{"uin":"BAJHLIP23213V052223","name":"Silver Health","url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223","insurer":{"slug":"bajaj-general-insurance","name":"Bajaj General Insurance Limited","url":"https://indiainsurances.com/insurer/bajaj-general-insurance"},"line":"health","category":"health-senior","category_name":"Senior citizen health","irdai_type":"Revision","kind":"product","status":"active","approved_on":"2020-08-31","withdrawn_on":null,"summary":"Silver Health is a Bajaj General hospitalisation indemnity policy for people entering at 46 to 80 years, sold as Plan A (individual, sum insured Rs 50,000 to 5 lakh) and Plan B (individual or floater, Rs 3 lakh to 10 lakh), with lifelong renewal and treatment in India only. Pre-existing diseases and 25 listed conditions wait 12 months, joint replacement waits 36 months (Plan A) or 24 months (Plan B), Plan B has a 10% co-payment on every claim and Plan A a 20% co-payment at non-network hospitals.","analysis":{"state":"extracted","analysed_at":"2026-10-16 08:29:39.570949+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":["Plan A","Plan B"],"display":"Plan A and Plan B","note":"Plan A is individual sum insured only; Plan B is available on individual or family floater basis and adds domiciliary cover.","quote":"“Silver Health-Individual”- For Plan A & Plan B ... “Silver Health-Family Floater” – For Plan B only","sources":[{"clause":"Section C","heading":"COVERAGE Types of Policy","page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-section-c"}],"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":"The policy can be taken for 1, 2 or 3 years.","display":"1, 2 or 3 years","note":"Long-term discount of 4% for 2 years and 8% for 3 years, not for instalment premiums.","quote":"Tenure of Policy: 1year, 2 years or 3 years","sources":[{"clause":"Section C","heading":"COVERAGE Types of Policy","page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-section-c"}],"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 must be intimated 48 hours before admission. Emergency hospitalisation must be intimated within 24 hours for cashless, and within 48 hours for reimbursement.","display":"48 hours before a planned admission; within 24 hours of an emergency admission (48 hours for reimbursement claims)","note":"Reimbursement claim documents are due within 30 days of discharge. The time limits may be waived 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 within 48 hours of hospitalization in case of emergency hospitalization and 48 hours prior to hospitalization in case of planned hospitalization","sources":[{"clause":"Section E(ii)","heading":null,"page":12,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-section-e-ii"},{"clause":"Section E(iii)","heading":null,"page":12,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-section-e-iii"},{"clause":"Section E(viii)","heading":null,"page":12,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-section-e-viii"}],"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":["Claim form with NEFT details & cancelled cheque duly signed by Insured","Original/Attested copies of Discharge Summary / Discharge Certificate / Death Summary with Surgical & anaesthetics notes","Attested copies of Indoor case papers (if available)","Original/Attested copies Final Hospital Bill with break up of surgical charges, surgeon’s fees, OT charges etc","Original Paid Receipt against the final Hospital Bill","Original bills towards Investigations done / Laboratory Bills","Original/Attested copies of Investigation Reports against Investigations done","Original bills and receipts paid for the transportation from Registered Ambulance Service Provider","Treating Medical practitioner certificate to transfer the Injured person to a higher medical centre for further treatment (if Applicable)","Cashless settlement letter or other company settlement letter","First consultation letter for the current ailment","In case of implant surgery, invoice & sticker"],"display":"Claim form with bank details, discharge summary, hospital bill and paid receipt, investigation bills and reports, ambulance bills, first consultation letter, implant invoice and sticker","note":"Documents go to Bajaj General, Viman Nagar, Pune, within 30 days of discharge. Attested copies are accepted where originals are with another insurer.","quote":"Claim form with NEFT details & cancelled cheque duly signed by Insured ... Original/Attested copies of Discharge Summary / Discharge Certificate / Death Summary with Surgical & anaesthetics notes ... Attested copies of Indoor case papers (if available) ... Original/Attested copies Final Hospital Bill with break up of surgical charges, surgeon’s fees, OT charges etc ... Original Paid Receipt against the final Hospital Bill. ... Original bills towards Investigations done / Laboratory Bills. ... Original/Attested copies of Investigation Reports against Investigations done. ... Original bills and receipts paid for the transportation from Registered Ambulance Service Provider. Treating Medical practitioner certificate to transfer the Injured person to a higher medical centre for further treatment (if Applicable). ... Cashless settlement letter or other company settlement letter ... First consultation letter for the current ailment. ... In case of implant surgery, invoice & sticker.","sources":[{"clause":"Section E(viii)","heading":null,"page":12,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-section-e-viii"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 17","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 22","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 23","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(iii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"claim_settlement_time","label":"Claim settlement time promised","section":"Claims","meaning":"How quickly the policy says a claim is decided or paid, and from when that is counted (intimation or last document).","status":"cross-checked","value":"The claim is settled or rejected within 15 days from receipt of the last necessary