{"uin":"BAJHLIP21273V012021","name":"Criti Care","url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021","insurer":{"slug":"bajaj-general-insurance","name":"Bajaj General Insurance Limited","url":"https://indiainsurances.com/insurer/bajaj-general-insurance"},"line":"health","category":"critical-illness","category_name":"Critical illness","irdai_type":null,"kind":"product","status":"active","approved_on":null,"withdrawn_on":null,"summary":"Criti Care is an individual critical illness policy from Bajaj General with five sections (Cancer, Cardiovascular, Kidney, Neuro, Transplants and Sensory Organs) covering 43 conditions, of which at least one section must be chosen. It pays a lump sum of 25% of the section Sum Assured for a Category A condition and 100% for a Category B condition, after a 180 or 120 day initial waiting period and a 0, 7 or 15 day survival period.","analysis":{"state":"extracted","analysed_at":"2026-10-16 08:29:37.878797+00","note":"Every stated fact carries a verbatim quote found in the cited clause."},"facts":[{"key":"plan_variants","label":"Plans and variants","section":"Overview","meaning":"The named plans inside this product (not cover types or payout options). Facts can differ between them.","status":"cross-checked","value":["Section I: Cancer Care","Section II: Cardiovascular Care","Section III: Kidney Care","Section IV: Neuro Care","Section V: Transplants Care and Sensory Organs Care"],"display":"5 sections: Cancer Care, Cardiovascular Care, Kidney Care, Neuro Care, Transplants Care and Sensory Organs Care","note":"At least one section must be chosen; each section has its own Sum Assured and benefits are independent for each section. The brochure calls the sections Plans.","quote":"It is mandatory to opt for at least one of the below listed sections ... A. SECTION I: CANCER CARE (Category A & B) B. SECTION II: CARDIOVASCULAR CARE (Category A & B) C. SECTION III: KIDNEY CARE (Category A & B) D. SECTION IV: NEURO CARE (Category A & B) E. SECTION V: TRANSPLANTS CARE AND SENSORY ORGANS CARE (Category A & B) ... There are 5 Plans (Sections) out of which at least one has to be opted ... The benefits payable will be independent for each section if more than one Critical Illness sections are chosen.","sources":[{"clause":"Section C(I)","heading":null,"page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-section-c-i"},{"clause":"Section IV","heading":"NEURO CARE","page":2,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/273#c-section-iv"}],"law":[]},{"key":"policy_term","label":"Policy term","section":"Eligibility","meaning":"How long one policy runs before it ends or must be renewed.","status":"cross-checked","value":"Individual policy with a tenure of 1, 2 or 3 years.","display":"1, 2 or 3 years","note":"Brochure: 4% long term discount for 2 years, 8% for 3 years (not on instalment premium).","quote":"Criti-Care is Individual Policy with Policy tenure of 1year, 2 years or 3 years. ... 4 % discount is applicable if policy is opted for 2 years ... 8 % discount is applicable if policy is opted for 3 years (Note: This is not applicable on instalment premium option)","sources":[{"clause":"Section C","heading":"COVERAGE","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-section-c"},{"clause":null,"heading":"2. Long Term Policy Discount","page":10,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/273#c-2-long-term-policy-discount"}],"law":[]},{"key":"claim_intimation","label":"Claim intimation deadline","section":"Claims","meaning":"How soon you must tell the insurer about a claim or hospitalisation.","status":"cross-checked","value":"Intimate the insurer within 30 days of first diagnosis, surgical procedure or medical event; submit claim documents within 30 days of discharge from the hospital.","display":"Within 30 days of first diagnosis (documents within 30 days of discharge)","note":null,"quote":"the Insured Event as described above shall be intimated to the Company within thirty (30) days date of first diagnosis of the Illness, date of surgical procedure or date of occurrence of the medical event as the case may be and the Insured shall, promptly and in any event within thirty (30) days of discharge from the Hospital, arrange for submission of the following documents to the Company","sources":[{"clause":null,"heading":"Claim Settlement Process","page":23,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-claim-settlement-process"}],"law":[{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 20, 21","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"claim_documents","label":"Claim documents","section":"Claims","meaning":"Documents the insurer asks for when you claim.","status":"cross-checked","value":["Certificate from the attending Medical Practitioner (name of the Insured, name, date and medical details of the Insured Event, confirmation that it does not relate to any Pre-Existing Condition or to any Illness or Injury within the first 90 days)","Duly completed claim forms","Original Discharge Certificate/Card from the Hospital/Medical Practitioner","Original investigation test reports, indoor case papers","Additional documents in cases of suspected fraud / misrepresentation"],"display":"Doctor's certificate, claim form, original discharge card, original test reports and indoor case papers","note":"Attested copies are accepted if the originals are with another insurer. Documents go to the Health Administration Team, Pune; claims are settled in house, no TPA. The certificate refers to the first 90 days although the waiting period is 180/120 days.","quote":"Certificate from the attending Medical Practitioner of the Insured confirming, inter alia, ... a) Name of the Insured; ... b) Name, date of occurrence and medical details of the Insured Event; ... c) Confirmation that the Insured Event does not relate to any Pre-Existing Condition; and ... d) Confirmation that the Insured Event does not relate to any Illness or Injury which existed within the first 90 days of commencement of the Policy Period ... Duly completed claim forms; ... Original Discharge Certificate/Card from the Hospital/Medical Practitioner; ... Original investigation test reports, indoor case papers; ... In cases of suspected fraud / misrepresentation, we may call for any additional document(s) in addition to the documents listed above. ... All Claims will be settled by In house claims settlement team of the company