Family Health Insurance

What is Family Health Insurance?

Family health insurance, or a family mediclaim policy, provides comprehensive health coverage for all family members under a single plan. These health insurance policies for families are designed to offer financial protection against medical expenses arising from hospitalisations, surgeries, and other treatments. Family medical insurance plans typically cover immediate family members, including spouses, children, and sometimes parents. Opting for health insurance plans for your family ensures that you and your loved ones are safeguarded against unexpected medical costs, promoting better health and peace of mind.

Key Features & Benefits of Family Health Insurance

Read on to learn more about the features of this policy:

- Platinum Plan: Super cumulative bonus of 50% per claim-free year

- Recharge Benefit: To take care of claims where the claim amount exceeds your sum insured

- Multiple Sum Insured Options: Enjoy the flexibility to choose between 3 plan variants along with the Sum Insured options ranging from INR 1.5 Lakh to 1 crore

- Immediate Family Cover: This policy covers you, your spouse and your children.

- Ayurvedic and Homoeopathic Treatment: Under the Gold & Platinum Plan, the policy covers in-patient hospitalisation expenses (up to INR 20,000) incurred in a recognised Ayurvedic/homoeopathic hospital where the admission period is not less than 24 hours.

- Daycare Procedures Cover: Medical expenses incurred during the treatment of listed daycare procedures or surgeries are covered under this policy.

- Convalescence Benefit: In case of continuous hospitalisation of more than 10 days, you will be eligible for a benefit payout of up to INR 7500 per year, provided the hospitalisation claim is admissible.

- Bariatric Surgery Cover: Bariatric surgery is covered under medical advice and is subject to specific terms and conditions.

- Sum Insured Reinstatement: If your sum insured and the cumulative bonus (if any) have been completely exhausted during the policy year, we will reinstate it.

- Pre and Post-Hospitalisation: The policy covers medical expenses 60 days immediately before and 90 days immediately after hospitalisation.

- Road Ambulance Cover: This policy covers ambulance expenses incurred up to Rs. 20,000 during per policy period

- Organ Donor Expenses Cover: Expenses towards organ donors' treatment for harvesting donated organs are covered under this policy.

- Daily Cash Benefit: A daily cash benefit of INR 500 per day, for up to 10 days during each policy year, will be payable as accommodation expenses for one parent/legal guardian to stay with a minor insured under the policy for an admissible claim.

- Maternity/Newborn Baby Cover: Maternity expenses and medical expenses towards the treatment of a newborn baby are covered under the policy and are subject to specific terms and conditions. This feature is available under the Gold & Platinum Plan.

Additional Benefits with Your Family Health Insurance Policy

Our family medical insurance provides various benefits for you and your loved ones:

●  Wellness benefit

Maintain good health & get rewarded with a wellness benefits discount of up to 12.5% on your renewal.

●  Renewability

This policy comes with the benefit of lifetime renewal.

●  Tax Saving

Income tax benefits are available under Section 80D of the Income Tax Act.

*On opting for a Family Health Insurance policy for yourself, your spouse, children and parents, you can avail of INR 25,000 per annum as a deduction against your taxes (provided you are not over 60 years). If you pay a premium for your parents who are senior citizens (age 60 or above), the maximum health insurance benefit for tax purposes is capped at INR 50,000. Therefore, as a taxpayer, you may maximise tax benefits under Section 80D up to INR 75,000 if you are below 60 and your parents are senior citizens. If you are above 60 and are paying a medical insurance premium for your parents, the maximum tax benefit under Section 80D is INR 1 lakh.

●  Hassle-free Claim Settlement

Our in-house claim settlement team ensures a quick, smooth and easy claim settlement process. Also, we offer cashless claim settlement at more than 18,400+ network hospitals* across India. This comes in handy in case of hospitalisation or treatment wherein we pay the bills directly to the network hospital, and you can focus on recovering and getting back on your feet.

●  Preventive Health Check-up

At the end of a block of every continuous period, as mentioned in coverage during which You have held Our Health Guard Policy, You are eligible for a free Preventive Health checkup.

●  Portablity Benefit

Suppose you and your loved ones are insured under any other family health insurance policy. In that case, you can switch to this policy with all accrued benefits after due allowances for waiting periods and enjoy the available benefits of the policy.

●  Long-Term Policy

This policy can be purchased for 1, 2 or 3 years.

●  Discount on Policy

Avail long-term policy discount of 4% for 2 years and 8% for 3 years.

Top Reasons to Choose Health Guard Policy by Bajaj Allianz Health Insurance Company

Bajaj Allianz General Insurance Company Health Guard Policy is one of the best family health insurance plans due to its extensive benefits and features.

Extensive Benefits and Features:

●  Multiple sum insured options.
●  Immediate family coverage.
●  Includes AYUSH treatment.

Unique Benefits:

●  Recharge benefit for the sum insured.
●  Sum insured reinstatement.
●  Coverage for daycare procedures.

Additional Coverage:

●  Maternity/newborn baby cover.
●  Bariatric surgery cover.
●  Convalescence benefits.

Holistic Coverage:

●  Comprehensive health insurance plans for the entire family.

Family Health Insurance Claim Process

Claim by Direct Click (CDC)

Bajaj Allianz General Insurance Company has introduced an app-based claim submission process known as Health Claim by Direct Click.

This facility allows you to register and submit documents through the app for claims up to Rs 20,000.

What you need to do:

●  Register your policy and card number in the Insurance Wallet App.

