{"uin":"GCIHLIP22234V012122","name":"Health Elite","url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122","insurer":{"slug":"generali-central-insurance","name":"Generali Central Insurance Company Limited","url":"https://indiainsurances.com/insurer/generali-central-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":"Health Elite is an indemnity health policy with individual and family floater sum insured options from Rs. 75L to Rs. 6Cr. It includes OPD, maternity, day care, domiciliary, AYUSH, restoration of 100% of base sum insured and medical treatment abroad excluding USA and Canada unless the optional cover is chosen.","analysis":{"state":"machine","analysed_at":"2026-10-19 19:57:17.478108+00","note":"First pass: one AI reading; every stated fact carries a verbatim quote found in the cited clause, but it has not been reviewed. Check the clause before relying on it."},"facts":[{"key":"plan_variants","label":"Plans and variants","section":"Overview","meaning":"The named plans inside this product (not cover types or payout options). Facts can differ between them.","status":"not-stated","value":null,"display":null,"note":"The documents state individual and family floater sum insured bases, but do not name plan variants inside the product.","quote":null,"sources":[],"law":[]},{"key":"policy_term","label":"Policy term","section":"Eligibility","meaning":"How long one policy runs before it ends or must be renewed.","status":"quote-verified","value":"One year, Two years and Three years.","display":"1 year, 2 years and 3 years","note":null,"quote":"The Policy Period offered under this product is One year, Two years and Three years.","sources":[{"clause":null,"heading":"7. Policy Period","page":38,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-7-policy-period"}],"law":[]},{"key":"claim_intimation","label":"Claim intimation deadline","section":"Claims","meaning":"How soon you must tell the insurer about a claim or hospitalisation.","status":"quote-verified","value":"For reimbursement claims, notification must be given immediately and within 48 hours of diagnosis or sustaining the illness or injury. Emergency treatment abroad must be intimated within 2 days, and planned listed critical illness treatment abroad needs pre-authorisation at least 15 days before planned admission.","display":"Immediately and within 48 hours; emergency abroad within 2 days; planned treatment abroad at least 15 days before admission","note":null,"quote":"We must be given Notification of Claim in writing immediately and in any event within 48 hours of the diagnosis of/sustaining the Illness or Injury. ... Claim must be intimated to Us or Our Assistance service provider in no more than 2 days from the date of occurrence of the illness or Injury or admission to the Hospital, whichever is earlier. ... request for pre-authorisation of treatment by way of written form prescribed by Us, at least 15 days prior to planned date to admission for treatment of listed critical illnesses.","sources":[{"clause":"11(b)(i)","heading":null,"page":41,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-11-b-i"},{"clause":null,"heading":"2.2 Emergency Treatments","page":14,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-2-2-emergency-treatments"},{"clause":"11(d)(i)","heading":null,"page":43,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-11-d-i"}],"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":"quote-verified","value":["claim form specified by Us duly completed and signed","First consultation letter","First prescription from the Medical Practitioner","Original vouchers","Original Hospital bills giving a detailed break up","Original Money receipt","Birth/death certificate","original Hospital discharge card","original laboratory and diagnostic test reports","medicine bill from the chemist","bill from the diagnostic centre","Copy of proposer photo ID proof & address proof","NEFT Form with photocopy of cancelled cheque","Copy of Operation Theatre Notes","Copy of the Claim Intimation","post mortem report","Discharge Summary mentioning LMP, EDD & Gravida","IOL sticker","Copies of health insurance policies held with any other insurer","certificate from the other insurer","certificate from the attending doctor","Insured Person passport, Visa, Tickets and Boarding Passes","Medical reports and transportation details issued by the air ambulance service provider","Original Bills for expenses incurred towards availing Air Ambulance services","Copy of the death certificate","Copy of the postmortem certificate","Documentary proof for expenses incurred towards disposal of the mortal remains"],"display":"Claim form, consultation and prescription, original bills/vouchers/receipts, discharge card, test reports, ID and NEFT details, and benefit-specific documents","note":"The policy also asks for extra documents for air ambulance and repatriation of mortal remains claims.","quote":"a) The claim form specified by Us duly completed and signed by the claimant or a family member.\nb) First consultation letter.\nc) First prescription from the Medical Practitioner.\nd) Original vouchers.\ne) Original Hospital bills giving a detailed break up of all expense heads mentioned in the bill.\nf) Original Money receipt duly signed with a revenue stamp.\ng) Birth/death certificate (as applicable).\nh) The original Hospital discharge card.\ni) All original laboratory and diagnostic test reports such as X-Ray, E.C.G, USG, MRI Scan, Haemogram, etc. ... l) Copy of proposer photo ID proof & address proof\nm) NEFT Form with photocopy of cancelled cheque with printed name of proposer\nn) Copy of Operation Theatre Notes, if applicable\no) Copy of the Claim Intimation, if any ... u. Additional documents for Benefit 2 (Medical Treatment Abroad)– Insured Person passport, Visa, Tickets and Boarding Passes.","sources":[{"clause":"11(b)(iv)","heading":null,"page":41,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-11-b-iv"}],"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":"quote-verified","value":"The insurer will settle or reject a claim within 15 days from receipt of the last necessary document. If investigation is needed, it must be completed within 30 days and the claim settled or rejected within 45 days from receipt of the last necessary document, with interest at 2% above the Bank Rate for delay.","display":"15 days from last necessary document; 45 days if investigation is needed","note":null,"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. ... it shall initiate and complete such investigation at the earliest, in any case not later than 30 days from the date of receipt of last necessary document. ln such cases, the Company shall settle or reject the claim within 45 days from the date of receipt of last necessary document. ... the Company shall be liable to pay interest to the policyholder at a rate 2% above the Bank Rate","sources":[{"clause":null,"heading":"7. Claim settlement (provisions on Penal Interest)","page":44,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-7-claim-settlement-provisions-on-penal-interest"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 64UM(4) to (6)","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 10","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 15","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 16","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 22","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(i), V.3(ii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(iii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.4","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 23","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"The Motor Vehicles Act, 1988: Chapter XI, insurance of motor vehicles against third party risks","section":"Section 149","url":"https://indiainsurances.com/law/motor-vehicles-act-1988"}]},{"key":"exclusions_main","label":"Main exclusions","section":"Exclusions","meaning":"What the policy does not pay for, in the policy's own words.","status":"quote-verified","value":["Pre-Existing Disease- Excl 01","Specified disease/procedure waiting period- Code- Excl02","30 days waiting period Excl -03","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","Unproven Treatments: Code- Excl16","Sterility and Infertility: Code- Excl17","Treatment outside India except as specified under Benefit 2 (Medical Treatment abroad), Benefit 3 (Emergency Ambulance Expenses) and Benefit 14 (Repatriation of mortal remains)"],"display":"Waiting periods, standard exclusions and specific exclusions including treatment outside India except specified benefits","note":null,"quote":"a) Pre-Existing Disease- Excl 01 ... b) Specified disease/procedure waiting period- Code- Excl02 ... c) 30 days waiting period Excl -03 ... a) Investigation & Evaluation- Code- Excl04 ... b) Rest Cure, rehabilitation and respite care- Code- Excl05 ... c) Obesity/ Weight Control: Code- Excl06 ... d) Change-of-Gender treatments: Code- Excl07 ... e) Cosmetic or Plastic Surgery: Code- Excl08 ... f) Hazardous or Adventure sports: Code- Excl09 ... g) Breach of law: Code- Excl10 ... h) Excluded Providers: Code- Excl11 ... i) Code- Excl12 Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof. ... m) Unproven Treatments: Code- Excl16 ... n) Sterility and Infertility: Code- Excl17 ... q) Treatment outside India except as specified under Benefit 2 (Medical Treatment abroad), Benefit 3 (Emergency Ambulance Expenses) and Benefit 14 (Repatriation of mortal remains)","sources":[{"clause":"IV","heading":"EXCLUSIONS","page":30,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-iv"},{"clause":"1","heading":"Exclusions applicable for all Benefits","page":32,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-1-2"},{"clause":"1(b)(iv)","heading":null,"page":32,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-1-b-iv"},{"clause":null,"heading":"C. Specific Exclusions","page":33,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-c-specific-exclusions"}],"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":"quote-verified","value":"First contact Generali Central Insurance through its website, toll-free numbers, email, courier to the Grievance Redressal Cell or any branch grievance cell. If not satisfied, contact the grievance officer at GCIGRO@generalicentral.com or 7900197777 before approaching the Insurance Ombudsman.","display":"Company grievance channels first; then grievance officer; then Insurance Ombudsman","note":null,"quote":"In case of any grievance, the Insured Person may contact the company through Website: https://generalicentralinsurance.com Toll Free: 1800-220-233 / 1860-500-3333 / 022-67837800 Email: GCIcare@generalicentral.com Courier: Grievance Redressal Cell, Generali Central Insurance Company Limited. ... lf lnsured person is not satisfied with the redressal of grievance through one of the above methods, Insured Person may contact the grievance officer at GCIGRO@generalicentral.com or call at: 7900197777 ... the Insured Person may also approach the office of lnsurance Ombudsman","sources":[{"clause":"11","heading":"Redressal of Grievance","page":36,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-11-3"}],"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":"quote-verified","value":"Rs. 75L, 1 Cr to 6Cr in multiples of Rs.50L.","display":"Rs. 75L, Rs. 1 Cr to Rs. 6Cr in multiples of Rs.50L","note":null,"quote":"Sum Insured Range | Rs. 75L, 1 Cr to 6Cr in multiples of Rs.50L","sources":[{"clause":"Annexure I","heading":"Schedule of Benefits","page":47,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-annexure-i"}],"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":"quote-verified","value":{"unit":"days","amount":30},"display":"30 days","note":"Does not apply to accident claims; does not apply after continuous coverage for more than twelve months.","quote":"Expenses related to the treatment of any illness within 30 days from the first policy commencement date shall be excluded except claims arising due to an accident, provided the same are covered.","sources":[{"clause":"IV","heading":"EXCLUSIONS","page":30,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-iv"}],"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":"quote-verified","value":{"unit":"months","amount":24},"display":"24 months","note":"On sum insured enhancement, the exclusion applies afresh to the increased sum insured; portability credit may reduce the waiting period.","quote":"Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications shall be excluded until the expiry of 24 months of continuous coverage after the date of inception of the first policy with Us.","sources":[{"clause":"IV","heading":"EXCLUSIONS","page":30,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-iv"}],"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":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"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":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"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":"quote-verified","value":{"unit":"months","amount":60},"display":"sixty continuous months","note":"For enhanced sum insured, sixty continuous months applies from the date of enhancement on the enhanced limits.","quote":"After completion of sixty continuous months of coverage (including portability and migration) in health insurance policy, no policy and claim shall be contestable by the insurer on grounds of non-disclosure, misrepresentation, except on grounds of established fraud.","sources":[{"clause":"8","heading":"Moratorium Period","page":36,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-8-3"}],"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":"quote-verified","value":"The insured can port the policy to other insurers at renewal by applying at least 30 days before, but not earlier than 60 days from the renewal due date. Waiting-period, no-claim-bonus and moratorium credits are transferred to the extent of the sum insured if continuously covered without lapses.","display":"Allowed at renewal with continuity credit","note":null,"quote":"The insured person will have the option to port the policy to other insurers at the time of renewal 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 due date for renewal as per IRDAI guidelines related to portability. ... then the credit gained to the extent of the Sum Insured, No Claim Bonus, Specific Waiting periods, waiting period for pre-existing diseases, Moratorium period etc. in the previous policy, shall be transferred from the existing Insurer to Our Company.","sources":[{"clause":null,"heading":"2. Portability","page":37,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-2-portability"}],"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":"quote-verified","value":true,"display":"Yes, lifelong","note":null,"quote":"This Policy shall be renewable lifelong provided the Insured Persons continue to be Indian Nationals and resident of India at subsequent renewals of this plan.","sources":[{"clause":null,"heading":"8. Other terms on Renewal","page":45,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-8-other-terms-on-renewal"}],"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":"quote-verified","value":"No loading applies on renewals based on individual claims experience.","display":"No loading on renewals based on individual claims experience","note":null,"quote":"No loading shall apply on renewals based on individual claims experience.","sources":[{"clause":null,"heading":"8. Other terms on Renewal","page":45,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-8-other-terms-on-renewal"}],"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":"quote-verified","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","Treatments received in heath hydros, nature cure clinics, spas or similar establishments","Dietary supplements and substances that can be purchased without prescription","Refractive Error: Code- Excl15","Unproven Treatments: Code- Excl16","Sterility and Infertility: Code- Excl17","External Congenital Anomaly and related illness/ defect","Stem cell storage","Intentional self-Injury"],"display":"Standard exclusions Excl04 to Excl17 printed in the policy, plus specific permanent exclusions","note":null,"quote":"a) Investigation & Evaluation- Code- Excl04 ... b) Rest Cure, rehabilitation and respite