Surgical Protection Plan lets only 50% of sum insured to get claimed

Majority of the people avoid buying health insurance as according to them, the main cost they will have to incur would be for surgery. To negate this, Bajaj Allianz Insurance has launched a new plan – a surgical protection plan that opposes to repay surgical expenses.

The plan has two sections – surgical benefit cover (mandatory cover) and optional add-on covers. The surgical benefit cover offers a fixed benefit for some stated surgeries. The plan covers around 600 kinds of surgeries and offers 11 sum insured, varying from Rs 1 lakh to Rs 10 lakh. However, the benefit amount is capped between Rs 5,000 and Rs 5 lakh, according to the grade of the surgery and the plan opted.

The plan implemented is not new to the market. “Aegon Religare Life Insurance's iHealth Plan provides similar features. It offers health insurance along with critical illness, daily cash and surgery benefits. Tata AIG General Insurance's Wellsurance and LIC's Jeevan Aarogya also provide surgical benefit. In addition, Tata AIG Life Insurance and Birla Sun Life Insurance provide surgical benefit riders with their life policies. These also offer a pre-fixed sum of money at the time of a surgery. Bajaj’s new plan has add-ones like hospital cash daily allowance, critical illness cover and personal accident cover.

Such products work well but could only be taken as supplementary cover because of very limited coverage. The policy would falter if you contract a disease that is not listed in it. These plans generally also limit one on the number of claims to be made in a year.

The plan has some more restrictions that one has to bear. In case of a claim under a particular grade, the coverage under that grade ceases for the remaining period of the policy. The product has five grades – supra major, major, sub-major, day care and minor.

Also, the plan lets only 50 per cent of the sum insured to be claimed for complicated surgeries in Grade A. For example if you have a sum-insured of Rs 12 lakh, the cover would allow you to claim only Rs 6 lakh.

Exclusions include: Any pre-existing ailment which requires surgery, and any treatment taken within 90 days of buying the policy. Many health conditions including gastric or duodenal ulcers, cardiovascular diseases, hernia, fistulae, fissure, cataract, endometriosis, hysterectomy, and surgery on all internal or external tumors are excluded for two years.