BAJAJ ALLIANZ

HEALTH ENSURE
HEALTH IS SURE
WITH HEALTH ENSURE

CIN: U66010PN2000PLC015329 | UIN: IRDAI/HLT/BAGI/P-H/V.II/112/2017-18

Introduction
We all want to give the best of facilities to our families and their sound health is of supreme importance to us hence we
want to have the best when it comes to Health Insurance.

Bajaj Allianz’s Health Ensure Policy comes with new comprehensive benefits at competitive premiums and is a perfect
product to care of medical expenses for you and your family in case of unfortunate event of hospitalisation for illness/
injury.

Special features of Health Ensure

 Individual and Floater policy for Self, Spouse, Children, Grandchildren, Brother, Sister, Parents, Parents in law, Grand
Parents
 No pre-policy medical tests up to 50 years of age (subject to clean proposal form)
 Pre-existing disease covered after 24 months from your first Health Policy
 Pre 30 days and post 60 days hospitalisation expenses cover
 Emergency road ambulance cover
 Day care procedures
 Free preventive health check up
 Income tax benefit under 80 D of the IT Act on premiums paid for this policy
 Ayurvedic and Homeopathic Hospitalisation Cover
 Organ Donor Expenses
 5% Cumulative bonus for each claim free year

What are the Sum Insured options available under the policy?
 Sum Insured Options Under Individual Policy-
Rs. 50,000, Rs. 75,000, Rs. 1 Lac, Rs.1.5 Lacs, Rs. 2 Lacs, Rs. 3 Lacs, Rs. 4 Lacs, Rs. 5 Lacs, Rs. 10 Lacs
 Sum Insured Options Under Floater Policy-
 Rs. 2 Lacs, Rs. 3 Lacs, Rs. 4 Lacs, Rs. 5 Lacs, Rs. 10 Lacs

What is Entry age under this policy?

 Minimum Entry age for proposer/ spouse/ dependent parents/ Sister/ Brother/Parent In law/Grand Parents - 18
years
 Maximum Entry Age for proposer/ spouse/ dependent parents/ Sister/ Brother/ Parent In law/Grand Parents -
Lifetime
 Minimum Entry age for Dependent Child/Grandchild - 3 months
 Maximum Entry Age for Dependent Child/Grandchild - 30 years

What is Renewal Age?

 Under normal circumstances, lifetime renewal benefit is available under the policy, except on the grounds of Your
moral hazard, misrepresentation, non- cooperation or fraud(Subject to policy is renewed annually with us within
the Grace period of 30 days from date of Expiry).
 For dependent children, Policy is renewable up to 35 years. After the completion of maximum renewal age of
dependent children, the policy would be renewed for lifetime. However a Separate proposal form should be
submitted to us at the time of renewal with the insured member as proposer

Eligibility
 Indian nationals residing in India would be considered for this policy.
 This policy can be opted by Non-Resident Indians also, provided premium is paid in Indian currency & by Indian
Account only
 Sum Insured for Self (i.e. Proposer) cannot be less than any of his/her family members

01 CIN: U66010PN2000PLC015329 / UIN- IRDAI/HLT/BAGI/P-H/V.II/112/2017-18

What is the Policy period?
 Policy can be taken for 1year/2years OR 3years.

What is Premium paying term?

 Annual Premium payment for 1 year policy and for long term policies of 2/3 years the total long term premium
would be collected at the time of risk inception and renewal as well.

Is this a floater policy / individual policy?

 Policy provides Individual as well as Floater sum insured options

Who can be covered under Health Ensure Policy?

 Self, Spouse, Dependent Children, Grandchildren, Parents, Sister, Brother, Parents In law, Grand Parents can be
covered under individual option
 Self, Spouse, dependent children can be covered under floater option. For Parents , Parents In law, separate floater
policy can be taken.

COVERAGE
1. In-patient Hospitalisation Treatment
If You are hospitalized 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 and Customary Medical Expenses incurred
below:
i) Room Rent, Boarding and Nursing Expenses as provided by the Hospital maximum of 1%of Sum Insured per
day or up to Rs. 5000/-, whichever is lower.
ii) ICU Charges- If admitted in ICU, we will pay ICU Charges as provided by the Hospital subject to maximum of
2% of Sum Insured per day or up to Rs. 10000/-, whichever is lower.
iii) Fees of Surgeon, Anesthetist, Medical Practitioner, Consultants and Specialists Doctors.
iv) Operation Theatre Charges, Anesthesia, Blood, Oxygen, surgical appliances, Medicines &Drugs, Dialysis,
Chemotherapy, Radiotherapy, cost of Artificial Limbs, cost of prosthetic devices implanted during surgical
procedure like Pacemaker, orthopedic implants, infra cardiac valve replacements, vascular stents, relevant
laboratory diagnostic tests, X-ray and such similar expenses that are medically necessary.
Note: In case of admission to a room at rates exceeding the limits as mentioned under 1.(i) & (ii), the
reimbursement of all other expenses incurred at the Hospital, with the exception of cost of medicines and
consumables, shall be payable in the same proportion as the admissible rate per day bears to the actual rate
per day of room rent charges.

2. Pre-Hospitalisation
The Medical Expenses incurred during the 30 days immediately before you were Hospitalised, provided that: Such
Medical Expenses were incurred for the same illness/injury for which subsequent Hospitalisation was required,
and We have accepted an inpatient Hospitalisation claim under Inpatient Hospitalisation Treatment.

3. Post-Hospitalisation
The Medical Expenses incurred during the 60 days immediately after You were discharged post Hospitalisation
provided that such costs are incurred in respect of the same illness/injury for which the earlier Hospitalisation was
required, and We have accepted an inpatient Hospitalisation claim under Inpatient Hospitalisation Treatment.

4. Road Ambulance
We will pay the reasonable cost to a maximum of Rs. 1000/- per Hospitalisation incurred on an ambulance offered
by a healthcare or ambulance service provider for transferring You to the nearest Hospital with adequate
emergency facilities for the provision of health services following an Emergency.
We will also reimburse the expenses incurred on an ambulance offered by a healthcare or ambulance service

CIN: U66010PN2000PLC015329 / UIN- IRDAI/HLT/BAGI/P-H/V.II/112/2017-18 02

 provider for transferring You from the Hospital where you were admitted initially to another hospital with higher
medical facilities.
Claim under this section shall be payable by Us only when:
a. Such life threatening emergency condition is certified by the Medical Practitioner, and
b. We have accepted Your Claim under "In-patient Hospitalisation Treatment" or "Day Care Procedures" section
of the Policy.
This benefit will be applicable annually for policies with term more than 1 year.

5. Day Care Procedures

We will pay you the medical expenses as listed above under In-patient Hospitalisation Treatment for Day care
procedures / Surgeries taken as an inpatient in a hospital or day care centre but not in the outpatient department.
List of Day Care Procedures is given in the annexure I of Policy wordings.

