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

The Bajaj Allianz Health Guard (Gold) plan offers an excellent balance of affordability, features, and benefits. In addition to being highly cost-effective compared to other products, it provides extensive coverage. The plan covers a wide range of expenses, such as the cost of consumable items, bariatric surgery, maternity expenses, and day-to-day OPD expenses for medicines, tests, consultations, and more. However, it is worth noting that the plan does not allow monthly premium payments, which may be a drawback for some. Our research indicates that customers are likely to have a positive experience with the insurer as they have received relatively few complaints regarding claim settlement and policy purchase.

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

Inpatient hospitalisation coverage: Similar to other health insurance plans, the Bajaj Allianz Health Guard (Gold) Plan provides coverage for inpatient hospitalisation expenses. This includes expenses that arise when you are hospitalised for more than 24 hours. Inpatient hospitalisation expenses typically cover room boarding and nursing charges, the cost of prescribed medications and drugs, medical practitioner fees, ICU charges, and other associated expenses.
Pre-hospitalisation coverage: Pre-hospitalisation charges are the medical expenses that you incur prior to hospitalisation. These expenses include the fees for consultations, tests, checkups, lab reports, etc. The insurer will cover these expenses only if they are related to the medical condition that eventually leads to hospitalisation. Your claim for these expenses must be approved as part of inpatient hospitalisation coverage. Under the Bajaj Allianz Health Guard (Gold) Plan, pre-hospitalisation expenses are covered for 60 days before hospitalisation up to the sum insured.
Post-hospitalisation coverage: After being discharged from the hospital, you may incur medical costs that fall under the category of post-hospitalisation expenses. These expenses can include follow-up consultations with your doctor, medical check-ups, rehabilitation sessions, physiotherapy, and other related costs. To qualify for coverage, these expenses must be connected to the condition for which you were hospitalised, and your claim must be approved under inpatient hospitalisation coverage. The Bajaj Allianz Health Guard (Gold) Plan provides coverage for post-hospitalisation expenses for 90 days after your hospitalisation up to the sum insured.
Daycare treatment coverage: Daycare treatment refers to a medical procedure or surgery that used to require an extended hospital stay but can now be completed within 24 hours due to advancements in medical technology. The Bajaj Allianz Health Guard (Gold) Plan covers 399 daycare procedures without any limit. This means that all expenses related to the 399 daycare treatments will be 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. The Bajaj Allianz Health Guard (Gold) Plan does not provide coverage for domiciliary treatments.
Organ donor coverage: Bajaj Allianz Health Guard (Gold) Plan provides coverage for organ donor expenses, where you are the recipient. Costs associated with harvesting the organ from the organ donor are covered up to the sum insured you choose under the policy.
Modern treatment coverage: As the healthcare industry evolves, treatments that were once thought impossible have now become a reality. These modern treatments, including radio surgeries, stem cell therapy, and more, aim to cure ailments that were once considered incurable. The Bajaj Allianz Health Guard (Gold) Plan is specifically designed to keep up with these advancements in medicine and provides coverage for the expenses associated with modern treatments up to the sum insured.
Non-medical expenses coverage: The Bajaj Allianz Health Guard (Gold) Plan specifically provides coverage for medical expenses, but not for non-medical expenses. Non-medical expenses are those that include the cost of consumables, such as gloves, nebulization kits, oxygen masks, and other items that are necessary for treatment.
No Claim Bonus: The Bajaj Allianz Health Guard (Gold) Plan offers a No-Claim Bonus as a reward if you do not file any claims during the policy year. This bonus amounts to 10% of the sum insured subject to a maximum of up to 100%. However, if a claim is made during the policy period, the accumulated bonus amount will be reduced. Please note that the maximum increase in the No Claim Bonus will be limited to 10 years and 100% of your first chosen base sum insured.
Super No Claim Bonus: The Super No Claim Bonus is a more accelerated version of the standard No Claim Bonus and functions in the same way. However, the Bajaj Allianz Health Guard (Gold) Plan does not offer the Super No Claim Bonus feature.
Restoration Benefit: The Restoration Benefit is a unique feature that restores your sum insured once it is depleted during a policy year. The Bajaj Allianz Health Guard (Gold) Plan offers this benefit for unrelated illnesses. The refill benefit is triggered only when both the sum insured and the No-Claim Bonus are fully exhausted. And it can only be used once in a policy year for subsequent claims. The restoration benefit can be used only once in a lifetime for claims related to cancer and kidney failure requiring regular dialysis.

