Bajaj Allianz My Health Care

Bajaj Allianz My Health Care is a health insurance policy offered by Bajaj Allianz General Insurance Company Limited. 

This plan offers a range of excellent features, with a particularly notable highlight being its coverage for surrogacy and complications expenses, along with medical costs for newborn babies from day one. It's worth mentioning that although it includes hospitalisation and related expenses, it does not provide comprehensive coverage. Additionally, you may face increased out-of-pocket expenses due to sub-limits imposed on specific treatments like cataract.

When it comes to purchasing and making claims, you are likely to have a positive experience with the insurer. Our research indicates that they have received fewer complaints regarding claim settlements and policy purchases.

What are the benefits offered by the Bajaj Allianz My Health Care Plan?

• Inpatient hospitalisation coverage:  The Bajaj Allianz My Health Care plan offers coverage for expenses related to hospitalisation that go beyond 24 hours, like nursing care, medical consultations, prescription medication, intensive care unit (ICU) charges, and any other related expenses.
• Pre-hospitalisation coverage:  Pre-hospitalisation coverage takes care of the expenses you have to bear before getting admitted to the hospital, such as consultations, tests, checkups, and more. To qualify for this coverage, the charges must be directly related to the medical condition that led to your hospitalisation and should be approved as part of the inpatient hospitalisation coverage. With the Bajaj Allianz My Health Care plan, you can rest easy knowing that pre-hospitalisation expenses incurred up to 180 days prior to your hospitalisation are covered up to the sum insured.
• Post-hospitalisation coverage:  Post-hospitalisation expenses refer to the medical costs that you incur after being discharged from the hospital. This includes follow-up consultations with your doctor, medical check-ups, rehabilitation sessions, physiotherapy, and other related expenses. It's important to note that these expenses are only eligible for coverage if they are directly related to the medical condition for which you were hospitalised and must be approved as part of your inpatient hospitalisation coverage. The Bajaj Allianz My Health Care plan takes care of your post-hospitalisation expenses for a period of 180 days following your hospital discharge, up to the sum insured.
• Daycare treatment coverage: Daycare treatments are medical procedures or treatments that formerly required a long hospital stay, but can now be done in just 24 hours - all thanks to medical advancements. With the Bajaj Allianz My Health Care plan, you get coverage for 399 daycare procedures, with no limit. This means all expenses related to daycare treatments are fully covered up to the sum insured.
• Domiciliary treatment coverage: Domiciliary treatments refer to medical treatments that require urgent attention at a hospital but are provided at home instead. This could be due to the seriousness of the patient's condition or if there are no available hospital beds nearby. The Bajaj Allianz My Health Care plan covers expenses of these treatments up to the sum insured.
• Organ donor coverage:  The Bajaj Allianz My Health Care plan has got you covered when it comes to covering the expenses associated with harvesting the organ from the donor. Rest assured, if you're the recipient, you won't have to worry about a thing as these costs will be taken care of up to the sum insured.
• Modern treatment coverage: Thanks to amazing technological advancements, the field of healthcare is moving at lightning speed. New and innovative treatments like stem cell therapy, robotic surgery, etc. are now available, offering hope for diseases that were once thought to be untreatable. The Bajaj Allianz My Health Care plan is designed to keep pace with these developments, providing coverage for the costs associated with these modern treatments up to the sum insured, without imposing any limits.
• Non-medical expenses coverage: The Bajaj Allianz My Health Care plan is specifically designed to cover medical expenses only. It's important to note that non-medical expenses, such as the costs of gloves, nebulization kits, oxygen masks, and other treatment essentials, are not included in the coverage.
• No Claim Bonus: If you manage to go through a policy period without making any claims, the insurance company will reward you with a No-Claim Bonus. With the Bajaj Allianz My Health Care plan, you can receive a bonus of 50% of your sum insured, up to a maximum of 100% of the sum insured. However, if you do end up making a claim during the policy year, your No Claim Bonus will reduce at the same rate it was earned.
• Super No Claim Bonus:  The Super No Claim Bonus is an upgraded version of the No Claim Bonus and functions in a similar way. Unfortunately, the Bajaj Allianz My Health Care plan does not offer the Super No-Claim Bonus feature.
• Restoration Benefit: The restoration benefit is a handy feature that restores your sum insured once it's been used up within a policy year. With the Bajaj Allianz My Health Care plan, you can enjoy this benefit for related and unrelated illnesses. Just keep in mind that it kicks in only when both your sum insured and Super No Claim Bonus are completely depleted. Plus, you can only use it unlimited times in policy year for subsequent claims.

