{"uin":"BAJHLIP23210V042223","name":"Health Care Supreme","url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223","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":"Revision","kind":"product","status":"active","approved_on":"2020-12-08","withdrawn_on":null,"summary":"Health Care Supreme is a Bajaj General indemnity health policy sold as Vital, Smart and Ultimo plans (Plans A to K) with hospitalisation sums insured of Rs 500,000 to Rs 5,000,000, on an individual or floater basis for 1, 2 or 3 years. It includes OPD, maternity after 24 months, 100% sum insured reinstatement once a year and a 10% a year cumulative bonus up to 50%, with a 24 month pre-existing disease wait and no co-payment or sub-limits.","analysis":{"state":"extracted","analysed_at":"2026-10-16 08:29:39.270558+00","note":"Every stated fact carries a verbatim quote found in the cited clause."},"facts":[{"key":"plan_variants","label":"Plans and variants","section":"Overview","meaning":"The named plans inside this product (not cover types or payout options). Facts can differ between them.","status":"cross-checked","value":["Health Care Supreme - Vital (Plans A, B, C)","Health Care Supreme - Smart (Plans D, E, F, G)","Health Care Supreme - Ultimo (Plans H, I, J, K)"],"display":"Vital (Plans A to C), Smart (Plans D to G), Ultimo (Plans H to K)","note":"From the sales brochure, which groups the plans clearly; the wording's Table of Benefits shows the same Plans A to K with Vital, Smart and Ultimo labels in a broken layout. Plans differ in hospitalisation, OPD, physiotherapy, maternity, donor, air ambulance and recovery benefit amounts.","quote":"Plans Health Care Supreme - Vital | Plan A Plan B Plan C ... Health Care Supreme - Smart | Plan D Plan E Plan F Plan G ... Health Care Supreme - Ultimo | Plan H Plan I Plan J Plan K","sources":[{"clause":"14(ii)","heading":null,"page":6,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/287#c-14-ii"}],"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, two or three years.","display":"1, 2 or 3 years","note":"Long term policy discount of 4% for 2 years and 8% for 3 years (not on instalment option).","quote":"1year, 2 years or 3 years","sources":[{"clause":null,"heading":"Policy Period","page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-policy-period"}],"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":"Planned hospitalisation: intimate 48 hours before admission. Emergency: within 24 hours of admission for cashless, within 48 hours for reimbursement.","display":"48 hours before planned admission; within 24 hours (cashless) or 48 hours (reimbursement) of emergency admission","note":"Reimbursement documents within 30 days of discharge. Waiver may be considered in extreme hardship.","quote":"In case of Planned hospitalization, You/the Insured Person/ Insured’s representative shall intimate such admission before 48 hours of such hospitalization. ... In case of Emergency hospitalization, You/ Insured Person/ Insured’s representative shall intimate such admission within 24 hours of such hospitalization. ... You or someone claiming on Your behalf must inform Us in writing immediately with 48 hours of hospitalization in case emergency hospitalization & 48 hours prior to hospitalization in case of planned hospitalization","sources":[{"clause":"Section E(ii)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-section-e-ii"},{"clause":"Section E(iii)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-section-e-iii"},{"clause":"Section E(a)","heading":null,"page":20,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-section-e-a"}],"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":["First Consultation letter from the Medical Practitioner/Doctor","Duly completed claim form signed by the Claimant","Hospital Discharge Card","Hospital Bill giving detailed break up of all expense heads","Money Receipt, duly signed with a Revenue Stamp","All original Laboratory and Diagnostic Test Reports","IOL Sticker in case of a Cataract Operation","Aadhar card & PAN card Copies","Other documents as may be required by Bajaj General"],"display":"Claim form, first consultation letter, discharge card, itemised bill, receipt, test reports, Aadhaar and PAN copies","note":"List for the Medical Expenses section. Critical illness, ancillary and personal accident add-ons have their own lists (death certificate, FIR, disability certificate and so on).","quote":"First Consultation letter from the Medical Practitioner/Doctor ... Duly completed claim form signed by the Claimant ... Hospital Discharge Card (Not applicable for Out Patient Expenses & Physiotherapy Expenses Section) ... Hospital Bill giving detailed break up of all expense heads mentioned in the bill. ... Money Receipt, duly signed with a Revenue Stamp ... All original Laboratory and Diagnostic Test Reports. ... In case of a Cataract Operation, IOL Sticker will have to be ... Other documents as may be required by Bajaj General to process the claim ... Aadhar card & PAN card Copies (Not mandatory if the same is linked with the policy while issuance or in previous claim)","sources":[{"clause":"Section E(i)","heading":null,"page":20,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-section-e-i-2"}],"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":"Within 15 days from receipt of the last necessary document; if investigated, the investigation must finish within 30 days of the last document. Delay attracts interest at 2% above bank rate.","display":"15 days from the last necessary document","note":"CIS says: 'TAT for claim settlement: 15 Working Days'; cashless pre-authorisation within 60 minutes and final bill authorisation within 180 minutes.","quote":"The Company shall settle or reject a claim, as the case may be, within 15 days from the date of receipt of last necessary document. ... not later than 30 days from the date of receipt of last necessary document ... the Company shall be liable to pay interest to the policyholder from the date of receipt of last necessary document to the date of payment of claim at a rate 2% above the bank rate.","sources":[{"clause":"3(i)","heading":null,"page":15,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-3-i"},{"clause":"3(iii)","heading":null,"page":15,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-3-iii"},{"clause":"3(ii)","heading":null,"page":15,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-3-ii"}],"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 until 24 months of continuous coverage (Excl01)","Listed conditions until 12 months of continuous coverage (Excl02); 24 months for joint replacement and others","Any illness within 30 days from the first policy commencement, except accidents (Excl03)","Pregnancy and childbirth until 24 months, except ectopic pregnancy","Admission primarily for diagnostics and evaluation (Excl04)","Rest cure, rehabilitation and respite care (Excl05)","Obesity/weight control surgery not meeting conditions (Excl06)","Change-of-gender treatments (Excl07)","Cosmetic or plastic surgery (Excl08)","Breach of law (Excl10)","Alcoholism, drug or substance abuse (Excl12)","Refractive error less than 7.5 dioptres (Excl15)","Unproven treatments (Excl16)","Sterility and infertility (Excl17)","Any treatment received outside India"],"display":"Waiting periods (PED 24 months, listed illnesses 12 or 24 months, first 30 days, maternity 24 months), standard IRDAI exclusions, treatment outside India","note":"Other exclusions include Excluded Providers (Excl11), health hydros (Excl13), dietary supplements (Excl14), dental treatment unless accidental, war, nuclear, non-medical items (Annexure II), external equipment and intentional self-injury. Add-on covers have their own exclusions.","quote":"Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications shall be excluded until the expiry of 24 months of continuous coverage ... 