{"uin":"BAJHLIP21606V022021","name":"Arogya Sanjeevani Policy, Bajaj General Insurance","url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021","insurer":{"slug":"bajaj-general-insurance","name":"Bajaj General Insurance Limited","url":"https://indiainsurances.com/insurer/bajaj-general-insurance"},"line":"health","category":"health-indemnity","category_name":"Health insurance (hospitalisation)","irdai_type":null,"kind":"product","status":"active","approved_on":null,"withdrawn_on":null,"summary":"Arogya Sanjeevani Policy from Bajaj General is a one-year hospitalisation indemnity cover with sum insured from Rs 1,00,000 to Rs 25,00,000 on an individual or floater basis. It carries a 5% co-pay on every claim, room rent capped at 2% of sum insured up to Rs 5,000 a day, a 36-month pre-existing disease wait and a 5% cumulative bonus per claim-free year up to 50%.","analysis":{"state":"extracted","analysed_at":"2026-10-16 08:29:38.145248+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":"not-stated","value":null,"display":null,"note":"No named plans. The documents offer Individual and Family Floater sum insured bases (cover types, not plans).","quote":null,"sources":[],"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":"One year.","display":"1 year","note":"The linked wording is the group version and names the certificate types 'Arogya Sanjeevani Policy, Bajaj General Insurance Limited (Group)-Individual' and '(Group)-Family Floater', each 1 year. The brochure says 'Policy can be taken for 1 year.'","quote":"Cover Period | 1 year","sources":[{"clause":"12","heading":"TABLEOFBENEFITS","page":14,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-12"}],"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":"Within 24 hours of emergency hospitalisation or before discharge, whichever is earlier; at least 48 hours before admission for planned hospitalisation.","display":"Emergency: within 24 hours (or before discharge, if earlier); planned: at least 48 hours before admission","note":"The reimbursement procedure in the same wording says 48 hours of emergency hospitalisation (the CIS repeats 48 hours for reimbursement), and the cashless clause says planned admission is intimated 'within 48 hours of such hospitalization'. Reimbursement documents are due within 30 days of discharge. Delay may be condoned on merit.","quote":"i) Within 24 hours from the date of emergency hospitalization required or before the Insured Beneficiary’s discharge from Hospital, whichever is earlier. ii) At least 48 hours prior to admission in Hospital in case of a planned Hospitalization.","sources":[{"clause":"9.1","heading":"Notification of Claim","page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-9-1"}],"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":["Duly completed claim form","Photo identity proof of the patient","Medical practitioner’s prescription advising admission","Original bills with itemized break-up","Payment receipts","Discharge summary including complete medical history of the patient","Investigation / Diagnostic test reports supported by the prescription from attending Medical Practitioner","OT notes or Surgeon’s certificate giving details of the operation performed (for surgical cases)","Sticker/Invoice of the Implants, wherever applicable","MLR (Medico Legal Report) copy if carried out and FIR (First Information Report) if registered, wherever applicable","NEFT Details and cancelled cheque","KYC (identity proof with address) of the proposer, where claim liability is above Rs. 1 Lakh","Legal heir/ succession certificate, wherever applicable","Any other relevant document required by Company/TPA"],"display":"Claim form, ID proof, admission prescription, original itemised bills and receipts, discharge summary, test reports, OT notes, implant invoices, MLR/FIR, NEFT details, KYC above Rs. 1 Lakh, legal heir certificate","note":"Documents are to be given within 30 days of discharge. Bills must be in the insured person's name.","quote":"i) Duly completed claim form ii) Photo identity proof of the patient iii) Medical practitioner’s prescription advising admission. iv) Original bills with itemized break-up v) Payment receipts vi) Discharge summary including complete medical history of the patient along with other details vii) Investigation / Diagnostic test reports etc. supported by the prescription from attending Medical Practitioner viii) OT notes or Surgeon’s certificate giving details of the operation performed (for surgical cases) ix) Sticker/Invoice of the Implants, wherever applicable. x) MLR (Medico Legal Report) copy if carried out and FIR (First Information Report) if registered, wherever applicable. x. NEFT Details (to enable direct credit of claim amount in bank account) and cancelled cheque xi) KYC (identity proof with address) of the proposer, where claim liability is above Rs. 1 Lakh asper AML Guidelines. xii) Legal heir/ succession certificate, wherever applicable xiii) AnyotherrelevantdocumentrequiredbyCompany/TPAforassessmentoftheclaim. ... The company shall only accept bills/invoices/medical treatment related documents only in the Insure Person’s name ... within 30 days of discharge from a Hospital give Us the documentation","sources":[{"clause":"9.2","heading":"Documents to be submitted","page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-9-2"},{"clause":"9(f)","heading":null,"page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-9-f"}],"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":"The insurer settles or rejects a claim within 15 days of receiving the last necessary document; if investigation is needed it is completed within 30 days of that date. Delay carries interest at 2% above the bank rate.","display":"15 days from the last necessary document (investigation: up to 30 days)","note":"The CIS says 'TAT for claim settlement: 15 Working Days'; the wording, which prevails, says 15 days. The wording's investigation clause also says the claim is then settled 'within 15 days from the date of receipt of last necessary document'.","quote":"i) 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. ... not later than 30 days from the date of receipt of last necessary document ... In case of delay beyond stipulated 15 days the Insurer shall be liable to pay interest at a rate 2% above the bank rate ... TAT for claim settlement: 15 Working Days","sources":[{"clause":"9.4(i)","heading":null,"page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-9-4-i"},{"clause":"9.4(iii)","heading":null,"page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-9-4-iii"},{"clause":"9.4(iv)","heading":null,"page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-9-4-iv"},{"clause":null,"heading":"36 months waiting period","page":3,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/275#c-36-months-waiting-period"}],"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":["Pre-existing diseases for 36 months (Excl01)","Listed conditions and surgeries for 24/36 months (Excl02)","Any illness within the first 30 days except accidents (Excl03)","Admission primarily for diagnostics and evaluation (Excl04)","Rest cure, rehabilitation and respite care (Excl05)","Obesity/ Weight Control surgery outside the stated conditions (Excl06)","Change-of-Gender treatments (Excl07)","Cosmetic or plastic Surgery (Excl08)","Hazardous or Adventure sports as a professional (Excl09)","Breach of law with criminal intent (Excl10)","Alcoholism, drug or substance abuse (Excl12)","Sterility and Infertility (Excl17)","Maternity Expenses (Excl 18)","Domiciliary Hospitalization and OPD Treatment","Treatment taken outside the geographical limits of India"],"display":"PED 36 months, listed conditions 24/36 months, first 30 days, diagnostics-only admissions, rest cure, obesity, gender change, cosmetic surgery, adventure sports, crime, addiction, infertility, maternity, domiciliary and OPD, treatment outside India","note":"Also excluded: excluded providers (Excl11), health hydros and nature cure clinics (Excl13), dietary supplements (Excl14), refractive error under 7.5 dioptres (Excl15), unproven treatments (Excl16), war and nuclear, chemical or biological attack, specified ICD codes of disclosed diseases named in the schedule, and the non-medical items in List I of Annexure A (see permanent_exclusions).","quote":"6.1 Pre-Existing Diseases (Code- Excl01) ... until the expiry of 36 months of continuous coverage ... 6.3 Specific Waiting Period: (Code- Excl02) ... until the expiry of 24/36 months of continuous coverage ... 6.2 First Thirty Days Waiting Period (Code- Excl03) ... Expenses related to the treatment of any illness within 30 days from the first policy commencement date shall be excluded except claims arising due to an accident ... 7.1 Investigation & Evaluation (Code- Excl04) ... Expenses related to any admission primarily for diagnostics and evaluation purposes only are excluded. ... 7.2 Rest Cure, rehabilitation and respite care (Code- Excl05) ... 7.3 Obesity/ Weight Control (Code- Excl06) ... 7.4 Change-of-Gender treatments: (Code- Excl07) ... 7.5 Cosmetic or plastic Surgery: (Code- Excl08) ... 7.6 Hazardous or Adventure sports: (Code- Excl09) ... participation as a professional in hazardous or adventure sports ... Breach of law: Code- (Excl10) ... committing or attempting to commit a breach of law with criminal intent. ... Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof. (Code- Excl12) ... 7.14 Sterility and Infertility: (Code- Excl17) ... 7.15 Maternity Expenses (Code: Excl 18) ... Any expenses incurred on Domiciliary Hospitalization and OPD Treatment. ... Treatment taken outside the geographical limits of India","sources":[{"clause":"6.1","heading":"Pre-Existing Diseases (Code- Excl01)","page":6,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-6-1"},{"clause":"6.3","heading":"Specific Waiting Period: (Code- Excl02)","page":6,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-6-3"},{"clause":"6.2","heading":"First Thirty Days Waiting Period (Code- Excl03)","page":6,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-6-2"},{"clause":"7.1","heading":"Investigation & Evaluation (Code- Excl04)","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-7-1"},{"clause":"7.2","heading":"Rest Cure, rehabilitation and respite care (Code- Excl05)","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-7-2"},{"clause":"7.3","heading":"Obesity/ Weight Control (Code- Excl06)","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-7-3"},{"clause":"7.4","heading":"Change-of-Gender treatments: (Code- Excl07)","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-7-4"},{"clause":"7.5","heading":"Cosmetic or plastic Surgery: (Code- Excl08)","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-7-5"},{"clause":"7.6","heading":"Hazardous or Adventure sports: (Code- Excl09)","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-7-6"},{"clause":"7.7","heading":"Breach of law: Code- (Excl10)","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-7-7"},{"clause":"7.9","heading":"Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof.","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-7-9"},{"clause":"7.14","heading":"Sterility and Infertility: (Code- Excl17)","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-7-14"},{"clause":"7.15","heading":"Maternity Expenses (Code: Excl 18)","page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-7-15"},{"clause":"7.18","heading":null,"page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-7-18"},{"clause":"7.19","heading":"Treatment taken outside the geographical limits of India","page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-7-19"}],"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":"First contact the insurer: toll-free 1-800-209-5858, branches, the website, or e-mail careforyou@bajajgeneral.com (senior citizens: seniorcitizen@bajajgeneral.com). If not satisfied, write to the Grievance Redressal Officer at ggro@bajajgeneral.com, then the Insurance Ombudsman.","display":"careforyou@bajajgeneral.com (Level 1), then Grievance Redressal Officer ggro@bajajgeneral.com (Level 2)","note":"Level 3: missed call on +91 80809 45060 or SMS to 575758 for a care specialist.","quote":"1. Our toll-free number 1-800-209- 5858 or 020-30305858, say Say “Hi” on WhatsApp on +91 7507245858 ... 2. Branches for resolution of your grievances / complaints ... 3. Register your grievances / complaints on our website ... 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 ... 5. If you are still not satisfied with the decision of the Insurance Company, you may approach the Insurance Ombudsman","sources":[{"clause":"11","heading":"Grievance Redressal Procedure","page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-11"},{"clause":"11(a)","heading":"Level 1","page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-11-a"},{"clause":"11(b)","heading":"Level 2","page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-11-b"},{"clause":"11(c)","heading":"Level 3","page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-11-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":"conflicting","value":"Rs 1,00,000, 1,50,000, 2,00,000, 2,50,000, 3,00,000, 3,50,000, 4,00,000, 4,50,000, 5,00,000, 7,50,000, 10,00,000, 12,50,000, 15,00,000, 20,00,000 or 25,00,000, on individual or floater basis.","display":"Rs 1,00,000 to Rs 25,00,000 in fixed steps","note":"Brochure says: minimum 'INR 50,000', maximum 'INR 25,00,000'. The wording's table of benefits starts at Rs 1,00,000.","quote":"Sum insured | INR ₹1,00,000, ₹ 1,50,000,₹ 2,00,000, ₹ 2,50,000, ₹ 3,00,000, ₹ 3,50,000, ₹ 4,00,000, ₹4,50,000, ₹5,00,000, ₹7,50,000, ₹ 10,00,000, ₹ 12,50,000,₹ 15,00,000, ₹ 20,00,000 and ₹ 25,00,000 ... Coverage | Sum Insured (Minimum) | Sum Insured (Maximum) ... 