FAQ's HEALTH GUARD
KEY FEATURES
Q What additional features does the revised health guard provide?
1
A
In addition to the inpatient hospitalisation & pre-post hospitalisation cover the revised health
guard provides vide range of covers viz Organ donor expenses,Convalesence benefit,organ
donor benefit,daily cash for insured child,sum insured reinstatement,preventive health check
up,maternity,ayurvedic & homoeopathic hospitalisation
Q Does the revised health guard provide wider sum insured options?
Yes, we have enhanced the sum insured options in the revised product
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Silver Plan- 1.5lacs & 2lacs
A Gold Plan-3/4/5/7.5/10/15/20/25/30/35/40/45/50 lacs
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Q What is the maximum tenure for which the policy can be opted?
A One can opt for either 1/2 or 3yr policy
Q Is there cumulative bonus(CB) in this product?
4
Yes, cumulative bonus is available under this product upto max 100% of Sum insured
A The CB will increase for 10% is case of NIL claims & decrease in same proportion in case of claim
FAMILY DEFINITION
Q What is the family definition under this product?
We have included many relations under this product5
Individual policy-Self,Spouse,Children,Grandchildren,Parents,Sister,Brother,Parent in
A laws,Uncle,Aunt
AGE ELIGIBILITY
Q What is the entry age under this product?
6
A
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The entry age for Self,Spouse,Parents,Sister,Brother,Parent in laws,Uncle,Aunt is 18-65yrs
For dependent children & grand children-3 months - 30yrs
Q Untill what age can policy be renewed?
This policy is reneweable for lifetime
A For dependent children & grand children-Upto 35yrs
What will happene to coverage of dependent children & grandchildren reach the max
Q renewalable age of 35yrs?
8
The children can be covered as self proposals in a separate policy where continuity for all
A waiitng periods will be passed
COVERAGES
Q What is covered under Organ Donor expenses?
9
A
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When a member covered under this policy undergoes an organ transplant surgery & if the claim
is paid, we shall also cover the expenses incurred by the donor for transplanting the
organ.Expenses for both the recepient(our insured) & donor shall be payable upto the sum
insured. We shall be liable to pay only hsopitalization expenses of the donor, pre & post
hospitalization expenses shall not be payable.
Q What is Convalescence Benefit?
Convalescence means time spent in recovering from an illness. We pay amount as specifed in
A policy schedule if the period of hospitalization exceeds 10days
Q What is Daily Cash benefit for accompanying child?
11
A
In case a child age 12yrs or below is hospitalized then we shall pay Rs.500/day for max 10days as
accomodation for one parent subjetc to main hopistalization claim is paid
Q What is Sum Insured Reinstatement?
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A
1.In case if the sum insured along with the Cumulative Bonus, is exhausted due to claims paid
under the policy then up to 100% of the sum insured is reinstated for future claims at no extra
premium
2.This benefit will trigger only once hospitalization insured & cumulative bonus is exhausted
during single policy period
3.If the claimed amount is higher than balance sum insured this benefit will not trigger
4.This benefit will not trigger if there is replase of same illness within 45days from 1st claim
5.This benefit can be utilised for similar ailments which claim have been paid in the same policy
previously
6.This benefit is applicable for once in a lifetime for cancer of specified severity & kidney failure
requiring dialysis for each insured member
Eg for Sum insured reinstatement is as below
Explain-This benefit is applicable for once in a lifetime for cancer of specified severity & kidney
Q failure requiring dialysis for each insured member
1.For any claim arising from cancer or kidney failure requiring dialysis wherein in sum insured is
reinstated the benefit will be applicable only once in lifetime of each insured person
2.If once reinstatement is done for claim relating to cancer it cannot be reinstated again for
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cancer however it may be reinsstated for claim related to kidney failure requiring dialysis & vise
versa
3.If reinstatement is done for claims relating to both cancer & kidney disease, sum insured
reinstatement can still be availed for other ailments apart from cancer & kidney disease
4.In case of floater policy this benefit is applicable to each insured member for both ailments
however reinstatement will be applicable only once in a policy year
A
Q How would sum insured reinstatement work in floater sum insured policies?