care- Code- Excl05 ... c) Obesity/ Weight Control: Code- Excl06 ... d) Change-of-Gender treatments: Code- Excl07 ... e) Cosmetic or Plastic Surgery: Code- Excl08 ... f) Hazardous or Adventure sports: Code- Excl09 ... g) Breach of law: Code- Excl10 ... h) Excluded Providers: Code- Excl11 ... i) Code- Excl12 Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof. ... j) Code- Excl13 Treatments received in heath hydros, nature cure clinics, spas or similar establishments ... k) Code- Excl14 Dietary supplements and substances that can be purchased without prescription ... l) Refractive Error: Code- Excl15 ... m) Unproven Treatments: Code- Excl16 ... n) Sterility and Infertility: Code- Excl17 ... f) External Congenital Anomaly and related illness/ defect. ... h) Stem cell storage. ... n) Intentional self-Injury.","sources":[{"clause":"1","heading":"Exclusions applicable for all Benefits","page":32,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-1-2"},{"clause":"1(b)(iv)","heading":null,"page":32,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-1-b-iv"},{"clause":null,"heading":"C. Specific Exclusions","page":33,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-c-specific-exclusions"}],"law":[{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 16","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"cancellation_refund","label":"Cancellation by you","section":"Renewal and rights","meaning":"What you get back if you cancel during the year.","status":"quote-verified","value":"You may cancel by giving 7 days written notice. If no claims are reported, premium for the unexpired policy or instalment period is refunded pro rata; if claims are reported, there is no refund for a 1-year term or current policy year/instalment period, but unutilized subsequent policy years in a 2/3-year single-premium policy may be refunded.","display":"7 days notice; pro-rata refund if no claims; limited or no refund if claims reported","note":null,"quote":"The policyholder may cancel this policy by giving 7 days written notice. ... where no claims are reported under the Policy, the Company shall refund premium for the unexpired policy/ instalment period ... There shall be refund of proportionate premium for the unexpired policy period on prorate basis. ... 1 year Policy Term - There shall be no refund of premium for the unexpired policy period. ... 2/3 years Policy Term – There shall be no refund of premium for the current Policy Year in which the claim got reported. However, the premium for the unutilized subsequent Policy Years (if any), shall be refunded.","sources":[{"clause":null,"heading":"9. Cancellation","page":38,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-9-cancellation"},{"clause":"11(c)(i)","heading":null,"page":38,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-11-c-i"}],"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":"quote-verified","value":"Treatment and investigations are covered anywhere in India, except for Medical Treatment Abroad, Emergency Ambulance Expenses and Repatriation of Mortal Remains. Medical Treatment Abroad and emergency ambulance abroad exclude USA and Canada unless the optional Treatment including USA & Canada cover is chosen.","display":"India, with specified overseas benefits excluding USA & Canada unless optional cover is chosen","note":null,"quote":"Except as provided in Benefit 2 (Medical Treatment Abroad), Benefit 3 (Emergency Ambulance Expenses) and Benefit 14 (Repatriation of Mortal Remains). We shall cover only treatment and investigations covered in terms of this Policy that is taken during the Policy Period and takes place anywhere in the territory of India. ... Treatment of Illnesses in USA and Canada. This exclusion will not be applicable in case Benefit 25 (Treatment including USA & Canada) is opted.","sources":[{"clause":null,"heading":"8. Territorial Limits and Law","page":38,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-8-territorial-limits-and-law"},{"clause":null,"heading":"Specific Exclusion","page":13,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-specific-exclusion-5"}],"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":"quote-verified","value":{"unit":"days","amount":30},"display":"thirty days","note":"Applies to new individual health insurance policies, not renewals or porting/migration.","quote":"The Insured Person shall be allowed free look period of thirty days from date of receipt of the policy document to review the terms and conditions of the policy, and to return the same if not acceptable.","sources":[{"clause":"3","heading":"Free Look Period","page":34,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-3-3"}],"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":"quote-verified","value":{"unit":"days","amount":15},"display":"15 days for monthly instalment; 30 days for quarterly / Half Yearly instalment premiums","note":"The renewal clause separately says the policy can be renewed within a Grace Period of 30 days to maintain continuity.","quote":"Grace Period of 15 days would be given to pay in case of monthly instalment premium and grace period of 30 days shall be given to pay in case of quarterly / Half Yearly installment premiums, due for the policy.","sources":[{"clause":null,"heading":"10. Premium Payment in installments","page":40,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-10-premium-payment-in-installments"}],"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":"quote-verified","value":"Minimum entry age is 91 Days for a child and 18 years for an adult/proposer. Maximum entry age is 65 years for an adult/proposer; child maximum is N/A.","display":"Child: 91 Days minimum; Adult/Proposer: 18 years to 65 years","note":null,"quote":"Proposer | Adult | Child\nMinimum | 18 years | 18 years | 91 Days\nMaximum | 65 years | 65 years | N/A","sources":[{"clause":null,"heading":"Entry Age","page":50,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-entry-age"}],"law":[]},{"key":"premium_modes","label":"Premium payment options","section":"Premium","meaning":"How often you can pay: yearly, half-yearly, quarterly, monthly.","status":"quote-verified","value":["Single Premium","Half Yearly","Quarterly","Monthly","Annually in case of long-term policies"],"display":"Single Premium, Half Yearly, Quarterly, Monthly & Annually in case of long-term policies","note":null,"quote":"Installment Options | Installment Options | Single Premium, Half Yearly; Quarterly, Monthly & Annually in case of long-term\npolicies","sources":[{"clause":null,"heading":"Others","page":49,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-others"}],"law":[]},{"key":"optional_covers","label":"Optional covers","section":"Cover","meaning":"Covers you can add for an extra premium. They change the answers above only if you buy them.","status":"quote-verified","value":["Co-pay waiver for Benefit 2 (Medical Treatment Abroad)","Treatment including USA & Canada"],"display":"Co-pay waiver; Treatment including USA & Canada","note":"Both are available on payment of additional premium.","quote":"Benefit 24. Co-pay waiver for Benefit 2 (Medical Treatment Abroad) ... Benefit 25. Treatment including USA & Canada","sources":[{"clause":null,"heading":"Benefit 24. Co-pay waiver for Benefit 2 (Medical Treatment Abroad)","page":30,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-benefit-24-co-pay-waiver-for-benefit-2-medical-t"},{"clause":null,"heading":"Benefit 25. Treatment including USA & Canada","page":30,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-benefit-25-treatment-including-usa-canada"}],"law":[]},{"key":"grace_cover","label":"Cover during the grace period","section":"Renewal and rights","meaning":"Whether a claim during the grace period is paid.","status":"quote-verified","value":"Coverage is not available during the grace period for renewal. The grace period definition also says coverage is offered during the grace period if premium is paid in instalments during the policy period.","display":"Coverage is not available during the grace period","note":"The definition and renewal clauses differ within the policy wording; this is noted but not treated as a document conflict.","quote":"Coverage