{"uin":"HDFHLIP22145V032122","name":"my:health Critical Suraksha Plus","url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122","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":"critical-illness","category_name":"Critical illness","irdai_type":"Revision","kind":"product","status":"unknown","approved_on":"2021-08-06","withdrawn_on":null,"summary":"my:health Critical Suraksha Plus is an individual HDFC ERGO critical illness policy that pays a lump sum on diagnosis of listed illnesses under Cancer, Heart, Nervous System and Other Major Organ covers, in four single pay plans and three Multi Pay plans. Sum insured ranges from Rs 1 lakh to 5 crore, entry age is 18 to 65 years, and claims need a 7-day survival period after a 90-day waiting period (180 days for Minor stage conditions).","analysis":{"state":"extracted","analysed_at":"2026-10-16 07:11:53.911113+00","note":"Every stated fact carries a verbatim quote found in the cited clause."},"facts":[{"key":"plan_variants","label":"Plans and variants","section":"Overview","meaning":"The named plans inside this product (not cover types or payout options). Facts can differ between them.","status":"cross-checked","value":["Cancer Suraksha","Cardiac Suraksha","Smart Suraksha","Comprehensive Suraksha","Multi Pay Suraksha Elite","Multi Pay Suraksha Supreme","Multi Pay Suraksha Comprehensive"],"display":"7 plans: Cancer Suraksha, Cardiac Suraksha, Smart Suraksha, Comprehensive Suraksha, Multi Pay Suraksha Elite, Multi Pay Suraksha Supreme, Multi Pay Suraksha Comprehensive","note":"From the prospectus plan chart. Single-pay Critical Illness plans: Cancer Suraksha (Cancer Cover), Cardiac Suraksha (Heart Cover), Smart Suraksha (Heart and Nervous System Covers), Comprehensive Suraksha (all four covers). Multi Pay plans: Elite (Cancer and Heart), Supreme (Cancer, Heart and Nervous System), Comprehensive (all four covers).","quote":"my:health Critical Suraksha Plus: Plans\nCoverage | Details | Cancer Suraksha | Cardiac Suraksha | Smart Suraksha | Comprehe nsive Suraksha | Multi Pay Suraksha Elite | Multi Pay Suraksha Supreme | Multi Pay Suraksha Compre hensive ... 1 | Cancer Cover | Malignant Cancer of Specified Severity | Covered | X | X | Covered | X | X | X ... 2 | Heart Cover | Illnesses and Procedures related to heart | X | Covered | Covered | Covered | X | X | X ... 3 | Nervous System Cover | Illnesses and Procedures related to nervous system | X | X | Covered | Covered | X | X | X ... 4 | Other Major Organ Cover | Organs and Functions | X | X | X | Covered | X | X | X ... 1 | Cancer Cover | Malignant Cancer of Specified Severity | X | X | X | X | Covered | Covered | Covered ... 2 | Heart Cover | Illnesses and Procedures related to heart | X | X | X | X | Covered | Covered | Covered ... 3 | Nervous System Cover | Illnesses and Procedures related to nervous system | X | X | X | X | X | Covered | Covered ... 4 | Other Major Organ Cover | Illnesses and Procedures related to Major Organs and Functions | X | X | X | X | X | X | Covered","sources":[{"clause":null,"heading":"1.1. Redressal of Grievance","page":27,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/133#c-1-1-redressal-of-grievance"},{"clause":"Row 1","heading":"Cancer Cover","page":29,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/133#c-row-1-2"},{"clause":"Row 2","heading":"Heart Cover","page":29,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/133#c-row-2-2"},{"clause":"Row 3","heading":"Nervous System Cover","page":29,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/133#c-row-3-2"},{"clause":"Row 4","heading":"Other Major Organ Cover","page":29,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/133#c-row-4-2"},{"clause":"Row 1","heading":"Cancer Cover","page":29,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/133#c-row-1-3"},{"clause":"Row 2","heading":"Heart Cover","page":29,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/133#c-row-2-3"},{"clause":"Row 3","heading":"Nervous System Cover","page":29,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/133#c-row-3-3"},{"clause":"Row 4","heading":"Other Major Organ Cover","page":29,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/133#c-row-4-3"}],"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":"The policy can be issued for 1, 2 or 3 years.","display":"1, 2 or 3 years","note":"From the prospectus.","quote":"This policy can be issued for 1 year/ 2 years/ 3 years.","sources":[{"clause":"4","heading":"Policy period","page":19,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/133#c-4-3"}],"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 14 days of the diagnosis of the critical illness or of undergoing the surgical procedure.","display":"Within 14 days of diagnosis or surgery","note":"Delay is condoned on merits if it was for reasons beyond the claimant's control.","quote":"Claim Intimation Timelines | Within 14 days of the diagnosis of Critical Illness or undergoing Surgical Procedure ... If the claim is not notified/ or submitted to Us within the specified time limits, then We shall be provided the reasons for the delay in writing. We\nwill condone such delay on merits where the delay has been proved to be for reasons beyond the claimant’s control","sources":[{"clause":"1","heading":"Claims procedure","page":40,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-1-4"}],"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":["Claim Form duly signed","Copy of Discharge Summary / Discharge Certificate","First consultation letter from treating Medical Practitioner","Medical certificate confirming diagnosis, and the treatment from Medical Practitioner","Certificate from treating Medical Practitioner, specifying the duration and etiology","OT Notes in case of Surgery","Medical certificate from treating Medical Practitioner specifying the diagnosis and need for the surgery","MLC/FIR copy/ certificate regarding abuse of Alcohol/intoxicating agent if applicable","All pathological/Histopathological and radiological Investigation Reports","NEFT details & cancelled cheque","KYC form with a copy of a KYC document for claims of Rs 1 lakh and above"],"display":"Claim form, discharge summary, doctor's certificates and diagnosis reports, bank details, KYC for claims of Rs 1 lakh and above","note":"For the optional Loss of Job cover: claim form, Form 16A, termination or resignation letter, NEFT details. The insurer may also ask for a medical examination at its own cost.","quote":"Claims documents for Critical Illnesses Cover and Multipay Critical Illness Cover | • Claim Form duly signed • Copy of Discharge Summary / Discharge Certificate; • First consultation letter from treating Medical Practitioner • Medical certificate confirming diagnosis, and