WHY HEALTH
INSURANCE?
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Why Health Insurance?
The digital healthcare market, is projected Life expectancy has exceeded 70 Years
1 to grow at a CAGR of 27.4% to reach 2 by 2022 making it the most populous
nation & the population is projected to
US$485.43 Billion by 2024
increase to 1.45 Billion by 2028
Share of Senior Citizens in population will
We have around 60 Million Diabetic
double from 8.6% in 2011 to 16% by
3 2041 & It is expected to have 300 Million 4 Patients, that is expected to swell to
Senior Citizens in 2050
90 Million by 2025
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Why Health Insurance?
Every fourth individual aged above Life expectancy has exceeded 70 Years
1 18 Years may have Hypertension. 2 in 2022 making it the most populous
nation
Share of Senior Citizens in population will India is World Capital for Diabetes
double from 8.6% in 2011 to 16% by patient with 60 Million Diabetic
3 2041 & It is expected to have 300 Million 4 Patients, expected to swell to 90 Million
Senior Citizens in 2050 by 2025
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Why Health Insurance?
IT employees are at risk of NCDs due to Nearly 5.8 Million die from Non
their lifestyle choices, lack of physical
5 activity, and high levels of stress in their 6 Communicable Diseases (heart, lung, stroke,
cancer and diabetes) every year
workplaces as per NIN
The rising Non Communicable Diseases Between 35 to 70+ age 1 in 10 men
7 burden is estimated to cost India USD 4.58 8 & 1 in 8 women can develop Cancer in
Trillion before 2030 their life span after the age of 35 years
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Why Health Insurance?
Almost 55% of all expenditure on health in
Urban India accounted for 42.3% of the
9 India is financed out-of-pocket against the
10 total healthcare-related expenditure while
global average of 18% as per World 57.7% of the expenditure from rural India
Bank
Indian households spent an estimated INR The digital healthcare market, is projected
11 120 billion on health and healthcare- 12 to grow at CAGR of 27.4% to reach
related services in Nov 2022 US$485.43 Billion by 2024
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Why Health Insurance?
In metros average claim for infectious
IPD treatment cost for common ailments has
diseases rose to nearly Rs. 80000 from
13 more than doubled in last 5 Years 14 Rs.30000
In Metros, average cost of respirator disorder Post COVID the share of consumables
15 has risen to Rs.1.7L from Rs.80000 16 has risen from 3-4% of the bill to up to
15% of the total IPD bill.
The average amount for Cataract treatment
17 rose to Rs.1.2 Lac from Rs.78325
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Treatment Cost for Common Medical Procedures in India
Sr. No. Medical Procedure India (INR)
1 Heart Bypass 6,29,156
2 Angioplasty 4,53,948
3 Heart Valve Replacement 7,56,580 * Medical Inflation estimated in India is 14%
4 Hip Replacement 5,73,408
5 Hip Resurfacing 7,72,508
6 Knee Replacement 5,25,624
7 Spinal Fusion 8,20,292
8 Dental Implant 71,676
9 Lap Band 5,81,372
10 Gastric Sleeve 4,77,840
11 Gastric Bypass 5,57,480
12 Hysterectomy 2,54,848
13 Breast Implant 2,38,920
14 Rhinoplasty 1,91,136
15 Rhytidectomy 2,78,740
16 Liposuction 2,22,992
17 Abdominoplasty 2,78,740
18 Lasik (Both Eyes) 79,640
19 IVF Treatment 1,99,100
Source: [Link]
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An Illustration of Monthly OPD Expense for a family of 2A+ 2C
Annual Amount
Category Description Amount (Rs.)
(Rs.)
Consultation with General
500 per visit * 6 Visits 3000
Physician
Doctor Consultancy
Consultation with a
1000 per visit * 2 Visits 2000
Specialist
Blood Tests 2000 per case * 6 Visits 12000
Pathology & Radiology Tests
CT Scan, MRI etc 10000 per case * 2 Visits 20000
Total Expenses 37000
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Financial Pyramid
Big Investments/ Expenses
Luxury
Home
Car
Marriage
Investment Education
Health
Travel
Savings
Only Non Negotiable Expense in
Protection our life is the Hospitalization Cost
Health + Assets of our family member
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Can I afford it?
How ?
