Bajaj Allianz General Insurance Company recently launched a health insurance plan know as “Surgical Protection Plan” which assures a guaranteed benefit depending on the surgical treatment out of 600 covered surgeries.  The policy has 11 plans ranging from 1lakh – 10lakh. Each plan has 5 grades which has pre defined cover for each surgery. The policy is a benefit policy which can be opted over and above normal health insurance policy.

Salient Features of this policy: –

• This one-of-its-kind policy provides you with a fixed benefit amount for specified surgeries and helps you to take care of the expensive medical treatment in a hospital.
• Comprehensive coverage for around 600 surgeries, with guaranteed benefit amount.
• This policy can be opted in addition to the hospitalisation policy
• The only benefit plan with cashless facility in around 3700 network hospitals all over India
• Very competitive premium rates with comprehensive coverage like Hospital Cash Daily Allowance, Critical illness and Personal Accident Cover.
• Total 11 Plans available with Rs.1 Lac to Rs.10 Lakh sum insured options under surgical benefit section
• Benefit amount will be payable, as per grade of surgery and plan opted

The following table shows 11 plans:-

The above fixed cost is payable for the surgeries which are divided under 5 grades as per the below table. The total list of surgery is available on company’s website.

Understanding the Policy – Now suppose, someone has opted for the plan 6, which is for Rs. 5Lakh. There can be two ways of using policy, either cashless option or claiming for reimbursement after getting discharged from hospital.

 Now suppose patient has undergone a Cataract Surgery which is a Grade 3 surgery, the benefit amount is Rs.85000. Let’s say the total cost of the surgery is Rs.50,000 in a Tier 2 city. If the patient goes for cashless treatment the company will pay the bill of Rs.50,000 during discharge and will pay Rs.35000 to the patient thus completing the benefit amount of Rs.85.000. And if the patient goes for reimbursement option the company will pay whole benefit amount of Rs.85000. 

Exclusion under this policy:-

• Abuse of intoxicant or hallucinogenic substance like drugs and alcohol.
• War or act of war, nuclear, chemical or biological weapon and radiation of any kind.
• Non-allopathic treatment.
• Cosmetic or aesthetic treatments of any description, treatment or surgery for change of life/gender.
• Intentional self-injury.
• Fertility, sub fertility, impotence, assisted conception operation or sterilization procedure.
• Weight management services and treatment related to weight reduction programs

 Advantages of this policy:-

• 15 days Free Look period for new policies
• 30 days grace period for renewal, from policy expiry date
• Pre-existing conditions shall be covered after 4 continuous renewals.
• In-house claims processing by Health Administration Team of Bajaj Allianz
• No pre-policy medical tests up to 45 years of age (subject to no adverse health conditions)
• Income Tax Benefit under Sec 80 D of the IT Act on the premium paid for Surgical Protection Plan except premium on personal accident cover

 The premium for this policy starts with as low as Rs.636 for a male in the slab of 3 Months – 25 yrs who is insured for Rs.1 lakh. The company offers a 5% family discount as well as extra 5% for maintaining good health. Also, if you buy this policy online you will get additional 10% discount. Also women enjoy a lower premium in comparison with men. So overall a family can claim maximum of 20% discount.

The entry age is 3months for dependent child and 18 years for proposer. It comes with the lifetime renewal facility which is good for the policy holders.

Riders:

There are few riders available with this policy:
1.       Daily cash allowance
2.       Critical illness.
3.       Personal Accident cover

How this policy is different from Critical Illness policy?

Critical illness policy covers some of the major illness mentioned in the policy. It pays a lump sum – one off payment in case you are diagnosed with one of the serious illness. Surgical protection plan also covers only those expenses which are due to be paid for a surgery mentioned in the policy.

There are 2 differences in both policies. First one is that the diseases covered are different in both the policies. Another one is that, in critical illness the patient gets the reimbursement only after he survives for 1 month once the critical illness is diagnosed. While in Surgical protection plan the money is reimbursed as soon as the bills are submitted in the company.

What is the tax treatment for the money received in access to the actual expenses?

Let’s once again consider the above example where actual expense are Rs.50,000 and company will reimburse Rs.85,000 as according to the grade. Now, as in the case of Critical illness policy the amount received is tax exempted through Sec10 (10D), in the same way the amount received in this policy will be a part of reimbursement and thus will be tax exempted.

Should you opt for this policy?

This particular policy covers about 600 surgeries and can be used with the existing health insurance policy.  A normal policy covers the OPD charges, Nursing Expenses, room rent, etc. While this policy will reimburse you the amount indicated in the grade for the surgery. That’s why a person can use this policy as an add on policy. The policy is one of its kind which is launched first time in the country. One can read the wordings of the policy on the company’s website and if find suitable one can opt for this as add on cover over their existing health insurance policy.  

Disclaimer: Since this is a new product, we are not sure how exactly claim logistics may workout. If you are considering buying such a policy, it will be a good idea to ask the Company representative to walk you through the illustration and policy wordings.