the treatment from Medical Practitioner • certificate from treating Medical Practitioner, specifying the duration and etiology • OT Notes in case of Surgery ... • Medical certificate from treating Medical Practitioner specifying the diagnosis and need for the surgery • MLC/FIR copy/ certificate regarding abuse of Alcohol/intoxicating agent if applicable • All pathological/Histopathological and radiological Investigation Reports • NEFT details & cancelled cheque ... Provide KYC ( Know your customer ) form along with photocopy of any one of following KYC documents for all claims amounting to Rs 1 lakh and above (Aadhaar Card, Passport, Driving Licence Voter ID, etc) ... Claims documents for loss of Job | • Duly Completed Claim Form signed by Insured Person; • Form 16A • Termination letter/Resignation Letter/ Resignation Acceptance letter • NEFT details & cancelled cheque","sources":[{"clause":"1","heading":"Claims procedure","page":40,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-1-4"}],"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 insurer settles or rejects a claim within 15 days from receipt of intimation; delay attracts interest at 2% above the bank rate.","display":"Within 15 days of claim intimation","note":"Interest for delay is counted from receipt of intimation to the date of payment.","quote":"a) The Company shall settle or reject a claim, as the case may be, within 15 days from the date of receipt of intimation. ... b) 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.","sources":[{"clause":"3(a)","heading":null,"page":37,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-3-a-4"},{"clause":"3(b)","heading":null,"page":37,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-3-b-4"}],"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":["Waiting period of 90 days from the first policy for Major stage conditions and 180 days for Minor stage conditions","36-month waiting period for pre-existing conditions declared and/or accepted at the first policy","Treatment arising from or consequent upon war or any act of war, invasion, act of foreign enemy, civil war, rebellion, revolution, nuclear, chemical and biological weapons, radiation of any kind","Any Illness, sickness or disease other than those opted and specified as Critical Illnesses or Surgical Procedure under this Policy","Any claim with respect to any Critical Illness diagnosed prior to Policy Inception Date","Any Critical Illness arising out of use, abuse or influence of any substance, intoxicant, drug, alcohol or hallucinogen unless prescribed by Medical Practitioner","Narcotics used by the Insured Person unless taken as prescribed by a registered Medical Practitioner","Any Claim caused due to intentional self-injury, suicide or attempted suicide","Any Critical Illness caused by or arising from foreign invasion, act of foreign enemies, hostilities, civil war, rebellion, revolution, insurrection, military or usurped power","Any claim caused by ionizing radiation or contamination by radioactivity from any nuclear fuel or nuclear waste, nuclear, chemical or biological attack","Working in underground mines, tunneling or involving electrical installations with high tension supply, or as jockeys or circus personnel","Congenital External Anomalies or any complications or conditions arising there from","Whilst engaging in Adventure Sports","Involvement in naval, military or air force operation","Participation in any flying activity, except as a bonafide passenger of a recognized airline on regular routes and on a scheduled timetable"],"display":"90-day and 180-day waiting periods, 36 months for pre-existing conditions, illnesses not listed, illness diagnosed before the policy, substance abuse, suicide, war, nuclear risks, hazardous jobs, congenital anomalies, adventure sports, military operations, non-airline flying","note":"Loss of Job cover (optional) also excludes retirement and resignation due to non-confirmation during probation.","quote":"whose diagnosis first commence/occurs after the applicable Waiting Period from commencement of first Policy with Us, We will pay Sum Insured or percentage of Sum Insured in accordance with table below ... Head and Neck | Major | 100% of Sum Insured | 90 days ... 5 | Early Stage Cancer | Minor | 25% of Sum Insured subject to maximum of Rs. 1,000,000 | 180 days ... i) A waiting period of 36 months shall apply for all Pre-existing Conditions declared and/or accepted at the time of applying first Policy with us. ... We will not make any payment for any claim in respect of any Insured Person, caused by, arising from or attributable to any of the following unless expressly stated to the contrary in this Policy: ... i) Treatment arising from or consequent upon war or any act of war (whether war be declared or not or caused during service in the armed forces of any country), invasion, act of foreign enemy, , civil war, public defense, rebellion, revolution, insurrection, military or usurped acts, nuclear weapons/materials, chemical and biological weapons, radiation of any kind. ... ii) Any Illness, sickness or disease other than those opted and specified as Critical Illnesses or Surgical Procedure under this Policy; ... iii) Any claim with respect to any Critical Illness diagnosed prior to Policy Inception Date ... iv) Any Critical Illness arising out of use, abuse or consequence or influence of any substance, intoxicant, drug, alcohol or hallucinogen unless prescribed by Medical Practitioner; ... v) Narcotics used by the Insured Person unless taken as prescribed by a registered Medical Practitioner, ... vi) Any Claim caused due to intentional self-injury, suicide or attempted suicide. ... vii) Any Critical Illness caused by or arising from or attributable to a foreign invasion, act of foreign enemies, hostilities, ... civil war, public defence, rebellion, revolution, insurrection, military or usurped power; ... viii) Any claim caused by ionizing radiation or contamination by radioactivity from any nuclear fuel (explosive or hazardous form) or from any nuclear waste from the combustion of nuclear fuel, nuclear, chemical or biological attack. ... ix) Working in underground mines, tunneling or involving electrical installations with high tension supply, or as jockeys or circus personnel; ... x) Congenital External Anomalies or any complications or conditions arising there from including any developmental conditions of the Insured; ... xi) Whilst engaging in Adventure Sports. ... xii) Involvement in naval, military or air force operation. ... xiii) Participation by the Insured Person in any flying activity, except as a bonafide passenger (fare paying and otherwise) of a recognized airline on regular routes and on a scheduled