1. Hospitalization | INR 50,000 | INR 25,00,000","sources":[{"clause":"12","heading":"TABLEOFBENEFITS","page":14,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-12"},{"clause":null,"heading":null,"page":1,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/276#c-s1"}],"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":30},"display":"30 days (accidents covered)","note":"Does not apply if the insured has continuous coverage for more than twelve months; applies afresh to an enhanced sum insured.","quote":"i) Expenses related to the treatment of any illness within 30 days from the first policy commencement date shall be excluded except claims arising due to an accident, provided the same are covered. ... ii) This exclusion shall not, however, apply if the Insured Beneficiary has Continuous Coverage for more than twelve months. iii) The within referred waiting period is made applicable to the enhanced sum insured in the event of granting higher sum insured subsequently.","sources":[{"clause":"6.2","heading":"First Thirty Days Waiting Period (Code- Excl03)","page":6,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-6-2"}],"law":[]},{"key":"ped_waiting","label":"Pre-existing disease waiting period","section":"Waiting periods","meaning":"How long you wait before conditions you already had when you bought the policy are covered. The law caps it at 36 months.","status":"cross-checked","value":{"unit":"months","amount":36},"display":"36 months","note":"Only PEDs declared at application and accepted are covered after 36 months; applies afresh to a sum insured increase; reduced by prior continuous cover under portability.","quote":"a) 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 Policy with us. ... b) In case of enhancement of sum insured the exclusion shall apply afresh to the extent of sum insured increase. c) If the Insured Beneficiary is continuously covered without any break as defined under the portability norms of the extant IRDAI (Health Insurance) Regulations then waiting period for the same would be reduced to the extent of prior coverage. d) Coverage under the Policy after the expiry of 36 months for any pre-existing disease is subject to the same being declared at the time of application and accepted by us.","sources":[{"clause":"6.1","heading":"Pre-Existing Diseases (Code- Excl01)","page":6,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-6-1"}],"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"}]},{"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":"cross-checked","value":{"unit":"months","amount":24},"display":"24 months (36 months for joint replacement and osteoarthritis/osteoporosis)","note":"36 months for joint replacement and age-related osteoarthritis and osteoporosis. Not applicable to accident claims.","quote":"shall be excluded until the expiry of 24/36 months of continuous coverage, as may be the case after the date of inception of the first policy with the Insurer. This exclusion shall not be applicable for claims arising due to an accident. ... i) 24 Months waiting period ... ii) 36 Months waiting period Treatment for joint replacement unless arising from accident | Age-related Osteoarthritis & Osteoporosis","sources":[{"clause":"6.3","heading":"Specific Waiting Period: (Code- Excl02)","page":6,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-6-3"},{"clause":"6.3(e)(i)","heading":null,"page":6,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-6-3-e-i"},{"clause":"6.3(e)(ii)","heading":null,"page":6,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-6-3-e-ii"}],"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":"cross-checked","value":["Benign ENT disorders","Tonsillectomy","Adenoidectomy","Mastoidectomy","Tympanoplasty","Hysterectomy","All internal and external benign tumors, cysts, polyps of any kind, including benign breast lumps","Benign prostate hypertrophy","Cataract and age related eye ailments","Gastric/ Duodenal Ulcer","Gout and Rheumatism","Hernia of all types","Hydrocele","Non Infective Arthritis","Piles, Fissures and Fistula in anus","Pilonidal sinus, Sinusitis and related disorders","Prolapse inter Vertebral Disc and Spinal Diseases unless arising from accident","Calculi in urinary system, Gall Bladder and Bile duct, excluding malignancy","Varicose Veins and Varicose Ulcers","Internal Congenital Anomalies","Treatment for joint replacement unless arising from accident (36 months)","Age-related Osteoarthritis & Osteoporosis (36 months)"],"display":"ENT disorders and surgeries, hysterectomy, benign tumours, prostate, cataract, ulcers, gout, hernia, hydrocele, arthritis, piles, sinusitis, spinal disc, stones, varicose veins, internal congenital anomalies (24 months); joint replacement, osteoarthritis and osteoporosis (36 months)","note":"The wording prints the 24-month list as a two-column table; the CIS prints the same conditions as numbered rows.","quote":"i) 24 Months waiting period Benign ENT disorders | Gout and Rheumatism Tonsillectomy | Hernia of all types Adenoidectomy | Hydrocele Mastoidectomy | Non Infective Arthritis Tympanoplasty | Piles, Fissures and Fistula in anus Hysterectomy | Pilonidal sinus, Sinusitis and related disorders All internal and external benign tumors, cysts, polyps of any | Prolapse inter Vertebral Disc and Spinal Diseases unless kind, including benign breast lumps | arising from accident Benign prostate hypertrophy | Calculi in urinary system, Gall Bladder and Bile duct, excluding malignancy. Cataract and age related eye ailments | Varicose Veins and Varicose Ulcers Gastric/ Duodenal Ulcer | Internal Congenital Anomalies ... ii) 36 Months waiting period Treatment for joint replacement unless arising from accident | Age-related Osteoarthritis & Osteoporosis","sources":[{"clause":"6.3(e)(i)","heading":null,"page":6,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-6-3-e-i"},{"clause":"6.3(e)(ii)","heading":null,"page":6,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-6-3-e-ii"}],"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 date of enhancement on the enhanced limit only.","quote":"After completion of sixty continuous months of coverage (including portability and migration) no look back would be applied. ... 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":"8","heading":"Moratorium Period","page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-8"}],"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 insured can port to another insurer, applying at least 30 days but not earlier than 60 days before renewal; waiting periods are reduced by the years of prior continuous cover, up to the previous sum insured and accrued bonus.","display":"Yes, with waiting-period credit; apply 30 to 60 days before renewal","note":"Migration to other Bajaj General health products also carries waiting-period credit.","quote":"The Insured Beneficiary will have the option to port the Certificate of Insurance to other insurers as per extant Guidelines related to Portability. ... The waiting periods specified in Section 6 shall be reduced by the number of continuous preceding years of coverage of the Insured Beneficiary under the previous Health Insurance Policy ... Portability benefit will be offered to the extent of sum of previous sum insured and accrued bonus ... at least 30 days before, but not earlier than 60 days from the Policy renewal date ... The Insured Beneficiary will have the option to migrate the Certificate of Insurance to other health insurance products/plans offered by the company","sources":[{"clause":"10.15","heading":"Portability","page":11,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-10-15"},{"clause":"10.14","heading":"Migration","page":11,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-10-14"}],"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":"The