Health Ensure is a comprehensive health insurance plan offered by general insurer Bajaj Allianz. This policy is designed to provide comprehensive benefits at an affordable premium amount. One of the notable features of this policy is that its floater version can be extended even to in laws and grandparents. With flexible sum insured options and multiple value added benefits, Bajaj Allianz Health Ensure is an ideal product to manage all your health care needs in case of an unfortunate hospitalisation.
Eligibility for Bajaj Allianz Health Ensure
Bajaj Allianz Health Ensure plan comes with the following eligibility criteria:
- The age of the proposer must be above 18 years.
- There is no maximum entry age for this policy, and it is available throughout one’s lifetime.
- Dependents can be covered from the age of 3 months to 30 years.
- The family floater version of this policy is available for self, spouse, dependent children, parents, siblings, parents-in-law, and grandparents.
Features of Bajaj Allianz Health Ensure
Some of the key features of Bajaj Allianz Health Ensure can be given as follows:
- The sum insured amount available for individual policy ranges from Rs.50,000 to Rs.10 lakh.
- The sum insured amount available for family floater cover ranges from Rs.2 lakh to Rs.10 lakh.
- Variable premiums are charged based on the location of the insured person. Zone A customers pay higher premiums than Zone B customers. However, a 20% copayment is necessary for customers living in Zone B locations.
- This policy can also be taken in 2 and 3-year policy terms. Long term discount of 4% and 8% on premiums is offered for 2 and 3 year policy terms respectively.
- Pre policy medical checkup is not required for people entering the cover till the age of 50. For those requiring this checkup, medical costs are reimbursed for up to 50% following successful acceptance of the proposal.
- Based on the existing medical conditions, premium loading may be applicable for policyholders. For instance, a 5% loading is applicable for people who have diabetes.
- There is an additional premium discount of 5% for policies purchased online.
- Pre and post hospitalisation medical expenses are covered for up to 30 days and 60 days respectively.
- Pre-existing conditions will not be covered for up to 24 months of continuous policy coverage.
- There is a general waiting period of up to 30 days from the date of commencement of the policy. This, however, does not apply for accidental injuries.
- For certain conditions such as cataract, hernia, hysterectomy, benign prostatic hypertrophy, etc., a 2-year waiting period is applicable.
- The company allows sum insured enhancement only at the time of policy renewal.
- The 15-day free look period allows customers to review the terms and conditions of the policy to decide on whether or not to continue with it.
- Customers have a grace period of up to 30 days from the date of expiry to renew this cover. However, coverage will not be provided for the days during which the premium is not paid.
- Portability options are allowed by the company as per the regulations set forth by the IRDAI.
- The premium amount paid for this policy is eligible for income tax relief as per Section 80D of the Income Tax Act.
Benefits of Bajaj Allianz Health Ensure
The range of benefits offered under Bajaj Allianz Health Ensure can be given as follows:
||Extent of Coverage
|Room rent, boarding, and nursing expenses
||Normal - 1% of the sum insured (max. Rs.5,000) per day
ICU - 2% of the sum insured (max. Rs.10,000) per day
||Coverage up to the sum insured limit
|Road ambulance coverage
||Actual expenses subject to a maximum of Rs.1,000 per policy year
|Day care treatment
||Covered for all the procedures listed in the policy schedule
|Preventive health checkup (Once every three claim-free years)
||Up to 1% of the sum insured amount subject to a maximum of Rs.1,500
||Up to 20% of the sum insured amount
Exclusions of Bajaj Allianz Health Ensure
The following list of exclusions applies to Bajaj Allianz Health Ensure:
- Self inflicted injuries or suicide attempt
- Sexually transmitted diseases and venereal diseases
- Medical expenses attributed to childbirth and pregnancy
- Cost of dental treatment unless arising out of accidents
- Expenses attributable to war, invasion, rebellion, etc.
- Medical expenses attributable to nuclear activity and radiation
- Cosmetic and aesthetic treatments of all kinds
- Weight loss and weight management treatments
- Plastic surgery unless necessary for burns, cancer, and accidental injuries
- Convalescence, general debility, rest cure, etc.
- Congenital diseases, birth defects, and anomalies
- Cost of spectacles, hearing aids, crutches, contact lenses, etc.
- Medical expenses related to drug or alcohol abuse
- Physical injuries sustained while under the influence of alcohol or drugs
- Treatment for mental and psychiatric illnesses
- Expenses related to experimental or unproven treatments
- Hospitalisation for the purpose of diagnosis and investigations
- All non-medical expenses incurred during hospital stay
The claim procedure begins with intimation to the company about the hospitalisation. Planned hospitalisation must be informed at least 48 hours in advance. Emergency hospitalisation can be informed within 24 hours of hospitalisation.
Cashless treatment is offered through the 6000+ network hospitals associated with Bajaj Allianz throughout the country. Pre authorisation can be obtained by sending the policy information to the company through fax or email. After the verification of the policy details, the company will provide the authorisation for cashless treatment.
For reimbursement claims, the insured can file the request after discharge from the hospital. Various documents including hospital bills, laboratory bills, diagnostic reports, physician certificate, etc. must be submitted along with the claim form. Following the submission of these documents, the company will verify the request and provide the settlement amount.