and no TPA is engaged. ... the Insured may provide the Company with the attested Xerox copies of such documents ... Health Administration Team, Bajaj General Insurance Ltd., 2nd Floor, Bajaj Finserv Building Viman Nagar, Pune 411014.","sources":[{"clause":"1","heading":null,"page":23,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-1-8"},{"clause":"2","heading":null,"page":23,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-2-8"},{"clause":"3","heading":null,"page":23,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-3-7"},{"clause":"4","heading":null,"page":23,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-4-7"},{"clause":"Section E","heading":"CONDITIONS -OTHER TERMS AND CLAUSES","page":23,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-section-e-3"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 17","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 22","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 23","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(iii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"claim_settlement_time","label":"Claim settlement time promised","section":"Claims","meaning":"How quickly the policy says a claim is decided or paid, and from when that is counted (intimation or last document).","status":"cross-checked","value":"Settled or rejected within 15 days of receipt of the last necessary document; payment within 7 days of accepting the settlement offer. If investigated, investigation within 30 days and settlement within 15 days of the last document; delay attracts interest at 2% above bank rate.","display":"15 days from the last necessary document","note":"CIS says: 'TAT for claim settlement: 15 Working Days'. If investigated, the investigation must finish within 30 days of the last necessary document.","quote":"The Company shall settle or reject a claim, as the case may be, within 15 days from the date of receipt of last necessary document. ... the payment of the amount due shall be made within 7 days from the date of acceptance of the offer by you ... not later than 30 days from the date of receipt of last necessary document ... at a rate 2% above the bank rate ... TAT for claim settlement: 15 Working Days","sources":[{"clause":"5(i)","heading":null,"page":18,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-5-i"},{"clause":"Section E(ii)","heading":null,"page":21,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-section-e-ii"},{"clause":"5(iii)","heading":null,"page":18,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-5-iii"},{"clause":"5(ii)","heading":null,"page":18,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-5-ii"},{"clause":"5","heading":"Physiotherapy Care: 5% of the Sum Insured subject to a maximum limit","page":4,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/272#c-5"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 64UM(4) to (6)","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 10","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 15","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 16","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 22","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(i), V.3(ii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(iii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.4","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 23","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"The Motor Vehicles Act, 1988: Chapter XI, insurance of motor vehicles against third party risks","section":"Section 149","url":"https://indiainsurances.com/law/motor-vehicles-act-1988"}]},{"key":"exclusions_main","label":"Main exclusions","section":"Exclusions","meaning":"What the policy does not pay for, in the policy's own words.","status":"cross-checked","value":["Any Critical Illness or its signs and symptoms diagnosed within the first 180/120 days of the first policy","Claims where the Insured does not survive the 0/ 7/15 days survival period","Misuse of intoxicating drugs and/or alcohol, except under the direction of Medical Practitioner","Treatment for any other system other than modern medicine (allopathy) and AYUSH therapies","Any sexually transmitted diseases","Treatment arising from or traceable to birth defects and congenital anomalies","War, invasion, act of foreign enemy, hostilities, civil war and similar events","Any natural peril","Radioactive contamination","Self-inflicted injuries, suicide attempt, insanity, and deliberate participation of the Insured in an illegal or criminal act with criminal intent","Condition-specific exclusions inside each illness definition (for example cardiomyopathy or coma directly related to alcohol or drug abuse)"],"display":"180/120 day initial waiting, survival period, drugs and alcohol, non-allopathic treatment, STDs, congenital anomalies, war, natural perils, radioactivity, self-inflicted injury","note":"The policy wording prints only two General Exclusions (drugs/alcohol, non-allopathic treatment); the CIS and brochure list eight. Each illness definition also carries its own exclusions.","quote":"Any Critical Illness or its signs and symptoms diagnosed within the first 180/120 days as mentioned in the policy schedule of the date of commencement of the First Policy with us is excluded. ... Insured should survive for 0/ 7/15 days as mentioned in the policy schedule from the diagnosis and fulfilment of the critical illness definition before the claim benefit will be paid. ... 1. Misuse of intoxicating drugs and/or alcohol, except under the direction of Medical Practitioner. ... 2. Treatment for any other system other than modern medicine (allopathy) and AYUSH therapies. ... 1.Any sexually transmitted diseases. 2.Treatment arising from or traceable to birth defects and congenital anomalies. 3.War, whether war be declared or not, invasion, act of foreign enemy, hostilities, civil war ... 4.Any natural peril ... 5.Radioactive contamination. 