Healthcare cost is growing
day by day
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Break Savings Take a Loan Sale of Assets
Borrow from Friends/Relatives Pray to God
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Choosing best
Healthcare for the family
Protect Savings
Protect Assets
Protect Dignity
Financial Security
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CARE MAXIMIZED
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Eligibility
S.I. on Individual basis
Policy Term: 1/2/3 Years
Relationship Minimum Maximum Renewal
Members : Self, Spouse, Entry Entry Age
Dependent Children, Grand Age
Children, Parents, Parent-In-
Laws, Sister, Brother, Aunt Adult 18 Years 65 Years
& Uncle Members Life Long
Dependent 3 Months 30 Years Renewal
Children
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Mid Term Inclusion Guideline
Newly wed spouse up to 2 months of
marriage
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Sum Insured
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Sections
Any One Section is mandatory for Policy Issuance
1 Cancer Care
2 Cardiovascular Care
3 Kidney Care
4 Neuro Care
Sensory Organs &
5 Transplants Care
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Pre Policy Check Up
For Cancer Care- No PPC required subject to Clean Proposal Form for Cancer Care Section
Non-Medical Limits
*Subject to no adverse health conditions
* If policy is issued we 100% of the standard medical tests charges would be reimbursed
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Pre Policy Check Up
100% Refund for PPC Charges Post Proposal Acceptance & Policy Issuance
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Waiting Period & Survival Period
Initial Waiting Period
120/180 Days as Opted
Survival Period
0/7/15 Days as Opted
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Income & SI Commensuration
Primary member or proposer Should be Earning Member
Sum Insured eligibility 10 times of Annual Income
Income proofs required For sum insured 20 Lacs & above
Income documents 1 Yr ITR or 3 Months Latest Salary slips Or Latest Form 16
For Non- earning dependent Sum Insured under each section cannot exceed 10 Lacs or SI opted
members for Primary Member whichever is Lower.
Sample Examples for Sum Insured Eligibility
Yearly Income Sum Insured Eligibility
1 lac 10 Lacs
1.5lacs 15 Lacs
2lacs 20 Lacs
2.5lacs 25 Lacs
5lacs 50 Lacs
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PRODUCT
FEATURES
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Every Section is Divided In 2 Categories
Category A (Minor Illness) - Category B (Major Illness) -
1 25% of Sum Assured 2 100% of Sum Assured
1. The benefits payable will be independent for each section if more than one Critical Illness sections are chosen.
2. Two claims (one from Category A conditions and another from Category B conditions) are allowed for each section.
3. Insured cannot claim under only one of opted Section(s) for two conditions listed in Category A of the same
section.
4. If a claim has already been paid for Category A condition of a section, the amount payable for Category B condition
under the same section will be the remaining Sum Assured i.e. 75% Sum Assured (i.e. 100% Claim if admissible
under Category B - 25% Paid against claim under Category A for the respective section.)
5. If we have paid 100% of the sum assured under any of the sections opted, then the coverage for the respective
section shall cease for the Insured Member, however Policy shall continue for rest of Sections (if opted). However
the premium for subsequent renewal/s would be calculated excluding the section for which claim has been paid.
6. After a claim from any critical illness section has been paid under Criti Care Policy, the said Insured will not be able
to opt for any new critical illness section
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Case Study
Mr. Sharma opts for 3 Sections (Criti Care) i.e. Cancer
Care, Cardiovascular Care and Neuro Care, he can claim
in any or all sections independently.