wording states no maximum renewal age; 'lifetime renewal' is from the sales brochure.","quote":"Your Policy shall be renewable except on grounds of established fraud or non-disclosure or misrepresentation by You, provided this policy is not withdrawn ... lifetime renewal benefit is available under the policy, except on the grounds of Your moral hazard, misrepresentation, non- cooperation or fraud.","sources":[{"clause":"10.16","heading":"Renewal of Certificate of Insurance","page":12,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-10-16"},{"clause":null,"heading":null,"page":1,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/276#c-s1"}],"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. Renewal cannot be refused because of claims, and renewal premium loadings are set for the portfolio, not on an individual policy's claim experience.","display":"No: loadings are portfolio-level, not based on your claims","note":null,"quote":"ii We shall not deny the renewal of this policy on the ground that You have made a claim or claims in the preceding policy years ... iv For this policy, the loadings on renewal premium shall be at portfolio and not based upon any individual policy claim experience. However, discount in premium may be provided by Us to You for good claims experience.","sources":[{"clause":"10.16","heading":"Renewal of Certificate of Insurance","page":12,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-10-16"}],"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":["Investigation & Evaluation (Excl04)","Rest Cure, rehabilitation and respite care (Excl05)","Obesity/ Weight Control (Excl06)","Change-of-Gender treatments (Excl07)","Cosmetic or plastic Surgery (Excl08)","Hazardous or Adventure sports (Excl09)","Breach of law (Excl10)","Excluded Providers (Excl11)","Alcoholism, drug or substance abuse or any addictive condition (Excl12)","Treatments received in heath hydros, nature cure clinics, spas or similar establishments (Excl13)","Dietary supplements and substances that can be purchased without prescription (Excl14)","Refractive Error less than 7.5 dioptres (Excl15)","Unproven Treatments (Excl16)","Sterility and Infertility (Excl17)","Maternity Expenses (Excl 18)","War (whether declared or not) and war like occurrence","Nuclear, chemical or biological attack or weapons","Domiciliary Hospitalization and OPD Treatment","Treatment taken outside the geographical limits of India","Specified ICD codes of existing diseases disclosed and mentioned in the Policy Schedule","Treatment for any other system other than modern medicine (allopathy) and AYUSH therapies (CIS)"],"display":"Standard exclusions Excl04 to Excl 18, plus war, nuclear/chemical/biological attack, domiciliary and OPD treatment, treatment outside India and specified ICD codes of disclosed diseases","note":"The wording prints the Excl13 code on its own line after the health hydro clause. The last item is from the CIS only; the wording does not list it.","quote":"7.1 Investigation & Evaluation (Code- Excl04) ... 7.2 Rest Cure, rehabilitation and respite care (Code- Excl05) ... 7.3 Obesity/ Weight Control (Code- Excl06) ... 7.4 Change-of-Gender treatments: (Code- Excl07) ... 7.5 Cosmetic or plastic Surgery: (Code- Excl08) ... 7.6 Hazardous or Adventure sports: (Code- Excl09) ... 7.7 Breach of law: Code- (Excl10) ... 7.8 Excluded Providers: Code- (Excl11) ... Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof. (Code- Excl12) ... Treatments received in heath hydros, nature cure clinics, spas or similar establishments ... Excl13 ... Dietary supplements and substances that can be purchased without prescription ... (Code-Excl14) ... 7.12 Refractive Error: (Code- Excl15) Expenses related to the treatment for correction of eye sight due to refractive error less than 7.5 dioptres. ... 7.13 Unproven Treatments:(Code- Excl16) ... 7.14 Sterility and Infertility: (Code- Excl17) ... 7.15 Maternity Expenses (Code: Excl 18) ... War (whether declared or not) and war like occurrence ... Nuclear, chemical or biological attack or weapons ... Any expenses incurred on Domiciliary Hospitalization and OPD Treatment. ... Treatment taken outside the geographical limits of India ... In respect of the existing diseases, disclosed by the Insured Beneficiary and mentioned in the Policy Schedule (based on Insured Beneficiary’s consent),he/she is not entitled to get the coverage for specified ICD codes. ... Treatment for any other system other than modern medicine (allopathy) and AYUSH therapies.","sources":[{"clause":"7.1","heading":"Investigation & Evaluation (Code- Excl04)","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-7-1"},{"clause":"7.2","heading":"Rest Cure, rehabilitation and respite care (Code- Excl05)","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-7-2"},{"clause":"7.3","heading":"Obesity/ Weight Control (Code- Excl06)","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-7-3"},{"clause":"7.4","heading":"Change-of-Gender treatments: (Code- Excl07)","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-7-4"},{"clause":"7.5","heading":"Cosmetic or plastic Surgery: (Code- Excl08)","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-7-5"},{"clause":"7.6","heading":"Hazardous or Adventure sports: (Code- Excl09)","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-7-6"},{"clause":"7.7","heading":"Breach of law: Code- (Excl10)","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-7-7"},{"clause":"7.8","heading":"Excluded Providers: Code- (Excl11)","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-7-8"},{"clause":"7.9","heading":"Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof.","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-7-9"},{"clause":"7.10","heading":null,"page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-7-10"},{"clause":"Excl13","heading":null,"page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-excl13"},{"clause":"7.11","heading":null,"page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-7-11"},{"clause":"7.12","heading":"Refractive Error: (Code- Excl15)","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-7-12"},{"clause":"7.13","heading":"Unproven Treatments:(Code- Excl16)","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-7-13"},{"clause":"7.14","heading":"Sterility and Infertility: (Code- Excl17)","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-7-14"},{"clause":"7.15","heading":"Maternity Expenses (Code: Excl 18)","page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-7-15"},{"clause":"7.16","heading":null,"page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-7-16"},{"clause":"7.17","heading":null,"page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-7-17"},{"clause":"7.18","heading":null,"page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-7-18"},{"clause":"7.19","heading":"Treatment taken outside the geographical limits of India","page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-7-19"},{"clause":"7.20","heading":null,"page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-7-20"},{"clause":"Row 6","heading":"Exclusions (What the policy does not cover)","page":2,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/275#c-row-6"}],"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":"On 7 days' written notice, the unexpired premium is refunded pro rata, provided no claim was made in the policy year; medical examination costs are deducted if cover has started. The insurer may cancel for misrepresentation, non-disclosure or fraud on 15 days' notice with no refund.","display":"Pro-rata refund if no claim in the year (7 days' notice)","note":"Refund delayed beyond 7 days carries interest at 2% above the bank rate. Instalment payers also get a pro-rata refund if no claim was made.","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. ... 