Overview
The Bajaj Allianz Health Guard Gold plan is a comprehensive health insurance policy offering sum insured options from ₹3 lakhs to ₹50 lakhs. The plan includes benefits like organ donor expenses, maternity coverage, and newborn baby care. It also offers a sum insured reinstatement benefit 100% of Base SI once a year and free preventive health check-ups after three policy years.
Experts Review
Written by Ishita Jain
Editor
The Bajaj Allianz Health Guard Gold plan is a robust health insurance solution that offers more extensive coverage compared to its Silver variant. Basic cover includes in-patient hospitalization, AYUSH, day care procedures, organ donor expenses, wellness benefits, and 60-90 days pre- and post-hospitalization, but excludes domiciliary treatment.
The Gold plan provides higher sum insured options, broader maternity coverage (with limits of ₹15,000 for normal and ₹25,000 for cesarean delivery (for sum insured ₹3–7.5 lakhs), and ₹25,000 for normal and ₹35,000 for cesarean delivery (for sum insured above ₹7.5 lakhs)), and newborn baby care benefits, making it suitable for families.
However, it includes sub-limits for cataract surgery (20% of the sum insured up to ₹1 lakh) and bariatric surgery (50% of the sum insured up to ₹5 lakhs), which may limit coverage for high-cost procedures. Further, room rent is restricted to a single private A/C room for sum insured between ₹3 lakhs and ₹7.5 lakhs, while there is no room category restriction for sum insured of ₹10 lakhs and above.
Bajaj Allianz has an average claim settlement ratio of 95% (across 2021-24), indicating reliable claims processing. While the plan offers comprehensive benefits.
Pros
Feature set is satisfactory.
Insurer has a solid track record with great claim and service metrics.
Cons
No coverage if you are forced to hospitalize at home, which is a notable gap.
Doctor consultations are not covered, which could be a drawback for some.
Bajaj Allianz
Key Insights
Founded
2001
Bajaj Allianz was established 24 years ago and has built strong credibility over time, backed by its long-standing presence in the market.
Claims Experience
97% claims settled in 30 Days
Bajaj Allianz settles 97% of all claims it receives demonstrating strong credibility.
Network Hospitals
12,000+
Bajaj Allianz has a strong network with over 12,000 hospitals, ensuring wide accessibility and convenience for policyholders.
Complaints
3 complaints per 10,000 claims registered
Bajaj Allianz maintains a low volume of complaints, reflecting strong customer satisfaction and effective service.
Features
All
Great
Good
Bad
Maternity
STANDOUT
The insurer will also cover expenses related to maternity— Think hospitalization expenses incurred while giving birth. But they’ll only pay upto ₹25,000 and make you wait 6 years before covering this expense. Also, you’ll only get the benefits if both, you and your spouse are enrolled in a single-family floater plan.
Co-payment
The insurer will bear the entire cost of treatment (up to the sum insured). You won’t have to pay a single penny. Meaning this policy has no co-payment.
Room Rent
Shared room, single room, deluxe room or any room that’s available. The insurer won’t nitpick on your choice of room since the policy has no restrictions on room rent.
Disease sub-limit
Your insurance cover won’t be fully available in case you are treated for eye related diseases like cataracts, up to 20% of base sum insured max. of ₹1,00,000 will be covered.
Pre existing diseases waiting
If you’re already dealing with diabetes, cardiovascular problems or any such illnesses, the insurer will cover all costs arising out of these pre-existing problems after you wait for 3 years.
Permanent Exclusions
Conditions or treatments that the policy clearly says it will not cover.
Expenses related to any admission primarily for diagnostics and evaluation purposes are excluded.
Diagnostic expenses not related or incidental to current diagnosis and treatment are excluded.
Expenses for admission primarily for bed rest and not for treatment are excluded.
Custodial care at home or in a facility for help with daily activities is excluded.
Services for terminally ill individuals addressing non-medical needs are excluded.
Disclaimer: For illustration purposes only - exact terms are in the policy wording.
Specific Illness
The following illnesses are not covered under the policy .
Any type of gastrointestinal ulcers
Cataracts (any type)
Any type of fistula
Macular degeneration
Benign prostatic hypertrophy (BPH)
Waiting Period
30 days Initial waiting period
3 years Pre-existing disease waiting period
Ditto's Take
◦ Standard ◦
After a close look at the waiting periods, it’s safe to say they are fairly standard overall. However, there is no specific illness waiting period which is a plus.
What's missing in the policy
No coverage if you are forced to hospitalize at home.
Doctor consultations are not covered.
Customer Reviews
H
Hrithik S.
Comprehensive coverage with higher sum insured options than Silver plan.
I
Inaaya V.
Maternity benefits and newborn baby cover are included, which is great for families.
I
Ishaan G.
Restoration of sum insured is available, providing an extra safety net.
L
Lavanya J (new)
Some sub-limits might still apply even in the Gold plan, so read the policy carefully.
K
Kiara K (new)
While comprehensive, premiums will be higher than the Silver plan.
K
Kavya P.
Good for families looking for a more robust plan from Bajaj Allianz.
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Frequently Asked Questions
Does Health Guard Gold have waiting periods?
- 30-Day Waiting Period: Hospitalizations won’t be covered for the first 30 days of the policy unless it’s an accident.
- Specific Illness Waiting Period: There’s a 2 to 3-year waiting period for a list of diseases which is a mandate before you can start claiming.
- Pre-Existing Disease Waiting Period: There's a 3-year waiting period for any pre-existing disease you may have while buying the policy.
- Maternity and Newborn Waiting Period: There’s a 6-year waiting period before you can make claims related to pregnancy and childbirth.
Does Health Guard Gold have room rent restrictions?
Does Health Guard Gold offer a restoration benefit?
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