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Bajaja Allianz Family Exclusions

Family Floater Health Guard

Exclusions valid for the first 30 Days

  • Any Medical Expenses incurred for any illness diagnosed or diagnosable within 30 days of the commencement of the Policy Period except those incurred as a result of Accidental Bodily Injury. In case of enhancement of Sum Insured the waiting periods shall apply afresh only to the extent of the amount by which the limit of indemnity has been increased (i.e. enhanced sum insured) if the policy is a renewal of Health Policy without break in cover.

Exclusions valid for the first 2 years

  • Without derogation from Pre-existing exclusion, any Medical Expenses incurred during the first two consecutive annual periods during which You have the benefit of a Health Guard Policy with Bajaj Allianz in connection with any types of
    • Gastric or duodenal ulcers
    • Cataracts
    • Benign prostatic hypertrophy
    • Hernia of all types
    • Hydrocele
    • All types of sinuses
    • Fistulae
    • Haemorrhoids
    • Fissure in ano
    • Dysfunctional uterine bleeding
    • Fibromyoma, endometriosis, hysterectomy
    • Stones in the urinary and biliary systems
    • Surgery on ears/tonsils/adenoids/paranasal sinuses
    • Surgery for any skin ailment
    • Surgery on all internal or external tumours/ cysts/nodules/polyps of any kind including breast lumps with exception of Malignant tumor or growth.
  1. This exclusion period shall apply for a continuous period of a full 4 years from the date of Your first Health Guard Policy with us if the above referred illness were present at the time of commencement of the policy and if You had declared such illness at the time of proposing the policy for the first time.
  2. In case of enhancement of Sum Insured the waiting periods shall apply afresh only to the extent of the amount by which the limit of indemnity has been increased (i.e. enhanced sum insured) if the policy is a renewal of Health Policy without break in cover.

Exclusions valid for the first 4 years

  • Pre-Existing Disease – 4 year waiting period applicable .
    1. The above exclusion shall cease to apply if You have maintained a Health Guard Policy with Bajaj Allianz for a continuous period of a full 4 years with out break from the date of Your first Health Guard Policy with Bajaj Allianz.
    2. In case of enhancement of Sum Insured this Exclusion shall apply afresh only to the extent of the amount by which the limit of indemnity has been increased (i.e. enhanced sum insured) if the policy is a renewal of Health Guard Policy without break in cover.
  • Any Medical Expenses incurred during the first four consecutive annual periods during which You have the benefit of a Health Guard Policy with Us in connection with
    • Joint replacement surgery
    • Surgery for prolapsed inter vertebral disc (unless necessitated due to accident )
    • Surgery to correct deviated nasal septum and hypertrophied turbinate
    • Congenital internal diseases or anomalies
    • Laser treatment for correction of eye sight due to refractive error.

In case of enhancement of Sum Insured the waiting periods shall apply afresh only to the extent of the amount by which the limit of indemnity has been increased (i.e. enhanced sum insured) if the policy is a renewal of Health Policy without break in cover.

Permanent Exclusions

  • War, invasion, acts of foreign enemies, hostilities (whether war be declared or not), civil war, commotion, unrest, rebellion, revolution, insurrection, military or usurped power or confiscation or nationalisation or requisition of or damage by or under the order of any government or public local authority.
  • Circumcision unless required for the treatment of Illness or Accidental bodily injury, cosmetic or aesthetic treatments of any description, treatment or surgery for change of life/gender.
  • Any form of plastic surgery unless necessary for the treatment of cancer ,burns or accidental Bodily Injury
  • The cost of spectacles, contact lenses, hearing aids, crutches, artificial limbs, dentures, artificial teeth and all other external appliances and/or devices whether for diagnosis or treatment except for intrinsic fixtures used for orthopedic treatments such as plates and K-wires .
  • External medical equipment of any kind used at home as post hospitalisation care including cost of instrument used in the treatment of Sleep Apnoea Syndrome (C.P.A.P), Continuous Peritoneal Ambulatory Dialysis (C.P.A.D) and Oxygen concentrator for Bronchial Asthmatic condition.
  • Dental treatment or surgery of any kind unless as a result of Accidental Bodily Injury to natural teeth and also requiring hospitalization .
  • Convalescence, general debility, rest cure, congenital external diseases or defects or anomalies, genetic disorders, stem cell implantation or surgery, or growth hormone therapy.
  • Intentional self-injury (including but not limited to the use or misuse of any intoxicating drugs or alcohol)
  • Ailments requiring treatment due to use or abuse of any substance, drug or alcohol and treatment for de-addiction.
  • Any condition directly or indirectly caused by or associated with Human Immunodeficiency Virus or Variant/mutant viruses and or any syndrome or condition of a similar kind commonly referred to as AIDS.
  • Medical Expenses relating to any hospitalization primarily and specifically for diagnostic, X-ray or laboratory examinations and investigations.
  • Medical expenses where Inpatient care is not warranted and does not require supervision of qualified nursing staff and qualified medical practitioner round the clock .
  • Any claim directly or indirectly caused by or contributed to by nuclear weapons and/or materials.
  • Treatment arising from or traceable to pregnancy and childbirth including caesarian section, and/or any treatment related to pre and postnatal care. (ectopic pregnancy is covered under the policy )
  • Vaccination or inoculation unless forming a part of post bite treatment.
  • Any fertility, sub fertility, impotence, assisted conception operation or sterilization procedure.
  • Vitamins, tonics, nutritional supplements unless forming part of the treatment for injury or disease as certified by the attending Doctor
  • Experimental, unproven or non-standard treatment.
  • Treatment for any other system other than modern medicine (also known as Allopathy)
  • Expenses related to donor screening, treatment, including surgery to remove organs from a donor in the case of transplant surgery.( not applicable for Daycare procedure no.111 Free skin transportation, donor site )
  • Venereal disease or any sexually transmitted disease or sickness.
  • Weight management services and treatment related to weight reduction programmes including treatment of obesity.
  • Treatment for any mental illness or psychiatric illness, Parkinson's and Alzheimer's disease.