Hospitalization Cover in leading hospitals across the country

15% discount on prevailing premium on every renewal

No claim bonus in the form of increase in sum assured @5% every year

Day Care Treatment for 140 day care procedures

Pre-Hospitalization and Post-Hospitalization Benefit

Reimbursement of Ambulance expenses

Choice to select Health Critical Illness rider

Choice to include Your spouse, children and parents

Cash Less Service Facility in leading hospitals across the country

11.

Hospital Cash Download

Brochure

Hospital Cash Policy guards you and your family against the trauma that you face

because of increased financial burden during hospitalization.

Premium Table

Coverage per day Proposer AgePremium(Rs) for

30day cover

Premium(Rs) for

60day cover

Rs.500

Upto 25 years

Above 25 years upto 40 years




250

400

650

900

1200

300

525

850

1200

1600

Rs.1000 Upto 25 years




300

600

900

1300

500

825

1800

2400

http://www.bajajallianz.com/Corp/content/Health%20Pdfs/Hospitalcash_brochure.pdf

Above 55 years upto 60 years 1800 3000

Rs.2000

Upto 25 years





600

850

1700

2800

3600

1000

1500

3600

4400

4800

Rs.2500

Upto 25 years





800

1100

2600

3500

4600

1350

1800

4200

5000

5800

Coverage

1. Whom all does the policy cover?

Hospital Cash offers complete health protection for you, your spouse as well as children.

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2. How can the Hospital Cash Policy work best for me?

It is recommended that the Hospital Cash Policy be taken as an add on policy along with our

Health Guard / Critical illness policies so as to be assured of peace of mind

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3. What are the exclusions under the policy?

http://www.bajajallianz.com/Corp/health/hospital-cash.jsp#top


Hospitalization with in 30 days from the commencement of the policy, pre-existing diseases,

dental treatment or surgery, treatment related to pregnancy, childbirth, natural perils like

avalanche, earthquake, volcanic eruptions etc., accidents resulting from drunken driving are

some exclusions.

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4. Claim Procedure

1. The illness / claim should be reported to Bajaj Allianz General Insurance Company Ltd. with

an immediate notice by telephone or in Writing (email / letter).

2. On receipt of claim intimation, Bajaj Allianz General Insurance Company Ltd. will forward a

claim form and check list for the documents to be submitted by the claimant.


mentioning the following mandatory

details :-



Details of the other hospital cash policies in force.


4. The other relevant documents to be submitted along with the claim form are as below :-

Discharge summary mentioning the diagnosis, date and time of admission and discharge,

past medical and surgical history with duration.

All supporting reports to prove diagnosis.

First consultation paper.



admissibility. A written communication would be sent to the insured regarding requirement of

documents if any or if the claim is deemed to be inadmissible as per policy terms and

conditions.

6. In case the claim is determined to be admissible a pay order and discharge voucher would be

sent to the insured address as mentioned on the policy document.

12. Silver health

Health care costs are high and getting higher. As the age of an individual increases, the health care costs increase manifold and become a burden on the individual. Senior citizens have to pay out of their hard-earned savings to meet the expenses. Bajaj Allianz's Silver Health Plan for senior citizens protects you and your spouse in case you need expensive medical care.

Be secure in your later years

Pre-existing illnesses covered* In-house Health Claim Administration Team Cashless facility Global expertise Quick disbursement of claims Innovative packages to match individual needs

Coverage

The policy covers hospitalisation expenses and an amount equivalent to 3% of admissible pre and post hospitalisation expenses.

Covers ambulance charges in an emergency, subject to a limit of Rs.1000. Pre-existing illnesses are covered from the second year of the policy. The Company's liability in case of any pre-existing illness from the second year of the

policy subject to limit of 50% of the Limit of Indemnity in a policy year. The policy has a lifetime indemnity limit of three times the Limit of Indemnity specified

in the earliest senior citizen plan, if the policy is renewed continuously.

Benefits

Cashless Facility: with Silver health plan, the member has access to cashless facility at various network hospitals across India (subject to exclusions and conditions).

The member can opt for other besides the empanelled ones, in which case the expenses incurred by him/ her shall be reimbursed within 14 working days from submission of all the documents.

20% co-payment the admissible claims to be paid by the member if treatment is taken in a hospital other than a network hospital. Waiver of co-payment is available on payment of additional premium.

Cumulative bonus of 5% to your Limit of Indemnity for every claim free year. Health checkup in designated Bajaj Allianze Diagnostic centers at the end of four

continuous claim-free years. Family Discount of 5%. Income tax benefit on the premium paid as per section 80 D of the Income Tax Act.

Eligibility

You are covered from Age of 46 yrs to 75 years. Age at entry is restricted to 70 years. Pre-acceptance medical tests are to be held at the cost of the proposer. However, if the

proposal is accepted, the Company will reimburse the cost of medical tests. (Only for fresh proposals)

Exclusions

All diseases/injuries existing at the time of proposing this insurance. Any disease contracted during the first 30 days of commencement of policy. Certain diseases such as hernia, piles, cataract, benign prostatic hypertrophy,

hysterectomy shall be covered after a waiting period of 1 year. Non-allopathic medicine. All expenses arising from AIDS and related disorders. Cosmetic, aesthetic or related treatment. Use of Intoxicating drugs and alcohol. Joint replacement surgery (other than due to accidents) will have a waiting period of four

years. Treatment of any mental illness or psychiatric illness.

Documents

Bajaj Allianz