Bajaj Allianz Group Health Insurance


2018-03-28 00:00:00 UTC

aka Employee Mediclaim Insurance


Also known as Mediclaim, or Group Mediclaim insurance, this policy provides health insurance to your employees. Group medical covers provide monetary support for your employees if there is a crisis without putting a financial burden on the business or the employee’s family. Group health is one of the most common and essential business insurance, and contributes to a high percentage of commercial insurance premiums.

Bajaj Allianz’s Group Mediclaim product is called Group Health Guard and offers many benefits greater than the standard health policy.

Benefits

  • Hospitalisation: In-patient treatment including room rent, ICU, nursing, medicines drugs & consumables covered without any sub-limits.

  • Ambulance charges: up to INR 1000. Ambulance must be provided by a registered service.

  • Pre and Post Hospitalization medical expenses: Medical expenses incurred up to 30 days immediately before hospitalization and up to 60 days immediately post hospitalization. This can be increased.

  • Day Care Procedures: The policy covers medical expenses for multiple day care treatments which do not require 24 hours hospitalization.

  • Maternity Benefit: Applicable for the first 2 children only. Both normal and caesarean delivery is covered for INR 50000. This limit will also apply for pre and post natal cover.

    • No 9 month waiting period

    • Baby covered from day 1 (opted for)

  • Domiciliary Treatment: The policy covers for the medical expenses incurred for availing medical treatment at home on the advice of the attending Medical Practitioner which would otherwise have required Hospitalisation.

  • Organ Donor: The policy covers Medical Expenses on harvesting the organ from the donor for organ transplantation.

  • Dental Treatment (in case of Accident): Insurer will reimburse Medical Expenses of any necessary dental treatment from a Dentist provided that the Dental treatment is required because of an Accident. Maximum liability shall be limited to the amount specified in the Schedule of Benefits of group health policy.

  • AYUSH Benefit: The policy covers you for medical expenses incurred for In-patient treatment taken under Ayurveda, Unani, Siddha or Homeopathy, up to INR 20,000 for sum insured from 2lacs to 4lacs and up to INR 25,000 for sum insured from 5 lacs to 10 lacs per policy year.

  • Room rent: Single standard room. Suite rooms are not allowed. Claim charges that vary with room rent will be paid on a proportionate basis if room rent charged is higher than allowed.

  • Specific OPD treatment: 50% Co-Pay for cyber-knife treatment, Gamma Knife treatment and Stem Cell Transplantation, Robotic Surgery, Femtolaser treatment for eye. It will be applicable for each eye each event. Cochlear Implant treatment shall be restricted to 50% of the Sum Insured.

  • Non-Standard Charges: Any Doctors/Surgeons/external consultants fees charged/paid over and above the Hospital Standard Tariff/Package stand excluded from the scope of the policy. The over & above limit will have to be borne by the customer.

  • Portability: Group to retail portability benefit can be availed at the time of retirement or resignation from the services (provided these events are falling within the policy period).

    • Standard coverage’s, terms, conditions, & guidelines of retail product would apply
  • Family: Family Definition is Employee + Spouse + 2 Dependent Children + 2 Dependent Parents/In-Laws. Only 1 set of Parents or Parents-in-law will be allowed to be covered. Mid-term change of dependents is not allowed. Group health policies are unique in that they allow you to cover three generations(yourself, parents, children) under one policy. Bajaj Allianz Group health policy allows you to cover yourself, spouse, parents and children

  • Waiting periods: The biggest benefit of all group health policies is that there are no waiting periods, unlike in individual covers. In a group cover, there are no waiting periods for:

    • Pre-existing conditions: individual policies have a waiting period of 4 years before pre-existing conditions are covered. You must be covered under a policy for 4 years continuously before this takes effect. Bajaj Allianz group health insurance has no waiting periods.

    • Specific illnesses: Individual policies have a list of specific illnesses which are only covered after a 2 year wait period. This includes cataract, gastro-intestinal issues, hernia, kidney problems, etc. Bajaj Allianz Group covers have no waiting period.

    • 30 day waiting period: Individual policy cover kicks in 30 days after issuance (except for accident related hospitalisation).

Terms & Conditions


Beneficiary name for issue of claim cheques will be assumed as name of the corporate unless otherwise specified.

• Any additions for new employee, spouse / children would be allowed within 45 days of date of joining, marriage / birth respectively.

• Additional premium for each additional member will be communicated, through Perilwise.

• Per person premium would be provided by HO once the quote is finalized.

• No Individual (Employee / Dependent) can be covered more than once in a policy.

• The list of members submitted at the inception of the policy will be considered as final.

• Claims servicing and processing will be done by In-house Health Administration Team, Bajaj Allianz General Insurance Company.

• Infertility treatment not covered under the policy.

• Psychiatric treatment not covered.

• Weight management services and treatment related to weight program's including treatment of obesity will not be payable.

• Exclusions as per Standard Group Health policy wording.

Claim Intimation

• Intimation within 8 Hrs will be required in case of emergency hospitalizations post admission.

• All reimbursement claims have to be intimated to Bajaj Allianz within 7 days of discharge and have to be submitted for reimbursement within 30 days of date of discharge of the patient.

Submission of Documents

For the main claim and pre-hospitalization documents,

• Window period for submission of claim documents is 45 calendar days post date of discharge.

• Delayed submission of claim documents greater than 45 days & less than 3 months will be settled on nonstandard basis at 75% of net payable amount.

• Delayed submission of claim documents greater than 3 months will be settled on nonstandard basis at 50% of net payable amount.

For Post hospitalization documents

• Window period for submission of claim documents is 90 calendar days post date of discharge of the main claim.

• Delayed submission of claim documents greater than 90 days & less than 4 months will be settled on nonstandard basis at 75% of net payable amount.

• Delayed submission of claim documents greater than 4 months & less than 6 months will be settled on nonstandard basis at 50% of net payable amount.

• Delayed submission of claim documents greater than 6 months will be settled on nonstandard basis at 25% of net payable amount.

Guideline for Deletion Endorsements

In case of refund endorsements because of deletion, pro-rata refund for entire family should be done subject to nil claims, whereas refund should be nil if the premium is charged on per family basis.

Deletion to be intimated immediately on finalization of last working day of employee. In case employee avails a claim after his last working day, insurer will recover paid amount from available float balance.

Pro-rata refund will be calculated as from DOL if intimation is within 7days else intimation date will be consider for calculation subject to nil claim.

Perilwise allows you to customise your group health cover benefits online and view tentative premiums as you do. This allows you to tailor make the best cover within your budget and allows us to figure out which insurer to go to a lot faster, thereby closing the entire deal in 70% faster than a traditional agent or broker! Get your estimate now!

We also provide a dashboard that allows you to manage all your insurance needs, including group health, at the click of a button. The Perilwise policy manager allows you to manage additions, deletions, claims, endorsements, and renewals, all from one place! Policy manager dashboard is in beta, request access here.

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