{"uin":"BAJHLIP24149V062324","name":"Health Ensure","url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324","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":"2020-07-29","withdrawn_on":null,"summary":"Health Ensure is a Bajaj General hospitalisation indemnity policy on an individual or family floater basis, for 1, 2 or 3 years, with sum insured up to Rs. 10 lakh and room rent capped at 1% of sum insured up to INR 5,000 per day. Pre-existing diseases wait 24 months, claims are handled in-house without a TPA, and Zone B premium payers treated in a Zone A city pay a 20% co-payment.","analysis":{"state":"extracted","analysed_at":"2026-10-16 08:29:39.854652+00","note":"Every stated fact carries a verbatim quote found in the cited clause."},"facts":[{"key":"plan_variants","label":"Plans and variants","section":"Overview","meaning":"The named plans inside this product (not cover types or payout options). Facts can differ between them.","status":"not-stated","value":null,"display":null,"note":"No named plans. The policy is sold on Individual Sum Insured and Family Floater bases, with optional covers.","quote":null,"sources":[],"law":[]},{"key":"policy_term","label":"Policy term","section":"Eligibility","meaning":"How long one policy runs before it ends or must be renewed.","status":"cross-checked","value":"1 year, 2 years or 3 years.","display":"1, 2 or 3 years","note":null,"quote":"Tenure of Policy: 1 year, 2 years or 3 years","sources":[{"clause":"Section C","heading":"OPERATIVE PARTS","page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#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":"Cashless: planned hospitalisation must be intimated 48 hours before admission, emergency hospitalisation within 24 hours. Reimbursement: inform in writing within 48 hours of emergency hospitalisation or 48 hours before planned hospitalisation.","display":"48 hours before planned admission; within 24 hours of emergency admission (cashless) or 48 hours (reimbursement)","note":"Documents for reimbursement 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 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":15,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-section-e-ii-2"},{"clause":"Section E(iii)","heading":null,"page":15,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-section-e-iii-2"},{"clause":"Section E(x)","heading":null,"page":15,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-section-e-x"}],"law":[{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 20, 21","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"claim_documents","label":"Claim documents","section":"Claims","meaning":"Documents the insurer asks for when you claim.","status":"cross-checked","value":["Duly Completed Claim form with NEFT details & cancelled cheque duly signed by Insured","Original/Attested copies of Discharge Summary / Discharge Certificate / Death Summary with Surgical & anesthetics notes","Attested copies of Indoor case papers (Optional)","Original/Attested copies Final Hospital Bill with breakup 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.","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 NEFT details, discharge summary, final bill and paid receipt, investigation bills and reports, first consultation letter and others","note":"Separate lists for death claims and Permanent Total Disability claims under the optional Personal Accident cover. Additional documents may be called for where fraud is suspected.","quote":"Duly Completed Claim form with NEFT details & cancelled cheque duly signed by Insured ... Original/Attested copies of Discharge Summary / Discharge Certificate / Death Summary with Surgical & anesthetics notes ... Attested copies of Indoor case papers (Optional) ... Original/Attested copies Final Hospital Bill with breakup 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. ... 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(x)","heading":null,"page":15,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-section-e-x"}],"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":"Settle or reject within 15 days from receipt of the last necessary document; if investigated, investigation within 30 days and decision within 15 days of the last document. Interest at 2% above bank rate for delay.","display":"15 days from the last necessary document","note":"CIS says: 'TAT for claim settlement: 15 Working Days'. Cashless pre-authorisation 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 ... 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. ... our representative then within 1 hour will respond with Approval, Rejection or more information. ... the same will be processed within 3 hours from the final documents received. ... TAT for claim settlement: 15 Working Days","sources":[{"clause":"5(i)","heading":null,"page":10,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-5-i"},{"clause":"5(iii)","heading":null,"page":10,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-5-iii"},{"clause":"5(ii)","heading":null,"page":10,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-5-ii"},{"clause":"Section E(v)","heading":null,"page":15,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-section-e-v"},{"clause":"Section E(vi)","heading":null,"page":15,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-section-e-vi"},{"clause":"15(g)","heading":null,"page":3,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/292#c-15-g"}],"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 waiting period (Excl01): 24 months","Specified disease/procedure waiting period (Excl02): 12/24/36 months","30-day waiting period (Excl03)","Investigation & Evaluation (Excl04)","Rest Cure, rehabilitation and respite care (Excl05)","Obesity/Weight Control (Excl06)","Cosmetic or plastic Surgery (Excl08)","Hazardous or Adventure Sports (Excl09)","Treatment for Alcoholism, drug or substance abuse (Excl12)","Unproven Treatments (Excl16)","Sterility and Infertility (Excl17)","Maternity (Excl 18)","Any treatment received outside India","All non-medical Items as per Annexure II","Congenital external diseases or defects or anomalies, growth hormone therapy, stem cell implantation or surgery"],"display":"Waiting periods, standard IRDAI exclusions, maternity, treatment outside India, non-medical items","note":"Stem cell exclusion does not apply to Hematopoietic stem cells for bone marrow transplant for hematological conditions.","quote":"Pre-existing Diseases waiting period (Excl01) ... 24 months of continuous coverage ... Specified disease/procedure waiting period (Excl02) ... 12/24/36 months ... 