●  Register your policy and health card number in the app.

●  Register the claim.

●   Fill the claim form and arrange for the hospital-related documents.

●  Upload the documents using the app menu.

●  Submit the claims for further processing.

●  Get confirmation within a few hours.

Cashless claim process (only applicable for treatment at a network hospital):

Cashless facilities at network hospitals are available 24/7 throughout the year without interruption. You must check the hospital list before getting admitted to the hospital. Hospitals that provide cashless settlements are liable to change their policy without notice. The updated list is available on our website and with our call centre. The Health Card by Bajaj Allianz General Insurance Company and government ID proof,f are mandatory when availing of the cashless facility.

When you are opting for cashless claims, the process is as follows:

- Get the pre-authorisation request form filled and signed by the treating doctor/hospital and signed by you or a family member, at the hospital’s insurance desk.

- The network hospital will fax the request to HAT.

- HAT doctors will examine the pre-authorisation request form and decide on cashless availability, as per the policy guidelines.

- Authorisation letter/denial letter/additional requirement letter is issued within 3 hours depending on the plan and its benefits.

- At the time of discharge, the hospital will share the final bill and discharge details with HAT, and based on their assessment, the final settlement will be processed.

Important points to note:

- In case of planned hospitalisation, register/reserve your admission per the network hospital’s procedure for admission in advance.

- Admission at a network hospital is subject to the availability of a bed.

- Cashless facility is always subject to your policy terms and conditions.

- The policy does not cover the following :

- Telephone charges

- Food and beverages for relatives

- Toiletries

- You must pay for the above services directly to the hospital before discharge.

- In-room rent nursing charges are included. However, you will bear the incremental charges if a higher-cost room is used.

- If the treatment is not covered per the policy terms and conditions, your claim, cashless or reimbursement, will be denied.

- Pre-authorisation for a cashless claim can be denied in case of inadequate medical information.

- The denial of the cashless facility does not mean denial of treatment and does not prevent you from seeking necessary medical attention or hospitalisation.

Reimbursement of pre/post hospitalisation expenses:

Relevant medical expenses incurred before admission and after hospital discharge will be reimbursed per the policy. Prescriptions and bills/receipts of such services should be submitted to Bajaj Allianz General Insurance Company along with the duly signed claim form.

Reimbursement Claim Process

Reimbursement claim process (in case of a non-network hospital)

- Inform the BAGIC HAT team about the hospitalisation.

- To register your claim online, click here

- To register your claim offline, please call us on our toll-free number: 1800-209-5858.

- After discharge, you or a family member must submit the following documents to the HAT within 30 days:

- Duly filled and signed claim form with mobile number and email ID.

- Original hospital bill and payment receipt.

- Investigation report

- Discharge card

- Prescriptions

- Bills of medicines and surgical items

- Details of pre-hospitalization expenses (if any)

- In-patient papers, if required.

- All documents are to be sent to HAT for further processing, and based on the assessment, the final settlement will be done within 10 working days.

- Post-hospitalisation claim documents must be sent within 90 days from discharge.

Documents required for reimbursement claim:

●  The original pre-numbered hospital payment receipt is duly sealed and signed.

●   Original prescriptions and pharmacy bills.

●   Original consultation papers (if any).

●  Original investigation and diagnostic reports, bills, and payment receipts for the investigation done within and outside the hospital.

●  If you or a family member availed a cashless claim but did not utilise it, a letter from the hospital stating so.

●  A letter from the treating doctor mentioning incident details (in case of an accident).

●  Hospital registration certificate and hospital infrastructure on the letterhead.

●  A cancelled cheque bearing the IFSC code and name of the insured.

●   An indoor case paper copy was attested from the hospital from admission to discharge, with a detailed medical history, doctor’s notes, and temperature, pulse, and respiration charts.

●  X-ray films (in case of a fracture).

●  Obstetric history from treating doctor (in maternity cases).

●  FIR copy (in accident case).

●  Additional requirements for some exceptional cases:

●   In case of a cataract operation, a lens sticker with a bill copy.

●   In case of surgery, use an implant sticker with a copy of the bill.

●  In case of a heart-related treatment, a stent sticker with a bill copy.

All original claim documents need to be submitted to the following address:

Health Administration Team

Bajaj Allianz House, Airport Road, Yerawada, Pune-411006

Mention your Policy Number, Health Card Number and Mobile Number clearly on the face of the envelope.

Note: Keep a photocopy of the documents and courier reference number for your records.

Things to Consider Before Buying a Family Health Insurance Plan

Selecting the best health insurance plan for a family requires careful consideration of factors that impact coverage and affordability.

●  Sum Insured :

Choose an adequate sum insured to cover all family members, especially those with pre-existing conditions or specific medical needs.

●  Premium Costs :

Premiums increase with the sum insured and the age of the eldest family member. Select an affordable option that provides comprehensive protection without straining your budget.

●  Network Hospitals :

Bajaj Allianz General Insurance Company has a broad network of hospitals across India, offering cashless treatment to reduce upfront payment burdens during emergencies.

●  Pre and Post-Hospitalisation Coverage :

Ensure your plan includes expenses for doctor visits, diagnostic tests, and medications both before and after hospitalisation.

●  Daycare Procedures :

Check if daycare treatments are covered, as these don’t require a 24-hour hospital stay but can be costly.

●  Ambulance Services :

Confirm if ambulance charges are included, as these can provide valuable support in emergencies or for planned treatments.