1 Pre-existing Diseases waiting period (Excl01) ... Specified disease/procedure waiting period (Excl02) ... Expenses related to the treatment of the listed Conditions, surgeries/treatments shall be excluded until the expiry of 12 months of continuous coverage ... Awaiting period of 24 months from the first Health Care Supreme Policy inception date will be applicable to the medical and surgical treatment of illness surgical procedures mentioned below. • Joint replacement surgery, ... 4. 30-daywaiting period (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 ... Any treatment arising from or traceable to pregnancy, child birth including cesarean section until 24 months continuous period has elapsed since the inception of the first Health Care Supreme Policy with US. However this exclusion will not apply to Ectopic pregnancy ... 1. Investigation & Evaluation (Excl04) ... Expenses related to any admission primarily for diagnostics and evaluation purposes only are excluded ... 2. Rest Cure, rehabilitation and respite care (Excl05) ... 3. Obesity/Weight Control (Excl06) ... Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions ... 4 Change-of-gender treatments (Excl07) ... 5 Cosmetic or plastic Surgery (Excl08) ... 6 Breach of law (Excl10) ... Treatment for Alcoholism, drug or substance abuse or any addictive condition and consequences thereof. (Excl12) ... 11 Refractive Error (Excl15) ... Expenses related to the treatment for correction of eye sight due to refractive error less than 7.5 dioptres ... 12 Unproven Treatments (Excl16) ... 13 Sterility and Infertility (Excl17) ... 10. Any treatment received outside India is not covered under this policy.","sources":[{"clause":"1","heading":"Pre-existing Diseases waiting period (Excl01)","page":12,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-1-7"},{"clause":"2","heading":"Specified disease/procedure waiting period (Excl02)","page":12,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-2-7"},{"clause":"2(a)","heading":null,"page":12,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-2-a"},{"clause":"3","heading":null,"page":12,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-3-7"},{"clause":null,"heading":"4. 30-daywaiting period (Excl03)","page":12,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-4-30-daywaiting-period-excl03"},{"clause":"Section D","heading":"EXCLUSIONS UNDER THE POLICY - SPECIFIC EXCLUSIONS","page":14,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-section-d-2"},{"clause":null,"heading":"1. Investigation & Evaluation (Excl04)","page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-1-investigation-evaluation-excl04"},{"clause":"3(I)(a)","heading":null,"page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-3-i-a-2"},{"clause":null,"heading":"2. Rest Cure, rehabilitation and respite care (Excl05)","page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-2-rest-cure-rehabilitation-and-respite-care-excl"},{"clause":null,"heading":"3. Obesity/Weight Control (Excl06)","page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-3-obesity-weight-control-excl06"},{"clause":"4","heading":"Change-of-gender treatments (Excl07)","page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-4-6"},{"clause":"5","heading":"Cosmetic or plastic Surgery (Excl08)","page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-5-6"},{"clause":"6","heading":"Breach of law (Excl10)","page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-6-6"},{"clause":"8","heading":null,"page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-8-6"},{"clause":"11","heading":"Refractive Error (Excl15)","page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-11-6"},{"clause":"12","heading":"Unproven Treatments (Excl16)","page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-12-6"},{"clause":"13","heading":"Sterility and Infertility (Excl17)","page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-13-6"},{"clause":"1(I)","heading":null,"page":14,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-1-i-2"}],"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":"Level 1: write to careforyou@bajajgeneral.com (senior citizens: seniorcitizen@bajajgeneral.com); toll-free 1-800-209-5858, branches or website. Level 2: Grievance Redressal Officer at ggro@bajajgeneral.com. Then the Insurance Ombudsman.","display":"careforyou@bajajgeneral.com, then Grievance Redressal Officer ggro@bajajgeneral.com","note":"Level 3: missed call on +91 80809 45060 or SMS to 575758 for a care specialist. CIS gives the same contacts; CIS helpline also lists 1800-103-2529.","quote":"Our toll-free number 1-800-209- 5858 or 020-30305858 ... Level 1: Write to careforyou@bajajgeneral.com and for senior citizens to seniorcitizen@bajajgeneral.com ... 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","sources":[{"clause":"16","heading":"Grievance Redressal Procedure","page":17,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-16-5"},{"clause":"16(a)","heading":"Level 1","page":18,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-16-a"},{"clause":"16(b)","heading":"Level 2","page":18,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-16-b"}],"law":[{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 3","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 4","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 5","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(11)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(42)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 34","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 69","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Insurance Act, 1938","section":"Section 38","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 12","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 19","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 20","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 13","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 2","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(5), 5(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(9)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 25","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 26","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 11","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 3","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 13","url":"https://indiainsurances.com/law/ombudsman-rules-2017"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 14","url":"https://indiainsurances.com/law/ombudsman-rules-2017"}]},{"key":"sum_insured_options","label":"Sum insured options","section":"Cover","meaning":"The cover amounts you can choose from.","status":"cross-checked","value":"Hospitalisation sum insured of 500,000 (Plan A), 800,000 (B), 1,000,000 (C), 1,500,000 (D), 2,000,000 (E), 2,500,000 (F), 3,000,000 (G), 3,500,000 (H), 4,000,000 (I), 4,500,000 (J) or 5,000,000 (K).","display":"Rs 500,000 to Rs 5,000,000 hospitalisation sum insured (Plans A to K)","note":"Each plan also has separate sums insured for OPD, physiotherapy, maternity, donor, air ambulance and recovery benefit; total sum insured 642,500 (Plan A) to 6,225,000 (Plan K). Individual or floater basis.","quote":"Plan A | 500,000 ... Plan B | 800,000 ... Plan C | 1,000,000 ... Plan D | 1,500,000 ... Plan E | 2,000,000 ... Plan F | 2,500,000 ... Plan G | 3,000,000 ... Plan H | 3,500,000 ... Plan I | 4,000,000 ... Plan J | 4,500,000 ... Plan K | 5,000,000","sources":[{"clause":null,"heading":"Medical Expenses Section - Sum Insured in INR","page":26,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-medical-expenses-section-sum-insured-in-inr"}],"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","note":"Does not apply after continuous coverage of more than twelve months; applies afresh to an enhanced sum insured. Physiotherapy has a 90 day waiting period in the first year; critical illness add-on 90 days.","quote":"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.","sources":[{"clause":null,"heading":"4. 