document; where investigation is needed it is completed within 30 days and the claim still settled within 15 days of the last document. Payment is made within 7 days of accepting the offer, with interest at 2% above bank rate for delay.","display":"15 days from the last necessary document","note":"CIS says '15 Working Days'. Cashless pre-authorisation is answered within 1 hour and final discharge authorisation within 3 hours.","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 ... at a rate 2% above the bank rate ... Upon acceptance of an offer of settlement by the Insured, the payment of the amount due shall be made within 7 days from the date of acceptance of the offer by the Insured. ... our representative then within 1 hour will respond with Approval, Rejection or more information. ... processed within 3 hours from the final documents received. ... Turnaround time (TAT) for claim settlement: 15 Working Days","sources":[{"clause":"3(i)","heading":null,"page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-3-i"},{"clause":null,"heading":"22. Paying a Claim","page":12,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-22-paying-a-claim"},{"clause":"Section E(v)","heading":null,"page":12,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-section-e-v"},{"clause":"Section E(vi)","heading":null,"page":12,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-section-e-vi"},{"clause":"1","heading":"Room Rent Capping (Applicable for Plan A & Plan B)","page":2,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/289#c-1"}],"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 12 months of continuous cover (Excl01)","Listed conditions, surgeries and treatments until 12 months of continuous cover (Excl02)","Joint replacement surgeries during the first 36 months (Plan A) or 24 months (Plan B), unless due to accident","Any illness within 30 days from the first policy commencement, except accidents (Excl03)","Admission primarily for diagnostics and evaluation (Excl04)","Rest cure, rehabilitation and respite care (Excl05)","Cosmetic or plastic surgery (Excl08)","Alcoholism, drug or substance abuse (Excl12)","Maternity expenses (Excl 18)","Dental treatment unless due to accidental injury and requiring hospitalisation","War, invasion, acts of foreign enemies","Spectacles, contact lenses, hearing aids and other external appliances","Intentional self-injury","All non-medical items as per Annexure II","Any treatment received outside India"],"display":"Waiting periods (pre-existing 12 months, listed conditions 12 months, joint replacement 36 or 24 months, first 30 days), diagnostics-only admissions, rest cure, cosmetic surgery, substance abuse, maternity, dental, war, external appliances, self-injury, non-medical items, treatment outside India","note":"The 30-day exclusion does not apply with continuous coverage of more than twelve months. Waiting periods apply afresh to any sum insured increase.","quote":"Pre-existing Diseases waiting period (Excl01) ... shall be excluded until the expiry of 12 months of continuous coverage ... Specified disease/procedure waiting period (Excl02) ... We will not pay any Medical Expenses incurred during the first 36 consecutive months for Plan A during which You have the benefit of a Silver Health Policy with Us & 24 consecutive months for Plan B ... Joint replacement surgeries unless necessitated by accidental Bodily Injury ... 30-day waiting 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 ... Investigation & Evaluation (Excl04) ... Rest Cure, rehabilitation and respite care- (Excl05) ... Cosmetic or plastic Surgery (Excl08) ... Treatment for Alcoholism, drug or substance abuse or any addictive condition and consequences thereof. (Excl12) ... Maternity (Excl 18) ... 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 and also requiring hospitalization. ... War, invasion, acts of foreign enemies ... The cost of spectacles, contact lenses, hearing aids, crutches, dentures, artificial teeth and all other external appliances ... Intentional self-injury ... All non-medical Items as per Annexure II ... Any treatment received outside India is not covered under this Policy.","sources":[{"clause":"1","heading":"Pre-existing Diseases waiting period (Excl01) (Applicable for Plan A & Plan B)","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-1-5"},{"clause":"1(a)","heading":null,"page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-1-a"},{"clause":"2","heading":"Specified disease/procedure waiting period (Excl02) (Applicable for Plan A & Plan B)","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-2-4"},{"clause":"2(a)","heading":null,"page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-2-a"},{"clause":"3","heading":null,"page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-3-4"},{"clause":null,"heading":"4. 30-day waiting period (Excl03)","page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-4-30-day-waiting-period-excl03"},{"clause":null,"heading":"II. General Exclusions","page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-ii-general-exclusions"},{"clause":"5","heading":"Cosmetic or plastic Surgery (Excl08)","page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-5-4"},{"clause":"8","heading":null,"page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-8-3"},{"clause":"14","heading":"Maternity (Excl 18)","page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-14-3"},{"clause":"1","heading":null,"page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-1-6"},{"clause":"3","heading":null,"page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-3-5"},{"clause":"5","heading":null,"page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-5-5"},{"clause":"8","heading":null,"page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-8-4"},{"clause":"11","heading":"All non-medical Items as per Annexure II","page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-11-4"},{"clause":"12","heading":null,"page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-12-4"}],"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":"Write