{"uin":"BAJHLIP26073V082526","name":"Health Guard","url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526","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":"2020-07-09","withdrawn_on":null,"summary":"Health Guard is a Bajaj General indemnity health policy sold as Individual or Family Floater in Silver, Gold and Platinum plans, for 1, 2 or 3 years, covering treatment within India only. It pays pre-hospitalisation for 60 days and post-hospitalisation for 90 days, has a 30-day initial waiting period, a 36-month pre-existing disease waiting period and a 24-month specific illness waiting period, and offers maternity cover only in Gold and Platinum after 72 months.","analysis":{"state":"extracted","analysed_at":"2026-10-16 04:48:11.690312+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":"quote-verified","value":["Silver Plan","Gold Plan","Platinum Plan"],"display":"Silver, Gold and Platinum plans","note":"Each can be taken as Health Guard-Individual or Health Guard-Family Floater (policy types, not plans).","quote":"Silver Plan: ... Gold Plan and Platinum Plan: ... Waiting Period (Applicable for Silver, Gold and Platinum Plan) ... Health Guard-Individual. ... Health Guard-Family Floater.","sources":[{"clause":"1","heading":"In-patient Hospitalization Treatment","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-1-3"},{"clause":"Section D","heading":"EXCLUSIONS UNDER THE POLICY-STANDARD EXCLUSIONS","page":12,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-section-d"},{"clause":"Section C","heading":"COVERAGE","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#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":"1 year, 2 years or 3 years, for both Individual and Family Floater policies.","display":"1 year, 2 years or 3 years","note":"Long term policy discount: 4% for 2 years, 8% for 3 years (not for instalment premiums).","quote":"Health Guard-Individual: 1year, 2 years or 3 years. ... Health Guard-Family Floater: 1year, 2 years or 3 years.","sources":[{"clause":"Section C","heading":"COVERAGE","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#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 within 24 hours for cashless or within 48 hours for reimbursement. Reimbursement documents within 30 days of discharge.","display":"48 hours before planned admission; emergency within 24 hours (cashless) or 48 hours (reimbursement)","note":"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 some-one 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. ... within 30 days of discharge from a Hospital give Us the documentation","sources":[{"clause":"Section E(ii)","heading":null,"page":23,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-section-e-ii-2"},{"clause":"Section E(iii)","heading":null,"page":23,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-section-e-iii-2"},{"clause":"Section E(x)","heading":null,"page":23,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#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":["Claim form with NEFT details & cancelled cheque duly signed by Insured Person","Original/Attested copies of Discharge Summary / Discharge Certificate / Death Summary with Surgical & anesthetics notes","Attested copies of Indoor case papers, if available","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","Treating Medical Practitioner certificate to transfer the Injured person to a higher medical Centre (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, discharge summary, bills and receipts, investigation reports, first consultation letter and others","note":"In case of death, a copy of the post mortem report (if any) within 30 days.","quote":"Claim form with NEFT details & cancelled cheque duly signed by Insured Person. ... Original/Attested copies of Discharge Summary / Discharge Certificate / Death Summary with Surgical & anesthetics notes. ... Attested copies of Indoor case papers, if available. ... 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. 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(x)","heading":null,"page":23,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#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":"conflicting","value":"The insurer settles or rejects a claim within 15 days from receipt of the last necessary document; delay attracts interest at 2% above the bank rate.","display":"Within 15 days of the last necessary document","note":"CIS says: 'TAT for claim settlement: 15 Working Days'. Where investigation is needed it must finish within 30 days and the claim is still settled or rejected within 15 days of the last document. 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. ... TAT for claim settlement: 15 Working Days","sources":[{"clause":"3(i)","heading":null,"page":16,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-3-i"},{"clause":null,"heading":"Waiting Period for Maternity Expenses (Applicable only for Gold and","page":4,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/5#c-waiting-period-for-maternity-expenses-applicable"}],"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":"quote-verified","value":["Pre-existing Diseases waiting period, 36 months (Excl01)","Specified disease/procedure waiting period, 24 months (Excl02)","30-day waiting period (Excl03)","Treatment outside India","Investigation & Evaluation (Excl04)","Obesity/Weight Control (Excl06)","Change-of-gender treatments (Excl07)","Cosmetic or plastic Surgery (Excl08)","Alcoholism, drug or substance abuse (Excl12)","Unproven Treatments (Excl16)","Sterility and Infertility (Excl17)","Maternity (Excl18), Silver Plan only","War, invasion, acts of foreign enemies","Intentional self-Injury","All non-medical Items as per Annexure II"],"display":"Waiting periods (pre-existing diseases, listed conditions, first 30 days), treatment outside India, cosmetic surgery, obesity, infertility, alcoholism, war, self-injury, non-medical items and others","note":"Some listed procedures wait the first three consecutive annual periods; maternity (Gold and Platinum) waits 72 months. Other standard exclusions: rest cure (Excl05), breach of law (Excl10), excluded providers (Excl11).","quote":"Pre-existing Diseases waiting period (Excl01) ... until the expiry of 36 months of continuous coverage ... Specified disease/procedure waiting period (Excl02) ... until the expiry of 24 months of continuous coverage ... 30-day waiting period (Excl03) ... Investigation & Evaluation (Excl04) ... Obesity/Weight Control (Excl06) ... Change-of-gender treatments (Excl07) ... Cosmetic or plastic Surgery (Excl08) ... Treatment for Alcoholism, drug or substance abuse or any addictive condition and consequences thereof. (Excl12) ... Unproven Treatments (Excl16) ... Sterility and Infertility (Excl17) ... Maternity (Excl18) (Applicable for Silver Plan only) ... War, invasion, acts of foreign enemies ... Intentional self-Injury ... All non-medical Items as per Annexure II. ... Any treatment received outside India is not covered under this Policy. ... first three consecutive annual periods ... Waiting period of 72 months","sources":[{"clause":"1","heading":"Pre-existing Diseases waiting period (Excl01)","page":12,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-1-4"},{"clause":"2","heading":"Specified disease/procedure waiting period (Excl02)","page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-2-4"},{"clause":"2(a)","heading":null,"page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-2-a"},{"clause":"3","heading":null,"page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-3-4"},{"clause":"3(b)(ii)","heading":null,"page":14,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-3-b-ii"},{"clause":"4","heading":"Change-of-gender treatments (Excl07)","page":14,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-4-4"},{"clause":"5","heading":"Cosmetic or plastic Surgery (Excl08)","page":14,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-5-4"},{"clause":"8","heading":null,"page":14,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-8-4"},{"clause":"12","heading":"Unproven Treatments (Excl16)","page":14,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-12-4"},{"clause":"13","heading":"Sterility and Infertility (Excl17)","page":15,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-13-4"},{"clause":"14","heading":"Maternity (Excl18) (Applicable for Silver Plan only)","page":15,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-14-4"},{"clause":"1","heading":null,"page":15,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-1-5"},{"clause":"14","heading":"Maternity Expenses (Applicable for Gold and Platinum Plan only)","page":11,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-14-3"}],"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), then to the Grievance Redressal Officer at ggro@bajajgeneral.com, then the care specialist line, before the Insurance Ombudsman. Toll-free 1-800-209-5858, branches and the website are also available.","display":"Level 1: careforyou@bajajgeneral.com; Level 2: Grievance Redressal Officer ggro@bajajgeneral.com","note":"Level 3: missed call on +91 80809 45060 or SMS to 575758. Toll-free 1-800-209-5858 or 020-30305858.","quote":"Our toll-free number 1-800-209-5858 or 020-30305858 ... Level 1: Write to careforyou@bajajgeneral.com and for senior citizens to seniorcitizen@bajajgeneral.com ... Level 2: In case you are not satisfied with the response given to you at Level 1 you may write to our Grievance Redressal Officer at ggro@bajajgeneral.com","sources":[{"clause":"16","heading":"Grievance Redressal Procedure","page":18,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-16-4"},{"clause":"16(a)","heading":"Level 1","page":19,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-16-a"},{"clause":"16(b)","heading":"Level 2","page":19,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-16-b"}],"law":[{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 3","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 4","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 5","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(11)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(42)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 34","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 69","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Insurance Act, 1938","section":"Section 38","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 12","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 19","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 20","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 13","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 2","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(5), 5(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(9)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 25","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 26","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 11","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 3","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 13","url":"https://indiainsurances.com/law/ombudsman-rules-2017"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 14","url":"https://indiainsurances.com/law/ombudsman-rules-2017"}]},{"key":"sum_insured_options","label":"Sum insured options","section":"Cover","meaning":"The cover amounts you can choose from.","status":"cross-checked","value":"Base Sum Insured from 3 lacs up to 1 Crore; the documents list 5L, 7.5L, 10L, 15L, 20L, 25L, 30L, 35L, 40L, 45L, 50L, 75L and 1Cr.","display":"3 lacs to 1 Crore","note":"No single table of sum insured options; the range is read from the room rent bands and the Air Ambulance table. Whether 3 lacs is available on the Silver Plan is not stated.","quote":"Sum Insured 3 lacs to 7.5 lacs ... Base Sum Insured | 5L | 7.5L | 10L | 15L | 20L | 25L | 30L | 35L | 40L | 45L | 50L | 75L | 1Cr","sources":[{"clause":"1","heading":"In-patient Hospitalization Treatment","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-1-3"},{"clause":"18","heading":"Air Ambulance (Optional available for SI 5Lacs and above)","page":12,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-18-3"}],"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","sources":[{"clause":"3","heading":null,"page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-3-4"}],"law":[]},{"key":"ped_waiting","label":"Pre-existing disease waiting period","section":"Waiting periods","meaning":"How long you wait before conditions you already had when you bought the policy are covered. The law caps it at 36 months.","status":"cross-checked","value":{"unit":"months","amount":36},"display":"36 months","note":"Reduced by prior continuous coverage under portability; applies afresh to any Sum Insured increase.","quote":"Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications shall be excluded until the expiry of 36 months of continuous coverage after the date of inception of the first Health Guard Policy with us.","sources":[{"clause":"1","heading":"Pre-existing Diseases waiting period (Excl01)","page":12,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#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":24},"display":"24 months","note":"A second list (joint replacement, vertebral column surgery, deviated nasal septum, bariatric surgery, Parkinson's disease and others) waits for the first three consecutive annual periods (36 months). Not applicable to accident claims.","quote":"Expenses related to the treatment of the listed Conditions, surgeries/treatments shall be excluded until the expiry of 24 months of continuous coverage after the date of inception of the first Health Guard Policy with Us.","sources":[{"clause":"2(a)","heading":null,"page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-2-a"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.7","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"specific_waiting_list","label":"Illnesses with a specific waiting period","section":"Waiting periods","meaning":"The named illnesses and procedures that carry the specific waiting period.","status":"cross-checked","value":["Any type gastrointestinal ulcers","Cataracts","Any type of fistula","Macular Degeneration","Benign prostatic hypertrophy","Hernia of all types","All types of sinuses","Fissure in ano","Hemorrhoids, piles","Hydrocele","Dysfunctional uterine bleeding","Fibromyoma","Endometriosis","Hysterectomy","Uterine Prolapse","Stones in the urinary and biliary systems","Surgery on ears / tonsils / adenoids / paranasal sinuses","Surgery on all internal or external tumors / cysts / nodules / polyps of any kind including breast lumps with exception of Malignant tumor or growth","Mental Illness","Diseases of gall bladder including cholecystitis","Pancreatitis","All forms of Cirrhosis","Gout and rheumatism","Tonsillitis","Surgery for varicose veins and varicose ulcers","Chronic Kidney Disease","Alzheimer’s Disease","Joint replacement surgery (three years)","Surgery for vertebral column disorders (unless necessitated due to an Accident) (three years)","Surgery to correct deviated nasal septum (three years)","Hypertrophied turbinate (three years)","Congenital internal diseases or anomalies (three years)","Treatment for correction of eye sight due to refractive error greater or equal to 7.5 (three years)","Bariatric Surgery (three years)","Parkinson’s Disease (three years)","Genetic disorders (three years)"],"display":"27 conditions at 24 months, plus 9 at three years","note":"The first 27 wait 24 months; the last 9 wait for the first three consecutive annual periods (CIS: 36 months).","quote":"1. Any type gastrointestinal ulcers | 2. Cataracts, ... 3. Any type of fistula | 4. Macular Degeneration ... 5. Benign prostatic hypertrophy | 6. Hernia of all types ... 7. All types of sinuses | 8. Fissure in ano ... 9. Hemorrhoids, piles | 10. Hydrocele ... 11. Dysfunctional uterine bleeding | 12. Fibromyoma ... 13. Endometriosis | 14. Hysterectomy ... 15. Uterine Prolapse | 16. Stones in the urinary and biliary systems ... 17. Surgery on ears / tonsils / adenoids / paranasal sinuses | 18. Surgery on all internal or external tumors / cysts / nodules / polyps of any kind including breast lumps with exception of Malignant tumor or growth. ... 19. Mental Illness | 20. Diseases of gall bladder including cholecystitis ... 21. Pancreatitis | 22. All forms of Cirrhosis ... 23. Gout and rheumatism | 24. Tonsillitis ... 25. Surgery for varicose veins and varicose ulcers | 26. Chronic Kidney Disease ... 27. Alzheimer’s Disease ... Any Medical Expenses incurred during the first three consecutive annual periods during which You have the benefit of a Health Guard Policy with Us in connection with: ... a) Joint replacement surgery. ... b) Surgery for vertebral column disorders (unless necessitated due to an Accident). ... c) Surgery to correct deviated nasal septum. ... d) Hypertrophied turbinate. ... e) Congenital internal diseases or anomalies. ... f) Treatment for correction of eye sight due to refractive error recommended by Ophthalmologist for medical reasons with refractive error greater or equal to 7.5. ... g) Bariatric Surgery. ... h) Parkinson’s Disease. ... i) Genetic disorders.","sources":[{"clause":"2(f)","heading":null,"page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-2-f"},{"clause":"3","heading":null,"page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-3-4"}],"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":"sixty months","note":"For an enhanced Sum Insured, the sixty months run from the date of enhancement on the enhanced part only.","quote":"After completion of sixty continuous months of coverage (including portability and migration) in this Policy, no Policy and Claim shall be contestable by Us on grounds of non-disclosure, misrepresentation, except on grounds of established fraud. ... completion of 60 continuous months would be applicable from date of enhancement of sums insured only on the enhanced limits","sources":[{"clause":"12","heading":"Moratorium Period","page":18,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-12-5"},{"clause":null,"heading":"Waiting Period for Maternity Expenses (Applicable only for Gold and","page":4,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/5#c-waiting-period-for-maternity-expenses-applicable"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 13","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 8","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"portability","label":"Portability","section":"Renewal and rights","meaning":"Whether you can move this policy to another insurer and keep waiting-period credit.","status":"cross-checked","value":"Yes. The policy can be ported to another insurer by applying at least 30 days, but not earlier than 60 days, before renewal, with accrued continuity benefits in waiting periods as per IRDAI guidelines.","display":"Yes, apply 30 to 60 days before renewal; waiting-period credit kept","note":"Migration to other products of the insurer is also allowed, applying 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 60days from the policy renewal date ... the proposed Insured Person will get the accrued continuity benefits in waiting periods as per IRDAI guidelines on portability.","sources":[{"clause":"9","heading":"Portability","page":17,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-9-5"}],"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","note":"No maximum renewal age is stated; renewal can be refused only for established fraud, non-disclosure or misrepresentation, or if the product is withdrawn.","quote":"Your Policy shall be renewable except on grounds of established fraud or non-disclosure or misrepresentation by You, provided this policy is not withdrawn ... Adults 18 yrs to Lifelong.","sources":[{"clause":"10(i)","heading":null,"page":17,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-10-i"},{"clause":"9","heading":"Named Insured/ Insured / Insured Person","page":6,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-9-2"}],"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 premium loadings are applied at portfolio level and not based on individual claim experience; renewal cannot be denied because of claims.","display":"No loading for individual claims","note":"Medical underwriting loading of up to 200% at issue may continue at renewals.","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","sources":[{"clause":"10(iv)","heading":null,"page":17,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-10-iv"},{"clause":"10(ii)","heading":null,"page":17,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-10-ii"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 10","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on 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":["Excl04 Investigation & Evaluation","Excl05 Rest Cure, rehabilitation and respite care","Excl06 Obesity/Weight Control","Excl07 Change-of-gender treatments","Excl08 Cosmetic or plastic Surgery","Excl10 Breach of law","Excl11 Excluded Providers","Excl12 Alcoholism, drug or substance abuse","Excl13 Treatments in health hydros, nature cure clinics, spas","Excl14 Dietary supplements","Excl15 Refractive Error","Excl16 Unproven Treatments","Excl17 Sterility and Infertility","Excl18 Maternity (Silver Plan only)","Cosmetic dental treatment, dentures, implants, orthodontics unless due to Accidental Bodily Injury","Medical Expenses where Inpatient care is not warranted","War, invasion, acts of foreign enemies","Spectacles, contact lenses, hearing aids and other external appliances","External medical equipment used at home","Congenital external diseases or defects or anomalies, growth hormone therapy","Intentional self-Injury","Vaccination or inoculation (except post bite or medically necessary)","All non-medical Items as per Annexure II","Treatment received outside India","Circumcision unless required for treatment","Treatment for any other system other than modern medicine (allopathy) and AYUSH"],"display":"Excl04 to Excl08, Excl10 to Excl18 (Excl18 Silver only), plus 12 specific exclusions","note":"Excl09 is not listed. Excl01 to Excl03 are waiting periods, not permanent exclusions. Excl18 (maternity) applies to the Silver Plan only.","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) ... nature cure clinics, spas or similar establishments ... (Excl13) ... Dietary supplements and substances that can be purchased without prescription ... (Excl14) ... Refractive Error (Excl15) ... Unproven Treatments (Excl16) ... Sterility and Infertility (Excl17) ... Maternity (Excl18) (Applicable for Silver Plan only) ... 1. Any dental treatment that comprises of cosmetic surgery, dentures, dental prosthesis, dental implants, orthodontics ... 2. Medical Expenses where Inpatient care is not warranted ... 3. War, invasion, acts of foreign enemies ... 4. The cost of spectacles, contact lenses, hearing aids ... 5. External medical equipment of any kind used at home ... 6. Congenital external diseases or defects or anomalies, growth hormone therapy ... 7. Intentional self-Injury ... 8. Vaccination or inoculation ... 9. All non-medical Items as per Annexure II. ... 10. Any treatment received outside India is not covered under this Policy. ... 11. Circumcision unless required for the treatment of Illness or Accidental bodily Injury. ... 12. Treatment for any other system other than modern medicine (allopathy) and AYUSH therapies.","sources":[{"clause":"3","heading":null,"page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-3-4"},{"clause":"3(b)(ii)","heading":null,"page":14,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-3-b-ii"},{"clause":"4","heading":"Change-of-gender treatments (Excl07)","page":14,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-4-4"},{"clause":"5","heading":"Cosmetic or plastic Surgery (Excl08)","page":14,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-5-4"},{"clause":"6","heading":"Breach of law (Excl10)","page":14,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-6-4"},{"clause":"7","heading":"Excluded Providers (Excl11)","page":14,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-7-4"},{"clause":"8","heading":null,"page":14,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-8-4"},{"clause":"9","heading":null,"page":14,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-9-4"},{"clause":"11","heading":"Refractive Error (Excl15)","page":14,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-11-4"},{"clause":"12","heading":"Unproven Treatments (Excl16)","page":14,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-12-4"},{"clause":"13","heading":"Sterility and Infertility (Excl17)","page":15,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-13-4"},{"clause":"14","heading":"Maternity (Excl18) (Applicable for Silver Plan only)","page":15,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-14-4"},{"clause":"1","heading":null,"page":15,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-1-5"}],"law":[{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 16","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"cancellation_refund","label":"Cancellation by you","section":"Renewal and rights","meaning":"What you get back if you cancel during the year.","status":"cross-checked","value":"On 7 days written notice, the premium for the unexpired period is refunded pro-rata, provided no claim has been made in the policy year; for multi-year policies, policy years not yet started are refunded in full. Medical examination expenses are deducted if risk has commenced.","display":"Pro-rata refund for the unexpired period if no claim in the policy year","note":"Instalment premium policies: pro-rata refund for the unexpired risk period if no claim in the policy year.","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":"7","heading":"Cancellation","page":16,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-7-5"}],"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":null,"quote":"We cover Medical Expenses for treatment availed within India only.","sources":[{"clause":"Section E(b)(iii)","heading":null,"page":22,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-section-e-b-iii-3"}],"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":"Thirty days from receipt of the policy document","note":"New individual policies only, not renewals or ported/migrated policies. Refund less medical examination and stamp duty, or proportionate risk premium if risk has commenced. CIS counts the 30 days from first inception rather than receipt.","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":"15","heading":"Free Look Period","page":18,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-15-4"},{"clause":null,"heading":"Waiting Period for Maternity Expenses (Applicable only for Gold and","page":4,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/5#c-waiting-period-for-maternity-expenses-applicable"}],"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","note":"Fifteen days where premium is paid in monthly instalments.","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","sources":[{"clause":"10(iii)","heading":null,"page":17,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-10-iii"},{"clause":"13","heading":"Premium Payment in Instalments (Wherever applicable)","page":18,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-13-5"}],"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":"Adults from 18 yrs with no upper entry age (Lifelong); dependent children and grandchildren from 3 months to 30 yrs.","display":"Adults 18 yrs to Lifelong; dependent children 3 months to 30 yrs","note":"The Dependent child definition separately says a child is a dependent until his 35th birthday if financially dependent.","quote":"Adults 18 yrs to Lifelong. ... Dependent Children/Grandchildren: 3 months – 30 yrs.","sources":[{"clause":"9","heading":"Named Insured/ Insured / Insured Person","page":6,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-9-2"}],"law":[]},{"key":"premium_modes","label":"Premium payment options","section":"Premium","meaning":"How often you can pay: yearly, half-yearly, quarterly, monthly.","status":"cross-checked","value":["Full premium at policy inception","Annual instalments (long term policies only)","Half Yearly","Quarterly","Monthly"],"display":"Full premium, or instalments: Annual (long term only), Half Yearly, Quarterly, Monthly","note":"Instalment option applies wherever applicable; in the event of a claim all remaining instalments become due.","quote":"Cancellation of policy where full premium received at policy inception ... If the Insured Person has opted for Payment of Premium on an instalment basis i.e. Annual (for long term polices only), Half Yearly, Quarterly or Monthly","sources":[{"clause":"7","heading":"Cancellation","page":16,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-7-5"},{"clause":"13","heading":"Premium Payment in Instalments (Wherever applicable)","page":18,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-13-5"}],"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":"quote-verified","value":["Air Ambulance (SI 5Lacs and above)","Voluntary co-payment","Voluntary Aggregate Deductible","Room Rent capping"],"display":"Air Ambulance, voluntary co-payment, voluntary aggregate deductible, room rent capping","note":"Air Ambulance is bought for additional premium and only for SI 5 lacs and above. Voluntary co-payment (10%/ 20%) earns a 10% or 20% premium discount; voluntary deductible of ₹ 50,000 / ₹ 100000 / ₹ 200000 / ₹ 300000 a year; room rent capping (1.5% of Sum Insured up to ₹ 7,500 per day, Gold and Platinum) earns a discount.","quote":"Air Ambulance (Optional available for SI 5Lacs and above) ... In consideration of payment of additional premium ... Voluntary co-payment: ... If opted voluntarily by You, You shall bear 10%/ 20% of co-payment ... Voluntary Aggregate Deductible: ... in excess of the Annual Aggregate Deductible limit of ₹ 50,000 / ₹ 100000 / ₹ 200000 / ₹ 300000, as opted by You ... If opted voluntarily and mentioned on the Policy Schedule that a Co-payment is effective by the Insured Person then Insured Person will be eligible of additional 10% or 20% discount on the Policy premium. ... Room Rent capping discount: If You opt for this cover You will be entitled for a per day room rent limit of 1.5% of hospitalization Sum Insured up to maximum ₹ 7,500 per day. ... Base SI | Gold Plan | Platinum Plan","sources":[{"clause":"18","heading":"Air Ambulance (Optional available for SI 5Lacs and above)","page":12,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-18-3"},{"clause":"Section E(b)(i)","heading":null,"page":20,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-section-e-b-i"},{"clause":"Section E(b)(ii)","heading":null,"page":20,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-section-e-b-ii"},{"clause":"Section E(a)","heading":null,"page":21,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-section-e-a-3"},{"clause":"Section E(b)","heading":null,"page":21,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-section-e-b-4"}],"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":"quote-verified","value":"No cover for the period for which no premium is received; where premium is paid in instalments, cover continues during the grace period.","display":"No cover for the unpaid period; instalment payers stay covered during the grace period","note":"Renewal within the grace period keeps all accrued credits (waiting periods, bonus, moratorium).","quote":"Coverage is not available for the period for which no premium is received. ... Coverage shall be available during the Grace period, if the premium is paid in Instalments during the Policy Period on due date. ... If the premium is paid in instalments during the policy period, coverage will be available for the grace period also. ... If the policy is renewed during grace period, all the credits (sum insured, No Claim Bonus, Specific Waiting periods, waiting periods for pre-existing diseases, Moratorium period etc.) accrued under the policy shall be protected.","sources":[{"clause":"17","heading":"Grace Period","page":2,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-17"},{"clause":"13","heading":"Premium Payment in Instalments (Wherever applicable)","page":18,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-13-5"}],"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":"Silver Plan: up to 1% of Sum Insured per day. Gold and Platinum: Single Private Air-Conditioned room for Sum Insured 3 lacs to 7.5 lacs; any room category for Sum Insured 10 Lacs and above.","display":"Silver: 1% of Sum Insured per day; Gold/Platinum: Single Private AC room (SI 3 to 7.5 lacs) or any room (SI 10 Lacs and above)","note":"Optional room rent capping (for a premium discount): 1.5% of Sum Insured up to Rs. 7,500 per day.","quote":"Silver Plan: ... Up to 1% of Sum Insured per day (Excluding Cumulative Bonus). ... Sum Insured 3 lacs to 7.5 lacs- maximum eligible room is Single Private Air-Conditioned room. ... Sum Insured 10 Lacs and above - eligible for any room category.","sources":[{"clause":"1","heading":"In-patient Hospitalization Treatment","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-1-3"}],"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":"quote-verified","value":"Gold and Platinum: maximum Single Private Air-Conditioned room for Sum Insured 3 lacs to 7.5 lacs, any room category for Sum Insured 10 Lacs and above. Silver Plan has a rupee limit (1% of Sum Insured per day), not a room category.","display":"Gold/Platinum: Single Private AC room (SI 3 to 7.5 lacs), any room (SI 10 Lacs and above); Silver: 1% of Sum Insured per day","note":"Single Private Room is the most economical single occupancy AC room with attached washroom, not a suite. CIS shows 'At Actuals' for SI 10 Lacs and above.","quote":"Silver Plan: ... Up to 1% of Sum Insured per day (Excluding Cumulative Bonus). ... Gold Plan and Platinum Plan: ... Sum Insured 3 lacs to 7.5 lacs- maximum eligible room is Single Private Air-Conditioned room. ... Sum Insured 10 Lacs and above - eligible for any room category. ... Single Private Room means a single occupancy air-conditioned room with an attached washroom/toilet. Such room must be the most economical of all accommodation available as single occupancy in that hospital and excludes a suite.","sources":[{"clause":"1","heading":"In-patient Hospitalization Treatment","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-1-3"},{"clause":"15","heading":"Single Private room","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-15-2"}],"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":"Actual ICU expenses charged by the hospital.","display":"Up to actual ICU expenses","note":null,"quote":"If admitted in ICU, the Company will pay up to actual ICU expenses provided by Hospital.","sources":[{"clause":"1","heading":"In-patient Hospitalization Treatment","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-1-3"}],"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 exceeds the limit, all other hospital expenses except pharmacy/medicines, consumables, implants, medical devices and diagnostics are paid in the same proportion. It does not apply in hospitals that do not follow differential billing.","display":"Yes, except medicines, consumables, implants, devices and diagnostics","note":"With the optional room rent capping, the proportionate co-payment applies to all expenses except medical consumables and medicines.","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","heading":"In-patient Hospitalization Treatment","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-1-3"}],"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":"quote-verified","value":"No co-payment for Zone A premium payers. Zone co-payment applies when treated in a higher zone: 15% (Zone B premium, Zone A treatment), 20% (Zone C premium, Zone A treatment), 5% (Zone C premium, Zone B treatment), not for accidents.","display":"None for Zone A premium; zone co-pay 15%, 20% or 5% when treated in a higher zone (not for accidents)","note":"Optional voluntary co-payment of 10%/ 20% earns a 10% or 20% premium discount and does not apply to procedures already sub-limited. CIS lists only the 20% and 5% zone co-payments, not the 15% one.","quote":"Policyholders paying Zone A premium rates can avail treatment allover India without any co-payment. ... Those, who pay Zone B premium rates and avail treatment in Zone A city will have to pay 15% co-payment on admissible claim amount. ... Those, who pay Zone C premium rates and avail treatment in Zone A city will have to pay 20% co-payment on admissible claim amount. ... Those, who pay Zone C premium rates and avail treatment in Zone B city will have to pay 5% co-payment on admissible claim amount. ... This Co – payment will not be applicable for Accidental Hospitalization cases. ... If opted voluntarily by You, You shall bear 10%/ 20% of co-payment for each and every claim payable under the In-patient Hospitalization Treatment section ... Voluntary Co-payment will not be applied on the claim related to procedures for which sublimit is already applied ... eligible of additional 10% or 20% discount on the Policy premium","sources":[{"clause":"Section E(b)(iii)","heading":null,"page":22,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-section-e-b-iii-3"},{"clause":"Section E(b)(i)","heading":null,"page":20,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-section-e-b-i"},{"clause":"Section E(a)","heading":null,"page":21,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-section-e-a-3"}],"law":[]},{"key":"deductible","label":"Deductible","section":"Limits and co-pay","meaning":"An amount of each claim or each year that you bear before the policy pays.","status":"quote-verified","value":"None unless the optional Voluntary Aggregate Deductible is chosen.","display":"None unless opted","note":"Optional Voluntary Aggregate Deductible of ₹ 50,000 / ₹ 100000 / ₹ 200000 / ₹ 300000, in aggregate over all in-patient claims in the policy period; not applied to Maternity and New Born Baby Cover claims.","quote":"Voluntary Aggregate Deductible: ... in excess of the Annual Aggregate Deductible limit of ₹ 50,000 / ₹ 100000 / ₹ 200000 / ₹ 300000, as opted by You ... The deductible is applicable in aggregate towards all claims ... This Deductible will not be applied on the claim admissible under Maternity and New Born Baby Cover.","sources":[{"clause":"Section E(b)(ii)","heading":null,"page":20,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-section-e-b-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 (cataract, knee replacement...), even if the sum insured is higher.","status":"cross-checked","value":["Cataract: 20% of Sum Insured for each eye, maximum Rs 1,00,000","Bariatric Surgery: 25% of Sum Insured (Silver); 50% of Sum Insured up to Rs 5 lac (Gold and Platinum)","Maternity (Gold and Platinum): Normal delivery ₹ 15000 and caesarian ₹25000 for SI 3 lacs up to 7.5 lacs; ₹25000 and ₹35000 above 7.5 lacs"],"display":"Cataract, bariatric surgery and maternity are sub-limited","note":"Optional Air Ambulance has its own sum insured limit by base Sum Insured.","quote":"Our obligation to make payment in respect of surgeries for cataracts (after the expiry of the 24 months period referred to in Exclusion 02) above, shall be restricted to 20% of the Sum Insured for each eye, subject to maximum of Rs 1,00,000/- for each of You. ... restricted to 25% of the Sum Insured in Silver Plan and 50% of the Sum Insured subject to maximum of Rs 5 lac in Gold and Platinum Plan. ... For Sum Insured 3 lacs up to 7.5 lacs the limit for Normal delivery is ₹ 15000 & ₹25000 for caesarian delivery. ... For Sum Insured Above ₹7.5 lacs the limit for Normal delivery is ₹25000 & ₹35000 for caesarian delivery.","sources":[{"clause":"Section E(b)(iii)","heading":null,"page":20,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-section-e-b-iii"},{"clause":"Section E(b)(iv)","heading":null,"page":20,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-section-e-b-iv"},{"clause":"Section E(a)","heading":null,"page":20,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-section-e-a-2"},{"clause":"Section E(b)","heading":null,"page":20,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-section-e-b-2"}],"law":[]},{"key":"pre_hospitalisation","label":"Pre-hospitalisation cover","section":"Cover","meaning":"Medical costs in the days before admission that are paid if related to the hospitalisation.","status":"cross-checked","value":{"unit":"days","amount":60},"display":"60 days","note":"Only if the in-patient claim is accepted and for the same illness or injury.","quote":"The Medical Expenses incurred during the 60 days immediately before You Were Hospitalized","sources":[{"clause":"2","heading":"Pre-Hospitalization","page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#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":90},"display":"90 days","note":"Only if the in-patient claim is accepted and for the same illness or injury.","quote":"The Medical Expenses incurred during the 90 days immediately after You were discharged post Hospitalization","sources":[{"clause":"3","heading":"Post-Hospitalization","page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#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":"Day care procedures listed in Annexure I of the policy wording are covered when taken in a hospital or day care centre, not in the outpatient department.","display":"Listed day care procedures (Annexure I) covered","note":"Standard exclusions and waiting periods apply to the listed procedures.","quote":"We will pay You the Medical Expenses as listed above under Section C. 1- In-patient Hospitalization Treatment for Day care procedures / Surgeries taken as an inpatient in a hospital or day care center but not in the outpatient department. Refer Annexure I of Policy Wordings for list of Day Care Procedures.","sources":[{"clause":"5","heading":"Day Care Procedures","page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-5-3"}],"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":null,"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":"In-patient Ayurvedic and Homeopathic treatment for not less than 24 hrs in a government AYUSH hospital or a government-recognised or accredited institute, covered up to the In-patient Hospitalization Treatment Sum Insured.","display":"Covered up to the In-patient Hospitalization Sum Insured","note":"The benefit names Ayurvedic and Homeopathic treatment only.","quote":"If You are Hospitalized for not less than 24 hrs., in any AYUSH Hospital which is a government hospital or in any institute recognized by government and/or accredited by Quality Council of India/National Accreditation Board on Health ... In- patient Treatment Medical Expenses for Ayurvedic and Homeopathic treatment ... Our maximum liability per Policy Year is up to the limit of ”In-patient Hospitalization Treatment” Sum Insured as specified in the Policy Schedule.","sources":[{"clause":"13","heading":"AYUSH Hospitalization","page":11,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-13-3"}],"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 (including robotic surgeries, oral chemotherapy, immunotherapy, stem cell therapy for haematological conditions) 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 (as per list in Annexure III) shall be covered up to Base Sum Insured, subject to Policy Terms, Conditions, coverages, Waiting Period and exclusions.","sources":[{"clause":"Section E(b)","heading":null,"page":20,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-section-e-b"}],"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 insured's in-patient claim is accepted.","display":"Yes","note":"Donation must comply with the Transplantation of Human Organs law and be for the Insured Person.","quote":"We will pay expenses towards organ donor’s treatment for harvesting of the donated organ","sources":[{"clause":"6","heading":"Organ Donor Expenses","page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-6-3"}],"law":[]},{"key":"ambulance","label":"Ambulance cover","section":"Cover","meaning":"Road (and air) ambulance cover and its limit.","status":"quote-verified","value":"Road ambulance up to ₹ 20,000/- per Policy Year for emergency transfer, if the in-patient or day care claim is accepted.","display":"Road ambulance up to ₹ 20,000/- per Policy Year","note":"Air ambulance is an optional cover for additional premium, for SI 5 lacs and above.","quote":"We will pay the reasonable cost to a maximum of ₹ 20,000/- per Policy Year incurred on an ambulance ... We have accepted Your Claim under “In-patient Hospitalization Treatment” or “Day Care Procedures” section ... Air Ambulance (Optional available for SI 5Lacs and above) ... In consideration of payment of additional premium","sources":[{"clause":"4","heading":"Road Ambulance","page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-4-3"},{"clause":"18","heading":"Air Ambulance (Optional available for SI 5Lacs and above)","page":12,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-18-3"}],"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":"100% of the Base Sum Insured is reinstated once per Policy Year after the Sum Insured and bonus are fully exhausted; not for the claim that exhausts it; for Cancer and Kidney Failure only once in a lifetime. Platinum also has a Recharge Benefit of 20% of Sum Insured up to 5 Lacs.","display":"100% of Base Sum Insured, once per Policy Year","note":"Not triggered for the same claim that exceeds the balance; available for subsequent claims of the same or other members. Recharge Benefit is Platinum only.","quote":"100% of the Base Sum Insured specified under In-patient Hospitalization Treatment would be reinstated for the particular Policy Year ... This benefit is- applicable only once during each Policy Year ... This benefit is applicable only once in life time of Insured Person covered under this Policy for claims regarding CANCER and KIDNEY FAILURE REQUIRING REGULAR DIALYSIS ... Sum Insured would be increased by 20% maximum up to 5 Lacs.","sources":[{"clause":"9","heading":"Sum Insured Reinstatement Benefit","page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-9-3"},{"clause":"9(iv)","heading":null,"page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-9-iv"},{"clause":"9(v)","heading":null,"page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-9-v"},{"clause":"17","heading":"Recharge Benefit","page":12,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-17-3"}],"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":"Silver and Gold: 10% of base Sum Insured per claim-free year, up to 10 years and 100%; reduced by 10% after a claim. Platinum (Super Cumulative Bonus): 50% per year for the first 2 years, then 10% for the next 5 years, up to 150%; reduced to the previous slab after a claim.","display":"Silver/Gold: 10% per claim-free year up to 100%; Platinum: 50% for 2 years then 10%, up to 150%","note":"Platinum: after a claim the increased limit is reduced to the previous slab.","quote":"We will increase the Limit of Indemnity by 10% of base Sum Insured per annum ... The maximum cumulative increase in the Limit of Indemnity for Silver and Gold will be limited to 10 years and 100% of base Sum Insured ... shall be reduced by 10% ... We will increase the Limit of Indemnity by 50% of base Sum Insured per annum for first 2 years and later 10% of base Sum Insured per annum for next 5 years. ... Maximum bonus will not exceed 150% of the Hospitalization Sum Insured.","sources":[{"clause":"Section E(b)","heading":null,"page":20,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-section-e-b-2"},{"clause":"Section E(b)(i)","heading":null,"page":20,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-section-e-b-i-2"},{"clause":"Section E(b)(iii)","heading":null,"page":20,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-section-e-b-iii-2"},{"clause":"16","heading":"Super Cumulative Bonus","page":11,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-16-3"}],"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":"No separate consumables cover. Non-medical items listed in Annexure II (for example gloves and masks) are not payable; consumables billed as part of hospital expenses are exempt from proportionate deduction.","display":"No separate cover; non-medical items in Annexure II (such as gloves and masks) are not payable","note":"AYUSH Hospitalization lists Medicines, drugs and Medical consumables among the payable expenses.","quote":"All non-medical Items as per Annexure II. ... GLOVES | Not Payable ... MASK | Not Payable ... with the exception of cost of Pharmacy/medicines, consumables, implants, medical devices & diagnostics","sources":[{"clause":"1","heading":null,"page":15,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-1-5"},{"clause":null,"heading":"List I: List of Non-Medical Items","page":29,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-list-i-list-of-non-medical-items"},{"clause":"1","heading":"In-patient Hospitalization Treatment","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-1-3"}],"law":[]},{"key":"maternity","label":"Maternity cover","section":"Cover","meaning":"Whether childbirth costs are covered, the limit and the waiting period.","status":"cross-checked","value":"Gold and Platinum only: delivery or lawful termination, maximum 2, after a 72 months waiting period. Limit ₹ 15000 normal / ₹25000 caesarean for Sum Insured 3 lacs up to 7.5 lacs, and ₹25000 / ₹35000 above 7.5 lacs. Excluded under Silver.","display":"Gold and Platinum only: up to ₹ 15000 normal / ₹25000 caesarean (SI 3 to 7.5 lacs), after 72 months","note":"SI above 7.5 lacs: ₹25000 normal, ₹35000 caesarean. Pre and post-natal (90 days) within the limit. Silver Plan: maternity excluded (Excl18).","quote":"limited to maximum 2 deliveries or termination(s) or either ... Waiting period of 72 months as mentioned in the Policy Schedule would apply from the date of issuance of the first Health Guard Policy with Us. ... For Sum Insured 3 lacs up to 7.5 lacs the limit for Normal delivery is ₹ 15000 & ₹25000 for caesarian delivery. ... For Sum Insured Above ₹7.5 lacs the limit for Normal delivery is ₹25000 & ₹35000 for caesarian delivery.","sources":[{"clause":"14","heading":"Maternity Expenses (Applicable for Gold and Platinum Plan only)","page":11,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-14-3"},{"clause":"Section E(a)","heading":null,"page":20,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-section-e-a-2"},{"clause":"Section E(b)","heading":null,"page":20,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-section-e-b-2"}],"law":[]},{"key":"newborn","label":"Newborn baby cover","section":"Cover","meaning":"Whether a newborn is covered from birth and for what.","status":"cross-checked","value":"Gold and Platinum only, if a maternity claim is accepted: newborn treatment and hospitalisation up to 90 days from birth, and mandatory vaccinations up to 90 days, within the maternity limit.","display":"Yes, up to 90 days within the maternity limit (Gold and Platinum)","note":"Mandatory vaccinations up to 90 days also covered within the maternity limit.","quote":"Coverage for newborn baby will be considered subject to a claim being accepted under Maternity Expenses (Section C 14). ... Hospitalization charges incurred on the new born baby during post birth including any complications shall be covered up to a period of 90 days from the date of birth and within limit of the Sum Insured under Maternity Expenses","sources":[{"clause":"15","heading":"New Born Baby Cover (Applicable for Gold and Platinum Plan only)","page":11,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-15-3"}],"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 (as listed in Annexure IV) is covered up to the Base Sum Insured.","display":"Covered up to Base Sum Insured","note":"Mental Illness carries the 24-month specific waiting period.","quote":"In-patient Treatment for Mental Illness: (As specified in Annexure IV) shall be covered up to Base Sum Insured subject to Policy Terms, Conditions, coverages, Waiting Period and exclusions.","sources":[{"clause":"Section E(a)","heading":"In-patient Treatment for Mental Illness","page":20,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-section-e-a"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 3","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch III I","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"The Mental Healthcare Act, 2017","section":"Section 21(4)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"},{"title":"The Mental Healthcare Act, 2017","section":"Section 2(1)(s)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"},{"title":"The Mental Healthcare Act, 2017","section":"Section 21(1)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"}]},{"key":"health_checkup","label":"Health check-up","section":"Cover","meaning":"Free preventive check-ups and how often.","status":"conflicting","value":"Free preventive health check-up at the end of each block: Silver 1% of Sum Insured up to ₹ 2000/- per block of 3 years; Gold 1% up to ₹ 5000/- per block of 3 years; Platinum 1% up to ₹ 5000/- per block of 2 years.","display":"1% of Sum Insured, up to ₹ 2000/- (Silver) or ₹ 5000/- (Gold, Platinum), every 3 years (Platinum: 2 years)","note":"CIS says: 'Available at the end of every 3 continuous policy years' for all plans, including Platinum. Floater: proposer and spouse only.","quote":"1% of the Sum Insured maximum up to ₹ 2000/- for each Insured Person in Individual Policy during the block of 3 years. ... 1% of the Sum Insured max up to ₹ 5000/- for each Insured Person in Individual Policy during the block of 3 years. ... 1% of the Sum Insured max up to ₹ 5000/- for each Insured Person in Individual Policy during the block of 2 years. ... Available at the end of every 3 continuous policy years","sources":[{"clause":"10","heading":"Preventive Health Check Up","page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-10-3"},{"clause":null,"heading":"Waiting Period for Maternity Expenses (Applicable only for Gold and","page":4,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/5#c-waiting-period-for-maternity-expenses-applicable"}],"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. Medical expenses where in-patient care is not warranted are excluded, and day care is paid only when not in the outpatient department.","display":"Not covered","note":"No OPD benefit is listed among the covers.","quote":"Medical Expenses where Inpatient care is not warranted and does not require supervision of qualified nursing staff and qualified Medical Practitioner round the clock. ... taken as an inpatient in a hospital or day care center but not in the outpatient department","sources":[{"clause":"1","heading":null,"page":15,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-1-5"},{"clause":"5","heading":"Day Care Procedures","page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-5-3"}],"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. Premium depends on Zone A, B or C (Zone B 20% and Zone C 30% discount); treatment in a higher zone than the premium zone attracts a co-payment of 5% to 20%.","display":"Yes, Zone A/B/C premiums; Zone B 20% and Zone C 30% discount","note":"Zone A: Delhi/NCR, Mumbai area, Hyderabad and Secunderabad, Kolkata, Ahmedabad, Vadodara, Surat. Zone C: listed states/UTs. Zone B: rest of India.","quote":"If You opt for coverage under Zone B, then You will be eligible for 20% discount on the premium. ... If You opt for coverage under Zone C, then You will be eligible for 30% discount on the premium. ... Those, who pay Zone C premium rates and avail treatment in Zone A city will have to pay 20% co-payment on admissible claim amount.","sources":[{"clause":"Section E(a)","heading":null,"page":21,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-section-e-a-6"},{"clause":"Section E(b)","heading":null,"page":21,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-section-e-b-6"},{"clause":"Section E(b)(iii)","heading":null,"page":22,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-section-e-b-iii-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":"Cashless treatment is available at Network Hospitals, and the wording also offers Cashless Everywhere at non-network hospitals that meet the IRDAI definition of Hospital. Pre-authorisation response within 1 hour, final discharge authorisation within 3 hours.","display":"Yes, at Network Hospitals and, per the wording, Cashless Everywhere","note":"CIS says: 'Cashless treatment is only available at Network Hospitals.'","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":"GENERAL TERMS AND CLAUSES -OTHER TERMS AND CLAUSES","page":23,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-section-e-3"},{"clause":"Section E(iv)","heading":null,"page":23,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-section-e-iv"},{"clause":null,"heading":"Waiting Period for Maternity Expenses (Applicable only for Gold and","page":4,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/5#c-waiting-period-for-maternity-expenses-applicable"}],"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 claims team, 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.","sources":[{"clause":"Section E","heading":"GENERAL TERMS AND CLAUSES -OTHER TERMS AND CLAUSES","page":23,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#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":"Floater covers the Insured Person, spouse and dependent children; parents need a separate floater policy.","quote":"Health Guard-Family Floater.","sources":[{"clause":"Section C","heading":"COVERAGE","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6#c-section-c"}],"law":[]}],"documents":[{"kind":"wording","label":"Health Guard Policy Wordings","pages":32,"fetched_at":"2026-10-16 04:47:22.856175+00","source_url":"https://www.bajajgeneralinsurance.com/download-documents/health-insurance/Health-PW/Health-Guard_PW.pdf","url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/6"},{"kind":"cis","label":"Health Guard Customer Information Sheet","pages":7,"fetched_at":"2026-10-16 04:47:18.979192+00","source_url":"https://www.bajajgeneralinsurance.com/download-documents/health-insurance/health-guard/Health-Guard-CIS-print.pdf","url":"https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526/document/5"}],"versions":[{"uin":"BAJHLIP21227V042021","version":null,"approved_on":null},{"uin":"BAJHLIP26073V082526","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 Guard (UIN BAJHLIP26073V082526), IndiaInsurances, https://indiainsurances.com/policy/bajaj-general-insurance/health-guard-bajhlip26073v082526"}