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A
Consider a family of 3 members having a floater policy of 5lacs & all 3 meet with an accident
which leads to hospitalization with claim amount of 3lacs each then in such cases the 1st 2
claims of 3 lacs each will be paid as 3+2lacs=5lacs(1lac self paid since sum insured is exhausted),
sum insured will be reinstated for the 3rd claim of 3lac. The balnce reinstated sum
insured(2lacs) can can be utilised by all 3 members covered in future claims.
4.In case of floater policy reinstatement benefit is applicable to each insured member for both
ailments however reinstatement will be applicable only once in a policy year
Q When & how can one avail of preventive health check up?
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A
1.Preventive health check is available at an interval of 3yrs irrespective of claims
2.Benefit is available upto 1% of the Sum insured upto max Rs.5000/3.The benefit can be availed on reimbursement basis as well as cashless(arranged by Us)
4.Under induvidual plan all members are eligible for this benefit however under floater policy
only self & spouse can avail this benfit
Q What is the coverage under Ayurvedic/Homoeopathic hospitalization?
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A
1.One can avail of this benefit upto Rs.20,000/- per policy period
2.24hrs of inpatient hospitalization is mandatory(shall include room rent,nursing,consultation
fees,medicines,ayurvedic & homoeopathic treatment procudures)
3.Facility can be availed in any government hospital or government recognised or accredited by
quality council of India/NABH
Q What is covered under maternity expenses?
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A
1.Maternity expenses cover expenses incurred for delivery of a baby or termination of
pregnency upto maximum 2 deleveries/terminations in lifetime of the insured female
2.There is 72months waiting period is applicable for avaling this benefit.This benefit is
applicablefrom date of issunace of 1st revised health guard gold plan with us
3.It is not mandatory for both self & spouse to be covered with us to avail this benefit
4.Dependent daughter/grandaughter may also avail this benefit if all above conditions are
fulfilled
5.Sum insured as mentioned in above question
Q What is covered under New Born Baby Cover?
New born baby expenses are covered within the maternity sum insured
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The expenses towards hospitalisation of baby upto 90days from birth can be covered under this
benefit
A Mandatory vaccinations upto 90days may also be covered
Q What is bariatric surgey cover?
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A
1.Bariatric surgery is a type of surgery conduted to manage morbid weight gain
2.Its applicable to insured members of age 18yrs & above
3.BMI should be equal to or more than 40 along with either coronary heart disease,high blood
pressure with 3 anti hypertnesive agents or type 2 diabetes
4.The procudure should be consented by 2 surgeons & prior approval from Bajaj Allianz GIC is
mandatory to seek this cover
5.Max limit is 50% of sum insured upto 5lacs under the gold plan
6.There is 36months waiting period is applicable for avaling this benefit.This benefit is
applicablefrom date of issunace of 1st revised health guard gold plan with us
WAITING PERIODS
Q What are the various waiting periods under this policy?
1. Pre exsisitng Diseases-36 months
2.Certain illness viz cataract,hernia,hysterectomy etc-24 months
3.Joint replacement,surery on deviated nasal septum,hypertrophied turbinates & prolapsed
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intervertebral disc,congenital internal diseases/anomalies,laser eye sight correction-36 months
4.Any disease/illness except accidental-30 days
5.Maternity-72 months
A 6.Bariatric Surgery Cover-36 months
CAPPING
Q Is there any room rent capping in this product?
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A
1.Yes there is room rent capping in the Silver plan under this product
2.The room rent is capped at 1% of Sum Insured
3.The room rent shall include nursing expense(e.g. For a person with Sum insured 2lacs- Room
rent is Rs.1700/- & Nursing expense is 400/- his total room rent would be Rs.2100/- which is
Rs.100/- above the eligibility)
4.If the availed room rent exceeds the eligible room category a proportionate co-payment shall
apply on the admissible claim amount
5.All other expenses incurred during hospitalizaion viz.Surgeon,Physician,Anesthesist,Specialist
fees,Blood,Oxygen,OT changes etc will be paid as per the room rent eligibility under the policy
6.Medicines will be paid as per actual
Q What about room rent on admission to ICU?
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A
There is no capping on per day room rent capping of the admission is in ICU
Q Is there any disease wise capping?
Yes the policy has capping for Cataract
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1.Silver Plan-20% of sum insured(base sum insured+cumulative bonus) per eye
2.Gold Plan-20% of sum insured(base sum insured+cumulative bonus) upto maximum 1lac per
A eye
Q Is there any other sum insured restriction for the coverages offered under the product?