30-daywaiting period (Excl03)","page":12,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-4-30-daywaiting-period-excl03"}],"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":24},"display":"24 months","note":"Reduced by prior continuous coverage under portability; applies afresh to sum insured increase; PED must be declared and accepted.","quote":"Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications shall be excluded until the expiry of 24 months of continuous coverage after the date of inception of the first Health Care Supreme Policy with us.","sources":[{"clause":"1","heading":"Pre-existing Diseases waiting period (Excl01)","page":12,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-1-7"}],"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":12},"display":"12 months (24 months for some procedures)","note":"24 months for joint replacement, prolapsed disc surgery, deviated nasal septum, congenital internal diseases, refractive error laser, Parkinson's disease and genetic disorders. The 12 month exclusion does not apply to accident claims; in the 24 month list only disc surgery needed due to an accident is exempt.","quote":"Expenses related to the treatment of the listed Conditions, surgeries/treatments shall be excluded until the expiry of 12 months of continuous coverage after the date of inception of the first Health Care Supreme Policy with Us. ... Awaiting period of 24 months from the first Health Care Supreme Policy inception date will be applicable to the medical and surgical treatment of illness surgical procedures mentioned below.","sources":[{"clause":"2(a)","heading":null,"page":12,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-2-a"},{"clause":"3","heading":null,"page":12,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-3-7"}],"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":["Any type gastrointestinal ulcers","Cataracts","Any type of fistula","Macular Degeneration","Benign prostatic hypertrophy","Hernia of all types","All types of sinuses","Fissure in ano","Haemorrhoids, piles","Hydrocele","Dysfunctional uterine bleeding","Fibromyoma","Endometriosis","Hysterectomy","Uterine Prolapse","Stones in the urinary and biliary systems","Surgery on ears/tonsils/ adenoids/ paranasal sinuses","Surgery on all internal or external tumours/cysts/ nodules/polyps of any kind including breast lumps (except malignant)","Mental Illness","Diseases of gall bladder including cholecystitis","Pancreatitis","All forms of Cirrhosis","Gout and rheumatism","Tonsilitis","Surgery for varicose veins and varicose ulcers","Chronic Kidney Disease","Alzheimer’s Disease","Joint replacement surgery (24 months)","Surgery for prolapsed inter vertebral disc (24 months)","Surgery to correct Deviated Nasal Septum and Hypertrophied Turbinates (24 months)","Congenital internal diseases or anomalies (24 months)","Laser treatment for correction of eye sight due to refractive error (24 months)","Parkinson’s Disease (24 months)","Genetic disorders (24 months)"],"display":"27 listed conditions at 12 months; joint replacement, disc surgery, nasal septum, congenital internal, refractive laser, Parkinson's, genetic disorders at 24 months","note":"The 12 month list is numbered 1 to 27 in the wording and CIS.","quote":"1. Any type gastrointestinal ulcers | 2. Cataracts, ... 3. Any type of fistula | 4. Macular Degeneration ... 5. Benign prostatic hypertrophy | 6. Hernia of all types ... 7. All types of sinuses | 8. Fissure in ano ... 9. Haemorrhoids, piles | 10. Hydrocele ... 11. Dysfunctional uterine bleeding | 12. Fibromyoma ... 13. Endometriosis | 14. Hysterectomy ... 15. Uterine Prolapse | 16. Stones in the urinary and biliary systems ... 17. Surgery on ears/tonsils/ adenoids/ paranasal sinuses | 18. Surgery on all internal or external tumours/cysts/ nodules/polyps of any kind including breast lumps with exception of Malignant tumor or growth. ... 19. Mental Illness | 20. Diseases of gall bladder including cholecystitis ... 21. Pancreatitis | 22. All forms of Cirrhosis ... 23. Gout and rheumatism | 24. Tonsilitis ... 25. Surgery for varicose veins and varicose ulcers | 26. Chronic Kidney Disease ... 27. Alzheimer’s Disease ... Awaiting period of 24 months from the first Health Care Supreme Policy inception date ... • Joint replacement surgery, ... • Surgery for prolapsed inter vertebral disc (unless necessitated due to an accident) ... • Surgery to correct Deviated Nasal Septum and Hypertrophied Turbinates ... • Congenital internal diseases or anomalies ... • Laser treatment for correction of eye sight due to refractive error. ... • Parkinson’s Disease ... • Genetic disorders ... Expenses related to the treatment of the listed Conditions, surgeries/treatments shall be excluded until the expiry of 12 months","sources":[{"clause":"2(f)","heading":null,"page":12,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-2-f"},{"clause":"3","heading":null,"page":12,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-3-7"},{"clause":"2(a)","heading":null,"page":12,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-2-a"}],"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 for the enhanced amount.","quote":"After completion of sixty continuous months of coverage (including portability and migration) no look back would be applied. This period of sixty months is called as moratorium period. ... After the expiry of Moratorium Period no claim under this policy shall be contestable except for proven fraud and permanent exclusions specified in the policy contract.","sources":[{"clause":"11","heading":"Moratorium Period","page":16,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-11-7"}],"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 whole policy can be ported to another insurer by applying at least 30 days but not earlier than 60 days before renewal, with accrued continuity benefits in waiting periods.","display":"Yes, apply 30 to 60 days before renewal; waiting-period credit carried","note":"Migration to other Bajaj General products is also allowed, applying at least 30 days before renewal.","quote":"The Insured Beneficiary will have the option to port the Policy to other insurers by applying to such insurer to port the entire Policy along with all the members of the family, if any, at least 30 days before, but not earlier than 60 days from the Policy renewal date ... the proposed Insured Beneficiary will get the accrued continuity benefits in waiting periods as per IRDAI guidelines on Portability.","sources":[{"clause":"9","heading":"Portability","page":16,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-9-7"}],"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, renewable for lifetime","note":"The wording sets no maximum renewal age. The brochure says adult entry is '18 yrs to lifetime'; dependent children are renewable up to 35 years, then for lifetime on their own proposal.","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 ... 