Health Guard: Gold Plan

Bajaj Allianz General Insurance Company Limited

GE Plaza, Airport Road, Yerewada, Pune-411006, Reg. no. 113
CIN: U66010PN2000PLC015329
Health Guard
Gold Plan
Policy Wordings
Preamble
Our agreement to insure You is based on Your Proposal to Us, which is the basis of this agreement, and Your payment
of the premium. This Policy records the entire agreement between Us and sets out what We insure, how We insure it, and
what Weexpect of You and what You can expect of Us.
Types of Policy
• “ Health Guard-Individual”
• “ Health Guard-Family Floater”
Policy period:
• “ Health Guard-Individual”: 1year, 2years or 3years
• “ Health Guard-Family Floater”:1year, 2years or 3years
Scope of cover:
The Company hereby agrees to pay in respect of an admissible claim, any or all of the following covers subject to the
Sum Insured, limits, terms, conditions and definitions, exclusions contained or otherwise expressed in this Policy.
A) COVERAGE
1. In-patient Hospitalisation Treatment

If You are hospitalized on the advice of a Doctor as defined under policy 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 subject to
i) Room, Boarding and Nursing Expenses as provided by the Hospital/Nursing Home without any sublimit.
ii) If admitted in ICU, we will pay up to actual expenses provided by Hospital.
iii) Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialists Fees.
iv) Anesthesia, Blood, Oxygen, Operation Theatre Charges, 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.
2. Pre-Hospitalisation
The Medical Expenses incurred during the 60 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. (Section A1)
3. Post-Hospitalisation
The Medical Expenses incurred during the 90 days immediately after Youwere 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. (Section A1)
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4. Road Ambulance
We will pay the reasonable cost to a maximum of Rs20000/- per policy yearincurred 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
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 Usonly when:
i. Such life threatening emergency condition is certified by the Medical Practitioner, and
ii. We have accepted Your Claim under "In-patient HospitalisationTreatment" or "Day Care Procedures" section
of the Policy.
Subject otherwise to the terms, conditions and exclusions 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 Section A1 In-patient HospitalisationTreatmentfor Day
care procedures / Surgeries taken as an inpatient in a hospital or day care centre but not in the outpatient
department. Indicative 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
HospitalisationTreatment (section A1).
7. Convalescence Benefit:
In the event of insured hospitalised for a disease/illness/injury for a continuous period exceeding 10 days, We will
pay benefit amount of Rs. 5,000 for Sum Insured up to Rs. 5lacs and Rs. 7500 for Sum Insured 7.5lacsand above
per policy year.
This benefit will be triggered provided that the hospitalization claim is accepted under Section A1-In Patient
Hospitalisation Treatment.
8. Daily Cash Benefit for Accompanying an Insured Child

We will pay Daily Cash Benefit of Rs. 500 per day maximum up to 10 days during each policy year for reasonable
accommodation expenses in respect of one parent/legal guardian, to stay with any minor Insured Person (under the
Age of 12), provided the hospitalization claim is paid under Section A1 Inpatient Hospitalisation Treatment.
9. Sum Insured Reinstatement Benefit:

If Section A1 Inpatient Hospitalization Treatment Sum Insured and Cumulative Bonus (if any) is exhausted due to
claims lodged during the Policy year, then it is agreed that 100% of the Sum Insured specified under Inpatient
Hospitalization Treatment be reinstated for the particular Policy year provided that:
1. The reinstated Sum Insured will be triggered only after the Inpatient Hospitalization Treatment Sum Insured
inclusive of the Cumulative Bonus(If applicable) has been completely exhausted during the policy year;
2. The reinstated Sum Insured can be used for claims made by the Insured Person in respect of the benefits
stated in Inpatient Hospitalization Treatment.
3. If the claimed amount is higher than the Balance Sum Insured inclusive of the Cumulative Bonus(If
applicable) under the policy, then this benefit will not be triggered for such claims
4. The reinstated Sum Insured would be triggered only for subsequent claims made by the Insured Person.In
case of relapse within 45 days, this benefit will not trigger
5. This benefit is applicable only once during each policy year& will not be carried forward to the subsequent
policy year/ renewals if the benefit is not utilized.
6. This benefit is applicable only once in life time of Insured Personcovered under this policy for claims
regarding CANCER OF SPECIFIED SEVERITY and KIDNEY FAILURE REQUIRING REGULAR DIALYSIS
as defined under the policy.
7. This benefit will be applicable annually for policies with term more than 1 year.
8. Additional premium would not be charged for reinstatement of the Sum Insured.
9. Incase Family Floater policy, Reinstatement of Sum Insuredwill be available for all Insured Persons in
thePolicy.
10. Preventive Health Check Up

At the end of block of every continuous period of 3 policy years during which You have held Our Health Guard 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. 5000/- 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.
You may approach us for the arrangement of the Health Check up. For the avoidance of doubt, Weshall not be liable for
any other ancillary or peripheral costs or expenses (including but not limited to those for transportation, accommodation or
sustenance).
11. 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 Healthon the advice of a Doctor because of Illness or AccidentalBodily Injury sustained or
contracted during the Policy Period then We will pay You:
In-patient Treatment- Medical Expenses for Ayurvedic and Homeopathic treatment:

• Room rent, boarding expenses
• Nursing care
• Consultation fees
• Medicines, drugs and consumables,
• Ayurvedic and Homeopathic treatment procedures
Our maximum liability maximum is up to Rs. 20000 per policy 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
12. Maternity Expenses

We will pay the Medical Expenses for the delivery of a baby (including caesarean section) and/or expenses
related to medically recommended and lawful termination of pregnancy, limited to maximum 2 deliveries or
termination(s) or either, during the lifetime of the insured person, provided that,
i. Our maximum liability per delivery or termination shall be limited to the amount specified in the policy
Schedule as per Sum Insured opted.
ii. From Sum insured Rs. 3lacs to Rs. 7.5 lacs is restricted to Rs. 15000 for normal delivery and Rs. 25000
for caesarean section and from Sum insured Rs. 10 lacs to Rs. 50lacs is restricted to Rs. 25000 for
normal delivery and Rs. 35000 for caesarean section
iii. We will pay the Medical Expenses of pre-natal and post-natal hospitalization per delivery or termination
up to the amount stated in the policy Schedule.
iv. Waiting period of 72 months from the date of issuance of the first policy with us, provided that the policy
has been renewed continuously renewed with us without break for you.Fresh waiting period of 72 months
would apply for all the policies which are issued with continuity under portability guidelines either from our
existing Health Product or any other Non-Health or Standalone Health Insurance Company.
v. We will not cover Ectopic pregnancy under this benefit (although it shall be covered under section A1 In
patient Hospitalisation Treatment)
vi. Any complications arising out of or as a consequence of maternity/child birth will be covered within the
limit of Sum Insured available under this benefit.
13. New Born Baby Cover

Coverage for new born baby will be considered subject to a valid claim being accepted under Maternity Expenses
(section A12). We will pay the following expenses within the limit of the Sum Insured available under the Maternity
Expenses section.
We will pay for,

i. Medical Expenses towards treatment of your new born baby while you are hospitalised as an inpatient for
delivery for the hospitalisation,
ii. Hospitalisation charges incurred on the new born baby during post birth including any complications shall
be covered up to a period of 90 days from the date of birth and within limit of the Sum Insured under
Maternity Expenses without payment of any additional premium
iii. Mandatory Vaccinations of the new born baby up to 90 days, as recommended by the Indian Pediatric
Association will be covered under the Maternity ExpensesSum Insured.
14. Bariatric Surgery Cover
If You are hospitalized on the advice of a Doctor because of Conditions mentioned below which required you to
undergo Bariatric Surgery during the Policy period, then We will pay You, Reasonable and Customary Expenses
related to Bariatric Surgery
Eligibility:
For adults aged 18 years or older, presence of severe obesity documented in contemporaneous clinical records,
defined as any of the following:
BMI greater than and equal to 40in conjunctions with any of the following severe comorbidities:
1. Coronary heart disease; or
2. Medically refractory hypertension (blood pressure greater than 140 mm Hg systolic and/or 90 mm Hg
diastolic despite concurrent use of 3 anti-hypertensive agents of different classes); or
3. Type 2 diabetes mellitus
Special Conditions applicable to Bariatric Surgery Cover

