Health Guard Platinum
Overview
Bajaj Allianz Health Guard Platinum is the most premium variant in the Health Guard lineup offered by Bajaj Allianz General Insurance Company Ltd. The plan covers hospitalisation expenses, cumulative bonus, convalescence benefit for a longer hospitalisation, preventive health check-up and maternity expenses.
Bajaj Allianz Health Guard Platinum 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.
- 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 you like.
- 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. Your 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
You get cover for 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 one-time recharge if claim exceeds the cover amount
If the claim amount exceeds the base cover, the insurer offers a recharge benefit equal to 20% of the base sum insured or Rs. 5 Lakh, whichever is less. This recharge benefit applies even for the first claim in a policy year.
Get no-claim bonus for not making a claim
You get no-claim bonus for not making a claim in a policy year. The maximum cumulative no-claim bonus is 150% of the base sum insured. However, if you make a claim, your no-claim bonus is reduced to the previous slab in the subsequent year.
Get convalescence benefit in case of longer hospitalisation
If your hospitalisation exceeds 10 consecutive days, the insurer provides you a fixed convalescence benefit of Rs. 5,000 for incidental expenses. 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 an array of 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. 5 Lakh and Rs. 1 Crore |
| 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 age eligibility for Bajaj Allianz Health Guard Platinum?
Adults aged 18 years and above are eligible for cover with lifelong renewability. Children aged between 91 days and 30 years can be covered under the family floater option.
Is the policy lifelong renewable?
Yes, covered members are eligible for lifelong renewability. Dependent children can renew cover under the same policy up to age 30.
What is the waiting period for pre-existing diseases under Bajaj Allianz Health Guard Platinum?
Pre-existing diseases are covered after a 24 month waiting period.
Any general waiting period after policy inception?
A standard 30‑day initial waiting period applies for all conditions, except accidental hospitalisation.
What is the available sum insured range in Bajaj Allianz Health Guard Platinum?
Sum insured options ranging from Rs. 5 Lakh to Rs. 1 Crore are available.
Does Bajaj Allianz Health Guard Platinum cover pre and post‑hospitalisation expenses?
Yes, the plan covers up to 60 days pre‑hospitalisation and 90 days post‑hospitalisation expenses.
Are daycare procedures included under Bajaj Allianz Health Guard Platinum?
Yes, day care procedures requiring less than 24 hour hospitalisation such as, dialysis and chemotherapy, are fully covered.
Is AYUSH treatment covered?
Yes, the plan includes full AYUSH coverage up to the sum insured.
Are maternity benefits included under Bajaj Allianz Health Guard Platinum?
Yes, the plan covers maternity and newborn care expenses after 6 continuous years on the policy.
Is there a convalescence benefit?
If your hospitalisation exceeds 10 consecutive days, the insurer provides you a fixed convalescence benefit of Rs. 5,000 for incidental expenses.
Is domiciliary (home) hospitalisation covered?
No, home hospitalisation expenses are not covered under Bajaj Allianz Health Guard Platinum.
Is there a cashless hospitalization option under Bajaj Allianz Health Guard Platinum?
Yes, a cashless hospitalisation facility is available at network hospitals with no upfront payment.
Are there any room rent limits included in Bajaj Allianz Health Guard Platinum?
Yes, 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.
Is there any copayment clause?
No, the plan does not include a copayment clause. You get 100% coverage up to the sum insured.
What is the Recharge Benefit under Bajaj Allianz Health Guard Platinum?
You get an additional 20% of base sum insured (up to Rs. 5 Lakh) once per policy year if your cover is exhausted.
How does the Super Cumulative Bonus work?
Your cover increases by 50% for each of the first two claim‑free years, then by 10% each year, up to a maximum of 150%.
Are wellness or preventive benefits included under Bajaj Allianz Health Guard Platinum?
Yes, wellness discounts (up to 12.5% on renewal) and free health check‑ups over time are included under the plan benefits.
Is the sum insured reinstated during the policy term?
Yes, one-time restoration of 100% of sun insured is available if the base cover gets exhausted.
How are claims processed?
Claims are either paid through cashless settlement at network hospitals or reimbursement mode after the discharge.
Can you port to this policy from another insurer?
Yes, IRDAI mandated portability is allowed under the plan, carrying forward cumulative benefits and waiting periods, subject to underwriting approval.
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