Bajaj Allianz M-Care Health Insurance Policy

Bajaj Allianz M-Care Health Insurance Policy review

• Scope of Cover

  If the Insured is diagnosed as suffering from a Vector Borne disease listed below which first occurs or manifests itself during the Policy Period, the Company shall pay a lump sum Benefit to the Insured or Insured Person [in floater policy], as specified under the Policy Schedule, Subject to Limit of Benefits, Sum Insured, limits, terms, conditions definitions and exclusions contained or otherwise expressed in the Policy Schedule.

  Sum Assured Options for M-Care Health Insurance	10,000 15,000 25,000 50,000 75,000
  Entry Age for M-Care Health Insurance	Minimum Entry age for proposer/spouse/ dependent parents – 18 years Maximum Entry age for proposer/ spouse/ dependent parents – 65 years Minimum Entry age for dependent children – 0 days
  Renewal Age	Under normal circumstances, lifetime renewal benefit is available under the policy, except on the grounds of Your moral hazard, misrepresentation, non- cooperation or fraud.
  Policy period	This is an Annual policy.
  Premium Paying term	Annual
  Is M-Care Health Insurance a floater policy / individual policy?	Policy provides Individual as well as Floater sum insured option
  Who can be covered under M-Care Health Insurance Policy?	Self, Spouse, Dependent Children & Dependent Parents

• Coverage of M-Care Health Insurance

  • If you are diagnosed during the policy period, we cover you from a host of diseases.
    1. Dengue Fever
       Subject to Limit of Benefits, the Company shall pay the benefit as specified in the Policy Schedule in theevent of Insured or the Insured Person(s), as the case may be being hospitalized during the the PolicyPeriod, with the diagnosis of Dengue which is confirmed by Medical Practitioner along with laboratoryexaminations results countersigned by a Pathologist/microbiologist indicating:
       • Decreasing platelet levels- less than 100,000 cells/mm3; and
       • Immunoglobulins /Polymerase Chain Reaction (PCR) test showing positive results for Dengue
       • Concurrent to the above two conditions the final diagnosis should be confirmed as Dengue Fever
    2. Malaria
       The Company shall pay the benefit as specified in the Policy Schedule in the event of Insured Person beinghospitalized during the the Policy Period, with the diagnosis of Malaria which is confirmed by a medicalpractitioner with confirmatory tests indicating presence of Plasmodium falciparum/ vivax/ malariae inhis/her blood by laboratory examination countersigned by a pathologist/microbiologist in peripheralblood smear or positive rapid diagnostic test (antigen detection test).
    3. Filariasis(Payable only once in a lifetime)
       The Company shall pay the benefit as specified in the Policy Schedule in the event of Insured Personbeing hospitalized during the the Policy Period, with the diagnosis of Filariasis commonly known aselephantiasis, and same must be confirmed by a Medical Practitioner with laboratory examination withpresence of microfilariae in a blood smear by microscopic examination and along with any two of thefollowing Clear and visible manifestation of the disease:
       • Lymphoedema
       • Elephantiasis and
       • Scrotal swelling
       • Concurrent to the above three conditions the final diagnosis should be confirmed as Filariasis
         • If the Insured Person is already infected with Filariasis prior to first Policy inception then this benefit willnot be extended for lifetime
         • Once the Sum Assured is paid for any Insured Person, no other claim for this particular condition shall bepaid to the Insured Person in his/her entire lifetime.
    4. Kala Azar
       The Company shall pay the benefit as specified in the Policy Schedule in the event of Insured Person beinghospitalized during the the Policy Period, with the diagnosis of Visceral Leishmaniosis, also known as kalaazar which is characterized by irregularbouts of fever, substantial weight loss, swelling of the spleen andliver and anaemia and same must be confirmed by a Medical Practitioner by parasite demonstrationin bone marrow/spleen/lymph node aspiration or in culture medium as the confirmatory diagnosis orpositive serological tests for kala azar indicating presence of this disease.
    5. Chikungunya
       The Company shall pay the benefit as specified in the Policy Schedule in the event of Insured Personbeing hospitalized during the the Policy Period, with the diagnosis of Chikungunya which is characterizedby an abrupt onset of fever with Joint pain. Other common signs and symptoms include muscle pain,headache, nausea, fatigue and rash and same must be confirmed by a Medical Practitioner and bySerological tests, such as enzyme-linked immunosorbent assays (ELISA), confirming the presence of IgMand IgG anti-chikungunya antibodies.
    6. Japanese Encephalitis
       The Company shall pay the benefit as specified in the Policy Schedule in the event of Insured Personbeing hospitalized during the the Policy Period, with the diagnosis of Japanese Encephalitis is whichis characterized by rapid onset of high fever, headache, neck stiffness, disorientation, coma, seizures,spastic paralysis and same must be confirmed by a Medical Practitioner by positive serological test forJapanese Encephalitis by immunoglobulin M (IgM) antibody capture ELISA (MAC ELISA) for serum andcerebrospinal fluid (CSF).
    7. Zika Virus
       The Company shall pay the benefit as specified in the Policy Schedule in the event of Insured Person beinghospitalized during the Policy Period, with the diagnosis of Zika virus disease which have symptomslike mild fever, skin rash, conjunctivitis, muscle and joint pain, malaise or headache and same must beconfirmed by a registered medical practitioner by plaque-reduction neutralization testing (PRNT). PRNTis performed by CDC or a CDC-designated confirmatory testing laboratory to confirm presumed positive,equivocal, or inconclusive IgM results

• Bajaj Allianz M-Care Health Insurance Policy exclusions

  • Any Treatment other than for vector-borne diseases as listed coverage section.
  • Admission to hospital for less than 24 hours.
  • Diagnosis and treatment outside India.
    However, this exclusion shall not be applicable in the below-listed countries however, this exclusion shall not be applicable in the below-listed countries
    • New Zealand
    • Japan
    • Singapore
    • Canada
    • Switzerland
    • Dubai
    • USA
    • Hong Kong
    • Malaysia
    • Countries of the European Union
  • M-Care health insurance gains momentum after a brief run-up! If you’re diagnosed with a vector-borne disease within the first 15 days of the date of commencement of your Health Insurance Policy, coverage is excluded. However if you have renewed an existing health insurance policy, we will be happy to provide coverage. Here, there is a caveat! For coverage to be applicable there must be no claims made in the previous year.
  • A 60 day waiting period will be applicable for any pre-existing illnesses for which you have undergone treatment prior to taking out your M-Care Health Insurance Policy. However if you have made a claim and renew your health insurance policy the following year, a 60 day waiting period would be applicable from the date of the last treatment for the specific condition for which a claim was made previously.
  • If you renew your M-Care Health Insurance Policy within 60 days of the date of the last paid claim, a 60 day cooling off period shall apply for the same ailment on renewal; however, there would be no waiting period for any other listed vector-borne diseases.
  • If your M-Care Health Insurance Policy is renewed 60 days after the date of admission of the previously paid claim, then a fresh waiting period of 15 days shall apply for all listed vector-borne diseases under the policy.