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Health Insurance
This Time, Prioritise Your Health
Coverage Highlights
Comprehensive coverage for a worry-free tomorrowChoose from Best of Plans
Choose from multiple plans to meet your requirements
Wide Sum Insured Options
Select adequate sum insured that suits you starting INR 3 lacs to INR 1 crore
Unlimited Reinstatement Benefit & Recharge
Get the option of unlimited reinstatement of sum insured even after it is exhausted after claims
Maternity & Newborn Care
Medical expenses related to delivery of baby and towards treatment of the new born baby are covered under select plans
Preventive Health Check-Up
Start receiving annual preventive health check-ups after 2/3 policy renewals as per the chosen plan
Online Discount
Get flat 5% discount when you buy a policy on our website or our Caringly Yours app
Zone Discount
Avail discounts of 20% for Zone B and 30% for Zone C depending on where you live
Fitness Discount & Wellness Discount
Avail up to 12.5% wellness discount for healthy habits on renewal
Note
Please read policy wording for detailed terms and conditions
Inclusions
What’s covered?In-Patient Hospitalisation Treatment
Offers comprehensive in-patient hospitalisation cover for your planned surgery or an unexpected illness to help you focus on your recovery not on your expenses
Hospital Room Coverage
Covers the cost of standard air-conditioned room ensuring you get the best care in a comfortable setting
ICU Cover
Covers your critical care expenses while ensuring you receive the best treatment without any financial burden
Pre-Hospitalisation Medical Expenses
Provides coverage for medical expenses for 30 days leading up to your hospital stay, ensuring you're prepared for the unexpected
Post-Hospitalisation Medical Expenses
Covers your post-hospitalisation medical expenses, including follow-up treatments and consultations, for up to 60 days after discharge
Day Care Treatment
Ensures that through advanced procedures you get back on your feet in less than 24 hours
Organ donor expenses
Offers coverage for organ transplant as per the policy terms, supporting the costs involved in the treatment
AYUSH Hospitalisation Cover
Coverage for ayurvedic, yoga, Unani, Siddha, and homoeopathic (AYUSH) treatment on a doctor’s advice for treating illness or physical injury
Road Ambulance
Covers emergency ambulance services to ensure you get swift and safe transport to the nearest medical facility
Domiciliary Hospitalisation
Ensures you receive the necessary medical care in the comfort of your home
Modern Treatment Methods and Advancement in Technologies
Covers modern treatments, like robotic surgeries and stem cell therapy, ensuring you have access to the latest medical advancements
Floater & Individual Sum Insured
Option to cover your family members under shared SI in case of a floater plan or separate SI in case of an individual plan
Note
Please read policy wording for detailed inclusions
Exclusions
What’s not covered?Investigation & Evaluation
Expenses related to any admission primarily for diagnostics and evaluation purposes only are excluded even if the same requires confinement at a hospital
Cosmetic or Plastic Surgery
Expenses for cosmetic or plastic surgery or any treatment to change appearance unless for reconstruction following an accident, burn(s) or cancer or as part of medically necessary treatment to remove a direct and immediate health risk to the insured are not covered
Hazardous or Adventure sports
Expenses related to any treatment necessitated due to participation as a professional in hazardous or adventure sports, including para-jumping, rock climbing, mountaineering, rafting, motor racing, horse racing, scuba diving, hand gliding, sky diving, and deep-sea diving, are not covered
Dietary Supplements & Substances
Cost of supplements that are purchased without a prescription by a certified doctor as a part of treatment, including vitamins, minerals and organic substances is not covered
Treatment for Self-Inflicted Acts
Medical expenses incurred as a result of self-harm, illegal actions, hazardous activities, etc. are not covered
Refractive Error
Expenses related to the treatment for correction of eyesight due to refractive error less than 7.5 dioptres are excluded
Unproven Treatments
Expenses related to any unproven treatment, services, and supplies in connection with any procedures or supplies that lack significant medical documentation to support their effectiveness stay uncovered
Sterility and Infertility
Expenses related to sterility and infertility, including any contraception, sterilisation and advanced reproductive technologies (such as IVF, ZIFT, GIFT, and ICSI), gestational surrogacy and reversal of sterilisation are not covered
Note
Please read policy wording for detailed exclusions
Additional Covers/Optional Covers
What else can you get?Sum Insured Reinstatement
Choose one-time or unlimited reinstatements each policy year for tailored, continuous protection
Procedure-wise/Disease-wise Sublimit
Unlock your full sum insured for key procedures and diseases (with no limitations on critical care)
Super Cumulative Bonus
Choose from three flexible growth options that match your health goals, get sum insured raised up to 200% as per the policy terms
No Claim Discount
Get accumulated bonus (Cumulative Bonus/Super Cumulative Bonus) with an immediate 1.5% discount on your next Premium payment at renewal
Cashless Discount
Enjoy a 5% discount on your premium by choosing cashless claims at our network hospitals for no upfront payments. Reimbursement claims will require a 20% co-pay.
Accidental Death Shield
Get financial protection for your loved ones, ensuring they're cared for even when you can't be there due to personal accident
Health Prime Rider
Get coverage for in-person or online doctor consultation, dental wellness, emotional wellness, diet & nutrition consultations as per the chosen plan
The Swasthya Sathi Coverage was launched by the West Bengal Government on December 30, 2016, as a comprehensive health insurance plan for residents. It offers cashless, paperless, and Swasthya Sathi card benefits to ensure citizens receive quality medical treatment without financial stress. The scheme covers the entire family with an annual sum insured of up to Rs 5 lakh per family, targeting secondary and tertiary healthcare needs. The scheme is fully funded by the state government, providing much-needed financial relief to the beneficiaries. Whether for consultations, diagnostics, or treatment, the Swasthya Sathi Scheme stands out for its inclusiveness and wide coverage across various medical procedures.
The primary objective of the Swasthya Sathi Coverage is to offer cashless healthcare services to every resident of West Bengal, focusing on reducing the burden of medical expenses for families. With rising healthcare costs, the Swasthya Sathi Scheme aims to enhance accessibility to quality healthcare, particularly for secondary and tertiary care. By empanelling hospitals and extending healthcare infrastructure in semi-urban and rural areas, the scheme ensures that quality medical services are within reach for all. The initiative addresses the need for affordable healthcare by eliminating citizens' out-of-pocket expenses.
Swasthya Sathi brings a variety of features that make it a robust health insurance plan:
● Transparent Hospital Grading: Hospitals are graded based on their services, and the empanelment committee approves them accordingly.
● Mandatory Pre-Authorisation: All treatments and medical procedures require pre-authorisation, which is processed within 24 hours.
● Real-Time Updates: Beneficiary health records are updated in real-time after hospital discharge, ensuring accurate data management.
● Swasthya Sathi Mobile App: The app provides easy access to information regarding hospitals, health packages, and e-health records.
● SMS Alerts: Beneficiaries receive SMS notifications if their health card is blocked or if there are any updates.
● Toll-Free Support: A 24-x7 toll-free helpline (1800-345-5384) is available for assistance.
● Quick Claim Settlements: Claims are processed within 30 days, reducing financial stress on beneficiaries and hospitals.
Get instant access to policy details with a single click
The Swasthya Sathi Scheme offers comprehensive benefits that cater to the healthcare needs of the beneficiaries:
● Health Coverage up to Rs 5 Lakh: Coverage is provided for both secondary and tertiary care, ensuring extensive medical support.
● Pre-existing Disease Coverage: The scheme covers all pre-existing conditions from day one, which is beneficial for those with ongoing health issues.
● No Cap on Family Size: The scheme covers the entire family, including in-laws and dependent physically challenged members, without restricting family size.
● Cashless Hospitalisation: The scheme covers expenses for doctor consultations, diagnostic tests, and medicines incurred one day before hospitalisation and up to five days post-treatment.
● Zero Premium Cost: The West Bengal Government fully bears the premium, making the coverage completely free for beneficiaries.
The Swasthya Sathi Card eligibility is as follows:
● You must be a permanent resident of West Bengal.
● You should not be covered under any other government-sponsored health insurance scheme.
● The health card is issued in the name of the eldest female member of the family.
● The scheme covers all family members, including parents of both spouses, unmarried daughters (up to 21 years), and dependent physically challenged members.
To apply for the Swasthya Sathi Mediclaim Policy, you will require the following documents:
● Proof of Identity (Aadhaar Card, Voter ID)
● Residential Proof
● Mobile Number
● Recent Photograph
The process to apply for the Swasthya Sathi Scheme is simple:
● Visit the official website of the Swasthya Sathi Scheme.
● Click on the ‘Apply Online’ option and select ‘Form B for Registration.’
● Fill in the required details and submit the form along with the necessary documents.