first to careforyou@bajajgeneral.com (senior citizens: seniorcitizen@bajajgeneral.com), or use the toll-free number 1-800-209-5858, branches or the website; if not satisfied, write to the Grievance Redressal Officer at ggro@bajajgeneral.com.","display":"careforyou@bajajgeneral.com (senior citizens: seniorcitizen@bajajgeneral.com), then the Grievance Redressal Officer at ggro@bajajgeneral.com","note":"Level 3: missed call on +91 80809 45060 or SMS to 575758. WhatsApp +91 7507245858. Then the Insurance Ombudsman.","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 ... please give a missed call on +91 80809 45060 OR SMS To 575758","sources":[{"clause":"15","heading":"Grievance Redressal Procedure","page":11,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-15-3"},{"clause":"15(a)","heading":"Level 1","page":11,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-15-a"},{"clause":"15(b)","heading":"Level 2","page":11,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-15-b"},{"clause":"15(c)","heading":"Level 3","page":11,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-15-c"}],"law":[{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 3","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 4","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 5","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(11)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(42)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 34","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 69","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Insurance Act, 1938","section":"Section 38","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 12","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 19","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 20","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 13","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 2","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(5), 5(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(9)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 25","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 26","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 11","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 3","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 13","url":"https://indiainsurances.com/law/ombudsman-rules-2017"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 14","url":"https://indiainsurances.com/law/ombudsman-rules-2017"}]},{"key":"sum_insured_options","label":"Sum insured options","section":"Cover","meaning":"The cover amounts you can choose from.","status":"cross-checked","value":"Plan A: 50,000 / 1 Lacs / 1.5 Lacs / 2 Lacs / 3 Lacs / 4 Lacs / 5 Lacs. Plan B: 3 Lacs / 5 Lacs / 7.5 Lacs / 10 Lacs.","display":"Plan A: Rs 50,000, 1, 1.5, 2, 3, 4 or 5 Lacs; Plan B: Rs 3, 5, 7.5 or 10 Lacs","note":"Plan B can be individual or floater.","quote":"Sum Insured | 50,000 / 1 Lacs /1.5 Lacs / 2 Lacs / 3Lacs / 4 Lacs / 5 Lacs | 3 Lacs / 5 Lacs / 7.5 Lacs / 10 Lacs","sources":[{"clause":"Section C","heading":"COVERAGE Types of Policy","page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-section-c"}],"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 with continuous coverage of more than twelve months; applies again to an enhanced sum insured.","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. ... This exclusion shall not, however apply if the Insured has Continuous Coverage for more than twelve months.","sources":[{"clause":null,"heading":"4. 30-day waiting period (Excl03)","page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-4-30-day-waiting-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":12},"display":"12 months","note":"Under Plan A, liability for any one pre-existing illness is then restricted to 50% of the limit of indemnity. Cover after 12 months only if the disease was declared and accepted. Reduced by prior continuous cover under portability.","quote":"Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications shall be excluded until the expiry of 12 months of continuous coverage after the date of inception of the first Silver Health Policy with us. ... Under Plan A, for any one Pre-existing Illness covered under this Policy (if this Policy is the renewal without break of an earlier Silver health Policy issued by Us and held for a continuous period of one year) our liability will be restricted to 50% of the Limit of Indemnity.","sources":[{"clause":"1(a)","heading":null,"page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-1-a"},{"clause":"1(d)","heading":null,"page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-1-d"}],"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","note":"Joint replacement surgeries: 36 months under Plan A and 24 months under Plan B (36 months if switching from an existing Silver Health policy to Plan B). Where a condition is also pre-existing, the longer period applies.","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 Silver Health Policy with Us. This exclusion shall not be applicable for claims arising due to an accident. ... during the first 36 consecutive months for Plan A during which You have the benefit of a Silver Health Policy with Us & 24 consecutive months for Plan B","sources":[{"clause":"2(a)","heading":null,"page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-2-a"},{"clause":"3","heading":null,"page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-3-4"}],"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":["Surgery for gastric or duodenal ulcers","Benign prostatic hypertrophy","Hydrocele","Haemorrhoids","Dysfunctional uterine bleeding","Endometriosis","Stones in the urinary and biliary systems","Prolapse genitourinary/intra abdominal organs","Surgery on ears","Treatment for prolapsed intervertebral discs","Cataracts","Hernia of all types","Fistulae","Fissure in ano","Fibromyoma","Hysterectomy","Surgery on skin/ all internal or external tumours/cysts/ nodules/polyps of any kind including breast lumps","Treatment for benign tumors or malignant conditions or for organomegaly","Surgery on joints","Mental Illness","Genetic disorders","Macular Degeneration","Parkinson’s Disease","Alzheimer’s disease","Bariatric Surgery","Joint replacement surgeries (36 months Plan A, 24 months Plan B)"],"display":"25 listed conditions and procedures (12 months), plus joint replacement surgeries (36 or 24 months)","note":"25 numbered items, counted in the list, wait 12 months. The wording's item 10 is cut to 'Treatment for prolapsed'; the CIS prints 'Treatment for prolapsed intervertebral discs'. Mental illness is limited to the ICD codes listed in the wording.","quote":"1. Surgery for gastric or duodenal ulcers, | 14. Fissure in ano ... 