6.Self-inflicted injuries, suicide attempt, insanity, and deliberate participation of the Insured in an illegal or criminal act with criminal intent ... Cardiomyopathy directly related to alcohol or drug abuse is excluded. ... Coma resulting directly from alcohol or drug abuse is excluded.","sources":[{"clause":"1","heading":null,"page":17,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-1-6"},{"clause":"2","heading":null,"page":17,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-2-6"},{"clause":null,"heading":"CUSTOMER INFORMATION SHEET","page":1,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/272#c-customer-information-sheet-2"},{"clause":"16(b)","heading":null,"page":11,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-16-b"},{"clause":"16(b)(iii)","heading":null,"page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-16-b-iii"}],"law":[{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 11","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 16","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grievance","label":"Grievance route","section":"Claims","meaning":"Who to complain to first, as stated in the policy, before going to the Insurance Ombudsman.","status":"cross-checked","value":"Contact the toll-free number 1-800-209-5858, a branch or the website; then e-mail Level 1 careforyou@bajajgeneral.com (senior citizens: seniorcitizen@bajajgeneral.com), Level 2 the Grievance Redressal Officer at ggro@bajajgeneral.com, Level 3 missed call on +91 80809 45060; then the Insurance Ombudsman.","display":"Level 1: careforyou@bajajgeneral.com; Level 2: ggro@bajajgeneral.com; then Insurance Ombudsman","note":null,"quote":"Our toll-free number 1-800-209- 5858 or 020-30305858, Say “Hi” on WhatsApp on +91 7507245858. ... a) Level 1: Write to careforyou@bajajgeneral.com and for senior citizens to seniorcitizen@bajajgeneral.com ... b) Level 2: In case you are not satisfied with the response given to you at Level 1 you may write to our Grievance Redressal Officer at ggro@bajajgeneral.com ... c) Level 3: If in case, your grievance is still not resolved, and you wish to talk to our care specialist, please give a missed call on +91 80809 45060 OR SMS To 575758 ... you may approach the Insurance Ombudsman","sources":[{"clause":"15","heading":"Grievance Redressal Procedure","page":20,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-15-4"},{"clause":"15(a)","heading":"Level 1","page":20,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-15-a"},{"clause":"15(b)","heading":"Level 2","page":20,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-15-b"},{"clause":"15(c)","heading":"Level 3","page":20,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-15-c"}],"law":[{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 3","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 4","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 5","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(11)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(42)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 34","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 69","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Insurance Act, 1938","section":"Section 38","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 12","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 19","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 20","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 13","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 2","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(5), 5(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(9)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 25","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 26","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 11","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 3","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 13","url":"https://indiainsurances.com/law/ombudsman-rules-2017"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 14","url":"https://indiainsurances.com/law/ombudsman-rules-2017"}]},{"key":"sum_insured_options","label":"Sum insured options","section":"Cover","meaning":"The cover amounts you can choose from.","status":"cross-checked","value":"Per section: minimum Rs 1 lac; maximum Rs 50 lacs up to entry age 60 and Rs 10 lacs for entry age 61-65; total across sections restricted to Rs 2 crores.","display":"Rs 1 lac to Rs 50 lacs per section (total up to Rs 2 crores)","note":"From the sales brochure; the wording and CIS refer to the Policy Schedule. Same limits for all five sections. Entry age 61-65: maximum 10 lacs per section. Renewal caps: 5 lacs per section at age 66-80, 2 lacs above 80.","quote":"Section | Minimum SA for entry age 18-65 yrs | Maximum SA up to entry age 60 | Maximum SA for entry age 61-65 ... Cancer Care | 1 lac | 50 lacs | 10 lacs ... If more than one Sections are chosen, the total SA will be restricted to INR 2 Crores ... For age 66-80 years, each section can be renewed only for maximum 5 Lacs. ... For age above 80 years, each section can be renewed only for maximum SA of 2 Lacs. ... For Entry age 61-65 years, the maximum SA for new business and renewals will be 10 Lacs under each section","sources":[{"clause":null,"heading":"4. Online Discount","page":10,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/273#c-4-online-discount"}],"law":[]},{"key":"initial_waiting","label":"Initial waiting period","section":"Waiting periods","meaning":"Days from the start of the first policy during which illness claims are not paid (accidents usually are).","status":"cross-checked","value":{"unit":"days","amount":120},"display":"180 or 120 days, as shown in the policy schedule","note":"180 or 120 days, whichever the policy schedule shows; 120 is the shorter option (used for sorting). Waived for an Insured renewed without a break. The wording does not carve out accidents.","quote":"Any Critical Illness or its signs and symptoms diagnosed within the first 180/120 days as mentioned in the policy schedule of the date of commencement of the First Policy with us is excluded. This exclusion shall not apply to an Insured for whom coverage has been renewed by the Named Insured, without a break, for subsequent years.","sources":[{"clause":"1","heading":null,"page":17,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-1-6"}],"law":[]},{"key":"specific_waiting","label":"Specific illness waiting period","section":"Waiting periods","meaning":"Waiting period for a list of named illnesses and procedures (cataract, hernia, joint replacement...). With several tiers (24 and 36 months), the shortest in the answer, the others in the note.","status":"not-stated","value":null,"display":null,"note":"No specific waiting period list is printed; only the standard definition ('a period up to 24 