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

Bajaj Allianz My Health Care: Financial Limits

• Room rent limit: It is the maximum limit up to which your insurer covers the costs of the room you stay in while you're in the hospital. If the room you choose is within the limit set by your health insurance policy, you won't have to pay any extra charges. But if the room you pick goes beyond the allowed limit, a deduction will be made proportionately. This means you'll have to pay a proportionate share of the total bill, and not just the difference in room rent. Under the Bajaj Allianz Health Guard (Platinum) Plan, the room rent limit is up to a single private room.
• ICU rent limit: This is the maximum limit up to which your plan will pay for your stay in the intensive care unit. With the Bajaj Allianz My Health Care plan, there is no limit to the coverage for ICU rent. This means that the plan will cover the entire cost of your ICU stay, up to the sum insured.
• Copayment: A copayment is a specific percentage of the claim amount you need to bear from your end. After you've paid this amount, the insurer will take care of the rest of the expenses. With the Bajaj Allianz My Health Care plan, you can choose between a 5%, 10% or 20% co-payment option. 
• Deductible: A deductible is the amount you have to pay upfront before your insurance starts covering your medical expenses. However with the Bajaj Allianz My Health Care plan, you don't have to worry about any deductible limits.
• Limits on surgeries/treatments: It is the maximum amount that a health insurance policy will pay for specific medical procedures or treatments. Some insurers have limits on coverage for certain procedures, while others may not. With the Bajaj Allianz My Health Care plan, cataract treatment is covered up to 20% of the sum insured per eye per policy year, with a maximum limit of Rs 1 Lakh. And, costs related to 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 My Health Care: Waiting Periods & Exclusions

👉Waiting period
Once you've bought a health insurance policy, there may be a certain period before coverage starts for certain illnesses and diseases. This timeframe is called the waiting period. But don't worry, once the waiting period is over, you'll be able to claim for these conditions. Let’s look at some of the types of waiting periods -

• Initial waiting period: There's a 30-day waiting period for all medical conditions, except accidents. So, for the first month after you purchase the policy, you won't be able to claim for any hospitalisation, unless it's due to an accident.
• Waiting period for pre-existing diseases:  A pre-existing disease is basically a medical condition or illness that you've had in the last 36 months before getting yourself a health insurance policy. With the Bajaj Allianz My Health Care plan, there's a waiting period of 36 months for pre-existing diseases. Meaning, during this time, you won't be able to claim for expenses related to your pre-existing conditions.
• Waiting period for specific diseases: In addition to any pre-existing conditions, insurance providers may have a list of particular medical conditions or illnesses that require a waiting period. This waiting period applies regardless of whether you've had these conditions in the past or not. The length of this waiting period is determined by the insurer and is not influenced by your current health status. In the Bajaj Allianz My Health Care plan, there is a 24-month waiting period for certain specific diseases.

👉Exclusions

Health insurance policies do not provide coverage for certain medical conditions or situations, commonly referred to as exclusions. Let's take a look at some of these 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: Treatment received from medical practitioners or hospitals excluded by the insurance company.
9. Narcotics: Treating addiction to substances such as alcohol, drugs, etc.
10. Treatments in establishments arranged for domestic purposes: Expenses incurred due to the treatment 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., that a medical practitioner does not prescribe.
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, and infertility: Contraception, sterilisation, artificial insemination, advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc. 
15. Maternity expenses: Pre/post-natal costs, childbirth-related hospitalisation expenses, etc. 

• Additional permanent exclusions: Insurance companies have the power to add extra exclusions for certain medical conditions or situations, alongside the usual permanent exclusions. If you happen to have a serious medical condition or a specific disease that the insurer sees as risky, they might decide to permanently exclude it from your policy. The IRDAI has created a list of illnesses that insurance companies are allowed to permanently exclude. Insurers are not allowed to enforce permanent exclusions for illnesses or diseases that are not included in this list.
• Non-standard exclusions (Specific exclusions):  The Bajaj Allianz My Health Care plan has specific exclusions that you need to be aware of apart from the aforementioned standard permanent exclusions. It's important to note that these exclusions may vary between insurance providers and are determined by the terms and conditions of the policy. Here are some of the main specific exclusions under the Bajaj Allianz My Health Care Plan -

1. Dental treatment, such as dentures, prostheses, implants, etc. except when necessary due to an accident.
2. Illness or injury resulting from war, invasion, acts of foreign enemies, military activities, government or public authority orders, etc., except in cases of terrorism.
3. Products like contact lenses, spectacles, hearing aids, dentures, artificial teeth, and similar items.
4. Any external equipment used for diagnosis or treatment after hospitalisation.
5. Expenses for treatment related to external birth defects, growth hormone therapy, and stem cell implantation (excluding bone marrow transplant for haematological conditions).
6. Treatment related to intentional self-inflicted injury, including the use or misuse of intoxicating drugs or alcohol.
7. Vaccination and inoculation costs, unless prescribed by a medical practitioner or required for post-animal bite treatment.
8. Circumcision, unless 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 claims 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: 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: 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

Bajaj Allianz General Insurance Company Limited was established in the year 2000 and is headquartered in Pune, Maharashtra. It is a partnership between Allianz SE and Bajaj Finserv Limited. Mr. Tapan Singhel serves as the CEO and MD of the company. The company provides a wide range of insurance products including health insurance, motor insurance, pet dog insurance, personal accident insurance, marine insurance, and others. Their services are tailored for individuals of all backgrounds as well as corporate clients.