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Features
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Individual Health Guard
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Family Floater Health Guard
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Extra Care - Policy (up to 3 Children)
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Silver Health - For Senior Citizens
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Entry age for proposer
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18–65 years. Renewed up to 80 years
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18–65 years. Renewed up to 80 years
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18–70 years. Renewed up to 80 years
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46 - 75years. Age at entry is restricted to 70 years
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Entry age for Children
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3 months to 25 years
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3 months to 25 years
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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
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Plan only for Senior Citizens
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Pre-policy check-up
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>=46 Years
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>=46 Years
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>=56Years
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Mandatory for all
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Cost of pre-policy check-up
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100% refunded if proposal is accepted
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100% refunded if proposal is accepted
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50% refunded if proposal is accepted
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100% refunded if proposal is accepted (for fresh proposals only)
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Cumulative bonus
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5% & maximum up to 50%-for sum insured Rs.2,00,000/- and above continuously
renewed with us
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5% & maximum up to 50%-for sum insured Rs.2,00,000/- and above continuously
renewed with us
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5% to your Limit of Indemnity for every claim free year
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5% & maximum up to 50% of sum insured
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Family discount
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10%
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Not Applicable
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Not Applicable
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5%
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Sum Assured(SA)
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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
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SA from 50000 to 500000 can be opted from 46 yrs to 70 yrs
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BENEFITS
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Hospitalization Expenses
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Covered
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Covered
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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)
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Covered
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Cashless facility
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Available
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Available
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Available
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Available
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Member Reimbursement
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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.
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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.
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Available
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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.
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Pre and post hospitalization expenses
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Pre - 60 days Post - 90 days
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Pre - 60 days Post - 90 days
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Pre - 60 days Post - 90 days
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An amount equivalent to 3% of the hospitalisation expenses covered in respect of
any and all pre-hospitalisation and post-hospitalisation expenses.
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Ambulance charges
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Limited to Rs.1000/-if claim accepted
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Limited to Rs.1000/-if claim accepted
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Up to Rs.3000/-
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Limited to Rs.1000/-if claim accepted
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Daycare procedures
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130 Daycare procedures covered
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130 Daycare procedures covered
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130 Daycare procedures covered
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Health check-up- at the end of 4 continuous claim-free years
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Upto Rs.1000/-Benefit can be availed by only one member of the family
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Benefit can be availed by you and your family member named in the schedule
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Applicable
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Co-Payment
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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.
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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.
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Not Applicable
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Income tax benefit
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Section 80D
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Section 80D
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Section 80D
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Section 80D
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EXCLUSIONS
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Disease contracted during the first 30 days of commencement of the policy
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Not covered
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Not covered
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Not covered
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Not covered
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Disease covered after a waiting period of 1 year
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Not covered
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Not covered
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Not covered
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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
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Disease covered after a waiting period of 2 years
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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
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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
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Pre-existing diseases
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Waiting period of 4 years is applicable
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Waiting period of 4 years is applicable
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Waiting period of 4 years is applicable
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Covered from 2nd year of policy, subject to limit of 50% of the Limit of Indemnity
in a policy year.
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Joint replacement surgery
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Waiting period of 4 years is applicable
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Waiting period of 4 years is applicable
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Waiting period of 4 years is applicable
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Waiting period of 4 years is applicable
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- Surgery for prolapsed inter vertebral disc (unless necessitated due to accident
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- 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
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Waiting period of 4 years is applicable
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Waiting period of 4 years is applicable
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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
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Not covered
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Not covered
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Not covered
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Not covered
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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
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Not covered
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Not covered
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Not covered
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Not covered
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Any form of plastic surgery unless necessary for the treatment of cancer, burns
or accidental Bodily Injury
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Not covered
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Not covered
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Not covered
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Not covered
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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
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Not covered
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Not covered
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Not covered
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Not covered
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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
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Not covered
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Not covered
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Not covered
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Not covered
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Dental treatment or surgery of any kind unless as a result of Accidental Bodily
Injury to natural teeth and also requiring hospitalization
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Not covered
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Not covered
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Not covered
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Not covered
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Convalescence, general debility, rest cure, congenital external diseases or
defects or anomalies, genetic disorders, stem cell implantation or surgery, or growth
hormone therapy
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Not covered
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Not covered
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Not covered
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Not covered
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Intentional self-injury (including but not limited to the use or misuse of any
intoxicating drugs or alcohol)
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Not covered
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Not covered
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Not covered
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Not covered
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Ailments requiring treatment due to use or abuse of any substance, drug or alcohol
and treatment for de-addiction
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Not covered
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Not covered
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Not covered
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Not covered
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Expenses arising from AIDS and other related diseases
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Not covered
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Not covered
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Not covered
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Not covered
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Medical Expenses relating to any hospitalisation primarily and specifically
for diagnostic, X-ray or laboratory examinations and investigations
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Not covered
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Not covered
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Not covered
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Not covered
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Medical expenses where Inpatient care is not warranted and does not require
supervision of qualified nursing staff and qualified medical practitioner round
the clock
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Not covered
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Not covered
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Not covered
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Not covered
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Any claim directly or indirectly caused by or contributed to by nuclear weapons
and/or materials
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Not covered
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Not covered
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Not covered
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Not covered
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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 )
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Not covered
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Not covered
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Not covered
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Not covered
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Vaccination or inoculation unless forming a part of post bite treatment
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Not covered
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Not covered
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Not covered
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Not covered
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Any fertility, sub fertility, impotence, assisted conception operation or sterilization
procedure
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Not covered
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Not covered
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Not covered
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Not covered
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Vitamins, tonics, nutritional supplements unless forming part of the treatment
for injury or disease as certified by the attending Doctor
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Not covered
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Not covered
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Not covered
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Not covered
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Experimental, unproven or non-standard treatment
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Not covered
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Not covered
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Not covered
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Not covered
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Treatment for any other system other than modern medicine (also known as Allopathy)
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Not covered
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Not covered
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Not covered
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Not covered
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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)
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Not covered
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Not covered
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Not covered
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Not covered
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Venereal disease or any sexually transmitted disease or sickness
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Not covered
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Not covered
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Not covered
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Not covered
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Weight management services and treatment related to weight reduction programmes
including treatment of obesity
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Not covered
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Not covered
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Not covered
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Not covered
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Treatment for any mental illness or psychiatric illness, Parkinson's and Alzheimer's
disease
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Not covered
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Not covered
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Not covered
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Not covered
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Surgery to correct deviated septum and hypertrophied turbinates
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Not covered
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