If Mr. Ajay is diagnosed with Carcinoma-In-Situ
(Category A Illness) in 8th month of Policy followed by
unfortunate Major Head Trauma (Category B Illness) in
11th month, he can independently claim for-
25% of Cancer Care Sum Insured ( 25% of S.I. because of
Category A condition)
100% of Neuro Care Sum Insured (100% of S.I. because
of Category B condition)
In the above example if Mr. Ajay is further diagnosed with Lymphoma (Category B Illness) supported by
histological evidence of Malignancy in 12th Month, he can further claim for rest of his balance Sum
Insured under Section 1 (Cancer Care). Here eligibility will be 75% of Cancer Care Sum Insured
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Category A Category B
Section I: (25% of Sum Assured) (100% of Sum Assured)
Cancer Care 1. Early Stage Cancers 3. Cancer of Specified Severity
2. Carcinoma-In-Situ
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Category A
(25% of Sum Assured)
4. Angioplasty
5. Insertion of Pacemaker / Implantable Cardioverter
Defibrillator
Section II 6. Minimally Invasive surgery of Aorta
7. Balloon Valvotomy or Valvuloplasty
:Cardiovascular 8. Surgery for Cardiac Arrhythmia
Care 9. Carotid Artery Surgery
10. Surgery to place Ventricular Assist Devices or total
artificial hearts
11. Infective Endocarditis
12. Pericardiectomy
13. Percutaneous Heart Valve Replacement / Repair
Category B
(100% of Sum Assured)
14. Myocardial Infarction (First Heart Attack – of
Section II Specific Severity)
:Cardiovascular 15. Open Chest CABG
16. Open Heart Replacement or Repair of Heart Valves
Care
17. Major Surgery of Aorta
18. Heart Transplant
19. Cardiomyopathy
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Category A Category B
(25% of Sum Assured) (100% of Sum Assured)
Section III:
22. Kidney Failure Requiring Regular Dialysis
Kidney Care 20. Removal of one Kidney
23. Systematic lupus Eryth. with Renal Involvement
21. Partial Nephrectomy
24. Kidney Transplant
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Category A Category B
(25% of Sum Assured) (100% of Sum Assured)
27. Stroke Resulting in Permanent Symptoms
Section IV: 28. Coma of Specified Severity
29. Permanent Paralysis of limbs
Neuro Care 25. Cerebral Aneurysm treatment via
Endovascular procedure
30. Motor Neurone Disease with Permanent Symptoms
31. Multiple Sclerosis with Persisting Symptoms
26. Permanent Paralysis of one limb
32. Benign Brain Tumour
33. Brain Surgery
34. Major Head Trauma
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Category A
Section V: (25% of Sum Assured)
Transplants Care 35. Blindness in one eye
And Sensory Organs 36. Deafness in one ear
Care
Category B
(100% of Sum Assured)
Section V: 37. Blindness in both the eyes
38. Deafness in both ears
Transplants Care 39. Loss of Speech
And Sensory Organs 40. Lung Transplant due to End stage
lung failure
Care 41. Liver Transplant due to End Stage
liver failure
42. Pancreas Transplant
43. Bone Marrow Transplant
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Additional Benefit
Following Benefits are linked to respective Sections & are payable in case of Category B Claim only
(Over & Above the Base Sum Insured)
10% of the Sum Insured subject to a
Cancer Reconstructive Surgery maximum limit of Rs.200,000
Cardiac Nursing 5% of the Sum Insured up to Rs.50,000
Dialysis Care 10% of the Sum Insured up to Rs.200,000
Physiotherapy Care 5% of the Sum Insured up to Rs.50,000
Sensory & Transplants Care 5% of the Sum Insured up to Rs.50,000
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Discounts
Long Term Discount
• 4% Discount 8% Discount
for 2 Years for 3 Years
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Wellness Benefit Discount
5% Discount applicable on each renewal for engaging in physical fitness activity with submission of
the below mentioned medical test reports:-
[Link]. Parameters Range
1 ECG Normal Sinus Rhythm
2 Fasting Blood Sugar Less than or equal to 100 mg/dl
3 Sr. Creatinine 0.90 - 1.2 mg /dl
Lipid Profile
4 Cholesterol Up to 200 mg/dl
Triglycerides Up to 150 mg/dl
5 BMI Up to 27
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Wellness Benefit Discount Guidelines
• Under Physical fitness activity minimum 15,000 steps every week or 60,000 steps every
month for minimum period of 6 months from the RID
• Reports conducted 3 months prior to renewal due date would be considered for this benefit.
• In case of a Long Term Policy (2 or 3 Years), the minimum mandatory period of 6 months must
be completed in each policy year
• Application must be downloaded within 30 days from policy RID to avail this benefit
• Average step count completed by an insured member would be tracked on this mobile
application
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Income Tax Benefit under Sec 80 D of I.T. Act
Total Tax Benefit under
Age of Proposer Tax Benefit Applicable
Sec 80D
Self, Spouse , Dependent
Age Criteria Parents Combined
Children
Less than 60 Years Up to Rs.25000 Up to Rs.25000 Up to Rs.50000
Self, spouse, Children less than
60 Years & Up to Rs.25000 Up to Rs.50000 Up to Rs.75000
Parents (either or both) above
60 Years
Self, Spouse (either or both)
above 60 Years and Children & Up to Rs.50000 Up to Rs.50000 Up to Rs.100,000
Parents (either or both) above
60 Years
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General Exclusions
• Any sexually transmitted diseases
• Treatment arising from or traceable to birth defects and congenital anomalies.
