Bajaj Allianz Tax Gain Health Insurance Plan: Coverage, Claim & Renewal

Published: 07-03-2019 07:19:36 AM

Bajaj Allianz have a unique policy called Bajaj Allianz Tax Gain Health Insurance Plan where the insured gets health cover as well as also gets the opportunity to save tax. Moreover, it covers hospitalisation and outpatient (OPD) expenses under one policy while helping you manage you tax efficiently.

What Is Bajaj Allianz Tax Gain Health Insurance Plan?

Tax Gain Plan by Baja Allianz is a family floater plan that covers all the hospitalisation and OPD expenses under one plan along with helping the policyholder to save tax. There is a separate plan meant for the senior citizens which covers both OPD and hospitalisation benefits.

Type Of Bajaj Allianz Tax Gain Health Insurance Plan

This policy is available in a floater health policy and covers the outpatient and Hospitalization expenses covered for self & spouse.

Eligibility Criteria

Particulars	Min-Max
Entry Age	18 yrs-75 yrs Plan A : 18yrs-55 yrs Plan B&C : 56yrs Plan D : 56yrs-75 yrs for senior citizens
Policy Term	1 Year
Coverage	Self, spouse can be covered under this policy

 

What Bajaj Allianz Tax Gain Health Insurance Plan Covers?

• Outpatient expenses
• Hospitalization expenses
• Pre & Post hospitalization expenses can be covered under the specified OPD expenses
• Emergency ambulance charges
• 130 day care procedures
• Expenses for crutches will be covered from day 1 under OPD benefit

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 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.

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 You Can’t Claim Bajaj Allianz Tax Gain Health Insurance Plan (Exclusion)

The insurance company won’t be liable to cover the claim if it arises due to the following situations:

• Expenses incurred due to the treatment of injuries from or caused by war, civil war, hostilities (whether declared or not), act of foreign enemies, unrest, commotion, revolution, rebellion, usurped or military power or nationalisation or confiscation or damage by or requisition of or under the order of any public local authority or government
• Expenses of aesthetic or cosmetic treatment, circumcision or gender change surgery
• Plastic surgery treatment expenses unless needed for accidental injuries, burns or cancer
• The expenses of contact lenses, spectacles, hearing aids/ devices, crutches, dentures, artificial limbs, artificial teeth and other types of external medical devices/ equipment
• Cost of dental surgery or treatment unless it is caused by an accident
• General debility, convalescence, congenital external defect/ anomaly/ disease, rest cure, stem cell surgery or implantation, genetic disorders and hormone growth therapy
• Treatment cost of HIV/ AIDS or mutual viruses or any other sexually transmitted disease or illness
• Hospitalisation expenses for x-rays, diagnostic, lab examination and investigation
• Inoculation or vaccination expenses are not covered unless they are the base of animal post-bite treatment
• Tonics, vitamins, nutritional supplements, etc. unless an important part of the treatment
• Surgery or treatment to correct deviated hypertrophied turbinate and nasal septum
• Treatment expenses of any sort of psychiatric or mental illness

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 Tax Gain Health Insurance Plan

Lifetime renewal benefit is available under this policy. After the policyholder have completed the age of 55 years, insured covered under Plan A, B & C would be offered to get covered under plan D. 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.

Advantages Of Buying Bajaj Allianz Tax Gain Health Insurance Plan

• Policy holder can have free health check-ups at the end of each 4 claim-free years
• The health plan by Bajaj Allianz provides certain tax benefits under section 80D of the prevailing Income Tax Act. Section 80C benefits are not included
• Covers hospitalisation and OPD expenses under one single plan on floater basis
• 10% co-payment of the admissible claims applicable if the treatment has been taken in a non-empanelled hospital
• Waiver of medical tests up to 45 years provided to no adverse health conditions

Critical Aspects

• Waiver of co-payment is available if the policyholder pays the additional premium
• In case of cataract claims, it would be payable after a waiting period of 2 years and it is restricted up to 10% of Sum Insured with minimum up to Rs 12000/- and maximum up to Rs 25000
• Benefits will be available after the 48 months of waiting period for any pre-existing condition ailment or injury
• There is a waiting period of 2 years for specified disease and 4 years for joint replacement surgery

 

Features
Claim Type (In-House or TPA)	In house claim settlement
Pre-Hospitalization	NA
Network Hospital Count	6000+
Post-Hospitalization	NA
Room Eligibility	Covered
Share Claim Payments	10% Co-pay if the treatment is taken in the non-network hospital
Restoration of Cover	NA
No Claim Bonus	NA
Ambulance Charges	Maximum of Rs 3000/- per valid hospitalisation claim
Worldwide Coverage	NA
Maternity Cover	NA
Hospitalization at Home	NA
Day Care Treatment	130 day care procedures are covered
Non-Allopathic Treatment Coverage	NA
Emergency Ambulance	Up to Rs 1000/-
Health Check up	Covered

FAQ’s 

Q1- Is medical test mandatory under this policy?

Pre-policy medical tests are compulsory for those who are 46 years or above and this would be arranged at the Bajaj Allianz network diagnostic centres. If the insurance policy is accepted by the insurance company, 100% of the expenses would be reimbursed.

Q2- When one can change the plan?

Change of plan can only be done at the time of renewal by submitting the fresh proposal form along with the renewal notice to the insurance company

Q3- How can I contact Bajaj Allianz?

To know more about the claim process, document required for claiming, settlement duration, top-up options, premium paying term, NAV and any other policy-related query, one can call on 1800-209-5858, write an email and send it on bagichelp@bajajallianz.co.in or simply visit their nearest branch office of Bajaj Allianz.