is not available during the grace period. ... Provided the insurers shall offer coverage during the grace period, if the premium is paid instalments during the policy period.","sources":[{"clause":null,"heading":"8. Other terms on Renewal","page":45,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-8-other-terms-on-renewal"},{"clause":"17","heading":"Grace Period","page":3,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#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":"quote-verified","value":"Room Rent for accommodation in a hospital room and other boarding charges is covered as part of Hospitalization Expenses up to the sum insured. No separate room-rent sub-limit is printed in the Schedule of Benefits.","display":"Up to Sum Insured as part of Hospitalization Expenses","note":null,"quote":"We will pay the Medical Expenses necessarily incurred, up to the Sum Insured specified in the Schedule of Benefits, for one or more of the following arising out of the Insured Person’s Hospitalization in India ... i) Reasonable and Customary Charges for Room Rent for accommodation in Hospital room and other boarding charges. ... Hospitalization | In Base Sum | Up To Sum Insured","sources":[{"clause":null,"heading":"A. Hospitalization Covers","page":7,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-a-hospitalization-covers"},{"clause":"Row 1","heading":"1","page":47,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-row-1-2"}],"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":"not-stated","value":null,"display":null,"note":"The policy covers room rent and boarding charges but does not state a permitted room category.","quote":null,"sources":[],"law":[]},{"key":"icu_limit","label":"ICU limit","section":"Limits and co-pay","meaning":"The most the policy pays per day for intensive care.","status":"quote-verified","value":"ICU Charges are covered as part of Hospitalization Expenses up to the sum insured. No separate ICU per-day sub-limit is printed in the Schedule of Benefits.","display":"Up to Sum Insured as part of Hospitalization Expenses","note":null,"quote":"We will pay the Medical Expenses necessarily incurred, up to the Sum Insured specified in the Schedule of Benefits ... ii) ICU Charges. ... Hospitalization | In Base Sum | Up To Sum Insured","sources":[{"clause":null,"heading":"A. Hospitalization Covers","page":7,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-a-hospitalization-covers"},{"clause":"Row 1","heading":"1","page":47,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-row-1-2"}],"law":[]},{"key":"proportionate_deduction","label":"Proportionate deduction","section":"Limits and co-pay","meaning":"If you choose a room above your limit, whether the insurer reduces associated charges (doctor fees, tests, procedures) by the same proportion.","status":"not-stated","value":null,"display":null,"note":"No clause found stating proportionate deduction for choosing a room above a limit.","quote":null,"sources":[],"law":[]},{"key":"copay","label":"Co-payment","section":"Limits and co-pay","meaning":"The share of every admissible claim you pay yourself, and when it applies (age, zone, choice of hospital).","status":"quote-verified","value":"A 20% co-payment applies to every admissible claim, other than OPD Treatment, for insured persons aged 61 years to 65 years being covered for the first time. All Medical Treatment Abroad claims also have 20% co-payment, which can be waived by an optional cover for Benefit 2.","display":"20% for first-time entry at ages 61 to 65; 20% for Medical Treatment Abroad","note":"The age-based co-payment has no waiver option. The Medical Treatment Abroad co-payment can be waived only if the optional Co-pay waiver is bought.","quote":"Any Insured Person aged 61 years to 65 years, being covered for the first time in this policy shall bear 20% of each and every admissible claim ... All claims admitted under “Medical Treatment Abroad” Benefit will be subject to 20% Co-payment. The Insured has an option to waive off this co-payment on payment of additional premium under Co-pay waiver “optional Cover.","sources":[{"clause":null,"heading":"4. Co-Payments Applicable under the Policy","page":44,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-4-co-payments-applicable-under-the-policy"}],"law":[]},{"key":"deductible","label":"Deductible","section":"Limits and co-pay","meaning":"An amount of each claim or each year that you bear before the policy pays.","status":"quote-verified","value":"Not Applicable.","display":"Not Applicable","note":null,"quote":"iii. Deductible- (It is a specified amount up to which an insurance company will not pay any claim, and which will be deducted from total claim amount (if claim amount is more than the specified amount) | Not Applicable | Not Applicable","sources":[{"clause":null,"heading":"HEALTH ELITE","page":1,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5766#c-health-elite-2"}],"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":"quote-verified","value":["Surgery for cataracts: maximum Rs.1,00,000/- per eye","listed Mental Healthcare/ Psychiatric illness treatment: up to the sum insured, or maximum of Rs. 1,00,00,000, which ever lower","Maternity Expenses: Normal Delivery +Pre Natal+ Post Natal Expenses- Up To Rs. 1,00,000","Maternity Expenses: Caesarean Delivery+ Pre Natal+ Post Natal Expenses- Up To Rs. 2,00,000","Bariatric Surgery: Up To Rs 10,00,000"],"display":"Cataract Rs.1,00,000 per eye; mental healthcare lower of SI or Rs.1,00,00,000; maternity Rs.1,00,000/Rs.2,00,000; bariatric Rs.10,00,000","note":null,"quote":"Claims related to Surgery for cataracts: Our obligation to make payment in respect of Surgery for cataracts (after the expiry of the two years waiting period, shall be restricted to a maximum of Rs.1,00,000/- per eye. ... Claims Related to listed Mental Healthcare/ Psychiatric illness treatment: Our obligation to make payment for Medical expenses incurred by the Insured Person with respect to below listed Mental/ Psychiatric conditions would be restricted either up to the sum insured, or maximum of Rs. 1,00,00,000, which ever lower ... Maternity Expenses (24/36 Months Waiting) | In Base Sum Insured | 1. Normal Delivery +Pre Natal+ Post Natal Expenses- Up To Rs. 1,00,000 2. Caesarean Delivery+ Pre Natal+ Post Natal Expenses- Up To Rs. 2,00,000 ... Bariatric Surgery | In Base Sum Insured | Up To Rs 10,00,000","sources":[{"clause":null,"heading":"3. Basis of Claims Payment","page":43,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-3-basis-of-claims-payment"},{"clause":"Section A","heading":"Hospitalization Covers","page":47,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-section-a-2"}],"law":[]},{"key":"pre_hospitalisation","label":"Pre-hospitalisation cover","section":"Cover","meaning":"Medical costs in the days before admission that are paid if related to the hospitalisation.","status":"quote-verified","value":{"unit":"days","amount":60},"display":"up to 60 days","note":"Available within India only.","quote":"We will pay the Reasonable and Customary Charges for Pre- hospitalization Medical Expenses that are incurred by the Insured Person related to any claim admitted under Benefit 1 (Hospitalization Expenses) and Benefit 2.1 (Listed Critical illness treatment), for up to 60 days immediately prior to the date of the Insured Person’s admission to Hospital.","sources":[{"clause":null,"heading":"Benefit 7. Pre-hospitalization Medical Expenses","page":19,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-benefit-7-pre-hospitalization-medical-expenses"}],"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":"quote-verified","value":{"unit":"days","amount":180},"display":"up to 180 days","note":"Available within India only.","quote":"We will pay the Reasonable and Customary Charges for Post- hospitalization Medical Expenses that are incurred by the Insured Person related to any claim admitted under Benefit 1 (Hospitalization Expenses) and Benefit 2.1 (Listed Critical illness treatment), for up to 180 days immediately following the Insured Person’s discharge from Hospital.","sources":[{"clause":null,"heading":"Benefit 8. Post-hospitalization Medical