Health Insurance Extra Care Policy FAQs – Bajaj Allianz

While buying health insurance, it is important to first know about then various types of health insurance policy, understand the extent of the cover and the features of the policy. This list of frequently asked questions can help you understand Bajaj Allianz Extra Care Policy fully. 1.    What is Extra Care Policy and what are its benefits? It is a top-up health cover over your existing health/ hospitalization policy. This policy can be taken as add-on cover to your existing hospitalization policy. In case of higher expenses due to illness or accidents, when the existing policy sum insured gets exhausted, the Extra Care policy takes care of the additional expenses.  2.    Can I opt for this policy if I do not have any existing health / hospitalization policy? Members who do not have any health policy can also opt for this policy, However, the expenses up to the deductible limit (per hospitalization) have to be borne by the member. 3.    Please explain what is ‘deductible limit’? In case you have an existing policy, then the sum insured in this base policy is the deductible limit. For example: For example: If you have a health insurance policy with 3 lakh sum insured, then 3 lakh would be the deductible limit. The extra care policy would be triggered when the 3 lakh would get exhausted. In case you do not have a health insurance policy, then the deductible limit would be as per the plan you have opted in Extra Care.  4.    What are the key features of this policy?   

• No medical tests up to 55 years subject to a clean proposal form
• Pre-existing diseases covered after 4 years of continuous renewal with Bajaj Allianz
• Access to over 2400+ hospitals for availing cashless health insurance in India
• The member can opt for hospitals besides the empanelled ones, in which the   expenses incurred by him shall be reimbursed within 14 working days from   submission of all the documents.
• Covers relevant medical expenses incurred 60 days prior to and 90 days after hospitalization.
• 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. This is a floater policy, single Sum Insured and single premium for the whole family
• Very competitive premium rates
• The policy covers ambulance charges in case of emergency subject to a maximum of Rs 3000/-

 5.    What are the plans available under this product? There are 3 plans under this policy; each top up health insurance has a specified deductible amount. Sum Insured & deductible amount given in the table below

Sum Insured (Rs)	Deductible per hospitalization (Rs)
1000000	300000
1200000	400000
1500000	500000

1. 6.    What is entry age for this policy?

The entry age for proposer is 18 years to 70 years Renewal till the age of 80 years Dependent children can be covered from 3 months to 25 years. Children below 5 years can be covered if both the parents are insured with us. 7.    To enroll is it necessary for me to undergo any medical examination? Medical tests are mandatory for the persons above 55 years, and for others based on the proposal form declarations. Tests would be arranged at our panel diagnostic centre 8.    Please confirm if the medical test charges are paid by the insurance company? If the proposal is accepted & the policy is issued the 50% of medical test charges would be reimbursed 9.    What is the process of medical examination?

• Fill the proposal form completely and submit along with the age/identity proof
• If there are any health declarations, please attach the relevant reports / discharge card / DRS prescriptions if any.
• On scrutiny of the proposal form, if there is any further requirement the same to be fulfilled
• Once we receive the completely filled proposal form, tests are advised
• Our team contacts the customer directly for the tests; appointment is fixed in our empanelled diagnostic center.
• After the tests the reports are directly sent to us (Health Administration Team)

The decision of the proposal is informed after the scrutiny of the reports. 10. Can I cover my parents, brothers and sisters as dependents? Parents, sisters and brothers cannot be covered as dependents. Under family, your self, spouse and children are covered. You have to opt for a separate policy for parents. 11. Do I get a family discount? Family discount is not applicable for Extra Care policy 12. Is Cumulative Bonus available in this plan? Cumulative bonus is not available in Extra Care product. 13. I am covered under Health Guard policy since last 4 years. I want to opt for the Extra care policy as an add-on to the Health Guard policy. Please confirm the benefits under Extra Care policy? If you are covered under any hospitalization policy without any break in the continuity, benefits would be passed under Extra Care policy. In case you are covered under our Health Guard policy since 5 years, continuity would be given for the 4 years waiting period of pre-existing illness and joint replacement surgery 14. What would be continuity benefits if I am having health policy with other company? In case of other company renewals, continuity would be given for the 4 years waiting period of pre-existing illness and joint replacement surgery. 15. What would be continuity benefits if I am covered under Group mediclaim policy of my Employer? Continuity would be given for the 4 years waiting period of pre-existing illness and joint replacement surgery for group mediclaim policy also in case the insured is covered in Group mediclaim policy for more than 4 years . 16. What are the exclusions under the policy?

• All diseases existing at the time of inception for 4 years
• Any diseases contracted within first 30 days of commencement of cover.
• Non-allopathic medicine.
• Congenital diseases.
• All expenses arising out of AIDS and other related diseases.
• Cosmetic and aesthetic treatments.
• Use of intoxicants, drugs and alcohol.
• Joint Replacement Surgery (other than due to accidents that have a waiting period of 4 years).

