Health insurance premiums have been on a steep rise over the past few years owing to several factors – the rate of inflation, the strain put on the health system due to the covid pandemic, the imbalance between demand and supply ratios, the state of the public health system and unfortunately, also partly due to the higher rate one is charged in general, if hospitalised under a cashless health insurance plan!
As one gets older, premiums for health insurance also rise, putting a huge burden on the elderly and retired. As this is the time when one is most likely to require healthcare, many service providers thus provide plans specifically designed for those who are no longer young. The Bajaj Allianz Silver Health Plan is one such health insurance plan. It mandates a compulsory pre-policy health check-up. If these tests are undertaken in Bajaj Allianz’s listed diagnostic centres, up to 100% of the charges incurred on the standard medical tests will be reimbursed if the proposal for insurance is accepted and the health insurance policy issued.
Scope of Coverage
Hospitalisation Cover: This plan offers cover for in-patient hospitalisation as well pre and post-hospitalisation. Expenses for pre-hospitalisation are covered up to a preceding period of 30 days. Post-hospitalisation expenses are covered up to 60 days from the date of discharge. These expenses have a sub-limit of 3% of the sum insured (SI).
Ambulance Expenses: The policy offers reimbursement of ambulance expenses in case of domestic emergencies, up to a sub limit of INR 1000/-.
Pre-existing Illness Cover: This plan offers to cover pre-existing illness after 1 year of the policy being issued. Most standard health insurance plans offer to cover pre-existing illnesses only after 4 years of continuous coverage. However, the coverage in such cases in this Silver Health Plan is limited to 50% of the plan amount.
Day Care Procedures: Up to 130 day-care procedures are covered by the Bajaj Allianz Silver Health Plan subject to certain terms and conditions attached to certain procedures. For e.g., in the case of cataract the limit of reimbursement is 10% of the indemnity amount.
Standard Exclusions
Permanent Exclusions: Non-allopathic treatment expenditure is not covered under this policy. Hospitalisation due to war, civil unrest, terrorism are permanently excluded from coverage. Attempted suicide or self-inflicted injury, and claims related to use of drugs and alcohol also are part of permanently excluded claims. Plastic surgery forms part of the exclusions unless it was carried out due to a medically necessary treatment. Other such exclusions include treatment related to external congenital disease, change of gender, dental treatment, hearing aids, spectacles and others.
Temporary Exclusions: Expenses against certain treatments can only be claimed after a waiting period. This is 12 months in the case of pre-existing diseases, piles, cataract and hysterectomy. Joint or hip replacement has a four year wait period unless necessitated by accident or injury.
Other Features
Sum Insured: This ranges from INR 50,000/- to INR 500,000/- while the premium ranges from approximately INR 2000/- to INR 40,000/-. This is dependent on the age of entry, the sum-insured and pre-existing disease conditions.
Age of Entry: This policy allows enrolment of individuals from the age of 46 to the age of 70. As such a lifetime renewal facility is available under this health insurance plan.
Cumulative Bonus: A No Claim Bonus (NCB) is provided as a cumulative bonus. This means that for every claim free year, the sum insured is topped up by 10% up to a limit of 50% of the SI.
Health Check-up: If the policyholder completes four continuous years without making any claim, she or he will be entitled to a standard health check-up at any of Bajaj Allianz’s designated medical centres, free of charge.
Family Discount: A discount of 5% is available for family members seeking coverage under the plan.
Cashless Coverage: The plan offers cashless coverage in its 8,000 plus network hospitals. However, treatment in non-network hospitals is also reimbursable. There is however, a mandatory co-payment necessary in this case.
Free-look Period: A fifteen-day free look period is offered in case of new policies taken out by individuals. If no claim has been made since purchase of the policy, Bajaj Allianz offers to refund the entire amount after deducting any amount spent on medical check-ups and stamp duty if the policy is returned. This facility is not available in the case of renewals, porting or migrating.
Migrating of Policy: The insured individual has the option to migrate to any other health insurance plan offered by Bajaj Allianz subject to the norms set out by the Insurance Regulatory and Development Authority of India (IRDAI.)
Conclusion
Summing up, the Silver Health Plan of Bajaj Allianz has several features that are tailored to suit the needs of persons over 46 years of age. Facilities such as a limited wait period of one-year in case of pre-existing diseases and lifetime renewability are two of the major attractions of this plan, in addition to cashless coverage and the cumulative bonus offer. Depending on the risk you perceive of contracting certain critical illnesses, it may be necessary to opt for an add-on critical insurance or top-up cover along with this.