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 ... the policy would be renewed for lifetime","sources":[{"clause":"6(i)","heading":null,"page":16,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-6-i"},{"clause":"6(ii)","heading":null,"page":16,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-6-ii"},{"clause":"14(ii)","heading":null,"page":6,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/287#c-14-ii"}],"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 loadings are applied at portfolio level, not on an individual policy's claim experience.","display":"No, loadings are portfolio-level only","note":"Health-condition loadings of 10% each (diabetes, hypertension, cholesterol, obesity, cardiovascular), capped at 50%, apply from commencement or on sum insured increase. 5% claim free renewal discount.","quote":"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":"6(iv)","heading":null,"page":16,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-6-iv"}],"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)","Breach of law (Excl10)","Excluded Providers (Excl11)","Alcoholism, drug or substance abuse (Excl12)","Health hydros, nature cure clinics, spas (Excl13)","Dietary supplements and substances without prescription (Excl14)","Refractive Error (Excl15)","Unproven Treatments (Excl16)","Sterility and Infertility (Excl17)","Dental treatment unless due to Accidental Bodily Injury","War, invasion, acts of foreign enemies","Circumcision unless required for treatment","Spectacles, contact lenses, hearing aids and external appliances","External medical equipment used at home","Intentional self-injury","All non-medical Items as per Annexure II","Any treatment received outside India","Nuclear weapons and/or materials","Congenital external diseases or defects or anomalies, growth hormone therapy, stem cell implantation (except haematopoietic stem cells)"],"display":"Excl04 to Excl08, Excl10 to Excl17, plus dental, war, nuclear, non-medical items, external aids and treatment outside India","note":"No Excl09 (hazardous sports) or Excl18 (maternity) is printed; maternity is covered after a 24 month waiting period instead. Also excluded: treatment under systems other than allopathy and AYUSH.","quote":"1. Investigation & Evaluation (Excl04) ... 2. Rest Cure, rehabilitation and respite care (Excl05) ... 3. Obesity/Weight Control (Excl06) ... 4 Change-of-gender treatments (Excl07) ... 5 Cosmetic or plastic Surgery (Excl08) ... 6 Breach of law (Excl10) ... 7 Excluded Providers (Excl11) ... Treatment for Alcoholism, drug or substance abuse or any addictive condition and consequences thereof. (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) ... 11 Refractive Error (Excl15) ... 12 Unproven Treatments (Excl16) ... 13 Sterility and Infertility (Excl17) ... Any dental treatment that comprises of cosmetic surgery, dentures, dental prosthesis, dental implants, orthodontics, surgery of any kind unless as a result of Accidental Bodily Injury to natural teeth ... 1. War, invasion, acts of foreign enemies ... 3. Circumcision unless required for the treatment of Illness or Accidental bodily injury ... 4. The cost of spectacles, contact lenses, hearing aids, crutches, dentures, artificial teeth and all other external appliances ... 5. Any External medical equipment of any kind used at home as post Hospitalization care ... 6. Intentional self-injury ... 9. All non-medical Items as per Annexure II provided in Policy Wordings ... 10. Any treatment received outside India is not covered under this policy. ... 11. Any claim directly or indirectly caused by or contributed to by nuclear weapons and/or materials. ... 12. Congenital external diseases or defects or anomalies, growth hormone therapy, stem cell implantation or surgery except for Hematopoietic stem cells for bone marrow transplant for haematological conditions","sources":[{"clause":null,"heading":"1. Investigation & Evaluation (Excl04)","page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-1-investigation-evaluation-excl04"},{"clause":null,"heading":"2. Rest Cure, rehabilitation and respite care (Excl05)","page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-2-rest-cure-rehabilitation-and-respite-care-excl"},{"clause":null,"heading":"3. Obesity/Weight Control (Excl06)","page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-3-obesity-weight-control-excl06"},{"clause":"4","heading":"Change-of-gender treatments (Excl07)","page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-4-6"},{"clause":"5","heading":"Cosmetic or plastic Surgery (Excl08)","page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-5-6"},{"clause":"6","heading":"Breach of law (Excl10)","page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-6-6"},{"clause":"7","heading":"Excluded Providers (Excl11)","page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-7-6"},{"clause":"8","heading":null,"page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-8-6"},{"clause":"9","heading":null,"page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-9-6"},{"clause":"10","heading":null,"page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-10-6"},{"clause":"11","heading":"Refractive Error (Excl15)","page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-11-6"},{"clause":"12","heading":"Unproven Treatments (Excl16)","page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-12-6"},{"clause":"13","heading":"Sterility and Infertility (Excl17)","page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-13-6"},{"clause":"Section D","heading":"EXCLUSIONS UNDER THE POLICY - SPECIFIC EXCLUSIONS","page":14,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-section-d-2"},{"clause":"1(I)","heading":null,"page":14,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-1-i-2"}],"law":[{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 16","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"cancellation_refund","label":"Cancellation by you","section":"Renewal and rights","meaning":"What you get back if you cancel during the year.","status":"cross-checked","value":"With 7 days written notice: annual policy refunds the unexpired period pro-rata if no claim was made in the policy year; multi-year policy refunds future years in full and the current year pro-rata if claim free; instalment policies pro-rata if claim free. Medical examination costs are deducted.","display":"Pro-rata refund of the unexpired period if no claim was made in the policy year","note":"The insurer may cancel for misrepresentation, non-disclosure or fraud with 15 days notice and no refund. Refund delay beyond 7 days carries interest at 2% above bank rate.","quote":"The Policyholder can cancel this Policy by providing a written notice of 7 days. ... Annual Policy: The premium refund for the unexpired risk period will be on a pro-rata basis, provided no claim has been made during the policy year. ... For any policy year where the risk date has not yet started, the premium will be refunded without any deduction. o For any policy year where the risk has started, the premium will be refunded on a pro-rata basis for that policy year, provided no claim has been made during the policy year and in full for future policy years. ... 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. ... expenses incurred by the Company on medical examination of the Policyholder will also be deducted before refunding of premium.","sources":[{"clause":"15","heading":"Cancellation","page":17,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-15-6"}],"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 for the medical expenses covers; personal accident and critical illness add-ons cover events anywhere in the world, paid in India in rupees.","display":"India only (add-on PA and CI worldwide)","note":null,"quote":"For all other Covers of this Policy, We cover treatment availed within India only. ... In case of Personal Accident Cover & Critical Illness Cover of this Policy, We cover the Critical illness as specified under the policy & the Accidental Bodily Injury/Critical Illness sustained during the Policy Period anywhere in the world ... 