{"uin":"HDFHLIP20175V011920","name":"Arogya Sanjeevani Policy, HDFC ERGO","url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920","insurer":{"slug":"hdfc-ergo-general-insurance","name":"HDFC ERGO General Insurance Company Limited","url":"https://indiainsurances.com/insurer/hdfc-ergo-general-insurance"},"line":"health","category":"health-indemnity","category_name":"Health insurance (hospitalisation)","irdai_type":"New","kind":"product","status":"unknown","approved_on":"2020-03-31","withdrawn_on":null,"summary":"Arogya Sanjeevani Policy, HDFC ERGO is a one-year indemnity health policy on an individual or family floater basis, with sum insured from Rs 50,000 to Rs 10 lakhs and treatment in India only. Every claim carries a 5% co-payment, room rent is capped at 2% of sum insured up to Rs 5,000 a day, and declared pre-existing diseases are covered after 36 months.","analysis":{"state":"extracted","analysed_at":"2026-10-16 07:11:53.006595+00","note":"Every stated fact carries a verbatim quote found in the cited clause."},"facts":[{"key":"plan_variants","label":"Plans and variants","section":"Overview","meaning":"The named plans inside this product (not cover types or payout options). Facts can differ between them.","status":"not-stated","value":null,"display":null,"note":"No named plans. The product is sold on an Individual or Floater sum insured basis, which are cover types, not plans.","quote":null,"sources":[],"law":[]},{"key":"policy_term","label":"Policy term","section":"Eligibility","meaning":"How long one policy runs before it ends or must be renewed.","status":"cross-checked","value":"One year.","display":"1 year","note":"The cumulative bonus clause mentions two or three year policy periods, but the table of benefits gives 1 year.","quote":"Policy Period | 1 year","sources":[{"clause":null,"heading":"10 Table Of Benefits","page":20,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-10-table-of-benefits"}],"law":[]},{"key":"claim_intimation","label":"Claim intimation deadline","section":"Claims","meaning":"How soon you must tell the insurer about a claim or hospitalisation.","status":"cross-checked","value":"Within 24 hours of an emergency hospitalisation or before discharge, whichever is earlier; at least 48 hours before admission for a planned hospitalisation.","display":"Emergency: within 24 hours or before discharge, whichever is earlier. Planned: at least 48 hours before admission","note":"Reimbursement documents within 30 days of discharge (post-hospitalisation bills within 15 days of completing that treatment). Delay may be condoned if beyond the insured's control.","quote":"Within 24 hours from the date of emergency hospitalization required or before the Insured Person’s discharge from Hospital, whichever is earlier. ... At least 48 hours prior to admission in Hospital in case of a planned Hospitalization. ... Within thirty days of date of discharge from hospital ... Within fifteen days from completion of post hospitalization treatment ... Any delay in notification or submission may be condoned on merit where delay is proved to be for reasons beyond the control of the Insured Person","sources":[{"clause":"2","heading":"Procedure for reimbursement of claims","page":19,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-2-16"},{"clause":"3","heading":"Notification of Claim","page":19,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-3-12"},{"clause":"4","heading":"Documents to be submitted","page":20,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-4"}],"law":[{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 20, 21","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"claim_documents","label":"Claim documents","section":"Claims","meaning":"Documents the insurer asks for when you claim.","status":"cross-checked","value":["Duly Completed claim form","Photo Identity proof of the patient","Medical practitioner’s prescription advising admission","Original bills with itemized break-up","Payment receipts","Discharge summary including complete medical history of the patient","Investigation/ Diagnostic test reports supported by the prescription from attending medical practitioner","OT notes or Surgeon’s certificate (for surgical cases)","Sticker/Invoice of the Implants, wherever applicable","MLR (Medico Legal Report) copy and FIR, where applicable","NEFT Details and cancelled cheque","KYC of the proposer, where claim liability is above Rs 1 Lakh","Legal heir/succession certificate, wherever applicable","Any other relevant document required by Company"],"display":null,"note":"Bills must be in the insured person's name. Copies certified by another insurer are accepted when originals went to that insurer.","quote":"i) Duly Completed claim form ... ii) Photo Identity proof of the patient ... iii) Medical practitioner’s prescription advising admission ... iv) Original bills with itemized break-up ... v) Payment receipts ... vi) Discharge summary including complete medical history of the patient ... vii) Investigation/ Diagnostic test reports etc. supported by the prescription from attending medical practitioner ... viii) OT notes or Surgeon’s certificate giving details of the operation performed (for surgical cases). ... ix) Sticker/Invoice of the Implants, wherever applicable. ... x) MLR(Medico Legal Report copy if carried out and FIR (First information report) if registered, where ever applicable. ... xi) NEFT Details (to enable direct credit of claim amount in bank account) and cancelled cheque ... xii) KYC (Identity proof with Address) of the proposer, where claim liability is above Rs 1 Lakh ... xiii) Legal heir/succession certificate , wherever applicable ... xiv) Any other relevant document required by Company for assessment of the claim.","sources":[{"clause":"4","heading":"Documents to be submitted","page":20,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-4"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 17","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 22","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 23","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(iii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"claim_settlement_time","label":"Claim settlement time promised","section":"Claims","meaning":"How quickly the policy says a claim is decided or paid, and from when that is counted (intimation or last document).","status":"cross-checked","value":"The company settles or rejects a claim within 15 days from receipt of intimation; for delay it pays interest at 2% above the bank rate.","display":"Within 15 days of receipt of intimation; interest at 2% above bank rate if delayed","note":"CIS adds: cashless pre-authorisation decision within 1 hour of request, and final bill authorisation within 3 hours of the discharge request.","quote":"The Company shall settle or reject a claim, as the case may be, within 15 days from the date of receipt of intimation. ... In the case of delay in the payment of a claim, the Company shall be liable to pay interest to the policyholder from the date of receipt of intimation to the date of payment of claim at a rate 2% above the bank rate. ... Decision on cashless authorization to be provided within 1 hour from the time of receipt of request ... Within 3 hours of the receipt of discharge authorization request from the hospital","sources":[{"clause":"3.9","heading":"Claim Settlement (provision for Penal Interest)","page":16,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-3-9"},{"clause":"Excl12(a)","heading":null,"page":8,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/122#c-excl12-a"},{"clause":"Excl12(b)","heading":null,"page":9,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/122#c-excl12-b"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 