Top-up Health Plan by Bajaj Allianz General Insurance Company

How will this top-up policy by Bajaj Allianz Health Insurance Company help you? 

• If your existing health insurance is insufficient, it will cover the remaining expenses
• If you do not want to exhaust your health insurance cover while undergoing treatment for a serious disease or accidental injuries, which requires exorbitant and long term care 
• It gives you a sense of security as you no longer need to worry about hospitalization expenses again.

See if you can buy Bajaj Allianz Extra Care Top-up Plan

• No pre-medical test required up to 55 years of age, subjected to the medical history
• In this top-up policy the entry age for proposers, spouse, and children is 18 years to 70 years
• The policyholder can extend coverage to  the spouse and up to 3 children
• Premium to be calculated on the basis of the eldest insured member
• Coverage to children within the age group of 3 months to 25 years, provided both  the parents are covered in the plan
• Coverage extendible to dependent parents, a separate policy will be issued for them
• Lifetime policy renewal can be done by the insured

Features & Benefits that one can avail under Bajaj Allianz Extra Care Top-up Plan

• Add-on insurance benefits on an existing health insurance plan
• A family floater plan, providing health insurance cover to the entire family in a  single plan and single premium
• Free cancellation within 15 days of free look period, provided no claim was made
• 30-days of grace period for renewing your existing health insurance policy
• Tax benefits  up to Rs 60000 under Sec 80/D
• Health CDC benefit, that provides quick claim settlement through the mobile application

What are the permissible claims under this policy?

• Medical Expenses up to the sum insured
• Ambulance expenses to be covered up to Rs 3000
• 60 days of pre-hospitalization expenses and post-hospitalization expenses to be covered within 90 days of discharge
• Pre-existing diseases to be covered after consecutive 4 years of policy coverage
• Ectopic pregnancy is covered in the plan

What cannot be claimed under this Top-up Health Plan?

You claim will be rejected under the following scenarios:

• Self-inflicted injuries and suicidal attempt are not covered
• AIDS, sexually transmitted disease, and Venereal disease are not covered
• Pre-existing disease are not covered before a waiting period of 4 years
• Any illnesses diagnosed during the initial 30 days of the policy issuance date
• Treatment for congenital disorders and diseases
• Treatment of other allopathy is not covered
• Joint replacement surgeries until the completion of 4 years waiting period
• Aesthetic treatments and cosmetic surgeries
• Health conditions resulting from an overdose of alcohol or drugs
• Fertility related treatments
• Pregnancy and childbirth complications

Coverage Amount

The sum insured options in this top-up policy range from Rs 10 lakh, Rs 12 lakh to Rs 15 lakh

Deductibles –

• Deductible of Rs 3 lakh applicable on the sum insured of Rs 10 lakh 
• Deductible of Rs 4 lakh applicable on the sum insured of Rs 12 lakh 
• Deductible of Rs 5 lakh applicable on the sum insured of Rs 15 lakh 

If the amount claimed is more than the deductibles, the insurer will pay amount over and above it up to the sum insured.

What is the procedure followed to register a claim with Bajaj Allianz Top-up Extra Care Plan?

If you choose to file a cashless claim then you need to follow the procedure given below:

1. Take healthcare treatment in one of the empaneled network hospitals.

2. TPA will verify all the details filled in the pre-authorization form.

3. After validating, the pre-authorization form will be sent the health insurance provider for further approval.

4. After cross verifying the pre-authorization form with the terms and conditions of the insurer and clauses mentioned in the policy documents, the status is conveyed to the hospital.

5. The policy holder can avail of cashless treatment after approval.

6. If more documents are required, the insured will need to submit all the remaining documents. Upon satisfaction of the TPA department and hospital authorities, the claim is approved. 

7. If the claim is rejected, the TPA department will intimate the policy holder, and claim reimbursement process will follow.

And if you choose to reimburse your claim, the procedure to recompense the hospitalization expenses in a non-network hospital is given below:

1. Once discharge papers are ready, the policyholder needs to submit all the documents including medical reports, bills, etc. to the TPA department of the hospital.

2. These documents are further verified by the health insurance provider.

3. In case the policy holder needs to submit more documents, he/she will be asked to do so in the stipulated time.

4. If the documents are provided within the time frame, usually the claim is settled within 15 to 20 days of intimation.

5. It is advisable that you provide all the details on time,  as the claim requests are generally closed after 45 days of intimation.

Points to remember-

Both reimbursement and cashless claim settlement are subjected to the deductible limits as mentioned in the policy wordings.

If you have an existing health insurance policy, you need to submit the proof of settlement of the deductible amount at the time of claim.

For reimbursement of claims inform the insurer about the illness or injury in writing immediately, or within 30 days of the incident.