Health Guard Gold
Overview
Bajaj Allianz Health Guard Gold is a comprehensive variant in the Health Guard lineup offered by Bajaj Allianz General Insurance Company Ltd. The plan offers hospitalisation cover, convalescence benefit for a longer hospitalisation, preventive health check-up and cover for maternity expenses.
Bajaj Allianz Health Guard Gold is an all-inclusive health insurance plan available at a reasonable price.
Pros and Cons
- Never spills the bill – The plan does not include a mandatory copay. In case of inpatient hospitalisation, you are fully covered up to the sum insured.
- Pre and Post Hospitalisation expenses covered – The insurer pays for medical expenses up to 60 days before and 90 after the hospitalisation.
- Maternity expenses covered – The plan covers maternity and newborn baby expenses after a waiting period of 72 months, subject to limits.
- Bariatric surgery cover – Covers weight loss treatment after a waiting period of 36 months if certain conditions are met.
- Reasonably priced – The plan is reasonably priced, making it a good value option.
- Room rent limit – Covers up to a single private AC room for base sum insured less than Rs. 10 Lakh. Otherwise, you are free to pick any room.
- Disease-specific limit – Includes sub-limit on common treatments like cataract surgery.
- Consumables not covered – The plan does not cover the cost of consumables. You bear the cost out-of-pocket.
- Domiciliary Hospitalisation – No cover if you are forced to be hospitalised at home.
Plan Benefits
Inpatient hospitalisation expenses covered
The plan covers inpatient hospitalisation expenses up to the sum insured. Room rent coverage is restricted to a single private AC room for sum insured less than Rs. 10 Lakh. Otherwise, you can choose any room during hospitalisation. ICU charges are covered at actuals.
Pre and post-hospitalisation expenses cover available
The plan covers hospitalisation-related medical expenses 60 days before and 90 days after hospitalisation. These include consultation fees, diagnostic tests, medication and other related expenses.
Road ambulance charges covered
Your insurer covers road ambulance charges up to Rs. 20,000/- per policy year.
Includes cover for daycare procedures
Many advanced surgeries or procedures done under anesthesia now require less than 24 hour hospitalisation. These are called day care treatments. Your insurer fully covers the cost of such procedures up to sum insured.
Get cover for alternative treatment
Want to take an alternative treatment like Ayurveda or Homeopathy? Don’t worry. The insurer fully covers your hospitalisation and related expenses.
Organ donor expenses covered
If you are an organ recipient, the insurer covers the hospitalisation expenses related to harvesting the organ from the donor.
Get coverage for maternity and related expenses
The plan covers delivery and newborn care expenses after a waiting period of 72 months, subject to limits. This benefit has a separate limit over and above the sum insured.
One-time restoration of sum insured available
If you claim a part of your base cover, you don’t have to worry about the coverage for future claims. The insurer restores your full sum insured once during a policy year upon full exhaustion of base cover. The restored amount can be used only for subsequent claims during the policy year.
Get convalescence benefit in case of longer hospitalisation
If the hospitalisation exceeds 10 consecutive days, the insurer provides you a fixed convalescence benefit of Rs. 5,000 or Rs. 7,500 for incidental expenses, depending on the base cover amount. This benefit has a separate limit over and above the sum insured.
Get daily cash benefit for accompanying a child
If a child aged less than 12 years is hospitalised, you get a daily cash benefit of Rs. 500/- per day for accompanying the insured child, for a maximum of 10 days every policy year. This benefit has a separate limit over and above the sum insured.
Get free preventive health check-up
Free preventive health check-up is available once in a block of 3 years for all lives in an individual policy. Family floaters provide preventive health check-up only for the policyholder and spouse.
Get cover for weight-loss treatment
Want to undergo weight loss treatment? The plan covers hospitalisation expenses for weight loss treatment up to the sum insured if certain conditions are met.
Stay healthy and get a discount on renewal premium
Stay healthy and monitor your health. You can get up to a 12.5% discount on subsequent premiums if certain health parameters meet the insurer’s benchmark.
Get air ambulance cover with an add-on
With this add-on, you get cover for air ambulance charges in case of emergencies, subject to limits.
Get OPD cover with Health Prime rider
With this add-on, get coverage for multiple wellness and OPD benefits. These include tele & in-person consultations with medical practitioners, doctor prescribed diagnostic tests, annual health check-ups and dental OPD treatment, among others.
Choose a voluntary deductible
If you find the plan expensive, opt for a small deductible to lower the premium. Flexible deductible options are available. However, choose this option with caution as you pay a fixed amount of claim out-of-pocket before the policy benefits kick in.
Policy Conditions
| Sum Insured Range | Rs. 3 Lakh – Rs. 50 Lakh |
| Entry Age | 91 Days – 30 Years for dependent children; 18 Years onwards for adults |
| Policy Tenure Options | 1, 2 or 3 Years |
| Coverage Types | Individual and Family Floater |
| Family Coverage | Self, Spouse, Dependent Children, Grandchildren, Parents, Sister, Brother, Parents-in-law, Aunt, Uncle can be covered. |
| Premium Payment Options | Monthly, Quarterly, Half-Yearly and Annual |
Exclusions
Waiting Periods
- Initial Waiting Period: 30 days (except accidents)
- Specific Illness Waiting Period: 24 months and 36 months, depending on the illness
- Waiting Period on Pre-Existing Diseases: 36 months
- Bariatric Surgery Waiting Period: 36 months
- Maternity Benefit Waiting Period: 72 months
Medical Exclusions
- Change of gender treatment
- Cosmetic surgeries (unless due to accident, cancer, etc.)
