Rising healthcare costs, sudden illnesses, and medical emergencies do not wait for the ‘right time’. This is exactly why choosing the right family health insurance plan has become not just smart but essential.

It ensures that when life throws the unexpected your way, you can focus on your family’s well-being instead of worrying about the hospital bills. And if you are looking to safeguard your loved ones, you are in the right place. Let us explore how family health insurance plans work, their features, and how to choose the perfect one for your family’s needs.

Family health insurance, or a family mediclaim policy, is a kind of insurance that provides comprehensive health coverage for all family members. At Bajaj General Insurance Limited , we design these health insurance policies for families to offer them financial protection against medical expenses arising from hospitalisations, surgeries, and other treatments.

Family health insurance plans typically cover immediate family members, including spouses, children, and sometimes parents. If you opt for health insurance plans for your family, you safeguard them against unexpected medical costs, promoting better health and peace of mind.

Read on to learn more about the features of this policy:

1. Platinum Plan: Super cumulative bonus of 50% per claim-free year under family floater health insurance.

2. Recharge Benefit: To take care of claims where the claim amount exceeds your sum insured.

3. Multiple Sum Insured Options: Enjoy the flexibility to choose between 3 plan variants along with the Sum Insured options ranging from ₹1.5 lakh to ₹1 crore.

4. Immediate Family Cover: This policy covers you, your spouse and your children.

5. Ayurvedic and Homoeopathic Treatment: Under the Gold and Platinum Plan, the policy covers in-patient hospitalisation expenses (up to ₹20,000) incurred in a recognised ayurvedic/homoeopathic hospital where the admission period is not less than 24 hours.

6. Daycare Procedures Cover: Medical expenses incurred during the treatment of listed daycare procedures or surgeries are covered under family floater health insurance.

7. Convalescence Benefit: In case of continuous hospitalisation of more than 10 days, you will be eligible for a benefit payout of up to ₹7500 per year, provided the hospitalisation claim is admissible.

8. Bariatric Surgery Cover: Bariatric surgery is covered under medical advice and is subject to specific terms and conditions.

9. Sum Insured Reinstatement: If your sum insured and the cumulative bonus (if any) have been completely exhausted during the policy year, we will reinstate it.

10. Pre and Post-Hospitalisation: The policy covers medical expenses 60 days immediately before and 90 days immediately after hospitalisation.

11. Road Ambulance Cover: Our family health coverage plans cover ambulance expenses incurred up to ₹20,000 during each policy period.

12. Organ Donor Expenses Cover: Expenses towards organ donors' treatment for harvesting donated organs are covered under this policy.

13. Daily Cash Benefit: A daily cash benefit of ₹500 per day, for up to 10 days during each policy year, will be payable as accommodation expenses for one parent/legal guardian to stay with a minor insured under the policy for an admissible claim.

14. Maternity/Newborn Baby Cover: Maternity expenses and medical expenses towards the treatment of a newborn baby are covered under the medical insurance for the family and are subject to specific terms and conditions. This feature is available under the Gold & Platinum Plan.

Additional Benefits with Your Family Health Insurance Policy

Our family medical insurance provides various benefits for you and your loved ones:

Wellness benefit

Many people might be unaware of this benefit that can save you a lot during renewal. If you maintain your health well, you are eligible for a discount of up to 12.5% on your family health insurance plan premium. This benefit can come in handy as it contracts the rising healthcare costs in the country.

Renewability

As per the report of Business Standard, around 75% of older people in India suffer from a chronic illness. This implies the increasing probability of the elderly investing more in their healthcare. Therefore, it is essential that you are able to keep your and your family’s health insurance intact over time. This is where the lifetime reliability of our family health insurance plans comes into play.

Tax Saving

Under Section 80D, you can claim ₹25,000 annually for all kinds of family health insurance plans premiums for yourself, spouse, and children (if you are under 60). Paying for senior-citizen parents allows an additional ₹50,000 deduction. This lets taxpayers below 60 claim up to ₹75,000, while those above 60 paying premiums for senior parents can claim up to ₹1,00,000.

Hassle-free Claim Settlement

Our in-house claim settlement team ensures a quick, smooth and easy claim settlement process. Also, we offer cashless claim settlement at more than 18,400+ network hospitals* across India. This comes in handy in case of hospitalisation or treatment, wherein we pay the bills directly to the network hospital, and you can focus on recovering and getting back on your feet.

Preventive Health Check-up

At the end of a block of every continuous period, as mentioned in the family health insurance plans coverage during which you have held our Health Guard Policy, you are eligible for a free Preventive Health checkup. These health checkups ensure that you detect any kind of issues in your body at an early stage and work on their treatment. This might not seem that important, but it makes a world of difference in positive healthcare.