Expenses","page":19,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-benefit-8-post-hospitalization-medical-expenses"}],"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":"quote-verified","value":"Day Care Treatment Expenses are covered up to the sub-limit in the Schedule of Benefits for listed day care treatments, and the annexure also says any other surgeries/procedures agreed by the insurer requiring less than 24 hours of hospitalization are covered.","display":"Listed day-care treatments, plus any other surgeries/procedures agreed by the insurer requiring less than 24 hours","note":"The schedule says Day Care Treatment Expenses are up to Sum Insured.","quote":"We will pay the Reasonable and Customary Charges up to the sub-Limit specified in the Schedule of Benefits towards Medically Necessary Treatment incurred by the Insured Person towards Day Care Treatments following an Illness or Injury that occurs during the Policy Period as specified in the list of Day Care Treatments at Annexure II of the Policy. ... In addition to the following list of Day Care Treatments, We would also cover any other Surgeries/procedures agreed by Us in a Hospital or a Day Care Centre which require less than 24 hours of Hospitalization for inpatient care due to subsequent advancement in technology.","sources":[{"clause":null,"heading":"Benefit 11. Day Care Treatment Expenses","page":20,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-benefit-11-day-care-treatment-expenses"},{"clause":"Annexure II","heading":"Day Care List","page":52,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-annexure-ii"}],"law":[]},{"key":"domiciliary","label":"Treatment at home","section":"Cover","meaning":"Whether treatment at home is covered when hospital admission is not possible or a doctor advises it.","status":"quote-verified","value":"Domiciliary hospitalization is covered up to 10% of the sum insured for medical expenses at home for illness or injury, if medically necessary treatment is required continuously for at least 3 days. It is India-only and excludes pre/post domiciliary hospitalization and listed conditions.","display":"Yes, up to 10% of Sum Insured if treatment at home continues at least 3 days","note":"Available within India only.","quote":"We will pay the Reasonable and Customary Charges incurred by the Insured Person up to a maximum of 10% of the Sum Insured (excluding the Cumulative Bonus, if any) for Medical Expenses incurred on the Domiciliary Hospitalization of the Insured Person for an Illness or Injury sustained during a Policy Period provided that the Medically Necessary Treatment is required for a continuous period of at least 3 days.","sources":[{"clause":null,"heading":"Benefit 6. Domiciliary Hospitalization Expenses","page":18,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-benefit-6-domiciliary-hospitalization-expenses"}],"law":[]},{"key":"ayush","label":"AYUSH treatment","section":"Cover","meaning":"Ayurveda, Yoga, Unani, Siddha and Homeopathy treatment in a recognised hospital, and any limit.","status":"quote-verified","value":"Hospitalization under Alternative Treatment under Ayurveda, Yoga and Naturopathy, Unani, Siddha or Homeopathy at an AYUSH Hospital is covered up to the Sum Insured, within India.","display":"AYUSH hospitalization at an AYUSH Hospital up to Sum Insured","note":"Preventive and rejuvenation treatments are excluded; available within India only.","quote":"We will pay the Medical Expenses, up to the Sum Insured specified in the Schedule of Benefits, incurred with respect to the Insured Person for Hospitalization under Alternative Treatment under Ayurveda, Yoga and Naturopathy, Unani, Siddha or Homeopathy at an AYUSH Hospital during the Policy Period.","sources":[{"clause":null,"heading":"Benefit 18. Alternative Treatment","page":22,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-benefit-18-alternative-treatment"}],"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":"not-stated","value":null,"display":null,"note":"The policy lists day-care treatments and listed critical illnesses but does not state a separate modern treatments cover or cap.","quote":null,"sources":[],"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":"quote-verified","value":"Organ donor treatment expenses for harvesting the donated organ are covered where the insured person is the recipient and the main hospitalization claim is accepted. Donor screening, donor pre/post hospitalization, other donor treatment and organ acquisition costs are excluded.","display":"Yes, donor harvesting expenses covered up to Sum Insured; screening and donor pre/post hospitalization excluded","note":"Organ donor expenses are not covered under Medical Treatment Abroad.","quote":"We will pay the Medical Expenses covered under Benefit 1 (Hospitalization Expenses) incurred by the Insured Person during the Policy Year for an organ donor’s treatment for the harvesting of the donated organ where the Insured Person is the recipient ... We will not pay the donor’s screening expenses or pre and post Hospitalization expenses or for any other medical treatment for the donor consequent to the harvesting;","sources":[{"clause":null,"heading":"Benefit 10. Organ Donor Expenses","page":20,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-benefit-10-organ-donor-expenses"}],"law":[]},{"key":"ambulance","label":"Ambulance cover","section":"Cover","meaning":"Road (and air) ambulance cover and its limit.","status":"quote-verified","value":"Emergency Ambulance Expenses cover road ambulance up to Rs 50,000 and air ambulance up to Rs 5,00,000, within India and outside India. USA and Canada are excluded unless the Treatment including USA & Canada optional cover is opted.","display":"Road ambulance up to Rs 50,000; air ambulance up to Rs 5,00,000","note":null,"quote":"Emergency Ambulance Expenses (Within India And Outside India) | In Base Sum Insured | 1. Up To Rs 50,000 For Road Ambulance 2. Up To Rs 5,00,000 For Air Ambulance ... Costs under this Benefit associated with Ambulance services taken in or to US and Canada. This exclusion will not be applicable in case Benefit 25 (Treatment including USA & Canada) is opted.","sources":[{"clause":"Row 3","heading":"Emergency Ambulance Expenses (Within India And Outside India)","page":47,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-row-3"},{"clause":"20(b)(vi)","heading":null,"page":16,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-20-b-vi"}],"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":"quote-verified","value":"If the sum insured and cumulative bonus are exhausted by payable claims in a policy year, a restore sum insured equal to 100% of the base sum insured is automatically available once that year. It is only for future claims in the same policy year and cannot be used for the same or related illness or for maternity expenses.","display":"100% of base Sum Insured, once in a Policy Year, for future different/unrelated claims","note":null,"quote":"If the Sum Insured and Cumulative Bonus (if any) is exhausted due to claims incurred ... a Restore Sum Insured (equal to 100% of the base Sum Insured) will be automatically available for the particular Policy Year ... The Restore Sum Insured cannot be used for claims based on Maternity Expenses/Treatment; ... The Restore Sum Insured can be used only for future claims ... cannot be used against same/related claim ... The Restoration of sum insured will happen only once during a Policy Year;","sources":[{"clause":null,"heading":"Benefit 19. Restoration of the Sum Insured","page":22,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-benefit-19-restoration-of-the-sum-insured"}],"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":"quote-verified","value":"Cumulative Bonus increases by 10% for each claim-free policy year, except OPD and Wellness Benefit claims, up to a maximum of 100% of the sum insured. If a claim is made, the accrued bonus is reduced at the same rate, but the base sum insured is not reduced.","display":"10% per claim-free year, maximum 100%; reduced at same rate after a claim","note":null,"quote":"Cumulative Bonus will be increased by 10% in respect of each claim free policy year (where no claims are reported) with the exception of any claim under Benefit 4 (OPD treatment ) and Benefit 23 (Wellness Benefits), provided the policy is renewed with Us without a break subject to maximum of 100% of the sum insured under the current policy year. 