- Unproven treatments
- Refractive error correction for less than 7.5 diopters
- OPD expenses and Dental OPD treatment
- Sterility and infertility
Non-Medical Exclusions
- Expenses related to any admission primarily for diagnostics and evaluation purposes
- Expenses related to any admission primarily for enforced bed rest
- Self-injury or attempt to suicide
- Alcoholism, drug or substance abuse
- Treatment necessitated by committing breach of law with criminal intent
- Treatment taken by a medical practitioner outside his discipline
- War, terrorism, nuclear events
- Injuries from hazardous sports
About the Insurer
Bajaj Allianz General Insurance Company Limited was established in 2001. It is a joint venture between Bajaj Finserv Limited and Allianz SE, a global insurance leader based in Germany. Over the years, the company has grown to become one of the country’s largest private general insurers, with a presence in over 1,100 towns and cities.
The company offers a comprehensive range of insurance products, including health, motor, travel, home, and commercial insurance, catering to both individual and corporate clients. With its customer-centric approach, the company has been able to deliver superior customer service. This is reflected in the insurer’s decent claim settlement ratio and minimal number of claim-related complaints.
Performance Highlights (FY24)
Turnover – Rs. 20,473 Crore
Claim Settlement Ratio – 93.65%
Incurred Claim Ratio – 73.80%
Volume of Claim Complaints – 2.87
Network Hospitals – 18,400+
Get In Touch
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Frequently Asked Questions
What is the entry age for Bajaj Allianz Health Guard Gold Plan?
Individuals aged 18 years and above can be covered. Dependent children aged 3 months to 30 years are also eligible under the family floater.
Is there a maximum age limit for renewal under Bajaj Allianz Health Guard Gold?
The policy offers lifelong renewability for adults. For dependent children, renewal is allowed for up to 30 years.
What are the sum insured options available under Bajaj Allianz Health Guard Gold?
The plan offers sum insured options ranging from Rs. 3 Lakh to Rs. 50 Lakh.
Are pre and post-hospitalisation expenses covered?
Yes, hospitalisation-related expenses incurred for up to 60 days before hospitalisation and up to 90 days after discharge are covered.
Does Bajaj Allianz Health Guard Gold cover daycare procedures?
Yes, all daycare procedures that require less than 24 hour hospitalisation are covered.
Is maternity coverage included under Bajaj Allianz Health Guard Gold?
Yes, the plan covers maternity and newborn care expenses after a waiting period of 6 years, subject to limits. This benefit has a separate limit over and above the base coverage.
What is the waiting period for pre-existing diseases under Bajaj Allianz Health Guard Gold?
Pre-existing diseases are covered after a waiting period of 3 years.
Are alternative treatments like AYUSH covered?
Yes, hospitalisation based treatments under Ayurveda, Yoga, Unani, Siddha, and Homeopathy are covered up to the sum insured.
Does Bajaj Allianz Health Guard Gold offer cumulative bonus?
No, cumulative bonus is not available under this variant.
Is there a restoration benefit?
Yes, the insurer restores 100% of the sum insured if it gets exhausted. The restored sum insured is only available for the subsequent claims in the same policy year.
Are organ donor expenses covered?
Yes, expenses incurred in harvesting the organ from a donor are covered up to the sum insured.
What is the coverage for ambulance charges?
Road ambulance charges are covered up to Rs. 20,000 per policy year.
Is there a convalescence benefit available under Bajaj Allianz Health Guard Gold?
Yes, if hospitalisation exceeds 10 consecutive days, a lump sum benefit of Rs. 5,000 (for sum insured up to Rs. 5 Lakh) or Rs. 7,500 (for sum insured above Rs. 5 Lakh) is provided.
Are preventive health check-ups included in Bajaj Allianz Health Guard Gold?
Yes, once in a block of 3 years, free preventive health check-ups are provided, up to Rs. 5,000 per member under individual policies. In case of family floaters, preventive health check-ups are only available for the policyholder and spouse.
Does the plan cover bariatric surgery?
Yes, bariatric surgery is covered up to 50% of the sum insured, subject to a maximum of Rs. 5 Lakh, if certain conditions are met. This benefit is available after a waiting period of 3 years.
Are there any discounts available?
Yes, discounts include:
- Family Discount: 10% for 2 members, 15% for 3 or more members.
- Long-term Policy Discount: 4% for a 2-year policy, 8% for a 3-year policy.
- Copay Discount: 10%-20% discount if you opt for a voluntary copay.
- Employee Discount: 20% for employees of Bajaj Allianz and group companies.
What is the claim settlement ratio for the plan?
The insurer’s claim settlement ratio for the financial year 2023-24 is 93.65%.
How can I renew the policy?
The policy can be renewed online through the Bajaj Allianz website or mobile app. Alternatively, you can contact your health insurance advisor for renewal support.
Are there any tax benefits?
Yes, the premiums you pay are eligible for tax deductions under Section 80D of the Income Tax Act.
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