Portability Benefit

Suppose you and your loved ones are insured under any other family health insurance policy. In that case, you can switch to this policy with all accrued benefits after due allowances for waiting periods and enjoy the available benefits of the policy. The benefits that you will be able to retain include cumulative bonuses.

Long-Term Policy

Getting short-term family health insurance plans is very disruptive. It expires too soon, and you are left with the responsibility to renew it. On top of this, if the time period of the policy is short, you might not get a chance to use it. This is the reason why we provide policies that can be purchased for 1, 2 or 3 years.

Discount on Policy

With us, not only can you enjoy the classic benefits of a long-term family health insurance policy, but also enjoy it with a discount. On our family health insurance plans, you can avail a long-term policy discount of 4% for 2 years and 8% for 3 years. This provides a slight financial relief while getting the policy.

Purchasing a health insurance policy for the family online from Bajaj General Insurance Limited comes with numerous advantages. Below are the 8 benefits you can get if you buy family health coverage plans from us:

Quick Claim Settlement

We provide online claim settlements for up to ₹20,000. You can get covered with just a few taps. This makes the claim process much easier and agile for you.

Cashless Coverage

We have over 18,400 network hospitals all over India. This proves you have access to cashless claim settlements, which takes out the worry of handling hospital bills.

Cumulative Bonuses

If you spend a claim-free year, you can get a cumulative bonus on your family health insurance plans. This means your sum insured increases by a few % as specified in your policy document.

Flexible Plans

There are various kinds of plans that we offer for your family. On top of this, you can get add-ons on your base plans, such as Non-Medical Expense, Maternity Cover, and Bariatric Surgery Cover.

Hybrid Process

We not only provide a digital service for tech-savvy Gen Zs and millennials, but also provide offline services for the people who like to make insurance purchases the traditional way.

Lifetime Renewability

We provide the option of lifetime renewability with our family health insurance plans. This way, you do not have to worry about your insurance betraying you ever.

Quick Quote Generation for Comparison

Our online service provides you with the benefit of generating multiple quotes in minutes and comparing plans to choose the best one for your family.

Already Trusted

We have a customer base of over 14 crore customers that have put their trust in us. This reflects our commitment to you so you can have a reliable shoulder in a crisis.

Top Reasons to Choose the Bajaj General Health Guard Policy

Bajaj General Insurance Limited Health Guard Policy is one of the best family health insurance plans due to its extensive benefits and features.

Extensive Benefits and Features

1. Multiple sum insured options.

2. Immediate family coverage.

3. Includes AYUSH treatment.

Unique Benefits

1. Recharge benefit for the sum insured.

2. Sum insured reinstatement.

3. Coverage for daycare procedures.

Additional Coverage

1. Maternity/newborn baby cover.

2. Bariatric surgery cover.

3. Convalescence benefits.

Holistic Coverage

1. Comprehensive health insurance plans for the entire family.

Individual Health Insurance vs. Family Health Insurance Comparison

Deciding between individual health insurance and family health insurance plans depends largely on your family’s age, medical history, and specific needs.

Things to Consider Before Buying a Family Health Insurance Plan

Selecting the best family health policy in India requires careful consideration of factors that impact coverage and affordability.

1. Sum Insured: Choose an adequate sum insured to cover all family members, especially those with pre-existing conditions or specific medical needs.

2. Premium Costs: Premiums increase with the sum insured and the age of the eldest family member. Select an affordable option that provides comprehensive protection without straining your budget.

3. Network Hospitals: Bajaj General Insurance Limited has a broad network of hospitals across India, offering cashless treatment to reduce upfront payment burdens during emergencies.

4. Pre and Post-Hospitalisation Coverage: Ensure your plan includes expenses for doctor visits, diagnostic tests, and medications both before and after hospitalisation.

5. Daycare Procedures: Check if daycare treatments are covered, as these don’t require a 24-hour hospital stay but can be costly.

6. Ambulance Services: Confirm if ambulance charges are included, as these can provide valuable support in emergencies or for planned treatments.

Family Health Insurance Claim Process

With Bajaj General Insurance, you can make a claim for family health insurance plans in many different ways. The process for making such claims is given below, along with other related things to remember:

Claim by Direct Click (CDC)

Bajaj General Insurance Limited has introduced an app-based claim submission process known as Health Claim by Direct Click. This facility allows you to register and submit documents through the app for claims up to ₹20,000.

To make a claim through this process, you need to follow the steps as given below:

Step 1: Register your policy and card number in the Bajaj General App.

Step 2: Register your policy and health card number in the app, and then register the claim.

Step 3: Fill the claim form and arrange for the hospital-related documents.

Step 4: Upload the documents using the app menu.

Step 5: Submit the claims for further processing.

Step 6: Get confirmation within a few hours.