64UM(4) to (6)","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 10","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 15","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 16","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 22","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(i), V.3(ii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(iii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.4","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 23","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"The Motor Vehicles Act, 1988: Chapter XI, insurance of motor vehicles against third party risks","section":"Section 149","url":"https://indiainsurances.com/law/motor-vehicles-act-1988"}]},{"key":"exclusions_main","label":"Main exclusions","section":"Exclusions","meaning":"What the policy does not pay for, in the policy's own words.","status":"cross-checked","value":["Pre-existing diseases until 36 months of continuous coverage","Any illness within 30 days from the first policy commencement date, except accidents","Listed conditions, surgeries and treatments until 24/36 months of continuous coverage","Admission primarily for diagnostics and evaluation","Rest cure, rehabilitation and respite care","Surgical treatment of obesity that does not meet the stated conditions","Change-of-gender treatments","Cosmetic or plastic surgery, unless for reconstruction after accident, burns or cancer or medically necessary","Treatment due to participation as a professional in hazardous or adventure sports","Alcoholism, drug or substance abuse or any addictive condition","Sterility and infertility","Maternity expenses (childbirth, miscarriage, termination), except ectopic pregnancy","War and nuclear, chemical or biological attack or weapons","Domiciliary hospitalisation and OPD treatment","Treatment taken outside the geographical limits of India"],"display":null,"note":"Also excluded: breach of law, excluded providers, health hydros and spas, unprescribed supplements, refractive error under 7.5 dioptres, unproven treatments, specified ICD codes for disclosed diseases, and the non-payable items in List I of Annexure A. Prospectus prints the second specific waiting tier as 48 months.","quote":"excluded until the expiry of 36months of continuous coverage ... 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 ... shall be excluded until the expiry of 24/36 months of continuous coverage ... Expenses related to any admission primarily for diagnostics and evaluation purposes. ... Rest Cure, rehabilitation and respite care ... Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions ... Change-of-Gender treatments ... Expenses for cosmetic or plastic surgery or any treatment to change appearance unless for reconstruction following an Accident, Burn(s) or Cancer or as part of medically necessary treatment ... Expenses related to any treatment necessitated due to participation as a professional in hazardous or adventure sports ... Treatment for, Alcoholism, drug or substance abuse or any addictive condition ... Expenses related to sterility and infertility. ... Medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred during hospitalization) except ectopic pregnancy; ... expenses towards miscarriage (unless due to an accident) and lawful medical termination of pregnancy ... War (whether declared or not) ... Nuclear, chemical or biological attack or weapons ... Any expenses incurred on Domiciliary Hospitalization and OPD treatment ... Treatment taken outside the geographical limits of India","sources":[{"clause":"1.1","heading":"Pre-Existing Diseases (Code- Excl01)","page":9,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-1-1-2"},{"clause":"1.2","heading":"First Thirty Days Waiting Period (Code- Excl03)","page":9,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-1-2-2"},{"clause":"1.3","heading":"Specific Waiting Period: (Code- Excl02)","page":10,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-1-3-2"},{"clause":"2.1","heading":"Investigation & Evaluation(Code- Excl04)","page":11,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-2-1"},{"clause":"2.2","heading":"Rest Cure, rehabilitation and respite care(Code- Excl05)","page":11,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-2-2-2"},{"clause":"2.3","heading":"Obesity/ Weight Control (Code- Excl06)","page":11,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-2-3"},{"clause":"2.4","heading":"Change-of-Gender treatments: (Code- Excl07)","page":11,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-2-4"},{"clause":"2.5","heading":"Cosmetic or plastic Surgery: (Code- Excl08)","page":11,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-2-5"},{"clause":"2.6","heading":"Hazardous or Adventure sports: (Code- Excl09)","page":11,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-2-6"},{"clause":"2.9","heading":null,"page":12,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-2-9"},{"clause":"2.14","heading":"Sterility and Infertility: (Code- Excl17)","page":12,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-2-14"},{"clause":"2.15","heading":"Maternity Expenses (Code - Excl 18)","page":12,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-2-15"},{"clause":"3.1","heading":null,"page":12,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-3-1"},{"clause":"3.2","heading":null,"page":12,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-3-2"},{"clause":"3.3","heading":"Any expenses incurred on Domiciliary Hospitalization and OPD treatment","page":13,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-3-3"},{"clause":"3.4","heading":"Treatment taken outside the geographical limits of India","page":13,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-3-4"}],"law":[{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 11","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 16","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grievance","label":"Grievance route","section":"Claims","meaning":"Who to complain to first, as stated in the policy, before going to the Insurance Ombudsman.","status":"cross-checked","value":"First contact the company by phone (022 6158 2020 / 022 6234 6234) or www.hdfcergo.com; then write to the Complaints & Grievance Cell (grievance@hdfcergo.com); then to the Chief Grievance Officer (cgo@hdfcergo.com).","display":"Company first (022 6158 2020 / 022 6234 6234, www.hdfcergo.com), then the Complaints & Grievance Cell (grievance@hdfcergo.com), then the Chief Grievance Officer (cgo@hdfcergo.com)","note":"Level 1 also has 18002677444. Escalate to Level 2 if no response within 15 days. Senior citizen helpline seniorcitizen@hdfcergo.com. After that, the Insurance Ombudsman or IRDAI Bima Bharosa.","quote":"First Point of Contact | Call us at 022 6158 2020 / 022 6234 6234/www.hdfcergo.com ... Write to The Complaints & Grievance Cell (C&G Cell) ... You can also write an email to grievance@hdfcergo.com ... Write to the Chief Grievance Officer ... You can also write an email to cgo@hdfcergo.com","sources":[{"clause":"3.11","heading":"Grievance Redressal Procedure","page":16,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-3-11"}],"law":[{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 3","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 4","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 5","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(11)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(42)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 