6. Organ Donor Expenses:

We will pay expenses towards organ donor’s treatment for harvesting of the donated organ, provided that,
i. The organ donor is any person whose organ has been made available in accordance and in compliance with
THE TRANSPLANTATION OF HUMAN ORGANS (AMENDMENT) BILL, 2011and the organ donated is for the use
of the Insured Person, and
ii. We have accepted an inpatient Hospitalisation claim for the insured member under In Patient Hospitalisation
Treatment.

Specific exclusions applicable to Organ Donor Expenses:

1. Claims which have NOT been admitted under In Patient Hospitalisation Treatment
2. Claims not in compliance with THE TRANSPLANTATION OF HUMAN ORGANS (AMENDMENT) BILL, 2011
3. The organ donors Pre and Post-Hospitalisation expenses.

7. Preventive Health Check Up

At the end of block of every continuous period of 3 years during which You have held Our Health Ensure policy, You
are eligible for a free Preventive Health checkup. We will reimburse the amount equal to 1% of the sum insured
max up to Rs. 1500/- for each member in Individual policy during the block of 3 years. This benefit can be availed by
proposer & spouse only under Floater Sum Insured Policies however the amount will not exceed 1% of sum insured
max up to Rs. 1500/-.
You may approach us for the arrangement of the Health Checkup. For the avoidance of doubt, We shall be liable for
medical check-up expenses and any other cost incurred such as for transportation, accommodation, food or
sustenance shall not be payable by us.

8. Ayurvedic / Homeopathic Hospitalisation Expenses

If You are Hospitalised for not less than 24 hrs, in an Ayurvedic / Homeopathic Hospital which is a government
hospital or in any institute recognized by government and/or accredited by Quality Council of India/National
Accreditation Board on Health and/or Teaching hospitals of AYUSH colleges recognized by Central Council of
Indian Medicine (CCIM) and Central Council of Homeopathy (CCH) and/or AYUSH Hospitals 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:

In-patient Treatment- Medical Expenses for Ayurvedic and Homeopathic treatment:

i. Room Rent and Boarding as provided by the Hospital maximum of 1% of Sum Insured per day or up to Rs.
5000/-, whichever is lower.
ii. Nursing care
iii. Consultation fees
iv. Medicines, drugs and consumables,

03 CIN: U66010PN2000PLC015329 / UIN- IRDAI/HLT/BAGI/P-H/V.II/112/2017-18

 v. Ayurvedic and Homeopathic treatment procedures

Note: In case of admission to a room at rates exceeding the limits as mentioned under (i), the reimburse-
ment of all other expenses incurred at the Hospital, with the exception of cost of medicines and consumables,
shall be payable in the same proportion as the admissible rate per day bears to the actual rate per day of room
rent charges.
Our maximum liability is up to 20% of Sum Insured per policy year. This benefit will be applicable annually for
policies with term more than 1 year.

The claim will be admissible under the policy provided that,

i. The illness/injury requires inpatient admission and the procedure performed on the insured cannot be carried
out on out-patient basis

EXCLUSIONS UNDER THE POLICY

We shall not be liable to make any payment for any claim directly or indirectly caused by, based on, arising out of or
attributable to any of the following:
1. Benefits will not be available for Any Pre-existing condition, ailment or injury, until 24 months of continuous
coverage have elapsed, after the date of inception of the first Health Policy, provided the preexisting disease /
ailment / injury is disclosed on the proposal form.
The above exclusion 1 shall cease to apply if You have maintained a Health Policy with Us for a continuous period of
a full 24 months without break from the date of Your first Health Policy.
In case of enhancement of Sum Insured, this exclusion shall apply afresh only to the extent of the amount by which
the limit of indemnity has been increased (i.e. enhanced Sum Insured) and if the policy is a renewal of Health
Ensure Policy with Us without break in cover.
2. Without derogation from C1) above, any Medical Expenses incurred during the first year in connection with any
types of gastric or duodenal ulcers, Surgery of varicose veins and varicose ulcers, hydrocele, undescended testes,
congenital internal diseases and surgery for any skin ailment, subject to the referred illness were not present at the
time of commencement of the policy.
This exclusion period shall apply for a continuous period of a full 2 years from the date of Your first Health Policy if
the above referred illness were present at the time of commencement of the policy and if You had declared such
illness at the time of proposing the policy.
3. We will also not pay for claims arising out of or howsoever connected to the following for the first 24 months of
Health Policy,

1. Benign prostatic hypertrophy 9. Hernia of all types

2. All types of sinuses 10. Fistulae, Fissure in ano
3. Haemorrhoids 11. Fibromyoma
4. Dysfunctional uterine bleeding 12. Hysterectomy
5. Endometriosis 13. Any kind of Malignant tumor or growth
6. Stones in the urinary and biliary systems 14. Surgery on all internal or external tumours/
7. Surgery on ears/tonsils/ adenoids/ paranasal sinuses cysts/ nodules/polyps of any kind including
breast lumps.
8. Cataracts,

In case of enhancement of Sum Insured, the waiting periods shall apply afresh only to the extent of the amount by
which the limit of indemnity has been increased (i.e. enhanced Sum Insured) and if the policy is a renewal of Health
Ensure Policy with Us without break in cover.
4 Any Medical Expenses incurred during the first 48 months during which You have the benefit of a Health Policy with
Us in connection with:

CIN: U66010PN2000PLC015329 / UIN- IRDAI/HLT/BAGI/P-H/V.II/112/2017-18 04

 i. Joint replacement surgery,
ii. Surgery for prolapsed inter vertebral disc (unless necessitated due to an accident)
iii. Surgery to correct deviated nasal septum
iv. Hypertrophied turbinate
v. Gout and Rheumatism
vi. Treatment for correction of eye sight due to refractive error recommended by Ophthalmologist for medical
reasons.
5. Any disease contracted and /or medical expenses incurred in respect of any disease /illness by the insured during
the first 30 days from the commencement of the policy, except for accidental injuries.
6. Any treatment arising from or traceable to pregnancy, child birth including cesarean section and/or any treatment
related to pre and postnatal care and complications arising out of Pregnancy and Childbirth.
However this exclusion will not apply to Ectopic Pregnancy proved by diagnostic means and certified to be life
threatening by the attending medical practitioner.
7. Any dental treatment that comprises cosmetic surgery, dentures, dental prosthesis, dental implants, orthodontics,
orthognathic surgery, jaw alignment or treatment for the temporomandibular (jaw) joint, or upper and lower jaw
bone surgery and surgery related to the temporomandibular (jaw) unless necessitated by an acute traumatic
injury requiring Hospitalisation
8. Medical expenses where Inpatient care is not warranted and does not require supervision of qualified nursing staff
and qualified medical practitioner round the clock. This exclusion is however not applicable for any day care
treatment taken for the accidental bodily injury in a day care centre/ hospital
9. War, invasion, acts of foreign enemies, hostilities (whether war be declared or not) [except for compelling the
Government or any other person to do or abstain from doing any act as defined under the definition of Terrorist
act], civil war, commotion, unrest, rebellion, revolution, insurrection, military or usurped power or confiscation or
nationalization or requisition of or damage by or under the order of any government or public local authority.
Any Medical expenses incurred due to Acts of Terrorism will be covered under the policy.
10. Circumcision unless required for the treatment of Illness or Accidental bodily injury,
11. Cosmetic or aesthetic treatments of any description, treatment or surgery for change of life/gender.
12. Any form of plastic surgery unless necessary for the treatment of cancer, burns or accidental Bodily Injury
13. The cost of spectacles, contact lenses, hearing aids, crutches, dentures, artificial teeth and all other external
appliances and/or devices whether for diagnosis or treatment except for intrinsic fixtures used for orthopedic
treatments such as plates and K-wires.
14. External medical equipment of any kind used at home as post hospitalisation care including cost of instrument
used in the treatment of Sleep Apnoea Syndrome (C.P.A.P), Continuous Peritoneal Ambulatory Dialysis (C.P.A.D)
and Oxygen concentrator for Bronchial Asthmatic condition.
15. Convalescence, general debility, rest cure, congenital external diseases or defects or anomalies, stem cell
implantation or surgery, or growth hormone therapy.
16. Intentional self-injury (including but not limited to the use or misuse of any intoxicating drugs or alcohol)
17. Ailments requiring treatment due to use or abuse of any substance, drug or alcohol and treatment for de-
addiction.
18. Any condition directly or indirectly caused by or associated with Human Immunodeficiency Virus (HIV) or
Variant/mutant viruses and or any syndrome or condition of a similar kind commonly referred to as AIDS.
19. Medical Expenses relating to any hospitalisation primarily and specifically for diagnostic, X-ray or laboratory
examinations and investigations
20. Vaccination or inoculation unless forming a part of post bite treatment or if medically necessary and forming a part
of treatment recommended by the treating doctor.

05 CIN: U66010PN2000PLC015329 / UIN- IRDAI/HLT/BAGI/P-H/V.II/112/2017-18

21. Any fertility, sub fertility, Infertility, sterility, erectile dysfunction, impotence, assisted conception operation or
sterilization procedure.
22. Vitamins, tonics, nutritional supplements unless forming part of the treatment for injury or disease as certified by
the attending Doctor
23. Experimental or unproven treatment
24. Weight management services and treatment related to weight reduction programmes including treatment of
obesity and treatment for arising direct or indirect complications of Obesity.
25. Treatment for any mental illness or psychiatric illness
26. All non-medical Items as per Annexure II provided in Policy Wordings
27. Any treatment received outside India is not covered under this policy.

Pre-policy checkup for the policy

• Applicable only for new proposals
• No Medical tests up to 50years, subject to no adverse health conditions
• Medical tests are applicable for members 51years and above.
• Pre-policy checkup would be arranged at our empanelled diagnostic centers.
• The validity of the test reports would be 30 days from date of medical examination.
• If pre-policy checkup would be conducted in our paneled diagnostic centre, 50% of the medical tests charges would
be reimbursed, subject to acceptance of proposal and policy issuance
Age of the person to be
Sum Insured Medical Examination
insured
Up to 50 years All Sum Insured options No Medical Tests*
Medical Tests required as listed below:
51years and above All Sum Insured options Full Medical Report, CBC, Urine R, ECG, Lipid profile,
Fasting BSL, HbA1c, SGOT, SGPT, Sr Creatinine
*Subject to no adverse health conditions

Discounts under the policy:

i. Employee Discount:20% discount on published premium rates to employees of Bajaj Allianz & its group
companies, this discount is applicable only if the policy is booked in direct office code
(Note: Online/Direct Customer Discount is not applicable to Employees)
ii. Online Discount/Direct Customer Discount: 5% discount is extended for the policies purchased online/ through
website and to direct customers.
(Note: Employee Discount is not applicable to Online/Direct Customers)
iii. Long Term Policy Discount:
a) 4 % discount is applicable if policy is opted for 2 years
b) 8 % discount is applicable if policy is opted for 3 years

Loading due to adverse Health Conditions:

• The loading would be applicable on per individual basis for the proposals with adverse health conditions given
below: Hypertension, Diabetes, Obesity, Cholesterol Disorder, Cardiovascular diseases, or multiple risk factors.

CIN: U66010PN2000PLC015329 / UIN- IRDAI/HLT/BAGI/P-H/V.II/112/2017-18 06

 Condition Loading on premium of the Individual
Diabetes 5%
Hypertension 5%
Cholesterol Disorder 5%
Obesity 5%
Cardiovascular diseases 5%

• For Multiple conditions cumulative loading would be applied on the published premium.
• The maximum risk loading applicable for an individual shall not exceed 25% of the published premiums, for overall
risk per person.
• These loadings are applied from Commencement Date of the Policy including subsequent renewal(s) with Us or
on the receipt of the request of increase in Sum Insured (for the increased Sum Insured).
• We will inform You about the applicable risk loading through a counter offer letter. You need to revert to Us with
consent and additional premium (if any), within 15 days of the issuance of such counter offer letter. In case, you
neither accept the counter offer nor revert to Us within 15 days, We shall cancel Your application and refund the
premium paid within next 7 days.
• Please note that We will issue Policy only after getting Your consent.

Enhancement of Sum Insured

i. The Insured member can apply for enhancement of Sum Insured at the time of renewal. You can apply for
enhancement of Sum Insured by submitting a fresh proposal form to the company.
ii. The acceptance of enhancement of Sum Insured would be at the discretion of the company, based on the health
condition of the insured members & claim history of the policy.
iii. All waiting periods as defined in the Policy shall apply for this enhanced Sum Insured limit from the effective date of
enhancement of such Sum Insured considering such Policy Period as the first Policy with the Company

Free Look Period

You have a period of 15 days from the date of receipt of the first policy document to review the terms and conditions of
this Policy. If You have any objections to any of the terms and conditions, You have the option of canceling the Policy
stating the reasons for cancellation.
If you have not made any claim during the Free look period, you shall be entitled to refund of premium subject to,
 a deduction of the expenses incurred by Us on Your medical examination, stamp duty charges, if the risk has not
commenced,
 a deduction of the stamp duty charges, medical examination charges & proportionate risk premium for period on
cover, If the risk has commenced
 a deduction of such proportionate risk premium commensurating with the risk covered during such period ,where
only a part of risk has commenced
 Free look period is not applicable for renewal policies.

