ECS. The minimum premium is Rs. 1000 for yearly mode and Rs. 100 for !

! Congenital diseases, and Physical Defects already manifested or evident
monthly mode.
Tax Benefits as per current tax laws
Contributions upto Rs. 10,000 will be eligible for tax benefits under Section
80D, as per applicable tax laws.
Loans
Loans are not available under this plan.
Exclusions
Exclusions for life cover.
Suicide: In case of suicide within one year from commencement /
reinstatement of policy, whether sane or not, no death benefit shall be
payable.
Exclusions under Hospital Cash Benefit:
The hospital cash benefit will not be paid if the hospital confinement is
due to:
! Any pre-existing conditions,
! Routine eye tests, dental treatment or other examination and/or tests
not incidental to the treatment or diagnosis of an injury, sickness or
disease,
! Pregnancy, miscarriage (except as a result of an accident), impotency,
sex change, abortion or birth control,
! Sleep disorder, psychiatric or mental disorders,
! AIDS, any AIDS related illness or HIV infection,
! Prostheses, cosmetic surgery or reconstructive surgery unless as a
result of an accidental injury,
! Custodial care, bed rest, convenience care, convalescence, general
debility, rest cure,
! Any treatment relating to obesity, weight reduction, weight
improvement,
! Self-inflicted injuries or attempted suicide while sane or insane,
! War, invasion, civil war, rebellion,
! Any injury, sickness or disease received as a result of the insured person
committing any breach of law,
! Any injury, sickness or disease received as a result of the insured person
being under the influence of alcohol or drugs other than in accordance
with the directions of a registered medical practitioner,
! Any injury, sickness or disease received as a result of the insured person
taking part in any naval, military or air force operation,
! Any injury, sickness or disease received as a result of the insured person
participating in or training for any dangerous or hazardous sport or
competition or riding or driving in any form of race or competition,
! Any injury, sickness or disease received as a result of aviation, gliding or
any form of aerial flight other than as a fare-paying passenger of a
recognized airline on regular routes and on a scheduled timetable.
Exclusions under surgical benefit
The Surgical benefit will not be paid if the surgery is due to:
! Disability occurs as a result of aviation, gliding or any form of aerial flight
at the time of taking the policy or of which the policyholder was aware at
the time of taking the policy,
! Any treatment relating to obesity, weight reduction, or weight
improvement,
! Self-inflicted injuries or attempted suicide while sane or insane,
! War, invasion, civil war, or rebellion,
! Any injury, sickness or disease received as a result of the insured person
committing any breach of law,
! Any injury, sickness or disease received as a result of the insured person
being under the influence of alcohol or drugs other than in accordance
with the directions of a registered medical practitioner,
! Any injury, sickness or disease received as a result of the insured person
taking part in any naval, military or air force operation,
! Any injury, sickness or disease received as a result of the insured person
participating in or training for any dangerous or hazardous sport or
competition or riding or driving in any form of race or competition,
! Any injury, sickness or disease received as a result of aviation, gliding or
any form of aerial flight other than as a fare-paying passenger of a
recognised airline on regular routes and on a scheduled timetable.
Exclusions under Critical Illness Benefit
In the following cases the critical illness benefit will not be paid:
! Critical illness or the related symptoms existed at the date of
commencement or reinstatement of risk,
! Critical illness is diagnosed within 180 days of the date of
commencement or reinstatement,
! Critical illness as a result of AIDS, any AIDS related illness or HIV
infection,
! Critical illness occurs as a result of the insured person committing any
breach of law,
! Critical illness as a result of war, invasion, civil war or rebellion,
! Critical illness as a result of self-inflicted injuries whilst sane or insane,
! Critical illness as a consequence of the insured person being under the
influence of alcohol or drugs other than in accordance with the
directions of a registered medical practitioner,
! Critical illness occurs as s result of the insured person taking part in any
naval, military or air force operation,
! Critical illness occurs as a result of the insured person participating in or
training for any dangerous or hazardous sport or competition or riding
or driving in any form of race or competition,
! Critical illness occurs as a result of aviation, gliding or any form of aerial
flight other than as a fare paying passenger of a recognised airline on
regular routes and on a scheduled timetable,
! Failure to seek or follow medical advice.
Exclusions under Accident Permanent Total/Partial Disability Benefit
In the following cases the disability benefits will not be paid:
! Disability occurs as a result of the insured person committing any
Contact Details
other than as a fare paying passenger of a recognised airline on regular
routes and on a scheduled timetable,
! Disability occurs as a result of attempted self injury whilst sane or
insane,
! Failure to seek or follow medical advice.
15 days Free Look Period
Within 15 days from the date of receipt of the policy, you have the option to
review the terms and conditions and return the policy, if you disagree to any of
the terms and conditions, stating the reasons for your objections. You will be
entitled to a refund of the premium paid, subject only to a deduction of a
proportionate risk premium for the period on cover and the expenses
incurred on medical examination and stamp duty charges.
HealthCare Plan – Frequently Asked Questions
Q 1. Why should I buy Bajaj Allianz HealthCare?
Ans. Bajaj Allianz HealthCare is a comprehensive Health insurance policy,
wherein it offers 6-in-1 insurance cover - i.e., Hospital Cash benefit, Post
Hospitalisation Benefit, Surgical Benefit, Critical Illness Cover, Benefit for
partial and total permanent disability due to accident and Life cover.
Q 2. Who can buy Bajaj Allianz HealthCare?
Ans. Anyone between the age of 18 and 57 can apply for the Bajaj Allianz
HealthCare plan.
Q 3. How can I buy Bajaj Allianz HealthCare?
Ans. Visit any of our branches, and our Consultants will get in touch with you
and guide you through the required process.
Q 4. Do I have to undergo medical check-up?
Ans. Yes. A complete medical examination which will be paid by us may have
to be carried out. Our Consultants will guide you through the required
process.
Q 5. Why should I buy HealthCare if I have other medical insurance
policies?
Ans. Bajaj Allianz HealthCare can be claimed along with other medical
insurance policies like Mediclaim. Besides, HealthCare provides
coverage for 3 years instead of one year, thereby giving added
protection and coverage. Premiums are guaranteed for 3 years.
Q 6. What if I miss paying the premiums?
Ans. The policy can be reinstated within 6 months from the due date of the
first unpaid premium subject to the payment of outstanding premiums
plus interest, subject to underwriting.
Q 7. Do I need to be treated only in particular hospitals, which are in your
panel?
Ans. No, you can choose your own hospital as per your convenience and
belief, provided it is a registered hospital with 15 beds. The hospital
need not be in our panel.
Why Bajaj Allianz Life Insurance?
Bajaj Allianz Life Insurance Company Limited is a union between Allianz SE, the
Life
Bajaj Allianz Life Insurance Company Limited,
Individual
G.E. Plaza, Airport Road, Yerawada, Pune - 411 006.
Tel: (020) 6602 6777. Fax: (020) 6602 6789.
www.bajajallianz.com
SMS LIFE 56070
For any queries please contact:
BSNL/MTNL Any Mobile & Landline Other
NEW
(Toll Free) (Toll Free) (Chargeble)
& RE
1800 22 5858 1800 209 5858 <Prefix City Code> 3030 5858 VISE
D
email: life@bajajallianz.co.in chat: bajajallianzlife.co.in/chat
Prohibition of Rebate: Section 41 of the Insurance Act, 1938 states
No person shall allow or offer to allow, either directly or indirectly, as an inducement
to any person to take out or renew or continue an insurance in respect of any kind of
risk relating to lives or property in India, any rebate of the whole or part of the
commission payable or any rebate of the premium shown on the policy, nor shall any
person taking out or renewing or continuing a policy accept any rebate, except such
rebate as may be allowed in accordance with the published prospectuses or tables of
the insurer.
Any person making default in complying with the provision of this section shall be
punishable with a fine that may extend to five hundred rupees.
SECTION 45 of the Insurance Act, 1938 states:
No Policy of life insurance effected after the coming into force of this Act shall, after the
expiry of two years from the date on which it was effected, be called in question by an
insurer on the ground that a statement made in the proposal for insurance or in any
report of a medical officer, or referee, or friend of the insured, or in any other
document leading to the issue of the policy, was inaccurate or false, unless the insurer
shows that such statement was on a material matter or suppressed facts which it was
material to disclose and that it was fraudulently made by the policy-holder and that
the policy holder knew at the time of making it that the statement was false or that it
suppressed facts which it was material to disclose.
Disclaimer:
This product brochure gives the salient features of the plan only. The policy document
is the conclusive evidence of the contract, and provides in detail all the conditions,
exclusions related to the “Bajaj Allianz HealthCare” Plan.
For More Information: For more details, kindly consult our "Insurance Care
Consultant" or call us today on the numbers mentioned above.
Please draw your cheques/ demand drafts in favour of “Bajaj Allianz Life
Insurance Company Limited”.

Bajaj Allianz Health Care (UIN) : 116N037V01

Health Care
! Pre-existing injuries, illnesses or conditions, breach of law,

! Routine eye tests, dental treatment or other examination and/or tests
not incidental to the treatment or diagnosis of an injury, sickness or
disease,
! Pregnancy, miscarriage (except as a result of an accident), impotency,
sex change, abortion or birth control,
! Sleep disorder, psychiatric or mental disorders,
! AIDS, any AIDS related illness or HIV infection,
! Prostheses, cosmetic surgery or reconstructive surgery unless as a
result of an accidental injury,
!
!
Disability as a result of war, invasion, civil war or rebellion,
Disability as a consequence of the insured person being under the
influence of alcohol or drugs other than in accordance with the
directions of a registered medical practitioner,
! Disability occurs as s result of the insured person taking part in any
naval, military or air force operation,
! Disability occurs as a result of the insured person participating in or
training for any dangerous or hazardous sport or competition or riding
or driving in any form of race or competition,
BJAZ-PB-0215/ 12-Aug-10
world’s leading insurer and Bajaj Finserv, one of India’s most respected names.
Allianz SE is a leading insurance conglomerate globally and one of the largest asset
mangers in the world. At Bajaj Allianz, we realize that you seek an insurer you can
Bajaj Allianz Health Care
trust your hard earned money with. Allianz SE has more than 119 years of financial
experience in over 70 countries and Bajaj Finserv demerged from Bajaj Auto, trusted
for over 65 years in the Indian market, are committed to offering you financial
solutions that provide all the security you need for your family and yourself.
At Bajaj Allianz, customer delight is our guiding principle. Ensuring world class
solutions by offering you customized products with transparent benefits supported by
the best technology is our business philosophy.
Insurance is the subject matter of the solicitation.

Bajaj Allianz Life Insurance Company Limited


Bajaj Allianz HealthCare treatment takes time, and our Post Hospitalization Benefit allows you
Live worry-free from the burden of hospitalization. this facility without adding burden to your wallet. We pay 50% of the
Hospital Cash benefit claim settled per day for a maximum of 5 days in a
Health is Wealth… particularly when health care costs are getting higher policy year for essential follow-up treatment on the basis of
every year. The emotional and financial burden of a serious accident, major recommendation of the hospital/surgeon.
illness or surgery often lasts beyond the immediate period of the trauma.
! Surgical Benefit: The costs of doing a surgery have gone up
Bajaj Allianz HealthCare protects you and your family from the high expenses
significantly today. Our Surgical benefit pays you for a surgery done by a
associated with medical care and provides you with a comprehensive
financial cushion against various health hazards. The benefits under this plan qualified surgeon performed at a registered hospital with a minimum
are payable in addition to the benefits under all other plans that you may have, of 15 beds (as in-patient) for surgical procedures advised by a qualified
including a Mediclaim policy. doctor/physician/surgeon. The benefit amount payable is equal to the
surgical expenses (i.e. surgeon’s fee, operation theatre charges and
What is Bajaj Allianz HealthCare? anesthetist’s charges) subject to the maximum surgical benefit
This is a three-year health insurance plan, providing comprehensive health amount payable in a policy year. The surgical benefit can only be
cover with life insurance benefit. You can choose the amount of cover for each claimed if the illness covered is diagnosed at least 180 days after the
benefit separately in multiples of the minimum cover amount, subject to a date of commencement of policy or reinstatement of policy. No waiting
maximum multiple of 10. period if surgery is due to accidental injury.
Feature Minimum Cover ! Critical Illness Benefit: Some illnesses are critical. They not only alter
your life’s pattern but also result in a financial drain. The Critical Illness
Life Cover Rs. 10,000
Benefit softens the impact on the family by paying out a lumpsum as per
Equal to Room charges (Min. Rs. 500
the cover selected immediately, while other policy benefits continue.
per day and Max. Rs. 1000 per day in
Hospital Cash (HC) The critical illness benefit can only be claimed if the illness is diagnosed
ICU), Maximum Rs. 30,000 in a policy
year. at least 180 days after the date of commencement or reinstatement of
50 % of Claim settled for HC per day , policy. We cover 11 critical illnesses: First Heart Attack, Coronary Artery
Post Hospitalization Benefit Disease Requiring Surgery, Stroke, Cancer, Kidney Failure, Major Organ
maximum 5 days in a policy year.
Transplantation, Multiple Sclerosis, Aorta Graft Surgery, Primary
Equal to surgical expenses,Rs. 50,000
Surgical Benefit Pulmonary Arterial Hypertension, Alzheimer’s Disease and Paralysis.
per policy year
! Accident Permanent Total / Partial Disability (APT/PD): Accidents
Critical Illness Cover Rs. 50,000 during the policy term
are unpredictable and so are the consequences. They may lead to a
Accidental Permanent Total / Partial Rs. 50,000 payable on total disability
and Rs. 25,000 payable on partial permanent disability - partial or total. This benefit provides a financial
Disability (APT/PD) disability cushion against such misfortunes.
Accidental permanent total disability will mean total and permanent
The benefits payable for all policies under Bajaj Allianz HealthCare plan
disability as a result of an accident (within 180 days from the date of
put together will not exceed the maximum amount of cover available
accident) resulting in one of: Loss of both eyes, Loss of both arms or both
under Bajaj Allianz Health Care.
hands, Loss of one arm and one leg, Loss of one arm and one foot, Loss of
Indicative Premiums*
one hand and one foot, Loss of one hand and one leg, Loss of both legs,
Loss of both feet, Removal of the lower jaw. Accidental permanent
Age For Minimum Cover (Male) For Minimum Cover (Female) partial disability will mean permanent disability as a result of an
20 917 972 accident resulting in one of: Loss of one eye, Loss of one leg, Loss of one
30 1011 1091 arm, Loss of one hand, Loss of one foot. Loss of hand will mean above
wrist, loss of arm will mean above elbow, loss of feet will mean above
40 1445 1347
ankle and loss of leg will mean above knee.
45 1887 1604
! Multiple Claims: Hospital Cash, Post Hospitalization Benefit & Surgical
50 2454 1937
Benefit can be claimed on multiple occasions as per the coverage
* Service Tax applicable as per the prevailing rates. selected (subject to the overall limits) provided the policy is in force at
the time of claim.
Benefits:
Claim Settlement Process
! Life Cover is payable on death of the life assured.
There are two modes of claim settlement – Cash Less Service facility at
! Hospital Cash Benefit: The worry of meeting expenses relating to
hospitalization adds to the trauma of hospitalization. Hospital Cash networked hospitals and reimbursement of hospitalisation expenses
(subject to limit as applicable under the plan) wherein treatment is taken in
Benefit reduces this financial burden and helps you recover with peace
non NWH.
of mind. If you have to stay in hospital as a result of injury, sickness or
disease, we will pay at the rate of the room charge in hospital, subject to Cashless Service Benefits
the limit of the benefit level chosen, for each full day’s stay in hospital • We have tied up with Medicare Third Party Administrator (TPA) Services
exceeding 3 days up to the total limit allowed in a policy year. The to provide you with customized, high-quality health benefits services
amount is payable in lump sum at the end of the stay in hospital. The under this product. Through TPA we have in our network some of the
benefit period starts after a waiting period of 60 (sixty) days from the best Hospitals, Nursing Homes and other Medical Resources. You can
commencement of policy or reinstatement of policy, except for avail Cash Less Service (CLS) in these networked hospitals. On
accidental injury. Multiple claims can be made in a policy year.
issuance of a policy, you would be provided with a Health Card (Photo
• Post Hospitalization Benefit: Recuperating from a surgery / major
Identity Card) and a Guide Book, which would contain list of Net Work
Hospitals (NWH), the details how to go about the Cash Less Service
(CLS) in case of planned and emergency hospitalisation and
Hospitalisation Intimation Form/Pre-authorization Form to be filled up
by your attending Doctor for hospitalisation in empanelled hospitals.
The Medicare TPA will maintain a 24/7 Helpline on Tollfree number as
well as mobile numbers to facilitate any medical emergency
requirements.
• The Cash Less Service would be facilitated by the TPA and will help you
avail of the hospitalisation benefits quickly through our NWH without
any caution deposit etc. To avail of the CLS facility all you need to do is to
contact our TPA at any of their offices which are convenient to you and
submit Hospitalisation Intimation /Pre-authorization Form.
• In case of emergency please produce your Health Card to take
admission at NWH. Within 48 hours of hopitalisation, contact the TPA to
obtain the cash less authorization and complete the formal process of
admission.
• If the TPA sanctions cash less request, the admissible claim amount
would directly be settled with NWH through TPA. Payment by you at
the time of discharge will only be required for the cost of inadmissible
items not covered by the policy under this plan .
• Cashless service is restricted only to those hospitalization expenses
which are directly related to the illness which necessitate
hospitalization.
• CLS is NOT available for Pre/Post hospitalization treatment.
Benefit through Reimbursement (Non CLS)
You have the right of getting treated in any Hospital any where in India that is
Non-NWH. If treated at Non-NWH we shall reimburse your hospitalization
expenses (subject to maximum allowed under the policy) within 7 days on
submission of all bills & requisite documents as explained under Claim
Procedure below.
Planned Hospitalisation Procedure
Pre Authorization
• Before planned hospitalization, please submit a duly completed
Hospitalization Intimation Form /Preauthorization Form to TPA as
provided in Guide Book which is also made available on our website
www.bajajallianz.com
• Please ensure that the information required to be filled in by the Doctor
is duly completed.
• On scrutinizing the Pre-authorization Form for conformance with the
Policy Terms & Conditions, your request for CLS will either be granted or
rejected.
• If granted, NWH will be authorized (with a copy to you) to facilitate your
admission.
• Denial of Cashless Service does NOT imply rejection of a Claim. You can
submit your Claim for reimbursement up to maximum of admissible
amount.
• Based on the details provided by you in the Form, you may be visited at
the NWH to ascertain your medical conditions, line of medical
treatment, cost and duration of treatment etc.
Admission in NWH to avail Cash Less Service
• Present your ID card and copy of the Authorization letter issued by our
TPA along with a photo ID, to the hospital (retain a copy for your
records).
Discharge from Net Work Hospital (NWH)
! If you have been admitted at our NWH:
! Pay for the cost of inadmissible items NOT covered under the policy.
! Do not collect original documents from the hospital at the time of
discharge.
! Sign the Claim Form in places marked with a cross (x).
! Counter sign the Hospital bills of the treating Doctors/Specialists
(regardless whether their charges are included in the hospital bill or
not).
! Sign the Loss/Claim Vouchers.
! Give a photocopy of your Insurance Policy Certificate to the hospital
authorities / representatives.
! If cashless service is disapproved, you can continue with the treatment,
settle the hospital bill and submit the claim later.
! If the approval does not come through before discharge, you may settle
the bill and claim for the same.
! If you have been admitted at a Non-NWH:
! Pay the bills in full.
! Make a claim for reimbursement.
! We will reimburse admissible expenses directly related to the illness,
which necessitated the hospitalization, within 7 days subject to receipt
of all bills and ALL documents required to make a “Complete Claim”
within 30 days from the date of discharge from the hospital.
Emergency Hospitalisation Procedure
! Use your ID Card to get admission in NWH; Normal Initial Deposit may
have to be paid.
Submit Hospitalisation Intimation Form/Pre-authorization Form to our
!
TPA within 48 hours of hospitalization. Failure to do so could not only
result in problems at the time of discharge, but also in rejection of your
claim.
! On scrutinizing the Form for conformance with policy Terms and
Conditions, your request for CLS will either be granted / rejected.
! If CLS is granted, the NWH will be authorized (with a copy to you), to
facilitate your admission.
! If denied, the expenses will have to be borne by you and a claim
submitted to us for reimbursement of admissible amount.
CLAIM PROCEDURES
Submission of Claim (when admission has been taken in Non-NWH or
sanction for CLS has NOT been granted)
If treated at a Non-NWH, please do the following:
a) Lodge your claim within maximum of 30 days from the date of
discharge.
b) Submit the following documents (originals) to us:
! Claim Form signed by the patient in places marked with a cross (x).
! Photocopy of the Insurance Policy.
! Hospital Discharge card.
! Hospital Bill – countersigned by patient / patient’s relative (in case
patient is unable to sign).
! Payment Receipt (of Hospital bill).
! Individual bills of doctors / Specialists (on their letter heads along with
registration number) who treated the patient, duly countersigned by
patient / patient’s relative – regardless whether their charges are
included in the hospital bill or not. (Supporting Prescription for
Consultation Fees with Regd.No. must be attached.)
! Detailed statement of medicines administered and charged in the
Hospital Bill.
! All other supporting reports – viz Laboratory / X-ray / Ultrasound, etc. (If
done outside the hospital, Doctor’s advice would be required).
! Loss Vouchers signed in duplicate.
! In case of payment by Credit Card – copy of Charge Slip should be
submitted.
! In case of Death claim – Death Certificate from Hospital should be
submitted in photocopy.
! In case of Road Traffic Accident – FIR copy should be submitted.
Our office will scrutinize the above documents for accuracy of content
and completeness. If found to be in order, we will reimburse all
admissible hospitalization expenses related directly to the illness,
which necessitated hospitalization, within 7 days of receipt of full /
completed claim.
DOs & DON’Ts
Do’s
! Go through the Policy Document issued by the Insurance Company and
the Guide Book issued by TPA to understand all the processes – involved.
! Submit Hospitalization Intimation Form ( Pre - authorization Form )
minimum 72 hours in advance in all cases except in case of Emergency
Hospitalization when the intimation must be submitted within 48
hours of admission.
! Obtain Pre – authorization from TPA 3-4 days prior to planned
admission in NWH for CLS.
! Produce ID card and pre - authorization letter issued by TPA to the NWH
for availing admission and CLS.
! Avail cashless treatment at the network hospital for the covered service
up to eligibility limit only.
! Inform TPA about the date and time of discharge at least 24 hours in
advance.
! Leave back all original documents and the signed Claim Form with the
NWH at the time of discharge.
! Make the payment to the NWH for the expenditure over and above the
sum insured/sanctioned amount and for the treatment / expenditure
not covered under the package / policy.
! Contact local TPA office in case of any query.
! In case of availing treatment at Non-NWH forward the documents to
TPA within 30 days of Discharge as indicated under Claim Procedure.
Note:
! Claim will be denied if Intimation Form is NOT submitted.
! CLS will be denied if Authorization has NOT been granted.
! Report to us if any Hospital / Medical Practitioner is overcharging /
resorting to unethical practice.
DON’TS
! Don’t insist upon admission for investigation for Medical evaluation or
Health Checkups.
! Don’t carry away any original document at the time of discharge, when
CLS has been granted.
! Don’t forget to sign the Claim Form.
! Don’t insist on admission at NWH without obtaining the pre-
authorization from TPA in case of non-emergency hospitalization.
! Don’t tolerate overcharging/unethical practice/suggestions that you
make wrong disclosure or insufficient disclosure or suppress facts
relating to your past or present medical case. This could cause your
claim to be repudiated, including legal action.
Who is Eligible?
All people who are between 18 and 57 years of age.
Premium Payment Mode
For your convenience we have provided Yearly and Monthly premium modes.
The monthly mode is available only under Salary Savings Schemes (SSS) and