For detailed list of the exclusions, please refer policy wordings 17. What are pre and post hospitalization expenses? The relevant expenses (investigation expenses, medicines, etc.) incurred before and after the hospitalization period. Under Extra Care we cover 60 days pre-hospitalization expenses and 90 days post hospitalization expenses which are related to the hospitalization claim. 18. What is the provision for rebate on Premium paid under Section 80-D of IT Act? As per current IT rules, you can get a rebate of up to a maximum sum of Rs.15000/- under Section 80-D. 19. Is maternity covered in Extra Care? Maternity is not covered under the plan. 20. Are Day care procedures covered under the policy? Day care procedures are not covered under the policy. 21. Does the policy covers the treatment expenses incurred out of India? This medical cover is available only for events occurring and treatment taken in India as per policy terms and conditions. 22. Is dental treatment covered? Dental treatment or surgery of any kind is not covered, unless it requires hospitalization and happens as a result of accidental bodily injury to natural teeth. 23. Does Extra Care policy Cover OPD (Outdoor Patient Department) Charges? OPD expenses are not covered, but if they are incurred during pre or post hospitalization, they can be covered under the pre-post expenses if the hospitalization claim is admissible. 24. I want to increase my coverage amount. What is the procedure? During the policy period you cannot increase you Sum Assured. When you receive your renewal notice, you can send an application to the local Bajaj Allianz office for increasing your Sum Assured.  SI can be increased only up to 70 years. 25. Can I opt for a lower sum insured from a higher sum insured? Under the policy, the plan can be changed only during renewal and the client can opt only a higher plan. 26. What is the minimum period of hospitalization required to be eligible for Claim Reimbursement? The minimum period of hospitalization required is 24 hours. 27. In case of a claim for Renal Failure there would be multiple hospitalizations for Renal Dialysis. Please confirm how the  deductible would be calculated for such claims? Is the deductible applied afresh for each claim of Dialysis? As per the definition of “deductible amount” If the first hospitalization claim is paid under Extra Care policy and the further claims are within 45 days after the discharge, then they would be considered under the same claim. The deductible would not be applied afresh for the recurrent claims for the same illness if they are within 45 days of discharge from hospital. 28. If a person has a mediclaim policy of a Sum Insured Rs 5 lakh, and he opts for an Extra Care policy of Sum insured Rs 10 lakh with 3 lakh deductible. He is hospitalized for cardiac illness; the claim amount is Rs 5 lakh. He has claimed Rs 3 lakh from his mediclaim policy; please confirm if the remaining claim amount of Rs 2 lakh is paid under Extra Care? The remaining claim amount would be paid on rateable proportion between both the policies. In this case the remaining claim amount of Rs 2 lakh would be distributed in ratable proportion, Rs 66,666/ would be paid from the mediclaim policy and Rs 1,33,334/- would be paid from the Extra Care policy 29. If a person has taken a plan of Rs10,00,000/3,00,000 and he lodges a claim of Rs13,00,000/- then how much claim he will get?  - The SI for this proposal will be 10 lakh which he/she would get. 30. Where can I get the claim form? Claim form can be obtained from the local office or can be downloaded from our website 31. I have lost my membership card, what do I do? If you lose your membership card, please call our Toll Free No. 1800-22-5858 and report the loss immediately. A duplicate card will be issued to you within 7 days of reporting the loss. Extra changes will be applicable to issue a duplicate card. The information given above is indicative in nature. Please refer to the policy wordings and brochure for details. 32. Where do I contact in case of a claim? You may call our 24 hours Call Centre number: 1800-22-5858 or 020-30305858. Our executives would cater to your needs. 33. What do terms Cashless Facility and Claim Reimbursement mean?        Cashless Facility

• The cashless facility can be availed in case of admission in network hospitals. If the policy holder presents the heath card or cashless card at the network hospital, the hospital authorities contact us and provide the details of the hospitalization. If the illness is covered as per the policy terms and conditions Authorization letter is issued to the hospital. The hospital sends all the bills and documents to us for settlement. The insured has to pay the non admissible expenses to the hospital.

• Claim-Reimbursement If the admission is in Non network hospital you need to settle the hospital bills and submit the hospitalization documents along with the claim form for reimbursement of hospitalization expenses.

34. How do I avail the cashless facility?

• For cashless hospitalization, present the health card at the network hospital and the hospital will contact our cashless department with all the details.

• As per the policy terms and conditions the admissibility is decided and the authorization letter or denial letter is sent to the hospital.

• In case of denial, the client can submit the claim documents for reimbursement.

The claim under cashless and reimbursement would be admissible in excess of the deductible limit, subject to terms, conditions, exclusions and definitions as per the policy wordings. 35. What are the documents to be submitted in case of reimbursement? We would require the following documents for easy processing of your Claim.  

• 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
• All the bills & money receipts of hospitalization expenses, diagnostics, medicines etc
• All original laboratory & diagnostic test reports

Only original documents need to be enclosed, duplicates or photocopies are not allowed , In case part of the claim settled by any other insurance co, attested Xerox copies to be attached . Also letter from that Co. mentioning the amount paid / deducted should be attached.  36. Pre & Post Hospital Expenses: For Pre & Post Hospitalisation expenses please provide the following documents:

• Medicines: Please provide the doctor’s prescription advising medicines and the relevant chemist bill.
• Doctor’s Consultation Charges: Please provide the doctor’s prescription and the doctor’s bill and receipt.
• Diagnostic Tests: Please provide the Doctor’s prescription advising tests, the actual test reports and the bill and receipt from the diagnostic centre. Once you have collected all the above documents, please send them to the following address:

The Claims Manager, Health Administration Team Bajaj Allianz General Insurance Company Ltd. Bajaj Finserv, 2nd floor, Survey # 208/1-B, Behind Weikfield IT-Park Viman Nagar, Pune - 411 014 Tel: (020)-30459200 Choosing the right health policy is imperative. Read about the different types of types of health insurance by Bajaj Allianz to make the right choice.