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Bajaj Allianz's Health Plans - Comparative Analysis

Features Individual Health Guard Family Floater Health Guard Extra Care - Policy (up to 3 Children) Silver Health - For Senior Citizens
Entry age for proposer 18–65 years. Renewed up to 80 years 18–65 years. Renewed up to 80 years 18–70 years. Renewed up to 80 years 46 - 75years. Age at entry is restricted to 70 years
Entry age for Children 3 months to 25 years 3 months to 25 years 3 months-5 years- covered if both the parents are insured. 6 to 18 years-covered if either of the parents is covered. 18 to 25 years-covered as self-proposer or as dependents Plan only for Senior Citizens
Pre-policy check-up >=46 Years >=46 Years >=56Years Mandatory for all
Cost of pre-policy check-up 100% refunded if proposal is accepted 100% refunded if proposal is accepted 50% refunded if proposal is accepted 100% refunded if proposal is accepted (for fresh proposals only)
Cumulative bonus 5% & maximum up to 50%-for sum insured Rs.2,00,000/- and above continuously renewed with us 5% & maximum up to 50%-for sum insured Rs.2,00,000/- and above continuously renewed with us 5% to your Limit of Indemnity for every claim free year 5% & maximum up to 50% of sum insured
Family discount 10% Not Applicable Not Applicable 5%
Sum Assured(SA)   3 months to 55 yrs - SA - Rs. 2 lacs to Rs.10 lacs 56 yrs to 65 yrs - SA - Rs. 2 lacs to Rs 5 lacs No tests required for SI upto Rs.10 lacs and age upto 45 yrs   SA from 50000 to 500000 can be opted from 46 yrs to 70 yrs
BENEFITS
Hospitalization Expenses Covered Covered This policy covers the medical expenses in excess of the specified deductible amount. For example - If the Sum Insured is Rs 10 lakhs and deductible is Rs 3 lakhs , Company liability for a claim of Rs 13 lakhs would be Rs 10 lakhs (which is over and above the deductible) Covered
Cashless facility Available Available Available Available
Member Reimbursement 10% co-payment of the admissible claim to be paid by the member if treatment is taken in a hospital other than a network hospital. Waiver of the co-payment clause is available on payment of additional premium. 10% co-payment of the admissible claim to be paid by the member if treatment is taken in a hospital other than a network hospital. Waiver of the co-payment clause is available on payment of additional premium. Available 20% co-payment the admissible claims to be paid by the member if treatment is taken in a hospital other than a network hospital. Waiver of co-payment is available on payment of additional premium.
Pre and post hospitalization expenses Pre - 60 days Post - 90 days Pre - 60 days Post - 90 days Pre - 60 days Post - 90 days An amount equivalent to 3% of the hospitalisation expenses covered in respect of any and all pre-hospitalisation and post-hospitalisation expenses.
Ambulance charges Limited to Rs.1000/-if claim accepted Limited to Rs.1000/-if claim accepted Up to Rs.3000/- Limited to Rs.1000/-if claim accepted
Daycare procedures 130 Daycare procedures covered 130 Daycare procedures covered   130 Daycare procedures covered
Health check-up- at the end of 4 continuous claim-free years Upto Rs.1000/-Benefit can be availed by only one member of the family Benefit can be availed by you and your family member named in the schedule   Applicable
Co-Payment 20% Co-payment if Insured person >= 56yrs Covered for the first time in the Health Guard policy and Bajaj Allianz liability,if any,shall only be in excess of that sum. 20% Co-payment if Insured person >= 56yrs Covered for the first time in the Health Guard policy and Bajaj Allianz liability,if any,shall only be in excess of that sum. Not Applicable  
Income tax benefit Section 80D Section 80D Section 80D Section 80D
EXCLUSIONS
Disease contracted during the first 30 days of commencement of the policy Not covered Not covered Not covered Not covered
Disease covered after a waiting period of 1 year Not covered Not covered Not covered Hernia of all types, cataract, benign prostatic hypertrophy, Prolapse of enitourinary/intraabdominal organs, hysterectomy, Hydrocele, Fistulae, Hemorrhoids, Fissure in anus, Dysfunctional uterine bleeding, fibromyoma, endometrioisis , hysterectomy, Stones in the urinary and biliary systems,Surgery on ears, Surgery on skin/internal tumours/cysts/nodules/polyps, Treatment for benign tumors or malignant conditions or for organomegaly, Surgery on joints, Treatment for prolapsed intervetebral discs, Surgery for gastric or duodenal ulcers Cataract-10% of the Limit of Indemnity for each and every claim, subject to a minimum of Rs 12,000 and maximum of Rs 25,000/- for each
Disease covered after a waiting period of 2 years Cataract(liability restricted upto 10% of SI, minimum of Rs 12000 (or the actual incurred amount whichever is lower) & max. upto Rs.35,000), Hernia of all types, All types of sinuses, Gastric or duodenal ulcers, Benign prostatic hypertrophy, Hydrocele, 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 Hernia of all types,cataract(liability restricted upto 10% of SI, max. upto Rs.35,000),All types of sinuses,Gastric or duodenal ulcers, Benign prostatic, Hypertrophy, Hydrocele, 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    
Pre-existing diseases Waiting period of 4 years is applicable Waiting period of 4 years is applicable Waiting period of 4 years is applicable Covered from 2nd year of policy, subject to limit of 50% of the Limit of Indemnity in a policy year.
