Bajaj Allianz Extra Care Plus Policy: Coverage, Claim & Renewal

Updated: 25-06-2024 07:48:58 AM

With rising medical expense, traditional medical insurance policy is not enough especially if you have a family to take care of. Bajaj Allianz comes with the Bajaj Allianz Extra Care Plus Policy which ensures the medical expenses is taken care of even if the sum insured from your health insurance is exhausted.

What Is Bajaj Allianz Extra Care Plus Policy?                       

The Bajaj Allianz Extra Care Plus is a top-up health cover that helps to enhance the cover of your health insurance policy. The biggest benefit of getting a top-up health plan is that basic medical insurance policy covers medical expenses up to the sum insured while a top-up plan covers costs after a certain threshold is reached. With rising inflation, this policy act as an additional cover to your existing health cover to meet higher medical expenses incurred due to illness or accidents. However, one should know that this policy comes into effect once you exhaust your Sum Insured.

Types Of Bajaj Allianz Extra Care Plus Policy

This top up plan is available as a floater policy for proper, spouse, dependent children/ dependent parents.

Eligibility Criteria

Parameters	Min-Max
Entry Age	Adult :18-80 years Child : 91 days-25 years
Sum Insured	Rs 3 lakh-Rs 50 lakh

 

What Bajaj Allianz Extra Care Plus Policy Covers?

This top up plan provides coverage for the following:

• In-Patient Treatment Expenses: Room rent, boarding, nursing, ICU rent
• Pre/ Post Hospitalisation Expenses
• Day Care Treatment
• Organ Donor Expenses
• Ambulance Expenses
• Emergency road ambulance

Claim Process

To avail the cashless hospitalisation benefit, follow the steps mentioned here:

• Inform the insurance company about planned treatment in advance to get the pre-authorisation or within 24/72 hours of admission for emergency treatment/planned hospitalisation at one of the network hospitals
• Show the pre-authorisation letter, health card issued by the company, ID proof, policy to the network hospital to avail the cashless treatment facility. The hospital will send the details to Bajaj Allianz for authorisation
• If the process is followed properly and the documents are in order, the company will settle the claim

Reimbursement Process

If the company has denied the cashless claim or if you do not wish to avail the treatment at the network hospital, below are the steps insured have to follow for reimbursement:

• Either the insured or someone from his behalf should inform the company within 48 hours of hospitalisation in case of emergency treatment or planned hospitalisation
• Consult with the doctor and start the treatment prescribed
• Fill out the claim form and send it to the company’s office along with other documents required for the process within 30 days of discharge from the hospital
• The company will verify the documents received and approve the claim if everything is in order.

Suggested Read: Bajaj Allianz Silver Health Plan for Senior Citizens

Document Required To Claim

Here are the documents required to submit to the insurance company:

• First consultation letter from the doctor
• Duly signed claim and NEFT form
• Original hospital discharge card
• Original hospital bill with detailed break up of all expenses including OT charges, doctor’s consultation and visit charges, OT consumables, transfusions, room rent, etc. with expense heads mentioned in the bill
• Original money receipt duly signed with a revenue stamp
• All original laboratory and diagnostic test reports such as X-Ray, ECG, USG, MRI Scan, Haemogram, etc.
• For a cataract operation, IOL Sticker will have to be enclosed
• Claim settlement letter from any other insurer (if any) in case of partial settlement
• Aadhaar card and PAN card copies 

Cases Where One Can’t Claim Bajaj Allianz Extra Care Plus Policy (Exclusions)

Temporary Exclusions (Valid for 12 months from the date of inception of the policy)

• Any types of gastric ulcers, duodenal ulcers
• All joint replacement surgeries
• Cardiovascular disease its complications and related disorders

Permanent Exclusions (Always excluded)

• Any cosmetic or aesthetic surgery
• Dental treatment or surgeries including dental implants, dentures, jaw alignment, etc.
• Medical expenses of the new born baby
• Medical expenses incurred because of illness or injury in the case of war, invasion, hostilities, etc.
• Intentional injury, attempted suicide, etc.
• Experimental or unproven treatment
• Any treatment received outside the country
• Any kind of substance abuse including the use of intoxicating liquor, drugs, etc.
• Cost of spectacles, contact lenses, hearing aids, crutches, dentures, artificial teeth, etc.
• Weight management services and services
• Treatment received outside India
• Treatment of sexually transmitted diseases
• Any pre-existing illness or injury

How Long Does It Take To Pay Out A Claim?