Additional benefits
 Cumulative Bonus
Cumulative Bonus is applicable only for In Patient Hospitalisation Treatment Section.
i. If You renew Your Health Ensure Policy with Us without any break in the Policy Period and there has been no

07 CIN: U66010PN2000PLC015329 / UIN- IRDAI/HLT/BAGI/P-H/V.II/112/2017-18

 claim in the preceding year, then We will increase the Limit of Indemnity by 5% of Sum Insured per annum as
Cumulative Bonus. In case long term policy is purchased, the cumulative bonus applicable to policy will
automatically be increased by 5% after the completion of every Policy year, in case of no claim is lodged under
the Policy.
ii. The maximum cumulative increase in the Limit of Indemnity will be limited to 25% of Sum Insured.
iii. In event of a claim under the Policy in a policy year, the cumulative bonus would be decreased by 5% after the
completion of Policy year. There will be no impact on the Sum Insured, only the accrued cumulative bonus will
be decreased.
 Income Tax Benefit as per Sec 80 D of the IT Act on the premiums paid for this policy

Multiple Policies
If two or more policies are taken by You during a period from one or more insurers to indemnify treatment costs, You
shall have the right to require a settlement of your claim in terms of any of your policies.
i. In all such cases the insurer who has issued the chosen policy shall be obliged to settle the claim as long as the
claim is within the limits of and according to the terms of the chosen policy.
ii. Claims under other policy/ies may be made after exhaustion of Sum Insured in the earlier chosen policy /
policies. It is further clarified that the policyholder having multiple policies shall also have the right to prefer
claims from other policy/policies for the amounts disallowed under the earlier chosen policy/ policies, even of
the sum insured is not exhausted. Then we shall settle the claim subject to the terms and conditions of the
other policy/policies so chosen.
iii. If the amount to be claimed exceeds the sum insured under a single policy after considering the deductibles or
co-pay, you shall have the right to choose insurers from whom you wants to claim the balance amount.
iv. Where you have policies from more than one insurer to cover the same risk on indemnity basis, the insured
shall only be indemnified the hospitalization costs in accordance with the terms and conditions of the chosen
policy.

Renewal
i. Under normal circumstances, renewal will not be refused except on the grounds of Your moral hazard, misrepre-
sentation, fraud, or your non-cooperation. (Subject to policy is renewed annually with us within the Grace period of
30 days from date of Expiry)
ii. In case of our own renewal, a grace period of 30 days is permissible and the Policy will be considered as continuous
for the purpose of all waiting periods. However, any treatment availed for an Illness or Accident sustained or
contracted during the break period will not be admissible under the Policy.
iii. For renewals received after completion of 30 days grace period, a fresh application of health insurance should be
submitted to Us, it would be processed as per a new business proposal.
iv. For dependent children, Policy is renewable up to 35 years. After the completion of maximum renewal age of
dependent children, the policy would be renewed for lifetime. However a Separate proposal form should be
submitted to us at the time of renewal with the insured member as proposer. Suitable credit of continuity/waiting
periods for all the previous policy years would be extended in the new policy, provided the policy has been
maintained without a break
v. Premium payable on renewal and on subsequent continuation of cover are subject to change with prior approval
from IRDAI.
vi. The loadings on renewals shall be in terms of increase or decrease in premiums offered for the entire portfolio and
shall not be based on any individual policy claim experience.

CIN: U66010PN2000PLC015329 / UIN- IRDAI/HLT/BAGI/P-H/V.II/112/2017-18 08

Cancellation
I. We may cancel this insurance by giving You at least 15 days written notice, and if no claim has been made then We
shall refund a pro-rata premium for the unexpired Policy Period. Under normal circumstances, Policy will not be
cancelled except for reasons of mis-representation, fraud, non-disclosure of material facts or Your non-
cooperation.
ii. You may cancel this insurance by giving Us at least 15 days written notice, and if no claim has been made then We
shall refund premium on short term rates for the unexpired Policy Period as per the rates detailed below.

Premium Refund
Period in Risk Policy Period Policy Period Policy Period
1 Year 2 Year 3 Year
Within 15 Days As per Free look up period
Exceeding 15 days but less than 3 months 65.00% 75.00% 80.00%
Exceeding 3 months but less than 6 months 45.00% 65.00% 75.00%
Exceeding 6 months but less than 12 months 0.00% 45.00% 60.00%
Exceeding 12 months but less than 15 months 30.00% 50.00%
Exceeding 15 months but less than 18 months 20.00% 45.00%
Exceeding 18 months but less than 24 months 0.00% 30.00%
Exceeding 24 months but less than 27 months 20.00%
Exceeding 27 months but less than 30 months 15.00%
Exceeding 30 months but less than 36 months 0.00%
Note:
• The first slab of Number of days “within 15 days” in above table is applicable only in case of new business.
• In case of renewal policies, period is risk “Exceeding 15 days but less than 3 months” should be read as “within 3 months”.

Portability Conditions
a. Retail Policies: As per the Portability Guidelines issued by IRDAI, applicable benefits shall be passed on to insured
persons who were holding similar retail health insurance policies of other non-life insurers. The pre-policy medical
examination requirements and provisions for such cases shall remain similar to non-portable cases.
b. Group Policies: As per the Portability Guidelines issued by IRDAI, applicable benefits shall be passed on to insured
persons who were insured under Our Group Health Policy and are availing our individual Health Policy.

Revision/ Modification of the policy:

There is a possibility of revision/ modification of terms, conditions, coverages and/or premiums of this product at any
time in future, with appropriate approval from IRDAI. In such an event of revision/modification of the product,
intimation shall be set out to all the existing insured members at least 3 months prior to the date of such revi-
sion/modification comes into the effect

Migration of policy:
 The insured can opt for migration of policy to our other similar or closely similar products at the time of renewal.
 The premium will be charged as per Our Underwriting Policy for such chosen new product, and all the guidelines,
terms and condition of the chosen product shall be applicable.
 Suitable credit of continuity/waiting periods for all the previous policy years would be extended in the new policy,
provided the policy has been maintained without a break

09 CIN: U66010PN2000PLC015329 / UIN- IRDAI/HLT/BAGI/P-H/V.II/112/2017-18

Withdrawal of Policy
There is possibility of withdrawal of this product at any time in future with appropriate approval from IRDAI, as We
reserve Our right to do so with a intimation of 3 months to all the existing insured members. In such an event of
withdrawal of this product, at the time of Your seeking renewal of this Policy, You can choose, among Our available
similar and closely similar Health insurance products. Upon Your so choosing Our new product, You will be charged the
Premium as per Our Underwriting Policy for such chosen new product, as approved by IRDAI.
Provided however, if You do not respond to Our intimation regarding the withdrawal of the product under which this
Policy is issued, then this Policy shall be withdrawn and shall not be available to You for renewal on the renewal date and
accordingly upon Your seeking renewal of this Policy, You shall have to take a Policy under available new products of Us
subject to Your paying the Premium as per Our Underwriting Policy for such available new product chosen by You and
also subject to Portability condition

PREMIUM CHART
There are Two Zones for Premium payment
Zone A
“Following cities has been clubbed in Zone A:-
Delhi / NCR, Mumbai including (Navi Mumbai, Thane and Kalyan), Hyderabad and Secunderabad, Bangalore,
Kolkata, Ahmedabad, Vadodara and Surat.

