Family Floater Health Guard
Family Floater Health Guard Policy is the perfect health protection for you and your family. It takes care of expensive medical treatments incurred during hospitalisation resulting from serious accidents or illnesses. The policy covers pre and post hospitalization expenses and also ambulance charges in case of an emergency (subject to a limit of Rs.1000/-).
- Entry age for proposer is 18 years - 65 years. Policy can be renewed up to 80 yrs.*
- Children aged 3 months to 25 years are eligible if both the parents are insured with Bajaj Allianz.
- With the Family Floater Health Guard, you will have access to cashless facility at various empanelled hospitals across India (subject to exclusions and conditions).
- In case you opt for a hospital not among the list of empanelled ones, the expenses incurred by you shall be reimbursed within 14 working days from the date of submission of all documents.
- Pre and post hospitalization expenses will cover relevant medical expenses incurred for 60 days prior to and 90 days after hospitalisation.
- Covers ambulance charges in an emergency subject to a limit of Rs.1000 /-.
- 10% co- payment applicable if treatment is taken in non-network hospitals.
- 20% co-payment applicable for members of age group 56 -65 years, if they are opting for this policy for the first time.
- Waiver on 10% co-payment is available on payment of additional premium.
- 130 daycare procedures are covered, subject to terms and conditions.
- 20% co-payment applicable for any insured person aged 56 years and above, if they are being covered for the first time in the Health Guard policy.
- Sum insured from Rs.2 lakhs to Rs.10 lakhs can be opted for a period of 3 months to 55 years.
- Sum insured from Rs.2 lakhs to Rs.5 lakhs can be opted for a period of 56 months to 65 years.
- No tests required for a sum insured of Rs.10 lakhs, as long as the insured is under 45 years of age (subject to a clean proposal form).
- Income tax benefit on the premium paid as per section 80-D of Income Tax Act as per existing IT law.
- Health Check up in designated Bajaj Allianz Diagnostic Centres or reimbursement for maximum amount of Rs.1000 /- at the end of 4 continuous claim-free years. This benefit can be availed by only one member of the family.
- A 4-year waiting period will be 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 up to 10% of the sum insured, maximum up to 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 and/or alcohol.
- Joint replacement surgery (other than due to accidents) shall have a waiting period of four years.
1. The illness/claim should be reported to Bajaj Allianz General Insurance Company Ltd. with an immediate notification 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:
- Details of the insured (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 other Mediclaim policies in force (if any)
- Signature of the claimant
4. The other relevant documents to be submitted along with the claim form are as follows:
- A photocopy of your policy details prior to taking your Health Guard policy from Bajaj Allianz (if applicable)
- 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 a detailed break up of all expense heads mentioned in the bill. (For example - 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, 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 be mentioned. In this way clear break-ups have to be mentioned for OT Charges, Doctor's Consultation and Visit Charges, OT Consumables, Transfusions, Room Rent, etc.)
- The Money Receipt, duly signed, with a Revenue Stamp.
- All Original Laboratory and Diagnostic Test Reports, such as 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 must 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
Note: Only original documents should be enclosed (except for policy copy), duplicates and/or photocopies will not be entertained.
- 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 the policy’s 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.