timetable.","sources":[{"clause":"1(i)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-1-i-2"},{"clause":null,"heading":"Specified Sites- Male","page":19,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-specified-sites-male"},{"clause":"1(i)","heading":null,"page":32,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-1-i-3"},{"clause":"2.1","heading":"Specific Exclusions (applicable to all Covers)","page":33,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-2-1"}],"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 call 022 6158 2020 / 022 6234 6234 or use www.hdfcergo.com; then write to the Complaints & Grievance Cell (grievance@hdfcergo.com); if not satisfied or no response within 15 days, write to the Chief Grievance Officer (cgo@hdfcergo.com).","display":"Call 022 6158 2020 / 022 6234 6234, then the Complaints & Grievance Cell (grievance@hdfcergo.com), then the Chief Grievance Officer (cgo@hdfcergo.com)","note":"Level 1 also by phone on 18002677444. Senior citizen helpline: seniorcitizen@hdfcergo.com, 022 6158 2026 in the wording (the prospectus and CIS print 022 6242 6226). Then the Insurance Ombudsman or IRDAI Bima Bharosa.","quote":"First Point of Contact | Call us at 022 6158 2020 / 022 6234 6234/www.hdfcergo.com ... Level 1 | For lack of a response or if the response provided does not meet your expectation, you can: 1. Write to The Complaints & Grievance Cell (C&G Cell) HDFC ERGO General Insurance Company Limited ... You can also write an email to grievance@hdfcergo.com ... Level 2 | If you're not satisfied with the resolution or if no response was received within 15 days, you can: 1. Write to the Chief Grievance Officer HDFC ERGO General Insurance Company Limited ... You can also write an email to cgo@hdfcergo.com ... 3. Call on 18002677444 (operational Monday - Saturday 9AM to 6PM) ... Senior Citizen | seniorcitizen@hdfcergo.com | 022 6158 2026 ... the Insured Person may also approach the office of Insurance Ombudsman of the respective area/region for redressal of grievance as per Insurance Ombudsman Rules 2017. Grievance may also be lodged at IRDAI Integrated Grievance Management System - https://bimabharosa.irdai.gov.in ... Contact Details for Senior Citizen: 022 – 6242 – 6226","sources":[{"clause":"3(c)","heading":null,"page":37,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-3-c-4"},{"clause":null,"heading":"1.1. Redressal of Grievance","page":27,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/133#c-1-1-redressal-of-grievance"}],"law":[{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 3","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 4","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 5","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(11)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(42)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 34","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 69","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Insurance Act, 1938","section":"Section 38","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 12","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 19","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 20","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 13","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 2","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(5), 5(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(9)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 25","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 26","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 11","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 3","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 13","url":"https://indiainsurances.com/law/ombudsman-rules-2017"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 14","url":"https://indiainsurances.com/law/ombudsman-rules-2017"}]},{"key":"sum_insured_options","label":"Sum insured options","section":"Cover","meaning":"The cover amounts you can choose from.","status":"cross-checked","value":"Rs 1 lakh to Rs 5 crore, on an individual sum insured basis.","display":"Rs 1 Lac to 5 Crs","note":"From the prospectus. Each insured person has a separate sum insured.","quote":"Rs 1 Lac to 5 Crs ... This Policyis offered on individual sum insured basis","sources":[{"clause":null,"heading":"Conditions","page":19,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/133#c-conditions"},{"clause":"5","heading":"Sum Insured Options","page":19,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/133#c-5-2"}],"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":90},"display":"90 days","note":"90 days for Major stage conditions; 180 days for Minor stage conditions (and Angioplasty under the Multi Pay Heart Cover). Counted from commencement of the first policy. The CIS calls the 90 days the initial waiting period.","quote":"whose diagnosis first commence/occurs after the applicable Waiting Period from commencement of first Policy with Us, We will pay Sum Insured or percentage of Sum Insured in accordance with table below ... Head and Neck | Major | 100% of Sum Insured | 90 days ... 5 | Early Stage Cancer | Minor | 25% of Sum Insured subject to maximum of Rs. 1,000,000 | 180 days ... 12 | Angioplasty | Minor | 25% subject to maximum payout of INR 1,000,000 | 180 days ... 1. Initial waiting Period: 90 days ... 3. 180 days waiting period applicable on all claims under all minor conditions listed under Section A- Critical Illness and Angioplasty Under Section A II, Heart Cover","sources":[{"clause":"1(i)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-1-i-2"},{"clause":null,"heading":"Specified Sites- Male","page":19,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-specified-sites-male"},{"clause":"4(ii)","heading":null,"page":3,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/134#c-4-ii"}],"law":[]},{"key":"specific_waiting","label":"Specific illness waiting period","section":"Waiting periods","meaning":"Waiting period for a list of named illnesses and procedures (cataract, hernia, joint replacement...). With several tiers (24 and 36 months), the shortest in the answer, the others in the note.","status":"cross-checked","value":{"unit":"days","amount":180},"display":"180 days for Minor stage conditions","note":"Applies to all Minor stage conditions; Major stage conditions have 90 days. Under the Multi Pay cover only Angioplasty carries the 180 days. The optional my:health Hospital Cash Benefit add-on has its own 24-month list of illnesses and procedures.","quote":"5 | Early Stage Cancer | Minor | 25% of Sum Insured subject to maximum of Rs. 1,000,000 | 180 days ... 12 | Angioplasty | Minor | 25% subject to maximum payout of INR 1,000,000 | 180 days ... 