Zone B
Rest of India apart from Zone A cities are classified as Zone B.
Note:-
Policyholders paying Zone A premium rates can avail treatment allover India without any co-payment.
But, those, who pay zone B premium rates and avail treatment in Zone A city will have to pay 20% co-payment on
admissible claim amount. This Co – payment will not be applicable for Accidental Hospitalization cases.”
Policyholder residing in Zone B can choose to pay premium for Zone A and avail treatment all over India without
any co-payment.

Premiums are exclusive of GST

Premium for Zone A (Individual)

Age / SI 50,000 75,000 1,00,000 1,50,000 2,00,000 3,00,000 4,00,000 5,00,000 10,00,000
0.3Mo-20 1,205 1,552 1,905 2,435 2,700 3,157 3,734 4,402 5,511
21-25 1,263 1,627 1,995 2,551 2,828 3,307 3,912 4,612 5,774
26-30 1,416 1,825 2,238 2,861 3,170 3,708 4,388 5,173 6,476
31-35 1,485 1,914 2,347 3,000 3,325 3,889 4,601 5,425 6,792
36-40 1,702 2,194 2,735 3,495 3,872 4,530 5,362 6,323 7,915
41-45 1,988 2,592 3,266 4,174 4,623 5,410 6,404 7,553 9,455
46-50 2,548 3,351 4,246 5,425 6,007 7,031 8,325 9,820 12,293
51-55 3,362 4,337 5,325 6,802 7,531 8,816 10,440 12,317 15,418
56-60 4,703 6,068 7,451 9,517 10,534 12,334 14,608 17,236 21,576
61-65 6,452 8,325 10,223 13,058 14,452 16,923 20,045 23,654 29,609
66-70 8,668 11,185 13,736 17,543 19,414 22,735 26,932 31,782 39,784
71-75 9,834 12,691 15,584 19,903 22,025 25,794 30,557 36,060 45,139
Above 75 11,234 14,497 17,803 22,736 25,159 29,464 34,906 41,194 51,565

CIN: U66010PN2000PLC015329 / UIN- IRDAI/HLT/BAGI/P-H/V.II/112/2017-18 10

 Premium for Zone B (Individual)

Age / SI 50,000 75,000 1,00,000 1,50,000 2,00,000 3,00,000 4,00,000 5,00,000 10,00,000
0.3Mo-20 964 1,242 1,524 1,948 2,160 2,526 2,988 3,522 4,409
21-25 1,010 1,302 1,596 2,041 2,262 2,646 3,130 3,689 4,619
26-30 1,133 1,460 1,790 2,289 2,536 2,967 3,510 4,138 5,181
31-35 1,188 1,531 1,878 2,400 2,660 3,111 3,681 4,340 5,433
36-40 1,362 1,755 2,188 2,796 3,098 3,624 4,289 5,058 6,332
41-45 1,591 2,074 2,613 3,339 3,699 4,328 5,123 6,042 7,564
46-50 2,038 2,681 3,397 4,340 4,806 5,625 6,660 7,856 9,834
51-55 2,690 3,469 4,260 5,442 6,025 7,053 8,352 9,853 12,334
56-60 3,763 4,854 5,960 7,613 8,428 9,867 11,687 13,789 17,261
61-65 5,162 6,660 8,179 10,446 11,561 13,538 16,036 18,923 23,687
66-70 6,934 8,948 10,989 14,034 15,531 18,188 21,546 25,426 31,827
71-75 7,867 10,152 12,468 15,923 17,620 20,635 24,445 28,848 36,111
Above 75 8,987 11,597 14,242 18,189 20,127 23,572 27,925 32,955 41,252

Premium Chart for Floater Sum Insured

1 Adult + 1 Child
Zone A Zone B
Age / SI
2,00,000 3,00,000 4,00,000 5,00,000 10,00,000 2,00,000 3,00,000 4,00,000 5,00,000 10,00,000
18-25 4,378 5,120 6,056 7,139 8,937 3,502 4,096 4,845 5,711 7,150
26-30 4,649 5,437 6,433 7,583 9,493 3,719 4,350 5,146 6,067 7,595
31-35 4,771 5,580 6,602 7,783 9,744 3,817 4,464 5,282 6,227 7,795
36-40 5,205 6,088 7,204 8,494 10,633 4,164 4,871 5,763 6,795 8,507
41-45 5,901 6,904 8,171 9,635 12,061 4,721 5,523 6,537 7,708 9,649
46-50 7,269 8,506 10,068 11,875 14,865 5,815 6,805 8,055 9,500 11,892
51-55 8,598 10,062 11,913 14,052 17,590 6,878 8,050 9,530 11,241 14,072
56-60 12,005 14,053 16,642 19,633 24,577 9,604 11,243 13,314 15,707 19,662
61-65 16,204 18,971 22,469 26,511 33,186 12,963 15,177 17,976 21,209 26,549
66-70 21,340 24,988 29,599 34,927 43,720 17,072 19,991 23,679 27,941 34,976
71-75 23,567 27,599 32,696 38,585 48,298 18,854 22,079 26,157 30,868 38,639
Above 75 26,920 31,527 37,350 44,078 55,174 21,536 25,222 29,880 35,262 44,140

1 Adult + 2 Children
Zone A Zone B
Age / SI
2,00,000 3,00,000 4,00,000 5,00,000 10,00,000 2,00,000 3,00,000 4,00,000 5,00,000 10,00,000
18-25 5,536 6,473 7,657 9,026 11,300 4,428 5,178 6,126 7,221 9,040
26-30 5,766 6,743 7,977 9,404 11,772 4,613 5,394 6,382 7,523 9,418
31-35 5,870 6,864 8,121 9,573 11,985 4,696 5,492 6,497 7,659 9,588
36-40 6,238 7,296 8,632 10,177 12,740 4,990 5,837 6,906 8,142 10,192
41-45 6,830 7,989 9,453 11,146 13,953 5,464 6,391 7,563 8,917 11,163
46-50 8,077 9,450 11,185 13,190 16,512 6,462 7,560 8,948 10,552 13,210
51-55 9,437 11,043 13,072 15,417 19,299 7,549 8,834 10,458 12,334 15,440
56-60 12,435 14,555 17,233 20,328 25,447 9,948 11,644 13,786 16,263 20,358
61-65 16,875 19,756 23,396 27,603 34,553 13,500 15,805 18,717 22,082 27,642
66-70 22,170 25,958 30,745 36,277 45,410 17,736 20,766 24,596 29,021 36,328
71-75 25,109 29,405 34,835 41,109 51,458 20,087 23,524 27,868 32,887 41,167
Above 75 28,681 33,589 39,793 46,961 58,784 22,945 26,872 31,835 37,569 47,027

11 CIN: U66010PN2000PLC015329 / UIN- IRDAI/HLT/BAGI/P-H/V.II/112/2017-18

 Premium Chart for Floater Sum Insured (Exclusive of Taxes as applicable)

