Policy explained · Bajaj Allianz
Bajaj Allianz Health Guard: what your policy covers
Bajaj Allianz Health Guard sets a room rent limit that depends on your plan. It has a 5% to 20% co-pay if you are treated in a higher zone than the one your policy covers and a 36-month wait for knee & hip replacement. For our example person, a typical ₹4,50,000 bill (estimate) is not covered yet: 36-month waiting period.
A person replies, not a bot. Free for you.
At a glance
- 🛏️Room rentSilver: 1% of the sum insured a day; Gold and Platinum: a single private AC roomPolicy wordings, page 8, read 27 Sep 2026
- 🧾5% to 20%Co-payIf you are treated in a higher zone than the one your policy coversNot in the worked examplePolicy wordings, page 22, read 27 Sep 2026
- ⏳36 monthsKnee & hip replacement waitNot over at month 30Policy wordings, page 13, read 27 Sep 2026
- ⏳36 monthsPre-existing conditions waitNot over at month 30Conditions apply, see the termsPolicy wordings, page 12, read 27 Sep 2026
- 🩹Not coveredConsumablesThese are yours to payPolicy wordings, page 15, read 27 Sep 2026
Waiting periods, month by month
- Pre-existing conditions36 monthsNot over at month 30Conditions apply, see the terms
- Knee & hip replacement36 monthsNot over at month 30
- Spine surgery36 monthsNot over at month 30
- Prostate surgery24 monthsOver by month 30Conditions apply, see the terms
- Hysterectomy24 monthsOver by month 30Conditions apply, see the terms
- Bariatric surgery36 monthsNot over at month 30
Worked example: a knee & hip replacement bill
The example person joined the policy before age 61, is treated at a network hospital in the zone their policy covers, has no add-ons, and has a ₹5,00,000 sum insured on a policy running 30 months.
Room rent ₹9,000 a day for 4 days (example), a semi-private room, on a typical NCR knee & hip replacement bill of ₹4,50,000 (estimate).
Not in these numbers: a 10% to 20% co-pay applies if you chose an optional co-pay or add-on. A 5% to 20% co-pay applies if you are treated in a higher zone than the one your policy covers.
Not covered yet: 36-month waiting period. The insurer pays ₹0 and you pay ₹4,50,000 (estimate).
The terms, with the policy text
14 terms read from the Bajaj Allianz Health Guard documents (UIN BAJHLIP26073V082526). Open a source to read the policy text, its conditions and the page.
| Term | What it means | Policy text and source |
|---|---|---|
| Room rent limit | Silver: 1% of the sum insured a day; Gold and Platinum: a single private AC roomDepends on your plan | Policy wordings, page 8Sum Insured 3 lacs to 7.5 lacs- maximum eligible room is Single Private Air-Conditioned room. |
| ICU limit | No limit (No limit) | Policy wordings, page 8If admitted in ICU, the Company will pay up to actual ICU expenses provided by Hospital. |
| Co-pay | 5% to 20% of the claim is yours if you are treated in a higher zone than the one your policy coversOnly in some cases | Policy wordings, page 22Those, who pay Zone C premium rates and avail treatment in Zone A city will have to pay 20% co - payment on admissible claim amount. |
| Proportionate deduction | Applies: if your room costs more than the limit, the insurer cuts the charges linked to the room in the same ratioCan cut your bill | Policy wordings, page 8Condition: Applies when the room costs more than your plan's limit: 1% of the sum insured a day on Silver, or a single private AC room on Gold and Platinum (sum insured ₹3 lakh to ₹7.5 lakh). It does not apply at hospitals that charge the same for every room. In case of admission to a room at rates exceeding the limits as mentioned under (i), the reimbursement of all other expenses incurred at the Hospital, with the exception of cost of Pharmacy/medicines, consumables, implants, medical devices & diagnostics, shall be payable in the same proportion as the admissible rate per day bears to the actual rate per day of room rent charges. |
| Consumables (gloves, masks and other non-medical items) | Not covered: these are yours to payNot covered | Policy wordings, page 159. All non-medical Items as per Annexure II. |