22 | Severe Osteoporosis | Minor | 25% subject to maximum payout of INR 1,000,000 | 180 days ... 3. 180 days waiting period applicable on all claims under all minor conditions listed under Section A- Critical Illness and Angioplasty Under Section A II, Heart Cover ... Expenses related to the treatment of the listed Conditions, surgeries/treatments shall be excluded until the expiry of 24 months of continuous coverage after the date of inception of the first Policy with us.","sources":[{"clause":null,"heading":"Specified Sites- Male","page":19,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-specified-sites-male"},{"clause":"4(ii)","heading":null,"page":3,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/134#c-4-ii"},{"clause":"1(a)","heading":null,"page":15,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/133#c-1-a-2"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.7","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"specific_waiting_list","label":"Illnesses with a specific waiting period","section":"Waiting periods","meaning":"The named illnesses and procedures that carry the specific waiting period.","status":"cross-checked","value":["Early Stage Cancer","Carcinoma in situ","Angioplasty","Balloon Valvotomy or Valvuloplasty","Insertion of Pacemaker","Severe Osteoporosis"],"display":"Early Stage Cancer, Carcinoma in situ, Angioplasty, Balloon Valvotomy or Valvuloplasty, Insertion of Pacemaker, Severe Osteoporosis","note":"Minor stage conditions of the Critical Illnesses Cover. Under the Multipay cover only Angioplasty carries the 180-day period.","quote":"5 | Early Stage Cancer | Minor | 25% of Sum Insured subject to maximum of Rs. 1,000,000 | 180 days\n6 | Carcinoma in situ | Minor ... 12 | Angioplasty | Minor | 25% subject to maximum payout of INR 1,000,000 | 180 days\n13 | Balloon Valvotomy or Valvuloplasty | Minor\n14 | Insertion of Pacemaker | Minor ... 22 | Severe Osteoporosis | Minor | 25% subject to maximum payout of INR 1,000,000 | 180 days ... 3. 180 days waiting period applicable on all claims under all minor conditions listed under Section A- Critical Illness and Angioplasty Under Section A II, Heart Cover","sources":[{"clause":null,"heading":"Specified Sites- Male","page":19,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-specified-sites-male"},{"clause":"4(ii)","heading":null,"page":3,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/134#c-4-ii"}],"law":[]},{"key":"moratorium","label":"Moratorium period","section":"Renewal and rights","meaning":"After this many months of continuous cover, the insurer cannot reject a claim for non-disclosure, except for proven fraud or permanent exclusions. The law sets 60 months.","status":"cross-checked","value":{"unit":"months","amount":60},"display":"60 months","note":"For an increased sum insured, the 60 months run from the date of the increase, on the increase only.","quote":"v. Moratorium Period 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(d)","heading":null,"page":34,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-3-d"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 13","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 8","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"portability","label":"Portability","section":"Renewal and rights","meaning":"Whether you can move this policy to another insurer and keep waiting-period credit.","status":"cross-checked","value":"Yes. The policy can be ported to another insurer by applying at least 30 days but not earlier than 60 days before renewal, with continuity benefits in waiting periods as per IRDAI guidelines.","display":"Yes, with waiting-period credit","note":null,"quote":"viii. Portability The Insured Person will have the option to port the Policy to other insurers by applying to such Insurer to port the entire policy along with all the members of the family, if any, at least 30 days before, but not earlier than 60 days from the policy renewal date as per IRDAI guidelines related to Portability. If such person is presently covered and has been continuously covered without any lapses under any health insurance policy with an Indian General/Health insurer, the proposed Insured Person will get the accrued continuity benefits in waiting periods as per IRDAI guidelines on portability.","sources":[{"clause":"3(e)","heading":null,"page":35,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-3-e"}],"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, no maximum renewal age printed","note":"No maximum renewal age is printed and renewal can be refused only for established fraud, non-disclosure or misrepresentation, or if the product is withdrawn; the documents do not use the word lifelong. Cover ends once a Major stage claim is admitted (single pay plans) or a claim has been admitted under each opted cover (Multi Pay plans).","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 ... Renewal of a health insurance policy shall not be denied on the ground that the insured had made a claim or claims in the preceding policy years, except for benefit based policies where the policy terminates following payment of the benefit covered under the policy like critical illness policies. ... Major Stage – On the admissibility of Claim under Major Stage condition, coverage under this Policy shall cease to exist. ... Coverage under this Section shall cease to exist; once a Claim has been admitted under each of the Covers as opted by the Insured Person","sources":[{"clause":"3(d)(iii)","heading":null,"page":35,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-3-d-iii"},{"clause":"3(a)","heading":null,"page":35,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-3-a-2"},{"clause":"3","heading":"Number of Claims and Benefits payable","page":23,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-3-2"},{"clause":null,"heading":"3. Number of Claims and Waiting Period","page":26,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-3-number-of-claims-and-waiting-period"}],"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 on renewal based on individual claims experience.","display":"No loading for claims","note":"Cover ends once a Major stage claim is admitted under the Critical Illnesses Cover.","quote":"c) No loading shall apply on renewals based on individual claims experience ... a) Renewal of a health insurance policy shall not be denied on the ground that the insured had made a claim or claims in the preceding policy years, except for benefit based policies where the policy terminates following payment of the benefit covered under the policy like critical illness