34","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 69","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Insurance Act, 1938","section":"Section 38","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 12","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 19","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 20","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 13","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 2","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(5), 5(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(9)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 25","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 26","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 11","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 3","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 13","url":"https://indiainsurances.com/law/ombudsman-rules-2017"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 14","url":"https://indiainsurances.com/law/ombudsman-rules-2017"}]},{"key":"sum_insured_options","label":"Sum insured options","section":"Cover","meaning":"The cover amounts you can choose from.","status":"cross-checked","value":"From Rs 50,000 to Rs 10 lakhs, in multiples of Rs 50,000, on an individual or floater basis.","display":"Rs 50,000 to Rs 10 lakhs, in multiples of Rs 50,000","note":"From the prospectus; the policy wording table says only 'INR' and the CIS says as opted in the schedule.","quote":"Min Rs 50,000 subject to a max of Rs 10 lakhs in the multiples of Rs 50,000/-","sources":[{"clause":null,"heading":"6 Table Of Benefits","page":8,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/121#c-6-table-of-benefits"}],"law":[]},{"key":"initial_waiting","label":"Initial waiting period","section":"Waiting periods","meaning":"Days from the start of the first policy during which illness claims are not paid (accidents usually are).","status":"cross-checked","value":{"unit":"days","amount":30},"display":"30 days","note":"Accidents are covered from day one. Does not apply with continuous coverage of more than twelve months. Applies afresh to any increase in sum insured.","quote":"Expenses related to the treatment of any illness within 30 days from the first policy commencement date shall be excluded except claims arising due to an accident, provided the same are covered. ... This exclusion shall not, however, apply if the Insured Person has Continuous Coverage for more than twelve months.","sources":[{"clause":"1.2","heading":"First Thirty Days Waiting Period (Code- Excl03)","page":9,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-1-2-2"}],"law":[]},{"key":"ped_waiting","label":"Pre-existing disease waiting period","section":"Waiting periods","meaning":"How long you wait before conditions you already had when you bought the policy are covered. The law caps it at 36 months.","status":"cross-checked","value":{"unit":"months","amount":36},"display":"36 months","note":"Only PEDs declared and accepted are covered after 36 months. Applies afresh to any sum insured increase; reduced by prior continuous coverage under portability. Prospectus table says 3 years. Disclosed diseases with specified ICD codes in the schedule are not covered.","quote":"Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications shall be excluded until the expiry of 36months of continuous coverage after the date of inception of the first policy with us. ... Coverage under the policy after the expiry of 36 months for any pre-existing disease is subject to the same being declared at the time of application and accepted by us.","sources":[{"clause":"1.1","heading":"Pre-Existing Diseases (Code- Excl01)","page":9,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-1-1-2"}],"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":"conflicting","value":{"unit":"months","amount":24},"display":"24 months","note":"Policy wording and CIS: 24 months for most listed conditions, 36 months for joint replacement and age-related osteoarthritis and osteoporosis. Prospectus says: '24/48 months' and '48 Months waiting period' for those two. Not applicable to accidents. The longer of this and the PED waiting period applies.","quote":"Expenses related to the treatment of the following listed conditions, surgeries/treatments shall be excluded until the expiry of 24/36 months of continuous coverage ... i) 24 Months waiting period ... ii) 36 Months waiting period ... ii.48 Months waiting period","sources":[{"clause":"1.3","heading":"Specific Waiting Period: (Code- Excl02)","page":10,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-1-3-2"},{"clause":"1.3(e)(i)","heading":null,"page":10,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-1-3-e-i"},{"clause":"1.3(e)(ii)","heading":null,"page":10,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-1-3-e-ii"},{"clause":"3.3(e)","heading":null,"page":4,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/121#c-3-3-e"}],"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":"conflicting","value":["Benign ENT disorders","Tonsillectomy","Adenoidectomy","Mastoidectomy","Tympanoplasty","Hysterectomy","All internal and external benign tumours, cysts, polyps of any kind, including benign breast lumps","Benign prostate hypertrophy","Cataract and age related eye ailments","Gastric/ Duodenal Ulcer","Gout and Rheumatism","Hernia of all types","Hydrocele","Non Infective Arthritis","Piles, Fissures and Fistula in anus","Pilonidal sinus, Sinusitis and related disorders","Prolapse inter Vertebral Disc and Spinal Diseases unless arising from accident","Calculi in urinary system,Gall Bladder and Bile duct, excluding malignancy.","Varicose Veins and Varicose Ulcers","Treatment for joint replacement unless arising from accident","Age-related Osteoarthritis & Osteoporosis"],"display":null,"note":"Wording: the first 19 items carry 24 months; the last two carry 36 months. Prospectus adds '20. InternalCongenitalAnomalies' to the 24-month list and gives 48 months for the last two.","quote":"1. Benign ENT disorders\n2. Tonsillectomy\n3. Adenoidectomy\n4. Mastoidectomy\n5. Tympanoplasty\n6. Hysterectomy\n7. All internal and external benign tumours, cysts, polyps of any kind, including benign breast lumps\n8. Benign prostate hypertrophy\n9. Cataract and age related eye ailments\n10. Gastric/ Duodenal Ulcer\n11. Gout and Rheumatism\n12. Hernia of all types\n13. Hydrocele\n14. Non Infective Arthritis\n15. Piles, Fissures and Fistula in anus\n16. Pilonidal sinus, Sinusitis and related disorders\n17. Prolapse inter Vertebral Disc and Spinal Diseases unless arising from accident\n18. Calculi in urinary system,Gall Bladder and Bile duct, excluding malignancy.\n19. Varicose Veins and Varicose Ulcers ... 1. Treatment for joint replacement unless arising from accident\n2. Age-related Osteoarthritis & Osteoporosis ... 