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Baroda Health

Baroda Health

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Published by Chhavi Bhatnagar
baroda health policy
baroda health policy

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Published by: Chhavi Bhatnagar on Jun 20, 2013
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06/04/2014

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What is Baroda Health Policy?

It is a Medical Insurance Scheme, available only to account holders of our Bank, which takes care of the hospitalization expenses incurred by the customer up to the amount of sum insured, in respect of the following eventualities.

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Any illness / disease Accidental injury and/ or any ailment. Any surgery that is required in respect of any disease or accident that has arisen during the policy period The minimum hospitalization should be for 24 hours

Key Benefits :
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Very low premium In this co-branded product, single premium (generally payable for a single person) is payable and Medical Health insurance cover is available to family of -4- (self, spouse and 2 dependent children) up to the amount insured without any additional premium. A member or all the members in insured family can avail hospitalization benefits during the policy period, to the extent of aggregate sum not exceeding the sum insured. Premium paid is eligible for Income Tax exemption under Section 80 D as per Income Tax Rules.

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Salient features:
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No medical examination required for commencement of health cover. Pre-existing diseases also get coverage after 3 continuous claim-free policy years. Coverage options available: 8 slabs ranging from Rs. 50,000/- to Rs. 5,00,000/- per family of 1+3. Upper age limit of primary member (first named person) is allowed upto 80 years, if a person obtains the insurance cover before completion of 65 years and continue to renew the policy upto the age he wishes to or 80 years, whichever is earlier. The scheme is administered through Third Party Administrators (TPAs) for settlement of Hospitalization Claims under the insurance cover. The insured individuals get cashless hospitalization facility also in the selected hospitals through TPAs. The whole process is hassle-free and treatment upto the limit of insurance is available without any payment at the time of admission or discharge. Payment of hospital bill up to the sum insured will be taken care of by the TPA directly.

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Baroda Health Policy 1.Salient 2.Scope 3.Additional Covers 4.Other Features Feature Cover

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Boarding expenses as provided by the Hospital/Nursing Home.000/-. Radiotherapy. However renewals are allowed up to 80 years at a premium loading of 25% of the specified premium.000/-to Rs 5.(Rupees one thousand only) per Policy period. 5) Pre-existing Diseases Cover: Benefits for pre existing diseases will be available only after the completion of 36 months of continuous claim free coverage since inception of the first policy with us. Scope of Cover 1) Room.00. Oxygen. ailment or injury or related condition(s) for which you had signs or symptoms and/or were diagnosed and/or received medical advice/treatment within 48 months prior to your first policy with us. either one or all members of the family who can utilize the Sum Insured during the policy period. Specialists Fees. In case of Hospitalization Expenses. Operation Theatre Charges.1000/.Major Exclusions 6. Consultants. 5) Coverage options available: 8 slabs ranging from Rs 50. Additional Covers 1) Ambulance charges not exceeding Rs. Dialysis.Claim Procedure 8. Cost of pacemaker. 3) Cost of health check-up: It is allowed at the rate of 1% of the sum insured after completion of three continuous claim free years of policy/policies issued by National Insurance Company Ltd. 3) Surgeon. Surgical appliances. Blood.General Instructions 1. Top 3. Artificial Limbs and cost of organs and similar expenses. Pre-existing disease shall mean any condition. The payment will be made on the basis of a declaration from the parent without insisting on any supporting bill/cash memo. Salient Feature Baroda Health policy is a unique Health insurance Policy designed especially for the a/c holders of Bank of Baroda. 2) In case of Hospitalisation of children below 12 years. only. i. Anaesthetist. holder and family.5. 4) Pre & Post Hospitalisation Expenses for first 30 days and 60 days respectively. 4) Anaesthesia. The entire family consisting of the a/c holder. Medical Practitioner. spouse and 2 dependent children can be covered under this policy.Premium 7. Chemotherapy. This policy covers Hospitalization expenses for a/c. Medicines & Drugs. Diagnostic Materials and X-Ray. Age: 3 months to 65 years.1000/(Rupees one thousand only) per policy period towards the out-of-pocket expenses. Other Features . the entire family is covered for the Floater Sum Insured as opted for.e.. Top 2. Top 4. 2) Nursing expenses. a lump sum amount of Rs.