10. Any treatment received outside India is not covered under this policy.","sources":[{"clause":"3(b)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-3-b"},{"clause":"3(a)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-3-a"},{"clause":"1(I)","heading":null,"page":14,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-1-i-2"}],"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":"New individual policies only, not renewals or ported/migrated policies. Refund less medical examination and stamp duty, or proportionate risk premium. CIS says 'up to 30 days from the first inception of policy'.","quote":"The insured person shall be allowed free look period of thirty days from date of receipt of the policy document to reviewthe terms and conditions of the policy, and to return the same if not acceptable.","sources":[{"clause":"12","heading":"Free Look Period","page":16,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-12-7"}],"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":null,"quote":"The Grace period for payment of the premium for all types of insurance policies shall be: fifteen (15) days where premium payment mode is monthly and thirty (30) days in all other cases. ... We shall condone a delay in renewal up to the Grace Period (30 days) from the due date of renewal without considering such condonation as a Break in Policy.","sources":[{"clause":"19","heading":"Grace Period","page":2,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-19"},{"clause":"6(iii)","heading":null,"page":16,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-6-iii"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 50","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 8","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 9","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 8","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, IV.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule I, Para 1.2","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.3","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"eligibility_entry_age","label":"Entry age","section":"Eligibility","meaning":"The youngest and oldest age at which you can buy this policy.","status":"cross-checked","value":"Medical expenses section: adults (proposer, spouse, parents, siblings, in-laws, aunt, uncle) from 18 years with no upper limit; dependent children and grandchildren 3 months to 25 years. Add-on covers: 18 to 65 years for adults.","display":"18 years to lifetime (children 3 months to 25 years)","note":"From the sales brochure; the policy wording and CIS print no entry ages. Medical tests are mandatory from age 46 (brochure).","quote":"Entry age for Medical Expenses Section: | • What is the premium paying term? ... Proposer, Spouse ,Dependent children, parents, Sister, Brother, In laws, Aunt, Uncle: 18 yrs to ... lifetime Dependent children and Grandchildren: 3 months – 25 yrs ... Entry age for Add- on Covers: ... Proposer, Spouse ,Dependent children, parents, Sister, Brother, In laws, Aunt, Uncle: 18 yrs – 65 yrs Dependent children and Grandchildren.: 3 months – 25 yrs","sources":[{"clause":"14(ii)","heading":null,"page":6,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/287#c-14-ii"}],"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":"Annual instalments are for long term policies only. The long term discount does not apply to instalments.","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","sources":[{"clause":"13","heading":"Premium Payment in Instalments (Wherever applicable)","page":17,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-13-7"}],"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":"cross-checked","value":["Ancillary Expenses Benefit (daily hospital cash)","Critical Illness cover","Personal Accident cover"],"display":"Ancillary Expenses Benefit, Critical Illness cover, Personal Accident cover","note":"5% discount if all add-ons are taken. Critical illness lists 15 illnesses (brochure: Rs 5 or 10 lakh); personal accident pays death, disability and weekly TTD.","quote":"Add-On Benefits section (Optional) covers ... Ancillary Expenses Benefit ... Critical Illness cover ... Personal Accident cover ... These benefits are optional and applicable only if opted for and issued accordingly in the Schedule of Benefits ... The Daily Allowance as specified under the policy, for each continuous and completed period of 24 hours of Hospitalization","sources":[{"clause":"Part II","heading":"Add-On Benefits section (Optional) covers","page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-part-ii"},{"clause":"1","heading":"Ancillary Expenses Benefit","page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-1-4"},{"clause":"2","heading":"Critical Illness cover","page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-2-4"},{"clause":"3","heading":"Personal Accident cover","page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-3-4"},{"clause":"Part II","heading":"HEALTH CARE SUPREME ADD ON COVERS","page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-part-ii-2"},{"clause":"1(i)","heading":null,"page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-1-i"}],"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 when premium is paid in instalments: cover continues during the grace period. Otherwise there is no cover for the period for which no premium is received.","display":"Covered only for instalment payers","note":"Brochure: treatment for illness or accident contracted during the break period is not admissible.","quote":"Coverage is not available for the period for which no premium is received. ... Coverage shall be available during the Grace period, if the premium is paid in Instalments during the Policy Period on due date. ... If the premium is paid in instalments during the policy period, coverage will be available for the grace period also.","sources":[{"clause":"19","heading":"Grace Period","page":2,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-19"},{"clause":"13","heading":"Premium Payment in Instalments (Wherever applicable)","page":17,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-13-7"}],"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":"No room rent limit: room rent and boarding are paid up to the hospitalisation sum insured; the CIS says sub-limits are not applicable.","display":"No limit, up to the sum insured","note":null,"quote":"We will pay You In-patient Treatment- Medical Expenses for the below listed items up to the Sum Insured as specified under the policy schedule ... • Room rent, boarding expenses ... Sub limits - Not applicable","sources":[{"clause":"1","heading":"Hospitalization Expenses","page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-1-5"},{"clause":null,"heading":"Waiting period applicable to Critical Illness Cover","page":6,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/286#c-waiting-period-applicable-to-critical-illness-co"}],"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":"cross-checked","value":"No room category limit: room rent and boarding are paid up to the hospitalisation sum insured.","display":"Any room, no category limit","note":"No room type is named in any document.","quote":"We will pay You In-patient Treatment- Medical Expenses for the below listed items up to the Sum Insured as specified under the policy schedule ... • Room rent, boarding expenses ... Sub limits - Not applicable","sources":[{"clause":"1","heading":"Hospitalization Expenses","page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-1-5"},{"clause":null,"heading":"Waiting period applicable to Critical Illness