The claims need to be intimated within the duration of 24 hours [under hospitalization]. Upon getting all the required documents, the insurance company will assess and evaluate them and accordingly settle the claim within 30 days.

Renewal Process Of Bajaj Allianz Extra Care Plus Policy

Bajaj Allianz Extra Care Plus Policy is issued for one year. For proposer, spouse, dependant parents, lifetime renewal option is available but for dependent children, policy is renewable up to 35 years. If the insured wish to increase the sum insured opted, S/he can do it only at the time of renewal. The policyholder will get 30 days as a grace period from the date of expiry to renew his policy. It is recommended for an insured to pay timely premium from before his policy gets lapsed. 

Also Read: Bajaj Allianz Tax Gain Health Insurance Plan

Advantages Of Buying Bajaj Allianz Extra Care Plus Policy 

• Acts as an additional cover to your existing health insurance cover and can be opted even if the policy seeker doesn’t have any health insurance policy
• It pays the hospitalisation expenses incurred above opted by you
• No need of undergoing pre-policy medical tests if the policy seeker is up to 55 years of age
• Free look period of 15 days is provided under Bajaj Allianz Extra Care Plus Policy wherein the policyholder can review the terms and conditions and return the same if not found suitable
• Free health check after three continuous years
• Premiums paid for this policy are eligible for relief under income tax benefit under 80D of the Income Tax Act
• Claim requests up to Rs 20,000 can be raised directly through the application which results in faster claim settlement

Also Read: Features of Aviva Extra Cover

Critical Aspects

• Bajaj Allianz Extra Care Plus Policy can be taken by the policy seeker even if they do not have a base health insurance plan
• Pre-existing disease are covered after 12 months from your first extra care plus policy
• Only Indian nationals residing in India are eligible for this policy
• Insurance company won’t be liable to make any payment if the hospitalisation occurs during the grace period

Features
Claim Type (In-House or TPA)	In house claim settlement
Pre-Hospitalization	Expenses incurred 60 days prior to hospitalisation
Network Hospital Count	6000+
Post-Hospitalization	Expenses incurred 90 days after hospitalisation
Room Eligibility	Covered
Share Claim Payments	Rs 2 lakh, Rs 3 lakh, Rs 5 lakh and Rs 10 lakh
Restoration of Cover	NA
No Claim Bonus	NA
Ambulance Charges	Maximum of Rs 3000/- per valid hospitalisation claim
Worldwide Coverage	NA
Maternity Cover	Covered, limited to maximum 2 deliveries
Hospitalization at Home	NA
Day Care Treatment	Covered
Non-Allopathic Treatment Coverage	NA
Emergency Ambulance	NA
Health Check up	Covered, subject to maximum Rs 2000

FAQ’s

Q1- Are there any riders one can avail off with this policy?

With additional premium, the insured can cover the air ambulance charges incurred for ambulance transportation in an airplane. The claim would be reimbursed up to the actual expenses subject to a maximum limit.

Q2- Who can be covered under Bajaj Allianz Extra Care Plus Policy?

A maximum of six members, self, spouse, dependent, children can be covered under Single floater policy.

Q3- Is there any pre-policy medical tests one has to have?

If the age of a proposer is up to 55 years then there is no need to have medical tests provided the policy seeker doesn’t have any adverse medical condition. However, if the age of a policy seeker is 56 and above, then medical tests criteria is applicable. If the policy is accepted, 50% of the expenses will be reimbursed by the insurance company.

Q4-How can I contact Bajaj Allianz for my health insurance related queries?

For any Bajaj Allianz health insurance related queries contact the insurance company in the ways mentioned here:

• Call: 1800-209-5858 (Toll-free)
• Email: websales@bajajallianz.co.in