• This benefit is subject to a waiting period of 36 months from the date of first commencement of this policy and
continuous renewal thereof with the Company. Fresh waiting period of 36 months would apply for all the
policies which are issued with continuity under portability guidelines either from our existing Health Product or
any other Non-Health or Standalone Health Insurance Company..
• Policies which are issued with continuity under portability guidelines either from our existing Health Product or
any other Non-Health or Standalone Health Insurance Company will have to wait for 36 months from issuance
of Health Guardpolicy to avail this benefit.
• Our maximum liability will be restricted to 50% of Sum insured maximum up to Rs. 5lac.
• Bariatric surgery performed for Cosmetic reasons is excluded.
• The indication for the procedure should be found appropriate by two qualified surgeons and the insured
person shall obtain prior approval for cashless treatment from the Company.
B) Definitions
1. Accident, Accidental –
An accident is a sudden, unforeseen and involuntary event caused by external, visible and violent means.
2. Act of Terrorism:-
Whoever
a. With intent to threaten the unity, integrity, security or sovereignty of India or to strike terror in the people
or any section of the people does any act or thing by using bombs, dynamite or other explosive
substances or inflammable substances or firearms or other lethal weapons or poisons or noxious gases
or other chemicals or by any other substances (whether biological or otherwise) of a hazardous nature or
by any other means whatsoever, in such a manner as to cause or likely to cause, death of or injuries to
any person or persons or loss of or damage to or destruction of property or disruption of any supplies or
services essential to the life of the community or causes damage or destruction of any property or
equipment used or intended to be used for the defense of India or in connection with any other purposes
of the Government of India, any state government or any of their agencies or detains any person and
threatens to kill or injure such person in order to compel the Government or any other person to do or
abstain from doing any act
b. Is or continues to be a member of an association declared unlawful under the Unlawful Activities
(Prevention) Act 1967, (37 of 1967), or voluntarily does an act aiding or promoting in any manner the
objects of such association and in either case is in possession of any unlicensed firearms, ammunition,
explosives or other instrument or substances capable of causing mass destruction and commits any act
resulting in loss of human life or grievous injury to any person or causes significant damage to any
property, commits a terrorist act.
3. Any one illness

Any one illness means continuous Period of illness and it includes relapse within 45 days from the date of last
consultation with the Hospital/Nursing Home where treatment may have been taken.
4. BajajAllianzNetworkHospitals / NetworkHospitals
Bajaj Allianz Network Hospitals / Network Hospitals means the Hospitals which have been empanelled by Us as
per the latest version of the schedule of Hospitals maintained by Us, which is available to You on request.For
updated list please visit our website.
5. Bajaj Allianz Diagnostic Centre

Bajaj Allianz Diagnostic Centre means the diagnostic centers which have been empanelled by us as per the latest
version of the schedule of diagnostic centers maintained by Us, which is available to You on request.
6. Bariatric surgery:
means Surgery on the stomach and/or intestines to help a person with extreme obesity to lose weight. Bariatric
surgery is an option for people who have a body mass index (BMI) above 40. Surgery is also an option for people
with a body mass index between 35 and 40 who have health problems like type 2 diabetes or heart disease.
7. Cancer of Specified Severity

A malignant tumor characterized by the uncontrolled growth & spread of malignant cells with invasion &
destruction of normal tissues. This diagnosis must be supported by histological evidence of malignancy &
confirmed by a pathologist. The term cancer includes leukemia, lymphoma and sarcoma.
The following are excluded –
• Tumors showing the malignant changes of carcinoma in situ & tumors which are histological
described as pre- malignant or non invasive, including but not limited to: Carcinoma in situ of breasts,
Cervical dysplasia CIN-1, CIN -2 & CIN-3.
• Any skin cancer other than invasive malignant melanoma
• All tumours of the prostate unless histological classified as having a Gleason score greater than 6 or
having progressed to at least clinical TNM classification T2N0M0.
• Papillary micro - carcinoma of the thyroid less than 1 cm in diameter
• Chronic lymphocyctic leukemia less than RAI stage 3
• Micro carcinoma of the bladder

• All tumors in the presence of HIV infection.
8. Cashless facility
"Cashless facility” means a facility extended by the insurer to the insured where the payments, of the costs of
treatment undergone by the insured in accordance with the policy terms and conditions, are directly made to the
network provider by the insurer to the extent pre-authorization approved.
9. Co-Payment
A co-payment is a cost-sharing requirement under a health insurance policy that provides that the
policyholder/insured will bear a specified percentage of the admissible claim amount. A co-payment does not
reduce the Sum Insured.
10. Condition Precedent

Condition Precedent shall mean a policy term or condition upon which the Insurer's liability under the policy is
conditional upon.
11. Congenital Anomaly

Congenital Anomaly refers to a condition(s) which is present since birth, and which is abnormal with reference to
form, structure or position.
a. Internal Congenital Anomaly- Congenital anomaly which is not in the visible and accessible parts of
the body
b. External Congenital Anomaly- Congenital anomaly which is in the visible and accessible parts of the
body
12. Contribution
Contribution is essentially the right of an insurer to call upon other insurers liable to the same insured to share the
cost of an indemnity claim on a ratable proportion of Sum Insured. This clause shall not apply to any Benefit
offered on fixed benefit basis.
13. Cumulative Bonus

Cumulative Bonus shall mean any increase in the Sum Insured granted by the insurer without an associated
increase in premium.
14. Day care centre

A day care centre means any institution established for day care treatment of illness and / or injuries or a medical
set -up within a hospital and which has been registered with the local authorities, wherever applicable, and is
under the supervision of a registered and qualified medical practitioner AND must comply with all minimum criteria
as under:- has qualified nursing staff under its employment has qualified medical practitioner (s) in charge has a
fully equipped operation theatre of its own where surgical procedures are carried out- maintains daily records of
patients and will make these accessible to the Insurance company’s authorized personnel.
15. Day Care Treatment

Day care treatment refers to medical treatment, and/or surgical procedure which is:
i. undertaken under General or Local Anesthesia in a hospital/day care centre in less than 24 hrs because of
technological advancement, and
ii. Which would have otherwise required a hospitalization of more than 24 hours.
Treatment normally taken on an out-patient basis is not included in the scope of this definition.
16. Dental Treatment

Dental treatment is treatment carried out by a dental practitioner including examinations, fillings (where
appropriate), crowns, extractions and surgery excluding any form of cosmetic surgery/implants.
17. Dependent child

A child is considered a dependent for insurance purposes until his 35th birthday (even if not enrolled in an
educational institution) provided he is financially dependent, on the proposal.
18. Disclosure to information norm

The Policy shall be void and all premium paid hereon shall be forfeited to the Company, in the event of
misrepresentation, mis-description or non-disclosure of any material fact.
19. Emergency Care

Emergency care means management for a severe illness or injury which results in symptoms which occur
suddenly and unexpectedly, and requires immediate care by a medical practitioner to prevent death or serious
long term impairment of the insured person’s health.
20. Family
For the purpose of Individual Sum Insured policy- includes the insured; his/her lawfully wedded spouse and
dependent children, parents, Sister, Brother, In laws, Aunt, Uncle, Grandchildren.
For the purpose of Family Floater- includesthe insured; his/her lawfully wedded spouse and dependent
children.ForParents separate floater policy can be taken.
21. Grace Period

Grace period means the specified period of time immediately following the premium due date during which a
payment can be made to renew or continue a policy in force without loss of continuity benefits such as waiting
periods and coverage of pre existing diseases. Coverage is not available for the period for which no premium is
received.
22. Hospital
A hospital means any institution established for in-patient care and day care treatment of illness and/or injuries
and which has been registered as a hospital with the local authorities under the Clinical Establishments
(Registration and Regulation) Act, 2010 or under the enactments specified under the Schedule of Section 56(1) of
the said Act OR complies with all minimum criteria as under:
--has qualified nursing staff under its employment round the clock;
--has at least 10 in-patient beds in towns having a population of less than 10,00,000 and at least 15 in-patient
beds in all other places;
--has qualified medical practitioner(s) in charge round the clock;
--has a fully equipped operation theatre of its own where surgical procedures are carried out;
--maintains daily records of patients and makes these accessible to the insurance company’s authorized
personnel.
23. Hospitalisation
Means admission in a Hospital for a minimum period of 24 In patient Care consecutive hours except for specified
procedures/ treatments, where such admission could be for a period of less than 24consecutive hours.
24. Illness
Illness means a sickness or a disease or pathological condition leading to the impairment of normal physiological
function which manifests itself during the Policy Period and requires medical treatment.
a. Acute condition - Acute condition is a disease, illness or injury that is likely to respond quickly to
treatment which aims to return the person to his or her state of health immediately before suffering the
disease/illness/injury which leads to full recovery.
b. Chronic condition - A chronic condition is defined as a disease, illness, or injury that has one or more of
the following characteristics:—it needs ongoing or long-term monitoring through consultations, examinations,
check-ups, and /or tests—it needs ongoing or long-term control or relief of symptoms— it requires your
rehabilitation or for you to be specially trained to cope with it—it continues indefinitely—it comes back or is
likely to come back.
25. Inpatient Care