Cover","page":6,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/286#c-waiting-period-applicable-to-critical-illness-co"}],"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":"No separate ICU limit: intensive care is paid up to the hospitalisation sum insured; the CIS says sub-limits are not applicable.","display":"No limit, up to the sum insured","note":null,"quote":"We will pay You In-patient Treatment- Medical Expenses for the below listed items up to the Sum Insured as specified under the policy schedule ... • Intensive care unit ... Sub limits - Not applicable","sources":[{"clause":"1","heading":"Hospitalization Expenses","page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-1-5"},{"clause":null,"heading":"Waiting period applicable to Critical Illness Cover","page":6,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/286#c-waiting-period-applicable-to-critical-illness-co"}],"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":"not-stated","value":null,"display":null,"note":"No proportionate deduction clause is printed; the policy has no room rent limit.","quote":null,"sources":[],"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":"None.","display":"None","note":"From the CIS; the wording defines co-payment but applies none.","quote":"Co-payment - Not applicable","sources":[{"clause":null,"heading":"Waiting period applicable to Critical Illness Cover","page":6,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/286#c-waiting-period-applicable-to-critical-illness-co"}],"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.","quote":"Deductible – Not applicable","sources":[{"clause":null,"heading":"Waiting period applicable to Critical Illness Cover","page":6,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/286#c-waiting-period-applicable-to-critical-illness-co"}],"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":["None (the CIS says sub-limits are not applicable)"],"display":"None","note":"From the CIS. Modern treatments and in-patient mental illness are covered up to the base sum insured; maternity, OPD, physiotherapy, organ donor, air ambulance and recovery benefit have their own plan sums insured (Table of Benefits).","quote":"The policy will pay only up to the limits specified hereunder for the following diseases/procedures: Sub limits - Not applicable","sources":[{"clause":null,"heading":"Waiting period applicable to Critical Illness Cover","page":6,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/286#c-waiting-period-applicable-to-critical-illness-co"}],"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":60},"display":"60 days","note":null,"quote":"The Medical Expenses incurred during the 60 days immediately before you were hospitalized","sources":[{"clause":"2","heading":"Pre-Hospitalization","page":6,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-2-5"}],"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":90},"display":"90 days","note":null,"quote":"The Medical Expenses incurred during the 90 days immediately after You were discharged post Hospitalization","sources":[{"clause":"3","heading":"Post-Hospitalization","page":6,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-3-5"}],"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 procedures are covered within the hospitalisation sum insured; Annexure I is an indicative list and other procedures needing under 24 hours due to technological advances are also covered.","display":"All day care procedures (indicative list)","note":null,"quote":"We will pay you the medical expenses as listed above under Section C- Part I-1 for Day care procedures / Surgeries taken as an inpatient in a hospital or day care centre but not in the outpatient department. Indicative list of Day Care Procedures is given in the annexure 1 of Policy wordings ... Above mentioned list is a indicative list of procedures, any other surgeries/procedures requiring less than 24 hours Hospitalization due to technological advances will also be covered under this policy","sources":[{"clause":"6","heading":"Day Care Procedures","page":6,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-6-4"},{"clause":"Annexure I(i)","heading":"Above mentioned list","page":22,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-annexure-i-i"}],"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":"not-stated","value":null,"display":null,"note":"Domiciliary hospitalisation is defined in the definitions but is not listed among the covers of the Medical Expenses section.","quote":null,"sources":[],"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":"Yes. In-patient AYUSH treatment of at least 24 hours in an AYUSH hospital is covered within the hospitalisation sum insured; the wording requires treatment in a government hospital.","display":"Yes, up to the hospitalisation sum insured","note":"AYUSH-specific exclusions: Unani, naturopathy, wellness centres and Panchakarma centres not meeting the AYUSH Hospital definition.","quote":"If You are Hospitalized for not less than 24 hrs, in an AYUSH Hospital on the advice of a Medical Practitioner/Doctor ... the treatment has been undergone in a government hospital ... Our maximum liability collectively for Hospitalization expenses (Section C Part I-1), Pre-hospitalization (Section C Part I-2), Post hospitalization (Section C Part I-3), Road ambulance (Section C Part I-4), Day Care expenses (Section C Part I-6), AYUSH Hospitalization Expenses (Section C Part I-12) would not exceed the hospitalization Sum Insured","sources":[{"clause":"12","heading":"AYUSH Hospitalization Expenses","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-12-4"}],"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":"Covered up to the base sum insured: uterine artery embolisation and HIFU, balloon sinuplasty, deep brain stimulation, oral chemotherapy, immunotherapy, intra vitreal injections, robotic surgeries, stereotactic radio surgeries, bronchial thermoplasty, prostate vaporisation, IONM and stem cell therapy for haematological conditions.","display":"Covered up to the base sum insured","note":null,"quote":"Modern Treatment Methods and Advancement in Technologies (as per below list) shall be covered up to Base Sum Insured, subject to Policy Terms, Conditions, coverage, Waiting Period and exclusions. A. Uterine Artery Embolization and HIFU B. Balloon Sinuplasty C. Deep Brain stimulation D. Oral chemotherapy D. Immunotherapy- Monoclonal Antibody to be given as injection E. Intra vitreal injections F. Robotic surgeries G. Stereotactic radio surgeries H. Bronchical Thermoplasty ... Vaporisation of the prostrate (Green laser treatment or holmium laser treatment) J. IONM - (Intra Operative Neuro Monitoring) K. Stem cell therapy Hematopoietic stem cells for bone marrow transplant for haematological conditions to be covered","sources":[{"clause":"16","heading":"Modern Treatment Methods and Advancement in Technologies","page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-16-4"},{"clause":"16(I)","heading":null,"page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-16-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":"cross-checked","value":"Yes, a one-time lump sum towards the donor's harvesting treatment, from 50,000 (Plan A) to 500,000 (Plan K), if the recipient's hospitalisation claim is accepted.","display":"Yes, lump sum of Rs 50,000 to Rs 500,000 by plan","note":"Separate sum insured outside the hospitalisation sum insured.","quote":"We will pay the lump sum amount as specified under the policy schedule towards organ donor’s treatment for harvesting of the donated organ ... Donor Expense ... Plan A | 500,000 | 2,500 | 5,000 | 25,000 | 50,000 ... Plan K | 5,000,000 | 25,000 | 50,000 | 100,000 | 500,000","sources":[{"clause":"8","heading":"Organ Donor Expenses","page":6,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-8-4"},{"clause":null,"heading":"Medical Expenses Section - Sum Insured in INR","page":26,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-medical-expenses-section-sum-insured-in-inr"}],"law":[]},{"key":"ambulance","label":"Ambulance cover","section":"Cover","meaning":"Road (and air) ambulance cover and its limit.","status":"cross-checked","value":"Road ambulance reimbursed within the hospitalisation sum insured (CIS: at actuals) if the hospitalisation claim is accepted. Air ambulance up to a separate limit of 50,000 (Plan A) to 500,000 (Plan K).","display":"Road at actuals; air ambulance Rs 50,000 to Rs 500,000 by plan","note":"Inter-hospital transfer to higher facilities also covered by road. Return transport home by air ambulance is excluded.","quote":"We will reimburse the expenses incurred on an ambulance offered by a healthcare or ambulance service provider for transferring You to the nearest Hospital with adequate emergency facilities ... 