Bajaj Allianz Health Guard (Platinum)

Bajaj Allianz Health Guard (Platinum) is a health insurance policy offered by Bajaj Allianz General Insurance Company Limited.

The Bajaj Allianz Health Guard (Platinum) plan strikes the perfect balance of affordability, features, and benefits. It not only stands out with its competitive pricing but also extends coverage to a range of expenses such as the cost of consumable items, bariatric surgery, maternity expenses, and OPD expenses for medicines, tests, consultations, etc. And, our research indicates that the insurer has a good track record with fewer claim settlements and policy purchase complaints, ensuring a smooth and hassle-free claims experience for you. On the flipside, the plan doesn’t cover expenses related to treatments taken at home ie. domiciliary treatments and has sub-limits on certain treatments like cataract. Further, the plan does not allow for monthly premium payments. 

What are the benefits offered by the Bajaj Allianz Health Guard (Platinum) Plan?

• Inpatient hospitalisation coverage: The Bajaj Allianz Health Guard (Platinum) Plan provides coverage for hospitalisation expenses, which include all costs associated with admission that exceed 24 hours, such as nursing care, medical consultations, prescription medication, intensive care unit (ICU), and any other related expenses.
• Pre-hospitalisation coverage: Pre-hospitalisation coverage includes the expenses incurred before hospitalisation, like consultations, tests, checkups, etc. To be eligible for this coverage, the charges must be related to the medical condition that resulted in hospitalisation and should be approved as part of the inpatient hospitalisation coverage. With the Bajaj Allianz Health Guard (Platinum) Plan, pre-hospitalisation expenses incurred up to 60 days before hospitalisation are covered up to the sum insured.
• Post-hospitalisation coverage: Post-hospitalisation expenses are the medical costs incurred after hospitalisation, including follow-up consultations with your doctor, medical check-ups, rehabilitation sessions, physiotherapy, and other related expenses. However, these expenses are eligible for coverage only if they are related to the medical condition for which you required hospitalisation and must be approved as part of inpatient hospitalisation coverage. The Bajaj Allianz Health Guard (Platinum) Plan covers post-hospitalisation expenses for 90 days after hospitalisation up to the sum insured.
• Daycare treatment coverage: Daycare treatment is a medical procedure or surgery that previously required an extended hospital stay but can now be completed within 24 hours because of advances in medical technology. The Bajaj Allianz Health Guard (Platinum) Plan provides coverage for 399 daycare procedures without any limit. This indicates that all costs associated with daycare treatments are covered up to the sum insured.
• Domiciliary treatment coverage: Domiciliary treatments are medical treatments for illnesses or injuries that necessitate immediate attention at the hospital but are given at home due to the severity of the patient’s condition or the absence of hospital beds in the vicinity. However, the Bajaj Allianz Health Guard (Platinum) Plan does not provide coverage for domiciliary treatment expenses.
• Organ donor coverage: The Bajaj Allianz Health Guard (Platinum) Plan covers the harvesting expenses of the organ donor up to the sum insured, where you are the recipient.
• Modern treatment coverage: With technological advancements, healthcare is rapidly progressing, and modern treatments are emerging. These treatments, including stem cell therapy, robotic surgery, etc., treat diseases that were previously considered incurable. The Bajaj Allianz Health Guard (Platinum) Plan is tailored to keep up with these advancements and covers the expenses related to modern treatments, up to the sum insured.
• Non-medical expenses coverage: The Bajaj Allianz Health Guard (Platinum) Plan is designed to cover only medical expenses and does not include coverage for non-medical expenses including the costs associated with the gloves, nebulization kits, oxygen masks, and other items essential for treatment.
• No Claim Bonus: A No-Claim Bonus is a reward given to you for refraining from making any claims during a policy year. However, it is worth noting that the Bajaj Allianz Health Guard (Platinum) plan does not offer a No-Claim Bonus.
• Super No Claim Bonus: The  Super No Claim Bonus is an enhanced version of the No Claim Bonus and works similarly. The Bajaj Allianz Health Guard (Platinum) Plan offers a Super No-Claim Bonus of 50% of the sum insured for the first 2 consecutive claim-free years, followed by 10% of the sum insured for the next 5 claim-free years. However, making a claim reduces the accumulated bonus. You can accumulate a maximum bonus of up to 150% of the sum insured. 
• Restoration Benefit: The restoration benefit is a feature that restores the sum insured after it has been used up during a policy year. The Bajaj Allianz Health Guard (Platinum) Plan provides this benefit for unrelated illnesses. This benefit is activated only when both the sum insured and the Super No-Claim Bonus are fully exhausted. Furthermore, it can only be used once in a policy year for subsequent claims. And, the restoration benefit is available only once in a lifetime for claims related to cancer and kidney failure that require frequent dialysis. 