20. InternalCongenitalAnomalies","sources":[{"clause":"1.3(e)(i)","heading":null,"page":10,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-1-3-e-i"},{"clause":"1.3(e)(ii)","heading":null,"page":10,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-1-3-e-ii"},{"clause":"3.3(e)","heading":null,"page":4,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/121#c-3-3-e"}],"law":[]},{"key":"moratorium","label":"Moratorium period","section":"Renewal and rights","meaning":"After this many months of continuous cover, the insurer cannot reject a claim for non-disclosure, except for proven fraud or permanent exclusions. The law sets 60 months.","status":"cross-checked","value":{"unit":"months","amount":60},"display":"60 months","note":"Applies to the first policy's sum insured; for any increase, the sixty months run from the date of enhancement on the enhanced limit. CIS says 5 continuous years.","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":"3.10","heading":"Moratorium Period","page":16,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-3-10"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 13","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 8","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"portability","label":"Portability","section":"Renewal and rights","meaning":"Whether you can move this policy to another insurer and keep waiting-period credit.","status":"cross-checked","value":"Yes. The whole policy can be ported to another insurer by applying at least 30 days, but not earlier than 60 days, before renewal, with accrued waiting-period credit.","display":"Yes, apply 30 to 60 days before renewal; waiting-period credit carried over","note":"Credit depends on continuous cover without lapses. Migration to another HDFC ERGO product also allowed, applying at least 30 days before renewal.","quote":"The Insured Person will have the option to port the Policy to other insurers by applying to suchinsurer to port the entire policy along with all the members of the family, if any, at least 30 days before, but not earlier than 60 days from the policy renewal date ... the proposed Insured Person will get all the accrued continuity benefits in waiting periods as per IRDAI guidelines on portability.","sources":[{"clause":"3.2","heading":"Portability","page":14,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-3-2-2"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 11","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.6","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, VII.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 24","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.4 and 1.5","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 10","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"lifelong_renewal","label":"Lifelong renewal","section":"Renewal and rights","meaning":"Whether the policy can be renewed for life without a maximum age.","status":"cross-checked","value":true,"display":"Yes","note":"No maximum renewal age is printed and the premium chart runs to the over-80 age band; renewal can be refused only for established fraud, non-disclosure or misrepresentation, or if the product is withdrawn.","quote":"A health insurance policy shall be renewable except on grounds of established fraud or non-disclosure or misrepresentation by the insured, provided the policy is not withdrawn ... >80","sources":[{"clause":"3.3","heading":"Renewal of Policy","page":15,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-3-3-2"},{"clause":"Annexure A","heading":null,"page":21,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/121#c-annexure-a"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 10","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch II D.II","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.5","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 9","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 7","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"}]},{"key":"claim_loading","label":"Premium loading after claims","section":"Renewal and rights","meaning":"Whether the premium can go up at renewal because you made a claim.","status":"cross-checked","value":"No. No loading applies at renewal based on individual claims experience.","display":"No loading for claims at renewal","note":"Premium rates can be revised for all with IRDAI approval, with three months' notice.","quote":"No loading shall apply on renewals based on individual claims experience","sources":[{"clause":"3.3","heading":"Renewal of Policy","page":15,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-3-3-2"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 10","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.5","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 9","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 4","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 7","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"}]},{"key":"permanent_exclusions","label":"Permanent exclusions","section":"Exclusions","meaning":"Conditions or treatments that are never covered: the standard IRDAI exclusion codes Excl04 to Excl18 and the product's own permanent exclusions. Excl01 to Excl03 are waiting periods, not permanent exclusions.","status":"cross-checked","value":["Investigation & Evaluation","Rest Cure, rehabilitation and respite care","Obesity/ Weight Control","Change-of-Gender treatments","Cosmetic or plastic Surgery","Hazardous or Adventure sports","Breach of law","Excluded Providers","Alcoholism, drug or substance abuse or any addictive condition","Treatments received in heath hydros, nature cure clinics, spas or similar establishments","Dietary supplements and substances that can be purchased without prescription","Refractive Error less than 7.5 dioptres","Unproven Treatments","Sterility and Infertility","Maternity Expenses","War and war like occurrence","Nuclear, chemical or biological attack or weapons","Domiciliary Hospitalization and OPD treatment","Treatment taken outside the geographical limits of India","Specified ICD codes for existing diseases disclosed and mentioned in the policy schedule","Items in List I of Annexure A"],"display":null,"note":"Standard exclusions Excl04 to Excl18 plus the policy's specific exclusions. Excluded providers: stabilisation costs are paid in life-threatening situations or after an accident.","quote":"Investigation & Evaluation ... Rest Cure, rehabilitation and respite care ... Obesity/ Weight Control ... Change-of-Gender treatments ... Cosmetic or plastic Surgery ... Hazardous or Adventure sports ... Breach of law ... Excluded Providers ... Treatment for, Alcoholism, drug or substance abuse or any addictive condition ... Treatments received in heath hydros, nature cure clinics, spas or similar establishments ... Dietary supplements and substances that can be purchased without prescription ... Refractive Error ... refractive error less than 7.5 dioptres ... Unproven Treatments ... Sterility and Infertility ... Maternity Expenses ... War (whether declared or not) and war like occurrence ... Nuclear, chemical or biological attack or weapons ... Any expenses incurred on Domiciliary Hospitalization and OPD treatment ... Treatment taken outside the geographical limits of India ... In respect of the existing diseases, disclosed by the insured and mentioned in the policy ... policyholder is not entitled to get the coverage for specified ICD codes. ... The expenses that are not covered in this policy are placed under List-I of Annexure A.","sources":[{"clause":"2.1","heading":"Investigation & Evaluation(Code- Excl04)","page":11,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-2-1"},{"clause":"2.2","heading":"Rest Cure, rehabilitation and respite care(Code- Excl05)","page":11,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-2-2-2"},{"clause":"2.3","heading":"Obesity/ Weight Control (Code- Excl06)","page":11,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-2-3"},{"clause":"2.4","heading":"Change-of-Gender treatments: (Code- Excl07)","page":11,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-2-4"},{"clause":"2.5","heading":"Cosmetic or plastic Surgery: (Code- Excl08)","page":11,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-2-5"},{"clause":"2.6","heading":"Hazardous