Charges incurred at Hospital or Nursing Home primarily for diagnosis purpose. if pre-existing. Benign. During the 1st year of operation of insurance cover the expenses on treatment of diseases such as Cataract. congenital external disease or defects or anomalies.Floater Sum Insured where any one or all of the entire family can avail of the Sum Insured opted. 4. 4. Fistula in anus. Hydrocele. Prostatic Hypertrophy. . plastic surgery other than as may be necessitated due to an accident or as apartof any illness. 7. Dental treatment or surgery of any kind unless requiring hospitalisation. 8. 6. 3. Cost of spectacles and contact lenses.The policy needs renewal on or before the expiry date for continuity. 2. Hernia. orFibromyoma. will be covered only as per provisions of 1 above. These diseases. 3.The premium shall be deducted from Bank a/c. Piles. Major Exclusions 1. 6. hearing aids. Circumcision. 5. general debility. A grace period of 15 days may be allowed in case of break in renewal caused due to circumstances beyond the physical control of the policyholder. congenital internal disease. Convalescence. Sterility. 7.1. 5. holder.Minimum hospitalisation for 24 hours. Infertility. of the a/c. Any hospitalisation expenses incurred in the first 30 days from the first commencement date of Insurance cover except in case of Injury arising out of accident. Expenses on vitamins and tonics unless forming part of treatment for injury or diseases as certified by the attending physician. 9. AIDS. and Hysterectomy for Hemorrhagic. Sinusitis and related disorders are not payable. run-down condition or rest cure. Benefits for pre existing diseases will not be available for any condition(s) as defined in the policy until 36 months of continuous Coverage has elapsed since inception of the first policy with us.Domiciliary Hospitalisation not covered under the policy. vaccination or inoculation or change of life or cosmetic or aesthetic treatment of any description.Tax benefit is available under Section 80D of IT Act. intentional self injury and use of intoxication drugs/alcohol. 2.The claims will be serviced by TPAs. Top 5. 10 Treatment arising from or traceable to pregnancy (including voluntary termination of pregnancy) and child birth (including Caesarean Section) and allied maternity benefits. Venereal disease.

000 1 lac 1.11. Naturopathy Treatment.0 lacs 5. (N. Premium Payable Floater Sum Insured (Rs.5 lacs 3.Claim form 2. Top 6. Documents to be submitted: 1. The benefits like Cumulative Bonus. health check up including continuity accruedunder the previous Policy/Policies.) 829/1556/2348/3020/3616/4213/5256/6300/- Top 7. .) 50.Any other documents required by TPA.0 lacs 2.Prescription with bills 4. Company's Liability in respect of all claims admitted during the period of Insurance shall not exceed the Floater Sum Insured per family as mentioned in the schedule). list of network hospitals/ nursing homes all outlined in a guidebook.Claims Procedure The Third Party Administrator (TPA) will settle hospitalization Claims. Procedure for availing Cashless Access Services in Network Hospital/Nursing Home.B. issued by any other Insurance Company shall not be available under this Policy.Discharge Summary 3.0 lacs 4.Test Reports 5.5 lacs 2. 12.0 lacs Premium plus Service Tax (Rs. It will send details of the claims procedure for emergency/planned hospitalization along with contact numbers of TPA.

The insurance company’s decision in this regard will be final and binding on TPA. The premium may be deducted from the bank account of the account holder by the Bank and paid per procedure to National Insurance Company Ltd. The proposal form should be duly filled in and submitted to the Bank of Baroda Branch where the account holder has an account. The policyholder may submit his complaint / grievance to the said grievance cell of the . The TPA reserves the right to deny pre-authorisation in case the insured person is unable to provide the relevant medical details as required by the TPA. IT certificate. The TPA will make it clear to the insured person that denial of Cashless Access is in no way construed to be denial of treatment. The TPA shall. 2002. 7. giving reasons. the Company has opened grievance cell at Divisional . money receipt and policy shall be issued by National Insurance Company and given to the Bank which may be collected by the insured. 4. also the ailment for which the person is seeking to be admitted as a patient. General Instructions 1. Regional as well as Head Office. Premium paid under the policy is eligible for tax benefit as per Income Tax Act. The insured person may obtain the treatment as per his/her treating doctors advice and later on submit the full claim papers to the TPA for reimbursement. verify that the person is eligible to claim under the policy and after satisfying itself will issue a preauthorisation letter/ guarantee of payment letter to the Hospital/Nursing Home mentioning the sum guaranteed as payable. 2 stamp size photographs to be affixed in the Proposal form for issuance if ID card. 3. 8. upon getting the related medical information from the insured persons/ network provider. list of network hospitals. The insured person shall have right of appeal to the insurance company if he/she feels that the claim is payable. if not covered under the terms of the policy. 5. In compliance to IRDA (Protection of Policy Holders’ Interest) Regulations. The ID card.Claims in respect of Cashless Access Services will be through the list of the network of Hospitals/Nursing Homes and is subject to pre admission authorization. 6. The TPA may repudiate the claim. The policy shall commence from either (a) the date of debit of premium from the bank account of the account holder if the instrument with the proposal/renewal advice is dispatched to the Company on the same date or (b) the actual date of dispatch of the instrument with proposal/renewal advice or (c) the date of deposit of premium with the Company to comply to provisions of Section 64 VB of Insurance Act. 9. contact details of TPA along with procedural details for claims shall be given to the insured by the TPA in a guidebook. Top 8. The prospectus contains only the salient features of the policy. 2.

The insured shall have the option to switch over with continuity benefit to an equivalent or closest health insurance policy in the basket of the Company subject to the terms. the current policy held by the insured may be allowed to continue till expiry.Company for remedial action. In the event of the tie up with the Bank being discontinued or not renewed. rates and conditions of the new policy. 10. The policy holder has also the option to approach the office of Insurance Ombudsman with complaints in respect of (a) any dispute on partial or total repudiation of claim (b) any dispute in regard to premium paid or payable in terms of policy (c) any dispute on the legal construction of the policy in so far as such disputes relate to claims (d) delay in settlement of claims and (e) non-issue of insurance document after receipt of premium. .

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