Cashless Claim Process (Only Applicable for Treatment at a Network Hospital)

Cashless facilities at network hospitals are available 24/7 throughout the year without interruption. You must check the hospital list before getting admitted to the hospital. Hospitals that provide cashless settlements are liable to change their policy without notice. The updated list is available on our ‘Bajaj General Branch Locator’ website and with our call centre. The Health Card by Bajaj General Insurance Limited and government ID proof are mandatory when availing of the cashless facility.

When you are opting for cashless claims under family health insurance plans, the process is as follows:

Step 1: Get the pre-authorisation request form filled and signed by the treating doctor/hospital, and signed by you or a family member at the hospital’s insurance desk.

Step 2: The network hospital will send the request to HAT.

Step 3: HAT doctors will examine the pre-authorisation request form and decide on cashless availability, as per the policy guidelines.

Step 4: An authorisation letter/denial letter/additional requirement letter is issued within a few hours (as per internal service timelines), depending on the plan and its benefits.

Step 5: At the time of discharge, the hospital will share the final bill and discharge details with HAT, and based on their assessment, the final settlement will be processed.

Important points to note:

1. In case of planned hospitalisation, register/reserve your admission per the network hospital’s procedure for admission in advance.

2. Admission at a network hospital is subject to the availability of a bed.

3. Cashless facility is always subject to your policy terms and conditions.

Aspects of Cashless Claim Settlement That the Policy Does Not Cover

Some of the aspects in cashless claim settlement that the policy does not cover are as follows

1. You must pay for the above services, such as telephone charges, food and beverages for relatives, and toiletries, directly to the hospital before discharge.

2. In-room rent nursing charges are included. However, you will bear the incremental charges if a higher-cost room is used.

3. If the treatment is not covered per the policy terms and conditions, your claim, cashless or reimbursement, will be denied.

4. Pre-authorisation for a cashless claim can be denied in case of inadequate medical information.

5. The denial of the cashless facility does not mean denial of treatment and does not prevent you from seeking necessary medical attention or hospitalisation.

Reimbursement of Pre-/Post-hospitalisation Process (In Case of a Non-network Hospital)

Relevant medical expenses incurred before admission and after hospital discharge will be reimbursed per the policy document of the family health insurance plans. Prescriptions and bills/receipts of such services should be submitted to Bajaj General Insurance Limited along with the duly signed claim form.

The steps to apply for a reimbursement claim are as follows:

Step 1: Inform the BGIL HAT team about the hospitalisation.

Step 2: To register your claim online, click here.

Step 3: To register your claim offline, please call us on our toll-free number: 1800-209-5858.

Step 4: After discharge, you or a family member must submit the following documents to the HAT within 30 days:

1. Duly filled and signed claim form with mobile number and email ID.

2. Original hospital bill and payment receipt

3. Investigation report

4. Discharge card

5. Prescriptions

6. Bills of medicines and surgical items

7. Details of pre-hospitalisation expenses (if any)

8. In-patient papers, if required

Step 5: All documents are to be sent to HAT for further processing, and based on the assessment, the final settlement will be done within 10 working days.

Please note: Post-hospitalisation, you need to send claim documents for a valid claim application under family health insurance plans within 90 days of discharge.

Below are the documents you will need to make a reimbursement claim with family health insurance plans:

1. The original pre-numbered hospital payment receipt is duly sealed and signed.

2. Original prescriptions and pharmacy bills.

3. The original consultation papers (if any).

4. Original investigation and diagnostic reports, bills, and payment receipts for the investigation done within and outside the hospital.

5. If you or a family member availed a cashless claim but did not utilise it, a letter from the hospital stating so.

6. Letter from the treating doctor mentioning incident details (in case of an accident).

7. Hospital registration certificate and hospital infrastructure on the letterhead.

8. A cancelled cheque bearing the IFSC code and the name of the insured.

9. An indoor case paper copy attested from the hospital from admission to discharge, with a detailed medical history, doctor’s notes, and temperature, pulse, and respiration charts.

10. X-ray films (in case of a fracture).

11. Obstetric history from the treating doctor (in maternity cases).

12. FIR copy (in accident case).

13. Additional requirements for some exceptional cases:

1)      A lens sticker with a bill copy, in case of a cataract operation.

2)      Use an implant sticker with a copy of the bill, in case of surgery.

3)      A stent sticker with a bill copy, in case of a heart-related treatment.

All original claim documents need to be submitted to the following address:

Bajaj Insurance House, Airport Road, Yerawada, Pune-411006

Note: Mention your Policy Number, Health Card Number and Mobile Number clearly on the face of the envelope. Note: Keep a photocopy of the documents and the courier reference number for your records.

Get comprehensive coverage, cashless hospitals, flexible plans, and digital services with Bajaj General Insurance’s Family Health Insurance Plans. Secure your family’s future today!