policies.","sources":[{"clause":"3(a)","heading":null,"page":35,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-3-a-2"},{"clause":"3(c)","heading":null,"page":35,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-3-c-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":["Treatment arising from or consequent upon war or any act of war, invasion, act of foreign enemy, civil war, rebellion, revolution, nuclear, chemical and biological weapons, radiation of any kind","Any Illness, sickness or disease other than those opted and specified as Critical Illnesses or Surgical Procedure under this Policy","Any claim with respect to any Critical Illness diagnosed prior to Policy Inception Date","Any Critical Illness arising out of use, abuse or influence of any substance, intoxicant, drug, alcohol or hallucinogen unless prescribed by Medical Practitioner","Narcotics used by the Insured Person unless taken as prescribed by a registered Medical Practitioner","Any Claim caused due to intentional self-injury, suicide or attempted suicide","Any Critical Illness caused by or arising from foreign invasion, act of foreign enemies, hostilities, civil war, rebellion, revolution, insurrection, military or usurped power","Any claim caused by ionizing radiation or contamination by radioactivity from any nuclear fuel or nuclear waste, nuclear, chemical or biological attack","Working in underground mines, tunneling or involving electrical installations with high tension supply, or as jockeys or circus personnel","Congenital External Anomalies or any complications or conditions arising there from","Whilst engaging in Adventure Sports","Involvement in naval, military or air force operation","Participation in any flying activity, except as a bonafide passenger of a recognized airline on regular routes and on a scheduled timetable"],"display":"Illnesses not listed, illness diagnosed before the policy, substance abuse, suicide, war, nuclear risks, hazardous jobs, congenital anomalies, adventure sports, military operations, non-airline flying","note":"The standard IRDAI codes Excl04 to Excl18 are printed only for the optional Hospital Cash Benefit add-on, not for the base cover. The optional Loss of Job cover also excludes retirement and resignation due to non-confirmation during probation.","quote":"We will not make any payment for any claim in respect of any Insured Person, caused by, arising from or attributable to any of the following unless expressly stated to the contrary in this Policy: ... i) Treatment arising from or consequent upon war or any act of war (whether war be declared or not or caused during service in the armed forces of any country), invasion, act of foreign enemy, , civil war, public defense, rebellion, revolution, insurrection, military or usurped acts, nuclear weapons/materials, chemical and biological weapons, radiation of any kind. ... ii) Any Illness, sickness or disease other than those opted and specified as Critical Illnesses or Surgical Procedure under this Policy; ... iii) Any claim with respect to any Critical Illness diagnosed prior to Policy Inception Date ... iv) Any Critical Illness arising out of use, abuse or consequence or influence of any substance, intoxicant, drug, alcohol or hallucinogen unless prescribed by Medical Practitioner; ... v) Narcotics used by the Insured Person unless taken as prescribed by a registered Medical Practitioner, ... vi) Any Claim caused due to intentional self-injury, suicide or attempted suicide. ... vii) Any Critical Illness caused by or arising from or attributable to a foreign invasion, act of foreign enemies, hostilities, ... civil war, public defence, rebellion, revolution, insurrection, military or usurped power; ... viii) Any claim caused by ionizing radiation or contamination by radioactivity from any nuclear fuel (explosive or hazardous form) or from any nuclear waste from the combustion of nuclear fuel, nuclear, chemical or biological attack. ... ix) Working in underground mines, tunneling or involving electrical installations with high tension supply, or as jockeys or circus personnel; ... x) Congenital External Anomalies or any complications or conditions arising there from including any developmental conditions of the Insured; ... xi) Whilst engaging in Adventure Sports. ... xii) Involvement in naval, military or air force operation. ... xiii) Participation by the Insured Person in any flying activity, except as a bonafide passenger (fare paying and otherwise) of a recognized airline on regular routes and on a scheduled timetable.","sources":[{"clause":"2.1","heading":"Specific Exclusions (applicable to all Covers)","page":33,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-2-1"}],"law":[{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 16","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"cancellation_refund","label":"Cancellation by you","section":"Renewal and rights","meaning":"What you get back if you cancel during the year.","status":"cross-checked","value":"With 7 days' written notice, a pro-rata refund of premium for the unexpired policy period; no refund if any claim has been admitted or any benefit availed.","display":"Pro-rata refund for the unexpired period; none after a claim","note":"For instalment policies, after an admissible claim future instalments for the year are adjusted in the claim and no premium is refunded.","quote":"a) 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. ... d) Notwithstanding anything contained herein or otherwise, 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":"3(a)","heading":null,"page":35,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-3-a-3"},{"clause":"3(d)","heading":null,"page":36,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-3-d-3"}],"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":"Worldwide, with no territorial limit.","display":"Worldwide","note":null,"quote":"i) Geography The policy provides worldwide coverage, there is no territorial limit","sources":[{"clause":null,"heading":"1. Specific General Terms & Conditions","page":39,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-1-specific-general-terms-conditions"}],"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 policies only, not renewals or porting. Refund is less medical examination and stamp duty costs (or proportionate risk premium if cover has started), if no claim was made. The CIS summary counts the 30 days 'from the beginning of the policy'; its process note and the wording count from receipt of the policy document.","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. ... i) a refund of the premium paid less any expenses incurred by the Company on medical examination of the Insured Person and the stamp duty charges or ... You may cancel the insurance policy if you do not want it, within 30days from the beginning of the policy.","sources":[{"clause":"3(d)","heading":null,"page":34,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-3-d"},{"clause":"3(d)(i)","heading":null,"page":35,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-3-d-i"},{"clause":"4(vii)","heading":null,"page":5,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/134#c-4-vii"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 5","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 5","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(1), 20(2)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(3) to 20(5)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, II.