4. Road Ambulance – At Actuals ... We will pay for ambulance transportation in an airplane or helicopter for emergency life threatening health conditions ... Air Ambulanc e Reimburs ement Expenses ... Plan A | 500,000 | 2,500 | 5,000 | 25,000 | 50,000 | 50,000 ... Plan K | 5,000,000 | 25,000 | 50,000 | 100,000 | 500,000 | 500,000","sources":[{"clause":"4","heading":"Road Ambulance","page":6,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-4-4"},{"clause":"Row 5","heading":"Policy Coverage (What the Policy Covers)","page":1,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/286#c-row-5"},{"clause":"5","heading":"Air Ambulance","page":6,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-5-4"},{"clause":null,"heading":"Medical Expenses Section - Sum Insured in INR","page":26,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-medical-expenses-section-sum-insured-in-inr"}],"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":"100% of the hospitalisation sum insured is reinstated once per policy period after the sum insured and cumulative bonus are completely exhausted; not for the same illness already claimed that year, not carried forward, no extra premium.","display":"100% once a year, not for the same illness","note":"Not triggered for a claim larger than the balance sum insured.","quote":"100% of the hospitalization Sum Insured specified under Hospitalization expenses (Section C Part I-1) will be reinstated for the particular Policy period ... The reinstated Sum Insured will be triggered only after the Hospitalization Sum Insured inclusive of the Cumulative Bonus (If applicable) has been completely exhausted during the policy period; ... The reinstated Sum Insured would be triggered only for subsequent claims made by the Insured Person and not arising out of any illness/disease (including its complications) for which a claim has been lodged in the current policy year ... This benefit is applicable only once during each policy period & will not be carried forward to the subsequent renewals if the benefit is not utilized. ... Additional premium would not be charged for reinstatement of the Sum Insured.","sources":[{"clause":"11","heading":"Sum Insured Reinstatement Benefit","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-11-4"}],"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 10% of the limit of indemnity per claim-free renewal, up to 50% (5 years); reduced by 10% after a claim, but never below the first policy's limit.","display":"10% a year, up to 50%; reduced by 10% after a claim","note":"Applies only to the hospitalisation section. No transfer of bonus from other insurers.","quote":"If You renew Your Health Care Supreme Policy with Us without any break in the Policy Period and there has been no claim in the preceding year, We will increase the Limit of Indemnity by 10% per annum ... The maximum cumulative increase in the Limit of Indemnity will be limited to 5 years and/ or 50% of Sum Insured. ... If a claim is made in any year where a cumulative increase has been applied, then the increased Limit of Indemnity shall be reduced by 10%, save that the Limit of Indemnity applicable to Your first Health Care Supreme Policy with Us shall be preserved.","sources":[{"clause":null,"heading":"21. Cumulative Bonus","page":18,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-21-cumulative-bonus"}],"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":"Non-medical items listed in Annexure II, such as gloves and masks, are not payable; the hospitalisation cover pays medicines, drugs and consumables.","display":"Annexure II non-medical items (gloves, masks) not paid","note":"Items in Lists II to IV of Annexure II are subsumed into room, procedure or treatment charges. No consumables add-on is offered among the optional covers.","quote":"• Medicines, drugs and consumables, ... 9. All non-medical Items as per Annexure II provided in Policy Wordings ... 56 | GLOVES | Not Payable ... 60 | MASK | Not Payable","sources":[{"clause":"1","heading":"Hospitalization Expenses","page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-1-5"},{"clause":"1(I)","heading":null,"page":14,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-1-i-2"},{"clause":"Annexure II","heading":null,"page":22,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-annexure-ii"}],"law":[]},{"key":"maternity","label":"Maternity cover","section":"Cover","meaning":"Whether childbirth costs are covered, the limit and the waiting period.","status":"cross-checked","value":"Yes. Delivery (including caesarean) and lawful termination, up to 2 in a lifetime, within a maternity sum insured of 25,000 (Plan A) to 100,000 (Plan K), after a 24 month waiting period; for self and spouse covered together.","display":"Yes, Rs 25,000 to Rs 100,000 by plan, after 24 months","note":"Includes pre-natal and post-natal hospitalisation. Ectopic pregnancy is paid under hospitalisation instead.","quote":"We will pay the Medical Expenses for the delivery of a baby (including caesarean section) and/or expenses related to medically recommended and lawful termination of pregnancy, limited to maximum 2 deliveries or termination(s) or either, during the lifetime of the insured person ... Waiting period of 24 months from the date of issuance of the first policy with us ... This coverage is limited to Self & a lawfully wedded spouse when both are covered under a single policy for 24 months ... Maternit y SI (Includin g New Born baby cover) ... Plan A | 500,000 | 2,500 | 5,000 | 25,000 ... Plan K | 5,000,000 | 25,000 | 50,000 | 100,000","sources":[{"clause":"13","heading":"Maternity Expenses","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-13-4"},{"clause":null,"heading":"Medical Expenses Section - Sum Insured in INR","page":26,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-medical-expenses-section-sum-insured-in-inr"}],"law":[]},{"key":"newborn","label":"Newborn baby cover","section":"Cover","meaning":"Whether a newborn is covered from birth and for what.","status":"cross-checked","value":"Yes, within the maternity sum insured and only if a maternity claim is accepted: treatment during delivery, hospitalisation up to 90 days from birth, and mandatory vaccinations up to 90 days.","display":"Yes, up to 90 days within the maternity sum insured","note":null,"quote":"Coverage for new born baby will be considered subject to a valid claim being accepted under maternity expenses Section C Part I-13. ... Hospitalization charges incurred on the new born baby during post birth including any complications shall be covered up to a period of 90 days from the date of birth and within limit of the Sum Insured under Maternity Cover ... Mandatory Vaccinations of the new born baby up to 90 days","sources":[{"clause":"14","heading":"New Born Baby Cover","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-14-4"}],"law":[]},{"key":"mental_illness","label":"Mental illness","section":"Cover","meaning":"Cover for in-patient treatment of mental illness.","status":"cross-checked","value":"In-patient treatment for mental illness is covered up to the base sum insured, after the 12 month specified disease waiting period.","display":"Covered up to the base sum insured (12 month wait)","note":"OPD cover includes consultations for psychiatric disorders up to the OPD limit.","quote":"In-patient Treatment for Mental Illness shall be covered up to Base Sum Insured subject to Policy Terms, Conditions, coverages, Waiting Period and exclusions. ... 