Health Insurance Plans

It is not mandatory to buy a health insurance policy in India. But, it is very important to have a financial security like that of a health insurance policy to handle any kind of medical emergencies.

With our Health Insurance policy, you enjoy coverage for pre and post hospitalization expenses for up to 60 and 90 days, respectively. The policy also covers in-hospital expenses, ambulance charges, room rent and boarding expenses (coverages will differ based on the selected product). You can avail cashless treatment at over 6,500+ hospitals across India. We also cover medical examinations, physician fees/doctor’s consultation fees and ambulance charges, leaving you totally stress-free!

If you want a quick and hassle-free purchase, buying online is the way to go. We are here to help you to buy Health Insurance easily and efficiently. Our multiple payment options will further ease your payment woes. Your medical insurance policy is issued online, which saves you the effort of ever carrying a hard copy. All these factors, along with proactive customer support, makes buying Health Insurance policy online a better alternative.

Bajaj Allianz General Insurance Health Insurance policy helps you save tax up to INR 1 lakh under Section 80D against the premiums you pay. Here’s how you can save tax:
On the premiums you pay for yourself, your spouse, children and parents, you can avail INR 25,000 per annum as a deduction against your taxes (provided you are not over 60 years). If you pay a premium for your parents who are senior citizens (age 60 or above), the maximum health insurance benefit for tax purposes is capped at INR 50,000. As a taxpayer, you may, therefore, maximize tax benefit under Section 80D up to a total of INR 75,000, if you are below 60 years of age and your parents are senior citizens. If you are above the age of 60 years and are paying a medical insurance premium for your parents, the maximum tax benefit under Section 80D is, then, INR 1 lakh.

You can purchase a health insurance policy in India, if you are an Indian citizen and above 18 years of age. If you are a minor (below 18 years of age), then your parents can cover you under their any medical insurance plans.

Health insurance covers you for hospitalization expenses including pre & post hospitalization expenses, doctor’s consultation fees and in-patient expenses.

Life insurance is a great investment and death cover option but it won’t come in handy to pay rising medical bills. A Health Insurance cover is a solution to deal with hospitalization and pay heavy medical expenses, should they arise. So, Health Insurance plans are your cover against unexpected health-related costs that may threaten to deplete your savings.

Entry age specifies that you should be at least that much old, so that you can get coverage under a health insurance policy. Exit age means that you will not be covered under your health insurance policy after crossing a certain age limit. The entry age and exit age are different for different health insurance plans.

Health insurance companies in India grant you a free look period of 15 days, during which you can analyze the health insurance policy that you have purchased. You can cancel your health insurance policy in these 15 days if you think that this medical insurance plan is not suitable for you without paying any cancellation fee.

Your children, spouse, parents and parents-in-law can be added as dependents in your health insurance policy.

Co-payment is the fixed percentage of the claim amount that you need to pay for every health insurance claim. While, deductible is the fixed amount that you need to pay when you make a health insurance claim.

Restoration or reinstatement of sum assured means that if you exhaust your existing SI, then it will automatically replenished to cover you for the next hospitalization expenses in the same policy year. However, you cannot carry forward the restoration benefit and it cannot be used for the same illness/injury for which you have once made a claim in your policy year.

With technological advancement, you are not required to get hospitalized for procedures like Septoplasty or lithotripsy. But, the medical expenses related to these procedures are very expensive. It is beneficial to have day care medical insurance plans, so that you are covered for these kinds of surgeries or medical procedures where you are not required to stay in the hospital for more than 24 hours.

Any one illness refers to continuous period of illness, including any relapse that happens within a certain number of days as per the terms and conditions of your health insurance policy.

You are eligible for free health check-up if you renew your health insurance policy continuously for 4 years without filing any health insurance claim. The expenses related to this health check-up are borne by your health insurance company.

You can buy a health insurance policy for a period of 1, 2 or 3 years. If you purchase a long term health insurance policy (more than 1 year), then you can get great discounts.

Some of the myths associated with health insurance are:

✓     You need to check the empanelled hospitals only when you buy any health insurance plans.

✓     Health insurance provided by employer is enough to cover you.

✓     If you have health insurance, then all your medical expenses are covered.

✓     You need to be hospitalized for at least 3 hours to get the benefit of your health insurance plans.

✓     You do not need health insurance if you are fit.

