Insurance – FAQs

Hospitilisation Cover - Extracted from the Policy

In consideration of payment of additional premium by the Insured to the Company and realization thereof by the Company, it is hereby agreed and declared that Global Personal Guard Policy is extended to cover the Insured Person, if he/ she is Hospitalized for a minimum period of 24 hours on the advice of a Doctor/ Medical Practitioner because of Accidental Bodily Injury sustained during the Policy Period, then the Company will pay the In-patient Treatment- Medical Expenses for the below listed items up to the Sum Insured stated under the heading ‘Accidental Hospitalization Expenses’, in the Policy Schedule, subject otherwise to all other terms, conditions and exclusions of the Policy:

* Room rent, boarding expenses
* Nursing
* Intensive care unit
* Consultation fees
* Anesthesia, blood, oxygen, operation theatre charges, surgical appliances
* Medicines, drugs and consumables,
* Diagnostic procedures,
* The Cost of prosthetic and other devices or equipment if implanted internally during a Surgical Procedure.
* Physiotherapy expenses as recommended by the treating Doctor

Day Care procedure coverage

Waiver of 24 hours hospitalization would be considered under Accidental Hospitalization Expenses for the surgeries/procedures due to technological advancement provided such procedures comply with the standard definition of Day Care Centre and Day Care treatment mentioned in the Policy definitions.

The Pre and Post Hospitalisation expenses payable under day care procedure shall include expenses incurred on Physiotherapy also.

If the claim under Accidental Hospitalization Expenses (including day care procedure) due to Accident of the Insured Person is accepted, then the Company will also pay below expenses:

i. Pre Hospitalization :

If the Company has accepted an inpatient Hospitalization claim under Accidental hospitalization Expenses then the Company will also reimburse the Medical Expenses incurred during the 60 days immediately before the Insured Person was Hospitalized for Accidental Bodily Injury, provided that such Medical Expenses were incurred for the same injury for which subsequent Hospitalization was required.

ii. Post-Hospitalization :

If the Company has accepted an inpatient Hospitalization claim under Accidental Hospitalization Expenses then the Company will also reimburse the Medical Expenses incurred during the 90 days immediately after the Insured was discharged post Hospitalization provided that, such costs are incurred in respect of the same injury for which the earlier Hospitalization was required.

Specific Exclusion Applicable to Accidental Hospitalization Expenses Cover:

1. Any Hospitalization for an existing disability from a previous Accident which has occurred prior to the first inception of this Policy.

2. Any stay in Hospital for an Injury due to Accident without undertaking any treatment.

3. Any Hospitalization for Accidental Injury aggravated by an existing disability or pre-existing illness / condition / injury.

4. Any Hospitalization due to an Accidental Injury where the treatment is undertaken by a family member and self medication or any treatment that is not scientifically recognized.

5. Vaccination and inoculation of any kind unless forming part of treatment for Injury due to an Accident as prescribed by the Medical Practitioner.

6. Vitamins and tonics unless forming part of treatment for Injury due to an Accident as prescribed by the Medical Practitioner.

7. Aesthetic treatment, cosmetic surgery and plastic surgery unless necessitated due to Accident or as a part of any Injury.

What is the Claim Procedure

If the Insured Person meets with any Accidental Bodily Injury that may result in a claim, then as a condition precedent to our liability:

a. Policyholder or the Insured Person or someone claiming on his/her behalf must inform us in writing immediately and in any event within 30 days from the date of the accident and submit all documents to us within 30 days from the date of intimation.

b. Insured Person must immediately consult a Doctor and follow the advice and treatment that he recommends.

c. Insured Person must take reasonable steps to lessen the consequence of Bodily injury.

d. Insured Person should allow examination by our medical advisors if we ask for this.

e. Policyholder or Insured Person or someone claiming on his/her behalf must promptly give us documentation and other information we ask for to investigate the claim or our obligation to make payment for it.

f. In case of the Insured Person’s death, someone claiming on his/her behalf must inform us in writing immediately and send us a copy of the post mortem report (if conducted) within 30 days.

*Note: Waiver of conditions (a) and (f) may be considered in extreme cases of hardship where it is proved to Our satisfaction that under the circumstances in which the Insured Person was placed, it was not possible for the Insured Person or any other person claiming on his/her behalf to give notice or file claim within the
prescribed time limit.

In case of any claim, please contact Bajaj Allianz 24 Hour Call Centre at : 1800-22-5858, 1800-102-5858 (Toll Free) / 91-020-30305858 (chargeable, add area code before this number in case of mobile call)
or email at [email protected] with cc to [email protected]

8. Treatment taken from persons not registered as Medical Practitioners under respective Medical Councils. .

9. Any other medical or surgical treatment except as may be necessary solely as a result of Injury.

10. Any treatment taken outside India.

11. Whilst engaged in adventure sports, unless specifically covered under the base policy.

12. Dental treatment or surgery of any kind unless as a result of Accidental Bodily Injury to natural teeth and also requiring hospitalization.

13. Experimental, unproven or non-standard treatment.

What are the documents required for a Claim

List of Claim documents in case for Death :

* Duly Completed Claim Form signed by Nominee/ legal heir of the Insured Person
* Copy of address proof (Ration card or electricity bill copy)
* Attested copy of Death Certificate
* Burial Certificate (wherever applicable)
* Attested copy of Statement of Witness, if any lodged with police authorities
* Attested copy of FIR / Panchanama / Inquest Panchanama
* Attested copy of Post Mortem Report (only if conducted)
* Attested copy of Viscera report if any (Only if Post Mortem is conducted)
* NEFT details & cancelled cheque of the Nominee/ legal heir of the insured Person
* Original Policy copy along with Original Assignment endorsement (if any)

List of Claim documents for Disappearance :

* Duly Completed Claim Form signed by Nominee/ legal heir of the Insured Person.
* Copy of address proof (Ration card or electricity bill copy)
* Attested copy confirming disappearance from appropriate authority following a forced landing, stranding, sinking or wrecking of a conveyance
* Documentary proof of fare paying passenger of a conveyance as an occupant
* Attested copy of Statement of Witness, if any lodged with police authorities
* Attested copy of FIR / Panchanama / Inquest Panchanama
* NEFT details & cancelled cheque of the Nominee/ legal heir of the insured Person
* Original Policy copy along with Original Assignment endorsement (if any)

List of Claim Documents Specific for Accidental Hospitalization Expenses :

* First Consultation letter from the Doctor
* Duly completed claim form signed by the Claimant
* Hospital Discharge Card
* Hospital Bill giving detailed break up of all expense heads mentioned in the bill. Clear break ups have to be mentioned for OT Charges, Doctor’s Consultation and Visit Charges, OT Consumables, Transfusions, Room Rent, etc.
* Money Receipt, duly signed with a Revenue Stamp
* All original Laboratory and Diagnostic Test Reports. E.g. X-Ray, E.C.G, USG, MRI Scan, Haemogram etc.
* Other documents as may be required by the Company to process the claim

List of Claim Document Specific to Adventure Sports Benefit :

* Certificate of participation from Sports event organizer, only in case of accident arising when participating in any competition / event.
* Pre participation fitness certificate (very important to procure and keep), and certificate from the treating doctor mentioning the nature of the Injury
* All Investigation reports
* Discharge summary (If hospitalized)
* Documents as listed for claim under Death / Permanent Total Disability
* PAI Incident report

For more information or follow up on insurance matters,
please connect with

Raghav Sundar
[email protected]
Cell : +91 98802 83946

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