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. However, Sum Insured will be maintained and will not be reduced in the policy year.","sources":[{"clause":null,"heading":"Benefit 22. Cumulative Bonus","page":24,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-benefit-22-cumulative-bonus"}],"law":[]},{"key":"consumables","label":"Consumables and non-medical items","section":"Cover","meaning":"Gloves, PPE, syringes and other items hospitals bill that standard policies exclude; whether this policy pays them.","status":"quote-verified","value":"Medicines, drugs and other allowable consumables prescribed by the treating medical practitioner are covered in hospitalization. However, the standard excluded items list says items such as GLOVES and MASK are not covered.","display":"Allowable consumables covered; listed non-medical items such as GLOVES and MASK are excluded","note":"Wellness reward points may be used for reimbursement of non-medical expenses in a hospitalization claim, but that is through wellness points rather than base hospitalization cover.","quote":"vi) Medicines, drugs and other allowable consumables prescribed by the treating Medical Practitioner. ... List I – Items for which coverage is not available in the Policy ... 56. | GLOVES ... 60. | MASK","sources":[{"clause":null,"heading":"A. Hospitalization Covers","page":7,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-a-hospitalization-covers"},{"clause":"Annexure III","heading":null,"page":57,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-annexure-iii"}],"law":[]},{"key":"maternity","label":"Maternity cover","section":"Cover","meaning":"Whether childbirth costs are covered, the limit and the waiting period.","status":"quote-verified","value":"Maternity Expenses are covered after 24 months if both self and spouse are covered, or 36 months if only self is covered. The Schedule limit is Rs. 1,00,000 for normal delivery plus pre-natal and post-natal expenses, and Rs. 2,00,000 for caesarean delivery plus pre-natal and post-natal expenses.","display":"Covered after 24/36 months; Rs. 1,00,000 normal and Rs. 2,00,000 caesarean","note":"Pre-natal hospitalization expenses are covered for 90 days before delivery and post-natal hospitalization expenses for 45 days after delivery, within the maternity sub-limit.","quote":"Maternity Expenses (24/36 Months Waiting) | In Base Sum Insured | 1. Normal Delivery +Pre Natal+ Post Natal Expenses- Up To Rs. 1,00,000 2. Caesarean Delivery+ Pre Natal+ Post Natal Expenses- Up To Rs. 2,00,000 ... If You and Your Spouse are covered under the Policy this Benefit will be applicable provided that We have received at least 3 continuous annual premiums ... and provided that at least 24 months of continuous coverage has elapsed ... If only You are covered and Your Spouse is not covered under the Policy, this Benefit will be applicable provided that We have received at least 4 continuous annual premiums ... and provided that at least 36 months of continuous coverage have elapsed","sources":[{"clause":"Section A","heading":"Hospitalization Covers","page":47,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-section-a-2"},{"clause":null,"heading":"Benefit 9. Maternity Expenses","page":19,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-benefit-9-maternity-expenses"}],"law":[]},{"key":"newborn","label":"Newborn baby cover","section":"Cover","meaning":"Whether a newborn is covered from birth and for what.","status":"quote-verified","value":"If the maternity claim is accepted, the newborn baby's medically necessary treatment while the insured is hospitalized for delivery is covered until the expiry date of that policy year, up to the mother's sum insured without additional premium. Newborn vaccination is covered up to Rs 10,000.","display":"Covered from birth after accepted maternity claim, up to mother's Sum Insured; vaccination up to Rs 10,000","note":"Restoration of Sum Insured is not applicable for newborn baby cover.","quote":"If We have accepted a claim under Benefit 9 (Maternity Expenses), then We will also pay ... Medical Expenses incurred towards the Medically Necessary Treatment of the Insured Person’s Newborn Baby while the Insured Person is Hospitalized for delivery and We will cover the Newborn Baby until the expiry date of the Policy Year in which the Newborn Baby is born, up to the sum insured as applicable for the Insured Person (mother) without any additional premium. ... Newborn Baby Expenses | In Base Sum Insured | Up To Sum Insured Vaccination Benefit - Up To Rs 10,000","sources":[{"clause":null,"heading":"Benefit 16. Newborn Baby Expenses","page":21,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-benefit-16-newborn-baby-expenses"},{"clause":"Section A","heading":"Hospitalization Covers","page":47,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-section-a-2"}],"law":[]},{"key":"mental_illness","label":"Mental illness","section":"Cover","meaning":"Cover for in-patient treatment of mental illness.","status":"quote-verified","value":"Listed mental healthcare and psychiatric illness treatment is covered up to the sum insured, or a maximum of Rs. 1,00,00,000, whichever is lower.","display":"Covered for listed conditions, up to SI or Rs. 1,00,00,000, whichever is lower","note":"The listed conditions include F01 Vascular dementia, F20 Schizophrenia, F30 Manic episode, F31 Bipolar affective disorder, F32-33 Depressive disorders and other listed ICD codes.","quote":"Claims Related to listed Mental Healthcare/ Psychiatric illness treatment: Our obligation to make payment for Medical expenses incurred by the Insured Person with respect to below listed Mental/ Psychiatric conditions would be restricted either up to the sum insured, or maximum of Rs. 1,00,00,000, which ever lower","sources":[{"clause":null,"heading":"3. Basis of Claims Payment","page":43,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-3-basis-of-claims-payment"}],"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":"quote-verified","value":"Health check-up is a wellness value-added service for everyone from age 18 onwards, available from the 1st Policy Year at the insurer's wellness partner empaneled Diagnostic Centres.","display":"From 1st Policy Year for ages 18 years onwards, at wellness partner diagnostic centres","note":"The policy lists tests including CBC, HbA1C, ECG, lipid tests, medical examination with blood pressure and BMI, thyroid function, calcium, uric acid, vitamin D, total protein, pulmonary function test and USG abdomen.","quote":"Health checkup Under this benefit, the Insured Person will be eligible for “Health checkup” under the Policy. Everyone from Age 18 years onwards is eligible for availing the Health Checkup. The health checkup can be conducted from 1st Policy Year of the Policy with Us. Health checkup will be provided at Our wellness partner empaneled Diagnostic Centres only.","sources":[{"clause":"20(I)(e)","heading":null,"page":26,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-20-i-e"}],"law":[]},{"key":"opd","label":"Out-patient (OPD) cover","section":"Cover","meaning":"Doctor consultations, tests and medicines without admission, and the limit.","status":"quote-verified","value":"OPD Treatment is covered up to Rs. 50,000 per policy per year, irrespective of individual or floater sum insured. Consultation, diagnostic tests, medications, home visits, qualified nurses and physiotherapists are covered at 80% of bills; dental treatment is covered at 70% of bills after a 6-month waiting period; optical aid is up to Rs. 6,500 and hearing aid is up to 30% of the OPD sub-limit every alternate policy year.","display":"Up to Rs. 50,000 per policy per year; 80%/70% bill limits and optical/hearing sub-limits","note":"Only allopathic treatment is covered under the OPD benefit.","quote":"OPD Treatment | In Base Sum Insured | Up To Rs. 50,000 Per Policy Per Year Irrespective Of Individual/ Floater Sum Insured\nA | Consultation, Diagnostic Tests And Medications | 80% Of Bills\nB | Dental Treatment | 70% Of Bills; 6 Months Waiting Period\nC | C | Hearing And Optical Aid | 1. Optical Aid covered up to Rs. 6,500 2. Hearing Aid covered up to 30% of OPD benefit Sub-limit 3. Claim can be made every alternate policy year.