Bajaj Allianz Health Guard

Plan details

Every field, in one place

Honesty note: Variant-specific room rent / NCB ladder differs (Silver / Gold / Platinum / Diamond); fields reflect typical Health Guard Silver as a representative variant.

Indicative premium

Order-of-magnitude only — NOT a quote

Indicative figures vary by city, family member count, medical loading and policy term. Always confirm on the insurer's premium calculator.

Known exclusions

What this plan typically does NOT cover

• ✕Cosmetic / aesthetic surgery
• ✕Maternity unless rider opted (waiting period applies)
• ✕Self-inflicted injury, hazardous sports
• ✕Sleep disorders without supporting diagnosis
• ✕Treatment for obesity below BMI threshold

Known traps

The fine print that decides claim outcomes

• ▸Restoration applies ONLY to unrelated illnesses — same-illness recurrence won't be re-covered in the same year.
• ▸20% copay kicks in for entry age 61+ — major issue for senior buyers.
• ▸Single private AC room cap on Silver variant; Platinum / Diamond have higher room categories.
• ▸Cumulative bonus at 10% per claim-free year, capped at 100% (slower than competitors offering 50% steps).
• ▸Day-care list is fixed in annexure — anything outside requires hospitalisation > 24h.

How to claim

Cashless vs reimbursement — the steps

1. 1Notify insurer. Within 24 hours of emergency admission or 48-72 hours for planned hospitalisation. Use Bajaj Allianz's helpline or app — keep the reference number.
2. 2Cashless: Pre-authorisation form filled by hospital, sent to Bajaj Allianzvia the hospital's TPA desk. Approval typically 4-6 hours during business; longer overnight. If your hospital is OUT of network (or PPN-only), you'll be on reimbursement.
3. 3Reimbursement:Pay hospital out-of-pocket, then submit claim form + original bills + discharge summary + investigation reports + KYC. Insurer's IRDAI-mandated turnaround is 30 working days from receipt of complete documents.
4. 4Watch for deductions. Room rent above your eligible category triggers proportionate deduction across the WHOLE bill, not just room rent. Sub-limits on cataract / modern treatment apply even when total SI is far higher.
5. 5If denied: Ask for a written denial citing the exact clause. Internal grievance redressal first, then IRDAI Bima Bharosa or the Insurance Ombudsman.