Rakesh Gupta, 48, woke up one morning with terrible chest pain. He called in sick at work and waited for the pain to pass. But it was still there the next morning. It was so bad that his family called an ambulance and rushed him to the hospital.

Once there, Rakesh underwent a thorough physical examination. The attending doctor ordered an angiography, which revealed three blockages in his heart. A simple angioplasty would not do in his case. He would need emergency bypass surgery.

Facing the surgical option

The Guptas had just bought an apartment and finances were tight. But Rakesh had a health insurance plan with Bajaj Allianz. The policy provided Rs.4 lakh as coverage.

The hospital they went to was part of the insurance company’s network. So, the Guptas did not have to pay anything. Rakesh’s son, Ajay, simply presented the health insurance card at the insurer’s helpdesk at the hospital. The third-party administrator (TPA) there noted that this was an emergency case. She fast-tracked the process for cashless insurance.

Rakesh underwent surgery the next day. The combined costs of the surgery and the hospital stay came up to Rs.2.5 lakh. The insurance covered all of it. It even covered the ambulance bill of Rs.750.

A few months later, however, Rakesh was back in the hospital. He had slipped while at the vegetable market and fractured his ankle. The orthopaedic surgery and the hospital stay pushed up costs to nearly Rs.90,000. But Rakesh still had coverage of Rs.1.5 lakh (Rs.4 lakh – Rs.2.5 lakh). So, the insurance covered the costs.

But this time, Rakesh went to a non-network hospital for the surgery. So, the cashless option was not available. The Guptas paid for the surgery and filed a reimbursement claim with the insurer. The insurance company settled this within 14 days.

Affording miscellaneous medical costs

Rakesh’s health insurance plan also covered pre- and post-hospitalisation expenses. The angiography was also included.

As Rakesh had just turned 46 when taking the policy, he had to undergo a pre-policy check-up. But the insurer refunded the check-up costs after approving the policy.

Rakesh’s wife, Anita, also took a similar policy. But she was below the age of 45 at the time and had no pre-existing health problems. So, she did not need to undergo any medical check-ups.

Over the next few years, Rakesh did not make any claims on the policy. So, he managed to accumulate a 30% no-claim bonus over three claim-free years. This brought down his premium amount. If he manages to add another claim-free year to the tally, he will be eligible for a free health check-up at a networked diagnostic centre.

A safeguard for your family’s health

The Bajaj Allianz Health Guard Individual option plan offers a range of benefits. It supports policyholders to avail quality healthcare at more than 4,000 networked hospitals. Apart from regular hospital bills, the plan covers 130 day-care procedures. There is coverage for pre-hospitalisation expenses up to 60 days prior to the hospitalisation and for post-hospitalisation expenses for 90 days after.

Besides, loyal customers get an added perk: a 10% family discount. Anita availed this when she took out her policy. It brought down her premium amount by quite a bit.