✓     Smokers cannot purchase health insurance

Pre-existing diseases are those you may already know the existence of in your life before you buy a medical insurance policy. Hence, you must declare any pre-existing disease/condition at the time of buying medical insurance plans.

One of the key factors to keep in mind is that the pre-existing diseases have a waiting period (which differs from company to company). Hence, by taking a policy at a young age you can only hope that by the time, and if you are diagnosed with a disease that falls under the pre-existing category, your waiting period will be complete. Also, you can ensure that you are eligible to avail full benefits of your medical insurance policy.

Sub-limit is the maximum amount that your health insurance policy will pay towards your medical expenses. The sub-limits usually include room rent sub-limit, post hospitalization sub-limit, ambulance charges, oxygen supply, doctor’s fees, diagnostic tests etc.

Health insurance is where you can file a claim and your insurer will reimburse you the claim amount up to the Sum Insured. On the other hand, Personal Accident insurance plan pays you the entire Sum Insured once you file a claim.

Individual health insurance policy has different Sum Insured for all the members covered under the policy, whereas all the insured members share a common Sum Insured under a family floater health insurance.

At Bajaj Allianz, we have special health insurance plans that takes care of expenses related to the health issues faced by women. Our critical illness plan for women is a special policy for all the ladies out there, that covers you against the risk of 8 critical illnesses like burns, breast cancer, vaginal cancer etc.

A waiting period of 72 months is applicable for the coverage of maternity expenses. If you opt for Sum Insured between INR 3 lakhs and INR 7.5 lakhs, then the coverage is restricted to INR 15000 for normal delivery and INR 25000 for caesarean section and if you opt for Sum insured between INR 10 lakhs and INR 50 lakhs, then it is restricted to INR 25000 for normal delivery and INR 35000 for caesarean section. The waiting period for Maternity for every product will differ based on the terms and conditions of every product.

You can fill a health declaration and endorsement form along with the additional premium amount to cover a new member to any existing family floater medical insurance plans.

You can change your details online by visiting our website or contact our customer care executive, who will help you make the required changes.

You can check the status of your policy online. Log onto our website with your user ID and password and enter the details of your policy – policy number, etc. to check the status. Alternately, you can download our ‘customer portal’ app and check your policy status.

Yes, you can buy more than one health insurance policies. However, it usually becomes cumbersome to handle multiple policies. We recommend you to buy a single health insurance policy with high SI instead of buying multiple health insurance policies with low SI.

You can renew your health insurance policy after one year. But, if there has been a break in your health insurance renewal, then you might need to contact our customer support team, who can guide you to take further necessary steps.

No. You do not have to undergo a medical check-up every time you renew your health insurance policy. However, if there has been a break in health insurance renewal or if you have upgraded the coverages of your medical insurance plan while renewing the policy, then you might be required to undergo some medical check-ups.

You can contact our customer support team and get complete details of the steps that you need to take to increase the Sum Insured.

You can renew your health insurance policy even after its expiry during the grace period of 30 days with all the benefits reinstated. However, if you do not renew your policy after the grace period is over, then you might have to start from scratch to get yourself covered.

Yes, with health insurance portability, you can switch your health insurance company.

No. usually medical tests are not mandatory for people below the age of 45 years. However, your insurance company can ask you to undergo certain medical tests depending upon the medical history submitted by you and the health insurance policy opted by you.

You have to bear the cost of the medical examination that you undergo before buying a health insurance policy. It can also be reimburse depending upon policy terms and conditions.

Yes, you are covered for all your health related emergencies with your health insurance provider all over India, subject to terms and conditions of your policy.

Before you buy a health insurance policy, you should take care of the following things:

✓     You should look for the exact coverages provided by your health insurance policy.

✓     You should take a note of waiting periods and exclusions.

✓     You should not hide anything from your health insurance provider like pre-existing illnesses.

✓     You should check the online processes of the insurance company.

✓     You should thoroughly enquire about topics like policy cancellation, policy lapse and policy renewal with your insurer.

✓     You should also take a good look at the break-up of your health insurance premium and clear all your doubts before making the payment.

Health insurance companies in India provide you a health card with your health insurance policy, which you can use at network hospitals to avail the cashless treatment benefit.

Yes, you can get a duplicate health insurance policy if you lose the original one. However, you might have to pay some fixed amount to get the duplicate copy of your health insurance policy.