Inpatient care means treatment for which the insured person has to stay in a hospital for more than 24 hours for a
covered event.
26. Injury/ Bodily Injury

Injury means accidental physical bodily harm excluding illness or disease solely and directly caused by external,
violent and visible and evident means which is verified and certified by a Medical Practitioner.
27. Intensive Care Unit
Intensive care unit means an identified section, ward or wing of a hospital which is under the constant supervision
of a dedicated medical practitioner(s), and which is specially equipped for the continuous monitoring and
treatment of patients who are in a critical condition, or require life support facilities and where the level of care and
supervision is considerably more sophisticated and intensive than in the ordinary and other wards.
28. Kidney Failure Requiring Regular Dialysis

End stage renal disease presenting as chronic irreversible failure of both kidneys to function, as a result
of which either regular renal dialysis (hemodialysis or peritoneal dialysis) is instituted or renal transplantation is
carried out. Diagnosis has to be confirmed by a Specialist Consultant.
29. Limit of Indemnity

Limit of Indemnity represents Our maximum liability to make payment for each and every claim per person and
collectively for all persons mentioned in the Schedule during the policy period and in the aggregate for the
person(s) named in the schedule during the policy period, and means the amount stated in the Schedule against
each Cover.
30. Maternity expense / treatment shall include the following Medical treatment Expenses:
Medical Expenses for a delivery (including complicated deliveries and caesarean sections) incurred during
Hospitalization; The lawful medical termination of pregnancy during the Policy Period limited to 2 deliveries
or terminations or either during the lifetime of the Insured Person;
Pre-natal and post-natal Medical Expenses for delivery or termination.
31. New Born Baby

Newborn baby means baby born during the Policy Period and is aged between 1 day and 90 days, both days
inclusive.
32. Medical Advise

Any consultation or advice from a Medical Practitioner including the issue of any prescription or repeat
prescription.
33. Medical expenses

Medical Expenses means those expenses that an Insured Person has necessarily and actually incurred for
medical treatment on account of Illness or Accident on the advice of a Medical Practitioner, as long as these are
no more than would have been payable if the Insured Person had not been insured and no more than other
hospitals or doctors in the same locality would have charged for the same medical treatment.
34. Medical Practitioner/ Physician/ Doctor:

A Medical Practitioner is a person who holds a valid registration from the Medical Council of any State or Medical
Council of India or Council for Indian Medicine or for Homeopathy set up by the Government of India or a State
Government and is thereby entitled to practice medicine within its jurisdiction; and is acting within the scope and
jurisdiction of license.
35. Medically Necessary

Medically necessary treatment is defined as any treatment, tests, medication, or stay in hospital or part of a stay
in hospital which
- is required for the medical management of the illness or injury suffered by the insured;
- must not exceed the level of care necessary to provide safe, adequate and appropriate medical care in scope,
duration, or intensity;
- must have been prescribed by a medical practitioner,
- must conform to the professional standards widely accepted in international medical practice or by the medical
community in India.
36. Named Insured/ Insured:

Insured means the persons, or his Family members, named in the Schedule provided that an Insured or his
Family Members has attained the age of 3 months and is not older than 65 years of age at the commencement of
the Policy Period.
37. Non- Network

Any hospital, day care centre or other provider that is not part of the network.
38. Notification of Claim

Notification of claim is the process of notifying a claim to the insurer or TPA by specifying the timelines as well as
the address / telephone number to which it should be notified.
39. OPD treatment

OPD treatment is one in which the Insured visits a clinic / hospital or associated facility like a consultation room
for diagnosis and treatment based on the advice of a Medical Practitioner. The Insured is not admitted as a day
care or in-patient.
40. Obesity means abnormal or excessive fat accumulation that may impair health. Obesity is measured in Body
Mass Index.
Body mass index (BMI) is a simple index of weight-for-height that is commonly used to classify overweight and
obesity in adults. It is defined as a person's weight in kilograms divided by the square of his height in meters
(kg/m2).
The WHO definition is:
• BMI greater than or equal to 25 is overweight
• BMI greater than or equal to 30 is obesity
41. Portability
Portability means transfer by an individual health insurance policyholder (including family cover) of the credit
gained for pre-existing conditions and time-bound exclusions if he/she chooses to switch from one insurer to
another.
42. Pre-Existing Disease

Any condition, ailment or injury or related condition(s) for which you had signs or symptoms, and / or were
diagnosed, and / or received medical advice / treatment within 48 months to prior to the first policy issued by the
insurer.
43. Pre-hospitalization Medical Expenses

Medical Expenses incurred immediately before the Insured Person is Hospitalised, provided that:
• Such Medical Expenses are incurred for the same condition for which the Insured Person’s
Hospitalisation was required, and
• The In-patient Hospitalization claim for such Hospitalization is admissible by the Insurance Company.
44. Post-hospitalization Medical Expenses

Medical Expenses incurred immediately after the Insured Person is Hospitalised, provided that:
• Such Medical Expenses are incurred for the same condition for which the Insured Person’s
Hospitalisation was required, and
• ii. The In-patient Hospitalization claim for such Hospitalization is admissible by the Insurance Company.
45. Qualified Nurse

Qualified nurse is a person who holds a valid registration from the Nursing Council of India or the Nursing Council
of any state in India.
46. Reasonable and Customary Charges

Reasonable and Customary charges means the charges for services or supplies, which are the standard charges
for the specific provider and consistent with the prevailing charges in the geographical area for identical or similar
services, taking into account the nature of the illness / injury involved
47. Room rent

Means the amount charged by a hospital for the occupancy of a bed on per day (24 hours) basis and shall include
associated medical expenses.
48. Renewal
Renewal defines the terms on which the contract of insurance can be renewed on mutual consent with a provision
of grace period for treating the renewal continuous for the purpose of all waiting periods.
49. Surgery
Surgery or Surgical Procedure means manual and / or operative procedure (s) required for treatment of an illness
or injury, correction of deformities and defects, diagnosis and cure of diseases, relief of suffering or prolongation
of life, performed in a hospital or day care centre by a medical practitioner
50. Schedule means the schedule and any annexure to it.
51. Unproven/Experimental treatment