months') appears.","quote":null,"sources":[],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.7","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"specific_waiting_list","label":"Illnesses with a specific waiting period","section":"Waiting periods","meaning":"The named illnesses and procedures that carry the specific waiting period.","status":"not-stated","value":null,"display":null,"note":"No list of named illnesses with a specific waiting period is printed.","quote":null,"sources":[],"law":[]},{"key":"moratorium","label":"Moratorium period","section":"Renewal and rights","meaning":"After this many months of continuous cover, the insurer cannot reject a claim for non-disclosure, except for proven fraud or permanent exclusions. The law sets 60 months.","status":"cross-checked","value":{"unit":"months","amount":60},"display":"60 months","note":"For an enhanced sum insured, the 60 months run from the enhancement on the enhanced part only.","quote":"After completion of sixty continuous months of coverage (including portability and migration) no look back would be applied. This period of sixty months is called as moratorium period. ... After the expiry of Moratorium Period no claim under this policy shall be contestable except for proven fraud and permanent exclusions specified in the policy contract. ... wherever, the sum insured is enhanced, completion of sixty continuous months would be applicable from the date of enhancement of sums insured only on the enhanced limits.","sources":[{"clause":"13","heading":"Moratorium Period","page":20,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-13-4"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 13","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 8","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"portability","label":"Portability","section":"Renewal and rights","meaning":"Whether you can move this policy to another insurer and keep waiting-period credit.","status":"cross-checked","value":"Yes. The policy can be ported to another insurer by applying at least 30 days, but not earlier than 60 days, before renewal, with accrued continuity benefits in waiting periods.","display":"Yes, apply 30 to 60 days before renewal","note":"Migration to another product of the same insurer is also allowed, applying at least 30 days before renewal.","quote":"The Insured beneficiary will have the option to port the policy to other insurers by applying to such insurer to port the entire policy along with all the members of the family, if any, at least 30 days before, but not earlier than 60 days from the policy renewal date as per IRDAI guidelines related to portability. If such person is presently covered and has been continuously covered without any lapses under any health insurance policy with an Indian General/Health insurer, the proposed Insured beneficiary will get the accrued continuity benefits in waiting periods ... The Insured beneficiary will have the option to migrate the policy to other health insurance products/plans offered by the company by applying for migration of the policy atleast 30 days before the policy renewal date","sources":[{"clause":"12","heading":"Portability","page":20,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-12-4"},{"clause":"11","heading":"Migration","page":20,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-11-4"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 11","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.6","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, VII.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 24","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.4 and 1.5","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 10","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"lifelong_renewal","label":"Lifelong renewal","section":"Renewal and rights","meaning":"Whether the policy can be renewed for life without a maximum age.","status":"cross-checked","value":true,"display":"Yes","note":"A section stops after 100% of its sum assured is paid. Brochure: renewal sum assured capped at 5 lacs per section at age 66-80 and 2 lacs above 80.","quote":"Under normal circumstances, lifetime renewal benefit is available under the Policy except on the grounds of fraud, misrepresentation or moral hazard or non-co-operation by the Insured or if any false statement, or declaration is made or used or Upon the occurrence of an event of Critical Illness. ... The section against which 100% of sum assured has been paid shall not be renewed for the insured member. ... For age 66-80 years, each section can be renewed only for maximum 5 Lacs. ... For age above 80 years, each section can be renewed only for maximum SA of 2 Lacs.","sources":[{"clause":"Section E(iv)","heading":null,"page":21,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-section-e-iv"},{"clause":"Section E(v)","heading":null,"page":22,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-section-e-v"},{"clause":null,"heading":"4. Online Discount","page":10,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/273#c-4-online-discount"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 10","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch II D.II","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.5","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 9","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 7","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"}]},{"key":"claim_loading","label":"Premium loading after claims","section":"Renewal and rights","meaning":"Whether the premium can go up at renewal because you made a claim.","status":"cross-checked","value":"No individual claim loading: renewal loadings are at portfolio level, not based on an individual policy's claim experience.","display":"No, loadings are at portfolio level only","note":"After a full section payout, renewal premium is calculated excluding that section.","quote":"For this policy, the loadings on renewal premium shall be at portfolio and not based upon any individual policy claim experience. ... However, the premium for subsequent renewal/s would be calculated excluding the section for which claim has been paid.","sources":[{"clause":"4(iv)","heading":null,"page":18,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-4-iv"},{"clause":"4","heading":null,"page":17,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-4-5"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 