फैमिली हेल्थ इंश्योरेंस

फैमिली हेल्थ इंश्योरेंस क्या है?

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.

हेल्थ इंश्योरेंस की प्रमुख विशेषताएं और लाभ

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

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

- रीचार्ज लाभ: क्लेम की राशि आपकी इंश्योर्ड की गयी धनराशि से ज्यादा होने पर क्लेम रियायत की सुविधा

- 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

- इमीडियेट फैमिली कवर: यह नीति आपको, आपके जीवनसाथी और आपके बच्चों को कवर करती है.

- 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.

आपकी फैमिली हेल्थ इंश्योरेंस पॉलिसी के साथ मिलने वाले अतिरिक्त लाभ

हमारा फैमिली हेल्थ इंश्योरेंस आपके और आपके प्रियजनों के लिए विभिन्न लाभ प्रदान करता है:

1) Wellness benefit

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

2) Renewability

यह पॉलिसी आजीवन रिन्यूअल के लाभ के साथ आती है.

3) 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.

4) 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.

5) 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.

6) 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.

7) Long-Term Policy

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

8) 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.

व्यापक लाभ और सुविधाएं:

✓ कई सम इंश्योर्ड विकल्प.
✓ तुरंत फैमिली कवरेज.
✓ आयुष ट्रीटमेंट शामिल है.

विशिष्ट लाभ:

✓ सम इंश्योर्ड के लिए रीचार्ज लाभ.
✓ सम इंश्योर्ड रीइंस्टेटमेंट.
✓ डे-केयर प्रोसीजर के लिए कवरेज.

अतिरिक्त कवरेज:

✓ मैटरनिटी/नवजात शिशु के लिए कवर.
✓ बैरिएट्रिक सर्जरी कवर.
✓ स्वास्थ्य लाभ.

संपूर्ण कवरेज:

✓ पूरे परिवार के लिए कम्प्रीहेंसिव हेल्थ इंश्योरेंस प्लान.

फैमिली हेल्थ इंश्योरेंस क्लेम प्रोसेस

क्लेम बाय डायरेक्ट क्लिक (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.

आपको क्या करने की आवश्यकता है:

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

2) Register your policy and health card number in the app.

3) Register the claim.

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

5) Upload the documents using the app menu.

6) Submit the claims for further processing.

7) Get confirmation within a few hours.

कैशलेस क्लेम प्रोसेस (केवल नेटवर्क हॉस्पिटल में उपचार के लिए लागू):

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.

जब आप कैशलेस दावों का विकल्प चुन रहे हैं, तो प्रक्रिया इस प्रकार है:

- इलाज करने वाले डॉक्टर / अस्पताल द्वारा पूर्व-अधिकृत रिक्वेस्ट फॉर्म भरा जाए और उस पर हस्ताक्षर किया जाए और अस्पताल के बीमा डेस्क पर आपके या परिवार के किसी सदस्य द्वारा हस्ताक्षर किए गए हों.

- नेटवर्क अस्पताल एचएटी को अनुरोध को फैक्स करेगा.

- HAT डॉक्टर प्री-ऑथराइज़ेशन अनुरोध फॉर्म की जांच करेंगे और पॉलिसी के दिशानिर्देशों के अनुसार कैशलेस उपलब्धता पर निर्णय लेंगे.

- प्लान और उसके लाभों के आधार पर प्राधिकरण पत्र (एएल)/इनकार पत्र/अतिरिक्त आवश्यकता पत्र 3 घंटे के भीतर जारी किया जाता है.

- 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.

नोट करने के लिए महत्वपूर्ण बातें:

- 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.

- कैशलेस सुविधा हमेशा आपकी पॉलिसी के नियम और शर्तों के अधीन होती है.

- पॉलिसी निम्नलिखित को कवर नहीं करती हैं :

- Telephone charges

- रिश्तेदारों के लिए खाने-पीने के खर्चे

- टॉयलेटरीज़

- 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.