30-day waiting period (Excl03) ... Investigation & Evaluation (Excl04) ... Rest Cure, rehabilitation and respite care- (Excl05) ... Obesity/Weight Control (Excl06) ... Cosmetic or plastic Surgery (Excl08) ... Hazardous or Adventure Sports (Excl09) ... Treatment for Alcoholism, drug or substance abuse or any addictive condition and consequences thereof. (Excl12) ... Unproven Treatments (Excl16) ... Sterility and Infertility (Excl17) ... Maternity (Excl 18) ... Any treatment received outside India is not covered under this policy. ... All non-medical Items as per Annexure II provided in Policy Wordings ... Congenital external diseases or defects or anomalies, growth hormone therapy, stem cell implantation or surgery","sources":[{"clause":"1","heading":"Pre-existing Diseases waiting period (Excl01)","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-1-4"},{"clause":"2","heading":"Specified disease/procedure waiting period (Excl02)","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-2-4"},{"clause":"2(f)(iii)","heading":null,"page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-2-f-iii"},{"clause":"2(b)(ii)","heading":null,"page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-2-b-ii"},{"clause":"5","heading":"Cosmetic or plastic Surgery (Excl08)","page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-5-4"},{"clause":"6","heading":"Hazardous or Adventure Sports (Excl09)","page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-6-4"},{"clause":"9","heading":null,"page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-9-3"},{"clause":"13","heading":"Unproven Treatments (Excl16)","page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-13-2"},{"clause":"14","heading":"Sterility and Infertility (Excl17)","page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-14-2"},{"clause":"15","heading":"Maternity (Excl 18)","page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-15-2"},{"clause":"9","heading":null,"page":10,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-9-4"},{"clause":"8","heading":"All non-medical Items as per Annexure II provided in Policy Wordings","page":10,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-8-5"},{"clause":"11","heading":null,"page":10,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-11-4"}],"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":"Level 1: write to careforyou@bajajgeneral.com (senior citizens: seniorcitizen@bajajgeneral.com); Level 2: Grievance Redressal Officer at ggro@bajajgeneral.com; then the Insurance Ombudsman.","display":"careforyou@bajajgeneral.com, then ggro@bajajgeneral.com","note":"Also toll-free 1-800-209-5858 or 020-30305858, WhatsApp +91 7507245858, branches and website. Level 3: missed call on +91 80809 45060 or SMS to 575758.","quote":"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":"17(a)","heading":"Level 1","page":12,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-17-a"},{"clause":"17(b)","heading":"Level 2","page":12,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-17-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":"Individual: Rs. 50,000, 75,000, 1 lakh, 1.5 lakh, 2 lakh, 3 lakh, 4 lakh, 5 lakh, 10 lakh. Floater: Rs. 2, 3, 4, 5 or 10 lakh.","display":"Rs. 50,000 to Rs. 10 lakh individual, Rs. 2 lakh to Rs. 10 lakh floater; new policies from Rs. 3 lakh","note":"From the sales brochure. Sum insured up to 2 lakh is only for renewals; 3 lakh and above for new business. Room rent upgrade, reinstatement and double SI for cancer need 5 lakh and above.","quote":"Sum Insured Options Under Individual Policy- Rs. 50,000, Rs. 75,000, Rs. 1 Lac, Rs.1.5 Lacs, Rs. 2 Lacs, Rs. 3 Lacs, Rs. 4 Lacs, Rs. 5 Lacs, Rs. 10 Lacs ... Sum Insured Options Under Floater Policy- Rs. 2 Lacs, Rs. 3 Lacs, Rs. 4 Lacs, Rs. 5 Lacs, Rs. 10 Lacs ... Sum insured upto 2 lakhs is only available for Renewals Sum Insured 3 lakhs and above is available for New Business","sources":[{"clause":null,"heading":null,"page":1,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/293#c-s1"}],"law":[]},{"key":"initial_waiting","label":"Initial waiting period","section":"Waiting periods","meaning":"Days from the start of the first policy during which illness claims are not paid (accidents usually are).","status":"cross-checked","value":{"unit":"days","amount":30},"display":"30 days","note":"Does not apply to accidents, or if the insured has continuous coverage for more than twelve months.","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 ... This exclusion shall not, however, apply if the Insured has Continuous Coverage for more than twelve months.","sources":[{"clause":"2(f)(iii)","heading":null,"page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-2-f-iii"}],"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":"Applies afresh to any increase in sum insured; reduced by prior continuous coverage under portability. Cover after 24 months only if the disease was 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 Ensure Policy with us. ... In case of enhancement of Sum Insured the exclusion shall apply afresh to the extent of Sum Insured increase. ... waiting period for the same would be reduced to the extent of prior coverage.","sources":[{"clause":"1","heading":"Pre-existing Diseases waiting period (Excl01)","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-1-4"}],"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 or 36 months for some conditions)","note":"Three tiers: 12 months (ulcers, varicose veins, hydrocele, etc.), 24 months (cataract, hernia, mental illness, etc.), 36 months (joint replacement, spinal surgery, etc.). Not applicable to accidents.","quote":"excluded until the expiry of 12/24/36 months of continuous coverage after the date of inception of the first Health Ensure Policy with Us. This exclusion shall not be applicable for claims arising due to an accident. ... i) 12 Months Waiting period: ... ii) 24 Months Waiting Period: ... iii) 36 months Waiting Period:","sources":[{"clause":"2","heading":"Specified disease/procedure waiting period (Excl02)","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-2-4"},{"clause":"2(f)(i)","heading":null,"page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-2-f-i"},{"clause":"2(f)(ii)","heading":null,"page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-2-f-ii"},{"clause":"2(f)(iii)","heading":null,"page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-2-f-iii"}],"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":["12 months: Any types of gastric or duodenal ulcers","12 months: Surgery of varicose veins and varicose ulcers","12 months: Hydrocele","12 months: Undescended testes","12 months: Congenital internal diseases","12 months: Surgery for any skin ailment","24 months: Benign prostatic hypertrophy","24 months: All types of sinuses","24 months: Hemorrhoids","24 months: Dysfunctional uterine bleeding","24 months: Endometriosis","24 months: Stones in the urinary and biliary systems","24 months: Surgery on ears/tonsils/ adenoids/ paranasal sinuses","24 months: Cataracts","24 months: Hernia of all types","24 months: Fistulae, Fissure in ano","24 months: Fibromyoma","24 months: Hysterectomy","24 months: Surgery on all internal or external tumours/ cysts/ nodules/polyps of any kind including breast lumps with exception of Malignant tumor or growth","24 months: Mental Illness","24 months: Parkinson's Disease","24 months: Alzheimer Disease","36 months: Joint replacement surgery","36 months: Surgery for vertebral column disorders (unless necessitated due to an accident)","36 months: Surgery to correct deviated nasal septum","36 months: Hypertrophied turbinate","36 months: Gout and Rheumatism","36 months: Treatment for correction of eyesight due to refractive error greater than 7.5 diopters"],"display":"Ulcers, hernia, cataract, piles, stones, mental illness, joint replacement and others","note":null,"quote":"i) 12 Months Waiting period: 1. Any types of gastric or duodenal ulcers | 2. Surgery of varicose veins and varicose ulcers 3. Hydrocele | 4. Undescended testes 5. Congenital internal diseases | 6. Surgery for any skin ailment ... ii) 24 Months Waiting Period: 1. Benign prostatic hypertrophy | 10. Fistulae, Fissure in ano 2. All types of sinuses | 11. Fibromyoma 3. Hemorrhoids | 12. Hysterectomy 4. Dysfunctional uterine bleeding | 13. Surgery on all internal or external tumours/ cysts/ nodules/polyps of any kind including breast lumps with exception of Malignant tumor or growth. 5. Endometriosis | 14. Mental Illness 6. Stones in the urinary and biliary systems | 15. Parkinson's Disease 7. Surgery on ears/tonsils/ adenoids/ paranasal sinuses | 16. Alzheimer Disease 8. Cataracts, 9. Hernia of all types ... iii) 36 months Waiting Period: 1. Joint replacement surgery | 2. Surgery for vertebral column disorders (unless necessitated due to an accident 3. Surgery to correct deviated nasal septum | 4. Hypertrophied turbinate 5. Gout and Rheumatism | 6. Treatment for correction of eyesight due to refractive error ... with refractive error greater than 7.5 diopters","sources":[{"clause":"2(f)(i)","heading":null,"page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-2-f-i"},{"clause":"2(f)(ii)","heading":null,"page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-2-f-ii"},{"clause":"2(f)(iii)","heading":null,"page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-2-f-iii"}],"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":"Counted afresh from the date of enhancement for any increase in sum insured.","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":"4","heading":"Moratorium Period","page":10,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-4-6"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 13","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 8","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"portability","label":"Portability","section":"Renewal and rights","meaning":"Whether you can move this policy to another insurer and keep waiting-period credit.","status":"cross-checked","value":"Yes. The policy can be ported to another insurer with all family members, applying at least 30 days but not earlier than 60 days before renewal; continuity benefits in waiting periods are given as per IRDAI guidelines.","display":"Yes, apply 30 to 60 days before renewal; waiting-period credit given","note":"Migration to other products of the same insurer is also allowed (apply at least 30 days before renewal).","quote":"The Insured Person will have the option to port the policy to other insurers by applying to such insurer to port the entire policy along with all the members of the family, if any, at least 30 days before, but not earlier than 60 days from the policy renewal date as per IRDAI guidelines related to portability. If such person is presently covered and has been continuously covered without any lapses under any health insurance policy with an Indian General/Health insurer, the proposed Insured Person will get the accrued continuity benefits in waiting periods as per IRDAI guidelines on portability.","sources":[{"clause":"12","heading":"Portability","page":12,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-12-3"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 11","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.6","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, VII.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 24","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.4 and 1.5","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 10","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"lifelong_renewal","label":"Lifelong renewal","section":"Renewal and rights","meaning":"Whether the policy can be renewed for life without a maximum age.","status":"cross-checked","value":true,"display":"Yes","note":"Dependent children renew up to 35 years, then for life on a separate proposal form with the member as proposer. Renewal can be refused for established fraud, non-disclosure or misrepresentation.","quote":"18 years to Lifetime | Life time renewals** ... ** Subject to policy is renewed annually with us within the Grace period of 30 days from date of Expiry.","sources":[{"clause":"Section E(b)(iii)","heading":null,"page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-section-e-b-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 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. Loadings on renewal premium are at portfolio level, not based on an individual policy's claim experience.","display":"No individual claim-based loading","note":"Separate loading of 5% per adverse health condition (diabetes, hypertension, etc.) at proposal, maximum 25%. The brochure premium chart says a 6% increase on base rates applies every year.","quote":"For this policy, the loadings on renewal premium shall be at portfolio and not based upon any individual policy claim experience.","sources":[{"clause":"9(iv)","heading":null,"page":11,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-9-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)","Hazardous or Adventure Sports (Excl09)","Breach of law (Excl10)","Excluded Providers (Excl11)","Treatment for Alcoholism, drug or substance abuse (Excl12)","Treatments received in heath hydros, nature cure clinics, spas (Excl13)","Dietary supplements and substances that can be purchased without prescription (Excl14)","Refractive Error (Excl15)","Unproven Treatments (Excl16)","Sterility and Infertility (Excl17)","Maternity (Excl 18)","Dental treatment unless as a result of Accidental Bodily Injury to natural teeth","War, invasion, acts of foreign enemies","Circumcision unless required for the treatment of Illness or Accidental bodily injury","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","Intentional self-injury","Vaccination or inoculation unless forming a part of post bite treatment","All non-medical Items as per Annexure II","Any treatment received outside India","Treatment for any other system other than modern medicine (allopathy) and AYUSH therapies","Congenital external diseases or defects or anomalies, growth hormone therapy, stem cell implantation or surgery","Medical expenses where Inpatient care and medical supervision is not required"],"display":"Standard IRDAI exclusions (Excl04 onwards) plus the policy's own specific exclusions","note":"Terrorism is covered despite the war exclusion. The in-patient-care exclusion is printed in the CIS (and brochure), not the policy wording. Further exclusions apply to the optional Personal Accident cover.","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) ... Hazardous or Adventure Sports (Excl09) ... 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 ... (Excl13) ... Dietary supplements and substances that can be purchased without prescription ... (Excl14) ... Refractive Error (Excl15) ... 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 ... War, invasion, acts of foreign enemies ... Circumcision unless required for the treatment of Illness or Accidental bodily injury ... 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 ... Intentional self-injury ... Vaccination or inoculation unless forming a part of post bite treatment ... All non-medical Items as per Annexure II ... Any treatment received outside India ... Treatment for any other system other than modern medicine (allopathy) and AYUSH therapies ... Congenital external diseases or defects or anomalies, growth hormone therapy, stem cell implantation or surgery ... Medical expenses where Inpatient care and medical supervision is not required","sources":[{"clause":"2(f)(iii)","heading":null,"page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-2-f-iii"},{"clause":"2(b)(ii)","heading":null,"page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-2-b-ii"},{"clause":"4","heading":"Change-of-gender treatments (Excl07)","page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-4-4"},{"clause":"5","heading":"Cosmetic or plastic Surgery (Excl08)","page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-5-4"},{"clause":"6","heading":"Hazardous or Adventure Sports (Excl09)","page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-6-4"},{"clause":"7","heading":"Breach of law (Excl10)","page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-7-4"},{"clause":"8","heading":"Excluded Providers (Excl11)","page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-8-4"},{"clause":"9","heading":null,"page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-9-3"},{"clause":"10","heading":null,"page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-10-3"},{"clause":"11","heading":null,"page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-11-3"},{"clause":"12","heading":"Refractive Error (Excl15)","page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-12-2"},{"clause":"13","heading":"Unproven Treatments (Excl16)","page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-13-2"},{"clause":"14","heading":"Sterility and Infertility (Excl17)","page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-14-2"},{"clause":"15","heading":"Maternity (Excl 18)","page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-15-2"},{"clause":"1","heading":null,"page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-1-5"},{"clause":"2","heading":null,"page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-2-5"},{"clause":"3","heading":null,"page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-3-4"},{"clause":"4","heading":null,"page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-4-5"},{"clause":"5","heading":null,"page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-5-5"},{"clause":"6","heading":null,"page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-6-5"},{"clause":"7","heading":null,"page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-7-5"},{"clause":"8","heading":"All non-medical Items as per Annexure II provided in Policy Wordings","page":10,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-8-5"},{"clause":"9","heading":null,"page":10,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-9-4"},{"clause":"10","heading":"Treatment for any other system other than modern medicine (allopathy) and AYUSH therapies","page":10,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-10-4"},{"clause":"11","heading":null,"page":10,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-11-4"},{"clause":null,"heading":"Specific Exclusions","page":2,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/292#c-specific-exclusions"}],"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 refunded pro-rata for the unexpired period if no claim was made in the policy year; multi-year policies refund future years in full and the current year pro-rata if no claim. Medical examination expenses are deducted.","display":"Pro-rata refund if no claim in the policy year","note":"Instalment policies: pro-rata if no claim. No refund when the company cancels for misrepresentation, non-disclosure or fraud.","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. ... expenses incurred by the Company on medical examination of the Policyholder will also be deducted before refunding of premium.","sources":[{"clause":"10","heading":"Cancellation","page":11,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-10-5"}],"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":"The optional Personal Accident cover applies anywhere in the world, with payment in India in rupees.","quote":"For all other Covers of this Policy, We cover insured events arising during the Policy Period, as well as treatment availed, within India only.","sources":[{"clause":"Section E(b)(ii)","heading":null,"page":15,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-section-e-b-ii-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 porting. CIS says 'up to 30 days from the first inception of policy'. Refund less medical examination expenses and stamp duty.","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.","sources":[{"clause":"11","heading":"Free Look Period","page":12,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-11-5"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 5","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 5","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(1), 20(2)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(3) to 20(5)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, II.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grace_period","label":"Grace period","section":"Renewal and rights","meaning":"Days you get after the due date to pay without losing cover or continuity.","status":"cross-checked","value":{"unit":"days","amount":30},"display":"30 days (15 days for monthly instalments)","note":null,"quote":"The grace period of fifteen days (where premium is paid on a monthly instalments) and thirty days (where premium is paid in quarterly/half yearly/annual instalments) is available on the premium due date, to pay the premium. ... We shall condone a delay in renewal up to the Grace Period (30 days) from the due date of renewal","sources":[{"clause":"3","heading":"Premium Payment in Instalments (Wherever applicable)","page":10,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-3-5"},{"clause":"9(iii)","heading":null,"page":11,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-9-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":"Adults (self, spouse, parents, siblings, parents-in-law, aunt, uncle): 18 years with no maximum (lifetime). Dependent children and grandchildren: 3 months to 30 years.","display":"18 years to lifetime (adults); 3 months to 30 years (dependent children)","note":null,"quote":"Self, Spouse, Parents, Sister, Brother, Parents In law, | 18 years to Lifetime | Life time renewals** Health Ensure | Aunt Uncle, Dependent Children, Grandchildren. | 3 months to 30 years","sources":[{"clause":"Section E(b)(iii)","heading":null,"page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-section-e-b-iii"}],"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":["Single premium (1 year and long term policies)","Annual instalments (for long term policies only)","Half Yearly","Quarterly","Monthly"],"display":"Single payment, or annual (long-term policies only), half-yearly, quarterly or monthly instalments","note":"Single payment from the sales brochure. The long term policy discount does not apply where premium is paid in 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 ... Premium can be paid as a single installment for 1 year and long term policies.","sources":[{"clause":"3","heading":"Premium Payment in Instalments (Wherever applicable)","page":10,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-3-5"},{"clause":null,"heading":null,"page":1,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/293#c-s1"}],"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 Upgradation (Sum Insured 5 Lacs and above only)","Cumulative Bonus Enhancement","Sum Insured Reinstatement Benefit (Sum Insured 5 Lacs and above only)","Double Sum Insured for Cancer (Indemnity based) (Sum Insured 5 Lacs and above only)","Personal Accident"],"display":"Room rent upgrade, bonus enhancement, sum insured reinstatement, double SI for cancer, personal accident","note":"Personal Accident is for the proposer only (sales brochure). A voluntary co-payment of 10% or 20% can also be chosen for a 10% or 20% premium discount.","quote":"1. Room Rent Upgradation (Applicable for Sum Insured 5 Lacs and above only) ... 2. Cumulative Bonus Enhancement ... 3. Sum Insured Reinstatement Benefit (Applicable for Sum Insured 5 Lacs and above only) ... 4. Double Sum Insured for Cancer (Indemnity based) (Applicable for Sum Insured 5 Lacs and above only) ... 5. Personal Accident ... Personal Accident (Applicable to Self/Proposer only)","sources":[{"clause":"8(c)","heading":null,"page":6,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-8-c"},{"clause":"8(i)","heading":null,"page":6,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-8-i-2"},{"clause":"8(i)(i)","heading":null,"page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-8-i-i"},{"clause":null,"heading":null,"page":1,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/293#c-s1"}],"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":"Claims in the grace period are covered only where premium is paid in instalments during the policy period; otherwise coverage need not be available for the period for which no premium is received.","display":"Covered only for instalment payers","note":"Brochure says: 'Coverage is not available during the grace period.'","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":"3","heading":"Premium Payment in Instalments (Wherever applicable)","page":10,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-3-5"},{"clause":"17","heading":"Grace Period","page":2,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-17"}],"law":[]},{"key":"room_rent","label":"Room rent limit","section":"Limits and co-pay","meaning":"The most the policy pays per day for the hospital room, or the room category allowed. If you take a costlier room, other bills can be cut in proportion.","status":"cross-checked","value":"Room rent, boarding and nursing up to 1% of sum insured per day or INR 5,000, whichever is lower.","display":"1% of sum insured per day, up to INR 5,000","note":"Optional Room Rent Upgradation (sum insured 5 lakh and above) raises it to a single private AC room up to INR 10,000 per day.","quote":"Room Rent, Boarding and Nursing Expenses as provided by the Hospital maximum of 1% of Sum Insured per day or up to INR 5,000, whichever is lower.","sources":[{"clause":"1(i)","heading":null,"page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-1-i"}],"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":"The base cover sets a rupee limit, not a room type: 1% of sum insured per day up to INR 5,000. Only with the optional Room Rent Upgradation does the limit become a Single Private Air-Conditioned Room, not exceeding INR 10,000 per day.","display":"No room type in the base cover (rupee limit); single private AC room only with the optional upgrade","note":"The optional Room Rent Upgradation is only for sum insured 5 Lacs and above, for an extra premium.","quote":"maximum of 1% of Sum Insured per day or up to INR 5,000, whichever is lower. ... will be upgraded to “Single Private Air-Conditioned Room, not exceeding INR 10,000 per day”","sources":[{"clause":"1(i)","heading":null,"page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-1-i"},{"clause":"8(c)","heading":null,"page":6,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-8-c"}],"law":[]},{"key":"icu_limit","label":"ICU limit","section":"Limits and co-pay","meaning":"The most the policy pays per day for intensive care.","status":"cross-checked","value":"ICU charges up to 2% of sum insured per day or INR 10,000, whichever is lower.","display":"2% of sum insured per day, up to INR 10,000","note":"ICU at actuals with the optional Room Rent Upgradation.","quote":"ICU Charges- If admitted in ICU, we will pay ICU Charges as provided by the Hospital subject to maximum of 2% of Sum Insured per day or up to INR 10,000, whichever is lower.","sources":[{"clause":"1(ii)","heading":null,"page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-1-ii"}],"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":"cross-checked","value":"Yes. If the room rate exceeds the limit, all other hospital expenses except pharmacy/medicines, consumables, implants, medical devices and diagnostics are paid in the same proportion. Not applied where hospitals do not follow differential billing.","display":"Yes, except medicines, consumables, implants, devices and diagnostics","note":null,"quote":"In case of admission to a room at rates exceeding the limits as mentioned under (i), the reimbursement of all other expenses incurred at the Hospital, with the exception of cost of Pharmacy/medicines, consumables, implants, medical devices & diagnostics, shall be payable in the same proportion as the admissible rate per day bears to the actual rate per day of room rent charges. ... Proportionate deductions shall not apply in respect of the Hospitals which do not follow differential billings","sources":[{"clause":"1(a)","heading":null,"page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-1-a"},{"clause":"1(b)","heading":null,"page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-1-b"}],"law":[]},{"key":"copay","label":"Co-payment","section":"Limits and co-pay","meaning":"The share of every admissible claim you pay yourself, and when it applies (age, zone, choice of hospital).","status":"cross-checked","value":"No co-pay for Zone A premium payers. Zone B premium payers treated in a Zone A city pay 20% of the admissible claim (not for accidental hospitalisation). Voluntary co-pay of 10% or 20% only if opted.","display":"20% if you pay Zone B premium and are treated in a Zone A city; otherwise none unless opted","note":"Voluntary co-pay of 10% or 20% gives a 10% or 20% premium discount.","quote":"Policyholders paying Zone A premium rates can avail treatment allover India without any co-payment. ... But, those, who pay zone B premium rates and avail treatment in Zone A city will have to pay 20% ... This Co - payment will not be applicable for Accidental Hospitalization cases. ... Voluntary co-payment: If opted voluntarily by you, You shall bear 10%/ 20% of co-payment for each and every claim","sources":[{"clause":"Section E(b)","heading":null,"page":14,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-section-e-b-3"},{"clause":"Section E(b)(i)","heading":"Voluntary co-payment","page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-section-e-b-i"}],"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":null,"quote":"Deductible - Not applicable","sources":[{"clause":"15(g)","heading":null,"page":3,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/292#c-15-g"}],"law":[]},{"key":"disease_sublimits","label":"Disease or procedure sub-limits","section":"Limits and co-pay","meaning":"Caps on what is paid for named treatments (cataract, knee replacement...), even if the sum insured is higher.","status":"cross-checked","value":["Cataract (per eye): Rs. 20000 for sum insured Rs. 50000, 75000 and 1 lac","Cataract (per eye): Rs. 30000 for sum insured Rs. 1.5, 2 and 3 lacs","Cataract (per eye): Rs. 40000 for sum insured Rs. 4, 5 and 10 lacs"],"display":"Cataract: Rs. 20,000 to Rs. 40,000 per eye by sum insured","note":"Road ambulance is capped at INR 1,000 per hospitalisation; preventive health check-up 1% of sum insured up to INR 1,500.","quote":"Sum Insured | Rs. 50000, Rs. 75000 and Rs. 1lac | Rs. 1.5lacs, Rs. 2lacs and Rs. 3lacs | Rs. 4lacs, Rs. 5lacs and Rs. 10lacs Rs. Particulars Cataract (per eye) | Rs. 20000/- | Rs. 30000/- | Rs. 40000/-","sources":[{"clause":"Section E(b)(ii)","heading":null,"page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-section-e-b-ii"}],"law":[]},{"key":"pre_hospitalisation","label":"Pre-hospitalisation cover","section":"Cover","meaning":"Medical costs in the days before admission that are paid if related to the hospitalisation.","status":"cross-checked","value":{"unit":"days","amount":30},"display":"30 days","note":"Only for the same illness/injury and if the in-patient claim is accepted.","quote":"The Medical Expenses incurred during the 30 days immediately before you were Hospitalized","sources":[{"clause":"2","heading":"Pre-Hospitalization","page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-2-3"}],"law":[]},{"key":"post_hospitalisation","label":"Post-hospitalisation cover","section":"Cover","meaning":"Medical costs in the days after discharge that are paid if related to the hospitalisation.","status":"cross-checked","value":{"unit":"days","amount":60},"display":"60 days","note":"Only for the same illness/injury and if the in-patient claim is accepted.","quote":"The Medical Expenses incurred during the 60 days immediately after You were discharged post Hospitalization","sources":[{"clause":"3","heading":"Post-Hospitalization","page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-3-3"}],"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":"Covered for day care procedures taken in a hospital or day care centre, not in the outpatient department. Annexure I is an indicative list; other procedures needing less than 24 hours due to technological advances are also covered.","display":"Covered; Annexure I list is indicative, others also covered","note":null,"quote":"We will pay you the medical expenses as listed under Section C.I 1 “In-patient Hospitalization Treatment” for Day care procedures / Surgeries taken as an In-patient in a hospital or day care centre but not in the outpatient department. ... Above mentioned list is a indicative list of procedures, any other surgeries/procedures requiring less than 24 hours hospitalisation due to technological advances will also be covered under this policy","sources":[{"clause":"5","heading":"Day Care Procedures","page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-5-3"},{"clause":"Annexure I(ii)","heading":"Above mentioned list","page":22,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-annexure-i-ii"}],"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 Hospitalization is defined (Section B) but no benefit for it is listed among the covers.","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":"Covered up to the sum insured for in-patient AYUSH treatment of at least 24 hours in a recognised AYUSH hospital; room rent up to 1% of sum insured per day or INR 5000.","display":"Up to sum insured; room rent 1% of SI per day up to INR 5000","note":"Proportionate deduction applies (except medicines and consumables) if a costlier room is taken.","quote":"If You are Hospitalized for not less than 24 hours, in an AYUSH Hospital ... Room Rent, Boarding as provided by the Hospital maximum of 1% of Sum Insured per day or up to INR 5000, whichever is lower. ... Our maximum liability is up to Sum Insured per policy year.","sources":[{"clause":"8","heading":"AYUSH Hospitalization Expenses","page":6,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-8-3"},{"clause":"8(i)","heading":null,"page":6,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-8-i"},{"clause":"8(b)","heading":null,"page":6,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-8-b"}],"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":"Modern treatment methods listed in Annexure III (robotic surgery, oral chemotherapy, immunotherapy, stem cell therapy for haematological conditions and others) are covered up to the base sum insured.","display":"Covered up to base sum insured","note":null,"quote":"Modern Treatment Methods and Advancement in Technologies (Annexure III) are covered up to Base Sum Insured, subject to policy Terms, Conditions, coverage, Waiting Periods and exclusions. ... Oral chemotherapy ... Immunotherapy- Monoclonal Antibody to be given as injection ... Robotic surgeries ... Stem cell therapy: Hematopoietic stem cells for bone marrow transplant for haematological conditions to be covered","sources":[{"clause":"Section E(a)","heading":null,"page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-section-e-a"},{"clause":"4","heading":"Oral chemotherapy","page":26,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-4-7"},{"clause":"5","heading":"Immunotherapy- Monoclonal Antibody to be given as injection","page":26,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-5-7"},{"clause":"7","heading":"Robotic surgeries","page":26,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-7-7"},{"clause":"12","heading":"Stem cell therapy","page":26,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-12-4"}],"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, the donor's treatment for harvesting the organ is paid if the recipient's in-patient claim is accepted; the donor's pre and post-hospitalisation expenses are excluded.","display":"Yes, harvesting costs; donor pre/post-hospitalisation excluded","note":"Donation must comply with the Transplantation of Human Organs (Amendment) Bill, 2011.","quote":"We will pay expenses towards organ donor's treatment for harvesting of the donated organ, provided that, ... We have accepted an In-patient Hospitalization claim for the Insured Member ... The organ donors Pre and Post-Hospitalization expenses.","sources":[{"clause":"6","heading":"Organ Donor Expenses","page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-6-3"},{"clause":"6(ii)","heading":null,"page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-6-ii"},{"clause":"6(iii)","heading":null,"page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-6-iii"}],"law":[]},{"key":"ambulance","label":"Ambulance cover","section":"Cover","meaning":"Road (and air) ambulance cover and its limit.","status":"cross-checked","value":"Road ambulance up to INR 1000 per hospitalisation for a certified emergency, if the hospitalisation or day care claim is accepted. Air ambulance not mentioned.","display":"Road ambulance up to INR 1000 per hospitalisation","note":"Also covers transfer to a hospital with higher facilities. CIS says '1000 per hospitalization per Policy Year'.","quote":"We will pay the reasonable cost to a maximum of INR 1000 per Hospitalization incurred on an ambulance","sources":[{"clause":"4","heading":"Road Ambulance","page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#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 in a year, how much, how often, and whether it works for the same illness.","status":"cross-checked","value":"None unless the optional Sum Insured Reinstatement Benefit is chosen.","display":"None unless opted","note":"Optional (sum insured 5 lakh and above): 100% of base sum insured once per policy year after exhaustion; not for the same claim; 15-day gap for the same person; only once in lifetime for cancer and kidney failure on dialysis.","quote":"3. Sum Insured Reinstatement Benefit (Applicable for Sum Insured 5 Lacs and above only) In consideration of payment of additional premium ... then 100% of the Base Sum Insured specified under “In-patient Hospitalization Treatment” would be reinstated for the particular Policy Year","sources":[{"clause":"8(i)","heading":null,"page":6,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-8-i-2"}],"law":[]},{"key":"no_claim_bonus","label":"No-claim or cumulative bonus","section":"Cover","meaning":"How much the cover grows each year, the maximum, whether it depends on not claiming, and what happens after a claim.","status":"cross-checked","value":"Cumulative bonus of 5% of sum insured per claim-free year, up to 25% of sum insured; after a claim it is decreased by 5%, sum insured not reduced.","display":"5% per claim-free year, max 25%","note":"Optional Cumulative Bonus Enhancement: 25% per claim-free year up to 200%, not reduced if claims paid in a year do not exceed INR 100,000.","quote":"then We will increase the Limit of Indemnity by 5% of Sum Insured per annum as Cumulative Bonus. ... The maximum cumulative increase in the Limit of Indemnity will be limited to 25% of Sum Insured. ... In event of a claim under the Policy in a policy year, the cumulative bonus would be decreased by 5% after the completion of Policy year.","sources":[{"clause":"Section E(b)(ii)","heading":null,"page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-section-e-b-ii"},{"clause":"Section E(b)(iii)","heading":null,"page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-section-e-b-iii"}],"law":[]},{"key":"consumables","label":"Consumables and non-medical items","section":"Cover","meaning":"Gloves, PPE, syringes and other items hospitals bill that standard policies exclude; whether this policy pays them.","status":"cross-checked","value":"Not covered: non-medical items in Annexure II (e.g. gloves, masks, ECG electrodes) are excluded.","display":"Not covered (Annexure II non-medical items excluded)","note":"Consumables are excluded from proportionate deduction and AYUSH in-patient cover lists 'Medicines, drugs and consumables'.","quote":"All non-medical Items as per Annexure II provided in Policy Wordings ... GLOVES | Not Payable ... MASK | Not Payable","sources":[{"clause":"8","heading":"All non-medical Items as per Annexure II provided in Policy Wordings","page":10,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-8-5"},{"clause":null,"heading":"List I: List of Non-Medical Item","page":22,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-list-i-list-of-non-medical-item"}],"law":[]},{"key":"maternity","label":"Maternity cover","section":"Cover","meaning":"Whether childbirth costs are covered, the limit and the waiting period.","status":"cross-checked","value":"Not covered. Childbirth expenses, miscarriage (unless due to an accident) and lawful termination of pregnancy are excluded (Excl 18).","display":"Not covered","note":"Ectopic pregnancy is not excluded.","quote":"Maternity (Excl 18) ... Medical Treatment Expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred during hospitalization) except ectopic pregnancy. ... Expenses towards miscarriage (unless due to an accident) and lawful medical termination of pregnancy during the policy period.","sources":[{"clause":"15","heading":"Maternity (Excl 18)","page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-15-2"}],"law":[]},{"key":"newborn","label":"Newborn baby cover","section":"Cover","meaning":"Whether a newborn is covered from birth and for what.","status":"not-stated","value":null,"display":null,"note":"New Born Baby is defined (up to 90 days) but no newborn cover is stated. Dependent children can be insured from 3 months.","quote":null,"sources":[],"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 a 24-month waiting period.","display":"Covered up to base sum insured; 24-month waiting","note":"Annexure IV lists ICD codes for mental illness. Alcohol and substance abuse are excluded (Excl12).","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 ... ii) 24 Months Waiting Period: ... 14. Mental Illness","sources":[{"clause":"Section E(b)","heading":null,"page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-section-e-b"},{"clause":"2(f)(ii)","heading":null,"page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-2-f-ii"}],"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 preventive health check-up at the end of every continuous block of 3 years, reimbursed up to 1% of sum insured, maximum INR 1500 per member; floater: proposer and spouse only.","display":"Every 3 years, 1% of SI up to INR 1500","note":"Does not reduce the sum insured.","quote":"At the end of block of every continuous period of 3 years during which You have held Our Health Ensure Policy, You are eligible for a free Preventive Health checkup. We will reimburse the amount equal to 1% of the Sum Insured maximum up to INR 1500 for each Insured Member in Individual policy during the block of 3 years. This benefit can be availed by proposer & spouse only under Floater Sum Insured Policies","sources":[{"clause":"7","heading":"Preventive Health Check Up","page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-7-3"}],"law":[]},{"key":"opd","label":"Out-patient (OPD) cover","section":"Cover","meaning":"Doctor consultations, tests and medicines without admission, and the limit.","status":"cross-checked","value":"Not covered: day care is paid only when not in the outpatient department, and expenses where in-patient care is not required are excluded.","display":"Not covered","note":null,"quote":"but not in the outpatient department ... Medical expenses where Inpatient care and medical supervision is not required","sources":[{"clause":"5","heading":"Day Care Procedures","page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-5-3"},{"clause":null,"heading":"Specific Exclusions","page":2,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/292#c-specific-exclusions"}],"law":[]},{"key":"zone_pricing","label":"Zone or city-based premium","section":"Premium","meaning":"Whether premium or co-pay depends on the city you are treated in.","status":"cross-checked","value":"Yes. Zone A cities (Delhi/NCR, Mumbai region, Hyderabad and Secunderabad, Kolkata, Ahmedabad, Vadodara, Surat) and Zone B (rest of India) have different premiums; Zone B payers treated in Zone A pay 20% co-pay.","display":"Yes, Zone A and Zone B; 20% co-pay for Zone B payers treated in Zone A","note":"Not for accidental hospitalisation. Zone B residents may pay Zone A premium to avoid the co-pay.","quote":"Zone A “Following cities has been clubbed in Zone A:- Delhi / NCR, Mumbai including (Navi Mumbai, Thane and Kalyan), Hyderabad and Secunderabad, Kolkata, Ahmedabad, Vadodara and Surat. Zone B Rest of India apart from Zone cities are classified as Zone B. ... But, those, who pay zone B premium rates and avail treatment in Zone A city will have to pay 20%","sources":[{"clause":"Section E(b)","heading":null,"page":14,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-section-e-b-3"}],"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 hospital definition. Pre-authorisation needed.","display":"Yes, network hospitals and also non-network hospitals ('Cashless Everywhere')","note":"CIS says: 'Cashless treatment is only available at Network Hospitals'. The CIS states the policy wording prevails.","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":"Section E","heading":"CONDITIONS -OTHER TERMS AND CLAUSES","page":15,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-section-e-3"},{"clause":"Section E(iv)","heading":null,"page":15,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-section-e-iv"},{"clause":"15(g)","heading":null,"page":3,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/292#c-15-g"}],"law":[]},{"key":"claims_handled_by","label":"Claims handled by","section":"Claims","meaning":"The insurer itself or a third-party administrator (TPA).","status":"cross-checked","value":"The insurer's in-house claims team; no TPA.","display":"In-house, no TPA","note":null,"quote":"All Claims will be settled by In house claims settlement team of the company and no TPA is engaged.","sources":[{"clause":"Section E","heading":"CONDITIONS -OTHER TERMS AND CLAUSES","page":15,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-section-e-3"}],"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 sum insured basis also available.","quote":"For the purpose of Family Floater- includes the insured; his/her lawfully wedded spouse and dependent children. For Parents and parents In laws separate floater policy can be taken.","sources":[{"clause":"5","heading":"Family","page":4,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291#c-5-2"}],"law":[]}],"documents":[{"kind":"wording","label":"Health Ensure Policy Wordings","pages":27,"fetched_at":"2026-10-16 08:29:39.654263+00","source_url":"https://www.bajajgeneralinsurance.com/download-documents/health-insurance/Health-PW/Health_Ensure_PW.pdf","url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/291"},{"kind":"cis","label":"Health Ensure Customer Information Sheet","pages":7,"fetched_at":"2026-10-16 08:29:39.654263+00","source_url":"https://www.bajajgeneralinsurance.com/download-documents/health-insurance/Health-CIS/Health-Ensure_CIS.pdf","url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/292"},{"kind":"brochure","label":"Health Ensure Brochure","pages":26,"fetched_at":"2026-10-16 08:29:39.654263+00","source_url":"https://www.bajajgeneralinsurance.com/download-documents/health-insurance/health-ensure/health_ensure.pdf","url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324/document/293"}],"versions":[{"uin":"BAJHLIP21127V032021","version":null,"approved_on":null},{"uin":"BAJHLIP24149V062324","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 Ensure (UIN BAJHLIP24149V062324), IndiaInsurances, https://indiainsurances.com/policy/bajaj-general-insurance/health-ensure-bajhlip24149v062324"}