10","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.5","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 9","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 4","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 7","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"}]},{"key":"permanent_exclusions","label":"Permanent exclusions","section":"Exclusions","meaning":"Conditions or treatments that are never covered: the standard IRDAI exclusion codes Excl04 to Excl18 and the product's own permanent exclusions. Excl01 to Excl03 are waiting periods, not permanent exclusions.","status":"cross-checked","value":["Misuse of intoxicating drugs and/or alcohol, except under the direction of Medical Practitioner","Treatment for any other system other than modern medicine (allopathy) and AYUSH therapies","Any sexually transmitted diseases","Treatment arising from or traceable to birth defects and congenital anomalies","War, invasion, act of foreign enemy, hostilities, civil war, insurrection, rebellion, revolution, mutiny, riot, strike and similar events","Any natural peril","Radioactive contamination","Self-inflicted injuries, suicide attempt, insanity, and deliberate participation of the Insured in an illegal or criminal act with criminal intent"],"display":"Drugs and alcohol, non-allopathic treatment, STDs, congenital anomalies, war, natural perils, radioactivity, self-inflicted injury","note":"The standard IRDAI codes Excl04 to Excl18 are not printed. The wording lists only two General Exclusions; the other six come from the CIS (the brochure prints them too). Each illness definition has its own exclusions.","quote":"1. Misuse of intoxicating drugs and/or alcohol, except under the direction of Medical Practitioner. ... 2. Treatment for any other system other than modern medicine (allopathy) and AYUSH therapies. ... 1.Any sexually transmitted diseases. 2.Treatment arising from or traceable to birth defects and congenital anomalies. 3.War, whether war be declared or not, invasion, act of foreign enemy, hostilities, civil war, insurrection, rebellion, revolution, mutiny, military or usurped power, riot, strike ... 4.Any natural peril ... 5.Radioactive contamination. 6.Self-inflicted injuries, suicide attempt, insanity, and deliberate participation of the Insured in an illegal or criminal act with criminal intent","sources":[{"clause":"2","heading":null,"page":17,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-2-6"},{"clause":null,"heading":"CUSTOMER INFORMATION SHEET","page":1,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/272#c-customer-information-sheet-2"}],"law":[{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 16","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"cancellation_refund","label":"Cancellation by you","section":"Renewal and rights","meaning":"What you get back if you cancel during the year.","status":"cross-checked","value":"With 7 days' written notice: pro-rata refund of the unexpired period if no claim was made in the policy year; on multi-year policies, future years refunded in full; medical examination expenses deducted if risk has commenced. No refund if the insurer cancels for misrepresentation, non-disclosure or fraud.","display":"Pro-rata refund if no claim in the policy year","note":"Instalment premiums: pro-rata refund of the unexpired risk period if no claim. Refund delayed beyond 7 days carries interest at 2% above bank rate.","quote":"The Policyholder can cancel this Policy by providing a written notice of 7 days. ... Annual Policy: The premium refund for the unexpired risk period will be on a pro-rata basis, provided no claim has been made during the policy year. ... For any policy year where the risk has started, the premium will be refunded on a pro-rata basis for that policy year, provided no claim has been made during the policy year and in full for future policy years. ... then expenses incurred by the Company on medical examination of the Policyholder will also be deducted before refunding of premium. ... The Company may cancel the Policy at any time on the grounds of misrepresentation, non-disclosure of material facts, or fraud by the Policyholder/insured person, by providing 15 days’ written notice. There will be no refund of premium for cancellations on these grounds. ... 2. Cancellation of policy where Premium Received on Instalment Basis: ... In case of any delay in refund of premium beyond stipulated 7 days, the Company shall refund such amounts along with interest, at a rate 2% above the bank rate","sources":[{"clause":"10","heading":"Cancellation","page":19,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-10-4"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 64VB","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 8","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 6","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 5","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 17","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(3) to 20(5)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.4","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, IV.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"territory","label":"Where it covers","section":"Overview","meaning":"Geographic area of cover: India only, worldwide, or listed countries. 'As stated in the schedule' is not an answer.","status":"not-stated","value":null,"display":null,"note":"No geographic scope of cover is printed. Claims are paid in Indian Rupees only; the brochure says Non-Resident Indians can buy if premium is paid in Indian currency.","quote":null,"sources":[],"law":[]},{"key":"free_look","label":"Free-look period","section":"Renewal and rights","meaning":"Days after you receive the policy in which you can return it for a refund if you do not agree with its terms.","status":"cross-checked","value":{"unit":"days","amount":30},"display":"30 days","note":"Refund less medical examination expenses and stamp duty (and proportionate risk premium if risk has commenced), if no claim made. Not on renewals or porting. CIS says: 'up to 30 days from the first inception of policy'.","quote":"The insured person shall be allowed free look period of thirty days from date of receipt of the policy document to review the terms and conditions of the policy, and to return the same if not acceptable. ... The Free Look Period shall be applicable on new individual health insurance policies and not on renewals