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 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. ... (D) 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":"10.10","heading":"Cancellation","page":11,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-10-10"}],"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":"cross-checked","value":"India only.","display":"India only","note":null,"quote":"All medical treatment for the purpose of this insurance will have to be taken in India only.","sources":[{"clause":"10.7","heading":"Territorial Limit","page":10,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-10-7"}],"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":"The linked wording is the group version (Certificate of Insurance, Insured Beneficiary); for an individual policy read it as 30 days from receipt of the policy, which the brochure says. Only at first inception, not on renewal or porting. Refund less medical examination and stamp duty costs, or proportionate risk premium if cover has started. The CIS counts 30 days 'from the first inception of policy'.","quote":"The Free Look Period shall be applicable at the inception of the Certificate of Insurance and not on renewals or at the time of porting the Certificate of Insurance. The Insured Beneficiary shall be allowed a period of thirty days from date of receipt of the Certificate of Insurance to review the terms and conditions of the Certificate of Insurance and Group Policy, and to return the same if not acceptable. ... i) A refund of the premium paid less any expenses incurred by the Company on medical examination of the Insured Beneficiary and the stamp duty charges; or ii) Where the risk has already commenced and the option of return of the Certificate of Insurance is exercised by the Insured Beneficiary, a deduction towards the proportionate risk premium for period of cover ... Free Look Cancellation: Insured has an option of cancelling his/her policy up to 30 days from the first inception of policy with Us","sources":[{"clause":"10.20","heading":"Free look period","page":12,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-10-20"},{"clause":null,"heading":"36 months waiting period","page":3,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/275#c-36-months-waiting-period"}],"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":"iii 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. ... i) 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.","sources":[{"clause":"10.16","heading":"Renewal of Certificate of Insurance","page":12,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-10-16"},{"clause":"10.18","heading":"Premium Payment in Installments","page":12,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-10-18"}],"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":"cross-checked","value":"Proposer 18 to 65 years (an older proposer can cover the family without covering self); dependent children 3 months to 25 years.","display":"18 to 65 years (children 3 months to 25 years)","note":"Brochure: proposer, spouse, parents and parents-in-law 18 to 65 years. Pre-policy medical tests are mandatory from 46 years.","quote":"Policy can be availed by persons between the age of 18 years and 65years, as Proposer. Proposer with higher age ... can obtain policy for family, without covering self. ... Dependent Children (i. e natural or legally adopted) between the age of 3months to 25years. ... Pre- medical tests are mandatory for 46 years and above. ... Proposer /legally wedded Spouse /Parents/ Parents In law: 18 yrs to 65 years","sources":[{"clause":"12","heading":"TABLEOFBENEFITS","page":14,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-12"},{"clause":null,"heading":null,"page":1,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/276#c-s1"}],"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":["Annual","Half Yearly","Quarterly","Monthly"],"display":"Annual, half-yearly, quarterly or monthly","note":"The instalment clause marks 'Annual' instalments as 'for long term polices only'; the cover period is 1 year.","quote":"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 ... Grace Period | For Yearly payment of mode","sources":[{"clause":"10.18","heading":"Premium Payment in Installments","page":12,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-10-18"},{"clause":"12","heading":"TABLEOFBENEFITS","page":14,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-12"}],"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":"The documents describe no optional covers or add-ons.","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 payers: if premium is paid in instalments, cover continues during the grace period. Otherwise cover need not be available for the period with no premium received.","display":"Yes for instalment payers; otherwise no cover during the grace period","note":"The brochure says: 'Coverage is not available during the grace period.'","quote":"iii) If the premium is paid in instalments during the policy period, coverage will be available for the grace period also. ... Coverage need not be available during the period for which no premium is received.","sources":[{"clause":"10.18","heading":"Premium Payment in Installments","page":12,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-10-18"},{"clause":"3.21","heading":"Grace Period","page":2,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-3-21"}],"law":[]},{"key":"room_rent","label":"Room rent limit","section":"Limits and co-pay","meaning":"The most the policy pays per day for the hospital room, or the room category allowed. If you take a costlier room, other bills can be cut in proportion.","status":"cross-checked","value":"Room rent, boarding and nursing up to 2% of the sum insured, maximum Rs 5,000 per day.","display":"2% of sum insured, max Rs 5,000 per day","note":null,"quote":"i) Room Rent, Boarding, Nursing Expenses all-inclusive as provided by the Hospital/Nursing Home up to 2% of the sum insured subject to maximum of Rs.5000/-, per day.","sources":[{"clause":"4.1","heading":"Hospitalization","page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-4-1"}],"law":[]},{"key":"room_category","label":"Room category allowed","section":"Limits and co-pay","meaning":"Shared room, single private room or any room, by plan, when the limit is a room type rather than a rupee amount.","status":"not-stated","value":null,"display":null,"note":"The limit is a rupee amount (2% of sum insured, max Rs 5,000 per day), not a room