Bajaj Allianz Health Care Supreme Plan Review Plan

Main Highlight of the plan

This plan offers coverage air ambulance cover up to 10% of sum insured and had 3 add-on benefits like personal accident cover, critical illness cover and ancillary cover.
This plan has additional coverage amount for covering maternity expense, Physiotherapy, OPD, Donor expenses, Air ambulance charges and Recovery benefit.
This plan covers all the day care procedures under hospitalization sum insured value.

Scope of cover

Plan	Entry Age	Maximum Members	Sum Insured Range	Premium Discounts
Individual Health Care Supreme Plan	Children- 3 months to 25 years for entry and 35 years for renewal Adults – 18 years onwards	Proposer, Spouse, dependent parents and dependent children	INR 5,00,000 to INR 50,00,000	5% discount up to maximum of 10% if 2 or more than 2 members are covered
Family Floater Health Care Supreme Plan	3 months onwards Adults – 18 years onwards	Proposer, Spouse and dependent children	INR 5,00,000 to INR 50,00,000	All the members are covered under a single premium
Group Health Care Supreme Plan	18 years onwards	2 to 1,00,000	INR 5,00,000 to INR 50,00,000	Premium discount in the range of 5% to 30% is applicable depending on the number of persons

Note: For add-on benefits the maximum entry age limit of 65 years is applicable.

In case a person opt for a basic plan with add-on benefit then a discount of 5% is applicable.

Pre-policy health check-up is required for individuals with entry age above 45 years.

Coverage: Benefits & Features

Most Important

ROOM RENT/ ROOM CATEGORY

This plan does not have any limit on room expenses.

CO-PAYMENT

This plan does not have any co-payment.

NO-CLAIM BENEFITS

In this plan no-claim bonus equal to 10% of basic sum insured up to a maximum of 50% is available for each unclaimed year. However, the bonus amount is reduced by 10 % of sum insured once a claim is made.

Note: After any claim, only the bonus amount would be reduced at the time of renewal. However, the basic sum insured will not be affected.
-Along with cumulative bonus this policy also offers 5% discount on premium on no-claim renewal.

Good to have

PRE/POST HOSPITALIZATION

60 days of pre hospitalization and 90 days of post hospitalization are provided in this plan.

RESTORE BENEFITS

This plan offers 100% restoration of sum insured after entire sum insured (including the bonus) is exhausted. For this restore to get activated,

The entire sum insured including the bonus amount (if any) should be exhausted.
The claims should be for unrelated ailments or for different family member.

HEALTH CHECK-UP

This plan offers health check-up benefit up to hospitalization sum insured, for the tests listed in the document, once every year irrespective of claims made.

Value Adds

AMBULANCE CHARGES

This plan provides coverage for ambulance charges up to hospitalization sum insured.

EYE COVER

This plan does not provide coverage for eye treatment expenses.

DOMICILIARY HOSPITALIZATION

This plan does not have domiciliary hospitalization coverage.

OUTPATIENT BENEFITS

This plan additionally covers outpatient benefits which in the range of INR 2,500 to INR 25,000 depending on the sum insured opted.

Additionally, physiotherapy is covered in the range of INR 5000 to INR 50,000.

CRITICAL ILLNESS COVERAGE

This plan provides additional cover for critical illness up to INR 1,00,000 as an add-on benefit. About 15 listed critical illnesses are covered under this add-on benefit.

ACCIDENTAL COVER

This plan provides accidental cover as an add-on benefit. With this cover, in case of death resulting from an accident within 12 months lump sum equal to 100% of sum insured is provided.

This plan cover permanent disability up to 200% of sum insured if the insured suffers permanent disability due to accident within 12 months.
This plan also covers temporary total disability, permanent partial disability, etc. up to the limit specified in the document.

ALTERNATIVE PRACTICE

This plan covers Ayurvedic and Homoepathic treatment expenses up to sum insured.

DENTAL COVER

This plan covers dental expenses under outpatient benefit.

DAILY CASH

This plan provides under add-on benefit of ancillary expense benefit.

With this benefit daily cash allowance of INR 1500 per day for a maximum of 30 days in case of normal hospitalization and INR 3000 for a maximum of 15 days in case of ICU admission is provided in this plan.

This benefit is available after each continuous 24 hours of hospitalization. A maximum of 30 days for individual coverage and 60 days for floater coverage are offered under this plan.
Note: In case of Family floater plan daily cash expense is covered up to 60 days.

ORGAN DONOR COVER

This plan additionally covers donor expenses in the range of INR 50,000 to INR 5,00,000 depending on the sum insured opted.

CONVALESCENCE BENEFIT

This plan provides convalescence benefit after 7 days of hospitalization in the range of INR 10,000 to INR 50,000.

MATERNITY COVER

This plan covers maternity and new born medical expenses after a waiting period of 2 years. These expenses are covered up to maternity sum insured i.e. in the range of INR 25,000 to INR 1,00,000 depending on the plan opted. Please refer the policy wording for more details.

Exclusions

A cooling off period of 30 days is applicable on buying a policy for the first year. No claims (other than claims related to an accident) can be made in this cooling off period. There is no cooling off period applicable on renewal of the health insurance policy.

Waiting period of 90 days is applicable for claims related to critical illness.

Waiting period of 1 year is applicable for some specified ailments and 2 years is applicable for some other illnesses. Refer to the policy wordings for the list of these specified ailments.

Waiting period of 2 years is applicable for pre-existing diseases.

PERMANENT EXCLUSIONS

Cosmetic surgery, Lasik eye treatments, drugs or alcohol abuse, genetic disorders, self inflicted injuries, war related injuries, etc. are some of the exclusions. For the detailed list of please refer the policy document.