or at the time of porting/migrating the policy. ... lf the insured has not made any claim during the Free Look Period ... a refund of the premium paid less any expenses incurred by the Company on medical examination of the insured person and the stamp duty charges ... a deduction towards the proportionate risk premium for period of cover ... Insured has an option of cancelling his/her policy up to 30 days from the first inception of policy with Us","sources":[{"clause":"9","heading":"Free Look Period","page":19,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-9-4"},{"clause":"5","heading":"Physiotherapy Care: 5% of the Sum Insured subject to a maximum limit","page":4,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/272#c-5"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 5","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 5","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(1), 20(2)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(3) to 20(5)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, II.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grace_period","label":"Grace period","section":"Renewal and rights","meaning":"Days you get after the due date to pay without losing cover or continuity.","status":"cross-checked","value":{"unit":"days","amount":30},"display":"30 days (15 days for monthly instalments)","note":"15 days where premium is paid monthly.","quote":"The grace period of fifteen days (where premium is paid on a monthly instalments) and thirty days (where premium is paid in quarterly/half-yearly/annual instalments) is available on the premium due date, to pay the premium. ... We shall condone a delay in renewal up to the Grace Period (30 days) from the due date of renewal without considering such condonation as a Break in Policy.","sources":[{"clause":"3","heading":"Premium Payment in Instalments (Wherever applicable)","page":17,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-3-6"},{"clause":"4(iii)","heading":null,"page":18,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-4-iii"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 50","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 8","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 9","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 8","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, IV.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule I, Para 1.2","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.3","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"eligibility_entry_age","label":"Entry age","section":"Eligibility","meaning":"The youngest and oldest age at which you can buy this policy.","status":"conflicting","value":"18 to 65 years at commencement of the policy.","display":"18 to 65 years","note":"The wording defines the Insured as a proposer aged 18 to 65. The brochure says: 'Minimum entry age for Child- 3 months', 'Maximum entry age for Child - 30 years', and lists children, grandchildren and other relatives as people who can be covered.","quote":"Insured/Named Insured means the proposer who proposes for himself as sole Insured who is not younger than 18 years and older than 65 years of age at the time of commencement of the Policy. ... Minimum entry age for Adult- 18 years ... Minimum entry age for Child- 3 months ... Maximum entry age for Adult - 65 years ... Maximum entry age for Child - 30 years","sources":[{"clause":"9","heading":"Insured/Named Insured","page":6,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-9-2"},{"clause":null,"heading":"4. Online Discount","page":10,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/273#c-4-online-discount"}],"law":[]},{"key":"premium_modes","label":"Premium payment options","section":"Premium","meaning":"How often you can pay: yearly, half-yearly, quarterly, monthly.","status":"cross-checked","value":["Full premium at policy inception","Annual (for long term polices only)","Half Yearly","Quarterly","Monthly"],"display":"Full premium, or instalments: annual (long term only), half-yearly, quarterly, monthly","note":null,"quote":"Cancellation of policy where full premium received at policy inception ... If the insured person has opted for Payment of Premium on an instalment basis i.e. Annual (for long term polices only), Half Yearly, Quarterly or Monthly","sources":[{"clause":"10","heading":"Cancellation","page":19,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-10-4"},{"clause":"3","heading":"Premium Payment in Instalments (Wherever applicable)","page":17,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-3-6"}],"law":[]},{"key":"optional_covers","label":"Optional covers","section":"Cover","meaning":"Covers you can add for an extra premium. They change the answers above only if you buy them.","status":"not-stated","value":null,"display":null,"note":"No add-on covers are printed. The five sections are chosen individually (see plan_variants); the initial waiting period (180/120 days) and survival period (0/7/15 days) are set in the schedule; the additional benefits are built into each section.","quote":null,"sources":[],"law":[]},{"key":"grace_cover","label":"Cover during the grace period","section":"Renewal and rights","meaning":"Whether a claim during the grace period is paid.","status":"cross-checked","value":"Only for instalment premiums: coverage is available during the grace period if premium is paid in instalments. Otherwise coverage is not available for the period for which no premium is received.","display":"Covered during grace only for instalment premiums","note":"On renewal: 'any accident/ injury contracted during the break period will be not be admissible under the Policy.'","quote":"Coverage is not available for the period for which no premium is received. ... Coverage shall be available during the Grace period, if the premium is paid in Instalments during the Policy Period on due date. ... If the premium is paid in instalments during the policy period, coverage will be available for the grace period also. ... However, any accident/ injury contracted during the break period will be not be admissible under the Policy.","sources":[{"clause":"16","heading":"Grace Period","page":3,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-16"},{"clause":"3","heading":"Premium Payment in Instalments (Wherever applicable)","page":17,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-3-6"},{"clause":"Section