Unproven/Experimental treatment is treatment, including drug Experimental therapy, which is not based on
established medical practice in India, is treatment experimental or unproven.
52. You, Your, Yourself, Your Family named in the schedule means the person or persons that We insure as set
out in the Schedule.
53. We, Our, Ours means the Bajaj Allianz General Insurance Company Limited.
C) 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 36 months of continuous
coverage have elapsed, after the date of inception of the first Health Guardpolicy, 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 Guardpolicy with Us for a
continuous period of a full 36 months without break from the date of Your first Health Guardpolicy.
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 Guardpolicy with Us without break in cover.
2. We will also not pay for claims arising out of or howsoever connected to the following for the first 24 months of
Health Guardpolicy,
1. Any types of gastric or duodenal ulcers, 9. Cataracts,
2. Benign prostatic hypertrophy 10. Hernia of all types
3. All types of sinuses 11. Fistulae, Fissure in ano
4. Haemorrhoids 12. Hydrocele
5. Dysfunctional uterine bleeding 13. Fibromyoma
6. Endometriosis 14. Hysterectomy
7. Stones in the urinary and biliary 15. Surgery for any skin ailment
systems
8. Surgery on 16. Surgery on all internal or external
ears/tonsils/adenoids/paranasal sinuses tumours/ cysts/ nodules/polyps of any
kind including breast lumps with
exception of Malignant tumor or growth.
This exclusion shall apply for a continuous period of 36 months from the date of Your Health Guardpolicy, 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 for the first time.
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 Guardpolicy with Us without break in cover.
3. Any Medical Expenses incurred during the first 36 months during which You have the benefit of a Health
Guardpolicy with Us in connection with:
Joint replacement surgery,
Surgery for prolapsed inter vertebral disc (unless necessitated due to an accident)
Surgery to correct deviated nasal septum
Hypertrophied turbinate
Congenital internal diseases or anomalies
Treatment for correction of eye sight due to refractive error recommended by Ophthalmologist for medical
reasons.
Bariatric Surgery
4. 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.
5. Any treatment arising from or traceable to pregnancy, child birth including cesarean sectionand/or any
treatment related to pre and postnatal care and complications arising out of Pregnancy and Childbirth until 72
months continuous period has elapsed since the inception of the first Health Guard Policy with US. However
this exclusion will not apply to Ectopic Pregnancy proved by diagnostic means and certified to be life
threatening by the attending medical practitioner.
6. 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 or cancer and also requiring Hospitalisation
7. Medical expenses where Inpatient care is not warranted and does not require supervision of qualified nursing
staff and qualified medical practitioner round the clock
8. 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.
9. Circumcision unless required for the treatment of Illness or Accidental bodily injury,
10. Cosmetic or aesthetic treatments of any description, treatment or surgery for change of life/gender.
11. Any form of plastic surgery unless necessary for the treatment of cancer, burns or accidental Bodily Injury
12. The cost of spectacles, contact lenses, hearing aids, crutches, artificial limbs, 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.
13. 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.
14. Convalescence, general debility, rest cure, congenital external diseases or defects or anomalies, genetic
disorders, stem cell implantation or surgery, or growth hormone therapy.
15. Intentional self-injury (including but not limited to the use or misuse of any intoxicating drugs or alcohol)
16. Ailments requiring treatment due to use or abuse of any substance, drug or alcohol and treatment for de-
addiction.
17. Any condition directly or indirectly caused by or associated with Human Immunodeficiency Virus or
Variant/mutant viruses and or any syndrome or condition of a similar kind commonly referred to as AIDS.
18. Medical Expenses relating to any hospitalisation primarily and specifically for diagnostic, X-ray or laboratory
examinations and investigations
19. 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.
20. Any fertility, sub fertility, Infertility, sterility, erectile dysfunction, impotence, assisted conception operation or
sterilization procedure.
21. Vitamins, tonics, nutritional supplements unless forming part of the treatment for injury or disease as certified by
the attending Doctor
22. Experimental, unproven or non-standard treatment
23. Weight management services and treatment related to weight reduction programmes including treatment of
obesity
24. Treatment for any mental illness or psychiatric illness, Parkinson’s Disease.
25. All non-medical Items as per Annexure II
26. Any treatment received outside India is not covered under this policy.
D) Conditions
1. Conditions Precedent
Where this Policy requires You to do or not to do something, then the complete satisfaction of that
requirement by You or someone claiming on Your behalf is a precondition to any obligation We have under
this Policy. If You or someone claiming on Your behalf fails to completely satisfy that requirement, then We
may refuse to consider Your claim.
2. Insured
Only those persons named as the insured in the Schedule shall be covered under this Policy. Cover under
this Policy shall be withdrawn from any insured member upon such insured member giving 14 days written
notice to be received by Us.
3. Communications
Any communication meant for Us must be in writing and be delivered to Our address shown in the Schedule.
Any communication meant for You will be sent by Us to Your address shown in the Schedule.
4. Claims Procedure
All Claims will be settled by In house claims settlement team of the company and no TPA is engaged.
If You meet with any Accidental Bodily Injury or suffer an Illness that may result in a claim, then as a condition
precedent to Our liability, You must comply with the following:
A. 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:
i. Prior to taking treatment and/or incurring Medical Expenses at a Network Hospital, You or your
representative must call Us and request pre-authorisation by way of the written form.
ii. After considering Your request and after obtaining any further information or documentation We have
sought, We may, if satisfied, send You or the NetworkHospital, 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 NetworkHospital identified in the pre-authorization letter at
the time of Your admission to the same.
iii. If the procedure above is followed, You will not be required to directly pay for the bill amount in the
NetworkHospital that We are liable under Section A1In-Patient Hospitalisation Treatment above and the
original bills and evidence of treatment in respect of the same shall be left with the NetworkHospital.
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.
B. Reimbursement Claims Procedure:

If Pre-authorisation as per Cashless Claims Procedure above is denied by Us or if treatment is taken in a
Hospital other than a Network Hospital or if You do not wish to avail cashless facility, then:
i. You or someone claiming on Your behalf must inform Us in writing immediately within 48 hours of
hospitalization 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
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
• 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.
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
5. 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 within a period of 30 days 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. 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.
6. 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. If opted voluntarily by you, You shall bear 10% / 20% of co-payment for each and every claim payable
under the Inpatient Hospitalization Treatment section and Our liability, if any, shall only be in excess of
that sum.
iii. 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.
iv. Our obligation to make payment in respect of surgeries for cataracts (after the expiry of the 24 months
period referred to in Exclusion C2) above, shall be restricted to 20% of the Sum insured for each eye,
subject to maximum of Rs 1,00,000/- for each of You.
v. Our obligation to make payment in respect of Bariatric Surgery (after the expiry of the36 months period
referred to in Exclusion C3) above, shall be restricted to 50% of the Sum insured, subject to maximum of Rs
5lac.
vi. We shall make payment in Indian Rupees only.
vii. If claim event falls within two policy periods the claims shall be administered taking into consideration
the available sum insured in the two policy periods, including the deductibles (if any) for each policy
period. The claim amount to be payable shall be reduced up to the extent of the premium to be received
for renewal/due date of premium of this policy, if the same is not received earlier.
7. Cumulative Bonus:
If You renew Your “ Health Guard” with Us without any break and there has been no claim in the preceding
year, We will increase the Limit of Indemnity by 10% of base sum insured per annum, but:
i. The maximum cumulative increase in the Limit of Indemnity will be limited to 10 years and 100% of
base sum insured of Your first “Health Guard” with Us.
ii. This clause does not alter the annual character of this insurance
iii. If a claim is made in any year where a cumulative increase has been applied, then the increased Limit
of Indemnity in the policy period of the subsequent “Health Guard” shall be reduced by 10%, save that
the limit of indemnity applicable to Your first “ Health Guard” with Us shall be preserved.
8. Fraud
If You make or progress any claim knowing it to be false or fraudulent in any way, then this Policy will be void
and all claims or payments due under it shall be lost and the premium paid shall become forfeited.
9. Other Insurance/ Contribution

If two or more policies are taken by You during a period from one or more insurers to indemnify treatment
costs, We shall not apply the contribution clause, but You shall have the right to require a settlement of your
claim in terms of any of your policies.
In all such cases the insurer who has issued the chosen policy shall be obliged to settle the claim without
insisting on the contribution clause as long as the claim is within the limits of and according to the terms of the
chosen policy.
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 by whom the claim to be settled. In such cases, the
insurer may settle the claim with contribution clause.
Except in benefit policies, in cases where Youhave policies from more than one insurer to cover the same risk
on indemnity basis, You shall only be indemnified the hospitalization costs in accordance with the terms and
conditions of the policy
10. Entry Age and Renewal Age
Cover Member Eligible Entry Age Renewal

Self, Spouse, Parents, Sister,
18 years to 65 years lifetime renewals**
Brother, In laws, Aunt, Uncle.
“Health Guard”
Dependent
3 months to 30 years 35 Years*
Children,Grandchildren.
* After the completion of maximum renewal age of dependent children, the policy would be renewed for lifetime,
subject to Separate proposal form should be submitted to us at the time of renewal with the insured member as
proposer and subsequently the policy should be renewed annually with us and within the Grace period of 30 days
from date of Expiry. Continuity for all the waiting periods shall be extended in the new policy.
** Subject to policy is renewed annually with us within the Grace period of 30 days from date of Expiry
Eligibility:
• Indian nationals residing in India would be considered for this policy.
• This policy can be opted by Non-Resident Indians also; however the policy will be issued during their stay in
India& premium paid in Indian currency & by Indian Account only
• Copy of any one of the below KYC documents will have to be submitted along with the Proposal form: Voters ID
Card, Driving License, Passport, PAN Card
• Sum Insured for Self (i.e. Proposer) cannot be less than any of his/her family members.
11. Renewal & Cancellation
i. Under normal circumstances, renewal will not be refused except on the grounds of Yourmoral hazard,
misrepresentation, 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.
vii. 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.
viii. 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
Policy
Period in Risk Policy Period 1 Policy Period 2
Period 3
Year Year
Year
Within 15 Days Pro Rata Refund
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 24 months but less than 27 months 20.00%
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”.
12. 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.
13. 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. However, such benefits shall be applicable only in the event of discontinuation/ non-
renewal of the Group Health Policy (applicable for both employer-employee relationships and non-
employer-employee relationships) and/or the particular insured person leaving the group on account of
resignation/ retirement (applicable for employer-employee relationships) or termination of relationship
with the Group Administrator (applicable for non-employer-employee relationships). The pre-policy
medical examination requirements and provisions for such cases shall remain similar to non-portable
cases.
14. Endorsements
This Policy constitutes the complete contract of insurance. This Policy cannot be changed by anyone
(including an insurance agent or broker) except Us. Any change that We make will be evidenced by a written
endorsement signed and stamped by Us.
15. 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 revision/modification comes into the effect
16. 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
17. Withdrawal of Policy

