Bajaj Allianz Individual Health Guard – Gold

What we love?
Option to avail OPD benefit by opting for Prime Rider

Cover amount: ₹5 Lakh

Cashless hospitals: 286

Premium:₹797/month (₹9557 paid annually)

Claim Settlement Ratio: 98%

98% Claim Settlement Ratio

  • This is explained as (Number of Claims Settled / Number of Claims) by the Insurance Company.
  • Source: Public Disclosures (NL25 for 2018-19).

Existing Illness Waiting Period

There is a waiting period of 3 years for coverage on conditions declared and existing at the time of first purchase

 

Why is it Important

The shorter waiting period, the better as the cost of your current illness can be expensive

Network Hospitals covered

5600+ Network hospitals offer cashless hospitalisation

 

Why is it Important

The higher the number of network hospitals the better as you can avail cashless treatment at more places.

ProTip: Check if the hospital of your choice or those near you are part of the network.

Hospital Room Eligibility

All Categories

 

Why is it Important

A lower cap is better as room rent eats into the claim amount which should be spent on treatment cost.

ProTip: Always opt for rooms within your rent eligibility, In case you opt for a room above this cap, you will have to bear the additional expenses

Day Care Treatments

130 Day care treatments that take less than 24 hours of hospitalization due to technological advancement but otherwise would have needed a day are covered

 

Why is it Important

The number of day care treatments are increasing every day and it is important that your insurance covers the same.

ProTip: Look for plans which cover maximum Day Care procedures

What’s covered

Covid-19 Coverage

Hospitalization due to omicron and all other variants of covid-19 are covered

 

Why is it Important

Most people infected with the virus will experience mild to moderate respiratory illness and recover without requiring special treatment. However, some will become seriously ill and require medical attention

ProTip: Protect yourself and others from infection by staying at least 1 metre apart from others, wearing a properly fitted mask, and washing your hands or using an alcohol-based rub frequently

Room rent limit

Up to single private room permissible for hospitalization in this plan

 

Why is it Important

A lower cap is better as room rent eats into the claim amount which should be spent on treatment cost.

ProTip: Always opt for rooms within your rent eligibility, In case you opt for a room above this cap, you will have to bear the additional expenses

Restoration of cover

Full reinstatement of Sum Insured for a non-related illness if the original sum insured + no claim bonus exhausted once in policy year

 

Why is it Important

It helps at the time of second hospitalization in the same year

ProTip: The restoration amount varies, please check the plan T&C for when restoration is allowed.

No claim bonus

Incremental cover up to Rs 50K added for every claim free year up to a cumulative maximum of Rs 5 Lacs; reduction by Rs 50K if there is a claim

 

Why is it Important

Since the medical expenses are rising every year, this benefit ensures you have sufficient funds for any medical emergency.

Free health checkup

Health checkup permissible once for every 3 continuous claim-free years, in designated network; maximum upto Rs 5K per member

 

Why is it Important

Health checks ensure you are treated before your medical condition gets serious.

ProTip: Look for the type, cost and number of tests your insurer allows.

Co-pay

Full claim paid by Insurer

Existing Illness cover

There is a waiting period of 3 years for coverage on conditions declared and existing at the time of first purchase

 

Why is it Important

The shorter waiting period, the better as the cost of your current illness can be expensive

Maternity cover

This plan provide coverage for maternity & related claims upto Rs 15K ; After 6 years

 

Why is it Important

Higher the maternity cover and a shorter waiting period is better. This allows you to avail the best hospitals and doctors for your new born.

ProTip: Check the waiting period after which you can claim for maternity.

Covid-19 Patient Eligibility

After 3 months of covid negative report date in case of Non-Hospitalisation; After 6 months in case of Hosptialisation

 

Why is it Important

Most people infected with the virus will experience mild to moderate respiratory illness and recover without requiring special treatment. However, some will become seriously ill and require medical attention

ProTip: Protect yourself and others from infection by staying at least 1 metre apart from others, wearing a properly fitted mask, and washing your hands or using an alcohol-based rub frequently

Cashless hospitals

7000+ Network hospitals

 

Why is it Important

The higher the number of network hospitals the better as you can avail cashless treatment at more places.

ProTip: Check if the hospital of your choice or those near you are part of the network.

Pre-hospitalization coverage

Medical expenses that are incurred in 60 days before hospitalisation are covered

 

Why is it Important

Typically there is a period of OPD and diagnostics before one is discharged. Longer the Pre-Hospitalisation cover period, better it is

ProTip: Make sure you claim the medical expenses for the same illness for which you got admitted later on.