type.","quote":null,"sources":[],"law":[]},{"key":"icu_limit","label":"ICU limit","section":"Limits and co-pay","meaning":"The most the policy pays per day for intensive care.","status":"cross-checked","value":"ICU/ICCU up to 5% of the sum insured, maximum Rs 10,000 per day.","display":"5% of sum insured, max Rs 10,000 per day","note":null,"quote":"ii) Intensive Care Unit (ICU) / Intensive Cardiac Care Unit (ICCU) expenses up to 5% of the sum insured subject to maximum of Rs.10,000/, per day.","sources":[{"clause":"4.1","heading":"Hospitalization","page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-4-1"}],"law":[]},{"key":"proportionate_deduction","label":"Proportionate deduction","section":"Limits and co-pay","meaning":"If you choose a room above your limit, whether the insurer reduces associated charges (doctor fees, tests, procedures) by the same proportion.","status":"conflicting","value":"Yes. If the room or ICU rate exceeds the limit, all other hospital expenses except medicines are paid in the same proportion.","display":"Yes, all expenses except medicines","note":"CIS says: 'Proportionate deduction shall be applicable on all expenses other than cost of Pharmacy/medicines, consumables, implants, medical devices & diagnostics'. The brochure says the same and adds that it does not apply in hospitals without differential billing.","quote":"2. In case of admission to a room/ICU/ICCU at rates exceeding the aforesaid limits, there imbursement/payment of all other expenses incurred at the Hospital, with the exception of cost of medicines, shall be effected in the same proportion as the admissible rate per day bears to the actual rate per day of Room Rent/ICU/ICCU charges. ... ** Proportionate deduction shall be applicable on all expenses other than cost of Pharmacy/medicines, consumables, implants, medical devices & diagnostics in case of admission to a room at rates exceeding the limit specified as per Sum insured ... b) Proportionate deductions shall not apply in respect of the Hospitals which do not follow differential billings","sources":[{"clause":"4.1.2","heading":"Other Expenses","page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-4-1-2"},{"clause":null,"heading":"36 months waiting period","page":3,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/275#c-36-months-waiting-period"},{"clause":"6(I)(b)","heading":null,"page":3,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/276#c-6-i-b"}],"law":[]},{"key":"copay","label":"Co-payment","section":"Limits and co-pay","meaning":"The share of every admissible claim you pay yourself, and when it applies (age, zone, choice of hospital).","status":"cross-checked","value":"5% of every admissible claim.","display":"5% on all claims","note":null,"quote":"Each and every claim under the Certificate of Insurance shall be subject to a Copayment of 5% applicable to claim amount admissible and payable","sources":[{"clause":"9.3","heading":"Co-payment","page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-9-3"}],"law":[]},{"key":"deductible","label":"Deductible","section":"Limits and co-pay","meaning":"An amount of each claim or each year that you bear before the policy pays.","status":"cross-checked","value":"None.","display":"None","note":"From the CIS; the wording sets no deductible.","quote":"Deductible – Not applicable","sources":[{"clause":null,"heading":"36 months waiting period","page":3,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/275#c-36-months-waiting-period"}],"law":[]},{"key":"disease_sublimits","label":"Disease or procedure sub-limits","section":"Limits and co-pay","meaning":"Caps on what is paid for named treatments (cataract, knee replacement...), even if the sum insured is higher.","status":"cross-checked","value":["Cataract: 25% of Sum Insured or Rs.40,000, whichever is lower, per each eye in one Policy Year","Listed modern treatment methods (items A to L): up to 50% of Sum Insured"],"display":"Cataract: 25% of SI or Rs 40,000 per eye; listed modern treatments: 50% of SI","note":"The procedures under the 50% cap are listed under modern_treatments. The CIS and brochure print the same limits.","quote":"The Company shall indemnify Medical Expenses incurred for treatment of Cataract, subject to a limit of 25% of Sum Insured or Rs.40,000/, whichever is lower, per each eye in one Policy Year. ... The following procedures will be covered (wherever medically indicated) either as In-patient or as part of day care treatment in a Hospital upto 50% of Sum Insured","sources":[{"clause":"4.3","heading":"Cataract Treatment","page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-4-3"},{"clause":"4.6","heading":null,"page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-4-6"}],"law":[]},{"key":"pre_hospitalisation","label":"Pre-hospitalisation cover","section":"Cover","meaning":"Medical costs in the days before admission that are paid if related to the hospitalisation.","status":"cross-checked","value":{"unit":"days","amount":30},"display":"30 days","note":null,"quote":"Pre Hospitalisation For 30 days prior to the date of hospitalization","sources":[{"clause":"12","heading":"TABLEOFBENEFITS","page":14,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-12"}],"law":[]},{"key":"post_hospitalisation","label":"Post-hospitalisation cover","section":"Cover","meaning":"Medical costs in the days after discharge that are paid if related to the hospitalisation.","status":"cross-checked","value":{"unit":"days","amount":60},"display":"60 days","note":null,"quote":"for a fixed period of 60 days from the date of discharge from the Hospital, following an admissible Hospitalization","sources":[{"clause":"4.5","heading":"Post Hospitalisation","page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-4-5"}],"law":[]},{"key":"day_care","label":"Day-care treatments","section":"Cover","meaning":"Treatments needing less than 24 hours in hospital (chemotherapy, dialysis, cataract) and whether all or only listed ones are covered.","status":"cross-checked","value":"All day care treatments are covered.","display":"All day care treatments covered","note":"The definition refers to procedures 'as listed in Annexure I', but no Annexure I is included in the wording.","quote":"iv) All Day Care Treatments ... Expenses of Hospitalization for a minimum period of 24 consecutive hours only shall be admissible. However, the time limit shall not apply in respect of Day Care Treatment","sources":[{"clause":"4.1.2","heading":"Other Expenses","page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-4-1-2"}],"law":[]},{"key":"domiciliary","label":"Treatment at home","section":"Cover","meaning":"Whether treatment at home is covered when hospital admission is not possible or a doctor advises it.","status":"cross-checked","value":"Not covered.","display":"Not covered","note":null,"quote":"Any expenses incurred on Domiciliary Hospitalization and OPD Treatment.","sources":[{"clause":"7.18","heading":null,"page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-7-18"}],"law":[]},{"key":"ayush","label":"AYUSH treatment","section":"Cover","meaning":"Ayurveda, Yoga, Unani, Siddha and Homeopathy treatment in a recognised hospital, and any limit.","status":"cross-checked","value":"In-patient