There is possibility of withdrawal of this product at any time in future with appropriate approval from IRDA, 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 IRDA.
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.
18. Discounts:
i. Family Discount:10% family discount shall be offered if 2 eligible family members are covered under a single
policy and 15% if more than 2 of any of the eligible family members are covered under a single policy. Moreover,
this family discount will be offered for both new policies as well as for renewal policies. Family discount is not
applicable to Health Guard Floater Policies
ii. 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
iii. Co-pay Discount:
If opted voluntarily and mentioned on the Policy Schedule that a Co-payment is effective by the Insured then
Insured will be eligible of additional 10% or 20% discount on the policy premium.
If a claim has been admitted under Section A 1)In-patient HospitalisationTreatmentthen, the insured person shall
bear 10% or 20% respectively of the eligible claim amount payable under this section and Our liability, if any, shall
only be in excess of that sum and would be subject to the Sum Insured.
iv. 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
19. Premium payment Zone:
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.
20. Sum Insured Enhancement:

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.
21. Inclusion of members under the policy:

Where an Insured Person is added to this Policy, either by way of endorsement or at the time of renewal, the pre-
existing disease clause, exclusions and waiting periods will be applicable considering such Policy Year as the first
year of Policy with the Company for the insured member.
22. Territorial Limits & Governing Law

i. We cover insured events arising during the Policy Period, as well as treatment availed, within India only. Our
liability to make any payment shall be to make payment within India and in Indian Rupees only.
ii. The Policy constitutes the complete contract of insurance. No change or alteration shall be valid or effective
unless approved in writing by Us, which approval shall be evidenced by an endorsement on the Schedule.
iii. The construction, interpretation and meaning of the provisions of this Policy shall be determined in
accordance with Indian law. The section headings of this Policy are included for descriptive purposes only
and do not form part of this Policy for the purpose of its construction or interpretation.
23. Arbitration and Reconciliation

i. If any dispute or difference shall arise as to the quantum to be paid under the Policy (liability being otherwise
admitted), such difference shall independently of all other questions be referred to decision of a sole arbitrator
in writing by the parties or if they cannot agree upon a single arbitrator within 30 days of any party invoking
arbitration, the same shall be referred to a panel of the arbitrators comprising of two arbitrators, one appointed
by each of the parties to the dispute/difference and the third arbitrator to be appointed by such two arbitrators
and arbitration shall be conducted under and in accordance with the provisions of the Arbitration and
Conciliation Act, 1996. The law of the arbitration will be Indian law, and the seat of the arbitration and venue
for all hearings shall be within India.
ii. It is clearly agreed and understood that no difference or dispute shall be referable to arbitration as herein
before provided, if Wehave disputed or not accepted liability under or in respect of this Policy.
iii. It is hereby expressly stipulated and declared that it shall be a condition precedent to any right of action or suit
upon this Policy that award by such arbitrator/arbitrators of the amount of the loss or damage shall be first
obtained.
iv. If these arbitration provisions are held to be invalid, then all such disputes or differences shall be referred to
the exclusive jurisdiction of the Indian Courts.
24. Grievance Redressal Procedure
Welcome to Bajaj Allianz and Thank You for choosing us as your insurer.
Please read your policy and schedule.
The policy and policy schedule set out the terms of your contract with us. Please read your policy and policy
schedule carefully to ensure that the cover meets your needs.
We do our best to ensure that our customers are delighted with the service they receive from Bajaj Allianz. If
you are dissatisfied we would like to inform you that we have a procedure for resolving issues. Please include
your policy number in any communication. This will help us deal with the issue more efficiently. If you don't have
it, please call our Branch office.
Initially, we suggest you contact the Branch Manager/ Regional Manager of the local office which has issued the
policy. The address and telephone number will be available in the policy. Naturally, we hope the issue can be
resolved to your satisfaction at the earlier stage itself. But if you feel dissatisfied with the suggested resolution of
the issue after contacting the local office, please e-mail or write to:
Bajaj Allianz General Insurance Co. Ltd

GE Plaza, Airport Road
Yerawada, Pune 411006
E-mail: customercare@bajajallianz.co.in
Call : 1800-225858 (free calls from BSNL/MTNL lines only)
1800-1025858 ( free calls from Bharti users – mobile /landline ) or020-30305858
Grievance Redressal Cell for Senior Citizens

Senior Citizen Cellfor 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:seniorcitizen@bajajallianz.co.in
If you are still not satisfied, you can approach the Insurance Ombudsman in the respective area for resolving
the issue. The contact details of the Ombudsman offices are mentioned below:
CONTACT DETAILS JURISDICTION
AHMEDABAD
Office of the Insurance Ombudsman,
State of Gujarat and Union
2nd floor, Ambica House, Near C.U. Shah College,
Territories of Dadra & Nagar Haveli
5, Navyug Colony, Ashram Road, Ahmedabad – 380 014
and Daman and Diu.
Tel.:- 079-27546150/139 Fax:- 079-27546142
Email:- insombahd@rediffmail.com
BHOPAL
JanakVihar Complex, 2nd Floor, 6, Malviya Nagar, Opp.Airtel, States of Madhya Pradesh and
Bhopal – 462 011. Chattisgarh.
Tel.:- 0755-2769200/201/202 Fax:- 0755-2769203
Email:- bimalokpalbhopal@airtelbroadband.in
BHUBANESHWAR
62, Forest park, Bhubneshwar – 751 009. State of Orissa.
Tel.:- 0674-2535220/3798/1607 Fax:- 0674-2531607
Email:- ioobbsr@dataone.in
CHANDIGARH
States of Punjab, Haryana, Himachal
S.C.O. No. 101, 102 & 103, 2nd Floor, Batra Building, Sector 17 – D,
Pradesh, Jammu & Kashmir and
Chandigarh – 160 017.
Union territory of Chandigarh.
Tel.:- 0172-2706196/5861/6468 Fax:- 0172-2708274
Email:- ombchd@yahoo.co.in
CHENNAI
Office of the Insurance Ombudsman, State of Tamil Nadu and Union
Fatima Akhtar Court, 4th Floor, 453 (old 312), Anna Salai, Teynampet, Territories - Pondicherry Town and
CHENNAI – 600 018. Karaikal (which are part of Union
Tel.:- 044-24333678/664/668 Fax:- 044-24333664 Territory of Pondicherry).
Email:- insombud@md4.vsnl.net.in
DELHI
2/2 A, Universal Insurance Building, Asaf Ali Road,
States of Delhi and Rajasthan.
New Delhi – 110 002.
Tel.:- 011-23239611/7539/7532 Fax:- 011-23230858
Email:- iobdelraj@rediffmail.com
GUWAHATI
States of Assam, Meghalaya,
'JeevanNivesh’, 5th Floor, Nr. Panbazar over bridge, S.S. Road,
Manipur, Mizoram, Arunachal
Guwahati – 781001(ASSAM).
Pradesh, Nagaland and Tripura.
Tel.:- 0361- 2132204/2131307/2132205 Fax:- 0361-2732937
Email:- ombudsmanghy@rediffmail.com
HYDERABAD
States of Andhra Pradesh,
6-2-46, 1st floor, "Moin Court" Lane Opp. Saleem Function Palace,
Karnataka and Union Territory of
A. C. Guards, Lakdi-Ka-Pool,
Yanam - a part of the Union Territory
Hyderabad - 500 004.
of Pondicherry.
Tel.:- 040-23325325/23312122 Fax:- 040-23376599
Email:- insombudhyd@gmail.com
KOCHI
2nd Floor, CC 27 / 2603, Pulinat Bldg., Opp. Cochin Shipyard, M. G. State of Kerala and Union Territory
Road, of (a) Lakshadweep (b) Mahe-a part
Ernakulam - 682 015. of Union Territory of Pondicherry.
Tel.:- 0484-2358734/759/9338 Fax:- 0484-2359336
Email:- iokochi@asianetindia.com
KOLKATA
States of West Bengal, Bihar,
Sikkim, Jharkhand and Union
North British Bldg., 3rd Floor, 29, N. S. Road, Kolkata - 700 001.
Territories of Andaman and Nicobar
Tel.:- 033-22134869/67/66 Fax:- 033-22134868
Islands.
Email:- iombkol@vsnl.net
LUCKNOW
Office of the Insurance Ombudsman, States of Uttar Pradesh
6th Floor, JeevanBhawan, Phase-II, Nawal Kishore Road, andUttaranchal.
Hazratganj, Lucknow-226 001.
Tel.:- 0522-2201188/31330/1 Fax:- 0522-2231310.