Joint replacement surgery Waiting period of 4 years is applicable Waiting period of 4 years is applicable Waiting period of 4 years is applicable Waiting period of 4 years is applicable
  1. Surgery for prolapsed inter vertebral disc (unless necessitated due to accident )
  2. Surgery to correct deviated nasal septum and hypertrophied turbinate
  3. Congenital internal diseases or anomalies
  4. Laser treatment for correction of eye sight due to refractive error
Waiting period of 4 years is applicable Waiting period of 4 years is applicable    
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 Not covered Not covered Not covered Not covered
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 Not covered Not covered Not covered Not covered
Any form of plastic surgery unless necessary for the treatment of cancer, burns or accidental Bodily Injury Not covered Not covered Not covered Not covered
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 Not covered Not covered Not covered Not covered
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 Not covered Not covered Not covered Not covered
Dental treatment or surgery of any kind unless as a result of Accidental Bodily Injury to natural teeth and also requiring hospitalization Not covered Not covered Not covered Not covered
Convalescence, general debility, rest cure, congenital external diseases or defects or anomalies, genetic disorders, stem cell implantation or surgery, or growth hormone therapy Not covered Not covered Not covered Not covered
Intentional self-injury (including but not limited to the use or misuse of any intoxicating drugs or alcohol) Not covered Not covered Not covered Not covered
Ailments requiring treatment due to use or abuse of any substance, drug or alcohol and treatment for de-addiction Not covered Not covered Not covered Not covered
Expenses arising from AIDS and other related diseases Not covered Not covered Not covered Not covered
Medical Expenses relating to any hospitalisation primarily and specifically for diagnostic, X-ray or laboratory examinations and investigations Not covered Not covered Not covered Not covered
Medical expenses where Inpatient care is not warranted and does not require supervision of qualified nursing staff and qualified medical practitioner round the clock Not covered Not covered Not covered Not covered
Any claim directly or indirectly caused by or contributed to by nuclear weapons and/or materials Not covered Not covered Not covered Not covered
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 ) Not covered Not covered Not covered Not covered
Vaccination or inoculation unless forming a part of post bite treatment Not covered Not covered Not covered Not covered
Any fertility, sub fertility, impotence, assisted conception operation or sterilization procedure Not covered Not covered Not covered Not covered
Vitamins, tonics, nutritional supplements unless forming part of the treatment for injury or disease as certified by the attending Doctor Not covered Not covered Not covered Not covered
Experimental, unproven or non-standard treatment Not covered Not covered Not covered Not covered
Treatment for any other system other than modern medicine (also known as Allopathy) Not covered Not covered Not covered Not covered
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) Not covered Not covered Not covered Not covered
Venereal disease or any sexually transmitted disease or sickness Not covered Not covered Not covered Not covered
Weight management services and treatment related to weight reduction programmes including treatment of obesity Not covered Not covered Not covered Not covered
Treatment for any mental illness or psychiatric illness, Parkinson's and Alzheimer's disease Not covered Not covered Not covered Not covered
Surgery to correct deviated septum and hypertrophied turbinates       Not covered