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grace_period","label":"Grace period","section":"Renewal and rights","meaning":"Days you get after the due date to pay without losing cover or continuity.","status":"cross-checked","value":{"unit":"days","amount":30},"display":"30 days","note":"15 days for monthly instalments; 30 days for yearly, half yearly and quarterly instalments.","quote":"i. A grace period of 30 days for Renewals is permissible and the Policy will be considered as continuous for the purpose of all waiting periods. ... Monthly | 15 days","sources":[{"clause":null,"heading":"1. Specific General Terms & Conditions","page":39,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-1-specific-general-terms-conditions"},{"clause":null,"heading":"Section. 2","page":39,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-section-2"}],"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":"Minimum entry age 18 years, maximum entry age 65 years.","display":"18 to 65 years","note":"From the prospectus. Same for proposer and adult dependents.","quote":"Minimum Entry Age – 18 Years Maximum Entry Age – 65 yrs","sources":[{"clause":null,"heading":"Conditions","page":19,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/133#c-conditions"}],"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":"Yearly, half yearly, quarterly or monthly","note":"Non-instalment payment is also possible.","quote":"If the Insured Person has opted for Payment of Premium on an installment basis i.e. Yearly, Half Yearly, Quarterly or Monthly ... In case of non-instalment premium payment, coverage shall not be available for the period for which no premium is received","sources":[{"clause":"3(d)(i)","heading":null,"page":36,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-3-d-i-2"},{"clause":"3(d)(ii)","heading":null,"page":36,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-3-d-ii-2"}],"law":[]},{"key":"optional_covers","label":"Optional covers","section":"Cover","meaning":"Covers you can add for an extra premium. They change the answers above only if you buy them.","status":"cross-checked","value":["Pre Diagnosis Cover","Post Diagnosis Support (Second Medical Opinion, Molecular Gene Expression Profiling Test, Post Diagnosis Assistance)","Loss of Job","my:health Hospital Cash Benefit Add on (with optional Hospital Cash benefit - Global)"],"display":"Pre Diagnosis Cover, Post Diagnosis Support, Loss of Job, Hospital Cash Benefit add-on","note":"Plan chart limits: Pre Diagnosis up to Rs 25000; Post Diagnosis Assistance up to Rs 3,000 per session for up to 6 sessions; Loss of Job up to 50% of monthly salary for up to 6 months.","quote":"These Covers are optional and applicable only if opted for. ... I) Pre Diagnosis Cover ... II. Post Diagnosis Support ... a) Second Medical Opinion ... b) Molecular Gene Expression Profiling Test ... c) Post Diagnosis Assistance ... III. Loss of Job ... my:health Hospital Cash Benefit Add on ... 1 Hospital Cash benefit - Global ... Benefit for listed diagnostic tests for any of the covered Illness, upto Rs 25000 ... Post diagnosis conselling expenses, Upto Rs 3,000 per session for up to maximum of 6 sessions ... Benefit upon resignation or termination due to diagnosis of any of the covered illness upto 50% of Monthly Salary, upto 6 months","sources":[{"clause":"4","heading":"Optional Covers","page":31,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-4-2"},{"clause":"4(I)","heading":null,"page":31,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-4-i"},{"clause":null,"heading":"II. Post Diagnosis Support","page":32,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-ii-post-diagnosis-support"},{"clause":"Row 16(a)","heading":null,"page":32,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-row-16-a"},{"clause":"Row 16(b)","heading":null,"page":32,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-row-16-b"},{"clause":"Row 16(c)","heading":null,"page":32,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-row-16-c"},{"clause":null,"heading":"III. Loss of Job","page":32,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-iii-loss-of-job"},{"clause":null,"heading":"Add On Cover","page":14,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/133#c-add-on-cover"},{"clause":"1","heading":"Hospital Cash benefit - Global","page":14,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/133#c-1-7"},{"clause":"Row 1","heading":"Pre Diagnosis Cover","page":29,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/133#c-row-1-4"},{"clause":"Row 2","heading":"Post Diagnosis Support","page":29,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/133#c-row-2-4"},{"clause":"Row 3","heading":"Loss of Job","page":29,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/133#c-row-3-4"}],"law":[]},{"key":"grace_cover","label":"Cover during the grace period","section":"Renewal and rights","meaning":"Whether a claim during the grace period is paid.","status":"cross-checked","value":"Only for instalment premiums: cover continues during the instalment grace period and eligible claims reported then are payable. For renewal or non-instalment premium, an illness contracted during the grace period is not covered.","display":"Yes for instalment premiums; no for renewal or non-instalment premium","note":null,"quote":"However, any treatment availed for an Illness contracted during the grace period will not be admissible under the Policy. ... 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). ... ii. All eligible claims reported in the installment grace period would be payable if otherwise admissible as per terms and conditions of the Policy","sources":[{"clause":null,"heading":"1. Specific General Terms & Conditions","page":39,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-1-specific-general-terms-conditions"},{"clause":null,"heading":"Section. 