Email:- ioblko@sancharnet.in
MUMBAI
3rd Floor, JeevanSevaAnnexe, S. V. Road, Santacruz (W), Mumbai - 400
States of Maharashtra and Goa.
054.
Tel.:- 022-26106928/360/889 Fax:- 022-26106052
Email:- ombudsman@vsnl.net
Note: Address and contact number of Governing Body of Insurance Council

Secretary General - Governing Body of Insurance Council
JeevanSevaAnnexe, 3rd Floor, S.V. Road, Santacruz (W), Mumbai - 400 054
Tel No: 022-2610 6889, 26106245, Fax No. : 022-26106949, 2610 6052, E-mail ID: inscoun@vsnl.net
Cashless facility offered through network hospitals of Bajaj Allianz only.Cashless facility at 3300+ Network
hospitals PAN India.
Please visit our website for list of network hospitals and network Diagnostic Centres , Website:
www.bajajallianz.com or get in touch with 24*7 helpline number: 1800-103-2529 (toll free) / 020-30305858
Annexure I
Indicative list of Day Care Procedures:
1. Suturing - CLW -under LA or GA

2. Surgical debridement of wound
3. Therapeutic Ascitic Tapping
4. Therapeutic Pleural Tapping
5. Therapeutic Joint Aspiration
6. Aspiration of an internal abscess under ultrasound guidance
7. Aspiration of hematoma
8. Incision and Drainage
9. Endoscopic Foreign Body Removal - Trachea /- pharynx-larynx/ bronchus
10. Endoscopic Foreign Body Removal -Oesophagus/stomach /rectum.
11. True cut Biopsy - breast/- liver/- kidney-Lymph Node/-Pleura/-lung/-Muscle biopsy/-Nerve biopsy/Synovial biopsy/-
Bone trephine biopsy/-Pericardial biopsy
12. Endoscopic ligation/banding
13. Sclerotherapy
14. Dilatation of digestive tract strictures
15. Endoscopic ultrasonography and biopsy
16. Nissen fundoplication for Hiatus Hernia /Gastro esophageal reflux disease
17. Endoscopic placement/removal of stents
18. Endoscopic Gastrostomy
19. Replacement of Gastrostomy tube
20. Endoscopic polypectomy
21. Endoscopic decompression of colon
22. Therapeutic ERCP
23. Brochoscopic treatment of bleeding lesion
24. Brochoscopic treatment of fistula /stenting
25. Bronchoalveolar lavage & biopsy
26. Tonsillectomy without Adenoidectomy
27. Tonsillectomy with Adenoidectomy
28. Excision and destruction of lingual tonsil
29. Foreign body removal from nose

30. Myringotomy
31. Myringotomy with Grommet insertion
32. Myringoplasty /Tympanoplasty
33. Antral wash under LA
34. Quinsy drainage
35. Direct Laryngoscopy with or w/o biopsy
36. Reduction of nasal fracture
37. Mastoidectomy
38. Removal of tympanic drain
39. Reconstruction of middle ear
40. Incision of mastoid process & middle ear
41. Excision of nose granuloma
42. Blood transfusion for recipient
43. Therapeutic Phlebotomy
44. Haemodialysis/Peritoneal Dialysis
45. Chemotherapy
46. Radiotherapy
47. Coronary Angioplasty (PTCA)
48. Pericardiocentesis
49. Insertion of filter in inferior vena cava
50. Insertion of gel foam in artery or vein
51. Carotid angioplasty
52. Renal angioplasty
53. Tumor embolisation
54. TIPS procedure for portal hypertension
55. Endoscopic Drainage of Pseudopancreatic cyst
56. Lithotripsy
57. PCNS (Percutaneous nephrostomy)
58. PCNL (percutaneous nephrolithotomy)
59. Suprapubiccytostomy
60. Tran urethral resection of bladder tumor
61. Hydrocele surgery
62. Epididymectomy
63. Orchidectomy
64. Herniorrhaphy
65. Hernioplasty
66. Incision and excision of tissue in the perianal region
67. Surgical treatment of anal fistula
68. Surgical treatment of hemorrhoids
69. Sphincterotomy/Fissurectomy
70. Laparoscopic appendicectomy
71. Laparoscopic cholecystectomy
72. TURP (Resection prostate)
73. Varicose vein stripping or ligation
74. Excision of dupuytren's contracture
75. Carpal tunnel decompression
76. Excision of granuloma
77. Arthroscopic therapy
78. Surgery for ligament tear
79. Surgery for meniscus tear
80. Surgery for hemoarthrosis/pyoarthrosis
81. Removal of fracture pins/nails
82. Removal of metal wire
83. Incision of bone, septic and aseptic
84. Closed reduction on fracture, luxation or epiphyseolysis with osetosynthesis
85. Suture and other operations on tendons and tendon sheath
86. Reduction of dislocation under GA
87. Cataract surgery
88. Excision of lachrymal cyst

89. Excision of pterigium
90. Glaucoma Surgery
91. Surgery for retinal detachment
92. Chalazion removal (Eye)
93. Incision of lachrymal glands
94. Incision of diseased eye lids
95. Excision of eye lid granuloma
96. Operation on canthus & epicanthus
97. Corrective surgery for entropion&ectropion
98. Corrective surgery for blepharoptosis
99. Foreign body removal from conjunctiva
100. Foreign body removal from cornea
101. Incision of cornea
102. Foreign body removal from lens of the eye
103. Foreign body removal from posterior chamber of eye
104. Foreign body removal from orbit and eye ball
105. Excision of breast lump /Fibro adenoma
106. Operations on the nipple
107. Incision/Drainage of breast abscess
108. Incision of pilonidal sinus
109. Local excision of diseased tissue of skin and subcutaneous tissue
110. Simple restoration of surface continuity of the skin and subcutaneous tissue
111. Free skin transportation, donor site
112. Free skin transportation recipient site
113. Revision of skin plasty
114. Destruction of the diseases tissue of the skin and subcutaneous tissue
115. Incision, excision, destruction of the diseased tissue of the tongue
116. Glossectomy
117. Reconstruction of the tongue
118. Incision and lancing of the salivary gland and a salivary duct
119. Resection of a salivary duct
120. Reconstruction of a salivary gland and a salivary duct
121. External incision and drainage in the region of the mouth, jaw and face
122. Incision of hard and soft palate
123. Excision and destruction of the diseased hard and soft palate
124. Incision, excision and destruction in the mouth
125. Surgery to the floor of mouth
126. Palatoplasty
127. Transoral incision and drainage of pharyngeal abscess
128. Dilatation and curettage
129. Myomectomies
130. Simple Oophorectomies
Note:
(i) Above mentioned list is a indicative list of procedures, any other surgeries/procedures requiring less than 24
hours hospitalisation due to technological advances will also be covered under this policy provided such
procedures comply with the standard definition of Day Care Centre and Day Care treatment mentioned in the
definitions.
(ii) The standard exclusions and waiting periods are applicable to all of the above procedures depending on the
medical condition/disease under treatment. Only 24 hours hospitalization is not mandatory.
Annexure II:- List of Non-Medical Items
S. List of Expenses Generally Excluded ("Non-Medical")

SUGGESTIONS
NO in Hospital Indemnity Policy -
TOILETRIES/COSMETICS/ PERSONAL COMFORT OR

CONVENIENCE ITEMS
1 HAIR REMOVAL CREAM Not Payable
2 BABY CHARGES (UNLESS SPECIFIED/INDICATED) Payable
3 BABY FOOD Not Payable
4 BABY UTILITES CHARGES Not Payable
5 BABY SET Not Payable
6 BABY BOTTLES Not Payable
7 BRUSH Not Payable
8 COSY TOWEL Not Payable
9 HAND WASH Not Payable
10 MOISTURISER PASTE BRUSH Not Payable
11 POWDER Not Payable
12 RAZOR Payable
13 SHOE COVER Not Payable
14 BEAUTY SERVICES Not Payable
Essential and may be
paid specifically for cases
15 BELTS/ BRACES who have undergone
surgery o f thoracic o r
lumbar spine.
16 BUDS Not Payable
17 BARBER CHARGES Not Payable
18 CAPS Not Payable
19 COLD PACK/HOT PACK Not Payable
20 CARRY BAGS Not Payable
21 CRADLE CHARGES Not Payable
22 COMB Not Payable
23 DISPOSABLES RAZORS CHARGES ( for site preparations) Payable
24 EAU-DE-COLOGNE / ROOM FRESHNERS Not Payable
25 EYE PAD Not Payable
26 EYE SHEILD Not Payable
27 EMAIL / INTERNET CHARGES Not Payable
FOOD CHARGES (OTHER THAN PATIENT'S DIET PROVIDED
28 Not Payable
BY HOSPITAL)
29 FOOT COVER Not Payable
30 GOWN Not Payable
Essential in bariatric and varicose

vein surgery and should be
31 LEGGINGS considered for these conditions
where
surgery itself is payable.
32 LAUNDRY CHARGES Not Payable

33 MINERAL WATER Not Payable
34 OIL CHARGES Not Payable
35 SANITARY PAD Not Payable

36 SLIPPERS Not Payable
37 TELEPHONE CHARGES Not Payable
38 TISSUE PAPER Not Payable
39 TOOTH PASTE Not Payable
40 TOOTH BRUSH Not Payable
41 GUEST SERVICES Not Payable
42 BED PAN Not Payable
43 BED UNDER PAD CHARGES Not Payable
44 CAMERA COVER Not Payable
45 CLINIPLAST Not Payable
Not Payable/ Payable by
46 CREPE BANDAGE
the patient
47 CURAPORE Not Payable
48 DIAPER OF ANY TYPE Not Payable
Not Payable ( However if
CD is specifically sought
49 DVD, CD CHARGES
by Insure r /T PA then
payable)
50 EYELET COLLAR Not Payable
51 FACE MASK Not Payable
52 FLEXI MASK Not Payable
53 GAUSE SOFT Not Payable
54 GAUZE Not Payable
55 HAND HOLDER Not Payable
56 HANSAPLAST/ADHESIVE BANDAGES Not Payable
57 INFANT FOOD Not Payable
Reasonable costs for one

sling in case o f upper arm
58 SLINGS
fractures should be
considered
ITEMS SPECIFICALLY EXCLUDED IN THE POLICIES
Exclusion in policy unless

59 WEIGHT CONTROL PROGRAMS/ SUPPLIES/ SERVICES
otherwise specified
COST OF SPECTACLES/ CONTACT LENSES/ HEARING AIDS Exclusion in policy unless

60
ETC., otherwise specified
DENTAL TREATMENT EXPENSES THAT DO NOT REQUIRE Exclusion in policy unless

61
HOSPITALISATION otherwise specified

62 HORMONE REPLACEMENT THERAPY
otherwise specified

63 HOME VISIT CHARGES
otherwise specified
INFERTILITY/ SUBFERTILITY/ ASSISTED CONCEPTION Exclusion in policy unless

64
PROCEDURE otherwise specified
OBESITY (INCLUDING MORBID OBESITY) TREATMENT IF Exclusion in policy unless otherwise

65
EXCLUDED IN POLICY specified

66 PSYCHIATRIC & PSYCHOSOMATIC DISORDERS
otherwise specified

67 CORRECTIVE SURGERY FOR REFRACTIVE ERROR
otherwise specified

68 TREATMENT OF SEXUALLY TRANSMITTED DISEASES
otherwise specified

69 DONOR SCREENING CHARGES
otherwise specified

70 ADMISSION/REGISTRATION CHARGES
otherwise specified
HOSPITALISATION FOR EVALUATION/ DIAGNOSTIC Exclusion in policy unless

71
PURPOSE otherwise specified
EXPENSES FOR INVESTIGATION/ TREATMENT Not Payable - Exclusion in

72 IRRELEVANT TO THE DISEASE FOR WHICH ADMITTED OR policy unless otherwise
DIAGNOSED specified
ANY EXPENSES WHEN THE PATIENT IS DIAGNOSED WITH

Not payable as per
73 RETRO VIRUS + OR SUFFERING FROM /HIV/ AIDS ETC IS
HIV/AIDS exclusion
DETECTED/ DIRECTLY OR INDIRECTLY
Not Payable except Bone

74 STEM CELL IMPLANTATION/ SURGERY and storage Marrow Transplantation where
covered by policy
ITEMS WHICH FORM PART OF HOSPITAL SERVICES WHERE

SEPARA TE
CONSUMABLES ARE NOT PA YABLE BUT THE SER VICE IS
Payable u n d e r OT
75 WARD AND THEATRE BOOKING CHARGES Charges ,not payable
separately
Rental charged by the

hospital payable.
76 ARTHROSCOPY & ENDOSCOPY INSTRUMENTS
Purchase of Instruments
not payable.
Payable under OT
77 MICROSCOPE COVER
Charges , not separately
Payable under OT
78 SURGICAL BLADES,HARMONIC SCALPEL,SHAVER
Payable under OT
79 SURGICAL DRILL
Payable under OT
80 EYE KIT
Charges ,not separately
Payable under OT Charges ,not

81 EYE DRAPE
separately
Payable under Radiology

82 X-RAY FILM Charges, not as
consumable
Payable under
83 SPUTUM CUP Investigation Charges, not
as consumable
Part o f OT Charges , not

84 BOYLES APPARATUS CHARGES
separately
BLOOD GROUPING AND CROSS MATCHING OF DONORS

85 Part o f Cost of Blood, not payable
SAMPLES
Not Payable -Part of
86 A n t i s e p t i c o r d i s in f e c t a n t lo t io n s
Dressing Charges
BAND AIDS, BANDAGES, STERLILE INJECTIONS, NEEDLES, Not Payable - Part of
87
SYRINGES Dressing charges
Not Payable -Part of
88 COTTON
Dressing Charges
Not Payable- Part of
89 COTTON BANDAGE
Dressing Charges
Not Payable-Payable by
the patient when
90 MICROPORE/ SURGICAL TAPE prescribed , otherwise
included as Dressing
Charges
91 BLADE Not Payable
Not Payable -P a r t of
Hospital Services/
92 APRON
Disposable linen to be
p a r t of OT/ICU charges
Not Payable (service is
charged by hospitals,
93 TORNIQUET
consumables c an n o t be
separately charged)
94 ORTHOBUNDLE, GYNAEC BUNDLE Part o f Dressing Charges
95 URINE CONTAINER Not Payable
ELEMENTS OF ROOM CHARGE

Actual tax levied by
government is
96 LUXURY TAX
payable. P a r t of room
charge for sub limits
Part o f room charge not

97 HVAC
payable separately
Part of room charge not

98 HOUSE KEEPING CHARGES
payable separately
SERVICE CHARGES WHERE NURSING CHARGE ALSO Part of room charge notpayable
99
CHARGED separately
Payable under room

100 TELEVISION & AIR CONDITIONER CHARGES charges not if separately
levied
Part of Room Charge , Not

101 SURCHARGES
payable separately
Not Payable - P a r t of
102 ATTENDANT CHARGES
Room Charges
Part of nursing charges,

103 M IV INJECTION CHARGES
not payable
Part of
104 CLEAN SHEET Laundry/Housekeeping
not payable separately
EXTRA DIET OF PATIENT(OTHER THAN THAT WHICH Patient Diet provided by
105
FORMS PART OF BED CHARGE) hospital is payable
106 BLANKET/WARMER BLANKET Not Payable- part of room charges
ADMINISTRATIVE OR NON-MEDICAL CHARGES

