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Bajaj Allianz Family Floater Health Guard Plan

Bajaj Allianz’s Family Floater Health Guard Plan is a health insurance plan for covering the entire family. The plan provides a comprehensive coverage under two different plan variants and allows a Sum Insured of up to Rs.50 lakhs.

Key features of the plan

  • The plan comes in two variants of Gold and Silver with Sum Insured ranging from Rs.1.5 lakhs to Rs.50 lakhs.
  • Dependent children are covered up to 35 years while adults can renew the plan lifelong.
  • No pre-entrance medical check-ups are required if the insured is up to 45 years.
  • Sum Insured reinstatement replenishes the Sum Insured if it is exhausted. Such a replenished Sum Insured can be used for paying treatment costs of the same illness.

How does the plan work?

Step 1 – the policyholder chooses the Sum Assured, the term of the plan, members to be covered and the plan variant.

Step 2 – the policyholder might also choose optional co-pay feature.

Step 3 – premium is calculated based on the Sum Insured, term, plan variant, members covered and the location of the insured.

Step 4 – If the insured faces any medical contingency and the related expenses are covered by the plan the expenses incurred are paid by the plan.

Step 5 – if the plan matures and no medical contingencies occur, no benefit is paid. However, the Sum Insured increases due to cumulative bonus feature.

Example

Rahim buys the policy covering him, his wife and 2 kids. The Sum Insured he chooses is Rs.10 lakhs and the tenure is 2 years.

Option 1 – Rahim’s wife suffers a fracture for which she is hospitalized. The bill comes to Rs.2 lakhs which is paid by the plan.

Option 2 – The first year of the plan comes to an end but Rahim does not make any claim. He gets a cumulative bonus of 10% increase in Sum Insured which becomes Rs.11 lakhs.

Plan benefits

  • Medical benefits – the list of medical expenses covered by the plan and their extent is as follows:
  • Coverages Silver Plan
    Sum Insured Rs.1.5 or 2 lakhs
    Gold Plan
    Sum Insured Rs.3-50 lakhs
    In-patient hospitalization Covered Covered
    Room rent 1% of Sum Insured/day No sub-limits
    Day care treatments Covered Covered
    Pre-hospitalization 60 days 60 days
    Post hospitalization 90 days 90 days
    Domiciliary hospitalization Covered Covered
    Organ Donor expenses Covered Covered
    AYUSH treatments Not covered Up to Rs.20,000
    Maternity Expenses Not covered Sum Insured Rs.3-7.5 lakhs
    Normal delivery – Rs.15,000
    Cesarean delivery – Rs.25,000
    Sum Insured Rs.10 lakhs and above
    Normal delivery– Rs.25,000
    Cesarean delivery – Rs.35,000
    New born baby cover Not covered Up to maternity Sum Insured for 90 days
    Vaccination for newborn baby Not covered Up to maternity Sum Insured for 90 days
    Bariatric surgery Not covered 50% of Sum Insured up to Rs.5 lakhs
    Daily Cash Benefit for accompanying minor child (for plans with a term >1 year) Rs.500/day up to Rs.5000 Rs.500/day up to Rs.5000
    Convalescence benefit (for plans with a term >1 year) Rs.5000 if hospitalization exceeds 10 days Rs.5000 for Sum Insured up to Rs.5 lakhs and Rs.7500 for Sum Insured Rs.7.5 lakhs and above if hospitalization exceeds 10 days
    AYUSH Coverage Up to Rs.20,000 Up to Rs.20,000
    Ambulance cover Up to Rs.20,000 Up to Rs.20,000
    Health check-ups Up to 1% of Sum once every 3 years to a maximum of Rs.2000 Up to 1% of Sum once every 3 years to a maximum of Rs.5000
    Sum Insured reinstatement (for plans with a term >1 year) Up to 100% of the original Sum Insured Up to 100% of the original Sum Insured
  • No Claim Bonus – if the policyholder does not make a claim in any policy year he earns a cumulative bonus of 10% increase in the Sun Insured subject to a maximum of 100%.
  • Premium discounts – premium is discounted by 4% if a 2-year policy term is chosen and 8% for 3-year policy term. A family discount is also available which is 10% for 2 members and 15% for 3 or more members
  • Optional benefit – the policyholder can opt for co-pay of 10% or 20% and choosing such co-pay gives a premium discount.

Eligibility Criteria

  Minimum Maximum
Age at entry (in completed years) Adults - 18 years
Dependent children – 3 months
Adults - 65 years
Dependent children – 30 years
Plan tenure 1 year 3 years
Premium paying options Single pay
Sum Assured Rs.1.5 lakhs Rs.15 lakhs

What is not covered by the plan?

Illnesses suffered during the first 30 days of the plan commencement are not covered.

Critical Illnesses suffered during the first 90 days of the plan commencement are not covered.

Pre-existing illnesses or conditions are not covered by the plan in the first 3 years of the policy

Maternity related expenses have a waiting period of 75 months

Bariatric surgery is covered after the first 3 years of the policy

Specific illnesses are not covered in the first two years of the plan.

Illnesses or accidents caused due to genetic disorder or stem cell surgery, substance abuse, participation in adventure sports or hazardous activities, criminal acts, attempted suicide, war and hazardous substances, etc. are not covered.

Treatments like cosmetic treatments, artificial life support, weight loss treatments, non-allopathic treatments or due to HIV/AIDS, etc. are not covered.

Premium Illustration

Below are the sample rates of premium payable by a non-smoking male aged 40 years living in Delhi for different combinations of plan variants and members covered. The Sum Insured is Rs.2 lakhs for Silver Plan and Rs.5 lakhs for Gold Plan and the policy is taken for 1 year.

FAQs

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CIN: U66000DL2011PTC214078


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