Bajaj Allianz Surgical Protection Plan

Entry Age

18 years- 65 years for policyholder / spouse / parents.

Children aged 3 months to 25 years.

Eligibility

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

Types

• Individual Surgical Protection Plan Policy.
• Group Surgical Protection Plan Policy.

Renewal

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

Features and advantages

• Comprehensive coverage for over 600 surgeries with guaranteed benefit amount.
• Can be opted for in addition to the hospitalization policy.
• Cashless facility in over 3,600 hospitals across India.
• 11 different plans with varying benefits.
• 15 day free look period for new policies.
• 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)

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

Grade 2 (Major Surgeries)

• 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)

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

Grade 4 (Day Care Procedures)

• Bronchoscopy, Circumcision, Dilatation and Curettage, etc.

Grade 5 (Minor Surgeries)

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

Other benefits

Hospital Cash Day Allowance

• 1,500 per day for every 24 hours of surgery-related hospitalization.
• Can be availed up to 30 days during each policy period.
• 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

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

Personal Accident Cover

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

Medical examination criteria

• 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.
• 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.
• Pre-policy medical check-up arranged at specific panelled diagnostic centre.
• 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%

Cumulative loading will be applicable for multiple conditions. Maximum risk loading will not exceed 50% of published premiums for overall risk per person.

Tax Benefit

Policyholders are eligible for tax benefit under Section 80D

Exclusions

Exclusions for Surgical Benefit Cover

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

Exclusions for Critical Illness Cover

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

Exclusions for Personal Accident Cover

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