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Bajaj Allianz's Surgical Protection Plan allows only 50% of sum insured to be claimed
The plan covers around 600 kinds of surgeries and offers 11 sum insured, ranging from ₹ 1 lakh to ₹ 10 lakh. However, the benefit amount is capped between ₹ 5,000 and ₹ 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.
It is costly as well, and by a good 10 per cent from the same insurer. A ₹ 10- lakh comprehensive health insurance cover for a26- 40 age bracket male would have a premium of ₹ 10,913. The premium of the surgical plan, for the same age bracket, will cost ₹ 11,500.
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 ₹ 10 lakh, the cover would allow you to claim only ₹ 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
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