Bajaj Allianz's Family Floater Health Guard

In these times of rising medical costs, Bajaj Allianz's Family Floater Health Guard Policy is the perfect Health protection for you and your family. It takes care of the expensive medical treatment incurred during hospitalization resulting from serious accident or illness. The policy covers pre and post hospitalization expenses and also ambulance charges in case of an emergency (subject to a limit of Rs. 1000/-)

What are the details of coverage the policy offers


* With Family Floater Health Guard, the member has access to cashless facility at various empanelled hospitals across India. (subject to exclusions and conditions)
* In case the member opts for hospitals besides the empanelled ones, the expenses incurred by him shall be reimbursed within 14 working days from submission of all documents
* Pre and post hospitalization expenses covers relevant medical expenses incurred 60 days prior to and 90 days after hospitalization
* 10% co-payment of the admissible claim to be paid by the member if treatment is taken in a hospital other than a network hospital. Waiver of the co-payment clause is available on payment of additional premium.
* Covers ambulance charges in an emergency subject to limit of Rs.1000/-
* 130 daycare procedures are covered subject to terms & conditions
* 20% Co-payment applicable for any insured person aged 56 yrs. And above, being covered for the first time in the Health Guard policy


Any exclusions?


* 4 years waiting period applicable for Pre-existing diseases
* All diseases/injuries existing at the time of proposing this insurance
* Any disease contracted during the first 30 days of commencement of the policy
* Certain diseases such as hernia, piles, cataract (liability restricted upto 10% of SI, max. upto Rs. 35,000), sinusitis shall be covered after a waiting period of 2 years
* Non Allopathic medicine
* Congenital diseases
* All expenses arising from AIDS and related diseases
* Cosmetic, aesthetic or related treatment
* Use of intoxicating drugs, alcohol
* Joint replacement surgery (other than due to accidents shall have a waiting period of four years)


Claim Procedure
1. The illness / claim should be reported to BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LTD. with an immediate notice by telephone or in Writing (email / Letter)
2. On receipt of claim intimation, BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LTD will forward a claim form and check list for the documents to be submitted by the claimant.
3. After receiving the claim form the claimant should submit the completed claim Form mentioning the following mandatory details:

* Insured details (Name / Address / Age / Sex / Contact No. )
* ID card number and the current policy number
* Hospitalization details (Date and time of admission and discharge).
* Details of the other mediclaim policies in force.
* Signature of the claimant.

4.The other relevant documents to be submitted along with the claim form are as below:

* A photocopy of your previous policy details prior to taking your Family Floater Health Guard policy from Bajaj Allianz
* A photocopy of your present policy document with Bajaj Allianz
* First Prescription from the Doctor.
* The Claim Form duly signed by the claimant or family member.
* The Hospital Discharge Card
* The Hospital Bill giving detailed break up of all expense heads mentioned in the bill. E.g. if Rs.1,000/- has been charged towards medicines in the bill, the names of the medicines, the unit price and the quantity used should be mentioned. Similarly e.g. If Rs.2,000/- has been charged towards Laboratory Investigations, then the names of the investigations, the number of times each investigation has been performed and the rate should mentioned. In this way clear break ups have to be mentioned for OT Charges, Doctor's Consultation and Visit Charges, OTConsumables, Transfusions, Room Rent, etc.
* The Money Receipt duly signed with a Revenue Stamp.
* All Original Laboratory & Diagnostic Test Reports. E.g. X-Ray, E.C.G, USG,MRI Scan, Haemogram etc.(Please note that it is not mandatory to enclose the films or plates, a printed report for each investigation is sufficient)
* If the medicines have been purchased in cash and if this has not been reflected in the hospital bill, a prescription from the doctor and the supporting medicine bill from the Chemist has to be enclosed.
* If the insured has paid in cash for Diagnostic or Radiology tests and it has not been reflected in the hospital bill, it is mandatory to enclose a prescription from the doctor advising the tests, the actual test reports and the bill from the diagnostic centre for the tests.
* In case of a Cataract Operation, Please enclose the IOL Sticker

PLEASE NOTE THAT ONLY ORIGINAL DOCUMENTS SHOULD BE ENCLOSED (EXCEPT FOR POLICY COPY), DUPLICATES OR PHOTOCOPIES WILL NOT BE ENTERTAINED

Pre & Post Hospital Expenses:

* Medicines: Mandatory to provide doctor's prescription advising medicines and the relevant chemist bill.
* Doctor's Consultation Charges: Mandatory to provide the Doctor's prescription and the doctor's bill and receipt.
* Diagnostic Tests: Mandatory to provide the Doctor's prescription advising tests, the actual test reports and the bill and receipt from the diagnostic centre.
* The claims team would assess the claim for completeness of documentation and Admissibility. A written communication would be sent to the insured regarding Requirement of documents if any or if the claim is deemed to be inadmissible as per Policy terms and conditions.
* In case the claim is determined to be admissible a pay order and discharge voucher would be sent to the insured address as mentioned on the policy document.




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