or Adventure sports: (Code- Excl09)","page":11,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-2-6"},{"clause":"2.7","heading":"Breach of law: (Code- Excl10)","page":11,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-2-7"},{"clause":"2.8","heading":"Excluded Providers: (Code-Excl11)","page":11,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-2-8"},{"clause":"2.9","heading":null,"page":12,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-2-9"},{"clause":"2.10","heading":null,"page":12,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-2-10"},{"clause":"2.11","heading":null,"page":12,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-2-11"},{"clause":"2.12","heading":"Refractive Error:(Code- Excl15)","page":12,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-2-12"},{"clause":"2.13","heading":"Unproven Treatments:(Code- Excl16)","page":12,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-2-13"},{"clause":"2.14","heading":"Sterility and Infertility: (Code- Excl17)","page":12,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-2-14"},{"clause":"2.15","heading":"Maternity Expenses (Code - Excl 18)","page":12,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-2-15"},{"clause":"3.1","heading":null,"page":12,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-3-1"},{"clause":"3.2","heading":null,"page":12,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-3-2"},{"clause":"3.3","heading":"Any expenses incurred on Domiciliary Hospitalization and OPD treatment","page":13,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-3-3"},{"clause":"3.4","heading":"Treatment taken outside the geographical limits of India","page":13,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-3-4"},{"clause":"3.5","heading":"In respect of the existing diseases, disclosed by the insured and mentioned in the policy","page":13,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-3-5"},{"clause":"1.7","heading":null,"page":8,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-1-7"}],"law":[{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 16","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"cancellation_refund","label":"Cancellation by you","section":"Renewal and rights","meaning":"What you get back if you cancel during the year.","status":"cross-checked","value":"On 7 days' written notice the company refunds a pro-rata premium for the unexpired policy period; no refund if any claim has been admitted or benefit availed.","display":"Pro-rata premium for the unexpired period; nothing if a claim was admitted","note":"Instalment policies: after an admissible claim, future instalments for the year are adjusted in the claim and no refund applies during the year.","quote":"The Policyholder may cancel this Policy by giving 7 days’ written notice and in such an event, the Company shall refund to the Insured a pro-rata premium for the unexpired Policy Period. ... no refunds of premium shall be made in respect of Cancellation where any claim has been admitted or any benefit has been availed by the Insured Person under the Policy.","sources":[{"clause":"1.6","heading":"Cancellation","page":14,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-1-6-2"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 64VB","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 8","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 6","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 5","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 17","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(3) to 20(5)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.4","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, IV.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"territory","label":"Where it covers","section":"Overview","meaning":"Geographic area of cover: India only, worldwide, or listed countries. 'As stated in the schedule' is not an answer.","status":"cross-checked","value":"India only.","display":"India only","note":"The CIS has a stray line on cashless claims outside India, but the wording excludes treatment outside India.","quote":"All medical treatment for the purpose of this insurance will have to be taken in India only. ... Treatment taken outside the geographical limits of India","sources":[{"clause":null,"heading":"2.4. Territorial Limit","page":18,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-2-4-territorial-limit"},{"clause":"3.4","heading":"Treatment taken outside the geographical limits of India","page":13,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-3-4"}],"law":[]},{"key":"free_look","label":"Free-look period","section":"Renewal and rights","meaning":"Days after you receive the policy in which you can return it for a refund if you do not agree with its terms.","status":"cross-checked","value":{"unit":"days","amount":30},"display":"30 days","note":"New individual policies only, not renewals or ported/migrated policies. Refund less medical examination and stamp duty costs, or proportionate risk premium if cover has started; only if no claim made.","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":"3.6","heading":"Free look period","page":15,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-3-6"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 5","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 5","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(1), 20(2)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(3) to 20(5)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, II.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grace_period","label":"Grace period","section":"Renewal and rights","meaning":"Days you get after the due date to pay without losing cover or continuity.","status":"cross-checked","value":{"unit":"days","amount":30},"display":"30 days (15 days for other payment modes)","note":"30 days for yearly payment; 15 days for half-yearly, quarterly or monthly instalments (table of benefits and instalment clause). The wording's Grace Period definition instead says fifteen days only for monthly mode and thirty days in all other cases. An instalment policy is cancelled if the instalment is not paid within the grace period.","quote":"Grace Period | For Yearly payment of mode, a fixed period of 30 days is to be allowed as\nGrace Period | Grace Period and for all other modes of payment a fixed period of 15 days be\nallowed as grace period. ... fifteen days where premium payment mode is monthly and thirty days in all other cases ... Grace Period of 15 days would be given to pay the installment premium due for the Policy.","sources":[{"clause":"Def. 15","heading":"Grace Period","page":3,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-def-15"},{"clause":"3.4","heading":"Premium Payment in Installments","page":15,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-3-4-2"},{"clause":"6(iii)","heading":null,"page":21,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-6-iii"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 50","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 8","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 9","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 8","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, IV.