Bajaj Allianz Surgical Protection Plan

Entry Age

18 years- 65 years for policyholder / spouse / parents. Children aged 3 months to 25 years.

Eligibility

1. Indian Nationals.
2. NRIs, policy issued in India, premiums paid in INR and by Indian Account.
3. Sum insured for self (proposer) must be higher than family members.

Types

1. Individual Surgical Protection Plan Policy.
2. Group Surgical Protection Plan Policy.

Renewal

1. Annual policy with lifetime renewability.
2. 30 day grace period from date of policy expiry.

Features and advantages

1. Comprehensive coverage for over 600 surgeries with guaranteed benefit amount.
2. Can be opted for in addition to the hospitalization policy.
3. Cashless facility in over 3,600 hospitals across India.
4. 11 different plans with varying benefits.
5. 15 day free look period for new policies.
6. No pre-policy medical tests up to 45 years of age. (depending on pre -existing adverse health conditions)

Sum Insured

Rs. 1 lakh to Rs. 10 lakhs. 11 different options available.

Grades of surgery covered

Grade 1 (Supra Major Surgeries)

1. Heart Bypass Surgery, Heart-Lung Transplant, Total Knee Replacement, Kidney Transplant, Chest Wall Resection, Liver Transplant, etc.

Grade 2 (Major Surgeries)

1. Back and Neck Surgery (Spinal Fusion), Plate and Screw Fixation of Arm Bones, Open Bladder Surgery, Lung Volume Reduction Surgery, etc.

Grade 3 (Sub-Major Surgeries)

1. Anterior cruciate ligament surgery, Appendectomy (Removal of Appendix), Cataract Surgery, Liver Biopsy, Laryngoscopy, Open rotator cuff repair, etc.

Grade 4 (Day Care Procedures)

1. Bronchoscopy, Circumcision, Dilatation and Curettage, etc.

Grade 5 (Minor Surgeries)

1. Bone Marrow Biopsy, Carpal tunnel release Surgery, Cyst or abscess drainage, etc.

Other benefits

Hospital Cash Day Allowance

1. 1,500 per day for every 24 hours of surgery-related hospitalization.
2. Can be availed up to 30 days during each policy period.
3. 3,000 per day for every 24 hours of surgery-related hospitalization in the ICU, up to a maximum of 15 days.

Critical Illness Cover

1. Coverage benefit of Rs. 1 lakh.
2. Coverage for 15 critical illnesses.

Personal Accident Cover

1. Accidental Death - 100% of sum insured.
2. Accidental Permanent Total Disability - 125% of sum insured.
3. Permanent Partial Disability cover.
4. Transportation benefit of Rs. 5,000.
5. Children education benefit of Rs. 5,000 each for up to 2 children.

Medical examination criteria

1. No medical tests up to 45 years of age (subject to no adverse health conditions), medical tests advised in case of Diabetes, Hypertension, Lipid Disorders, Obesity, Joint Disorders or a combination of any of these.
2. Medical tests mandatory for applicants above 45 years of age - Full Medical Report, CBC, Urine R, ECG, Lipid profile, Fasting BSL, HbA1c, SGOT, SGPT, Sr. Creatinine.
3. Pre-policy medical check-up arranged at specific panelled diagnostic centre.
4. All medical tests will be 100% reimbursed at the panelled diagnostic centre, subject to accepting the policy.

Loading on adverse health conditions

Diabetes - 10%

Hypertension - 10%

Cholesterol disorder - 10%

Obesity - 10%

Cardiovascular diseases - 10%

Tax Benefit

Policyholders are eligible for tax benefit under Section 80D

Exclusions

Exclusions for Surgical Benefit Cover

1. Drug or alcohol abuse.
2. War, acts of war, nuclear, chemical or biological weapons and radiation of any kind.
3. Cosmetic or aesthetic surgeries, surgery for change of gender.
4. Intentional self-injury.
5. Fertility, sub-fertility, impotence, assisted conception or sterilization.
6. Weight management services and treatment related to weight reduction programs.

Exclusions for Critical Illness Cover

1. Any pre-existing critical illness.
2. Any critical illness diagnosed within the first 90 days of Policy commencement.
3. Expenses arising from HIV / AIDS, other STDs.

Exclusions for Personal Accident Cover

1. Suicide, attempted suicide or self-inflicted injury.
2. Breach of law with criminal intent.
3. Participation in hazardous sporting activities.