Yes there are certain sum insured restrictions as below
1.Road Ambulance-Rs.20,000/- per policy year
2.Convalescence Benefit-Rs.5000/- for Sum insured upto 5lacs & Rs.7500 for Sum insured of 7.5
lacs & above per policy period
3.Daily Cash benefit for accompanying child-Rs.500/day for max 10days
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4.Preventive Health Check Up-1% of sum insured upto max Rs.5000/5.Ayurvedic/Homoeopathic hospitalization-Rs.20,000/- per policy period
6.Maternity Expenses-Sum Insured 3lacs to 7.5 lacs-Rs.15000/- for normal delivery & Rs.25000/for Cesarean section. For Sum Insured 10lacs to 50lacs-Rs.25000/- for normal delivery &
Rs.35000/- for Cesarean section.
7.New Born Baby Expenses-Within the Sum insured limit under maternity expenses
A 8.Bariatric Surgery Cover-50% of the sum insured upto max 5lacs
PREPOLICY MEDICALS
Q What is the criteria for prepolicy medicals?
All members of age 46yrs & above will have to mandatorily under prepolicy medical
examination
Any member declares of positive medical history may have to undergo medical examination
irrespective of the age
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A
PREMIUM
Q How is premium collected under this product?
The premium is based on zone.There are two zones – Zone A & Zone B
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Zone A - Delhi / NCR, Mumbai including Navi Mumbai, Thane and Kalyan, Hyderabad and
Secunderabad, Bangalore, Kolkata, Ahmedabad, Vadodara and Surat.
A Zone B - Rest of India apart from Zone A cities are classified as Zone B
Q Is there any impact on claim for zone A & B?
1.Policyholders paying Zone A premium rates can avail treatment allover India without
any co- payment
2.Those who pay zone B premium rates and avail treatment in Zone A city will have to pay 20%
co-payment on admissible claim amount. This Co – payment will not be applicable for Accidental
Hospitalization cases
3.Policyholder residing in Zone B can choose to pay premium for Zone A and avail treatment all
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over India without any co-payment
ExampleA person residing in Mumbai (which is in Zone A) & pays premium for Mumbai can take
treatment anywhere in India without any Co-payment.
But if a person residing in Pune (which is in Zone B) takes a policy with premium of Pune, but
takes treatment in Mumbai then he would have to bear a Co pay of 20%.
However the person residing in Pune has the option to buy the policy of zone A by paying the
A premium of Zone A & can take treatment anywhere in India.
Q Is there any discount in premium?
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A
Yes this policy has below discount options
1.Family Discount in induvidual policies-10% if 2 eligible family members are covered under a
single policy & 15% if more than 2 of any of the eligible family members are covered under a
single policy
2.Co-pay Discount-10% or 20% if one opts for voluntary co-payment
3.Long Term Policy Discount-4 % discount is applicable if policy is opted for 2 yrs & 8% for 3yrs
policy
Q Calculation logic
Base Premium For 1 year
Multiplied by 3 -for 3 years Premium(age slab wise for each yr)
Less Family Discount@15%
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Less Co Pay discount@10%
Less long Term Discount@8%
Add S Tax@15%
Final Premium (inclusive of S Tax @ 15%)
A
PORTABILITY
Q Will continuity be given from current health guard policy to revised health guard
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Yes continuity will be given for all waiting periods except maternity benefit & bariatric surgery
A cover
Q Any special conditions for other company renewals?
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Yes continuity will be given for all waiting periods except maternity benefit & bariatric surgery
A cover
Q What is criteria for enhancement in sum insured for our own renewals?
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A
MISCELLANEOUS
What do we mean by "This benefit will be applicable annually for policies with term more than
Q 1year"
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A
We mean that the said benefit will be applicable each year in case of long term policies
ExamplePolicy period 1st April 2017 to 31st Mar 2020
Convalescence benefit claim paid in June 2017 then for period 1st Apr to 31st Mar 2018 this
benefit cannot be claimed again
However from 1st Apr 2018 to 31st Mar 2019 it can be claim again & similarly from 1st Apr 2019
to 31st Mar 2020
SUM INSURED ILLUSTRATION