AYUSH treatment in an AYUSH Hospital is covered up to the sum insured.","display":"Covered up to sum insured (in-patient, AYUSH Hospital)","note":null,"quote":"The Company shall indemnify Medical Expenses incurred for Inpatient Care treatment under Ayurveda, Yoga and Naturopathy, Unani, Sidha and Homeopathy systems of medicines during each Policy Yearupto the limit of Sum Insured as specified in the Certificate of Insurance in any AYUSH Hospital.","sources":[{"clause":"4.2","heading":"AYUSH Treatment","page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-4-2"}],"law":[{"title":"Guidelines on providing AYUSH coverage in Health Insurance policies, 2024","section":"Para 1","url":"https://indiainsurances.com/law/irdai-ayush-2024"},{"title":"Guidelines on providing AYUSH coverage in Health Insurance policies, 2024","section":"Para 2","url":"https://indiainsurances.com/law/irdai-ayush-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 1","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch II A.I(1)","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 5","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"modern_treatments","label":"Modern treatments","section":"Cover","meaning":"Robotic surgery, immunotherapy, oral chemotherapy, stem cell therapy and the like, and any cap on them.","status":"cross-checked","value":"Listed procedures (robotic surgery, oral chemotherapy, immunotherapy, stem cell therapy and others in items A to L) are covered as in-patient or day care up to 50% of the sum insured.","display":"Covered up to 50% of sum insured","note":null,"quote":"The following procedures will be covered (wherever medically indicated) either as In-patient or as part of day care treatment in a Hospital upto 50% of Sum Insured, specified in the Certificate of Insurance, during the Cover Period: A. Uterine Artery Embolization and HIFU (High Intensity focused ultrasound) B. Balloon Sinuplasty C. Deep Brain Stimulation D. Oral Chemotherapy E. Immunotherapy – Monoclonal Antibody to be given as injection F. Intra vitreal injections G. Robotic surgeries H. Stereotactic radio surgeries ... I) Bronchical Thermoplasty J. Vaporisation of the prostrate (Green laser treatment or holmium laser treatment) K. IONM – (Intra Operative Neuro Monitoring) L. Stem Cell Therapy: Hematopoietic stem cells for bone marrow transplant for hematological conditions to be covered.","sources":[{"clause":"4.6","heading":null,"page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-4-6"},{"clause":"4.6(I)","heading":null,"page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-4-6-i"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 2","url":"https://indiainsurances.com/law/irdai-health-mc-2024"}]},{"key":"organ_donor","label":"Organ donor expenses","section":"Cover","meaning":"Whether the donor's hospital costs for an organ transplant are paid.","status":"not-stated","value":null,"display":null,"note":"The documents do not mention organ donor expenses.","quote":null,"sources":[],"law":[]},{"key":"ambulance","label":"Ambulance cover","section":"Cover","meaning":"Road (and air) ambulance cover and its limit.","status":"cross-checked","value":"Road ambulance up to Rs 2,000 per hospitalisation.","display":"Road ambulance, max Rs 2,000 per hospitalisation","note":"Air ambulance is not mentioned.","quote":"v) Expenses incurred on road ambulance subject to a maximum of Rs.2000/- per Hospitalisation.","sources":[{"clause":"4.1.2","heading":"Other Expenses","page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-4-1-2"}],"law":[]},{"key":"restoration","label":"Restoration of sum insured","section":"Cover","meaning":"Whether the sum insured is refilled after it is used up in a year, how much, how often, and whether it works for the same illness.","status":"cross-checked","value":"No. Cover for the policy year ends once the sum insured and cumulative bonus are used up; there is no refill.","display":"No: cover ends for the year when the sum insured is used up","note":"The documents describe no restoration or recharge benefit.","quote":"The coverage for the Insured Beneficiary(s) shall automatically terminate: ... 2. Upon exhaustion of Sum insured and Cumulative Bonus, for the Policy Year. However, the Certificate of Insurance is subject to renewal on the due date","sources":[{"clause":"10.11","heading":null,"page":11,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-10-11"}],"law":[]},{"key":"no_claim_bonus","label":"No-claim or cumulative bonus","section":"Cover","meaning":"How much the cover grows each year, the maximum, whether it depends on not claiming, and what happens after a claim.","status":"cross-checked","value":"Cumulative bonus of 5% of the sum insured for each claim-free year, up to 50%, if renewed without a break. After a claim it is reduced at the same rate it accrued.","display":"5% per claim-free year, max 50%; reduced at the same rate after a claim","note":"On floater cover, a claim by any member reduces the family's bonus.","quote":"Cumulative Bonus will be increased by 5% in respect of each claim free Policy Year (no claims are reported), provided the Certificate of Insurance is renewed with the company without a break subject to maximum of 50% of the sum insured under the current Policy Year. If a claim is made in any particular year, the cumulative bonus accrued shall be reduced at the same rate at which it has accrued. ... ii) In case where the Policy is on floater basis, the CB shall be added and available to the family on floater basis, provided no claim has been reported from any member of the family. CB shall reduce in case of claim from any of the Insured Beneficiary/ies.","sources":[{"clause":"5","heading":"Cumulative Bonus (CB)","page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-5"},{"clause":"5(ii)","heading":null,"page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-5-ii"}],"law":[]},{"key":"consumables","label":"Consumables and non-medical items","section":"Cover","meaning":"Gloves, PPE, syringes and other items hospitals bill that standard policies exclude; whether this policy pays them.","status":"cross-checked","value":"Not paid. Non-medical items such as gloves and masks are in List I of Annexure A, the expenses not covered.","display":"Not covered: List I non-medical items such as gloves and masks","note":"The CIS exempts consumables from proportionate deduction, but the wording does not cover the List I items.","quote":"The expenses that are not covered in this Policy are placed under List-I of Annexure-A. ... List I: List of Non-Medical Items ... 56 | GLOVES ... 