If you have just purchased your health insurance policy, you can cancel it in the free look period without paying any cancellation fee. But, you will have to pay the premium amount for the number of days the policy covered you.

You can also cancel your health insurance policy before its expiry instead of renewing it.

You might also be eligible for certain benefits, if you surrender your policy after renewing it without break for a certain fixed number of years. You can contact your health insurance provider and know the complete details to cancel your medical insurance plan.

Your coverage amount depends on your lifestyle, medical background, pre-existing diseases, members of your family, annual income, residential address and age.

Pre hospitalization expense is as a result of tests, medication that would have to be undertaken prior to the hospitalization for the treatment. Similarly, post hospitalization expenses can be for recovery and medicines that need to be taken post the hospitalization treatment. Pre and post hospitalization are 60 and 90 days respectively, depending on the policy terms and conditions When you fall sick, you usually consult your family physician and get relevant investigations done. On the advice of your physician, you get hospitalized for further treatment of the disease if required. These medical expenses incurred before hospitalization are called pre hospitalization expenses. Post hospitalization expenses include all expenses or charges incurred by you after you are discharged or after hospitalization treatment is done. For example, the consulting physician may prescribe certain tests to ascertain your progress or recovery after surgery.

Domiciliary Hospitalization refers to a situation where you are undergoing a treatment or are under medical care at home instead of hospital and still you are considered as hospitalized. You might be taking the treatment as home because of non-availability of hospital beds/room in the hospital or you are not in a condition to be shifted to a hospital for the treatment.

The domiciliary hospitalization covers you for the expenses related to the treatment you receive for an Illness/disease/injury at home instead of a hospital.

Non-medical items such as hair removal cream, hand wash, cozy towel, baby bottles, brush, paste, moisturizer, caps, eye pad, comb, cradle buds etc. are all non-payable under your health insurance policy. For a detailed list of non-payable items, please read your policy wordings carefully.

Yes, health insurance companies offer coverage to diabetes patients. However, you might have to undergo some medical tests before you get the coverage. Also, there might be some waiting period applicable as per your medical test reports. *Also subject to UW acceptance

Yes, health insurance in India covers some medical tests and scans as per the terms and conditions mentioned in your policy for in-patient hospitalization.

Yes, health insurance plans cover you for maternity and new born care. However, there will be a waiting period before the coverage for the same starts. You should check the coverage and the waiting period with your insurer if you are buying a health insurance in India specifically for maternity expenses coverage.

Yes, outpatient expenses are covered under medical insurance plans either with mandatory hospitalization of 24 hours or as a top-up in the form of OPD cover.

Some of the day care procedures covered under health insurance in India are:

✓    Incision of bone, septic and aseptic

✓    Dilatation of digestive tract strictures

✓    Surgical treatment of hemorrhoids

✓    Surgery for ligament tear

✓    Cataract surgery

✓    Glaucoma Surgery

✓    Foreign body removal from nose

✓    Removal of metal wire

✓    Removal of fracture pins/nails

✓    Foreign body removal from lens of the eye

You can refer your policy document for a detailed list of day care procedures.

Dental treatment means a treatment related to teeth or structures supporting teeth including examinations, fillings (where appropriate), crowns, extractions and surgery.

Any dental treatment that comprises of cosmetic surgery, dentures, dental prosthesis, dental implants, orthodontics, surgery of any kind is excluded unless as a result of Accidental Bodily Injury to natural teeth and also requiring hospitalization.

Health insurance policies that cover AYUSH treatments also cover homeopathic treatments. You can check the same with your health insurance provider or refer your policy wording to know whether the coverage is included in your health cover or not.

With Bajaj Allianz’s critical illness policy, you are covered for 10 major critical illnesses:

✓     Aorta graft surgery

✓     Cancer

✓     Coronary artery bypass surgery

✓     First heart attack (myocardial infarction)

✓     Kidney failure

✓     Major organ transplant

✓     Multiple sclerosis with persisting symptoms

✓     Permanent paralysis of limbs

✓     Primary pulmonary arterial hypertension

✓     Stroke

A health insurance policy from your employer might have a few benefits, but, there are also some drawbacks associated with the corporate health insurance plans like:

✓    You will not be able to customize the corporate plan as per your health insurance requirements and health conditions.

✓    Your coverage will be over as soon as you resign from the company.

✓    Health insurance plans from your employer will not cover you after you retire.

✓    Corporate health insurance plans have very little scope for planning your future.

✓    You are covered for a lesser SI as compared to private health insurance plans.

Thus, you should also buy an individual medical insurance plan that suits your budget as well as your health insurance requirements.

Yes, you can increase your medical insurance plan’s cover during renewal. You might be required to submit a few documents for the same and also pay the additional premium for enhancing the coverage of your medical insurance plans.

No, but you can buy our Silver Health plan, which is a Special health insurance designed for senior citizens.

The Health Insurance premium amount mainly depends on the sum insured and the number of members covered under the Health Insurance policy. Here are a few other factors that determine your Health Insurance premium:

✓     Your age

✓     Pre-existing diseases

✓     Add-on covers (optional)

You can use our health insurance calculator to get an estimate of the premium that you need to pay towards your health insurance policy. You can use our health insurance calculator for free and use the generated quote for future references.

You can make the premium payment using the following modes:

✓     Cheque or cash payment at our branch

✓     ECS

✓     Online payment – Debit/credit card and net banking

Your health insurance premium might increase during renewal under the following circumstances:

✓     Change in the age band

✓     Premium revision by the regulator (of which you will be informed well in advance of your health insurance renewal

✓     Change in taxes, duties and cess as per government laws

You might have to pay a higher premium towards your health insurance policy if you are a smoker. Also, you might need to undergo a few medical tests before a health insurance policy provides coverage to you.

You should pay your health insurance premium before your policy expires, so that there is a continuity of the coverages provided by your health insurance policy. However, if you are unable to pay your health insurance premium before policy expiry, then you can use the grace period given by your insurer to renew your medical insurance policy. But, if you do not renew your policy in the grace period as well, then your health insurance policy will lapse and you will not be covered for any medical emergency.

GST is Goods and Service Tax. It was first launched in 2017 and it covers all the indirect taxes such as service tax, VAT etc. There are four tax slabs under GST – 0%, 5%, 12% and 28%. And, there are two types of GST – State GST and Central GST.

Before GST, the tax rate applicable on health insurance policy was 15% and now the tax rate applicable is 18% on all health insurance policies.

All the health insurance policies do not accept the payment of your health insurance premium on installment basis. However, with policies like Arogya Sanjeevani, you can pay health insurance premium on installment basis – yearly, half-yearly, quarterly and monthly as per your convenience.

Claim settlement ratio of a health insurance company is the ratio of the number of claims settled by a health insurance company to the total number of claims raised in a given time frame. The higher the number of claim settlement ratio, the better the health insurance company.

You can track the status of your health insurance claim using our mobile app - Caringly Yours, by using our online claim settlement portal and by calling our customer care.

You can either file a cashless health insurance claim or a reimbursement claim. At Bajaj Allianz, we have our in-house Health and Administration Team (HAT), so the claim processing is quick and easy.

For cashless claims, you need to get a pre-authorization letter from the network hospital and we will approve the claim after successful verification of your pre-authorization form and your health insurance policy. You can avail the benefit of cashless claims once we provide the approval to the network hospital.

In case of reimbursement claim settlement, you will need to send us documents like your medical bills along with your policy details and discharge summary provided by the non-network hospital. We will verify these documents and settle your claim by depositing the final claim amount directly in your bank account.

At Bajaj Allianz, we settle your cashless claims within 60 minutes with the help of our fast claim processing in –house Health Administration Team (HAT).

With the Health CDC (Claim by Direct Click) feature of our mobile app, Caringly Yours, we settle your claims up to INR 20,000 within 20 minutes.

We settle your reimbursement claims within 10 days after receiving and assessing all the documents submitted by you.

You should make a health insurance claim only if you think that the medical expenses are huge and you cannot pay for them from out of your pocket. This will help you earn the benefit of NCB (No Claim Bonus) when you renew your health insurance policy.

You can make any number of valid health insurance claims in a policy year. However, the number of times you file a claim depends upon the exhaustion of your Sum Insured.

When you get the treatment for your illness/injury in a network hospital, you are eligible for cashless mediclaim. With cashless mediclaim, your medical bill will be automatically by your health insurance provider to the network hospital where you are undergoing a treatment. However, you will have to bear the cost of non-medical items and other non-payable items as per your health insurance policy.

To avail the benefit of cashless claims, all you need to do is approach a network hospital and show your health card, which has your policy number, name of the insurance company and type of health insurance policy. You will also have to fill up a pre-authorization form that will be sent by the network hospital to your insurance company. On verification of these documents, your claim will be directly settled by your insurer to the hospital.

After your claim is filed and settled, your insurance cover will be reduced by the amount that has already been paid to you.

Yes, the best health insurance policy will cover you for all the medical expenses. However, you will have to pay for non-medical items and the non-payable items as mentioned in your he insurance policy.

After your claim is filed and settled, your insurance cover will be reduced by the amount that has already been paid to you. For example, if your policy was issued in January with INR 5 lakh coverage and if you claimed an amount of INR 3 lakh in July, then a balance of INR 2 lakh is available to you between August-December.

You will not get a refund of your health insurance premium even if you do not file a health insurance claim in the policy year. But, you will be eligible for NCB (No Claim Bonus), which will reduce the premium amount when you renew your health insurance policy. Also, you will be eligible for cumulative bonus, which lets you enjoy the benefit of increased SI by paying the same premium as the previous policy year.

TPA stands for Third Party Administrator. It is an organization that processes claims on behalf of your health insurance provider. It acts as an intermediary between you and your health insurance company for processing and settling your health insurance claims.

Yes, you can change your hospital during the course of treatment. But, you will have to inform the same to your health insurance provider and also submit the related documents to them.

You can claim Convalescence Benefits once in a year.

Yes, your medical policy will cover the medical treatment at any hospital you choose (network or non-network hospital). However, there might be some hospitals that may have been delisted by your insurance provider and you will not be covered in case you choose one of those hospitals for getting the required medical attention.

Yes, you can submit your medical bills along with other documents to file a reimbursement claim if you get treatment in a non-network hospital.

Yes, if the actual expenses exceed the cover opted by you, you will have to pay the difference amount.

The Health Administration Team (HAT) comprises of doctors and paramedics who are responsible for health underwriting and claims settlement. It is a single window assistance for healthcare related services. This in-house team resolves issues related to health insurance customers. The team ensures faster claim settlement as a single point of contact. It is effective for quick resolution of customer queries by health insurance experts. It also controls claim settlements and customer service, given its in-house capabilities.

Your health insurance company might deny your claim settlement in case of following scenarios:

✓     Claim filed for intentional self-injury

✓     In case of misrepresentation, fraud, nondisclosure of material facts or non-cooperation from insured’s end

✓     Claim filed for coverage of the pre-existing diseases before the waiting period gets over

✓     In case of claim filed for any of the exclusions mentioned in the policy document

Yes, the hospitalization expenses on account of COVID-19 will be covered under your existing health insurance policy under In Patient Hospitalizarion as per the terms and conditions mentioned in your policy.

If your family members are covered in your existing health insurance policy, then they will be covered for the hospitalization expenses (Under In Patient Hospitalization) as per policy terms & Condition related to COVID-19.

All the non-payable items mentioned in your policy document along with the list of non-payables issued by IRDAI will be excluded from COVID-19 coverage.

These expenses are covered if your health insurance policy provides coverage for out-patient hospitalization. Please contact your insurer and get clarification on these coverages under your health insurance policy.

No, your travel history abroad will not affect the admissibility of claim under your health insurance policy, if you are hospitalized in India.

With Bajaj Allianz’s smooth claim settlement process, here is how you can register and settle your health insurance claim during the lockdown:

✓     With our Caringly Yours app, you can register health insurance claims up to INR 20,000 via paper-less procedure – Health CDC (Claim by Direct Click) available on our Caringly Yours App.

✓     You can give us a missed call on +91 80809 45060, and we’ll call you back to take you through the process.

✓     You can also SMS ‘WORRY’ to 575758.

✓     You can choose to send us a mail on bagichelp@bajajallianz.co.in to register your claim as well.

✓     Another way to register and track your claim is visiting our online claim portal, where you can enter some of your basic details such as your policy number and quickly make a claim.

Yes, a standard waiting period of 30 days is applicable to COVID-19 health insurance.

You will be able to enhance your Sum Insured during the renewal of your policy as per underwriting terms and conditions.