Search for details of BAJAJ ALLIANZ GENERAL INSURANCE network hospitals in India.
Bajaj Allianz Health Insurance is one of the leading health insurance providers in the country today, maintaining a steady growth and profitability in the industry. The insurer has received the iAAA rating for the 10th consecutive year from ICRA, indicating its ability to honour claims in an efficient manner. This also portrays its strong position in the insurance industry. Apart from this award, the insurer has been honoured with a large number of recognitions, some of which include the Claims Award Asia 2015, Pharma Leaders Power Brands Awards 2015, and Outlook Money Awards 2015.
The insurance company has a tie-up with more than 5,000 network hospitals and 1,500 diagnostic clinics in the country. Bajaj Allianz Health Insurance cashless claims provide 24/7 consultation on issues regarding claims settlement through their dedicated claims assistance cell.
The health insurance schemes offered by Bajaj Allianz include the following:
Individual Health Guard Insurance - This is an affordable health insurance plan that protects an individual against increased medical costs during emergencies or hospitalisation.
Global Personal Guard Policy - A health insurance plan that covers you for death, permanent partial disability and permanent total disability.
Critical Illness Policy - This policy offers protection against pre-defined critical illnesses, such as cancers and stroke.
Health Extra Care - This plan enables you to extend your health insurance coverage at a relatively lower cost, and is an add-on policy.
Health Care Supreme - A comprehensive plan that has a wide coverage and offers protection for the policyholder and his/her family throughout life. The policy is notable in the fact that it offers a sum assured which ranges from Rs.5 lakh to Rs.50 lakh.
Hospital Cash - The hospital cash policy protects you and your family from increased expenses during hospitalisation.
Silver Health - This policy is designed specifically for senior citizens, and it offers protection to the policyholder and his/her spouse. From the second year of the policy, the coverage also includes pre-existing illnesses.
Star Package - This is a family floater plan that offers protection against various health risks, household contents, travel baggage, and public liability. The plan also covers education grant, and is unique in the variety of coverage it offers.
Health Ensure - This policy covers the cost of medical treatment incurred through serious illnesses, accidents, or hospitalisation. The scheme offers a 5% discount for family coverage.
Tax Gain - This family floater plan, apart from providing coverage for outpatient expenses and hospitalisation charges, also assists the policyholder in managing tax.
Personal Accident - This individual plan covers the policyholder against death or bodily injury caused by accidents.
Critical Illness for Women - This unique critical illness plan offers protection for women against the risk of 8 pre-defined critical illnesses. The policy also provides additional benefits, such as Congenital Disability Benefit, Loss of Job Cover, and Children Education Bonus.
Premium Personal Guard - This policy offers protection to the insured from temporary total disability, permanent total disability, permanent partial disability, and death. The policy also offers a substantial sum assured that ranges between Rs.10 lakh and Rs.25 lakh.
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Bajaj Allianz Health Insurance Cashless Network Hospitals
A cashless network hospital has a tie-up with the insurance company, and it offers cashless services to the policyholder when he/she is hospitalised there. Effectively, the policyholder is not required to pay upfront for the medical expenses. The medical costs are deducted from the annual sum assured of the patient’s health insurance, and are settled directly between the insurance company and the network hospital. However, this is possible only if the treatment comes under the coverage of the health insurance policy that the patient is equipped with.
To avail cashless hospitalisation facility, the policyholder is required to inform the insurer of the network hospital from where he/she would avail treatment. The policyholder is also required to produce a proof of identity in the form of an ID card (issued by the insurer) or the policy documentation.
Bajaj Allianz has an extensive network of 5,000 hospitals and 1,500 diagnostic centres in India, as indicated above. Based on the insurance coverage of the policy, the customer can avail cashless treatments at these hospitals in a hassle-free and streamlined manner.
What are the types of claims that can be done at Bajaj Allianz Health Insurance network hospitals?
The following types of claims can be executed at Bajaj Allianz network hospitals:
Cashless Claims - If the policyholder seeks medical treatment at any of the network hospitals affiliated to Bajaj Allianz, he/she need not pay for the medical expenses at the time of discharge. This amount is borne by the insurer, and is deducted from the annual sum assured under the health insurance policy.
Reimbursement Claims - If the policyholder is hospitalised at any hospital, the expenses for treatment will have to be paid at the time of discharge. Following this, the insured raises a claim under the policy for the reimbursement of these costs. The insurer reviews the claim, and if approved, pays the insured accordingly.
How do you file claims at Bajaj Allianz Health Insurance network hospitals?
The claim process for cashless hospitalisation is as follows:
The policyholder can approach a hospital in the Bajaj Allianz network for cashless treatment.
The hospital verifies the details of the customer and sends the completed pre-authorization form by fax to the insurer.
The insurer validates the pre-authorization form and compares it with the policy benefits. The decision is then conveyed to the medical service provider.
If the request for cashless hospitalisation is approved by Bajaj Allianz, an authorisation letter is sent to the hospital, which provides treatment to the patient without any deposit, till discharge.
In case the request is rejected, the denial letter is sent to the hospital. The patient will then have to pay cash (at the time of the discharge) for the treatment received, and he/she can subsequently raise a reimbursement claim under the policy.