60 | MASK","sources":[{"clause":"4.6(I)","heading":null,"page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-4-6-i"},{"clause":"Annexure A","heading":null,"page":15,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-annexure-a"}],"law":[]},{"key":"maternity","label":"Maternity cover","section":"Cover","meaning":"Whether childbirth costs are covered, the limit and the waiting period.","status":"cross-checked","value":"Not covered: childbirth, caesarean, miscarriage and termination expenses are excluded (Excl 18), except ectopic pregnancy.","display":"Not covered (Excl 18), except ectopic pregnancy","note":null,"quote":"7.15 Maternity Expenses (Code: Excl 18) i) medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred during hospitalization) except ectopic pregnancy; ii) expenses towards miscarriage (unless due to an accident) and lawful medical termination of pregnancy during the Cover Period.","sources":[{"clause":"7.15","heading":"Maternity Expenses (Code: Excl 18)","page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-7-15"}],"law":[]},{"key":"newborn","label":"Newborn baby cover","section":"Cover","meaning":"Whether a newborn is covered from birth and for what.","status":"cross-checked","value":"No cover from birth: dependent children can be covered only from 3 months of age.","display":"Not from birth: children from 3 months","note":"Childbirth expenses are excluded (Excl 18).","quote":"Dependent Children (i.e. natural or legally adopted) between the age 3monthsto 25 years.","sources":[{"clause":"3.20","heading":"Family","page":2,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-3-20"}],"law":[]},{"key":"mental_illness","label":"Mental illness","section":"Cover","meaning":"Cover for in-patient treatment of mental illness.","status":"not-stated","value":null,"display":null,"note":"The documents neither cover nor exclude mental illness by name.","quote":null,"sources":[],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 3","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch III I","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"The Mental Healthcare Act, 2017","section":"Section 21(4)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"},{"title":"The Mental Healthcare Act, 2017","section":"Section 2(1)(s)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"},{"title":"The Mental Healthcare Act, 2017","section":"Section 21(1)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"}]},{"key":"health_checkup","label":"Health check-up","section":"Cover","meaning":"Free preventive check-ups and how often.","status":"not-stated","value":null,"display":null,"note":"Only a pre-policy check-up at entry (mandatory above 45 years, cost refunded if the policy is issued) is mentioned; no periodic preventive check-up.","quote":null,"sources":[],"law":[]},{"key":"opd","label":"Out-patient (OPD) cover","section":"Cover","meaning":"Doctor consultations, tests and medicines without admission, and the limit.","status":"cross-checked","value":"Not covered.","display":"Not covered","note":null,"quote":"Any expenses incurred on Domiciliary Hospitalization and OPD Treatment.","sources":[{"clause":"7.18","heading":null,"page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-7-18"}],"law":[]},{"key":"zone_pricing","label":"Zone or city-based premium","section":"Premium","meaning":"Whether premium or co-pay depends on the city you are treated in.","status":"cross-checked","value":"Premium is zone-based: the CIS benefit illustration quotes Zone A premiums. The co-pay is 5% on all claims, not by zone.","display":"Premium varies by zone (CIS quotes Zone A); co-pay not zone-based","note":"The documents do not define the zones or the cities in each.","quote":"Premium (for zone A) ... Total Premium (for Zone A) for all members of the family ... Co-Payment - 5% co pay on all claims","sources":[{"clause":null,"heading":"36 months waiting period","page":3,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/275#c-36-months-waiting-period"}],"law":[]},{"key":"cashless","label":"Cashless treatment","section":"Claims","meaning":"Whether and where the insurer pays the hospital directly instead of you paying and claiming back.","status":"conflicting","value":"Yes, at network hospitals with pre-authorisation, and the wording also offers 'Cashless Everywhere' in non-network hospitals that meet the IRDAI definition of Hospital.","display":"Yes: network hospitals, and 'Cashless Everywhere' in other qualifying hospitals","note":"CIS says: 'Cashless treatment is only available at Network Hospitals'.","quote":"i) Treatment may be taken in a network provider and is subject to pre-authorization by the Company or its authorized TPA. ... d) We offer Cashless Everywhere, even in hospitals which are not part of our network subject to hospitals fulling IRDAI definition of Hospital facility ... Cashless treatment is only available at Network Hospitals","sources":[{"clause":"9(i)","heading":null,"page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-9-i"},{"clause":"9(d)","heading":null,"page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-9-d"},{"clause":null,"heading":"36 months waiting period","page":3,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/275#c-36-months-waiting-period"}],"law":[]},{"key":"claims_handled_by","label":"Claims handled by","section":"Claims","meaning":"The insurer itself or a third-party administrator (TPA).","status":"cross-checked","value":"The insurer's in-house claims team; no TPA is engaged.","display":"In-house (no TPA)","note":"From the sales brochure. The group wording refers generally to 'the Company or its authorized TPA' without naming one, and says a TPA never settles or rejects claims.","quote":"All Claims will be settled by In house claims settlement team of the company and no TPA is engaged.","sources":[{"clause":"Excl12(c)(xiv)","heading":null,"page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/276#c-excl12-c-xiv"}],"law":[]},{"key":"family_floater","label":"Family floater available","section":"Cover","meaning":"Whether one sum insured can be shared by the whole family.","status":"cross-checked","value":true,"display":"Yes","note":null,"quote":"Product Type | Individual/Floater ... On Floater basis – SI shall apply to the entire family","sources":[{"clause":"12","heading":"TABLEOFBENEFITS","page":14,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274#c-12"}],"law":[]}],"documents":[{"kind":"wording","label":"Arogya Sanjeevani Policy, Bajaj General Insurance Policy Wordings","pages":18,"fetched_at":"2026-10-16 08:29:37.949061+00","source_url":"https://www.bajajgeneralinsurance.com/download-documents/health-insurance/Health-PW/Arogya-Sanjeevani-Policy_PW.pdf","url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/274"},{"kind":"cis","label":"Arogya Sanjeevani Policy, Bajaj General Insurance Customer Information Sheet","pages":6,"fetched_at":"2026-10-16 08:29:37.949061+00","source_url":"https://www.bajajgeneralinsurance.com/download-documents/health-insurance/Health-CIS/Arogya-Sanjeevani_CIS.pdf","url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/275"},{"kind":"brochure","label":"Arogya Sanjeevani Policy, Bajaj General Insurance Brochure","pages":9,"fetched_at":"2026-10-16 08:29:37.949061+00","source_url":"https://www.bajajgeneralinsurance.com/download-documents/health-insurance/Arogya-Sanjeevani/AROGYA-SANJEEVANI-brochure.pdf","url":"https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021/document/276"}],"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":"Arogya Sanjeevani Policy, Bajaj General Insurance (UIN BAJHLIP21606V022021), IndiaInsurances, https://indiainsurances.com/policy/bajaj-general-insurance/arogya-sanjeevani-policy-bajaj-general-insurance-bajhlip21606v022021"}