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule I, Para 1.2","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.3","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"eligibility_entry_age","label":"Entry age","section":"Eligibility","meaning":"The youngest and oldest age at which you can buy this policy.","status":"cross-checked","value":"Proposer between 18 and 65 years; dependent children between 3 months and 25 years.","display":"18 to 65 years (proposer); children 3 months to 25 years","note":"A proposer older than 65 can buy for the family without covering self. A financially independent child over 18 becomes ineligible at later renewals. No separate entry age is printed for spouse or parents.","quote":"Policy can be availed by persons between the age of 18 years and 65years,\nas Proposer. Proposer with higher age can obtain policy for family, without covering self. ... Dependent Children (i.e. natural or legally adopted) between the age 3 months to 25 years.","sources":[{"clause":null,"heading":"10 Table Of Benefits","page":20,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-10-table-of-benefits"},{"clause":"6(iii)","heading":null,"page":21,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-6-iii"}],"law":[]},{"key":"premium_modes","label":"Premium payment options","section":"Premium","meaning":"How often you can pay: yearly, half-yearly, quarterly, monthly.","status":"cross-checked","value":["Yearly","Half Yearly","Quarterly","Monthly"],"display":null,"note":null,"quote":"Payment of Premium on an installment basis i.e. Half Yearly, Quarterly or Monthly ... For Yearly payment of mode","sources":[{"clause":"3.4","heading":"Premium Payment in Installments","page":15,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-3-4-2"},{"clause":"6(iii)","heading":null,"page":21,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-6-iii"}],"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":"not-stated","value":null,"display":null,"note":"No optional covers are described. The CIS says covers are 'as per the plan opted' without naming any.","quote":null,"sources":[],"law":[]},{"key":"grace_cover","label":"Cover during the grace period","section":"Renewal and rights","meaning":"Whether a claim during the grace period is paid.","status":"cross-checked","value":"Yes for instalment premiums: cover continues during the grace period. For non-instalment (single annual) premium, there is no cover for the period for which no premium is received.","display":"Yes if paying by instalments; otherwise no cover for the unpaid period","note":"Continuity of waiting periods is kept if premium is paid within the grace period.","quote":"If premium is paid in instalments then coverage will be available during the grace period also. (Note: In case of non-instalment premium payment, coverage shall not be available for the period for which no premium is received).","sources":[{"clause":"3.4","heading":"Premium Payment in Installments","page":15,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-3-4-2"}],"law":[]},{"key":"room_rent","label":"Room rent limit","section":"Limits and co-pay","meaning":"The most the policy pays per day for the hospital room, or the room category allowed. If you take a costlier room, other bills can be cut in proportion.","status":"cross-checked","value":"Room rent, boarding and nursing up to 2% of the sum insured, maximum Rs. 5,000 per day.","display":"2% of sum insured, up to Rs. 5,000 per day","note":"A costlier room leads to proportionate reduction of associated medical expenses.","quote":"Room Rent, Boarding, Nursing Expenses as provided by the Hospital / Nursing Home up to 2% of the sum insured subject to maximum of Rs.5000/-, per day.","sources":[{"clause":"1.1","heading":"Hospitalization","page":7,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-1-1"}],"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-applicable","value":null,"display":null,"note":"The room limit is a rupee amount (2% of sum insured, up to Rs. 5,000 per day), not a room type; no room category is named in any document.","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":"cross-checked","value":"ICU / ICCU up to 5% of the sum insured, maximum Rs. 10,000 per day.","display":"5% of sum insured, up to Rs. 10,000 per day","note":null,"quote":"Intensive Care Unit (ICU) / Intensive Cardiac Care Unit (ICCU) expenses up to 5% of sum insured subject to maximum of Rs.10,000/- per day.","sources":[{"clause":"1.1","heading":"Hospitalization","page":7,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-1-1"}],"law":[]},{"key":"proportionate_deduction","label":"Proportionate deduction","section":"Limits and co-pay","meaning":"If you choose a room above your limit, whether the insurer reduces associated charges (doctor fees, tests, procedures) by the same proportion.","status":"cross-checked","value":"Yes. If room rent exceeds the limit, room rent and all associated medical expenses are paid in the same proportion, except in hospitals that do not bill associated expenses by room type.","display":"Yes, associated medical expenses cut in proportion","note":"Associated Medical Expenses: consultation fees, operation theatre, surgical appliances, nursing, anaesthesia, blood, oxygen.","quote":"In case Room Rent during Hospitalization of Insured Person exceeds the aforesaid limits, the reimbursement/payment of Room Rent charges including all Associated Medical Expenses incurred at Hospital shall be effected in the same proportion as the admissible rate per day bears to the actual rate per day of Room Rent charges. This condition is not applicable in respect of Hospitals where differential billing for Associated Medical Expenses is not followed based on Room Rent.","sources":[{"clause":"1.1.1(v)","heading":null,"page":7,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-1-1-1-v"}],"law":[]},{"key":"copay","label":"Co-payment","section":"Limits and co-pay","meaning":"The share of every admissible claim you pay yourself, and when it applies (age, zone, choice of hospital).","status":"cross-checked","value":"5% co-payment on each and every admissible claim.","display":"5% on every claim","note":"Applies at all ages; not linked to zone or hospital.","quote":"Each and every claim under the Policy shall be subject to a Co-payment of 5% applicable to claim amount admissible and payable as per the terms and conditions of the Policy.","sources":[{"clause":"5","heading":"Co-payment","page":20,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-5"}],"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":"not-stated","value":null,"display":null,"note":"No deductible clause in the wording; the CIS deductible row appears to show 'NA' but the table text is garbled.","quote":null,"sources":[],"law":[]},{"key":"disease_sublimits","label":"Disease or procedure sub-limits","section":"Limits and co-pay","meaning":"Caps on what is paid for named treatments (cataract, knee replacement...), even if the sum insured is higher.","status":"cross-checked","value":["Cataract: 25% of Sum Insured or Rs.40,000, whichever is lower, per eye in one policy year","Listed modern treatments (such as robotic surgeries, oral chemotherapy, immunotherapy, stem cell therapy): up to 50% of Sum Insured"],"display":null,"note":"Room rent, ICU and road ambulance carry their own caps (see those fields). Stem cell therapy is limited to hematopoietic stem cells for bone marrow transplant for haematological conditions.","quote":"subject to a limit of 25% of Sum Insured or Rs.40,000/-, whichever is lower, per each eye in one policy year. ... The following procedures will be covered (wherever medically indicated) either as in patient or as part of day care treatment in a hospital up to 50% of Sum Insured ... D. Oral chemotherapy E. Immunotherapy- Monoclonal Antibody to be given as injection ... G. Robotic surgeries ... L. Stem cell therapy: Hematopoietic stem cells for bone marrow transplant for haematological conditions to be covered.","sources":[{"clause":"1.3","heading":"Cataract Treatment","page":8,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-1-3"},{"clause":"1.6","heading":null,"page":8,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-1-6"},{"clause":"1.6(I)","heading":null,"page":8,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-1-6-i"}],"law":[]},{"key":"pre_hospitalisation","label":"Pre-hospitalisation cover","section":"Cover","meaning":"Medical costs in the days before admission that are paid if related to the hospitalisation.","status":"cross-checked","value":{"unit":"days","amount":30},"display":"30 days","note":"Only for expenses related to an admissible in-patient hospitalisation.","quote":"for a fixed period of 30 days prior to the date of admissible hospitalization covered under the policy.","sources":[{"clause":"1.4","heading":"Pre Hospitalization","page":8,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-1-4"}],"law":[]},{"key":"post_hospitalisation","label":"Post-hospitalisation cover","section":"Cover","meaning":"Medical costs in the days after discharge that are paid if related to the hospitalisation.","status":"cross-checked","value":{"unit":"days","amount":60},"display":"60 days","note":"Claim post-hospitalisation bills within fifteen days of completing that treatment.","quote":"for a fixed period of 60 days from the date of discharge from the hospital, following an admissible hospitalization covered under the policy.","sources":[{"clause":"1.5","heading":"Post Hospitalisation","page":8,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-1-5"}],"law":[]},{"key":"day_care","label":"Day-care treatments","section":"Cover","meaning":"Treatments needing less than 24 hours in hospital (chemotherapy, dialysis, cataract) and whether all or only listed ones are covered.","status":"cross-checked","value":"All day care treatments are covered.","display":"All day care treatments covered","note":"The 24-hour admission rule does not apply to day care treatment.","quote":"iv) All the day care treatments","sources":[{"clause":"1.1.1(iv)","heading":null,"page":7,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-1-1-1-iv"}],"law":[]},{"key":"domiciliary","label":"Treatment at home","section":"Cover","meaning":"Whether treatment at home is covered when hospital admission is not possible or a doctor advises it.","status":"cross-checked","value":"Not covered: domiciliary hospitalisation is excluded.","display":"Not covered","note":null,"quote":"Any expenses incurred on Domiciliary Hospitalization and OPD treatment","sources":[{"clause":"3.3","heading":"Any expenses incurred on Domiciliary Hospitalization and OPD treatment","page":13,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-3-3"}],"law":[]},{"key":"ayush","label":"AYUSH treatment","section":"Cover","meaning":"Ayurveda, Yoga, Unani, Siddha and Homeopathy treatment in a recognised hospital, and any limit.","status":"cross-checked","value":"In-patient AYUSH treatment in an AYUSH hospital is covered up to the sum insured.","display":"In-patient, up to sum insured","note":null,"quote":"The Company shall indemnify medical expenses incurred only for inpatient care treatment under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems of medicines during each Policy Year up to the limit of sum insured as specified in the policy schedule in any AYUSH Hospital.","sources":[{"clause":"1.2","heading":"AYUSH Treatment","page":8,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-1-2"}],"law":[{"title":"Guidelines on providing AYUSH coverage in Health Insurance policies, 2024","section":"Para 1","url":"https://indiainsurances.com/law/irdai-ayush-2024"},{"title":"Guidelines on providing AYUSH coverage in Health Insurance policies, 2024","section":"Para 2","url":"https://indiainsurances.com/law/irdai-ayush-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 1","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch II A.I(1)","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 5","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"modern_treatments","label":"Modern treatments","section":"Cover","meaning":"Robotic surgery, immunotherapy, oral chemotherapy, stem cell therapy and the like, and any cap on them.","status":"cross-checked","value":"Covered as in-patient or day care up to 50% of the sum insured: uterine artery embolization and HIFU, balloon sinuplasty, deep brain stimulation, oral chemotherapy, immunotherapy, intra vitreal injections, robotic surgeries, stereotactic radio surgeries, bronchical thermoplasty, vaporisation of the prostate, IONM and stem cell therapy.","display":"Covered up to 50% of sum insured","note":"Stem cell therapy limited to hematopoietic stem cells for bone marrow transplant for haematological conditions.","quote":"The following procedures will be covered (wherever medically indicated) either as in patient or as part of day care treatment in a hospital up to 50% of Sum Insured, specified in the policy schedule, during the policy period:\nA. Uterine Artery Embolization and HIFU (High intensity focused ultrasound) B. Balloon Sinuplasty C. Deep Brain stimulation D. Oral chemotherapy E. Immunotherapy- Monoclonal Antibody to be given as injection F. Intra vitreal injections G. Robotic surgeries H. Stereotactic radio surgeries ... I) Bronchical Thermoplasty J. Vaporisation of the prostrate (Green laser treatment or holmium laser treatment) K. IONM - (Intra Operative Neuro Monitoring) L. Stem cell therapy: Hematopoietic stem cells for bone marrow transplant for haematological conditions to be covered.","sources":[{"clause":"1.6","heading":null,"page":8,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-1-6"},{"clause":"1.6(I)","heading":null,"page":8,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-1-6-i"}],"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":"not-stated","value":null,"display":null,"note":"Organ donor expenses are not mentioned.","quote":null,"sources":[],"law":[]},{"key":"ambulance","label":"Ambulance cover","section":"Cover","meaning":"Road (and air) ambulance cover and its limit.","status":"cross-checked","value":"Road ambulance up to Rs. 2,000 per hospitalisation.","display":"Road ambulance up to Rs. 2,000 per hospitalisation","note":"Air ambulance not mentioned. Annexure A List I also lists 'AMBULANCE' among non-payable items.","quote":"Expenses incurred on road Ambulance subject to a maximum of Rs.2000/- per hospitalisation.","sources":[{"clause":"1.1.1(v)","heading":null,"page":7,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-1-1-1-v"}],"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":"not-stated","value":null,"display":null,"note":"No restoration or reinstatement of sum insured is mentioned.","quote":null,"sources":[],"law":[]},{"key":"no_claim_bonus","label":"No-claim or cumulative bonus","section":"Cover","meaning":"How much the cover grows each year, the maximum, whether it depends on not claiming, and what happens after a claim.","status":"cross-checked","value":"Cumulative bonus of 5% of the base sum insured for each renewal without a break, up to 50%, irrespective of claims.","display":"5% a year, up to 50%, irrespective of claims","note":"Available only if renewed within the grace period. Reduced proportionately if sum insured is reduced. Note k says CB applies only if specified in the policy schedule.","quote":"On Renewal of this Policy with the Company without a break, a sum equal to 5% of the Base Sum Insured of the expiring Policy maximum upto 50% shall