Please remember that the limitations and conditions mentioned in the benefits above apply to a sum insured of Rs. 10 lakhs. 

Bajaj Allianz Health Guard (Platinum): Financial Limits

• Room rent limit: A room rent limit covers the expenses related to the room you stay in during your hospitalisation. If the room you choose falls within the limit specified by your health insurance policy, you won’t have to pay any additional costs. However, if the room you select exceeds the eligibility limit, a proportionate deduction applies. And you will be responsible for paying a proportionate share of the total bill, not just the difference in the room rent. Fortunately, the Bajaj Allianz Health Guard (Platinum) Plan allows you to choose any type of room without any limitations.
• ICU rent limit: It is the maximum amount covered by your health insurance policy for your ICU stay in the hospital. The Bajaj Allianz Health Guard (Platinum) Plan provides coverage for the ICU rent without any limit. This means the plan covers the entire cost up to the sum insured.
• Copayment: A co-payment refers to a certain percentage of the claim amount that you must pay out of your own pocket. Once this amount is paid, the insurer will cover the remaining expenses. In the Bajaj Allianz Health Guard (Platinum) Plan, you can opt for a copayment limit of either 10% or 20%, depending on your preferences and budget.
• Deductible: A deductible refers to a certain amount that you must pay from your end before your coverage kicks in to cover your medical expenses. However, with the Bajaj Allianz Health Guard (Platinum) Plan, there's no deductible limit.
• Limits on surgeries/treatments: It is the maximum amount that a health insurance policy will pay for certain medical procedures or treatments. While some insurers have limits on the amount they will cover for certain procedures, others may not. The Bajaj Allianz Health Guard (Platinum) Plan provides coverage for cataract treatment up to 20% of the sum insured per eye per policy year, subject to a maximum limit of Rs 1 lakh. However, costs associated with a joint replacement surgery are covered up to the sum insured. 

Please note that the above financial limits are taken for a 30-year-old individual, opting for a sum insured of Rs. 10 Lakhs.

Bajaj Allianz Health Guard (Platinum): Waiting Periods & Exclusions

👉Waiting period

After you purchase a health insurance policy, some illnesses and diseases may not be covered for a certain period of time. This duration is referred to as the waiting period. But, once the waiting period ends, you can claim for these conditions -

• Initial waiting period: An initial waiting period of 30 days applies for all medical conditions except accidents. This means that you will not be able to make a claim for any hospitalisation, except for accidents, for the initial 30 days of policy purchase. 
• Waiting period for pre-existing diseases: A pre-existing disease refers to a medical condition or illness you have experienced in the past 36 months before purchasing a health insurance policy. Pre-existing diseases are subject to a waiting period of 36 months under the Bajaj Allianz Health Guard (Platinum) Plan. This implies that during this period, you will not be able to make any claims for expenses related to your pre-existing diseases.
• Waiting period for specific diseases: Apart from pre-existing diseases, insurers will have a list of specific medical conditions or illnesses that are subject to a waiting period, irrespective of whether you have had those diseases before or not. The duration of this waiting period is decided by the insurer and is not based on your current health status. Under the Bajaj Allianz Health Guard (Platinum) Plan, a waiting period of 24 months is applicable for specific diseases. Some conditions entail a waiting period of 36 months.

👉Exclusions

Health insurance policies do not cover certain medical conditions. These are known as exclusions. Here are some of the types of exclusions - 

• Standard permanent exclusions: All insurance providers are required to adhere to the ‘standard permanent exclusions’ established by IRDAI. These include -