\nD | Home Visit Cover | 80% Of Bills\nE | Qualified Nurses | 80% Of Bills\nF | Physiotherapists | 80% Of Bills","sources":[{"clause":"Row 4","heading":"OPD Treatment","page":47,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-row-4"}],"law":[]},{"key":"zone_pricing","label":"Zone or city-based premium","section":"Premium","meaning":"Whether premium or co-pay depends on the city you are treated in.","status":"not-stated","value":null,"display":null,"note":"No city or zone-based premium or treatment co-pay clause was found.","quote":null,"sources":[],"law":[]},{"key":"cashless","label":"Cashless treatment","section":"Claims","meaning":"Whether and where the insurer pays the hospital directly instead of you paying and claiming back.","status":"quote-verified","value":"Cashless facility is available only at a Network Provider. If the pre-authorisation procedure is followed, the insured need not directly pay covered medical expenses to the Network Provider, but pre-authorisation does not guarantee all costs are covered.","display":"Available at Network Providers with pre-authorisation","note":"For Medical Treatment Abroad, the assistance service provider coordinates cashless facility where available.","quote":"Cashless Facility is only available at a Network Provider. ... For availing cashless at a Network Provider, We must be called at Our call centre and a request for pre-authorisation must be made by way of the written form prescribed by Us. ... Where the above procedure is followed, the Insured Person will not be required to directly pay for those Medical Expenses to the Network Provider that We are liable to indemnify under this Policy.","sources":[{"clause":"11(e)(xi)","heading":null,"page":40,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-11-e-xi"},{"clause":"11(a)(i)","heading":null,"page":40,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-11-a-i"},{"clause":"11(a)(iii)","heading":null,"page":41,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-11-a-iii"}],"law":[]},{"key":"claims_handled_by","label":"Claims handled by","section":"Claims","meaning":"The insurer itself or a third-party administrator (TPA).","status":"quote-verified","value":"Claims within India are handled by the Claims Department, Generali Central Health (GCH), Generali Central Insurance Company Limited. For Medical Treatment Abroad, outside-India ambulance and repatriation claims, the contact is Europ Assistance India Pvt. Ltd.","display":"Generali Central Health (GCH); Europ Assistance India Pvt. Ltd. for specified overseas benefits","note":null,"quote":"In case of any claims within India please contact:\nClaims Department: ... Generali Central Health (GCH) ... Generali Central Insurance Company Limited. ... In case of any claims for Benefit 2 (Medical Treatment Abroad), Benefit 3 (Emergency Ambulance Charges- Outside India), Benefit 14 (Repatriation of Mortal Remains) please contact Europ Assistance India Pvt. Ltd.","sources":[{"clause":null,"heading":"Entry Age","page":50,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-entry-age"},{"clause":null,"heading":"Generali Central Health (GCH)","page":51,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-generali-central-health-gch"}],"law":[]},{"key":"family_floater","label":"Family floater available","section":"Cover","meaning":"Whether one sum insured can be shared by the whole family.","status":"quote-verified","value":true,"display":"Yes, Family Floater","note":"A maximum of 15 members can be covered under one policy on either individual or floater sum insured basis.","quote":"Sum Insured Basis | Individual & Family Floater","sources":[{"clause":null,"heading":"Others","page":49,"url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769#c-others"}],"law":[]}],"documents":[{"kind":"wording","label":"Health Elite Policy Wordings","pages":62,"fetched_at":"2026-10-17 19:32:48+00","source_url":"https://www.generalicentralinsurance.com/downloads/health-insurance/health-elite/policy-wording/health-elite-policy-wording.pdf","url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5769"},{"kind":"prospectus","label":"Health Elite Prospectus Form","pages":62,"fetched_at":"2026-10-17 19:32:51+00","source_url":"https://www.generalicentralinsurance.com/downloads/health-insurance/health-elite/prospectus-forms/health-elite-policy-prospectus.pdf","url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5767"},{"kind":"cis","label":"Health Elite Customer Information Sheet","pages":10,"fetched_at":"2026-10-17 19:32:52+00","source_url":"https://www.generalicentralinsurance.com/downloads/health-insurance/health-elite/customer-information-sheet/health-elite-cis.pdf","url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5766"},{"kind":"brochure","label":"Health Elite Product Brochure","pages":20,"fetched_at":"2026-10-17 19:32:42+00","source_url":"https://www.generalicentralinsurance.com/downloads/health-insurance/health-elite/product-brochures/health-elite-brochure.pdf","url":"https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122/document/5764"}],"versions":[],"where_to_buy":[{"purpose":"buy","kind":"insurer","name":"Generali Central Insurance official website","url":"https://www.generalicentralinsurance.com/","note":"Buy directly from the insurer."},{"purpose":"buy","kind":"ours","name":"Get free help from IndiaInsurances","url":"/help","note":"Free. We do not sell insurance and earn no commission; your request is not passed to anyone."}],"claims_and_complaints":[{"purpose":"claim","kind":"insurer","name":"Motor claim process","url":"https://www.generalicentralinsurance.com/motor-insurance/motor-claim-process","note":null},{"purpose":"claim","kind":"insurer","name":"Other claim process","url":"https://www.generalicentralinsurance.com/other-claim-process","note":null},{"purpose":"claim","kind":"ours","name":"Get free help from IndiaInsurances","url":"/help","note":"Free. We do not sell insurance and earn no commission; your request is not passed to anyone."},{"purpose":"grievance","kind":"insurer","name":"Grievance redressal","url":"https://www.generalicentralinsurance.com/customer-service/grievance-redressal","note":null},{"purpose":"grievance","kind":"official","name":"Bima Bharosa (IRDAI grievance portal)","url":"https://bimabharosa.irdai.gov.in/","note":"Register and track a complaint against any insurer with IRDAI. Complain to the insurer first; escalate here if the reply is late or unsatisfactory."},{"purpose":"grievance","kind":"official","name":"e-Daakhil (consumer commission e-filing)","url":"https://edaakhil.nic.in/","note":"Not reachable from our crawler on 2026-10-19; use e-Jagriti if this link does not open."},{"purpose":"grievance","kind":"official","name":"e-Jagriti (consumer commission filing)","url":"https://e-jagriti.gov.in/","note":"Ministry of Consumer Affairs platform for consumer commission cases, a route for insurance disputes that the Ombudsman does not settle."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Ahmedabad","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Gujarat, Dadra & Nagar Haveli, Daman and Diu. Email: oio.ahmedabad@cioins.co.in. Phone: 079 - 25501201/02. Address: Office of the Insurance Ombudsman, Jeevan Prakash Building, 6th floor, Tilak Marg, Relief Road, AHMEDABAD – 380 001."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Bengaluru","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Karnataka. Email: oio.bengaluru@cioins.co.in. Phone: 080 - 26652048 / 26652049. Address: Office of the Insurance Ombudsman, Jeevan Soudha Building,PID No. 57-27-N-19 Ground Floor, 19/19, 24th Main Road, JP Nagar, Ist Phase, Bengaluru – 560 078."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Bhopal","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Madhya Pradesh, Chhattisgarh. Email: oio.bhopal@cioins.co.in. Phone: 0755 - 2769201 / 2769202 / 2769203. Address: Office of the Insurance Ombudsman, 1st floor,\"Jeevan Shikha\", 60-B,Hoshangabad Road, Opp. Gayatri Mandir,Arera Hills Bhopal – 462 011."