| Costs before and after the hospital stay | 60 days before admission, 90 days after dischargeCovered | Policy wordings, page 8The Medical Expenses incurred during the 60 days immediately before You Were Hospitalized, provided that: Such Medical Expenses were incurred for the same Illness/Injury for which subsequent Hospitalization was required / The Medical Expenses incurred during the 90 days immediately after You were discharged post Hospitalization provided that: Such costs are incurred in respect of the same Illness/Injury for which the earlier Hospitalization was required |
| Waiting period for pre-existing conditions | 36 months of continuous coverNot over at month 30 | Policy wordings, page 12Condition: Starts again on the increased part if you raise the sum insured. Expenses related to the treatment of a pre -existing Disease (PED) and its direct complications shall be excluded until the expiry of 36 months of continuous coverage after the date of inception of the first Health Guard Policy with us. |
| Waiting period for knee & hip replacement | 36 months of continuous coverNot over at month 30 | Policy wordings, page 133. Any Medical Expenses incurred during the first three consecutive annual periods during which You have the benefit of a Health Guard Policy with Us in connection with: a. Joint replacement surgery. |
| Waiting period for spine surgery | 36 months of continuous coverNot over at month 30 | Policy wordings, page 13b. Surgery for vertebral column disorders (unless necessitated due to an Accident). |
| Waiting period for prostate surgery | 24 months of continuous coverOver by month 30 | Policy wordings, page 13Condition: Not applicable to claims arising from an accident. 5. Benign prostatic hypertrophy |
| Waiting period for hysterectomy | 24 months of continuous coverOver by month 30 | Policy wordings, page 13Condition: Not applicable to claims arising from an accident. 11. Dysfunctional uterine bleeding 12. Fibromyoma 13. Endometriosis 14. Hysterectomy 15. Uterine Prolapse |
| Waiting period for bariatric surgery | 36 months of continuous coverNot over at month 30 | Policy wordings, page 13g. Bariatric Surgery. |
| Sub-limit for bariatric surgery | Silver: 25% of the sum insured; Gold and Platinum: 50% of the sum insured, up to ₹5,00,000Depends on your plan | Policy wordings, page 20iv. Bariatric Surgery Limit: Our obligation to make payment in respect of Bariatric Surgery after the expiry of the 36 months period, shall be restricted to 25% of the Sum Insured in Silver Plan and 50% of the Sum Insured subject to maximum of Rs 5 lac in Gold and Platinum Plan. |
| Exclusion rule for bariatric surgery | Covered when the policy's conditions are metConditions apply | Policy wordings, page 10Condition: Payable only after the 36-month wait, within the bariatric sub-limit: 25% of the sum insured on Silver, and 50% up to ₹5 lakh on Gold and Platinum. 11. Bariatric Surgery Cover: If You are hospitalized on the advice of a Medical Practitioner because of Conditions mentioned below which required You to undergo Bariatric Surgery during the Policy Period, then We will pay You, Reasonable and Customary Expenses related to Bariatric Surgery |
Questions
Does Bajaj Allianz Health Guard have a room rent limit?
Yes, and at a ₹5 lakh sum insured it depends on your plan. Silver: 1% of the sum insured a day; Gold and Platinum: a single private AC room. Your policy schedule names your plan. Source: Policy wordings, page 8, read 27 Sep 2026.
How is proportionate deduction calculated on Bajaj Allianz Health Guard?
If your room costs more than the room rent limit, the insurer divides the limit by your room's daily rent and pays that share of the charges linked to the room. Applies when the room costs more than your plan's limit: 1% of the sum insured a day on Silver, or a single private AC room on Gold and Platinum (sum insured ₹3 lakh to ₹7.5 lakh). It does not apply at hospitals that charge the same for every room. Source: Policy wordings, page 8, read 27 Sep 2026.
Check your own policy
Send your policy on WhatsApp. A person reads it and works out what your stay would cost you before you are admitted.
A person replies, not a bot. Free for you.
Sources
- Bajaj Allianz Health Guard: policy wordings (accessed 27 Sep 2026)
- Bajaj Allianz Health Guard: customer information sheet (cis) (accessed 28 Aug 2026)