2","page":39,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-section-2"}],"law":[]},{"key":"illness_count","label":"Number of illnesses covered","section":"Cover","meaning":"How many critical illnesses are listed. The definitions matter more than the count.","status":"not-stated","value":null,"display":null,"note":"No total is printed. Counting the tables of the Critical Illnesses Cover gives 59 conditions across the four covers (Cancer 6, Heart 14, Nervous System 17, Other Major Organ 22, with the specified-site cancers counted as one row); the Multipay cover lists 53. A plan covers only the covers it includes.","quote":null,"sources":[],"law":[]},{"key":"illness_list","label":"Illnesses covered","section":"Cover","meaning":"The listed illnesses. Standard definitions are set by IRDAI.","status":"cross-checked","value":["Malignant Cancer of specified Sites (Female: Breast, Cervix, Uterus, Fallopian Tube, Ovary, Vagina/Vulva; Male: Head and Neck, Lung, Stomach, Colorectum, Prostate)","Cancer of specified severity","Aplastic Anemia","Major Organ Transplant - Bone Marrow","Early Stage Cancer (Minor)","Carcinoma in situ (Minor)","Open Chest CABG","Myocardial Infarction (First Heart Attack of specified severity)","Open Heart Replacement or Repair of Heart Valves","Major Organ Transplant - Heart","Surgery of Aorta","Primary (Idiopathic) Pulmonary Hypertension","Other serious coronary artery disease","Dissecting Aortic Aneurysm","Cardiomyopathy","Eisenmenger's Syndrome","Infective Endocarditis","Angioplasty (Minor)","Balloon Valvotomy or Valvuloplasty (Minor)","Insertion of Pacemaker (Minor)","Multiple Sclerosis with persisting symptoms","Permanent Paralysis of Limbs","Stroke resulting in permanent symptoms","Benign Brain Tumour","Coma of specified severity","Parkinson's Disease","Alzheimer's Disease","Motor Neurone Disease with permanent symptoms","Muscular Dystrophy","Apallic Syndrome","Bacterial Meningitis","Creutzfeldt-Jakob Disease (CJD)","Encephalitis","Major Head Trauma","Progressive Supranuclear Palsy","Brain Surgery","Loss of Speech","Kidney failure requiring regular dialysis","Major Organ Transplant - Kidney, Lung, Liver and Pancreas","End Stage Liver Failure","Medullary Cystic Disease","Systemic Lupus Erythematous with Lupus Nephritis","End Stage Lung Failure","Fulminant Hepatitis","Chronic Adrenal Insufficiency (Addison's Disease)","Progressive Scleroderma","Chronic Relapsing Pancreatitis","Elephantiasis","Pneumonectomy","Terminal Illness","Myelofibrosis","Pheochromocytoma","Crohn's Disease","Severe Rheumatoid Arthritis","Severe Ulcerative Colitis","Deafness","Blindness","Third Degree Burns","Severe Osteoporosis (Minor)"],"display":"Conditions under the Cancer, Heart, Nervous System and Other Major Organ covers (see list)","note":"List for the Critical Illnesses Cover with all four covers (Comprehensive Suraksha). Plans include only some covers. The Multipay cover omits Early Stage Cancer, Carcinoma in situ, Malignant Cancer of specified Sites, Balloon Valvotomy, Pacemaker and Severe Osteoporosis; Angioplasty is its only Minor condition.","quote":"1 | Malignant Cancer of specified Sites\nSpecified Sites- Female\nBreast ... Cervix | 90 days ... Uterus | Major\nFallopian Tube Ovary Vagina/Vulva ... Head and Neck | Major | 100% of Sum Insured | 90 days\nLung 90 days 100% of Sum\nStomach | Major\nInsured Colorectum Prostate\n2 | Cancer of specified severity | Major | 100% of Sum Insured | 90 days\n3 | Aplastic Anemia | Major | 100% of Sum Insured | 90 days\n4 | Major Organ Transplant – Bone Marrow | Major | 100% of Sum Insured | 90 days\n5 | Early Stage Cancer | Minor | 25% of Sum Insured subject to maximum of Rs. 1,000,000 | 180 days\n6 | Carcinoma in situ | Minor ... 1 | Open Chest CABG | Major | 100% of Sum Insured | 90 days\n2 | Myocardial Infarction (First Heart Attack of specified severity) | Major\n3 | Open Heart Replacement or Repair of Heart Valves | Major\n4 | Major Organ Transplant – Heart | Major\n5 | Surgery of Aorta | Major\n6 | Primary (Idiopathic) Pulmonary Hypertension | Major\n7 | Other serious coronary artery disease | Major\n8 | Dissecting Aortic Aneurysm | Major\n9 | Cardiomyopathy | Major\n10 | Eisenmenger's Syndrome | Major\n11 | Infective Endocarditis | Major\n12 | Angioplasty | Minor | 25% subject to maximum payout of INR 1,000,000 | 180 days\n13 | Balloon Valvotomy or Valvuloplasty | Minor\n14 | Insertion of Pacemaker | Minor ... 1 | Multiple Sclerosis with persisting symptoms | Major | 100% of Sum Insured | 90 days\n2 | Permanent Paralysis of Limbs | Major\n3 | Stroke resulting in permanent symptoms | Major\n4 | Benign Brain Tumour | Major\n5 | Coma of specified severity | Major\n6 | Parkinson’s Disease | Major\n7 | Alzheimer's Disease | Major\n8 | Motor Neurone Disease with permanent symptoms | Major\n9 | Muscular Dystrophy | Major\n10 | Apallic Syndrome | Major\n11 | Bacterial Meningitis | Major\n12 | Creutzfeldt-Jakob Disease (CJD) | Major\n13 | Encephalitis | Major\n14 | Major Head Trauma | Major\n15 | Progressive Supranuclear Palsy | Major\n16 | Brain Surgery | Major\n17 | Loss of Speech | Major ... 1 | Kidney failure requiring regular dialysis | Major | 100% of Sum Insured | 90 days\n2 | Major Organ Transplant – Kidney, Lung, Liver and Pancreas | Major\n3 | End Stage Liver Failure | Major\n4 | Medullary Cystic Disease | Major\n5 | Systemic Lupus Erythematous with Lupus Nephritis | Major\n6 | End Stage Lung Failure | Major\n7 | Fulminant Hepatitis | Major\n8 | Chronic Adrenal Insufficiency (Addison's Disease) | Major\n9 | Progressive Scleroderma | Major\n10 | Chronic Relapsing Pancreatitis | Major\n11 | Elephantiasis | Major\n12 | Pneumonectomy | Major\n13 | Terminal Illness | Major\n14 | Myelofibrosis | Major\n15 | Pheochromocytoma | Major\n16 | Crohn's Disease | Major\n17 | Severe Rheumatoid Arthritis | Major\n18 | Severe Ulcerative Colitis | Major\n19 | Deafness | Major\n20 | Blindness | Major\n21 | Third Degree Burns | Major\n22 | Severe Osteoporosis | Minor | 25% subject to maximum payout of INR 1,000,000 | 180 days","sources":[{"clause":"1(i)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-1-i-2"},{"clause":null,"heading":"Specified Sites- Male","page":19,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-specified-sites-male"}],"law":[]},{"key":"payout","label":"Payout","section":"Cover","meaning":"Lump sum on diagnosis, staged payouts by severity, or reimbursement.","status":"cross-checked","value":"Lump sum on diagnosis: 100% of sum insured for a Major stage condition; 25% of sum insured up to Rs 10,00,000 for a Minor stage condition. Under the Multipay cover, up to 100% of sum insured is paid under each opted cover.","display":"Lump sum: 100% of sum insured for Major stage; 25% (max Rs 10,00,000) for Minor stage","note":"A Minor stage claim ends cover for the other Minor stage conditions; Major stage conditions stay covered for the balance sum insured.","quote":"whose diagnosis first commence/occurs after the applicable Waiting Period from commencement of first Policy with Us, We will pay Sum Insured or percentage of Sum Insured in accordance with table below ... 