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Bhubaneswar","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Odisha. Email: oio.bhubaneswar@cioins.co.in. Phone: 0674 - 2596461 /2596455/2596429/2596003. Address: Office of the Insurance Ombudsman, 62, Forest park, Bhubaneswar – 751 009."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Chandigarh","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Punjab, Haryana (excluding Gurugram, Faridabad, Sonepat and Bahadurgarh), Himachal Pradesh, Union Territories of Jammu & Kashmir,Ladakh & Chandigarh. Email: oio.chandigarh@cioins.co.in. Phone: 0172-2706468. Address: Office Of The Insurance Ombudsman, Jeevan Deep Building SCO 20-27, Ground Floor Sector- 17 A, Chandigarh – 160 017."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Chennai","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Tamil Nadu, PuducherryTown and Karaikal (which are part of Puducherry). Email: oio.chennai@cioins.co.in. Phone: 044 - 24333668 / 24333678. Address: Office of the Insurance Ombudsman, Fatima Akhtar Court, 4th Floor, 453, Anna Salai, Teynampet, CHENNAI – 600 018."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Delhi","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Delhi & following Districts of Haryana - Gurugram, Faridabad, Sonepat & Bahadurgarh. Email: oio.delhi@cioins.co.in. Phone: 011 - 46013992/23213504/23232481. Address: Office of the Insurance Ombudsman, 2/2 A, Universal Insurance Building, Asaf Ali Road, New Delhi – 110 002."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Guwahati","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Assam, Meghalaya, Manipur, Mizoram, Arunachal Pradesh, Nagaland and Tripura. Email: oio.guwahati@cioins.co.in. Phone: 0361 - 2632204 / 2602205 / 2631307. Address: Office of the Insurance Ombudsman, Jeevan Nivesh, 5th Floor, Near Pan Bazar , S.S. Road, Guwahati – 781001(ASSAM)."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Hyderabad","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Andhra Pradesh, Telangana, Yanam and part of Union Territory of Puducherry. Email: oio.hyderabad@cioins.co.in. Phone: 040 - 23312122 / 23376991 / 23376599 / 23328709 / 23325325. Address: Office of the Insurance Ombudsman, 6-2-46, 1st floor, \"Moin Court\", Lane Opp.Hyundai Showroom , A. C. Guards, Lakdi-Ka-Pool, Hyderabad - 500 004."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Jaipur","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Rajasthan. Email: oio.jaipur@cioins.co.in. Phone: 0141- 2740363. Address: Office of the Insurance Ombudsman, Jeevan Nidhi – II Bldg., Gr. Floor, Bhawani Singh Marg, Jaipur - 302 005."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Kochi","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Kerala, Lakshadweep, Mahe-a part of Union Territory of Puducherry. Email: oio.ernakulam@cioins.co.in. Phone: 0484 - 2358759. Address: Office of the Insurance Ombudsman, 10th Floor, Jeevan Prakash,LIC Building, Opp to Maharaja's College Ground,M.G.Road, Kochi - 682 011."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Kolkata","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: West Bengal, Sikkim, Andaman & Nicobar Islands. Email: oio.kolkata@cioins.co.in. Phone: 033 - 22124339 / 22124341. Address: Office of the Insurance Ombudsman, Hindustan Bldg. Annexe, 7th Floor, 4, C.R. Avenue, KOLKATA - 700 072."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Lucknow","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Districts of Uttar Pradesh : Lalitpur, Jhansi, Mahoba, Hamirpur, Banda, Chitrakoot, Allahabad, Mirzapur, Sonbhabdra, Fatehpur, Pratapgarh, Jaunpur,Varanasi, Gazipur, Jalaun, Kanpur, Lucknow, Unnao, Sitapur, Lakhimpur, Bahraich, Barabanki, Raebareli, Sravasti, Gonda, Faizabad, Amethi, Kaushambi, Balrampur, Basti, Ambedkarnagar, Sultanpur, Maharajgang, Santkabirnagar, Azamgarh, Kushinagar, Gorkhpur, Deoria, Mau, Ghazipur, Chandauli, Ballia, Sidharathnagar. Email: oio.lucknow@cioins.co.in. Phone: 0522 - 4002082 / 3500613. Address: Office of the Insurance Ombudsman, 6th Floor, Jeevan Bhawan, Phase-II, Nawal Kishore Road, Hazratganj, Lucknow - 226 001."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Mumbai","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: List of wards under Mumbai Metropolitan Region excluding wards in Mumbai – i.e M/E, M/W, N , S and T covered under Office of Insurance Ombudsman Thane and excluding areas of Navi Mumbai. Email: oio.mumbai@cioins.co.in. Phone: 022 - 69038800/27/29/31/32/33. Address: Office of the Insurance Ombudsman, 3rd Floor, Jeevan Seva Annexe, S. V. Road, Santacruz (W), Mumbai - 400 054."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Noida","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: State of Uttarakhand and the following Districts of Uttar Pradesh: Agra, Aligarh, Bagpat, Bareilly, Bijnor, Budaun, Bulandshehar, Etah, Kannauj, Mainpuri, Mathura, Meerut, Moradabad, Muzaffarnagar, Oraiyya, Pilibhit, Etawah, Farrukhabad, Firozbad, Gautam Buddh nagar, Ghaziabad, Hardoi, Shahjahanpur, Hapur, Shamli, Rampur, Kashganj, Sambhal, Amroha, Hathras, Kanshiramnagar, Saharanpur. Email: oio.noida@cioins.co.in. Phone: 0120-4027589. Address: Office of the Insurance Ombudsman, Bhagwan Sahai Palace 4th Floor, Main Road, Naya Bans, Sector 15, Distt: Gautam Buddh Nagar, U.P-201301."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman: offices and jurisdiction","url":"https://www.cioins.co.in/Ombudsman","note":"Addresses, phone numbers, e-mail and the states or districts each Ombudsman office covers."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Patna","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Bihar, Jharkhand. Email: oio.patna@cioins.co.in. Phone: 0612-2547068. Address: Office of the Insurance Ombudsman, 2nd Floor, Lalit Bhawan, Bailey Road, Patna 800 001."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Pune","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: State of Goa and State of Maharashtra excluding areas of Navi Mumbai, Thane district,Palghar District, Raigad district & Mumbai Metropolitan Region. Email: oio.pune@cioins.co.in. Phone: 020-24471175. Address: Office of the Insurance Ombudsman, Jeevan Darshan Bldg., 3rd Floor, C.T.S. No.s. 195 to 198, N.C. Kelkar Road, Narayan Peth, Pune – 411 030."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman: register a complaint online","url":"https://cioins.co.in/Complaint/Online","note":"Council for Insurance Ombudsmen. Free. For disputes with an insurer after its own grievance process; the office is chosen by where you live (see the offices list)."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Thane","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Area of Navi Mumbai, Thane District, Raigad District, Palghar District and wards of Mumbai , M/East, M/West, N, S and T. Email: oio.thane@cioins.co.in. Phone: 022-20812868/69. Address: Office of the Insurance Ombudsman, Jeevan Chintamani Building, 2nd Floor,Near New RTO Office, Louis Wadi,Vasantrao Naik Mahamarg, Thane (West)- 400604."},{"purpose":"grievance","kind":"official","name":"National Consumer Helpline","url":"https://consumerhelpline.gov.in/public/","note":"Government consumer helpline; can take up a complaint before you go to a consumer commission."},{"purpose":"port","kind":"ours","name":"Get free help from IndiaInsurances","url":"/help","note":"Free. We do not sell insurance and earn no commission; your request is not passed to anyone."},{"purpose":"renew","kind":"insurer","name":"Renewals","url":"https://www.generalicentralinsurance.com/renewals","note":null}],"notice":"Information, not advice. IndiaInsurances is not an insurer or an insurance intermediary, does not sell insurance and earns no commission. Policy terms change and your own policy schedule can differ: always confirm with the policy document and the insurer before you buy or claim.","cite_as":"Health Elite (UIN GCIHLIP22234V012122), IndiaInsurances, https://indiainsurances.com/policy/generali-central-insurance/health-elite-gcihlip22234v012122"}