Bajaj Allianz total health secure goal

Bajaj Allianz total health secure goal review

• Key Features of Total Health Secure Goal Combi plan

  • Comprehensive plan providing Hospitalization benefit & Life cover
  • Rebate for High Sum Assured & Health Lifestyle insurance
  • Comprehensive health care program to cover the cost of hospitalization arising from an accident or illness.
  • Apart from hospitalization also involves aspects such as the amount of covered recovery, organ donation costs, maternity, etc.

• Eligibility Parameters of Total Health Secure Goal(Applicable for the Combo Proposition Only)

  Parameter	Bajaj Allianz iSecure	Bajaj Allianz Health Guard
  Min & Max Entry Age	18 to 60 years
  Policy Term	10 /15 /20 /25/ 30 years	Renewable for Life
  Premium Payment Term	Equal to Policy Term	Annual premium payment with lifetime renewable option for health cover
  Benefit Payable	Sum Assured opted at inception	Hospitalization expenses as per policy terms & conditions
  Sum Assured/Sum Insured	Minimum –INR 250000 Maximum – As per Board Approved Underwriting Process	Minimum- INR 150000 Maximum- INR 5000000
  Premium Payment Frequency	Yearly
  Grace Period	30 Days
  Entry age	Proposer /Spouse /Parents/Sister/ Brother/ Father In law/ Mother In law/ Aunt/ Uncle - 18 yrs to 65 years Dependent Children/Grandchildren: 3 months – 30 yrs
  Renewal age	The policy is renewable for lifetime. For Dependent Children/ Grand Children- Renewal up to 35 years.
  Policy Period?	Policy can be taken for 1year/2years OR 3years.
  Premium Paying Term	Annual premium payment for 1 year policy. For long term policies one time premium will be collected at the time of risk inceptionand for renewal at the end of the policy term.
  Floater policy / Individual policy	Policy provides Individual as well as Floater sum insured options under both plans.
  Relationships that can be covered	Self, Spouse, Dependent Children, Grandchildren, Parents, Sister, Brother, Father In law, Mother In law, Aunt, Uncle can be coveredunder individual option

• Advantages of Total Health Secure Goal Combi plan

  • Hassle free comprehensive coverage taking care of life & health insurance needs
  • Single policy covering Health & Life cover
  • Single touch point for all communications
  • In-house Claim Administration
  • Global Expertise in managing Health Insurance
  • Quick disbursement of claims
  • Option to choose the right variant as per your needs from Silver & Gold, providing all round cover during hospitalization
  • Simple steps to get a wide range of Health & Life cover
  • An additional discount of 5% is available on the total premium payable under the Combi plan