19. Mental Illness ... shall be excluded until the expiry of 12 months of continuous coverage","sources":[{"clause":null,"heading":"17. Basis of Claims Payment","page":18,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-17-basis-of-claims-payment"},{"clause":"2(f)","heading":null,"page":12,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-2-f"},{"clause":"2(a)","heading":null,"page":12,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-2-a"}],"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":"cross-checked","value":"Free annual preventive health check-up after each renewal at empanelled centres; all members on individual policies, proposer and spouse only on floater policies.","display":"Yes, free after each renewal","note":"Test list depends on age and sex (CBC, FBS, creatinine, ECG, cholesterol, ultrasound and so on).","quote":"After each renewal of Health Care Supreme policy with us you will be entitled for a Free Annual Preventive Health Check-up at Our empanelled Diagnostic centers Or empanelled Hospitals ... This benefit can be availed by all members covered under Individual Sum Insured Policies. This benefit can be availed by proposer & spouse only under Floater Sum Insured Policies","sources":[{"clause":"15","heading":"Free Annual Preventive Health Check Up","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-15-4"}],"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":"Yes. Specialist consultations, prescribed investigations and medicines, root canal treatment and extractions, and psychiatric consultations, up to an OPD sum insured of 2,500 (Plan A) to 25,000 (Plan K).","display":"Yes, Rs 2,500 to Rs 25,000 by plan","note":"30 day initial waiting period applies; OPD claims can be submitted only twice per policy period. Physiotherapy on OPD basis has a separate limit of 5,000 to 50,000 (10 sittings per illness, 90 day first-year wait).","quote":"we will pay you Out Patient expenses for, ... • Specialist Consultations ... • Investigations related to the illness / injury as prescribed by the specialist ... • Medicines related to the illness / injury as prescribed by the specialist ... • Dental Procedures – Root Canal Treatment, Extractions ... • Consultations for Psychiatric disorders ... OPD SI ... Plan A | 500,000 | 2,500 ... Plan K | 5,000,000 | 25,000","sources":[{"clause":"7","heading":"Out Patient Expenses","page":6,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-7-4"},{"clause":null,"heading":"Medical Expenses Section - Sum Insured in INR","page":26,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-medical-expenses-section-sum-insured-in-inr"}],"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":"not-stated","value":null,"display":null,"note":"The CIS benefit illustration labels premiums 'for zone A', but no zones, zone definitions or zone-based co-payment are printed.","quote":null,"sources":[],"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, for the hospitalisation expenses section, at network hospitals; the wording also offers 'Cashless Everywhere' at non-network hospitals that meet the IRDAI hospital definition.","display":"Yes, network hospitals and Cashless Everywhere","note":"CIS says: 'Cashless treatment is only available at Network Hospitals'. Pre-authorisation reply within 1 hour; discharge within 3 hours.","quote":"Applicable only for Hospitalization Expenses Section Cashless treatment is available at Network Hospitals. ... We offer Cashless Everywhere, even in hospitals which are not part of our network subject to hospitals fullfiing IRDAI definition of Hospital facility ... Cashless treatment is only available at Network Hospitals","sources":[{"clause":null,"heading":"A. Cashless Claims Procedure","page":19,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-a-cashless-claims-procedure"},{"clause":"Section E(iv)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-section-e-iv"},{"clause":null,"heading":"Waiting period applicable to Critical Illness Cover","page":6,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/286#c-waiting-period-applicable-to-critical-illness-co"}],"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 itself: you call Bajaj General for pre-authorisation and its representative responds. No TPA is named.","display":"Bajaj General (in-house); no TPA named","note":"The documents do not mention a third-party administrator for claims.","quote":"You must call Us and request pre-authorization by way of the written form. ... our representative then within 1 hour will respond with Approval, Rejection or more information. ... We, Our, Ours, Us means the Bajaj General Insurance Limited.","sources":[{"clause":"Section E(i)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-section-e-i"},{"clause":"Section E(v)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-section-e-v"},{"clause":"24","heading":"We, Our, Ours, Us","page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-24-2"}],"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":"Individual and group variants also exist. Personal accident and critical illness add-ons are individual sum insured only (brochure).","quote":"Floater Health Care Supreme Policy ... For the purpose of Family Floater - includes the Insured; his/her lawfully wedded spouse and dependent children. For Parents separate floater Policy can be taken.","sources":[{"clause":null,"heading":"Types of Policy","page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-types-of-policy"},{"clause":"9","heading":"Family or Family Members","page":4,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285#c-9-2"}],"law":[]}],"documents":[{"kind":"wording","label":"Health Care Supreme Policy Wordings","pages":27,"fetched_at":"2026-10-16 08:29:39.053163+00","source_url":"https://www.bajajgeneralinsurance.com/download-documents/health-insurance/Health-PW/Health-Care-Supreme_PW.pdf","url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/285"},{"kind":"cis","label":"Health Care Supreme Customer Information Sheet","pages":10,"fetched_at":"2026-10-16 08:29:39.053163+00","source_url":"https://www.bajajgeneralinsurance.com/download-documents/health-insurance/Health-CIS/Health-Care-Supreme_CIS.pdf","url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/286"},{"kind":"brochure","label":"Health Care Supreme Brochure","pages":25,"fetched_at":"2026-10-16 08:29:39.053163+00","source_url":"https://www.bajajgeneralinsurance.com/download-documents/health-insurance/health-care-supreme/hcs-customer-brochure.pdf","url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223/document/287"}],"versions":[{"uin":"BAJHLIP21143V022021","version":null,"approved_on":null},{"uin":"BAJHLIP23210V042223","version":null,"approved_on":null}],"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":"Health Care Supreme (UIN BAJHLIP23210V042223), IndiaInsurances, https://indiainsurances.com/policy/bajaj-general-insurance/health-care-supreme-bajhlip23210v042223"}