be provided as irrespective of any claims","sources":[{"clause":"2","heading":"Cumulative Bonus (CB)","page":8,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-2"}],"law":[]},{"key":"consumables","label":"Consumables and non-medical items","section":"Cover","meaning":"Gloves, PPE, syringes and other items hospitals bill that standard policies exclude; whether this policy pays them.","status":"cross-checked","value":"Not covered. Items in List I of Annexure A, such as gloves and masks, are not payable.","display":"Not covered (List I items such as gloves and masks)","note":"Items in Lists II to IV are payable only as part of room, procedure or treatment charges.","quote":"The expenses that are not covered in this policy are placed under List-I of Annexure A. ... List I – Items for which coverage is not available in the policy ... GLOVES ... MASK","sources":[{"clause":"1.7","heading":null,"page":8,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-1-7"},{"clause":"Annexure A","heading":null,"page":22,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-annexure-a"}],"law":[]},{"key":"maternity","label":"Maternity cover","section":"Cover","meaning":"Whether childbirth costs are covered, the limit and the waiting period.","status":"cross-checked","value":"Not covered: childbirth, miscarriage and lawful termination are excluded, except ectopic pregnancy.","display":"Not covered (except ectopic pregnancy)","note":"Miscarriage due to an accident is not excluded.","quote":"Medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred during hospitalization) except ectopic pregnancy; ... expenses towards miscarriage (unless due to an accident) and lawful medical termination of pregnancy during the policy period.","sources":[{"clause":"2.15","heading":"Maternity Expenses (Code - Excl 18)","page":12,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-2-15"}],"law":[]},{"key":"newborn","label":"Newborn baby cover","section":"Cover","meaning":"Whether a newborn is covered from birth and for what.","status":"not-stated","value":null,"display":null,"note":"Newborn cover is not mentioned. Dependent children can be covered from 3 months of age; maternity is excluded.","quote":null,"sources":[],"law":[]},{"key":"mental_illness","label":"Mental illness","section":"Cover","meaning":"Cover for in-patient treatment of mental illness.","status":"not-stated","value":null,"display":null,"note":"Mental illness is not mentioned.","quote":null,"sources":[],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 3","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch III I","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"The Mental Healthcare Act, 2017","section":"Section 21(4)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"},{"title":"The Mental Healthcare Act, 2017","section":"Section 2(1)(s)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"},{"title":"The Mental Healthcare Act, 2017","section":"Section 21(1)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"}]},{"key":"health_checkup","label":"Health check-up","section":"Cover","meaning":"Free preventive check-ups and how often.","status":"not-stated","value":null,"display":null,"note":"No preventive health check-up benefit. The prospectus describes pre-policy check-ups for underwriting only.","quote":null,"sources":[],"law":[]},{"key":"opd","label":"Out-patient (OPD) cover","section":"Cover","meaning":"Doctor consultations, tests and medicines without admission, and the limit.","status":"cross-checked","value":"Not covered: OPD treatment is excluded.","display":"Not covered","note":null,"quote":"Any expenses incurred on Domiciliary Hospitalization and OPD treatment","sources":[{"clause":"3.3","heading":"Any expenses incurred on Domiciliary Hospitalization and OPD treatment","page":13,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-3-3"}],"law":[]},{"key":"zone_pricing","label":"Zone or city-based premium","section":"Premium","meaning":"Whether premium or co-pay depends on the city you are treated in.","status":"not-stated","value":null,"display":null,"note":"No zone or city factor is printed; the prospectus premium chart varies by age band and sum insured only.","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":"cross-checked","value":"Yes, at network providers, subject to pre-authorisation by the company.","display":"Yes, at network hospitals with pre-authorisation","note":"If cashless is denied, treatment can be taken and claimed by reimbursement. CIS: pre-authorisation decision within 1 hour.","quote":"Treatment may be taken in a network provider and is subject to pre authorization by the Company","sources":[{"clause":"1(i)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-1-i"}],"law":[]},{"key":"claims_handled_by","label":"Claims handled by","section":"Claims","meaning":"The insurer itself or a third-party administrator (TPA).","status":"cross-checked","value":"The company (HDFC ERGO): claim notices and cashless requests are sent to the Company.","display":"HDFC ERGO (the Company)","note":"No TPA is named; definitions mention a TPA only in general terms.","quote":"Cashless request form available with the network provider and shall be completed and sent to the Company for authorization. ... Notice with full particulars shall be sent to the Company","sources":[{"clause":"1(i)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-1-i"},{"clause":"3","heading":"Notification of Claim","page":19,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-3-12"}],"law":[]},{"key":"family_floater","label":"Family floater available","section":"Cover","meaning":"Whether one sum insured can be shared by the whole family.","status":"cross-checked","value":true,"display":"Yes","note":"Family: spouse, parents, parents-in-law and dependent children.","quote":"Product Type | Individual/ Floater ... On Floater basis – SI shall apply to the entire family","sources":[{"clause":null,"heading":"10 Table Of Benefits","page":20,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120#c-10-table-of-benefits"}],"law":[]}],"documents":[{"kind":"wording","label":"Arogya Sanjeevani - Retail","pages":29,"fetched_at":"2026-10-16 07:11:36.292261+00","source_url":"https://customer-portal-assets.hdfcergo.com/documents/arogya-sanjeevani-policy-retail-pw-570443039657.pdf","url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/120"},{"kind":"prospectus","label":"Arogya Sanjeevani - Retail","pages":26,"fetched_at":"2026-10-16 07:11:36.292261+00","source_url":"https://customer-portal-assets.hdfcergo.com/assets/v2/docs/default-source/downloads/prospectus/health/arogya-sanjeevani-policy-p-711232097845.pdf","url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/121"},{"kind":"cis","label":"Arogya Sanjeevani - Retail","pages":13,"fetched_at":"2026-10-16 07:11:36.292261+00","source_url":"https://customer-portal-assets.hdfcergo.com/assets/v2/docs/default-source/downloads/cis/arogya-sanjeevani-policy-retail-cis/PDF294-813914878965.pdf","url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920/document/122"}],"versions":[],"where_to_buy":[],"claims_and_complaints":[],"notice":"Information, not advice. IndiaInsurances is not an insurer or an insurance intermediary, does not sell insurance and earns no commission. Policy terms change and your own policy schedule can differ: always confirm with the policy document and the insurer before you buy or claim.","cite_as":"Arogya Sanjeevani Policy, HDFC ERGO (UIN HDFHLIP20175V011920), IndiaInsurances, https://indiainsurances.com/policy/hdfc-ergo-general-insurance/arogya-sanjeevani-policy-hdfc-ergo-hdfhlip20175v011920"}