Bajaj Allianz General Insurance

Bajaj Allianz My Health Care

Plain-English breakdown of the plan — every field a shopper actually needs before clicking buy. Compiled from public Bajaj Allianz brochures and policy wordings. Always confirm against the official PDF below.

family floaterindividual

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Trust at a glance

Bajaj Allianz — IRDAI FY 2024-25

Verified

Claim Settlement Ratio: 95.04%
Incurred Claim Ratio: 87.31%
Complaints / 10,000 claims: 3
Network hospitals: 8,000

Source: IRDAI Annual Report FY 2024-25 · UIN 113PolicyPlain earns no commission · numbers shown verbatim

Plan details

Every field, in one place

Sum insured options: ₹3L · ₹5L · ₹7.5L · ₹10L · ₹15L · ₹20L · ₹50L · ₹1Cr
Pre-existing disease (PED) waiting: 36 months
Pre-existing covered: Covered after PED waiting period
Co-payment: No copay published
Room rent: Single private AC room
Restoration of sum insured: Once per policy year
No Claim Bonus (NCB): 33% per claim-free year
Cashless network: 8,000 hospitals (insurer disclosure)
Free-look cancellation window: 15 days
Premium grace days: 30 days
IRDAI UIN: Not confirmed — verify on irdai.gov.in
Last verified: 2026-06 · third party aggregator

Honesty note: My Health Care positioned above Health Guard; field values inferred from brochure — confirm against policy wording.

Indicative premium

Order-of-magnitude only — NOT a quote

Age	Sum insured	Approx annual premium
35	₹10L	~₹13,500/yr
45	₹10L	~₹18,500/yr

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 surgery (non-reconstructive)
Substance abuse
Adventure activities
Sleep disorders without diagnosis
Treatment for obesity below BMI

Known traps

The fine print that decides claim outcomes

Restoration triggers ONCE per policy year for unrelated illness only.
Cumulative bonus is at 33% per claim-free year — capped at 99%.
Day-care list is fixed in annexure — anything outside requires > 24h stay.
Pre-policy medical screening based on age and SI.
Renewal premium re-rates with age band.

How to claim

Cashless vs reimbursement — the steps

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.
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.
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.
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.
5If denied: Ask for a written denial citing the exact clause. Internal grievance redressal first, then IRDAI Bima Bharosa or the Insurance Ombudsman.

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