1. Investigation and evaluation: Hospital admission for observation or monitoring.
2. Rest, rehabilitation, and respite care: Admission to a facility for bed rest without active treatment. 
3. Obesity/weight control: Treatment or surgery related to weight control or obesity.
4. Gender reassignment: Treatments aimed at altering the body’s characteristics to match the opposite sex. 
5. Plastic/Cosmetic surgery: Treatment or surgery intended to modify body characteristics or appearance.
6. Profession in hazardous or adventure sports: Treatment expenses resulting from participating in adventurous activities such as river rafting, mountaineering, scuba diving, etc. as a professional.  
7. Breach of law: Expenses incurred in treating a person who has committed or attempted to commit a criminal act.
8. Excluded providers: Treatments received from medical practitioners or hospitals excluded by the insurance company.
9. Narcotics: Treatment for addiction to substances such as alcohol, drugs, etc.
10. Treatments in establishments arranged for domestic purposes: Expenses incurred for treatments received in health spas, nursing homes, or similar establishments arranged entirely or partially for domestic reasons. 
11. Dietary supplements, substances purchased without subscription: Vitamins, minerals, etc., not prescribed by a medical practitioner.
12. Refractive error: Expenses associated with correcting refractive errors of up to 7.5 diopters to improve eyesight.
13. Unproven treatments: Surgeries, medical procedures, or treatments that are not proven to be effective.
14. Expenses related to birth control, sterility, infertility: Expenses related to contraception, sterilisation, artificial insemination, advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc. 
15. Maternity expenses: Expenses related to pre/post-natal costs, childbirth-related hospitalisation expenses, etc. 

• Additional permanent exclusions: Insurance companies can impose additional exclusions for certain medical conditions or situations apart from the standard permanent exclusions. In case you have a severe medical condition or a specific disease that is considered risky by the insurer, they may choose to permanently exclude it from the policy. The IRDAI has established a list of illnesses for which insurance companies can enforce permanent exclusions. However, insurers cannot impose permanent exclusions on illnesses or diseases that are not on this list.  
• Non-standard exclusions (Specific exclusions): Specific exclusions are the medical conditions that are excluded from a health insurance policy along with the standard permanent exclusions listed by the IRDAI. These exclusions may differ across insurance providers and are subject to the terms and conditions of the policy. Below are some of the key specific exclusions under the Bajaj Allianz Health Guard (Platinum) Plan –
• Treatment of dental issues, unless caused by an accident.
• Injuries or illnesses resulting from war, invasion, foreign enemies, warlike operations, etc. other than terrorism.
• Costs associated with hearing aids, spectacles, contact lenses, crutches, etc.
• Any type of external equipment used for diagnosis or treatment.
• Expenses associated with treatment of external birth defects, growth hormone therapy, and stem cell implantation (except for bone marrow transplants for haematological conditions).
• Self-inflicted injuries or illnesses resulting from participation in naval, military, air force operations, etc.
• Vaccination and inoculation costs (except for post-animal bite treatment).
• Circumcision unless medically necessary for treating a disease or injury.

What to expect in terms of claims experience if you buy from Bajaj Allianz General Insurance Company Limited?

• Speed of claims: Bajaj Allianz General Insurance Company has demonstrated a high level of efficiency in processing claims. It has settled 99.44% of claims within 30 days. 
• Claim-related complaints: According to our research, Bajaj Allianz General Insurance Company has received a lower number of complaints regarding claims, as compared to other insurance providers, accounting for just 0.03%. This implies that their process of settling claims is smooth and effective.
• Claims incurred ratio: The claims incurred ratio reflects the financial performance of the company. It represents the total number of claims incurred by the insurance company compared to the total premiums they collected in a given financial year. Bajaj Allianz General Insurance Company has a claim incurred ratio of 84.96%. 
• Claim settlement ratio: The claim settlement ratio is the percentage of claims settled by the insurer compared to the total number of claims received in a financial year. The claim settlement ratio of Bajaj Allianz General Insurance Company is 92.06%. 
• Network hospitals: Bajaj Allianz General Insurance Company has a network of over 18,400+ hospitals. Such a vast network enables you to receive cashless treatments from a wide range of healthcare providers across various locations.

How is the customer service of Bajaj Allianz General Insurance Company Limited?

• Policy purchase-related complaints: According to our research, Bajaj Allianz General Insurance Company has an exceptionally low rate of 0.00% complaints regarding their after-sales service, when compared to other insurers.
• Response on toll-free: As per our research, Bajaj Allianz General Insurance Company's response on their toll-free number is average, as compared to other insurance companies.
• Response on Twitter: Bajaj Allianz General Insurance Company's response on their Twitter channel is quick when compared to other insurance companies.

About Bajaj Allianz General Insurance Company Limited

Established in 2000, Bajaj Allianz General Insurance Company Limited has its headquarters located in Pune, Maharashtra. It is a joint venture between Allianz SE and Bajaj Finserv Limited. It provides a wide range of insurance products, including health insurance, motor insurance, pet dog insurance, personal accident insurance, marine insurance, etc. The insurer caters to both individuals across various demographics and corporate clients. The current CEO and MD of the company is Mr. Tapan Singhel.