Overview
Bajaj Allianz’s Health Ensure Family Plan is a comprehensive health insurance offering benefits like emergency ambulance cover (up to maximum of Rs. 1000/- per Hospitalisation), organ donor expenses, and free preventive health check-ups (at the end of block of every continuous period of 3 years on a reimbursement basis up to specified limits). The plan provides a cumulative bonus of 5% increase up to 25% of Base SI for each claim-free year, with options for enhanced bonus through an add-on.
Experts Review
Written by Nikhil Nair
Senior Writer
The Bajaj Allianz Health Ensure Family Plan is a robust health insurance solution that offers comprehensive coverage for families. Basic cover includes in-patient hospitalization, day care procedures, organ donor expenses, AYUSH treatments, and preventive health check-ups, with no co-payment; however, it excludes domiciliary treatment, has room rent restrictions (1% of sum insured per day or ₹5,000, whichever is lower; ICU: 2% of sum insured per day or ₹10,000 whichever is lower), and includes disease-wise sub-limits.
However, the plan's pre- and post-hospitalization coverage (30 pre-/60 post-hospitalization) is relatively limited compared to other plans, which may offer up to 60 days pre- and 90 days post-hospitalization expenses.
On the bright side, the plan's premium is 5-10% lower than comparable family health insurance plans for similar coverage. Bajaj Allianz's 3-year (2021-24) average claim settlement ratio is competitive (95%), but buyers should evaluate the plan's restrictions and limited pre/post-hospitalization coverage before purchasing.
Pros
Insurer has a solid track record with great claim and service metrics.
Cons
Not very feature-rich.
No Restoration Benefit, which is a notable gap.
No coverage if you are forced to hospitalize at home, which could be a drawback for some.
Maternity benefits not offered, which is a key feature.
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
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
Your insurer won’t let you stay in a room whose rent exceeds 1% of the sum insured. If it’s an ICU they’ll bump it to 2% of the sum insured. And in the event you breach these limits, then you’ll have to pay a lot more.
Customisable
Changes 1% of Sum Insured maximum up to ₹5000/day to Single Private Room
Disease sub-limit
Your insurance cover won’t be fully available in case you are treated for eye related diseases like cataracts, which would be covered up to a max. of ₹40,000.
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 just 2 years. It’s probably the best deal you can get to be honest.
Pre/Post hospitalization
No worries if the doctor had to run a host of diagnostic tests before or after hospitalizing you. The insurer has your back. They will cover this amount in full for a pretty reasonable duration - 30 days before you are hospitalized and 60 days after discharge. This includes the cost of medication by the way.
Add-ons
Cumulative Bonus Enhancement
Recommended
Additional bonus of 25% up to a maximum of 200%, with a clawback of 25% if claimed in the previous year. Bonus will not be clawed back if the total claim is less than ₹1,00,000. This benefit is available for sum insured 5 lakhs and above.
Restoration
Recommended
Restores the cover once a year up to 100% of the sum insured for any illness.
Personal Accident Cover
Payout of a lump sum amount based on the cover chosen, in case the insured member passes away in an accident.
Room Rent Modifier
Changes 1% of Sum Insured maximum up to ₹5000/day to Single Private Room
Double Sum Insured for Cancer
Paid out as an extra 100% of the sum insured for cancer.
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 for 3 years.
Benign prostatic hypertrophy
All types of sinuses
Haemorrhoids
Dysfunctional uterine bleeding
Endometriosis
Waiting Period
30 days Initial waiting period
3 years Specific illness waiting period
2 years Pre-existing disease waiting period
Ditto's Take
◦ Excellent ◦
After a close look at the waiting periods, we can say that the waiting periods on this policy are excellent. Especially the PED waiting period which is better than usual.
What's missing in the policy
No Restoration Benefit.
No coverage if you are forced to hospitalize at home.
Maternity benefits not offered.
Doctor consultations are not covered.
Customer Reviews
P
Priya Desai
Good that it covers a wide range of family members, including siblings and in-laws.
R
Rohit Malhotra
Emergency ambulance cover is included, which is essential.
A
Aishwarya S.
Free preventive health check-ups after three claim-free years is a nice touch.
A
Alok Verma
The base cumulative bonus is quite low. You need to pay extra for better bonus.
G
Girish Kumar
Pre- and post-hospitalization coverage (30/60 days) is very limited. Many plans offer 60/90 or even 60/180.
V
Varun Gill
Cumulative bonus of 5% is okay, and can be enhanced with add-ons.
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Frequently Asked Questions
Does Health Ensure Family Plan 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.
- There’s a 1 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 2-year waiting period for any pre-existing disease you may have while buying the policy.
Does Health Ensure Family Plan have room rent restrictions?
Does Health Ensure Family Plan offer a restoration benefit?
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