This is a specialised health insurance plan that offers a benefit to policyholders who might be required to undergo certain surgical procedures. The plan can be purchased in combination with certain add-ons like Hospital Cash Daily Allowance, Critical Illness Cover and Personal Accident Cover by paying an additional premium specified by the insurer, Bajaj Allianz.
Eligibility of Surgical Protection Plan
Bajaj Allianz specifies certain criteria that should be met in order to purchase the Surgical Protection Plan.
- The minimum age to purchase the plan is 18 years and maximum age is 65 years for adults. The same applies for the policyholder’s spouse and dependent parents.
- The age range for dependent children is 3 months to 25 years.
- Indian nationals resident in India can avail this plan.
- Non-resident Indians, too, can avail the plan provided the policy is purchased in India and the premium is paid in Indian rupees through an Indian bank account.
Sum Insured and Premium Range
The sum insured is the total amount a policyholder can claim from the insurer in an event where medical attention is required.
|Minimum Sum Insured
|Maximum Sum Insured
Features of Bajaj Allianz Surgical Protection Plan
- The sum insured can be claimed by the policyholder when he/she is hospitalised on the advice of a doctor due to an illness or accident and is required to undergo a surgery.
- The insurer lists out 595 surgeries like ankle replacement, cataract surgery, discectomy, foot fusion, heart transplant, tumour surgeries, etc. The claim can be made only is the surgery is one of the 595 enlisted surgeries.
- The enlisted surgeries are classified into 5 grades from Grade 1 to Grade 5. The surgeries are classified under supra-major surgeries, major surgeries, sub-major surgeries, day care procedures, and minor surgeries.
Add-on Plans for Bajaj Allianz Surgical Protection Plan
- Hospital Cash Daily Allowance
The hospitalisation expenses resulting from one of the surgeries mentioned in the policy are covered by this add-on.
- The insurer will provide Rs.1,500 to the policyholder for every 24 hours of hospitalisation necessitated by one of the surgeries mentioned in the policy.
- The insurer will provide Rs.3,000 to the policyholder for every 24 hours if admitted in the ICU due to one of the surgeries specified in the policy.
A claim can be made towards the above-mentioned cover if the policyholder is diagnosed with one of the listed critical illnesses mentioned in the policy, during the policy period.
- The sum insured for the Critical Insurance Cover can be claimed if the policyholder is diagnosed with a critical illness during the policy period and he/she survives 30 days from the date of diagnosis.
- Once the claim is made, this cover will cease to exist for the policyholder and will not be eligible for renewal in the future too.
If the policyholder suffers an accidental bodily injury, the sum insured under the Personal Accident Cover can be claimed. The percentage of sum insured that can be claimed varies as follows:
- Death- 100%
- Permanent Total Disability- 125%
- Permanent Partial Disability- Varies with the nature of disability
Once the Personal Accident Cover is utilised, the cover will cease to exist for the policyholder.
Coverage/Benefits provided by Bajaj Allianz Surgical Protection Plan
- The plan offers a payout in case of the need for a surgical procedure arises from an illness or accidental bodily injury sustained during the policy period.
- Tax benefits can be availed under Section 80(D) of the Income Tax Act, 1961.
- The benefit of cashless hospitalisation across a network of hospitals throughout the country can be availed.
Exclusions of Bajaj Allianz Surgical Protection Plan
- Surgery that results from a pre-existing condition unless the plan has been in force for 4 years without a break.
- Treatments availed within 90 days of from the date of inception of the policy unless it is an accident.
- Claims made in the event of wars, commotion, unrest, damage by the order of a public authority, etc.
- Circumcision and dental treatment unless it is caused by an accident.
- Cosmetic surgeries and intentional self-injury.
- Expenses for plastic surgery unless the need arose due to cancer, burns or accidental injuries.
- Genetic disorders, Congenital External Anomaly, stem cell implantation, stem cell surgery, rest cure, growth hormone therapy, or convalescence.
- Medical conditions resulting from substance abuse or treatment of drug de-addiction.
- Ailments directly or indirectly linked to HIV/AIDS or the like.
- Hospitalisation as a result of laboratory, X-ray or diagnostic examinations.
- Any conditional that does not require qualified nursing attention and intensive care.
- Treatments required due to pregnancy or childbirth.
Procedures related to assisted conception, impotence, fertility, or subfertility.
- Experimental or treatments that do not abide by the standards.
- Non-allopathy treatments.
- Sexually transmitted diseases or sicknesses.
- Treatments with regard to weight reduction.