2 | Cancer of specified severity | Major | 100% of Sum Insured | 90 days ... 5 | Early Stage Cancer | Minor | 25% of Sum Insured subject to maximum of Rs. 1,000,000 | 180 days ... Coverage under this Section shall cease to exist; once a Claim has been admitted under each of the Covers as opted by the Insured Person and maximum 100% of the Sum Insured is paid by the Company under such Covers ... The Policy shall continue to Cover Major Stage condition for the Balance Sum Insured.","sources":[{"clause":"1(i)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-1-i-2"},{"clause":null,"heading":"Specified Sites- Male","page":19,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-specified-sites-male"},{"clause":"3","heading":"Number of Claims and Benefits payable","page":23,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-3-2"},{"clause":null,"heading":"3. Number of Claims and Waiting Period","page":26,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-3-number-of-claims-and-waiting-period"}],"law":[]},{"key":"survival_period","label":"Survival period","section":"Waiting periods","meaning":"Days you must survive after diagnosis before the money is paid.","status":"cross-checked","value":{"unit":"days","amount":7},"display":"7 days","note":"Same 7 days for each claim under the Multipay cover. No claim if the diagnosis is made post mortem.","quote":"Claim under Section B-1-I, i to iv is payable only if Insured Person survives 7 days from the diagnosis and fulfillment of the definition of the Critical Illness or Surgical Procedure covered.","sources":[{"clause":"2","heading":"Survival Period","page":22,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-2-2"}],"law":[]},{"key":"multiple_claims","label":"Multiple claims","section":"Cover","meaning":"Whether you can claim for more than one illness.","status":"cross-checked","value":"Critical Illnesses Cover: one claim per stage; after a Minor stage claim the Major stage conditions stay covered for the balance sum insured, and a Major stage claim ends the cover. Multipay cover: one claim under each opted cover, up to 100% of sum insured each, with 12 months between claims under any two covers.","display":"Single-pay plans: one Minor then one Major claim; Multipay plans: one claim per cover, 12 months apart","note":"Prospectus: Multipay pays up to 400% of sum insured across the four covers.","quote":"Only one claim is payable under each of the stages given below during lifetime of the Policy under this Section subject to maximum 100% of Sum Insured ... Minor Stage - On the admissibility of Claim under Minor Stage condition under the Policy, coverage for all other Minor stage Conditions shall cease to exist. The Policy shall continue to Cover Major Stage condition for the Balance Sum Insured. Major Stage – On the admissibility of Claim under Major Stage condition, coverage under this Policy shall cease to exist. ... Coverage under this Section shall cease to exist; once a Claim has been admitted under each of the Covers as opted by the Insured Person and maximum 100% of the Sum Insured is paid by the Company under such Covers subject to 12 months waiting period between Claims under any two Covers. ... Multiple claim pay out up to 400% of SI under the policy under different groups of critical illnesses.","sources":[{"clause":"3","heading":"Number of Claims and Benefits payable","page":23,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-3-2"},{"clause":null,"heading":"3. Number of Claims and Waiting Period","page":26,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-3-number-of-claims-and-waiting-period"},{"clause":"3","heading":null,"page":1,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/133#c-3"}],"law":[]},{"key":"ped_waiting","label":"Pre-existing conditions","section":"Waiting periods","meaning":"Whether an illness you already had can ever be claimed: after a waiting period, or never.","status":"cross-checked","value":"Pre-existing conditions declared and/or accepted at the first policy are covered after a 36-month waiting period; a critical illness diagnosed before the policy inception date is never covered.","display":"Covered after 36 months if declared; illness diagnosed before the policy never covered","note":"On a sum insured increase the waiting period applies afresh to the increase.","quote":"i) A waiting period of 36 months shall apply for all Pre-existing Conditions declared and/or accepted at the time of applying first Policy with us. In case of enhancement of Sum Insured the exclusion shall apply afresh to the extent of Sum Insured increase. ... iii) Any claim with respect to any Critical Illness diagnosed prior to Policy Inception Date","sources":[{"clause":"1(i)","heading":null,"page":32,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-1-i-3"},{"clause":"2.1","heading":"Specific Exclusions (applicable to all Covers)","page":33,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132#c-2-1"}],"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"}]}],"documents":[{"kind":"wording","label":"my:health Critical Suraksha Plus","pages":45,"fetched_at":"2026-10-16 07:11:37.395212+00","source_url":"https://customer-portal-assets.hdfcergo.com/documents/myhealth-critical-suraksha-plus-pw-954531935739.pdf","url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/132"},{"kind":"prospectus","label":"my:health Critical Suraksha Plus","pages":38,"fetched_at":"2026-10-16 07:11:37.395212+00","source_url":"https://customer-portal-assets.hdfcergo.com/assets/v2/docs/default-source/downloads/prospectus/health/myhealth-critical-suraksha-plus-prospectuse-342600860548.pdf","url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/133"},{"kind":"cis","label":"my health Critical Suraksha Plus","pages":8,"fetched_at":"2026-10-16 07:11:37.395212+00","source_url":"https://customer-portal-assets.hdfcergo.com/assets/v2/docs/default-source/downloads/cis/cis---my-health-critical-suraksha-plus/pdf206-486213315032.pdf","url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122/document/134"}],"versions":[],"where_to_buy":[],"claims_and_complaints":[],"notice":"Information, not advice. IndiaInsurances is not an insurer or an insurance intermediary, does not sell insurance and earns no commission. Policy terms change and your own policy schedule can differ: always confirm with the policy document and the insurer before you buy or claim.","cite_as":"my:health Critical Suraksha Plus (UIN HDFHLIP22145V032122), IndiaInsurances, https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-health-critical-suraksha-plus-hdfhlip22145v032122"}