Please note that the limits and conditions mentioned in the above benefits and features are for a sum insured of Rs. 10 Lakhs.

Bajaj Allianz Health Guard (Gold): Financial Limits

Room rent limit: The room rent limit is the maximum amount that your insurance company will cover for the room you stay in during hospitalisation. If you choose a room that falls within your plan's room rent limit, you will not have to pay any additional charges. However, if you opt for a room with a higher rent than what you are eligible for, then you will be subject to a proportionate deduction. This means that you will have to pay a proportionate share of the entire bill, rather than just the difference. Fortunately, with the Bajaj Allianz Health Guard (Gold) Plan, you have the flexibility to select any room type without any restrictions.
ICU rent limit: The Intensive Care Unit (ICU) rent limit is the maximum amount that a health insurance policy covers for the cost of an ICU stay. The Bajaj Allianz Health Guard (Gold) Plan does not have an ICU rent limit. This means that the plan covers the full cost of an ICU stay without any restrictions.
Copayment: A copayment is a portion of the approved claim amount that you have to pay out of pocket. The remaining amount will be covered by the insurance company. The Bajaj Allianz Health Guard (Gold) Plan offers an optional copayment limit of either 10% or 20%, giving you the option to choose the one you are comfortable with.
Deductible: A deductible is an amount that you have to pay from your end before your policy coverage starts paying for your medical expenses. With the Bajaj Allianz Health Guard (Gold) Plan, there is no set deductible limit.
Limits on surgeries/treatments: It is the maximum amount that the health insurance policy will cover for certain medical procedures or treatments. Some policies may have restrictions on the amount that they will cover for specific procedures, while others may not. With the Bajaj Allianz Health Guard (Gold) Plan, there is a limit of 20% of the sum insured per eye per policy year, up to a maximum of Rs 1 Lakh for cataract treatments. However, joint replacement surgery costs are covered up to the sum insured. This means that the policy covers the entire cost of joint replacement surgery without any cap on the amount.

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 (Gold): Waiting Periods & Exclusions

👉Waiting period

Once you buy a health insurance policy, some illnesses and diseases may not be covered for a certain duration, which is referred to as the waiting period. You can only make claims for these conditions once the waiting period ends. Here are some types of waiting periods -

Initial waiting period: Under the Bajaj Allianz Health Guard (Gold) Plan, an initial waiting period of 30 days applies to all medical conditions, except for accidents. During this period, you will not be eligible to make a claim for any hospitalisation expenses, except in the case of accidents. Once the initial waiting period is over, you will be able to make claims for all covered medical conditions.
Waiting period for pre-existing diseases: A pre-existing disease is any medical condition or illness that you have had within 48 months before applying for the policy. There is a waiting period of 36 months for pre-existing diseases in the Bajaj Allianz Health Guard (Gold) Plan. This means that during this period, you will not be able to claim any expenses related to pre-existing diseases.
Waiting period for specific diseases: Insurance companies may impose waiting periods on certain medical conditions or illnesses other than pre-existing diseases. These waiting periods are predetermined by the insurer and are not influenced by your current health status. The Bajaj Allianz Health Guard (Gold) Plan has a waiting period of 24 months for such medical conditions and 36 months for some conditions.

👉Exclusions

Your health insurance policy has certain situations that it will not cover, which are referred to as exclusions. These include –

Standard permanent exclusions: All insurance companies are required by the IRDAI to follow a set of “standard permanent exclusions”. These exclusions include –