E(iv)","heading":null,"page":21,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-section-e-iv"}],"law":[]},{"key":"illness_count","label":"Number of illnesses covered","section":"Cover","meaning":"How many critical illnesses are listed. The definitions matter more than the count.","status":"cross-checked","value":43,"display":"43 illnesses","note":"From the sales brochure. Counting the wording's tables and definitions gives the same 43: Cancer Care 3, Cardiovascular Care 16, Kidney Care 5, Neuro Care 10, Transplants and Sensory Organs Care 9.","quote":"Wide range of Critical Illnesses covered- total 43 illnesses","sources":[{"clause":"Section IV","heading":"NEURO CARE","page":2,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/273#c-section-iv"}],"law":[]},{"key":"illness_list","label":"Illnesses covered","section":"Cover","meaning":"The listed illnesses. Standard definitions are set by IRDAI.","status":"cross-checked","value":["Early Stage Cancers (A)","Carcinoma -in-situ (A)","Cancer of Specified Severity (B)","Angioplasty (A)","Insertion of Pacemaker/ Implantable Cardioverter Defibrillator (A)","Minimally Invasive surgery of Aorta (A)","Balloon Valvotomy or Valvuloplasty (A)","Surgery for Cardiac Arrhythmia (A)","Carotid Artery Surgery (A)","Surgery to place Ventricular Assist Devices or total artificial hearts (A)","Infective Endocarditis (A)","Pericardiectomy (A)","Percutaneous Heart Valve Replacement / Repair (A)","Myocardial Infarction (First Heart Attack – of Specific Severity) (B)","Open Chest CABG (B)","Open Heart Replacement or Repair of Heart Valves (B)","Major Surgery of Aorta (B)","Heart Transplant (B)","Cardiomyopathy (B)","Removal of one Kidney (A)","Partial Nephrectomy (A)","Kidney Failure Requiring Regular Dialysis (B)","Systematic lupus Eryth. with Renal Involvement (B)","Kidney Transplant (B)","Cerebral Aneurysm treatment via Endovascular procedure (A)","Permanent Paralysis of one limb (A)","Stroke Resulting in Permanent Symptoms (B)","Coma of Specified Severity (B)","Permanent Paralysis of Limbs (B)","Motor Neurone Disease with Permanent Symptoms (B)","Multiple Sclerosis with Persisting Symptoms (B)","Benign Brain Tumour (B)","Brain Surgery (B)","Major Head Trauma (B)","Blindness in one eye (A)","Deafness in one ear (A)","Blindness in both the eyes (B)","Deafness in both ears (B)","Loss of Speech (B)","Lung Transplant due to End stage lung failure (B)","Liver Transplant due to End Stage liver failure (B)","Pancreas Transplant (B)","Bone Marrow Transplant (B)"],"display":"Conditions in five sections; Category A pays 25%, Category B 100% of the section Sum Assured","note":"(A) = Category A, 25% of the section Sum Assured; (B) = Category B, 100%. The wording's Neuro Care table prints 'Permanent Paralysis of one limb' twice; the definitions show the Category B item is Permanent Paralysis of Limbs (two or more limbs). Lung and liver benefits are also payable on end stage failure.","quote":"Category A Conditions (25% Sum Assured) | Category B Conditions (100% Sum Assured) Early Stage Cancers | Cancer of Specified Severity Carcinoma -in-situ ... Angioplasty | Myocardial Infarction (First Heart Attack – of Specific Severity) Insertion of Pacemaker/ Implantable Cardioverter Defibrillator | Open Chest CABG Minimally Invasive surgery of Aorta | Open Heart Replacement or Repair of Heart Valves Balloon Valvotomy or Valvuloplasty | Major Surgery of Aorta Surgery for Cardiac Arrhythmia | Heart Transplant Carotid Artery Surgery | Cardiomyopathy Surgery to place Ventricular Assist Devices or total artificial hearts Infective Endocarditis Pericardiectomy Percutaneous Heart Valve Replacement / Repair ... Removal of one Kidney | Kidney Failure Requiring Regular Dialysis Partial Nephrectomy | Systematic lupus Eryth. with Renal Involvement Kidney Transplant ... Cerebral Aneurysm treatment via Endovascular procedure | Stroke Resulting in Permanent Symptoms Permanent Paralysis of one limb | Coma of Specified Severity ... Motor Neurone Disease with Permanent Symptoms Multiple Sclerosis with Persisting Symptoms Benign Brain Tumour Brain Surgery Major Head Trauma ... 5. Category B- Permanent Paralysis of Limbs ... Blindness in one eye | Blindness in both the eyes Deafness in one ear | Deafness in both ears Loss of Speech Lung Transplant due to End stage lung failure* Liver Transplant due to End Stage liver failure** Pancreas Transplant Bone Marrow Transplant ... 5. Category B- Loss of Speech ... *The benefit will also be payable on End stage lung failure. ... ** The benefit will also be payable on End stage liver failure.","sources":[{"clause":null,"heading":"A. SECTION I: CANCER CARE","page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-a-section-i-cancer-care"},{"clause":null,"heading":"B. SECTION II: CARDIOVASCULAR CARE","page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-b-section-ii-cardiovascular-care"},{"clause":null,"heading":"C. SECTION III: KIDNEY CARE","page":11,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-c-section-iii-kidney-care"},{"clause":null,"heading":"D. SECTION IV: NEURO CARE","page":12,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-d-section-iv-neuro-care"},{"clause":"16(b)(iii)","heading":null,"page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-16-b-iii"},{"clause":null,"heading":"E. SECTION V: TRANSPLANTS CARE AND SENSORY ORGANS CARE","page":14,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-e-section-v-transplants-care-and-sensory-organs"},{"clause":"16(b)(iii)","heading":null,"page":14,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-16-b-iii-2"}],"law":[]},{"key":"payout","label":"Payout","section":"Cover","meaning":"Lump sum on diagnosis, staged payouts by severity, or reimbursement.","status":"cross-checked","value":"Lump sum on diagnosis after the survival period: 25% of the section Sum Assured for a Category A condition and 100% for a Category B condition (75% if a Category A claim was already paid in that section). Additional lump sums of 5% or 10% of Sum Insured (capped) after a Category B claim.","display":"Lump sum: 25% (Category A) or 100% (Category B) of the section Sum Assured","note":"Additional lump sums after an accepted Category B claim: Cancer Reconstructive Surgery and Dialysis Care 10% of the Sum Insured up to INR 200,000; Cardiac Nursing, Physiotherapy Care and Sensory Care 5% up to INR 50,000.","quote":"we will pay Sum Assured as