The claim process for reimbursement hospitalisation is as follows:
The customer collects all documentation related to the hospitalisation at the time of discharge from the hospital.
He/she submits the same to the insurer, who validates the bills with the policy benefits.
If the claim is approved, the payment is released to the policyholder through ECS or cheque.
If the claim is found to be deficient in information, the insurer informs the customer of the additional documents that need to be submitted, and sends follow-up reminders. If the insurer has not received the documents even after 3 reminders, the claim will be closed at the end of 45 days. The closure letter is subsequently sent to the insured.
Procedures offered/covered in Bajaj Allianz Health Insurance network hospitals across India
The medical procedures covered under the Bajaj Allianz policies include surgeries of the eyes, nose and sinus, ears, skin, bones, and tongue. Some ailments like piles, hernia, sinusitis, and cataract are covered after the insured has completed two policy years. Certain policies also cover critical illnesses, such as kidney failure, cancer, first heart attack, stroke, major organ transplant, specific heart surgeries, and permanent paralysis of limbs.
However, the specific coverage varies according to the policy chosen, and this information will be available under the terms and conditions of the policy documentation.
Exclusions under Bajaj Allianz Health Insurance network hospital services
The insured is expected to wait for 4 years for the inclusion of pre-existing diseases to the coverage.
All diseases that the insured contracts within 30 days of commencement of the policy will not be included under the coverage.
Treatments under alternative medical streams, i.e., non-allopathic medicine, will be excluded.
Congenital external ailments are excluded from the policies permanently. Congenital internal ailments are included under the coverage only after a 4-year waiting period, if accepted by the insurer.
Cosmetic or aesthetic treatments are usually not covered under the Bajaj Allianz policies.
Treatment for repercussions from solvent or alcohol abuse and usage of narcotics will not be covered.
Joint replacement surgeries (apart from those due to accidents) will have a 4-year waiting period before these are included in the coverage.
Treatment for complications arising from attempted suicide or self-inflicted injury will not be covered.
If the insured commits any anti-social activity with criminal intent, then he/she will not be covered for any bodily injuries arising out of that.
Bodily injuries arising out of participation in any dangerous hobby or pursuit will not be covered.
FAQs – Frequently Asked Questions:
I am already in possession of a life insurance plan. Do I still need to buy a health insurance policy?
A life insurance coverage protects the dependents of the policyholder from losses that may arise from an untimely death or accidental disability. The payout of a life insurance policy is made after the death of the insured or at the time of policy maturity. On the other hand, a health insurance policy protects the policyholder from ill-health or diseases by covering the expenses of treatment availed. There are no payouts made at the time of policy maturity. Health insurance also needs to be renewed on a yearly basis.
I am already covered under the health insurance policy provided by my employer. Do I need to buy individual health insurance separately?
The employer’s health insurance will not be effective in the event of a job change or retirement. In the transition period between jobs, you will be exposed to health risks that may prove to be very costly. Transfer of the health insurance benefits from the old employment to the new company may not be possible, as well. Moreover, the employer’s health insurance may not have extensive coverage or effective protection against pre-existing diseases. So, it is advisable to purchase a separate health insurance policy to provide you optimum coverage.
Are maternity expenses covered under the Bajaj Allianz health insurance plans?
No, pregnancy or maternity expenses are usually not covered under the Bajaj Allianz health plans. This facility is sometimes included under the group insurance plans offered by employers.
Is health insurance liable for tax benefits?
Yes, it is possible to avail tax benefits under Section 80D of the Income Tax Act, 1961, when you pay premiums towards the health insurance policies from Bajaj Allianz. The annual deduction is Rs.15,000 from the taxable income when you pay the premium for self and dependents. In the case of senior citizens, this amount will be Rs.20,000.
Do I need to undergo a medical check-up before the purchase of a policy?
In the case of a new health insurance policy, a medical checkup will be required for customers above the age of 40 or 45 years, based on the policy terms and conditions. Medical checkups are usually not mandated for policy renewal.
Are expenses for MRI scan, ultrasound scan, and X-Ray included under health insurance?
Health insurance generally covers all diagnostic tests, such as MRI scan, blood tests, X-Ray, etc. However, these expenses are covered only if the patient is hospitalised for at least one night. Diagnostic tests that are prescribed in the OPD are usually excluded.
Is it possible to buy more than one health insurance policy?
Yes, this is possible. In the event of a claim, each insurance company will pay a proportion of the expenses, as per the coverage under each scheme.
How many claims can I make during a policy year?
There is no limit on the number of times you can make claims in a policy year. However, the sum of the claim amounts cannot exceed the policy sum insured.
Can I avail a reimbursement of premium when I cancel my policy?
If you cancel your health insurance policy, your insurance coverage will cease to exist from the date of policy cancellation. The premium will be refunded to you on short period cancellation rates. These details are further explained in the policy terms and conditions.
Can I avail reimbursement under my health insurance for treatment seeked at home?
Most policies from Bajaj Allianz covers treatment at home if:
The condition of the patient is such that he/she cannot be transported to a hospital.
There is no availability of a bed at any of the hospitals, and the treatment at home is similar to that availed at a hospital. This is known as domiciliary hospitalisation, and is restricted in coverage and benefits.