The Swasthya Sathi Prokolpo comes with a host of functionalities aimed at making healthcare accessible and affordable:
The scheme has empanelled more than 2,290 hospitals, providing beneficiaries access to a wide range of medical facilities across the state.
Beneficiary records are updated instantly, ensuring that all medical histories are accurately documented.
An online platform allows beneficiaries to lodge complaints and track resolutions, making the system transparent.
Treatments under the scheme are pre-authorised online within 24 hours, streamlining the process and avoiding delays.
The scheme generates monthly reports accessible to the public for review and suggestions, promoting accountability.
The scheme covers diagnostic and treatment costs across empanelled hospitals, ensuring that beneficiaries face no out-of-pocket expenses.
Patients are provided a transport allowance post-discharge, ensuring seamless transitions back home.
Hospitals can register under the Swasthya Sathi Scheme by following these steps:
● Visit the official Swasthya Sathi portal.
● Click on the ‘Apply Online’ option and select ‘Hospital Registration.’
● Fill in the required details, such as hospital name, contact details, and category.
● Attach the necessary documents and apply for review.
Step-by-Step Guide
How to Buy
0
Visit Bajaj Allianz website
1
Enter personal details
2
Compare health insurance plans
3
Select suitable coverage
4
Check discounts & offers
5
Add optional benefits
6
Proceed to secure payment
7
Receive instant policy confirmation
How to Renew
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Login to the app
1
Enter your current policy details
2
Review and update coverage if required
3
Check for renewal offers
4
Add or remove riders
5
Confirm details and proceed
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Complete renewal payment online
7
Receive instant confirmation for your policy renewal
How to Claim
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Notify Bajaj Allianz about the claim using app
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Submit all the required documents
2
Choose cashless or reimbursement mode for your claim
3
Avail treatment and share required bills
4
Receive claim settlement after approval
How to Port
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Check eligibility for porting
1
Compare new policy benefits
2
Apply before your current policy expires
3
Provide details of your existing policy
4
Undergo risk assessment by Bajaj Allianz
5
Receive approval from Bajaj Allianz
6
Pay the premium for your new policy
7
Receive policy documents & coverage details
To check the registration status of a hospital under the Swasthya Sathi Scheme:
Visit the official Swasthya Sathi portal.
Click on the ‘Check Hospital Reg. Status’ option.
Enter your registered mobile number to view the status.
If you need treatment outside West Bengal under the Swasthya Sathi Scheme:
Go to the official portal.
● Select the ‘Registration Outside of West Bengal’ option.
● Enter your URN number and complete the registration by providing the necessary details and documents.
The Swasthya Sathi Health Card is issued in the name of the eldest female family member. This card contains all essential details, including family biometrics, photographs, and contact information. It is auto-renewed annually and has lifetime validity, allowing beneficiaries to receive cashless treatment across empanelled hospitals.
To view details about hospitals under the Swasthya Sathi Scheme:
● Visit the official portal and select ‘Hospital Information.’
● You can view relevant information by selecting from options such as Active Hospital List or Hospital HR Details and submitting the form.
Excellent Service
Bajaj Allianz provides excellent service with user-friendly platform that is simple to understand. Thanks to the team for serving customers with dedication and ensuring a seamless experience.
Amagond Vittappa Arakeri
Mumbai
27th Jul 2020
Swift Claim Settlement
I am extremely happy and satisfied with my claim settlement, which was approved within just two days—even in these challenging times of COVID-19.
Ashish Jhunjhunwala
Vadodara
27th Jul 2020
Quick Service
The speed at which my insurance copy was delivered during the lockdown was truly commendable. Hats off to the Bajaj Allianz team for their efficiency and commitment!
Sunita M Ahooja
Delhi
3rd Apr 2020
Outstanding Support
Excellent services during COVID-19 for your mediclaim cashless customers. You guys are COVID warriors, helping patients settle claims digitally during these challenging times.
Arun Sekhsaria
Mumbai
27th Jul 2020
Seamless Renewal Experience
I am truly delighted by the cooperation you have extended in facilitating the renewal of my Health Care Supreme Policy. Thank you very much!
Vikram Anil Kumar
Delhi
27th Jul 2020
Quick Claim Settlement
Good claim settlement service even during the lockdown. That’s why I sell Bajaj Allianz Health Policy to as many customers as possible.
Prithbi Singh Miyan
Mumbai
27th Jul 2020
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