2. Benign prostatic hypertrophy | 15. Fibromyoma ... 3. Hydrocele | 16. Hysterectomy ... 4. Haemorrhoids | 17. Surgery on skin/ all internal or external tumours/cysts/ nodules/polyps of any kind including breast lumps. ... 5. Dysfunctional uterine bleeding | 18.Treatment for benign tumors or malignant conditions or for organomegaly ... 6. Endometriosis | 19. Surgery on joints ... 7. Stones in the urinary and biliary systems | 20. Mental Illness* ... 8. Prolapse genitourinary/intra abdominal organs | 21. Genetic disorders ... 9. Surgery on ears | 22. Macular Degeneration ... 10. Treatment for prolapsed intervertebral discs | 23. Parkinson’s Disease ... 11. Cataracts, | 24. Alzheimer’s disease ... 12. Hernia of all types | 25. Bariatric Surgery ... 13. Fistulae ... during the first 36 consecutive months for Plan A during which You have the benefit of a Silver Health Policy with Us & 24 consecutive months for Plan B ... Joint replacement surgeries unless necessitated by accidental Bodily Injury","sources":[{"clause":"2(e)","heading":null,"page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-2-e"},{"clause":"3","heading":null,"page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-3-4"},{"clause":"1","heading":"Room Rent Capping (Applicable for Plan A & Plan B)","page":2,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/289#c-1"}],"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 sixty months run from the date of enhancement, on the enhanced limit only.","quote":"After completion of sixty continuous months of coverage (including portability and migration) no look back would be applied. 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":10,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-11-5"}],"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 before, but not earlier than 60 days from, the renewal date, with accrued continuity benefits in waiting periods.","display":"Yes, apply 30 to 60 days before renewal; waiting-period credit carries over","note":"The new insurer may consider a request made within 15 days of renewal. Migration to another Bajaj General product is also allowed.","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":"8","heading":"Portability","page":10,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-8-5"}],"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, lifelong","note":"Renewal can be refused for established fraud, non-disclosure or misrepresentation, or if the product is withdrawn.","quote":"Renewal age | Life Long ... Your Policy shall be renewable except on grounds of established fraud or non-disclosure or misrepresentation by You, provided this policy is not withdrawn","sources":[{"clause":"Section C","heading":"COVERAGE Types of Policy","page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-section-c"},{"clause":"9(i)","heading":null,"page":10,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-9-i"}],"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 and not on an individual policy's claim experience, and renewal cannot be denied because of claims.","display":"No, loadings are at portfolio level, not on your claims","note":"A claim in the year reduces the cumulative bonus by 10%.","quote":"For this policy, the loadings on renewal premium shall be at portfolio and not based upon any individual policy claim experience. ... 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 increased Limit of Indemnity in the Policy Period of the subsequent “Silver Health” shall be reduced by 10%","sources":[{"clause":"9(iv)","heading":null,"page":10,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-9-iv"},{"clause":"9(ii)","heading":null,"page":10,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-9-ii"},{"clause":"Section E(d)(iii)","heading":null,"page":14,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-section-e-d-iii"}],"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 or any addictive condition (Excl12)","Treatments in heath hydros, nature cure clinics, spas or similar establishments (Excl13)","Dietary supplements and substances that can be purchased without prescription (Excl14)","Refractive Error less than 7.5 dioptres (Excl15)","Unproven Treatments (Excl16)","Sterility and Infertility (Excl17)","Maternity (Excl 18)","Dental treatment unless due to accidental injury to natural teeth and requiring hospitalisation","Medical expenses where inpatient care is not warranted","War, invasion, acts of foreign enemies, hostilities, civil war and similar","Spectacles, contact lenses, hearing aids, crutches, dentures and other external appliances","External medical equipment used at home after hospitalisation (CPAP, CPAD, oxygen concentrator)","Congenital external diseases or defects, growth hormone therapy, stem cell implantation (except haematopoietic stem cells for bone marrow transplant)","Intentional self-injury","Vaccination or inoculation unless part of post-bite or medically necessary treatment","Circumcision unless required for treatment of illness or injury","All non-medical items as per Annexure II","Any treatment received outside India","Treatment under any system other than modern medicine (allopathy) and AYUSH"],"display":"Standard exclusions Excl04 to Excl08 and Excl10 to Excl 18, plus dental, war, external appliances and home equipment, congenital external defects, self-injury, vaccination, circumcision, non-medical items, treatment outside India and non-allopathy/AYUSH systems","note":"The wording prints no Excl09 (hazardous or adventure sports). Medical expenses due to an act of terrorism are covered. Excluded providers: stabilisation costs in life-threatening situations or after an accident are paid.","quote":"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) ... 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) ... Refractive Error (Excl15) ... refractive error less than 7.5 dioptres ... Unproven Treatments (Excl16) ... Sterility and Infertility (Excl17) ... Maternity (Excl 18) ... 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 and also requiring hospitalization. ... Medical expenses where Inpatient care is not warranted ... War, invasion, acts of foreign enemies, hostilities (whether war be declared or not), civil war ... The cost of spectacles, contact lenses, hearing aids, crutches, dentures, artificial teeth and all other external appliances ... External medical equipment of any kind used at home as post Hospitalization care including cost of instrument used in the treatment of Sleep Apnoea Syndrome (C.P.A.P), Continuous Peritoneal Ambulatory Dialysis (C.P.A.D) and Oxygen concentrator ... 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. ... Intentional self-injury ... Vaccination or inoculation unless forming a part of post bite treatment or if medically necessary ... Circumcision unless required for the treatment of Illness or Accidental bodily injury ... All non-medical Items as per Annexure II ... Any treatment received outside India is not covered under this Policy. ... Treatment for any other system other than modern medicine (allopathy) and AYUSH therapies.","sources":[{"clause":null,"heading":"II. General Exclusions","page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-ii-general-exclusions"},{"clause":"3(b)(ii)","heading":null,"page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-3-b-ii"},{"clause":"4","heading":"Change-of-gender treatments (Excl07)","page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-4-4"},{"clause":"5","heading":"Cosmetic or plastic Surgery (Excl08)","page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-5-4"},{"clause":"6","heading":"Breach of law (Excl10)","page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-6-4"},{"clause":"7","heading":"Excluded Providers (Excl11)","page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-7-4"},{"clause":"8","heading":null,"page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-8-3"},{"clause":"9","heading":null,"page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-9-3"},{"clause":"10","heading":null,"page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-10-3"},{"clause":"11","heading":"Refractive Error (Excl15)","page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-11-3"},{"clause":"12","heading":"Unproven Treatments (Excl16)","page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-12-3"},{"clause":"13","heading":"Sterility and Infertility (Excl17)","page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-13-3"},{"clause":"14","heading":"Maternity (Excl 18)","page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-14-3"},{"clause":"1","heading":null,"page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-1-6"},{"clause":"2","heading":null,"page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-2-5"},{"clause":"3","heading":null,"page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-3-5"},{"clause":"5","heading":null,"page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-5-5"},{"clause":"6","heading":null,"page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-6-5"},{"clause":"7","heading":null,"page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-7-5"},{"clause":"8","heading":null,"page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-8-4"},{"clause":"9","heading":null,"page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-9-4"},{"clause":"10","heading":null,"page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-10-4"},{"clause":"11","heading":"All non-medical Items as per Annexure II","page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-11-4"},{"clause":"12","heading":null,"page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-12-4"},{"clause":"13","heading":null,"page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-13-4"}],"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":"You can cancel with 7 days' written notice. An annual policy refunds the unexpired period pro-rata if no claim was made in the policy year; a multi-year policy refunds future years in full and the current year pro-rata if no claim was made; instalment policies refund pro-rata if no claim. Medical examination expenses are deducted once risk has started.","display":"Pro-rata refund of the unexpired period if no claim was made in the policy year; future years of a multi-year policy in full","note":"The wording does not say what is refunded when a claim has been made. The insurer may cancel for misrepresentation, non-disclosure or fraud on 15 days' notice with no refund. Refund delayed beyond 7 days carries interest at 2% above bank rate.","quote":"The Policyholder can cancel this Policy by providing a written notice of 7 days. ... Annual Policy: The premium refund for the unexpired risk period will be on a pro-rata basis, provided no claim has been made during the policy year. ... For any policy year where the risk 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":"7","heading":"Cancellation","page":10,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-7-6"}],"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.","display":"India only","note":null,"quote":"We cover medical expenses for treatment availed within India only.","sources":[{"clause":null,"heading":"30. Territorial Limits & Governing Law","page":14,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-30-territorial-limits-governing-law"}],"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 policies only, not renewals or porting. Refund less medical examination and stamp duty costs, or proportionate risk premium if risk has started. CIS says 30 days from the first inception of the policy.","quote":"The insured person shall be allowed free look period of thirty days from date of receipt of the policy document to review the terms and conditions of the policy, and to return the same if not acceptable. ... Insured has an option of cancelling his/her policy up to 30 days from the first inception of policy with Us","sources":[{"clause":"14","heading":"Free Look Period","page":11,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-14-4"},{"clause":"1","heading":"Room Rent Capping (Applicable for Plan A & Plan B)","page":2,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/289#c-1"}],"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":"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. ... The grace period of fifteen days (where premium is paid on a monthly instalments) and thirty days (where premium is paid in quarterly/half- yearly/annual instalments) is available on the premium due date, to pay the premium.","sources":[{"clause":"9(iii)","heading":null,"page":10,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-9-iii"},{"clause":"12","heading":"Premium Payment in Instalments (Wherever applicable)","page":11,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-12-5"}],"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":"Minimum entry age 46 years and maximum 80 years.","display":"46 to 80 years","note":"The wording's definition of Insured (Specific Definitions 10) says 'has attained the age of 3 months and is not older than 65 years of age at the commencement of the Policy Period', which contradicts the plan table. Brochure gives 46 years to 80 years for Plan A.","quote":"Entry age Min | 46 Years ... Entry age Max | 80 Years ... has attained the age of 3 months and is not older than 65 years of age at the commencement of the Policy Period ... “Silver Health – Plan A” | Individual | 46 years to 80 years","sources":[{"clause":"Section C","heading":"COVERAGE Types of Policy","page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-section-c"},{"clause":"10","heading":"Named Insured/ Insured/Insured Person","page":4,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-10-2"},{"clause":null,"heading":"What is the entry age?","page":3,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/290#c-what-is-the-entry-age"}],"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 only for 2 and 3 year policies. Brochure: a 1 year policy is paid annually and a long-term premium is collected in full at inception unless instalments are chosen.","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":"12","heading":"Premium Payment in Instalments (Wherever applicable)","page":11,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-12-5"}],"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":["Room Rent Capping (room rent limited to 1% of Sum Insured per day, up to Rs. 7,500, for a premium discount)","Waiver of Co-Payment on Non-Network Hospital (for extra premium)"],"display":"Room Rent Capping (cheaper premium, 1% of Sum Insured per day up to Rs. 7,500); waiver of the non-network co-payment","note":"Room Rent Capping gives a 10% premium discount for sum insured up to 2 lakhs and 5% for 3 lakhs and above. The non-network co-payment waiver applies to Plan A, for a 15% loading on the final premium.","quote":"Room Rent Capping (Applicable for Plan A & Plan B) ... If You opt for this cover You will be entitled for a per day room rent limit of 1% of hospitalization Sum Insured up to maximum Rs. 7,500 per day ... Waiver of Co-Payment on Non-Network Hospital- Waiver of Co-Payment for treatment availed in Non-Network Hospital ... This co-payment can be waived subject to payment of extra premium. ... Cost Sharing, is available subject to 15% loading on the final premium. ... For SI up to 2 lakhs = 10% discounts on premium","sources":[{"clause":"1","heading":"Room Rent Capping (Applicable for Plan A & Plan B)","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-1-4"},{"clause":"Section E(d)(i)","heading":null,"page":14,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-section-e-d-i"},{"clause":"Section E(c)(ii)","heading":null,"page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-section-e-c-ii"},{"clause":"Section E(d)(ii)","heading":null,"page":14,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-section-e-d-ii"}],"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":"If the premium is paid in instalments during the policy period, cover continues during the grace period. Otherwise the definition says coverage need not be available for the period for which no premium is received.","display":"Yes, if the premium is paid in instalments; otherwise cover need not be available for the unpaid period","note":null,"quote":"If the premium is paid in instalments during the policy period, coverage will be available for the grace period also. ... Coverage need not be available during the period for which no premium is received.","sources":[{"clause":"12","heading":"Premium Payment in Instalments (Wherever applicable)","page":11,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-12-5"},{"clause":"15","heading":"Grace Period","page":2,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-15"}],"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.","status":"cross-checked","value":"Room rent is paid as charged up to a Single Private Air-Conditioned room; ICU at actuals.","display":"Up to a Single Private Air-Conditioned room","note":"A higher room leads to proportionate deduction of other expenses (not medicines, consumables, implants, devices, diagnostics or ICU). With the optional Room Rent Capping cover the limit is 1% of Sum Insured per day up to Rs. 7,500.","quote":"Room rent and Boarding expenses as provided by the Hospital/Nursing Home subject to maximum eligible room is Single Private Air- Conditioned room ... If admitted in ICU, the Company will pay up to actual ICU expenses provided by Hospital. ... If You opt for this cover You will be entitled for a per day room rent limit of 1% of hospitalization Sum Insured up to maximum Rs. 7,500 per day","sources":[{"clause":"1","heading":"In-patient Hospitalization Treatment – (Applicable for Plan A & Plan B)","page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-1-3"},{"clause":"1","heading":"Room Rent Capping (Applicable for Plan A & Plan B)","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-1-4"}],"law":[]},{"key":"copay","label":"Co-payment","section":"Limits and co-pay","meaning":"The share of every admissible claim you pay yourself.","status":"cross-checked","value":"Plan B: 10% co-payment on each and every admissible claim. Plan A: no general co-payment, but 20% of each admissible claim when treated in a non-network hospital, waivable for extra premium.","display":"Plan B: 10% on every claim; Plan A: 20% at non-network hospitals only","note":"The Plan A 20% non-network co-payment can be waived by paying a 15% loading on the final premium (optional).","quote":"Co-payment on all claims | NA | 10% co-payment (Each and every admissible claim) ... Co-Payment on Non-Network Hospital | 20% of each and every admissible claim if Treatment availed in Non- Network Hospital This co-payment can be waived subject to payment of extra premium. | NA ... Cost Sharing, is available subject to 15% loading on the final premium.","sources":[{"clause":"Section E(c)(ii)","heading":null,"page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-section-e-c-ii"},{"clause":"Section E(d)(ii)","heading":null,"page":14,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-section-e-d-ii"}],"law":[]},{"key":"disease_sublimits","label":"Disease or procedure sub-limits","section":"Limits and co-pay","meaning":"Caps on what is paid for named treatments even if the sum insured is higher.","status":"cross-checked","value":["Cataract (per eye): 10% of Sum Insured, max up to 40,000 per claim, whichever is lower","Pre-existing disease (Plan A): 50% of Sum Insured from second year onwards"],"display":"Cataract: 10% of Sum Insured or Rs 40,000 per eye per claim, whichever is lower; Plan A pre-existing diseases: 50% of Sum Insured from the second year","note":"Other cover limits in the same table: road ambulance Rs 1000 per claim; Plan B domiciliary 10% of Sum Insured; Plan A pre and post hospitalisation 3% of hospitalisation expenses. Mental illness (in-patient) and modern treatment methods are covered up to the base sum insured.","quote":"Cataract (Per Eye) | 10% of Sum Insured, Max up to 40,000 per claim (whichever is lower) ... Sub limit on PED | 50% of Sum Insured from second year onwards | NA ... Under Plan A, for any one Pre-existing Illness covered under this Policy (if this Policy is the renewal without break of an earlier Silver health Policy issued by Us and held for a continuous period of one year) our liability will be restricted to 50% of the Limit of Indemnity.","sources":[{"clause":"Section E(c)(i)","heading":null,"page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-section-e-c-i"},{"clause":"1(d)","heading":null,"page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-1-d"}],"law":[]},{"key":"pre_policy_checkup","label":"Medical tests before buying","section":"Eligibility","meaning":"Whether you need medical tests before the policy is issued.","status":"cross-checked","value":"Yes. Pre-policy medical tests are mandatory for every proposal, at empanelled diagnostic centres.","display":"Yes, for every proposal","note":"From the sales brochure. Tests include full medical report, ECG, blood sugar, HbA1c, lipids, liver and kidney tests and urinalysis. The brochure says the proposer pays for the tests and 100% of the cost is refunded if the policy is issued.","quote":"Pre-Policy medical tests are mandatory for every proposal. ... The pre-policy checkup would be arranged at our empanelled diagnostic centres. ... 46 years and above | All Sum Insured options | Medical Tests required as listed below ... If the policy is issued we will refund you 100% of the cost of the pre-policy medical examination","sources":[{"clause":"1(d)","heading":null,"page":6,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/290#c-1-d"},{"clause":"25","heading":"Any treatment received outside India is not covered under this Policy","page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/290#c-25"}],"law":[]},{"key":"pre_hospitalisation","label":"Pre-hospitalisation cover","section":"Cover","meaning":"Medical costs before admission that are paid.","status":"cross-checked","value":{"unit":"days","amount":30},"display":"30 days (Plan B); Plan A: 3% of admissible hospitalisation expenses for pre and post together","note":"Plan A has no day limit; it pays a lump amount of 3% of the admissible hospitalisation expenses.","quote":"Plan A: An amount equivalent to 3% of the admissible Hospitalization expenses covered in Section C-I.1 in respect of any and all pre- Hospitalization and post Hospitalization expenses. ... The Medical Expenses Incurred during 30 days for Pre-Hospitalization & 60 Days for Post Hospitalization","sources":[{"clause":"2","heading":"Pre- & Post Hospitalization: (Applicable for Plan A & Plan B)","page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-2-3"}],"law":[]},{"key":"post_hospitalisation","label":"Post-hospitalisation cover","section":"Cover","meaning":"Medical costs after discharge that are paid.","status":"cross-checked","value":{"unit":"days","amount":60},"display":"60 days (Plan B); Plan A: 3% of admissible hospitalisation expenses for pre and post together","note":"Plan A has no day limit; it pays a lump amount of 3% of the admissible hospitalisation expenses.","quote":"Plan A: An amount equivalent to 3% of the admissible Hospitalization expenses covered in Section C-I.1 in respect of any and all pre- Hospitalization and post Hospitalization expenses. ... The Medical Expenses Incurred during 30 days for Pre-Hospitalization & 60 Days for Post Hospitalization","sources":[{"clause":"2","heading":"Pre- & Post Hospitalization: (Applicable for Plan A & Plan B)","page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-2-3"}],"law":[]},{"key":"day_care","label":"Day-care treatments","section":"Cover","meaning":"Treatments needing less than 24 hours in hospital.","status":"cross-checked","value":"Covered for both plans: day care procedures and surgeries taken as an inpatient in a hospital or day care centre, as listed in Annexure I.","display":"Covered, as listed in Annexure I","note":null,"quote":"We will pay You the medical expenses as listed above under Section C-I.1- In-patient Hospitalization Treatment for Day care procedures / Surgeries taken as an inpatient in a hospital or day care centre but not in the outpatient department. List of Day Care Procedures is given in the annexure I of Policy wordings.","sources":[{"clause":"4","heading":"Day Care Procedures (Applicable for Plan A & Plan B)","page":6,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-4-3"}],"law":[]},{"key":"restoration","label":"Restoration of sum insured","section":"Cover","meaning":"Whether the sum insured is refilled after it is used up.","status":"not-stated","value":null,"display":null,"note":"No restoration or refill of the sum insured is described in the documents.","quote":null,"sources":[],"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":"On renewal without a break and with no claim in the preceding year, the limit of indemnity rises by 10% of base sum insured a year, up to 100%. A claim in a year with bonus reduces it by 10% in the next policy, never below the first policy's sum insured.","display":"10% of base sum insured per claim-free year, up to 100%; reduced by 10% after a claim","note":null,"quote":"If You renew Your “Silver Health” with Us without any break and there has been no claim in the preceding year, We will increase the Limit of Indemnity by 10% of base Sum Insured per annum, but: ... The maximum cumulative increase in the Limit of Indemnity will be limited up to 100% of base Sum Insured of Your first “Silver Health” with Us. ... If a claim is made in any year where a cumulative increase has been applied, then the increased Limit of Indemnity in the Policy Period of the subsequent “Silver Health” shall be reduced by 10%, save that the limit of indemnity applicable to Your first “Silver Health” with Us shall be preserved.","sources":[{"clause":"Section E(d)(ii)","heading":null,"page":14,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-section-e-d-ii"},{"clause":"Section E(d)(iii)","heading":null,"page":14,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-section-e-d-iii"}],"law":[]},{"key":"cashless","label":"Cashless treatment","section":"Claims","meaning":"Whether and where the insurer pays the hospital directly instead of you paying and claiming back.","status":"conflicting","value":"Yes, at network hospitals, and the wording also offers 'Cashless Everywhere' in non-network hospitals that meet the IRDAI definition of hospital.","display":"Yes, at network hospitals and (per the wording) any hospital meeting the IRDAI definition","note":"CIS says: 'Cashless treatment is only available at Network Hospitals'. Pre-authorisation answered within 1 hour.","quote":"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":"21. Claims Procedure","page":12,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-21-claims-procedure"},{"clause":"Section E(iv)","heading":null,"page":12,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-section-e-iv"},{"clause":"1","heading":"Room Rent Capping (Applicable for Plan A & Plan B)","page":2,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/289#c-1"}],"law":[]},{"key":"claims_handled_by","label":"Claims handled by","section":"Claims","meaning":"The insurer itself or a third-party administrator (TPA).","status":"cross-checked","value":"The insurer's in-house claims settlement team; no TPA is engaged.","display":"In-house, no TPA","note":"The insurer reserves the right to engage a TPA at any time.","quote":"All Claims will be settled by In house claims settlement team of the Company and no TPA is engaged. However the Company reserves to engage TPA at any time, at the sole discretion of the Company.","sources":[{"clause":null,"heading":"21. Claims Procedure","page":12,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-21-claims-procedure"}],"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, Plan B only","note":"Plan B floater covers self, spouse and parents or parents-in-law. Family discount does not apply to floater policies.","quote":"“Silver Health-Family Floater” – For Plan B only ... Sum insured type | Individual | Individual & Floater ... Family discount is not applicable to Silver Health Floater Policies.","sources":[{"clause":"Section C","heading":"COVERAGE Types of Policy","page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-section-c"},{"clause":null,"heading":"A. Discount","page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288#c-a-discount"}],"law":[]}],"documents":[{"kind":"wording","label":"Silver Health Policy Wordings","pages":22,"fetched_at":"2026-10-16 08:29:39.362689+00","source_url":"https://www.bajajgeneralinsurance.com/download-documents/health-insurance/Health-PW/Silver-Health_PW.pdf","url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/288"},{"kind":"cis","label":"Silver Health Customer Information Sheet","pages":7,"fetched_at":"2026-10-16 08:29:39.362689+00","source_url":"https://www.bajajgeneralinsurance.com/download-documents/health-insurance/Health-CIS/Silver-Health_CIS.pdf","url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/289"},{"kind":"brochure","label":"Silver Health Brochure","pages":18,"fetched_at":"2026-10-16 08:29:39.362689+00","source_url":"https://www.bajajgeneralinsurance.com/download-documents/health-insurance/silver-health/silver_health.pdf","url":"https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223/document/290"}],"versions":[{"uin":"BAJHLIP21183V022021","version":null,"approved_on":null},{"uin":"BAJHLIP23213V052223","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":"Silver Health (UIN BAJHLIP23213V052223), IndiaInsurances, https://indiainsurances.com/policy/bajaj-general-insurance/silver-health-bajhlip23213v052223"}