अस्पताल में भर्ती होने से पहले/बाद के खर्चों का रीइम्बर्समेंट:

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.

रीइंबर्समेंट क्लेम प्रोसेस

रीइंबर्समेंट क्लेम प्रोसेस (गैर-नेटवर्क अस्पताल के मामले में)

- हॉस्पिटलाइज़ेशन के बारे में BAGIC HAT टीम को सूचित करें.

- To register your claim online, click here

- अपना क्लेम ऑफलाइन रजिस्टर करने के लिए, कृपया हमें हमारे टोल-फ्री नंबर पर कॉल करें: 1800-209-5858.

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

- मोबाइल नंबर और ईमेल आईडी के साथ विधिवत भरा और हस्ताक्षरित क्लेम फॉर्म.

- हॉस्पिटल का ओरिजनल बिल एवं भुगतान की रसीद.

- तहकीकात प्रतिवेदन

- डिस्चार्ज कार्ड

- प्रिस्क्रिप्शन

- मूल नुस्खे और औषधालय बिल

- Details of pre-hospitalization expenses (if any)

- अंतरंग रोगी के कागजात, यदि आवश्यक हो.

- 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.

रीइम्बर्समेंट क्लेम के लिए आवश्यक डॉक्यूमेंट:

● 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.

सभी मूल दस्तावेजों को निम्नलिखित पते पर जमा करना होगा:

हेल्थ एडमिनिस्ट्रेशन टीम

बजाज आलियांज हाउस, एयरपोर्ट रोड, यरवदा, पुणे -411006

लिफाफे पर अपना पॉलिसी नंबर, हेल्थ कार्ड नंबर और मोबाइल नंबर स्पष्ट रूप से लिखें.

नोट: अपने रिकॉर्ड के लिए दस्तावेजों और कूरियर संदर्भ संख्या की एक फोटोकॉपी रखें.

फैमिली हेल्थ इंश्योरेंस प्लान खरीदने से पहले इन बातों पर विचार करें

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

1) Sum Insured :

परिवार के सभी सदस्यों, विशेष रूप से पहले से मौजूद बीमारियों या विशिष्ट मेडिकल आवश्यकताओं को कवर करने के लिए पर्याप्त सम इंश्योर्ड चुनें.

2) Premium Costs :

सम इंश्योर्ड और परिवार के सबसे बड़े सदस्य की आयु के साथ प्रीमियम बढ़ जाते हैं. एक किफायती विकल्प चुनें, जो आपके बजट को बढ़ाए बिना कम्प्रीहेंसिव सुरक्षा प्रदान करता हो.

3) Network Hospitals :

बजाज आलियांज़ जनरल इंश्योरेंस कंपनी के पास पूरे भारत में हॉस्पिटल्स का एक विस्तृत नेटवर्क है, जो एमरजेंसी के दौरान भुगतान के बोझ को कम करने के लिए कैशलेस ट्रीटमेंट प्रदान करती है.

4) Pre and Post-Hospitalisation Coverage :

यह सुनिश्चित करें कि आपके प्लान में हॉस्पिटलाइज़ेशन से पहले और बाद में डॉक्टर की विज़िट, डायग्नोस्टिक टेस्ट और दवाओं के खर्च शामिल हैं.

5) Daycare Procedures :

चेक करें कि डे-केयर ट्रीटमेंट कवर किए जाते हैं या नहीं, क्योंकि इनके लिए 24-घंटे के हॉस्पिटल में रहने की आवश्यकता नहीं होती है लेकिन यह महंगा हो सकता है.

6) Ambulance Services :

कन्फर्म करें कि क्या एम्बुलेंस शुल्क शामिल हैं, क्योंकि ये एमरजेंसी स्थितियों में या प्लान किए गए ट्रीटमेंट के लिए मूल्यवान सहायता प्रदान कर सकते हैं.