 "A supplementary cover at best")
Most individuals defer buying health insurance as they believe the main cost they will have to incur is for surgery, say insurance players. To address this, Bajaj Allianz General Insurance has introduced a new plan – Surgical Protection Plan, a benefit plan which proposes to repay surgical expenses.
The plan has two sections – surgical benefit cover (mandatory cover) and optional add-on covers. The surgical benefit cover provides a fixed benefit for specified surgeries. The plan covers around 600 kinds of surgeries and offers 11 sum insured, ranging from Rs 1 lakh to Rs 10 lakh. However, the benefit amount is capped between Rs 5,000 and Rs 5 lakh, according to the grade of the surgery and the plan opted.
This is not a new plan in the market, say experts. “Aegon Religare Life Insurance’s iHealth Plan has similar features. It offers health insurance along with critical illness, daily cash and surgery benefits. Tata AIG General Insurance’s Wellsurance and LIC’s Jeevan Aarogya also provide surgical benefit,” says Mahavir Chopra, a health insurance expert. In addition, Tata-AIA Life Insurance and Birla Sun Life Insurance offer surgical benefit riders with their life policies. These also provide a pre-fixed sum of money in the event of a surgery. Bajaj’s new plan has add-ones like hospital cash daily allowance, critical illness cover and personal accident cover.
Chopra says while there is a need for such products, these work well only as supplementary cover because of very restrictive coverage. What if you contract something outside the list in policy? Another executive in a health insurance firm says such plans usually have an additional restriction on the number of claims to be made in a year.
And, this plan has some tough restrictions. That is, if there is any claim under a particular grade, then the coverage under that grade will cease for the balance period of the policy. The product has five grades – supra major, major, sub-major, day care and minor.
The premium for a sum insured of Rs 10 lakh for Bajaj Allianz Health Guard individual hospitalisation reimbursement plan is Rs 10,913 for a male in the 26 – 40 age bracket. The premium for Surgical Protection Plan which is a benefit product for the same age bracket and same sum insured is Rs 11,500 is for the base plan plus all the three add-on covers like Hospital Cash, Critical Illness and PA cover. These add-on covers are optional. Just for the Surgical Protection Plan base policy the premium for 26-30 age group and the same sum insured is Rs 5,639 for male and Rs 5,468 for females.
Additionally, the plan allows only 50 per cent of the sum insured to be claim for complicated surgeries in Grade A. Say you have a sum-insured of Rs 10 lakh, the cover would allow you to claim only Rs 5 lakh.
Exclusions will include: Any pre-existing disease for which surgery is required, and any treatment taken within 90 days of the commencement of the policy. Many medical conditions including gastric or duodenal ulcers, cardiovascular diseases, hernia, fistulae, fissure, cataract, endometriosis, hysterectomy, and surgery on all internal or external tumours would be excluded for two years.
The plan has two sections – surgical benefit cover (mandatory cover) and optional add-on covers. The surgical benefit cover provides a fixed benefit for specified surgeries. The plan covers around 600 kinds of surgeries and offers 11 sum insured, ranging from Rs 1 lakh to Rs 10 lakh. However, the benefit amount is capped between Rs 5,000 and Rs 5 lakh, according to the grade of the surgery and the plan opted.
This is not a new plan in the market, say experts. “Aegon Religare Life Insurance’s iHealth Plan has similar features. It offers health insurance along with critical illness, daily cash and surgery benefits. Tata AIG General Insurance’s Wellsurance and LIC’s Jeevan Aarogya also provide surgical benefit,” says Mahavir Chopra, a health insurance expert. In addition, Tata-AIA Life Insurance and Birla Sun Life Insurance offer surgical benefit riders with their life policies. These also provide a pre-fixed sum of money in the event of a surgery. Bajaj’s new plan has add-ones like hospital cash daily allowance, critical illness cover and personal accident cover.
Chopra says while there is a need for such products, these work well only as supplementary cover because of very restrictive coverage. What if you contract something outside the list in policy? Another executive in a health insurance firm says such plans usually have an additional restriction on the number of claims to be made in a year.
And, this plan has some tough restrictions. That is, if there is any claim under a particular grade, then the coverage under that grade will cease for the balance period of the policy. The product has five grades – supra major, major, sub-major, day care and minor.
The premium for a sum insured of Rs 10 lakh for Bajaj Allianz Health Guard individual hospitalisation reimbursement plan is Rs 10,913 for a male in the 26 – 40 age bracket. The premium for Surgical Protection Plan which is a benefit product for the same age bracket and same sum insured is Rs 11,500 is for the base plan plus all the three add-on covers like Hospital Cash, Critical Illness and PA cover. These add-on covers are optional. Just for the Surgical Protection Plan base policy the premium for 26-30 age group and the same sum insured is Rs 5,639 for male and Rs 5,468 for females.
Additionally, the plan allows only 50 per cent of the sum insured to be claim for complicated surgeries in Grade A. Say you have a sum-insured of Rs 10 lakh, the cover would allow you to claim only Rs 5 lakh.
Exclusions will include: Any pre-existing disease for which surgery is required, and any treatment taken within 90 days of the commencement of the policy. Many medical conditions including gastric or duodenal ulcers, cardiovascular diseases, hernia, fistulae, fissure, cataract, endometriosis, hysterectomy, and surgery on all internal or external tumours would be excluded for two years.
ALSO READ: Bajaj Allianz General Insurance launches insurance cover for surgical treatments
ALSO READ: Are family floater health plans cheaper?