Post-hospitalization coverage

Medical expenses that are incurred in 90 days post hospitalisation are covered

 

Why is it Important

There are usually expenses on medicines and treatments even after hospitalization. This benefit helps to cover the same.

ProTip: More the number of days covered, the better it is

Day care treatment

130 Day care treatments that take less than 24 hours of hospitalization due to technological advancement but otherwise would have needed a day are covered

 

Why is it Important

The number of day care treatments are increasing every day and it is important that your insurance covers the same.

ProTip: Look for plans which cover maximum Day Care procedures

Alternate medicine (AYUSH)

Upto Rs 20K for utilizing ayurveda, unani or other alternate medicine methods

 

Why is it Important

This benefit covers you for alternative treatment options which are becoming more and more popular.

ProTip: Don’t forget to check if your insurance plan covers AYUSH treatment

Ambulance charges

Up to Rs 20,000 per Year offered for utilizing ambulance services; payable with hospitalization claim

ProTip: Check if your insurance plan covers the Ambulance cost and how much

Cover for organ donor

Medical expenses of organ donor are covered Upto SI

 

Why is it Important

It ensures that expenses of the donor are covered, and the insured gets the organ that is required in time

ProTip: Make sure the cover amount is high as the organ transplant is expensive.

Daily cash allowance

Rs 500 daily cash for hospitalization upto 10 days

 

Why is it Important

The money can be used for meeting additional expenses that are not covered by health insurance

ProTip: The higher the daily cash allowance the better as these additional costs do add up during hospitalization.

What’s not covered

Hospitalization at home

Treatments done at home due to patient condition or unavaiability of hospital bed are not covered

 

Why is it Important

The higher the cover amount, the better as sometimes — especially during seasonal outbreaks like dengue — hospitals may not have accomodation.

ProTip: Look out for the cover amount and the number of days at home treatment is covered.

Worldwide coverage

No coverage provided outside India even under emergency

ProTip: The higher the coverage the better as medical treatments abroad are expensive.
Looking for plans with Worldwide coverage? VIEW PLANS

Domestic evacuation

No cover for emergency evacuation services

E-consultation

No complimentary access to doctors in company network through a call

 

Why is it Important

It is a value-added service and you get a convenient second opinion.

Discount on Renewal

Not covered

Out patient consultation benefits

No coverage for treatments not requiring hospitalization, such as consultations

 

Why is it Important

The higher the coverage the better as most treatments do not require hospitalization.

ProTip: If you stand to lose your NCB, it is advisable not to claim OPD expenses.

Animal bite vaccination

No coverage provided for vaccination against animal bites

 

Why is it Important

This add-on is beneficial as stray animals are everywhere and you can’t predict when one might bite you.

About Bajaj Allianz

Bajaj Allianz General Insurance, which started its operations in the year 2001, is a joint venture between Bajaj Finserv Limited (recently demerged from Bajaj Auto Limited) and Allianz SE. As of 2014, Allianz SE is the world’s largest insurance company, the largest financial services group and the largest company according to a composite measure by Forbes magazine, as well as the largest financial services company when measured by 2013 revenue.Bajaj Allianz General is the 2nd largest private general insurer in the country and was also ranked 2nd amongst top health insurance brands in the country on the basis of customer loyalty according to a syndicated survey conducted by Indian Market Research Bureau (IMRB). The company has also been the most profitable general insurer recording a profit after tax of Rs.564 crore for 2015-16.The company has also been among a winner of series of awards over these years. Some prominent awards won by them include ‘Best Corporate Brand’ 2016 awarded by The Economic Times, ‘Most Admired Health Insurance Company of the Year’ 2015 by Pharma Leaders Power Brands Awards, ‘One of the best Health Insurance Providers of the Year’ 2015 by Outlook Money Awards, ‘Insurer Claims Team of the Year Award’ 2014 and 2015 by Claims Award Asia, ‘Claims Innovation of the Year’ 2013 also by Claims Award Asia.

Most Asked Question For Your Profile

Are PPE kits and other consumable items covered in Health Insurance policies?
Mostly policies don’t cover it by default, however you can buy some very low cost riders and get consumables like PPE kits covered. These include riders such as Care Shield with Care Health Products, or Safeguard with Max Bupa products.

 

Is HomeCare treatment covered in my Health Insurance policy?
Many Comprehensive health plans provide Home Care treatment where Hospitalisation was required, but patients couldn’t be hospitalised because beds weren’t available. This will include the cost of treatment, diagnosis, medication, oxygen, etc. Check with your advisor for options where HomeCare for Covid-19 is also covered

 

Will my Health policies cover Black Fungus or any other complications of Covid-19?
Absolutely, Health Insurance covers Covid-19 and all its related complications such as Black Fungus.