Bajaj Allianz Life’s Health Care Goal: A critical illness plan for the family

This has some unique features, but check if you need them and can afford the cost

Given the increasing lifestyle disorders and the double-digit inflation in medical costs, a health insurance policy is a must, today.

For critical illnesses such as heart ailments or cancer, one however needs a specialised policy and can’t make do with regular medi-claim policies. Two reasons for this. One, the medi-claim plans do not cover expenses on diagnostic tests and other non-medical expenses, and two, they are very expensive for higher SA of say 25/50 lakhs. It is thus required that you buy a critical illness plan or a focussed disease specific plan.

In critical illness policies, the full sum assured is paid as one lump-sum on the policyholder being diagnosed for any of the covered illnesses.

Here, a review of the recently Bajaj Allianz Life’s Health Care Goal, a critical illness policy.

What’s on offer?

The plan offers four variants — Critical Long Term Health Care, Critical Long Term Health Care Plus and Long Term Family Health Care and Long Term Family Health Care Plus.

While Critical Long Term Health Care/Plus are individual plans, the Long Term Family Health Care/Plus plans are family covers with the option of including spouse and dependent children (maximum of six members). The common feature of all the plans is payment of SA on diagnosis of listed critical illnesses, waiver of premium in case of total disability of the insured following an accident, and return of premium on death, in the case of policyholders who have not claimed on the policy.

Critical Long Term Health Care Plus and Long Term Family Health Care Plus offer an additional feature of ‘return of premium’ on maturity of the plan. The policy covers 36 critical illnesses, including heart and cancer.

The maximum SA is ₹50 lakh. Each family member under the policy has the flexibility to choose the SA.

Our take

While the name may mislead one into believing that Health Care Goal is a medi-claim (hospitalisation) policy, it is a critical illness (CI) policy that will pay the SA as lump sum on manifestation of the covered illnesses.

For those looking for protection against heart-ailments/cancer/diabetes, it is always better to go for disease-specific plans rather than a normal CI policy.

CI plans come with a large list of exclusions. For instance, Health Care Goal doesn’t cover cancers of all severity. Under Health Care Goal, the number of illnesses covered is also not very comprehensive. While this policy covers 36 illnesses, Apollo Munich’s Optima Vital covers 37 illnesses and, under the CI cover, Future Generali Life’s Heart and Health Insurance plan covers 59 illnesses.

The survival period for a claim to be valid is 30 days under Health Care Goal. This is in line with most plans in the market, including Apollo Munich Optima Vital and Bharti Axa Triple Health. But in the case of Future Generali Life’s Heart and Health plan, this condition doesn’t apply for cancer; for heart ailments, it is 21 days.

To note is that, under the Health Care Goal policy, when ‘return of premium’ is triggered at death or maturity, if a claim for angioplasty has been made during the policy term, only the premium for the portion of the un-utilised SA is paid back.

(While, normally, on manifestation of any covered critical illness, the Health Care Goal policy pays the full SA and terminates at that point, in the case of angioplasty, a maximum settlement of up to ₹5 lakh is made and, if the policy’s SA is above ₹5 lakh, the policy continues to be in force for the remaining SA).

In the case of Health Care Goal, there is no classification of ailments as minor/major based on severity. So the SA is paid lump sum at the first instance of any of the covered illnesses. This is an advantage compared to a few plans in the market where, based on the severity of the illness, a fixed percentage of SA is paid. For instance, in Future Generali Life’s Heart and Health plan, the policy pays 25 per cent of SA on diagnosis of a minor ailment; 50 per cent in case of a moderate condition and 100 per cent if it’s a major condition. Also, the family cover options under Health Care Goal come for a nominal price. But you have to fist decide if you need one. It covers two juvenile critical illnesses — bacterial meningitis and encephalitis. The return of premium option is very expensive with premium being 2-2.5 times higher.

For a 35-year-old person, the annual premium (for seven-year premium term and a 10-year policy term) on a ₹10-lakh policy with the Health Care Goal’s Critical Long Term Health Care (the individual cover) is ₹5,270 (excluding taxes). If you choose Critical Long Term Health Care Plus, the premium will be ₹17,800.

For the same person, the critical illness cover of Future Generali Heart and Health Insurance plan (where 59 illnesses are covered) comes for ₹8,136, including taxes.

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