• Any natural peril (including but not limited to storm, tempest, avalanche, earthquake, volcanic
eruptions, hurricane, or any other kind of natural hazard).
• Radioactive contamination
• Self-inflicted injuries, suicide attempt, insanity, and deliberate participation of the Insured in an illegal
or criminal act with criminal intent.
• Use or misuse of intoxicating drugs and/or alcohol, except under the direction of Medical Practitioner
For complete list of Exclusions, please refer to the Policy Wordings
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Premium Chart
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Premium Chart
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STANDARD
CONDITIONS
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Standard Conditions
Free Look In Period Grace Period
15 Days from the Date of Receipt 30 Days for Renewal
of the first Policy Document from Policy Expiry Date
Sum Insured Enhancement
Will be allowed only at the time of Renewal
subject to U/w Approval
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CLAIMS
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Claims
1800- 209- 5858
9156 191 111 (Claim Status)
bagichelp@[Link]
[Link]
Caringly Yours App
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Claim Procedure
Insured/proposer must inform BAGIC in writing
immediately within 48 hours of diagnosis of any
of the listed Critical Illnesses.
Insured must immediately consult a Doctor and
follow the advice and treatment that he
recommends.
Insured/proposer must submit Claim documents
within 30 days of diagnosis of any of the listed
Critical Illnesses
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Health CDC – Claims by Direct Click
Mobile App- Caringly Yours Allianz Mobile App- On Caringly Yours
Caringly Yours
It is Mandatory to Write on BOLD
Letters on all documents claim with
“BAJAJ ALLIANZ GENERAL
INSURANCE COMPANY LIMITED”
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Claims Documentation
1. Claim Form duly signed by the insured along
with NEFT form
2. Copy of Discharge Summary / Discharge
Certificate
3. Copy of Final Hospital Bill
4. Policy copy
5. First consultation letter for Illness
6. Medical certificate for the duration of illness
7. All required Investigation Reports as per
the Illness Please send the documents on below address
8. Medical certification from specialist 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
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Health Claims Strength
Empaneled network of over
Our Claim
Settlement Ratio 97.3% 8,000 hospitals across the country to avail cashless
treatment
1st in the Industry to have an In-house Health Claims
Management Team
Preferred Partner Network (PPN) of over 6,000
hospitals offering curated treatment rates
Seamless transfer of data between hospitals and
insurer to provide faster claim processing via the E-
card module
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We are proud of…
Lowest Grievance Ratio
Consistent growth and underwriting profits
Strongest Solvency Ratio: 391%
Outstanding Claims Settlement Ratio
97.3% Health Claim Settlement Ratio
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Policy Collaterals & FAQ Links
Collateral [Link]
Downloads [Link]
Customer Service [Link]
Grievance [Link]
Redressal [Link]
Service [Link]
Parameters [Link]
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Pre-Policy Self Service Via WhatsApp
The pre-policy process is now at your fingertips with an interactive chatbot enabled on
WhatsApp
Key Highlights
• Self Service for booking appointments by customers
• Check real time case journey status by customers
• Medical Report download facility for customers
Objective
• Customers satisfaction and delight
• Self-service for customs
• Reduce TAT
• Quick resolutions of deficiency
• Reduce dependency
• Easy tracking of proposal
Type PPMC and send it to WhatsApp no.: 7507245858 to
check quote status, book their appointment and download
their medical report via “ WhatsApp”
Note: This process is applicable only for Prepolicy Maximus cases
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Grievance Process
Level 1 Policy Issuing Branch
Level 2 E- Mail to bagichelp@[Link] with all the details
Grievance Officer
Level 3
Write to Grievance Redressal Officer Mr. Jerome Vincent at ggro@[Link]
Talk to Care Specialist, give a missed on +91 80809 45060 OR SMS <WORRY> To
Level 4
575758 & Care Specialist will call back
If after having following Level 1, 2, 3 & 4 issue remains unresolved, may approach Insurance
Ombudsman for Redressal at [Link]
Disclaimer: This document is an overview of the product, for more details please refer the Policy Wording
Disclaimer: This document is an overview of the product, for more details please refer the Policy Wording