1 Adult + 3 Children
Zone A Zone B
Age / SI
2,00,000 3,00,000 4,00,000 5,00,000 10,00,000 2,00,000 3,00,000 4,00,000 5,00,000 10,00,000
18-25 6,667 7,796 9,222 10,871 13,609 5,334 6,237 7,378 8,697 10,887
26-30 6,876 8,041 9,512 11,213 14,038 5,501 6,433 7,610 8,971 11,230
31-35 6,970 8,151 9,643 11,367 14,230 5,576 6,521 7,714 9,094 11,384
36-40 7,304 8,542 10,107 11,915 14,916 5,843 6,834 8,085 9,532 11,932
41-45 7,841 9,171 10,851 12,793 16,016 6,272 7,337 8,681 10,235 12,812
46-50 8,972 10,496 12,421 14,647 18,336 7,178 8,397 9,937 11,718 14,669
51-55 10,283 12,032 14,241 16,794 21,024 8,226 9,625 11,393 13,436 16,819
56-60 13,211 15,461 18,304 21,591 27,027 10,569 12,369 14,644 17,273 21,622
61-65 17,666 20,679 24,488 28,889 36,163 14,133 16,543 19,590 23,111 28,930
66-70 23,490 27,509 32,588 38,456 48,138 18,792 22,007 26,070 30,765 38,511
71-75 26,650 31,210 36,974 43,633 54,618 21,320 24,968 29,579 34,906 43,694
Above 75 30,442 35,652 42,237 49,845 62,394 24,354 28,522 33,789 39,876 49,915

1 Adult + 4 Children
Zone A Zone B
Age / SI
2,00,000 3,00,000 4,00,000 5,00,000 10,00,000 2,00,000 3,00,000 4,00,000 5,00,000 10,00,000
18-25 7,811 9,133 10,804 12,735 15,943 6,248 7,307 8,643 10,188 12,755
26-30 8,007 9,363 11,076 13,057 16,346 6,405 7,491 8,861 10,446 13,077
31-35 8,095 9,467 11,199 13,202 16,527 6,476 7,573 8,959 10,561 13,222
36-40 8,409 9,834 11,635 13,716 17,171 6,727 7,868 9,308 10,973 13,736
41-45 8,913 10,425 12,334 14,541 18,204 7,130 8,340 9,867 11,633 14,563
46-50 9,976 11,670 13,809 16,283 20,384 7,981 9,336 11,048 13,026 16,307
51-55 11,208 13,112 15,519 18,300 22,909 8,966 10,490 12,415 14,640 18,327
56-60 14,031 16,420 19,438 22,926 28,699 11,225 13,136 15,550 18,341 22,960
61-65 18,501 21,661 25,658 30,277 37,899 14,801 17,329 20,526 24,221 30,319
66-70 24,849 29,100 34,473 40,681 50,923 19,880 23,280 27,579 32,545 40,738
71-75 28,192 33,016 39,113 46,157 57,778 22,554 26,413 31,290 36,926 46,222
Above 75 32,204 37,715 44,680 52,729 66,003 25,763 30,172 35,744 42,183 52,802

2 Adults
Zone A Zone B
Age / SI
2,00,000 3,00,000 4,00,000 5,00,000 10,00,000 2,00,000 3,00,000 4,00,000 5,00,000 10,00,000
18-25 4,376 5,117 6,053 7,136 8,933 3,501 4,094 4,843 5,709 7,147
26-30 4,906 5,738 6,789 8,004 10,020 3,924 4,590 5,431 6,403 8,016
31-35 5,144 6,017 7,120 8,395 10,509 4,115 4,814 5,696 6,716 8,407
36-40 5,991 7,010 8,296 9,783 12,247 4,793 5,608 6,637 7,826 9,797
41-45 7,154 8,371 9,909 11,687 14,630 5,723 6,697 7,927 9,349 11,704
46-50 9,295 10,879 12,881 15,195 19,021 7,436 8,703 10,305 12,156 15,217
51-55 11,653 13,641 16,154 19,057 23,856 9,322 10,913 12,923 15,246 19,085
56-60 16,300 19,084 22,603 26,670 33,385 13,040 15,268 18,083 21,336 26,708
61-65 22,361 26,184 31,016 36,599 45,814 17,889 20,947 24,813 29,279 36,651
66-70 30,039 35,177 41,672 49,177 61,557 24,031 28,142 33,338 39,341 49,246
71-75 34,080 39,911 47,281 55,796 69,843 27,264 31,928 37,824 44,637 55,875
Above 75 38,929 45,590 54,011 63,740 79,786 31,143 36,472 43,209 50,992 63,829

CIN: U66010PN2000PLC015329 / UIN- IRDAI/HLT/BAGI/P-H/V.II/112/2017-18 12

 Premium Chart for Floater Sum Insured (Exclusive of Taxes as applicable)

2 Adults + 1 Child
Zone A Zone B
Age / SI
2,00,000 3,00,000 4,00,000 5,00,000 10,00,000 2,00,000 3,00,000 4,00,000 5,00,000 10,00,000
18-25 5,612 6,563 7,764 9,152 11,457 4,490 5,250 6,211 7,321 9,166
26-30 6,072 7,102 8,402 9,905 12,400 4,858 5,681 6,722 7,924 9,920
31-35 6,279 7,344 8,689 10,244 12,825 5,023 5,875 6,952 8,196 10,260
36-40 7,015 8,206 9,711 11,450 14,333 5,612 6,565 7,768 9,160 11,467
41-45 8,110 9,489 11,230 13,244 16,579 6,488 7,591 8,984 10,595 13,263
46-50 10,199 11,936 14,130 16,666 20,862 8,159 9,548 11,304 13,333 16,690
51-55 12,350 14,455 17,115 20,189 25,272 9,880 11,564 13,692 16,151 20,218
56-60 17,256 20,202 23,925 28,227 35,334 13,805 16,162 19,140 22,581 28,267
61-65 23,448 27,455 32,518 38,370 48,030 18,758 21,964 26,015 30,696 38,424
66-70 31,398 36,769 43,557 51,401 64,342 25,118 29,415 34,846 41,121 51,474
71-75 35,621 41,716 49,420 58,320 73,003 28,497 33,373 39,536 46,656 58,402
Above 75 40,690 47,653 56,454 66,623 83,396 32,552 38,122 45,163 53,299 66,717

2 Adults + 2 Children
Zone A Zone B
Age / SI
2,00,000 3,00,000 4,00,000 5,00,000 10,00,000 2,00,000 3,00,000 4,00,000 5,00,000 10,00,000
18-25 6,769 7,915 9,363 11,037 13,818 5,415 6,332 7,491 8,830 11,054
26-30 7,188 8,406 9,945 11,724 14,677 5,750 6,725 7,956 9,379 11,742
31-35 7,377 8,628 10,207 12,033 15,064 5,901 6,902 8,166 9,627 12,051
36-40 8,047 9,413 11,138 13,132 16,440 6,438 7,530 8,910 10,506 13,152
41-45 9,046 10,582 12,523 14,767 18,486 7,236 8,466 10,019 11,814 14,789
46-50 11,028 12,905 15,275 18,015 22,552 8,823 10,324 12,220 14,412 18,042
51-55 13,198 15,447 18,287 21,570 27,002 10,559 12,357 14,630 17,256 21,602
56-60 17,775 20,811 24,649 29,083 36,405 14,220 16,649 19,719 23,266 29,124
61-65 24,384 28,553 33,822 39,911 49,959 19,507 22,843 27,058 31,929 39,967
66-70 32,757 38,360 45,443 53,626 67,127 26,205 30,688 36,354 42,901 53,701
71-75 37,163 43,522 51,558 60,845 76,163 29,730 34,817 41,247 48,676 60,930
Above 75 42,451 49,715 58,898 69,507 87,005 33,961 39,772 47,118 55,606 69,604

2 Adults + 3 Children
Zone A Zone B
Age / SI
2,00,000 3,00,000 4,00,000 5,00,000 10,00,000 2,00,000 3,00,000 4,00,000 5,00,000 10,00,000
18-25 7,912 9,252 10,945 12,902 16,151 6,330 7,402 8,756 10,321 12,921
26-30 8,306 9,714 11,492 13,547 16,959 6,645 7,771 9,193 10,838 13,567
31-35 8,483 9,921 11,738 13,837 17,323 6,787 7,937 9,390 11,070 13,858
36-40 9,113 10,659 12,612 14,870 18,615 7,291 8,528 10,090 11,896 14,892
41-45 10,051 11,758 13,914 16,406 20,538 8,041 9,406 11,131 13,125 16,430
46-50 11,914 13,940 16,499 19,457 24,357 9,531 11,152 13,199 15,566 19,486
51-55 14,027 16,414 19,431 22,918 28,689 11,221 13,131 15,545 18,334 22,951
56-60 18,514 21,675 25,671 30,290 37,916 14,811 17,340 20,537 24,232 30,333
61-65 25,396 29,738 35,226 41,567 52,032 20,317 23,790 28,181 33,253 41,625
66-70 34,116 39,952 47,328 55,851 69,912 27,292 31,961 37,862 44,681 55,929
71-75 38,705 45,327 53,697 63,369 79,322 30,964 36,262 42,958 50,695 63,458
Above 75 44,212 51,778 61,341 72,391 90,615 35,370 41,422 49,073 57,912 72,492

13 CIN: U66010PN2000PLC015329 / UIN- IRDAI/HLT/BAGI/P-H/V.II/112/2017-18

 Premium Chart for Floater Sum Insured (Exclusive of Taxes as applicable)

2 Adults + 4 Children
Zone A Zone B
Age / SI
2,00,000 3,00,000 4,00,000 5,00,000 10,00,000 2,00,000 3,00,000 4,00,000 5,00,000 10,00,000
18-25 9,069 10,604 12,544 14,787 18,512 7,255 8,484 10,035 11,830 14,809
26-30 9,446 11,047 13,068 15,405 19,286 7,557 8,837 10,455 12,324 15,428
31-35 9,616 11,246 13,304 15,684 19,634 7,693 8,996 10,643 12,547 15,707
36-40 10,219 11,953 14,142 16,672 20,872 8,176 9,562 11,313 13,338 16,697
41-45 11,118 13,005 15,389 18,144 22,714 8,894 10,404 12,311 14,515 18,171
46-50 12,903 15,096 17,866 21,068 26,374 10,322 12,077 14,293 16,854 21,099
51-55 14,927 17,466 20,675 24,384 30,524 11,941 13,973 16,540 19,507 24,419
56-60 19,297 22,586 26,741 31,543 39,486 15,438 18,068 21,393 25,234 31,589
61-65 26,408 30,923 36,629 43,222 54,104 21,126 24,738 29,303 34,578 43,283
66-70 35,475 41,543 49,213 58,076 72,697 28,380 33,234 39,370 46,461 58,157
71-75 40,247 47,133 55,836 65,893 82,482 32,197 37,706 44,669 52,715 65,986
Above 75 45,973 53,840 63,784 75,274 94,225 36,778 43,072 51,028 60,219 75,380

Claim Process
Cashless Claims Procedure:
Cashless treatment is only available at Network Hospitals. In order to avail of cashless treatment, the following
procedure must be followed by You or Your representative:
i. Prior to taking treatment and/or incurring Medical Expenses at a Network Hospital, You must call Us and
request pre-authorisation by way of the written form.
ii. In case of Planned hospitalization , You/the insured person/ insured representative shall intimate such
admission within 48 hours of such hospitalisation
iii. In case of Emergency hospitalization , You/the insured person/ insured representative shall intimate such
admission within 24 hours of such hospitalisation
iv. On receipt of your pre-authorization form duly filled and signed by you, our representative then within 2 hours
will respond with Approval, Rejection or an more information
v. After considering Your request and after obtaining any further information or documentation We have
sought, We may, if satisfied, send You or the Network Hospital, an authorisation letter. The authorisation letter,
the ID card issued to You along with this Policy and any other information or documentation that We have
specified must be produced to the Network Hospital identified in the pre-authorization letter at the time of
Your admission to the same.
vi. If the procedure above is followed, You will not be required to directly pay for the bill amount in the Network
Hospital that We are liable under In-Patient Hospitalisation Treatment and the original bills and evidence of
treatment in respect of the same shall be left with the Network Hospital. Pre-authorisation does not guarantee
that all costs and expenses will be covered. We reserve the right to review each claim for Medical Expenses and
accordingly coverage will be determined according to the terms and conditions of this Policy.

Reimbursement Claims Procedure:

I. You or someone claiming on Your behalf must inform Us in writing immediately within 48 hours** of hospitaliza-
tion in case of emergency hospitalization and 48 hours prior to hospitalization in case of planned hospitalization
ii. You must immediately consult a Doctor and follow the advice and treatment that he recommends.
iii. You must take reasonable steps or measures to minimize the quantum of any claim that may be made under this
Policy.
iv. You must have Yourself examined by Our medical advisors if We ask for this, and as often as We consider this to be
necessary at our cost.
v. You or someone claiming on Your behalf must promptly and in any event within 30 days of discharge from a

CIN: U66010PN2000PLC015329 / UIN- IRDAI/HLT/BAGI/P-H/V.II/112/2017-18 14

 Hospital give Us the documentation as listed out in greater detail below and other information We ask for to
investigate the claim or Our obligation to make payment for it.
vi. In the event of the death of the insured person, someone claiming on his behalf must inform Us in writing
immediately and send Us a copy of the post mortem report (if any) within 30 days**
vii. If the original documents are submitted with the co-insurer, the Xerox copies attested by the co-insurer should be
submitted

*Note: In case You are claiming for the same event under an indemnity based policy of another insurer and are
required to submit the original documents related to Your treatment with that particular insurer, then You may
provide Us with the attested Xerox copies of such documents along with a declaration from the particular insurer
specifying the availability of the original copies of the specified treatment documents with it.
**Note: Waiver of conditions (i) and (vi) may be considered in extreme cases of hardship where it is proved to Our
satisfaction that under the circumstances in which You were placed, it was not possible for You or any other person
to give notice or file claim within the prescribed time limit.

List of Claim documents:

 Claim form with NEFT details & cancelled cheque duly signed by Insured
 Original/Attested copies of Discharge Summary / Discharge Certificate / Death Summary with Surgical &
anesthetics notes
 Attested copies of Indoor case papers (Optional)
 Original/Attested copies Final Hospital Bill with break up of surgical charges, surgeon's fees, OT charges etc
 Original Paid Receipt against the final Hospital Bill.
 Original bills towards Investigations done / Laboratory Bills.
 Original/Attested copies of Investigation Reports against Investigations done.
 Original bills and receipts paid for the transportation from Registered Ambulance Service Provider. Treating Doctor
certificate to transfer the Injured person to a higher medical centre for further treatment (if Applicable).
 Cashless settlement letter or other company settlement letter
 First consultation letter for the current ailment.
 In case of implant surgery, invoice & sticker.
 In cases where a fraud is suspected, we may call for any additional document(s) in addition to the documents listed
above
 AADHAR No. & PAN Card/ Form 60 of proposer
Note- Aadhar and PAN/Form 60 of the deceased policyholder would not be insisted upon for settlement of death
claim to the nominee or legal heirs, however Aadhar and PAN/Form 60 of the nominee or legal heirs is mandatory

Please send the documents on below address

Bajaj Allianz General Insurance Company
2nd Floor, Bajaj Finserv Building, Behind Weikfield IT park, Off Nagar Road, Viman Nagar, Pune 411014
Toll free: 1800-103-2529, 1800-22-5858

Paying a Claim
i. You agree that We need only make payment when You or someone claiming on Your behalf has provided Us with
necessary documentation and information.
ii. We will make payment to You or Your Nominee. If there is no Nominee and You are incapacitated or deceased, We
will pay Your heir, executor or validly appointed legal representative and any payment We make in this way will be a
complete and final discharge of Our liability to make payment.
iii. On receipt of all the documents and on being satisfied with regard to the admissibility of the claim as per policy
terms and conditions, we shall offer a settlement of the claim to the insured. Upon acceptance of an offer of
settlement by the insured, the payment of the amount due shall be made within 7 days from the date of
acceptance of the offer by the insured. We will settle the claim within thirty (30) days of the receipt of the last

15 CIN: U66010PN2000PLC015329 / UIN- IRDAI/HLT/BAGI/P-H/V.II/112/2017-18

 necessary document. In the cases of delay in the payment, the insurer shall be liable to pay interest at a rate which is
2% above the bank rate prevalent at the beginning of the financial year in which the claim is reviewed by it.
iv. If the insurer, for any reasons decides to reject the claim under the policy the reasons regarding the rejection shall
be communicated to the insured in writing within 30 days of the receipt of documents. The insured may take
recourse to the Grievance Redressal procedure stated under policy.

Basis of Claims Payment

i. If You suffer a relapse within 45 days of the date when You last obtained medical treatment or consulted a Doctor
and for which a claim has been made, then such relapse shall be deemed to be part of the same claim.
ii. The day care procedures listed are subject to the exclusions, terms and conditions of the policy and will not be
treated as independent coverage under the policy.
iii. Our obligation to make payment in respect of illness/surgeries listed below will be restricted to (after the expiry of
the 24 months period from commencement of your first Health Ensure Policy)
Rs. 50000, Rs. 75000 Rs. 1.5lacs, Rs. 2lacs Rs. 4lacs ,Rs. 5lacs and
Sum Insured Rs.
and Rs. 1lac and Rs. 3 lacs Rs. 10lacs
Cataract (per eye) Rs. 20000/- Rs. 30000/- Rs. 40000/-

iv. We shall make payment in Indian Rupees only.

Process to buy this policy?
1. Discuss the policy benefits, coverage and premium details with your insurance advisor or visit our website
(www.bajajallianz.com) for details
2. Actively seek information on the charges and exclusions under the policy
3. Fill the proposal form stating your personal details and health profile
4. Ensure that the information given in the form is complete and accurate
5. The Policy Schedule, Policy Wordings, Cashless Cards and Health Guide will be sent to your mailing address
mentioned on the proposal form

Contact:
Health Administration Team,
Bajaj Allianz General Insurance Co. Ltd. 2nd floor, Bajaj Finserv Building, Behind Weikfield IT Park, Off Nagar Road,Viman
Nagar-Pune - 411 014.
For sales and Renewal-1800- 209- 0144 • For service-1800- 209- 5858 / 1800- 102- 5858 / 020-30305858
Cashless facility offered through network hospitals of Bajaj Allianz only.Cashless facility at 5500+ Network hospitals
PAN India. Please visit our website for list of network hospitals and network Diagnostic Centers , Website:
www.bajajallianz.com or get in touch with 24*7 helpline number: 1800-103-2529 (toll free) / 020-30305858

Grievance Redressal Cell for Senior Citizens

Senior Citizen Cell for Insured Person who are Senior Citizens
‘Good things come with time’ and so for our customers who are above 60 years of age we have created special cell to
address any health insurance related query. Our senior citizen customers can reach us through the below dedicated
channels to enable us to service them promptly
Health toll free number: 1800-103-2529 • Exclusive Email address: [email protected]

Section 41 of Insurance Act 1938 as amended by Insurance Laws Amendment Act, 2015 (Prohibition of
Rebates): 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 insurers. Any person making default in complying
with the provision of this section shall be liable for a penalty which may extend to 10 lakh rupees.
Disclaimer: The above information is only indicative in nature and for more details on the coverage, terms and
exclusions, please get in touch with nearest office of Bajaj Allianz General Insurance Co. Ltd.

CIN: U66010PN2000PLC015329 / UIN- IRDAI/HLT/BAGI/P-H/V.II/112/2017-18 16

 BAJAJ ALLIANZ GENERAL INSURANCE CO. LTD.
BAJAJ ALLIANZ HOUSE, AIRPORT ROAD, YERAWADA,
PUNE - 411006. IRDA REG NO.: 113.

FOR ANY QUERY (TOLL FREE)

1800-209-0144 /1800-209-5858

www.bajajallianz.com

[email protected]

For more details on risk factors, Terms and Conditions, please read the sales
brochure before concluding a sale.

CIN: U66010PN2000PLC015329 | UIN: IRDAI/HLT/BAGI/P-

H/V.II/112/2017-18

BJAZ-B-0263/18-Feb-19

Policy holders can download Insurance Wallet for one -touch access Available on: