{"uin":"BAJHLIP26074V022526","name":"My Health Care Plan","url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526","insurer":{"slug":"bajaj-general-insurance","name":"Bajaj General Insurance Limited","url":"https://indiainsurances.com/insurer/bajaj-general-insurance"},"line":"health","category":"health-indemnity","category_name":"Health insurance (hospitalisation)","irdai_type":null,"kind":"product","status":"active","approved_on":null,"withdrawn_on":null,"summary":"My Health Care Plan 1 is a Bajaj General indemnity health policy, individual or family floater, with sum insured from Rs 3 lakh to Rs 5 crore, a single private AC room up to Rs 10 lakh SI, and 60 and 90 days pre and post hospitalisation. It has 30-day, 24-month and 36-month waiting periods, maternity for SI 5 lakh and above, a separate Baby Care sum insured, an OPD sum insured of 2X the net premium and unlimited reinstatement for SI 5 lakh and above.","analysis":{"state":"extracted","analysed_at":"2026-10-16 08:29:40.454442+00","note":"Every stated fact carries a verbatim quote found in the cited clause."},"facts":[{"key":"plan_variants","label":"Plans and variants","section":"Overview","meaning":"The named plans inside this product (not cover types or payout options). Facts can differ between them.","status":"cross-checked","value":["My Health Care Plan 1"],"display":"My Health Care Plan 1 (Plan 1)","note":"These documents cover Plan 1 only; other plans filed under the same UIN have their own documents. Within Plan 1 the limits vary by sum insured.","quote":"MY HEALTH CARE PLAN (PLAN 1) ... Table of Benefits My Health Care Plan (Plan-1)","sources":[{"clause":null,"heading":"POLICY WORDING","page":1,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-policy-wording"},{"clause":"Annexure IV","heading":null,"page":51,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-annexure-iv"}],"law":[]},{"key":"policy_term","label":"Policy term","section":"Eligibility","meaning":"How long one policy runs before it ends or must be renewed.","status":"cross-checked","value":"One, two or three years.","display":"1, 2 or 3 years","note":"The wording refers to 2 and 3 year long-term policies; the full list of terms is from the sales brochure.","quote":"4% discount is applicable if Policy is opted for 2 years ... 8% discount is applicable if Policy is opted for 3 years ... Policy can be taken for 1year/ 2years OR 3years","sources":[{"clause":"Section E(a)","heading":null,"page":32,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-section-e-a"},{"clause":"Section E(b)","heading":null,"page":32,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-section-e-b"},{"clause":null,"heading":"A Healthcare Plan that cares","page":1,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/299#c-a-healthcare-plan-that-cares"}],"law":[]},{"key":"claim_intimation","label":"Claim intimation deadline","section":"Claims","meaning":"How soon you must tell the insurer about a claim or hospitalisation.","status":"cross-checked","value":"Cashless: tell the insurer 48 hours before a planned admission and within 24 hours of an emergency admission. Reimbursement: within 48 hours of an emergency admission or 48 hours before a planned one; claim documents within 30 days of discharge.","display":"48 hours before planned admission; within 24 hours (cashless) or 48 hours (reimbursement) of emergency admission","note":"International Cover (optional): inform within 24 hours of the emergency. Waiver may be considered in extreme hardship.","quote":"In case of Planned hospitalization, You/ the Insured Person/ Insured’s representative shall intimate such admission before 48 hours of such hospitalization. ... In case of Emergency hospitalization, You/ Insured Person/ Insured’s representative shall intimate such admission within 24 hours of such hospitalization. ... You or someone claiming on Your behalf must inform Us in writing immediately within 48 hours of Hospitalisation in case of emergency Hospitalisation and 48 hours prior to Hospitalisation in case of planned Hospitalisation. ... must promptly and in any event within 30 days of discharge from a Hospital give Us the documentation ... The Insured person has to inform us within 24 hours of occurrence of the emergency condition","sources":[{"clause":"4(b)(ii)","heading":null,"page":33,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-4-b-ii"},{"clause":"4(b)(iii)","heading":null,"page":34,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-4-b-iii"},{"clause":"4(b)(x)","heading":null,"page":34,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-4-b-x"},{"clause":"20","heading":"Consumable Expenses","page":18,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-20-3"}],"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 Beneficiary","Original Discharge Summary/ Discharge Certificate/ Death Summary with Surgical & anaesthetics notes","Attested copies of Indoor case papers, if available","Original Final Hospital Bill with break-up of surgical charges, surgeon’s fees, OT charges etc.","Original Paid Receipt against the final Hospital Bill","Original bills towards Investigations done/ Laboratory Bills","Original Investigation Reports against Investigations done","Original bills and receipts paid for the transportation from Registered Ambulance Service Provider","Cashless settlement letter or other Company settlement letter, if applicable","First consultation letter for the current ailment","In case of implant surgery, submit invoice & sticker"],"display":"Claim form, discharge summary, hospital bills and receipts, investigation bills and reports, first consultation letter and others","note":"Renewal Premium Waiver claims also need a death certificate; International Cover claims need passport and visa copies and a ROMIF form. The list is indicative.","quote":"1. Claim form with NEFT details & cancelled cheque duly signed by Insured Beneficiary. ... 2. Original Discharge Summary/ Discharge Certificate/ Death Summary with Surgical & anaesthetics notes. ... 3. Attested copies of Indoor case papers, if available. ... 4. Original Final Hospital Bill with break-up of surgical charges, surgeon’s fees, OT charges etc. ... 5. Original Paid Receipt against the final Hospital Bill. ... 6. Original bills towards Investigations done/ Laboratory Bills. ... 7. Original Investigation Reports against Investigations done. ... 8. Original bills and receipts paid for the transportation from Registered Ambulance Service Provider. ... 9. Cashless settlement letter or other Company settlement letter, if applicable. ... 10. First consultation letter for the current ailment. ... 11. In case of implant surgery, submit invoice & sticker.","sources":[{"clause":"4(b)(x)","heading":null,"page":34,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-4-b-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 claim is settled or rejected within 15 days of the last necessary document; where investigation is needed it is completed within 30 days of the last necessary document. Delay attracts interest at 2% above the bank rate.","display":"15 days from the last necessary document","note":"CIS says: 'TAT for claim settlement: 15 Working Days'. Clause 31 of the same wording also says the claim will be settled 'within 30 days of the receipt of the last necessary document' and paid within 7 days of acceptance. Cashless: pre-authorisation within 1 hour, final discharge authorisation within 3 hours.","quote":"The Company shall settle or reject a claim, as the case may be, within 15 days from the date of receipt of last necessary document. ... not later than 30 days from the date of receipt of last necessary document ... at a rate 2% above the bank rate ... TAT for claim settlement: 15 Working Days ... the Company will settle the claim within 30 days of the receipt of the last necessary document","sources":[{"clause":"5(i)","heading":null,"page":26,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-5-i"},{"clause":"5(iii)","heading":null,"page":26,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-5-iii"},{"clause":"5(ii)","heading":null,"page":26,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-5-ii"},{"clause":null,"heading":"Exclusions for Annual Preventive Health Check -up cover","page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/298#c-exclusions-for-annual-preventive-health-check-up"},{"clause":"4(b)(x)","heading":null,"page":34,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-4-b-x"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 64UM(4) to (6)","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 10","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 15","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 16","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 22","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(i), V.3(ii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(iii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.4","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 23","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"The Motor Vehicles Act, 1988: Chapter XI, insurance of motor vehicles against third party risks","section":"Section 149","url":"https://indiainsurances.com/law/motor-vehicles-act-1988"}]},{"key":"exclusions_main","label":"Main exclusions","section":"Exclusions","meaning":"What the policy does not pay for, in the policy's own words.","status":"cross-checked","value":["Pre-Existing Diseases Waiting Period (Code-Excl01)","Specified disease/ procedure Waiting Period (Code-Excl02)","30-day Waiting Period (Code-Excl03)","Maternity Package Expenses Waiting Period","Investigation & Evaluation (Code-Excl04)","Rest Cure, rehabilitation and respite care (Code-Excl05)","Cosmetic or plastic Surgery (Code-Excl08)","Hazardous or Adventure sports (Code- Excl09)","Treatment for Alcoholism, drug or substance abuse or any addictive condition and consequences thereof","Sterility and Infertility (Code-Excl17)","Any dental treatment that comprises of cosmetic surgery, dentures, dental prosthesis, dental implants, orthodontics","War, invasion, acts of foreign enemies","The cost of spectacles, contact lenses, hearing aids, dentures, artificial teeth and similar expenses","External medical equipment of any kind used at home as post Hospitalisation care","Any medical treatment received outside India is not covered under this Policy except in case of optional cover “International Cover-emergency care only” is opted"],"display":"Waiting periods, investigation-only admissions, rest cure, cosmetic surgery, adventure sports, addiction, infertility, cosmetic dental, war, spectacles, home equipment, treatment abroad","note":"Dental treatment is covered if due to Injury to natural teeth and requiring hospitalisation. External medical aids are paid under the Cost of Prescribed External Medical Aid cover. Acts of terrorism are covered.","quote":"Pre-Existing Diseases Waiting Period (Code-Excl01) ... Specified disease/ procedure Waiting Period (Code-Excl02) ... 3. 30-day Waiting Period (Code-Excl03) ... Maternity Package Expenses Waiting Period ... Investigation & Evaluation (Code-Excl04) ... Rest Cure, rehabilitation and respite care (Code-Excl05) ... Cosmetic or plastic Surgery (Code-Excl08) ... Hazardous or Adventure sports: (Code- Excl09) ... Treatment for Alcoholism, drug or substance abuse or any addictive condition and consequences thereof. ... Expenses related to sterility and infertility. ... Sterility and Infertility (Code-Excl17) ... Any dental treatment that comprises of cosmetic surgery, dentures, dental prosthesis, dental implants, orthodontics ... War, invasion, acts of foreign enemies ... The cost of spectacles, contact lenses, hearing aids, dentures, artificial teeth and similar expenses. ... External medical equipment of any kind used at home as post Hospitalisation care ... Any medical treatment received outside India is not covered under this Policy except in case of optional cover “International Cover-emergency care only” is opted.","sources":[{"clause":"1","heading":"Pre-Existing Diseases Waiting Period (Code-Excl01)","page":20,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-1-4"},{"clause":"2","heading":"Specified disease/ procedure Waiting Period (Code-Excl02)","page":20,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-2-4"},{"clause":"2(f)","heading":null,"page":21,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-2-f"},{"clause":"4","heading":"Maternity Package Expenses Waiting Period","page":21,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-4-4"},{"clause":"Excl04","heading":"Investigation & Evaluation (Code-Excl04)","page":22,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-excl04"},{"clause":"Excl05","heading":"Rest Cure, rehabilitation and respite care (Code-Excl05)","page":22,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-excl05"},{"clause":"Excl08","heading":"Cosmetic or plastic Surgery (Code-Excl08)","page":22,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-excl08"},{"clause":"6","heading":"Hazardous or Adventure sports: (Code- Excl09)","page":22,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-6-4"},{"clause":"9","heading":null,"page":23,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-9-4"},{"clause":"14","heading":"Sterility and Infertility (Code-Excl17)","page":23,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-14-4"},{"clause":"1","heading":null,"page":23,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-1-5"},{"clause":"3","heading":null,"page":23,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-3-4"},{"clause":"4","heading":null,"page":23,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-4-5"},{"clause":"5","heading":null,"page":23,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-5-5"},{"clause":"10","heading":null,"page":24,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-10-5"}],"law":[{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 11","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 16","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grievance","label":"Grievance route","section":"Claims","meaning":"Who to complain to first, as stated in the policy, before going to the Insurance Ombudsman.","status":"cross-checked","value":"Level 1: the Customer Experience Team (website, toll free 1800 209 5858, careforyou@bajajgeneral.com, or by post to Pune). Level 2: the Grievance Redressal Officer at ggro@bajajgeneral.com. Then the Insurance Ombudsman.","display":"Customer Experience Team (1800 209 5858, careforyou@bajajgeneral.com), then the Grievance Redressal Officer (ggro@bajajgeneral.com)","note":"Level 3: missed call on +91 80809 45060 or SMS to 575758; then Head of Customer experience (head.customerservice@bajajgeneral.com). Senior citizens: 1800-103- 2529, seniorcitizen@bajajgeneral.com.","quote":"Level 1 In case you have any concern, you may please reach out to our Customer Experience Team through any of the following options: ... Call us on our Toll free no 1800 209 5858 ... Mail us on careforyou@bajajgeneral.com ... Level 2 In case you are not satisfied with the response given to you by our team, you may write to our Grievance Redressal Officer at ggro@bajajgeneral.com ... you may approach the Insurance Ombudsman","sources":[{"clause":"16","heading":"Redressal of Grievance","page":29,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-16-4"}],"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":"Rs 3, 4, 5, 7.5, 10, 15, 20, 25, 30, 35, 40, 45, 50 and 75 lakh, and Rs 1, 2, 3, 4 and 5 crore.","display":"3 lakh to 5 crore (3/4/5/7.5/10/15/20/25/30/35/40/45/50/75 lakh and 1/2/3/4/5 crore)","note":"The wording's Table of Benefits prints '3 5' (garbled); the brochure prints 35.","quote":"3/4/5/7.5/10/15/20/25/30/3 5/40/45/50/75 lacs and In-Patient Hospitalization Expenses 1/2/3/4/5 Crore ... 3/4/ 5 / 7.5 / 10 / 15 / 20 / 25 / 30 / 35 / 40 / 45 / 50 /75 Lacs and 1/2/3/4/5 crore","sources":[{"clause":"Annexure IV","heading":null,"page":51,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-annexure-iv"},{"clause":"4","heading":"Day Care Treatment","page":2,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/299#c-4"}],"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":"Accidents are covered from day one. Not applied with more than 12 months of continuous prior coverage. OPD covers also carry a 30-day waiting period in the first year.","quote":"Initial Waiting period | 30 days ... Expenses related to the treatment of any Illness within 30 days as per the option specified in the Policy Schedule from the first Policy commencement date shall be excluded except claims arising due to an Accident ... This exclusion shall not, however apply if the Insured Beneficiary has continuous coverage for more than 12 months.","sources":[{"clause":"2(b)","heading":null,"page":52,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-2-b-3"},{"clause":"2(a)","heading":null,"page":21,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-2-a-2"},{"clause":"2(b)","heading":null,"page":21,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-2-b-2"}],"law":[]},{"key":"ped_waiting","label":"Pre-existing disease waiting period","section":"Waiting periods","meaning":"How long you wait before conditions you already had when you bought the policy are covered. The law caps it at 36 months.","status":"cross-checked","value":{"unit":"months","amount":36},"display":"36 months","note":"Options to change the PED waiting period to 1, 2 or 3 years are listed; the period opted is printed on the Policy Schedule. Reduced by prior continuous coverage on portability; applies afresh to an enhanced sum insured.","quote":"Pre-Existing Diseases Waiting Period | 36 months ... 1 year\nOptions Available for Change in PED waiting Period | 2 years\n3 years","sources":[{"clause":"2(b)","heading":null,"page":52,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-2-b-3"}],"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":"Options of 1, 2 or 3 years are listed; the period opted is printed on the Policy Schedule. Not applied to claims due to an Accident. Where a listed condition is also pre-existing, the longer waiting period applies.","quote":"Specified Disease/ Procedure Waiting Period | 24 months ... 1 year\nOptions Available for Change in Specific Disease | 2 years\nwaiting Period 3 years","sources":[{"clause":"2(b)","heading":null,"page":52,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-2-b-3"}],"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","Any type of fistula","Benign prostatic hypertrophy","All types of sinuses","Haemorrhoids, piles","Dysfunctional uterine bleeding","Endometriosis","Uterine Prolapse","Surgery on ears/tonsils/ adenoids/ paranasal sinuses","Diseases of gall bladder including cholecystitis","All forms of Cirrhosis","Surgery for varicose veins and varicose ulcers","Alzheimer’s Disease","Surgery for vertebral column disorders (unless necessitated due to an Accident)","Hypertrophied turbinate","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","Cataracts","Macular Degeneration","Hernia of all types","Fissure in ano","Hydrocele","Fibromyoma","Hysterectomy","Stones in the urinary and biliary systems","Surgery on all internal or external tumours/ cysts/ nodules/polyps of any kind including breast lumps except malignancy","Pancreatitis","Gout and rheumatism","Chronic Kidney Disease","Joint replacement surgery","Surgery to correct deviated nasal septum","Congenital internal diseases or anomalies","Bariatric Surgery"],"display":"Ulcers, fistula, BPH, sinuses, piles, cataract, hernia, stones, joint replacement, bariatric surgery and others","note":"Quoted from the CIS table, which prints the same list as the wording's two-column table (clause 2(f) of Section D), where the columns are interleaved in the extracted text.","quote":"1. Any type gastrointestinal ulcers | 2. Cataracts, ... 3. Any type of fistula | 4. Macular Degeneration ... 5. Benign prostatic hypertrophy | 6. Hernia of all types ... 7. All types of sinuses | 8. Fissure in ano ... 9. Haemorrhoids, piles | 10. Hydrocele ... 11. Dysfunctional uterine bleeding | 12. Fibromyoma ... 13. Endometriosis | 14. Hysterectomy ... 15. Uterine Prolapse | 16. Stones in the urinary and biliary systems ... 17. Surgery on ears/tonsils/ adenoids/ paranasal sinuses | 18. Surgery on all internal or external tumours/ cysts/ nodules/polyps of any kind including breast lumps except malignancy ... 19. Diseases of gall bladder including cholecystitis | 20. Pancreatitis ... 21. All forms of Cirrhosis | 22. Gout and rheumatism ... 23. Surgery for varicose veins and varicose ulcers | 24. Chronic Kidney Disease ... 25. Alzheimer’s Disease | 26. Joint replacement surgery ... 27. Surgery for vertebral column disorders (unless necessitated due to an Accident) | 28. Surgery to correct deviated nasal septum ... 29. Hypertrophied turbinate | 30. Congenital internal diseases or anomalies ... 31. 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 | 32. Bariatric Surgery","sources":[{"clause":null,"heading":"Exclusions for Annual Preventive Health Check -up cover","page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/298#c-exclusions-for-annual-preventive-health-check-up"}],"law":[]},{"key":"moratorium","label":"Moratorium period","section":"Renewal and rights","meaning":"After this many months of continuous cover, the insurer cannot reject a claim for non-disclosure, except for proven fraud or permanent exclusions. The law sets 60 months.","status":"cross-checked","value":{"unit":"months","amount":60},"display":"60 months","note":"For an enhanced sum insured, the 60 months run from the date of enhancement on the enhanced limit only.","quote":"After completion of 60 continuous months of coverage (including portability and migration) no look back would be applied. ... After the expiry of Moratorium Period no claim under this policy shall be contestable except for proven fraud and permanent exclusions specified in the policy contract.","sources":[{"clause":"11","heading":"Moratorium Period","page":28,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-11-6"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 13","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 8","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"portability","label":"Portability","section":"Renewal and rights","meaning":"Whether you can move this policy to another insurer and keep waiting-period credit.","status":"cross-checked","value":"Yes. The whole policy, with all family members, can be ported to another insurer by applying at least 30 days but not earlier than 60 days before renewal, with accrued continuity benefits in waiting periods.","display":"Yes, apply 30 to 60 days before renewal; waiting-period credit is kept","note":"Migration to another Bajaj General plan is also allowed (apply at least 30 days before renewal).","quote":"The Insured Beneficiary will have the option to port the Policy to other insurers by applying to such insurer to port the entire Policy along with all the members of the family, if any, at least 30 days before, but not earlier than 60 days from the Policy renewal date ... the proposed Insured Beneficiary will get the accrued continuity benefits in waiting periods as per IRDAI guidelines on Portability.","sources":[{"clause":"8","heading":"Portability","page":28,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-8-6"}],"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, lifetime renewal","note":"'Renewal age - Lifetime' is from the sales brochure; the wording names no maximum renewal age. Renewal is subject to the product not being withdrawn.","quote":"Your Policy shall be renewable except on grounds of established fraud or non-disclosure or misrepresentation by You ... Renewal age - Lifetime","sources":[{"clause":"6(i)","heading":null,"page":27,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-6-i"},{"clause":null,"heading":"A Healthcare Plan that cares","page":1,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/299#c-a-healthcare-plan-that-cares"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 10","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch II D.II","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.5","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 9","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 7","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"}]},{"key":"claim_loading","label":"Premium loading after claims","section":"Renewal and rights","meaning":"Whether the premium can go up at renewal because you made a claim.","status":"cross-checked","value":"No. Renewal loadings are at portfolio level, not based on an individual policy's claim experience, and renewal is not denied because of claims.","display":"No loading for claims","note":"A medical-underwriting loading set at issue (maximum 200% per person) applies to later renewals.","quote":"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 ... For this policy, the loadings on renewal premium shall be at portfolio and not based upon any individual policy claim experience. ... The maximum risk loading for any individual for all conditions put together will not exceed 200% per insured person. ... This loading will take effect from the Policy's Commencement Date and will apply to any subsequent renewals with the Company.","sources":[{"clause":"6(ii)","heading":null,"page":27,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-6-ii"},{"clause":"6(iv)","heading":null,"page":27,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-6-iv"},{"clause":"18","heading":"Medical Underwriting","page":30,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-18-4"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 10","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.5","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 9","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 4","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 7","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"}]},{"key":"permanent_exclusions","label":"Permanent exclusions","section":"Exclusions","meaning":"Conditions or treatments that are never covered: the standard IRDAI exclusion codes Excl04 to Excl18 and the product's own permanent exclusions. Excl01 to Excl03 are waiting periods, not permanent exclusions.","status":"cross-checked","value":["Investigation & Evaluation (Code-Excl04)","Rest Cure, rehabilitation and respite care (Code-Excl05)","Obesity/Weight Control (Code-Excl06)","Change-of-gender treatments (Code-Excl07)","Cosmetic or plastic Surgery (Code-Excl08)","Hazardous or Adventure sports (Code- Excl09)","Breach of law (Code-Excl10)","Excluded Providers (Code-Excl11)","Treatment for Alcoholism, drug or substance abuse or any addictive condition and consequences thereof (Excl12)","Treatments received in health hydros, nature cure clinics, spas or similar establishments (Code-Excl13)","Dietary supplements and substances that can be purchased without prescription (Code-Excl14)","Refractive Error (Code-Excl15)","Unproven Treatments (Code-Excl16)","Sterility and Infertility (Code-Excl17)","Maternity (Code Excl18)","Any dental treatment that comprises of cosmetic surgery, dentures, dental prosthesis, dental implants, orthodontics","Medical Expenses where Inpatient care is not warranted","War, invasion, acts of foreign enemies","The cost of spectacles, contact lenses, hearing aids, dentures, artificial teeth and similar expenses","External medical equipment of any kind used at home as post Hospitalisation care","Congenital external diseases or defects or anomalies, growth hormone therapy, stem cell implantation or surgery","Intentional self-Injury","Vaccination or inoculation","All non-medical Items as per Annexure II","Any medical treatment received outside India","Circumcision unless required for the treatment of Illness or Accidental bodily Injury","Treatment for any other system other than modern medicine (allopathy) and AYUSH therapies"],"display":"Standard exclusions Excl04 to Excl18 and the product's own exclusions (dental, war, spectacles, home equipment, self-injury, treatment abroad and others)","note":"Excl18 (maternity) stands deleted where Maternity Package Expenses is covered under the plan (Plan 1: SI 5 lakh and above). Excl12 is printed as a bare code under clause 9 (alcoholism). Hematopoietic stem cells for bone marrow transplant are excepted from the stem cell exclusion; treatment abroad is covered only with the optional International Cover.","quote":"Investigation & Evaluation (Code-Excl04) ... Rest Cure, rehabilitation and respite care (Code-Excl05) ... Obesity/Weight Control (Code-Excl06) ... Change-of-gender treatments (Code-Excl07) ... Cosmetic or plastic Surgery (Code-Excl08) ... Hazardous or Adventure sports: (Code- Excl09) ... Breach of law (Code-Excl10) ... Excluded Providers (Code-Excl11) ... Treatment for Alcoholism, drug or substance abuse or any addictive condition and consequences thereof. ... Excl12 ... Treatments received in health hydros, nature cure clinics, spas or similar establishments ... (Code-Excl13) ... Dietary supplements and substances that can be purchased without prescription ... (Code-Excl14) ... Refractive Error (Code-Excl15) ... Unproven Treatments (Code-Excl16) ... Sterility and Infertility (Code-Excl17) ... Maternity: (Code Excl18) ... Any dental treatment that comprises of cosmetic surgery, dentures, dental prosthesis, dental implants, orthodontics ... Medical Expenses where Inpatient care is not warranted ... War, invasion, acts of foreign enemies ... The cost of spectacles, contact lenses, hearing aids, dentures, artificial teeth and similar expenses. ... External medical equipment of any kind used at home as post Hospitalisation care ... Congenital external diseases or defects or anomalies, growth hormone therapy, stem cell implantation or surgery ... Intentional self-Injury ... Vaccination or inoculation ... All non-medical Items as per Annexure II. ... Any medical treatment received outside India ... Circumcision unless required for the treatment of Illness or Accidental bodily Injury. ... Treatment for any other system other than modern medicine (allopathy) and AYUSH therapies.","sources":[{"clause":"Excl04","heading":"Investigation & Evaluation (Code-Excl04)","page":22,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-excl04"},{"clause":"Excl05","heading":"Rest Cure, rehabilitation and respite care (Code-Excl05)","page":22,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-excl05"},{"clause":"Excl06","heading":"Obesity/Weight Control (Code-Excl06)","page":22,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-excl06"},{"clause":"Excl07","heading":"Change-of-gender treatments (Code-Excl07)","page":22,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-excl07"},{"clause":"Excl08","heading":"Cosmetic or plastic Surgery (Code-Excl08)","page":22,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-excl08"},{"clause":"6","heading":"Hazardous or Adventure sports: (Code- Excl09)","page":22,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-6-4"},{"clause":"7","heading":"Breach of law (Code-Excl10)","page":22,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-7-4"},{"clause":"8","heading":"Excluded Providers (Code-Excl11)","page":22,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-8-4"},{"clause":"9","heading":null,"page":23,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-9-4"},{"clause":"Excl12","heading":null,"page":23,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-excl12"},{"clause":"10","heading":null,"page":23,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-10-4"},{"clause":"11","heading":null,"page":23,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-11-4"},{"clause":"12","heading":"Refractive Error (Code-Excl15)","page":23,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-12-4"},{"clause":"13","heading":"Unproven Treatments (Code-Excl16)","page":23,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-13-4"},{"clause":"14","heading":"Sterility and Infertility (Code-Excl17)","page":23,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-14-4"},{"clause":"15","heading":"Maternity: (Code Excl18)","page":23,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-15-4"},{"clause":"1","heading":null,"page":23,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-1-5"},{"clause":"2","heading":null,"page":23,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-2-5"},{"clause":"3","heading":null,"page":23,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-3-4"},{"clause":"4","heading":null,"page":23,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-4-5"},{"clause":"5","heading":null,"page":23,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-5-5"},{"clause":"6","heading":null,"page":23,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-6-5"},{"clause":"7","heading":null,"page":23,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-7-5"},{"clause":"8","heading":null,"page":24,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-8-5"},{"clause":"9","heading":null,"page":24,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-9-5"},{"clause":"10","heading":null,"page":24,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-10-5"},{"clause":"11","heading":null,"page":24,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-11-5"},{"clause":"12","heading":null,"page":24,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-12-5"}],"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":"With 7 days written notice: annual policies get a pro-rata refund for the unexpired period if no claim was made in the policy year; multi-year policies get a full refund for years not started and pro-rata for the current year if claim free; instalment policies get pro-rata if claim free. Medical examination costs are deducted.","display":"Pro-rata refund if no claim in the policy year (7 days notice)","note":"No refund when the insurer cancels for misrepresentation, non-disclosure or fraud. Clause 29 also deducts stamp duty.","quote":"The Policyholder can cancel this Policy by providing a written notice of 7 days. ... Annual Policy: The premium refund for the unexpired risk period will be on a pro-rata basis, provided no claim has been made during the policy year. ... For any policy year where the risk date has not yet started, the premium will be refunded without any deduction. o For any policy year where the risk has started, the premium will be refunded on a pro-rata basis for that policy year, provided no claim has been made during the policy year and in full for future policy years. ... Cancellation of policy where Premium Received on Instalment Basis The premium refund for the unexpired risk period will be on a pro-rata basis, provided no claim has been made during the policy year. ... expenses incurred by the Company on medical examination of the Policyholder will also be deducted before refunding of premium.","sources":[{"clause":"7","heading":"Cancellation","page":27,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-7-6"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 64VB","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 8","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 6","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 5","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 17","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(3) to 20(5)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.4","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, IV.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"territory","label":"Where it covers","section":"Overview","meaning":"Geographic area of cover: India only, worldwide, or listed countries. 'As stated in the schedule' is not an answer.","status":"cross-checked","value":"India only, unless the optional International Cover (Emergency Care only) is bought.","display":"India only","note":"The optional International Cover pays emergency in-patient care anywhere in the world: 45 continuous days per trip, 180 days a year, 10% co-payment.","quote":"All medical treatment for the purpose of the Policy Schedule will have to be taken in India only (except in case of optional cover- “International Cover-emergency care only” is opted).","sources":[{"clause":"Section E(iii)","heading":null,"page":31,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-section-e-iii"}],"law":[]},{"key":"free_look","label":"Free-look period","section":"Renewal and rights","meaning":"Days after you receive the policy in which you can return it for a refund if you do not agree with its terms.","status":"cross-checked","value":{"unit":"days","amount":30},"display":"30 days","note":"At inception only, not on renewal or porting. Refund less medical examination and stamp duty charges if no claim was made. CIS counts the 30 days 'from the first inception of policy' rather than from receipt.","quote":"The Insured Beneficiary shall be allowed a period of 30 days from date of receipt of the Policy document to review the terms and conditions of the Policy, and to return the same if not acceptable.","sources":[{"clause":"17","heading":"Free Look Period","page":30,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-17-4"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 5","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 5","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(1), 20(2)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(3) to 20(5)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, II.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grace_period","label":"Grace period","section":"Renewal and rights","meaning":"Days you get after the due date to pay without losing cover or continuity.","status":"cross-checked","value":{"unit":"days","amount":30},"display":"30 days (15 days for monthly instalments)","note":"15 days where premium is paid monthly.","quote":"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 15 days (where premium is paid on a monthly instalments) and 30 days (where premium is paid in quarterly/half-yearly/annual instalments)","sources":[{"clause":"6(iii)","heading":null,"page":27,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-6-iii"},{"clause":"3","heading":"Premium Payment in Installments","page":26,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-3-5"}],"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":"From 3 months up to 65 years at the start of the policy. The brochure gives 18 to 65 years for adults and 3 months to 30 years for dependent children and grandchildren.","display":"3 months to 65 years","note":"Adult and child bands are from the sales brochure.","quote":"provided that an Insured or his Family Members has attained the age of 3 months and is not older than 65 years of age at the commencement of the Policy Period. ... Dependent Aunt/ Dependent Uncle - 18 years to 65 years ... Dependent Children/ Dependent Grandchildren: 3 months – 30 years","sources":[{"clause":"14","heading":"Named Insured/ Insured/ Insured Person/ Insured Beneficiary","page":8,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-14-2"},{"clause":null,"heading":"A Healthcare Plan that cares","page":1,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/299#c-a-healthcare-plan-that-cares"}],"law":[]},{"key":"premium_modes","label":"Premium payment options","section":"Premium","meaning":"How often you can pay: yearly, half-yearly, quarterly, monthly.","status":"cross-checked","value":["Annual","Half Yearly","Quarterly","Monthly"],"display":"Annual, half-yearly, quarterly or monthly","note":"Annual instalments apply to long-term policies.","quote":"If the insured person has opted for Payment of Premium on an instalment basis i.e. Annual (for long term polices only), Half Yearly, Quarterly or Monthly","sources":[{"clause":"3","heading":"Premium Payment in Installments","page":26,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-3-5"}],"law":[]},{"key":"optional_covers","label":"Optional covers","section":"Cover","meaning":"Covers you can add for an extra premium. They change the answers above only if you buy them.","status":"cross-checked","value":["Loss of Income Cover","Major Illness and Accident Multiplier (Indemnity)","International Cover– Emergency Care only"],"display":"Loss of Income, Major Illness and Accident Multiplier, International Cover (emergency care)","note":"A voluntary co-payment (5%, 10%, 15% or 20%) can be chosen for a premium discount. Room rent, pre and post hospitalisation and waiting period options are also listed in the Table of Benefits.","quote":"OPTIONAL COVERS AVAILABLE IN MY HEALTH CARE PLAN\n1. Loss of Income Cover (Applicable to Part I and Part II)\n2. Major Illness and Accident Multiplier (Indemnity) (Applicable to Part I only)\n3. International Cover– Emergency Care only (Applicable to Part I only)","sources":[{"clause":"2(b)","heading":null,"page":52,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-2-b-3"}],"law":[]},{"key":"grace_cover","label":"Cover during the grace period","section":"Renewal and rights","meaning":"Whether a claim during the grace period is paid.","status":"cross-checked","value":"For premium paid in instalments, cover continues during the grace period. For other policies the documents only say coverage need not be available for the period with no premium.","display":"Yes for instalment premiums","note":null,"quote":"If the premium is paid in instalments during the policy period, coverage will be available for the grace period also. ... Coverage need not be available during the period for which no premium is received.","sources":[{"clause":"3","heading":"Premium Payment in Installments","page":26,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-3-5"},{"clause":"17","heading":"Grace Period","page":3,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-17"}],"law":[]},{"key":"room_rent","label":"Room rent limit","section":"Limits and co-pay","meaning":"The most the policy pays per day for the hospital room, or the room category allowed. If you take a costlier room, other bills can be cut in proportion.","status":"cross-checked","value":"Single private AC room for sum insured of Rs 3 lakh to 10 lakh; actuals above Rs 10 lakh.","display":"Single private AC room (SI 3 to 10 lakh); actuals above 10 lakh","note":"Other room options listed: general ward, twin sharing, actual, 1% of SI max 5000, 1.5% of SI max 7500, 2% of SI max 7500 (the option table is garbled). CIS says 'SI 10 Lacs and above – At Actuals'.","quote":"Room rent for 3 Lac to 10 Lac SI | Single Pvt AC Room\nRoom rent for Above 10 Lacs SI | Actuals","sources":[{"clause":"Annexure IV","heading":null,"page":51,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-annexure-iv"}],"law":[]},{"key":"room_category","label":"Room category allowed","section":"Limits and co-pay","meaning":"Shared room, single private room or any room, by plan, when the limit is a room type rather than a rupee amount.","status":"cross-checked","value":"Single private AC room for sum insured 3 lakh to 10 lakh; any room (actuals) above 10 lakh.","display":"Single private AC room (SI 3 to 10 lakh); any room above 10 lakh","note":"General ward and twin sharing are also listed as options.","quote":"Room rent for 3 Lac to 10 Lac SI | Single Pvt AC Room\nRoom rent for Above 10 Lacs SI | Actuals ... General Ward Twin Sharing Single Pvt Ac","sources":[{"clause":"Annexure IV","heading":null,"page":51,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-annexure-iv"},{"clause":"2(b)","heading":null,"page":52,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-2-b-3"}],"law":[]},{"key":"icu_limit","label":"ICU limit","section":"Limits and co-pay","meaning":"The most the policy pays per day for intensive care.","status":"cross-checked","value":"ICU expenses are paid at actuals.","display":"At actuals","note":null,"quote":"If admitted in ICU, the Company will pay up to ICU expenses at actuals.","sources":[{"clause":"1","heading":"In-patient Hospitalisation Treatment","page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#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. In a room above the opted limit or category, other hospital expenses (except pharmacy, consumables, implants, medical devices and diagnostics) are paid in the same proportion; not where the hospital does not bill differently by room.","display":"Yes, except medicines, consumables, implants, devices and diagnostics","note":null,"quote":"In case of admission to a room at rates/ category exceeding the opted limits/ category as mentioned under Part I and Part II, the reimbursement of all other expenses incurred at the Hospital, with the exception of cost of Pharmacy/ medicines, Medical 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 Hospitalisation Treatment","page":9,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#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":"cross-checked","value":"No compulsory co-payment on in-patient claims is printed; a voluntary co-payment of 5%, 10%, 15% or 20% can be chosen for a discount.","display":"None unless the voluntary co-payment (5%, 10%, 15% or 20%) is opted","note":"Optional International Cover: mandatory 10% co-payment. OPD investigations: 20% co-payment on reimbursement claims not pre-approved.","quote":"In the Voluntary Co-payment option is opted, then a discount corresponding to the o-payment opted would be applicable. ... the Insured shall bear a 5% or 10% or 15% or 20% (proportion to extent to discount availed) of the eligible claim amount ... A mandatory Co-payment of 10% is applicable ... A Co-payment of 20% will be applicable on all reimbursement claims which are not pre-approved.","sources":[{"clause":"4(a)","heading":null,"page":33,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-4-a"},{"clause":"4(b)","heading":null,"page":33,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-4-b"},{"clause":"20","heading":"Consumable Expenses","page":18,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-20-3"},{"clause":"11(III)","heading":null,"page":14,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-11-iii-2"}],"law":[]},{"key":"deductible","label":"Deductible","section":"Limits and co-pay","meaning":"An amount of each claim or each year that you bear before the policy pays.","status":"cross-checked","value":"Not applicable for Plan 1.","display":"None (NA)","note":"From the sales brochure Table of Benefits for Plan 1.","quote":"Aggregate Deductible | NA","sources":[{"clause":"Excl12","heading":null,"page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/299#c-excl12"}],"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: for SI up to 10 Lac, 20% of SI max 1 Lac per eye; above 10 Lac, actual","Maternity: SI 3 and 4 Lac not covered; SI 5 Lac to 10 Lac INR 50,000; SI 15 Lac to 20 Lac INR 75,000; above 20 Lacs INR 1,00,000"],"display":"Cataract 20% of SI up to 1 Lac per eye (SI up to 10 Lac); maternity package limits by SI","note":"Other caps: Home Nursing, External Medical Aid, Airlift and Family Visit limits by SI; OPD consultation sub-limit INR 500 (general physician) and INR 1,200 (specialist).","quote":"For SI up to 10 Lac- 20% of SI max 1 Lac per eye. ... For SI above 10 Lac– Actual. ... For SI 3 and 4 Lac– Not covered ... For SI 5 Lac to 10 Lac– INR 50,000 ... For SI 15 Lac to 20 Lac– INR 75,000 ... For SI above 20 Lacs– INR 1,00,000","sources":[{"clause":"4(b)(x)","heading":null,"page":34,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-4-b-x"},{"clause":"Annexure IV","heading":null,"page":51,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-annexure-iv"},{"clause":"2","heading":"Maternity expenses for Surrogacy","page":52,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-2-9"}],"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":"Options of 0, 15, 30, 60, 90, 180 or 240 days (240 days for SI 5 lakh and above only); the option is printed on the Policy Schedule.","quote":"Pre-hospitalization Medical Expenses | 60 days ... Options Available for Pre-Hospitalization Expenses | 60 days\n90 days 180 days 240 days (this option will be available for SI 5 Lac and above only) ... 0 days 15 days 30 days","sources":[{"clause":"Annexure IV","heading":null,"page":51,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-annexure-iv"},{"clause":"2(b)","heading":null,"page":52,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-2-b-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":"Options of 0, 15, 30, 60, 90, 180 or 240 days (240 days for SI 5 lakh and above only).","quote":"Post-hospitalization Medical Expenses | 90 days ... Options Available for Post Hospitalization Expenses | 60 days\n90 days 180 days 240 days (this option will be available for SI 5 Lac and above only) ... 0 days 15 days 30 days","sources":[{"clause":"Annexure IV","heading":null,"page":51,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-annexure-iv"},{"clause":"2(b)","heading":null,"page":52,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-2-b-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":"All day care procedures taken as an in-patient in a hospital or day care centre are covered up to the sum insured; Annexure I is an indicative list.","display":"All day care treatments, up to sum insured","note":null,"quote":"We will indemnify You against the Reasonable and Customary Medical Expenses up to Inpatient Hospitalization Treatment Sum Insured for Day care procedures/ surgeries taken as an Inpatient in a Hospital or Day care centre but not in the Outpatient department. Indicative list of Day Care Treatments is given in Annexure I of this Policy document. ... Above mentioned list is a indicative list of procedures, any other surgeries/ procedures requiring less than 24 hours hospitalisation due to technological advances will also be covered","sources":[{"clause":"5","heading":"Day Care Treatment","page":10,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-5-3"},{"clause":"99(b)(i)","heading":"Above mentioned list","page":47,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-99-b-i"}],"law":[]},{"key":"domiciliary","label":"Treatment at home","section":"Cover","meaning":"Whether treatment at home is covered when hospital admission is not possible or a doctor advises it.","status":"cross-checked","value":"Yes, up to the sum insured, when the patient cannot be moved to hospital or no room is available, and the home treatment exceeds 3 days; listed conditions such as asthma, diabetes, hypertension and psychiatric disorders are excluded.","display":"Yes, up to sum insured, if more than 3 days","note":null,"quote":"We will indemnify You against Reasonable and Customary Medical Expenses for Medical Treatment for an illness/ disease/ injury up to In-patient Hospitalization Treatment Sum Insured ... is taken whilst confined at home ... Domiciliary Hospitalization should exceed 3 days. ... Asthma, Bronchitis, Tonsillitis ... Diabetes Mellitus and Insipidus, ... Hypertension, ... Psychiatric or Psychosomatic Disorders of all kinds,","sources":[{"clause":"12","heading":"Domiciliary Hospitalization","page":16,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-12-3"}],"law":[]},{"key":"ayush","label":"AYUSH treatment","section":"Cover","meaning":"Ayurveda, Yoga, Unani, Siddha and Homeopathy treatment in a recognised hospital, and any limit.","status":"cross-checked","value":"Covered up to the in-patient sum insured for admission of at least 24 hours in an AYUSH hospital.","display":"Up to sum insured","note":"Out-patient AYUSH and comfort treatments (steam bath, sauna, oil massage) are excluded.","quote":"If You are hospitalized in an AYUSH Hospital for a period not less than 24 hours ... We will indemnify You against Reasonable and Customary Medical Expenses incurred for AYUSH treatment up to In-patient Hospitalization Treatment Sum Insured.","sources":[{"clause":"7","heading":"AYUSH Hospitalization Cover","page":11,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-7-3"}],"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":"Covered up to the in-patient sum insured: uterine artery embolization and HIFU, balloon sinuplasty, deep brain stimulation, oral chemotherapy, immunotherapy, intra-vitreal injections, robotic surgeries, stereotactic radio surgeries, bronchial thermoplasty, prostate vaporisation, IONM and stem cell therapy for bone marrow transplant.","display":"Up to sum insured, no separate cap","note":null,"quote":"We will indemnify You against all the eligible Reasonable and Customary Medical Expenses incurred if You undergo procedures as listed below, maximum up to Inpatient Hospitalization Treatment Sum Insured. ... Uterine Artery Embolization and HIFU ... Balloon Sinuplasty ... Deep Brain stimulation ... Oral chemotherapy ... Immunotherapy- Monoclonal Antibody to be given as injection ... Intra-vitreal injections ... Robotic surgeries ... Stereotactic radio surgeries ... Bronchial Thermoplasty ... Vaporisation of the prostrate ... IONM- (Intra Operative Neuro Monitoring) ... Stem cell therapy: Hematopoietic stem cells for bone marrow transplant","sources":[{"clause":"4","heading":"Modern Treatment Methods and Advancement in Technologies","page":10,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-4-3"}],"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 up to the in-patient sum insured when the insured is the recipient; donor pre and post hospitalisation is not paid.","display":"Yes, up to sum insured","note":"Reinstatement and multiplier benefits do not apply to organ donor expenses.","quote":"We will indemnify You against the expenses incurred towards organ donor’s treatment for harvesting of the donated organ up to Inpatient Hospitalization Treatment Sum Insured ... We will pay if Insured Beneficiary is the receiver of the organ. ... Pre and Post-Hospitalization expenses, and any other consequential medical expenses in respect of donor are not payable. ... Multiplier Benefit, Sum Insured Reinstatement, Recharge, Double Sum Insured Benefit will not be applicable for/ under Organ donor expenses cover.","sources":[{"clause":"6","heading":"Organ donor expenses","page":10,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-6-3"}],"law":[]},{"key":"ambulance","label":"Ambulance cover","section":"Cover","meaning":"Road (and air) ambulance cover and its limit.","status":"cross-checked","value":"Road ambulance up to the in-patient sum insured, in an emergency, including transfer to a better hospital. Airlift cover for SI 75 lakh to 1 crore up to INR 10 lakh, above 1 crore up to INR 20 lakh, within India, for distances over 200 km with pre-approval.","display":"Road: up to sum insured; air: up to 10 Lac or 20 Lac (SI 75 Lac and above)","note":null,"quote":"We will indemnify You against the Reasonable and Customary expenses, up to In-patient Hospitalization Sum Insured, incurred on a road ambulance ... For SI 75 Lac to 1 Crore– Limit for Air Lift up to INR 10 Lac Airlift Cover For SI Above 1 Crore– Limit for Air Lift up to INR 20 Lac ... Distance between Insured beneficiary’s location and hospital is more than 200 kms. ... Pre-approval is mandatory for making a claim under this cover. ... This cover is applicable only for Airlift facility availed within Indian Geographical limits.","sources":[{"clause":"8","heading":"Road Ambulance","page":11,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-8-3"},{"clause":"2(b)","heading":null,"page":52,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-2-b-3"},{"clause":"16","heading":"Airlift Cover","page":17,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-16-3"}],"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":"conflicting","value":"Yes. The in-patient sum insured is reinstated once a year for SI below 5 lakh and unlimited times for SI 5 lakh and above, available for the same illness; for the same person the next hospitalisation must be at least 15 days after discharge.","display":"Once (SI below 5 lakh) or unlimited (SI 5 lakh and above), same illness included","note":"CIS says: 'the base Sum Insured will be restored one time', against 'Unlimited' for SI 5 lakh and above in its own limits table and in the wording. Not carried forward; at policy level for floaters.","quote":"Sum Insured Reinstatement | For SI less than 5 lacs– Once\n(Available for same illness) | For SI 5 lacs and above– Unlimited ... the subsequent hospitalization is after a gap of at least 15 days from the date of discharge. This 15-day period is not applicable if the subsequent claim is for the other Insured Beneficiary. ... This benefit is applicable during each Policy year and will not be carried forward ... the base Sum Insured will be restored one time","sources":[{"clause":"2(b)","heading":null,"page":52,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-2-b-3"},{"clause":"15","heading":"Sum Insured Reinstatement","page":17,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-15-3"},{"clause":"2","heading":null,"page":2,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/298#c-2"}],"law":[]},{"key":"no_claim_bonus","label":"No-claim or cumulative bonus","section":"Cover","meaning":"How much the cover grows each year, the maximum, whether it depends on not claiming, and what happens after a claim.","status":"conflicting","value":"Cumulative bonus of 25% a year for SI 3 and 4 lakh and 50% a year for SI 5 lakh and above, for each claim-free year, up to 100%; after a claim it is reduced at the same rate at which it accrued.","display":"50% a year up to 100% (25% for SI 3 and 4 lakh); reduced after a claim","note":"CIS row 6 says: 'For SI more than 5 Lacs - 25% increase in base sum insured per claim free policy Year', against 50% in the CIS limits table, the wording and the brochure.","quote":"For SI 3 & 4 lacs– 25% Per Annum max 100%\nCumulative bonus (reduces in case of claim) | For SI 5 Lac and above– 50% Per Annum max 100% ... If a claim is made in any particular year, the cumulative bonus accrued shall be reduced at the same rate at which it has accrued. ... For SI more than 5 Lacs - 25% increase in base sum insured per claim free policy Year max up to 100%of base Sum Insured","sources":[{"clause":"2(b)","heading":null,"page":52,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-2-b-3"},{"clause":"17","heading":"Cumulative Bonus","page":17,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-17-3"},{"clause":"2(x)","heading":null,"page":3,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/298#c-2-x"}],"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":"Yes. Non-medical items listed in Annexure IV (gloves, masks, braces, ECG electrodes and others) are paid up to the in-patient sum insured on an admissible in-patient claim.","display":"Yes, Annexure IV items up to sum insured","note":null,"quote":"We will indemnify You against the Non-Medical Expenses/ consumables (as specified in Annexure IV) incurred during treatment of the Insured Beneficiary during the Policy Period up to Inpatient hospitalisation treatment Sum Insured ... 29 Gloves ... 32 Mask ... 28 Ecg Electrodes","sources":[{"clause":"20","heading":"Consumable Expenses","page":18,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-20-3"},{"clause":"Annexure IV","heading":null,"page":51,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-annexure-iv"}],"law":[]},{"key":"maternity","label":"Maternity cover","section":"Cover","meaning":"Whether childbirth costs are covered, the limit and the waiting period.","status":"cross-checked","value":"Covered for SI 5 lakh and above: INR 50,000 (SI 5 to 10 lakh), INR 75,000 (SI 15 to 20 lakh), INR 1,00,000 (above 20 lakh) per delivery or termination, up to 2 in a lifetime, after a 36-month waiting period, for insured up to 45 years. Not covered for SI 3 and 4 lakh.","display":"Yes for SI 5 lakh and above: INR 50,000 to 1,00,000, after 36 months","note":"Waiting period reduces by 1 year if a long-term policy is paid upfront. Includes pre-natal and post-natal (90 days) hospitalisation, surrogacy and complications of assisted reproduction within the same limit. Limits for SI 7.5 lakh fall in the 5 to 10 lakh band.","quote":"limited to maximum 2 deliveries or termination(s) or either during the lifetime of the Insured Beneficiary ... For SI 3 and 4 Lac– Not covered ... For SI 5 Lac to 10 Lac– INR 50,000 ... For SI 15 Lac to 20 Lac– INR 75,000 ... For SI above 20 Lacs– INR 1,00,000 ... Maternity Expenses waiting period | 36 months ... This cover is applicable for Insured Beneficiary up to 45 years of age. ... Our maximum liability per delivery or termination shall be as per the Maternity Package limit specified in the Policy Schedule.","sources":[{"clause":"9","heading":"Maternity Package Expenses","page":11,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-9-3"},{"clause":"Annexure IV","heading":null,"page":51,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-annexure-iv"},{"clause":"2","heading":"Maternity expenses for Surrogacy","page":52,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-2-9"},{"clause":"2(b)","heading":null,"page":52,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-2-b-3"},{"clause":"9(vi)","heading":null,"page":11,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-9-vi"},{"clause":"9(i)","heading":null,"page":11,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-9-i"}],"law":[]},{"key":"newborn","label":"Newborn baby cover","section":"Cover","meaning":"Whether a newborn is covered from birth and for what.","status":"cross-checked","value":"Baby Care: in-patient treatment of a newborn born during the policy period, with a separate sum insured over the in-patient SI (1 lakh for SI up to 4 lakh, 5 lakh for SI 5 to 10 lakh, 10 lakh for SI 15 to 50 lakh, 15 lakh above 50 lakh), after a 36-month waiting period; birth to be intimated within 90 days.","display":"Yes, separate Baby Care sum insured of 1 to 15 Lac, after 36 months","note":"Waiting period reduces by 1 year if a long-term policy is paid upfront. The CIS adds 'subject to Maternity claim being accepted by Us'.","quote":"Baby Care (The Sum Insured for this cover would be over and above the In- patient Hospitalization Sum Insured) We will indemnify You against Reasonable and Customary hospitalization expenses incurred for your newborn baby ... You should intimate Us about the birth of your baby within 90 days of delivery. ... For SI up to 4 Lac– 1 Lac For SI 5 Lac to 10 Lac– 5 Lac\nBaby care | For SI 15 Lac to 50 Lac– 10 Lac\nFor SI above 50 Lac– 15 Lac ... Baby Care waiting period | 36 months","sources":[{"clause":"10","heading":null,"page":12,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-10-3"},{"clause":"2","heading":"Maternity expenses for Surrogacy","page":52,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-2-9"},{"clause":"2(b)","heading":null,"page":52,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-2-b-3"}],"law":[]},{"key":"mental_illness","label":"Mental illness","section":"Cover","meaning":"Cover for in-patient treatment of mental illness.","status":"not-stated","value":null,"display":null,"note":"Annexure III lists ICD codes for mental illness, but no cover clause refers to it; psychiatric disorders are excluded from domiciliary cover and psychiatric counselling from OPD.","quote":null,"sources":[],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 3","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch III I","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"The Mental Healthcare Act, 2017","section":"Section 21(4)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"},{"title":"The Mental Healthcare Act, 2017","section":"Section 2(1)(s)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"},{"title":"The Mental Healthcare Act, 2017","section":"Section 21(1)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"}]},{"key":"health_checkup","label":"Health check-up","section":"Cover","meaning":"Free preventive check-ups and how often.","status":"cross-checked","value":"Yes, a preventive health check-up once every policy year, cashless only at the service provider's network centres; 1 voucher for an individual policy and 2 for a floater.","display":"Once every policy year (cashless)","note":"Fixed test list (CBC, LFT, urine, sugar, lipid, KFT, thyroid); not carried forward; 30-day initial wait in year one.","quote":"The Insured Beneficiary/ies can avail the Preventive health check-up once in every Policy Year as per the list given below on cashless basis only in the network centres of our Service Provider. ... d) Annual Preventive Health check-up cover - (1 voucher) for individual (2 vouchers) for Floater","sources":[{"clause":"11(IV)","heading":null,"page":15,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-11-iv-2"},{"clause":"2(b)","heading":null,"page":52,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-2-b-3"}],"law":[]},{"key":"opd","label":"Out-patient (OPD) cover","section":"Cover","meaning":"Doctor consultations, tests and medicines without admission, and the limit.","status":"cross-checked","value":"Yes. OPD sum insured of 2 times the net premium covers tele consultations, in-clinic doctor consultations (limit 50% of OPD SI) and prescribed pathology and radiology tests (50% of OPD SI); reimbursement needs pre-approval, with sub-limits of INR 500 (general physician) and INR1,200 (specialist) per consultation.","display":"Yes, OPD wallet of 2X the net premium","note":"The OPD sum insured figure is from the CIS. 30-day initial and PED waiting periods apply; tele consultations limited to 5 a day and 15 a month. 20% co-payment on investigation reimbursements not pre-approved.","quote":"OPD Sum Insured | 2X of the Net Premium ... Doctor Consultation Cover (in clinic) | 50% of OPD SI ... Doctor Prescribed investigation/ pathology and Radiology Cover | 50% of OPD SI ... Sub-limit of INR 500 for general physician and INR1,200 for specialists per consultation as specified under the plan.","sources":[{"clause":null,"heading":"Exclusions for Annual Preventive Health Check -up cover","page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/298#c-exclusions-for-annual-preventive-health-check-up"},{"clause":"11(II)","heading":null,"page":13,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-11-ii-2"}],"law":[]},{"key":"zone_pricing","label":"Zone or city-based premium","section":"Premium","meaning":"Whether premium or co-pay depends on the city you are treated in.","status":"cross-checked","value":"Premium depends on the zone of residence: Zone B gets 15% and Zone C 25% off the Zone A premium. No zone-based co-payment is printed.","display":"Yes, premium only: Zone B 15%, Zone C 25% discount on Zone A","note":"Zone A: Delhi/NCR, Mumbai region, Hyderabad, Kolkata, Ahmedabad, Vadodara, Surat.","quote":"Zone Discount Below discount will be applicable based on residential address of the proposer or insured person\n• Residential address in Zone B: 15% on Zone A Premium\n• Residential address in Zone C: 25% on Zone A Premium","sources":[{"clause":"Section E(iv)","heading":null,"page":31,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-section-e-iv"}],"law":[]},{"key":"cashless","label":"Cashless treatment","section":"Claims","meaning":"Whether and where the insurer pays the hospital directly instead of you paying and claiming back.","status":"conflicting","value":"Yes, at network hospitals, and 'Cashless Everywhere' also at non-network hospitals that meet the IRDAI hospital definition, with pre-authorisation.","display":"Yes, network hospitals and Cashless Everywhere","note":"CIS says: 'Cashless treatment is only available at Network Hospitals.' Pre-authorisation reply within 1 hour; discharge within 3 hours.","quote":"Cashless treatment is available at Network Hospitals. ... We offer Cashless Everywhere, even in hospitals which are not part of our network subject to hospitals fulfilling IRDAI definition of Hospital facility. ... Cashless treatment is only available at Network Hospitals.","sources":[{"clause":"4(b)","heading":null,"page":33,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-4-b"},{"clause":"4(b)(iv)","heading":null,"page":34,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-4-b-iv"},{"clause":null,"heading":"Exclusions for Annual Preventive Health Check -up cover","page":5,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/298#c-exclusions-for-annual-preventive-health-check-up"}],"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; the insurer may engage a TPA at its discretion.","display":"In-house (insurer)","note":"OPD services run through the Caringly Yours app or the service provider's application.","quote":"All Claims will be settled by In house claims settlement team of the Company. However, the Company reserves right to engage TPA at any time, at the sole discretion of the Company.","sources":[{"clause":"4(b)","heading":null,"page":33,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-4-b"}],"law":[]},{"key":"family_floater","label":"Family floater available","section":"Cover","meaning":"Whether one sum insured can be shared by the whole family.","status":"cross-checked","value":true,"display":"Yes","note":"Individual policies can cover a wider family; family discount does not apply to floaters.","quote":"For the purpose of Family Floater policy- includes the Insured; his/her lawfully wedded spouse and dependent children. For Parents/ Parents in law separate floater Policy can be taken.","sources":[{"clause":"9","heading":"Family or Family Members","page":7,"url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297#c-9-2"}],"law":[]}],"documents":[{"kind":"wording","label":"My Health Care Plan 1 Policy Wordings","pages":53,"fetched_at":"2026-10-16 08:29:40.224815+00","source_url":"https://www.bajajgeneralinsurance.com/download-documents/health-insurance/Health-PW/My-Health-Care-Plan1-PW.pdf","url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/297"},{"kind":"cis","label":"My Health Care Plan 1 Customer Information Sheet","pages":9,"fetched_at":"2026-10-16 08:29:40.224815+00","source_url":"https://www.bajajgeneralinsurance.com/download-documents/health-insurance/Health-CIS/My-Health-Care-Plan1_CIS.pdf","url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/298"},{"kind":"brochure","label":"My Health Care Plan 1 Brochure","pages":15,"fetched_at":"2026-10-16 08:29:40.224815+00","source_url":"https://www.bajajgeneralinsurance.com/download-documents/health-insurance/My-Health-Care-Plan/My-Health-Care-plan-1-brochure.pdf","url":"https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526/document/299"}],"versions":[],"where_to_buy":[],"claims_and_complaints":[],"notice":"Information, not advice. IndiaInsurances is not an insurer or an insurance intermediary, does not sell insurance and earns no commission. Policy terms change and your own policy schedule can differ: always confirm with the policy document and the insurer before you buy or claim.","cite_as":"My Health Care Plan (UIN BAJHLIP26074V022526), IndiaInsurances, https://indiainsurances.com/policy/bajaj-general-insurance/my-health-care-plan-bajhlip26074v022526"}