• Coverages of Total Health Secure Goal Combi plan

  1. In-patient Hospitalisation Treatment
     If the Insured is Hospitalised on the advice of a Medical Practitioner (as defined under Policy) because of Illness or Accidental Bodily Injury sustained or contracted during the Policy Period, then the Company will pay the Insured, Reasonable and Customary Medical Expenses incurred for:
     • Room and Boarding expenses as provided by the Hospital/ Nursing Home, maximum up to the per day room rent plan opted by the Insured
     • If admitted in ICU, the Company will pay up to actual ICU expenses provided by Hospital.
     • Nursing Expenses as provided by the hospital
     • Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees.
     • Anaesthesia, Blood, Oxygen, Operation Theatre Charges, surgical appliances,
     • Dialysis, Chemotherapy, Radiotherapy, physiotherapy
     • Medicines, Drugs and consumables.
     • Cost of Artificial Limbs, cost of prosthetic devices implanted during surgical procedure like Pacemaker, orthopaedic implants, infra cardiac valve replacements, vascular stents.
     • Relevant laboratory diagnostic tests, X-ray and such similar expenses that are medically prescribed by the treating Medical Practitioner
  2. Pre-Hospitalisation
     The Medical Expenses incurred during the 60 days immediately before the Insured was Hospitalised, provided that: Such Medical Expenses were incurred for the same illness/injury for which subsequent Hospitalisation was required, and the Company has accepted an inpatient Hospitalisation claim under “In-patient Hospitalisation Treatment”
  3. Post-Hospitalisation
     The Medical Expenses incurred during the 90 days immediately after the Insured was discharged post Hospitalisation provided that: Such costs are incurred in respect of the same illness/injury for which the earlier Hospitalisation was required, and the Company has accepted an inpatient Hospitalisation claim under “Inpatient Hospitalisation Treatment”
  4. Road Ambulance
     • The Company will pay the reasonable cost upto a maximum of Rs 20,000/- per Hospitalisation incurred on an ambulance offered by a healthcare or ambulance service provider for transferring the Insured to the nearest Hospital with adequate emergency facilities for the provision of health services following an Emergency
     • The Company will also reimburse the expenses incurred on an ambulance offered by a healthcare or ambulance service provider for transferring the Insured from the Hospital where he/ she was admitted initially to another hospital with higher medical facilities.
     • Claim under this section shall be payable by the Company only when:
       • Such life threatening emergency condition is certified by the Medical Practitioner, and
       • The Company has accepted Insured’s Claim under “In-patient Hospitalisation Treatment” or “Day Care Procedures” section of the Policy
       • Subject otherwise to the terms, conditions and exclusions of the Policy.
  5. Day Care Procedures
     The Company will pay the Insured, medical expenses as listed above under “In-patient Hospitalisation Treatment” for Day Care medical treatment, and/or surgical procedure which is
     • Undertaken under General or Local Anaesthesia in a hospital/day care centre in less than 24 hrs because of technological advancement, and
     • Which would have otherwise required Hospitalisation of more than 24 hours.
     • Exclusions specific to Day Care Procedures. Treatment normally taken on an out-patient basis
       • Any dental treatment or procedure
  6. Preventive Health Check Up
     After continuously renewing the Health Guard Policy for 3 years with us, You are eligible for a free Preventive Health check-up. We will reimburse the amount equal to per day room rent as opted by You, maximum up to ₹2000/-for each Insured Member covered under the Policy during the block of 3 years
     You may approach us for the arrangement of the Health Check up. For the avoidance of doubt, We shall not be liable for any other ancillary or peripheral costs or expenses (including but not limited to those for transportation, accommodation or sustenance). Contact Email id - healthcheck@bajajallianz.co.in
  7. Organ Donor Expenses
     We will pay expenses towards organ donor’s treatment for harvesting of the donated organ, provided that,
     • The organ donor is any person whose organ has been made available in accordance and in compliance with THE TRANSPLANTATION OF HUMAN ORGANS (AMENDMENT) BILL, 2011and the organ donated is for the use of the Insured Person, and
     • We have accepted an inpatient Hospitalisation claim for the insured member under In Patient Hospitalisation Treatment
  8. Convalescence Benefit
     In the event of insured hospitalised for a disease/ illness/ injury for a continuous period exceeding 10 days, We will pay benefit amount of Rs. 5,000 per policy year. This benefit will be triggered provided that the hospitalization claim is accepted under In Patient Hospitalisation Treatment. This benefit will be applicable annually for policies with term more than 1 year.
  9. Daily Cash Benefit for Accompanying an Insured Child
     We will pay Daily Cash Benefit of Rs. 500 per day maximum up to 10 days during each policy year for reasonable accommodation expenses in respect of one parent/legal guardian, to stay with any minor Insured Person (under the Age of 12), provided the hospitalization claim is paid under Inpatient Hospitalisation Treatment. This benefit will be applicable annually for policies with term more than 1 year.
  10. Sum Insured Reinstatement Benefit
      If Inpatient Hospitalization Treatment Sum Insured and cumulative bonus (if any) is exhausted due to claims lodged during the Policy year, then it is agreed that 100% of the Sum Insured specified under Inpatient Hospitalization Treatment be reinstated for the particular Policy year provided that:
      • The reinstated Sum Insured will be triggered only after the Inpatient Hospitalization Treatment Sum Insured inclusive of the Cumulative Bonus(If applicable) has been completely exhausted during the policy year;
      • The reinstated Sum Insured can be used for claims made by the Insured Person in respect of the benefits stated in Inpatient Hospitalization Treatment.
      • If the claimed amount is higher than the Balance Sum Insured inclusive of the Cumulative Bonus (If applicable) under the policy, then this benefit will not be triggered for such claims
      • The reinstated Sum Insured would be triggered only for subsequent claims made by the Insured Person. In case of relapse within 45 days, this benefit will not trigger
      • This benefit is applicable only once during each policy year & will not be carried forward to the subsequent policy year/ renewals if the benefit is not utilized.
      • This benefit is applicable only once in life time of Insured Person covered under this policy for claims regarding CANCER OF SPECIFIED SEVERITY and KIDNEY FAILURE REQUIRING REGULAR DIALYSIS as defined under the policy.
      • This benefit will be applicable annually for policies with term more than 1 year.
      • Additional premium would not be charged for reinstatement of the Sum Insured.
      • Incase Family Floater policy, Reinstatement of Sum Insured will be available for all Insured Persons in the Policy