specified on the Policy Schedule ... and the insured survives the defined survival period. ... d) 25% Sum Assured is payable for Category A conditions and 100% Sum Assured is payable for Category B conditions for each section. ... e) If a claim has already been paid for Category A condition of a section, the amount payable for Category B condition under the same section will be the remaining Sum Assured i.e. 75% Sum Assured ... Lump sum payout irrespective of treatment cost ... The Company will make an additional payment of 10% of the Sum Insured subject to a maximum limit of INR 200,000 ... The Company will make an additional payment of 5% of the Sum Insured subject to a maximum limit of INR 50,000 ... The Company will make an additional payment of 10% of the Sum Insured subject to a maximum limit of INR 200,000 as specified in the Policy Schedule under Section III: Kidney Care ... The Company will make an additional payment of 5% of the Sum Insured subject to a maximum limit of INR 50,000 as specified in the Policy Schedule under Section V: Transplants Care And Sensory Organs Care ... 4 Physiotherapy Care","sources":[{"clause":"Section C(I)","heading":null,"page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-section-c-i"},{"clause":"Section IV","heading":"NEURO CARE","page":2,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/273#c-section-iv"},{"clause":"1","heading":"Cancer Reconstructive Surgery","page":15,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-1-4"},{"clause":"2","heading":"Cardiac Nursing","page":15,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-2-4"},{"clause":"3","heading":"Dialysis Care","page":15,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-3-4"},{"clause":"5","heading":"Sensory Care","page":16,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-5-4"},{"clause":"4","heading":"Physiotherapy Care","page":16,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-4-4"}],"law":[]},{"key":"survival_period","label":"Survival period","section":"Waiting periods","meaning":"Days you must survive after diagnosis before the money is paid.","status":"cross-checked","value":{"unit":"days","amount":0},"display":"0, 7 or 15 days, as shown in the policy schedule","note":"0, 7 or 15 days, whichever the policy schedule shows; 0 is the shortest option (used for sorting).","quote":"Insured should survive for 0/ 7/15 days as mentioned in the policy schedule from the diagnosis and fulfilment of the critical illness definition before the claim benefit will be paid.","sources":[{"clause":"2","heading":null,"page":17,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-2-6"}],"law":[]},{"key":"multiple_claims","label":"Multiple claims","section":"Cover","meaning":"Whether you can claim for more than one illness.","status":"cross-checked","value":"Yes. Sections pay independently. Within each section two claims are allowed, one Category A and one Category B (not two Category A). A section ends after 100% of its Sum Assured is paid; the policy continues for other sections, but no new section can be added after a claim.","display":"Yes: one Category A and one Category B claim per section, sections independent","note":null,"quote":"The benefits payable will be independent for each section if more than one Critical Illness sections are chosen. ... b) Two claims (one from Category A conditions and another from Category B conditions) are allowed for each section. ... c) Insured cannot claim under only one of opted Section(s) for two conditions listed in Category A of the same section ... If we have paid 100% of the sum assured under any of the sections opted, then the coverage for the respective section shall cease for the Insured Member, however Policy shall continue for rest of Sections (if opted). ... After a claim from any critical illness section has been paid under Criti-Care Policy, the said Insured will not be able to opt for any new critical illness section.","sources":[{"clause":"Section C(I)","heading":null,"page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-section-c-i"},{"clause":"4","heading":null,"page":17,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-4-5"},{"clause":"5","heading":null,"page":17,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271#c-5-5"}],"law":[]},{"key":"ped_waiting","label":"Pre-existing conditions","section":"Waiting periods","meaning":"Whether an illness you already had can ever be claimed: after a waiting period, or never.","status":"not-stated","value":null,"display":null,"note":"No pre-existing disease waiting period is printed. The claim certificate must confirm that the Insured Event does not relate to any Pre-Existing Condition (clause 10174), and the CIS asks you to disclose pre-existing diseases.","quote":null,"sources":[],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 8","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.6","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 7","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]}],"documents":[{"kind":"wording","label":"Criti Care Policy Wordings","pages":23,"fetched_at":"2026-10-16 08:29:37.677264+00","source_url":"https://www.bajajgeneralinsurance.com/download-documents/health-insurance/Health-PW/Criti-Care_PW.pdf","url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/271"},{"kind":"cis","label":"Criti Care Customer Information Sheet","pages":7,"fetched_at":"2026-10-16 08:29:37.677264+00","source_url":"https://www.bajajgeneralinsurance.com/download-documents/health-insurance/Health-CIS/Criti-Care_CIS.pdf","url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/272"},{"kind":"brochure","label":"Criti Care Brochure","pages":14,"fetched_at":"2026-10-16 08:29:37.677264+00","source_url":"https://www.bajajgeneralinsurance.com/download-documents/health-insurance/Criti-Care/Criti-Care_Brochure.pdf","url":"https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021/document/273"}],"versions":[],"where_to_buy":[],"claims_and_complaints":[],"notice":"Information, not advice. IndiaInsurances is not an insurer or an insurance intermediary, does not sell insurance and earns no commission. Policy terms change and your own policy schedule can differ: always confirm with the policy document and the insurer before you buy or claim.","cite_as":"Criti Care (UIN BAJHLIP21273V012021), IndiaInsurances, https://indiainsurances.com/policy/bajaj-general-insurance/criti-care-bajhlip21273v012021"}