Bajaj Allianz Extra Care

• Premiums as low as Rs12/day for coverage of Rs.4 Lakhs*
• 10,000+ hospitals for cashless treatment
• Claim up to Rs. 55,000 deduction under section 80D**

The Extra Care health insurance plan offered by the general insurance company, Bajaj Allianz, is a beneficial plan that offers coverage for treatment costs incurred by insured members. It covers hospitalisation expenses for a range of illnesses including critical illnesses. Pre and post-hospitalisation expenses are also covered. This policy can be purchased in addition to another individual or family health insurance policy to act as an add-on cover for that policy. It will provide an additional sum insured amount that may be required during hospitalisation.

Eligibility for Bajaj Allianz Extra Care

The insurance company has laid down certain guidelines with regard to who can purchase the policy. The eligibility requirements are given below:

• The entry age for the proposer of the policy, his/her spouse, and parents is between 18 years and 70 years.
• Children between 3 months and 25 years of age can be covered as dependents.

Features of Bajaj Allianz Extra Care

The salient features of this special health insurance plan are listed below:

• The plan offers a lifetime renewability option.
• The policy will be issued on an annual basis.
• A family floater option that requires the policyholder to pay a single premium is available under the plan.
• An individual can include his/her spouse as well as 3 dependent children. Parents, if included, will be covered under a separate policy.
• Individuals below the age of 55 years need not undergo a pre-medical examination unless he/she has an adverse medical history.
• Applicants who have crossed 55 years are required to go through a pre-medical examination and they will be reimbursed with 50% of the costs incurred, provided their application is accepted.
• Policyholders have the option to return their policy and get a refund if he/she is not satisfied with the policy. This option, however, is available only during the first 15 days known as the freelook period.
• Policyholders have 30 days, starting from the renewal due date, to pay the renewal premium for policy renewal.
• The policy can be cancelled at any time during the term of the policy by submitting a cancellation notice 15 days in advance. The premium refunded will be calculated as per the rates mentioned in the policy.
• A person who has a similar insurance policy under a different insurer can port to the Bajaj Allianz Extra Care and avail the benefits offered.
• The waiting periods will be continued from the base insurance policy purchased by the policyholder earlier.
• Deductibles are applicable as per the plan opted for.
• Policyholders who wish to enhance their sum insured, may do so at the time of renewal. A form will have to be submitted at the time of renewal along with the renewal notice.
• Policyholders can enjoy a tax benefit under Section 80D of the Income Tax Act, 1961.

Benefits of Bajaj Allianz Extra Care

The benefits offered under this health insurance policy are explained below:

Exclusions of Bajaj Allianz Extra Care

The policy has certain exclusions as mentioned below:

• Pre-existing conditions are not covered until completion of 4 years of the policy period.
• Joint replacement surgery is not covered until completion of 4 years unless an accidental injury was suffered by the insured.
• All illnesses and diseases for the first 30 days, unless hospitalisation is required due to a road traffic accident.
• Injuries or illnesses caused by war or war-like situations.
• Circumcision, laser eye treatment for correction of eye refractive error, plastic surgery, or cosmetic surgeries.
• Cost of crutches, contact lenses, dentures, spectacles, artificial teeth, and so on.
• Dental surgery or treatment unless requiring hospitalisation caused by an accident.
• Intentional self-injury.
• Injury caused by consumption of alcohol or drugs.
• Expenses incurred on X-ray or laboratory examinations.
• Treatments related to infertility or sterilisation.
• Treatments related to HIV, sexually transmitted diseases, pregnancy, childbirth, experimental treatments, transplant surgery, weight control treatments among others.
• Surgery to treat deviated septum/hypertrophied turbinates.

Claim Procedure

Insured members can opt for cashless hospitalisation or the reimbursement facility as per their convenience. The procedure to raise claims under each of the options is given below:

Cashless hospitalisation

• At the time of hospitalisation, present the ID card provided by the insurer along with the policy document.
• Request for a pre-authorisation letter.
• In case of planned hospitalisation, you will be needed to get the pre-authorisation letter in advance and submit it with the ID card, policy document, and other necessary documentation.
• Once the pre-authorisation is provided, you need not worry about paying the hospital bill at the time of discharge. You will only have to pay any expenses that are not included or that exceed the sum insured amount of the policy.

Reimbursement claim

• Inform the insurance company as soon as possible, within 30 days from the date of discharge.
• Submit the claim form along with the below-mentioned documents:
  • Original hospital discharge summary
  • First consultation paper
  • Original hospital bill
  • Original money receipt
  • Original laboratory and diagnostic test reports
  • Claim settlement letter from co-insurer, if any
  • Aadhaar or PAN copy
• The claim will be settled within 7 days from the day the last document is accepted by the insurer. In case of a delay, the insurer will have to pay interest that is 2% over the bank rate applicable during that financial year.