• General Exclusions

  1. Any dental treatment that comprises of cosmetic surgery, dentures, dental prosthesis, dental implants, orthodontics, surgery of any kind unless as a result of Accidental Bodily Injury to natural teeth and also requiring hospitalization.
  2. Medical expenses where Inpatient care is not warranted and does not require supervision of qualified nursing staff and qualified medical practitioner round the clock
  3. War, invasion, acts of foreign enemies, hostilities (whether war be declared or not), civil war, commotion, unrest, rebellion, revolution, insurrection, military or usurped power or confiscation or nationalization or requisition of or damage by or under the order of any government or public local authority.
  4. Circumcision unless required for the treatment of Illness or Accidental bodily injury, Investigation & Evaluation
  5. Rest Cure, rehabilitation and respite care
     • Expenses related to any admission primarily for enforced bed rest and not for receiving treatment. This also includes:
       • Custodial care either at home or in a nursing facility for personal care such as help with activities of daily living such as bathing, dressing, moving around either by skilled nurses or assistant or non-skilled persons.
       • Any services for people who are terminally ill to address medical, physical, social, emotional and spiritual needs.
  6. Obesity/Weight Control : Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions:
     • Surgery to be conducted is upon the advice of the Doctor
     • The surgery/Procedure conducted should be supported by clinical protocols
     • The member has to be 18 years of age or older and
     • Body Mass Index (BMI);
       • greater than or equal to 40 or
       • greater than or equal to 35 in conjunction with any of the following severe co-morbidities following failure of less invasive methods of weight loss:
     • Obesity-related cardiomyopathy
     • Coronary heart disease
     • Severe Sleep Apnea
     • Uncontrolled Type2 Diabetes
  7. Change-of-gender treatments : Expenses related to any treatment, including surgical management, to change characteristics of the body to those of the opposite sex.
  8. Cosmetic or plastic Surgery : Expenses for cosmetic or plastic surgery or any treatment to change appearance unless for reconstruction following an Accident, Burn(s) or Cancer or as part of medically necessary treatment to remove a direct and immediate health risk to the insured. For this to be considered a medical necessity, it must be certified by the attending Medical Practitioner.
  9. Hazardous or Adventure Sports : Expenses related to any treatment necessitated due to participation as a professional in hazardous or adventure sports, including but not limited to, para-jumping, rock climbing, mountaineering, rafting, motor racing, horse racing or scuba diving, hand gliding, sky diving, deep-sea diving.
  10. The cost of spectacles, contact lenses, hearing aids, crutches, dentures, artificial teeth and all other external appliances and/or devices whether for diagnosis or treatment except for Cost of Artificial Limbs, cost of prosthetic devices implanted during surgical procedure like Pacemaker, orthopaedic implants, infra cardiac valve replacements, vascular stents etc.
  11. External medical equipment of any kind used at home as post Hospitalization care including cost of instrument used in the treatment of Sleep Apnoea Syndrome (C.P.A.P), Continuous Peritoneal Ambulatory Dialysis (C.P.A.D) and Oxygen concentrator for Bronchial Asthmatic condition.
  12. Congenital external diseases or defects or anomalies, growth hormone therapy, stem cell implantation or surgery except for Hematopoietic stem cells for bone marrow transplant for haematological conditions.
  13. Intentional self-injury (including but not limited to the use or misuse of any intoxicating drugs or alcohol)
  14. Breach of law : Expenses for treatment directly arising from or consequent upon any Insured committing or attempting to commit a breach of law with criminal intent.
  15. Birth control, Sterility and Infertility :Expenses related to Birth Control, sterility and infertility. This includes:
      • Any type of contraception, sterilization
      • Assisted Reproduction services including artificial insemination and advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI
      • Gestational Surrogacy
      • Reversal of sterilization
  16. Maternity :Medical Treatment Expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred during hospitalization) except ectopic pregnancy. Expenses towards miscarriage (unless due to an accident) and lawful medical termination of pregnancy during the policy period.