Investigation and evaluation: Hospitalisation for monitoring or observation purposes.
Rest cure, rehabilitation, and respite care: Admission to a facility for rest or respite where no active medical treatment is given.
Obesity/weight control: Any treatment or surgery intended for weight control or obesity.
Change of gender treatment: Any medical treatment intended to alter the characteristics of the body to that of the opposite gender.
Plastic/cosmetic surgery: Any surgical or medical procedures intended for the modification of appearance or body characteristics.
Profession in hazardous or adventure sports: Any medical expenses incurred while participating as a professional in adventure activities such as mountaineering, river rafting, scuba diving, horse racing, etc. are not covered.
Breach of law: Any expenses related to the treatment of a person who has committed or attempted to commit a criminal act.
Excluded providers: Treatment from a medical practitioner or hospital excluded by the insurance company.
Narcotics: Treatment for addictive conditions like alcohol addiction, drug usage, etc.
Treatments in establishments arranged for domestic purposes: Treatment expenses incurred in health spas, nursing homes, or similar establishments arranged entirely or partially for domestic reasons.
Dietary supplements, substances purchased without prescription: Expenses on vitamins, minerals, and other dietary supplements not prescribed by a medical practitioner.
Refractive error: Expenses associated with correcting refractive errors up to 7.5 diopters for improved eyesight.
Unproven treatments: Any surgeries, medical procedures, or treatments that are not proven to be effective are not covered.
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.
Maternity expenses: Costs related to pre/post-natal care, childbirth, hospitalisation expenses, etc.

Additional permanent exclusions: Apart from the standard permanent exclusions mandated by the IRDAI, insurance companies can also add “specific exclusions” based on certain medical conditions or situations. If the insurer considers certain diseases or severe medical conditions as high-risk, they may permanently exclude them from coverage under your policy. It is important to note that insurers can only apply permanent exclusions to a list of pre-approved illnesses outlined by the IRDAI. Any disease or medical condition outside this list cannot be permanently excluded by the insurer.
Non-standard exclusions (Specific exclusions): These are exclusions that go beyond the standard permanent exclusions designated by the IRDAI and may vary among insurers depending on their policies and terms. Here are some of the top specific exclusions under the Bajaj Allianz Health Guard (Gold) Plan -

Dental treatment except for treatment required due to an accident.
Injury or disease due to war, invasion, an act of a foreign enemy, and warlike operations.
Hearing aids, multifocal lenses, spectacles, contact lenses, etc.
External equipment of any kind used for diagnosis or treatment.
Expenses for treatment related to external birth defects, growth hormone therapy, and stem cell implantation except for bone marrow transplant for haematological conditions.
Treatment-related to intentional self-inflicted Injury or attempted suicide by any means.
Vaccination, inoculation, and immunisation costs (except post-animal bite treatment).
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 settled 99.38% of claims, in less than 30 days. This indicates that they render a quick claim settlement process.
Claim-related complaints: Our research reveals that Bajaj Allianz General Insurance Company receives very few complaints (0.06%) related to claims when compared to other insurers. This suggests that their claims settlement process is efficient and hassle-free.
Claims incurred ratio: The financial performance of an insurer is measured by its claims incurred ratio. This represents the total claims incurred compared to the premiums collected. Bajaj Allianz General Insurance Company’s claims incurred ratio is 81.10%.
Claim settlement ratio: Bajaj Allianz General Insurance Company's claim settlement ratio of 72.14%. It reflects the percentage of claims settled by the insurer compared to the total claims received in a financial year.
Network hospitals: Bajaj Allianz General Insurance Company offers an extensive network of 8,000+ hospitals. This vast network ensures that customers have access to a wide range of healthcare providers in different locations, enabling them to receive cashless treatment without worrying about financial constraints.

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

Policy purchase-related complaints: Our research indicates that Bajaj Allianz General Insurance Company has 0.00% of complaints related to their after-sales service.
Response on Toll-Free: Compared to other insurance companies, Bajaj Allianz General Insurance Company's response regarding their toll-free number for customer service was found to be average in our research.
Response on Twitter: Based on our research, Bajaj Allianz General Insurance Company's response time is average on Twitter.

About Bajaj Allianz General Insurance Company Limited

Bajaj Allianz General Insurance Company Limited was founded in 2000. It has its headquarters in Pune, Maharashtra. The company is a joint venture between Allianz SE and Bajaj Finserv Limited, offering a broad range of insurance products such as health insurance, motor insurance, pet dog insurance, personal accident insurance, marine insurance, and more. Their customers are individuals across various demographics and corporate sectors. The company’s CEO and MD is Mr. Tapan Singhel.