Bajaj Allianz Extra Care Plus Insurance

What is deductible? How is the deductible applied at the time of claim?

• Deductible means the amount stated in the schedule which shall be borne by the insured in respect of each and every hospitalization claim incurred in the policy period.
• The company’s liability to make any payment for each and every claim under the policy is in excess of the deductible.
• Deductible would be applied afresh for each claim.
• Each and every hospitalization would be considered as a separate claim.
• The limit of indemnity /Sum Insured is the maximum liability above the deductible.
  • For example – If the Sum Insured is Rs 10 lakhs and deductible is Rs 3 lakhs, our liability for a claim of Rs 13 lakhs would be Rs 10 lakhs (which is over and above the deductible).

What are the Sum Insured options under this policy?

Sum Insured ( excluding deductibles)	Deductible per hospitalization
₹10,00,000/-	₹3,00,000/-
₹12,00,000/-	₹4,00,000/-
₹15,00,000/-	₹5,00,000/-

What is the entry age under this policy?

• Age of entry for proposer, spouse and parents is 18 yrs – 70 Years.
• Children from 3 Months - 25 years can be covered as dependents.

What will be the renewal age?
Under normal circumstances, lifetime renewal benefit is available under the policy except on the grounds of fraud, misrepresentation or moral hazard.

What is the policy period?
This is an annual policy

Who can be covered under this Policy?

• Self, spouse and 3 dependent children can be covered under the policy.
• Dependent parents can also be covered under this policy, a separate policy would be issued for parents.

Do I need to undergo medical check up?

• Waiver of medical tests up to 55 years subject to no adverse medical history.
• Medical tests (pre-policy check up) would be advised for members 56 years and above.
• List of the medical tests to be conducted are :
  • Full Medical report, ECG, Complete Blood Count, Fasting Blood Sugar, Lipid Profile, Serum Creatinine, SGOT, SGPT, GGT and Urine Routine
• The pre-policy check up would be arranged at our empanelled diagnostic centers.
• The validity of the test reports would be 30 days from date of medical examination.
• 50 % cost of pre-policy check up would be refunded if the proposal is accepted & policy is issued

Coverages under this Extra Care Plus Plan

1. Medical Expenses
   If You/Your family member(s) named in the schedule are hospitalised on the advice of a Doctor because of Illness or accidental Bodily Injury sustained or contracted during the Policy Period, then We will pay You, Reasonable charges Medical Expenses incurred , in excess of the deductible stated in the schedule.
   • Hospitalization expenses:- As an in-patient in a Hospital for accommodation; Boarding Expenses including patients diet as provided by the hospital / nursing home ; nursing care; the attention of medically qualified staff; undergoing medically necessary procedures; medical consumables;
   • Pre-hospitalization expenses : In respect of the medical treatment of an Illness during the consecutive 60-day period immediately preceding Your admission to Hospital for that Illness
   • Post-hospitalization expenses : In respect of medical treatment and essential investigations for a period of upto 90 days after discharge from a Hospital for medical treatment related to the Illness or Accidental Bodily Injury
2. Ambulance Expenses
   If a claim under Cover 1) is accepted, We will also pay the ambulance expenses to a maximum of Rs 3000 per valid hospitalization claim for transferring You/Your family member(s) named in the schedule to or between Hospitals in the Hospital’s ambulance or in an ambulance provided by any ambulance service provider

Bajaj Allianz Extra Care Plus Insurance exclusions

1. War, invasion, acts of foreign enemies, hostilities (whether war be declared or not), civil war, commotion, unrest, rebellion, revolution, insurrection, military or usurped power or confiscation or nationalisation or requisition of or damage by or under the order of any government or public local authority and claims due to nuclear weapons and/or materials.
2. Circumcision, cosmetic or aesthetic treatments, surgery for change of life/gender.
3. Any form of plastic surgery (unless necessary for the treatment of cancer ,burns or accidental Bodily Injury).
4. The cost of spectacles, contact lenses, hearing aids, crutches, artificial limbs, dentures, artificial teeth and all other external medical equipment or devices
5. Dental treatment or surgery of any kind unless as a result of Accidental Bodily Injury to natural teeth and also requiring hospitalization.
6. Convalescence, general debility, rest cure, congenital external diseases or defects or anomalies, genetic disorders, stem cell implantation or surgery, or growth hormone therapy.
7. Intentional self-injury (including but not limited to the use or misuse of any intoxicating drugs or alcohol) and treatment due to use or abuse of any substance, drug or alcohol and treatment for de-addiction.
8. Human Immunodeficiency Virus or Variant/mutant viruses and AIDS, Venereal disease or any sexually transmitted disease.
9. Hospitalisation primarily and specifically for diagnostic, X-ray or laboratory examinations and investigations.
10. Treatment arising from or traceable to pregnancy and childbirth and related complications. (Ectopic pregnancy is covered under the policy)
11. Vaccination or inoculation unless forming a part of post bite treatment.
12. Any fertility, sub fertility, impotence or assisted conception operation or sterilization
13. Vitamins, tonics, nutritional supplements unless forming part of the treatment
14. Treatment for any other system other than modern medicine (also known as Allopathy), Experimental, unproven or non-standard treatment.
15. Surgery to correct deviated septum and hypertrophied turbinate.
16. Expenses related to donor screening, treatment, including surgery to remove organs from a donor in the case of transplant surgery.
17. Weight management services and treatment related to weight reduction programmes including treatment of obesity.
18. Treatment for any mental illness or psychiatric illness.