107 ADMISSION KIT Not Payable
108 BIRTH CERTIFICATE Not Payable
BLOOD RESERVATION CHARGES AND ANTE NATAL
109 Not Payable
BOOKING CHARGES
110 CERTIFICATE CHARGES Not Payable
111 COURIER CHARGES Not Payable
112 CONVENYANCE CHARGES Not Payable
113 DIABETIC CHART CHARGES Not Payable
DOCUMENTATION CHARGES / ADMINISTRATIVE
114 Not Payable
EXPENSES
115 DISCHARGE PROCEDURE CHARGES Not Payable
116 DAILY CHART CHARGES Not Payable
117 ENTRANCEPASS / VISITORS PASS CHARGES Not Payable
To be claimed by patient
118 EXPENSES RELATED TO PRESCRIPTION ON DISCHARGE under Post Hosp where
admissible
119 FILE OPENING CHARGES Not Payable
INCIDENTAL EXPENSES / MISC. CHARGES (NOT
120 Not Payable
EXPLAINED)
121 MEDICAL CERTIFICATE Not Payable
122 MAINTENANCE CHARGES Not Payable
123 MEDICAL RECORDS Not Payable
124 PREPARATION CHARGES Not Payable
125 PHOTOCOPIES CHARGES Not Payable
126 PATIENT IDENTIFICATION BAND / NAME TAG Not Payable
127 WASHING CHARGES Not Payable
128 MEDICINE BOX Not Payable
Payable upto 24 hrs, shifting charges

129 MORTUARY CHARGES
not payable
130 MEDICO LEGAL CASE CHARGES (MLC CHARGES)
EXTERNAL DURABLE DEVICES

131 WALKING AIDS CHARGES Not Payable
132 BIPAP MACHINE Not Payable
133 COMMODE Not Payable
134 CPAP/ CAPD EQUIPMENTS Device not payable
135 INFUSION PUMP - COST Device not payable
136 OXYGEN CYLINDER (FOR USAGE OUTSIDE THE HOSPITAL) Not Payable
137 PULSEOXYMETER CHARGES Device not payable
138 SPACER Not Payable
139 SPIROMETRE Device not payable
140 S P0 2PRO B E Not Payable
141 NEBULIZER KIT Not Payable
142 STEAM INHALER Not Payable
143 ARMSLING Not Payable
Not Payable (paid by
144 THERMOMETER
patient)
145 CERVICAL COLLAR Not Payable
146 SPLINT Not Payable
147 DIABETIC FOOT WEAR Not Payable
148 KNEE BRACES ( LONG/ SHORT/ HINGED) Not Payable
149 KNEE IMMOBILIZER/SHOULDER IMMOBILIZER Not Payable
Essential and should be

paid specifically for cases
150 LUMBOSACRAL BELT
who have undergone
surgery of lumbar spine.
Payable for any ICU

patient requiring more
than 3 days in ICU, all
patients with
151 NIMBUS BED OR WATER OR AIR BED CHARGES paraplegia /quadriplegia for any
reason and at
reasonable cost of
approximately Rs 200/
day
152 AMBULANCE COLLAR Not Payable

153 AMBULANCE EQUIPMENT Not Payable
154 MICROSHEILD Not Payable
Essential and should be paid in

post surgerypatients of major
abdominal surgery including TAH,
155 ABDOMINAL BINDER
LSCS, incisional hernia repair,
exploratory laparotomy for intestinal
obstruct ion, liver transplant etc.
ITEMS PA YABLE IF SUPPORTED BY A PRESCRIPTION

May be payable when
BETADINE \ HYDROGEN PEROXIDE\SPIRIT\ prescribed for patient , not payable
156
DISINFECTANTS ETC for hospital use in OT o r ward o r
for dressings in hospital
Post hospitalization
157 PRIVATE NURSES CHARGES- SPECIAL NURSING CHARGES nursing charges not
Payable
NUTRITION PLANNING CHARGES - DIETICIAN CHARGES- Patient Diet provided by
158
DIET CHARGES hospital is payable
Payable -S u g a r free
159 SUGAR FREE Tablets variants of admissible
medicines are not excluded
CREAMS POWDERS LOTIONS (Toileteries are not payable
160 only Payable when prescribed
prescribed medical pharmaceuticals payable)
161 Digestion gels Payable when prescribed
Upto 5 electrodes are
required for every case
visiting OT or ICU. For
162 ECG ELECTRODES longer stay in ICU, may
require a change and at
least one set every second
day must be payable.
Sterilized Gloves payable /
163 GLOVES unsterilized gloves not
payable
Payable - payable Pre
164 HIV KIT
op e ra t iv e screening
165 LISTERINE/ ANTISEPTIC MOUTHWASH Payable when prescribed
166 LOZENGES Payable when prescribed
167 MOUTH PAINT Payable when prescribed
If used during
168 NEBULISATION KIT hospitalization is payable
reasonably
169 NOVARAPID Payable when prescribed
170 VOLINI GEL/ ANALGESIC GEL Payable when prescribed
171 ZYTEE GEL Payable when prescribed
Routine Vaccination not
172 VACCINATION CHARGES Payable / Post Bite
Vaccination Payable
PART OF HOSPITAL'S OWN COSTS AND NOT PA YA BLE
173 AHD
Hospital's internal Cost
174 ALCOHOL SWABES
175 SCRUB SOLUTION/STERILLIUM
OTHERS
176 VACCINE CHARGES FOR BABY Payable
177 AESTHETIC TREATMENT / SURGERY Not Payable
178 TPA CHARGES Not Payable
179 VISCO BELT CHARGES Not Payable
ANY KIT WITH NO DETAILS MENTIONED [DELIVERY KIT,
180 Not Payable
ORTHOKIT, RECOVERY KIT, ETC]
181 EXAMINATION GLOVES Not Payable
182 KIDNEY TRAY Not Payable
183 MASK Not Payable
184 OUNCE GLASS Not Payable
Not payable, except for
185 OUTSTATION CONSULTANT'S/ SURGEON'S FEES telemedicine consultations
w here covered by policy
186 OXYGEN MASK Not Payable
187 PAPER GLOVES Not Payable
Should be payable in case

o f PI VI) requiring
188 PELVIC TRACTION BELT
traction as this is
generally not reused
189 REFERAL DOCTOR'S FEES Not Payable

Not payable pre
hospitalisation or post
190 ACCU CHECK ( Glucometery/ Strips) hospitalisation / Reports
an d Charts required /
Device not payable
191 PAN CAN Not Payable
192 SOFNET Not Payable
193 TROLLY COVER Not Payable
194 UROMETER, URINE JUG Not Payable
Payable-Ambulance from home to

hospital or inter hospital shifts
195 AMBULANCE
is payable/ RTA as specific
requirement is payable
Payable - maximum o f 3
196 TEGADERM / VASOFIX SAFETY in 48 hrs an d then 1 in 24
hrs
Payable w here medically

197 URINE BAG necessary till a reasonable cost -
maximum 1 per 24hrs
198 SOFTOVAC Not Payable

Essential for case like
199 STOCKINGS CABG etc. where it
should be paid.

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Bajaj Allianz General Insurance Company Limited

Bajaj Allianz General Insurance Company Limited

1. In-patient Hospitalisation Treatment

5. Day Care Procedures

6. Organ Donor Expenses:

8. Daily Cash Benefit for Accompanying an Insured Child

9. Sum Insured Reinstatement Benefit:

10. Preventive Health Check Up

11. Ayurvedic / Homeopathic Hospitalisation Expenses

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

Our maximum liability maximum is up to Rs. 20000 per policy year.

The claim will be admissible under the policy provided that,

12. Maternity Expenses

13. New Born Baby Cover

We will pay for,

14. Bariatric Surgery Cover

Special Conditions applicable to Bariatric Surgery Cover

3. Any one illness

5. Bajaj Allianz Diagnostic Centre

7. Cancer of Specified Severity

• Micro carcinoma of the bladder

10. Condition Precedent

11. Congenital Anomaly

13. Cumulative Bonus

14. Day care centre

15. Day Care Treatment

16. Dental Treatment

17. Dependent child

18. Disclosure to information norm

19. Emergency Care

21. Grace Period

25. Inpatient Care

26. Injury/ Bodily Injury

27. Intensive Care Unit

28. Kidney Failure Requiring Regular Dialysis

29. Limit of Indemnity

31. New Born Baby

32. Medical Advise

33. Medical expenses

34. Medical Practitioner/ Physician/ Doctor:

35. Medically Necessary

36. Named Insured/ Insured:

37. Non- Network

38. Notification of Claim

39. OPD treatment

42. Pre-Existing Disease

43. Pre-hospitalization Medical Expenses

44. Post-hospitalization Medical Expenses

45. Qualified Nurse

46. Reasonable and Customary Charges

47. Room rent

50. Schedule means the schedule and any annexure to it.

51. Unproven/Experimental treatment

C) EXCLUSIONS UNDER THE POLICY

22. Experimental, unproven or non-standard treatment

25. All non-medical Items as per Annexure II

A. Cashless Claims Procedure: