{"uin":"RQBHLGP26042V022526","name":"Group Health Insurance","url":"https://indiainsurances.com/policy/raheja-qbe-general-insurance/group-health-insurance-rqbhlgp26042v022526","insurer":{"slug":"raheja-qbe-general-insurance","name":"Raheja QBE General Insurance Co. Ltd.","url":"https://indiainsurances.com/insurer/raheja-qbe-general-insurance"},"line":"health","category":"group-health","category_name":"Group health","irdai_type":"Group","kind":"product","status":"active","approved_on":"2021-03-26","withdrawn_on":null,"summary":"This is a group health indemnity policy with in-patient hospitalization, day care, domiciliary hospitalization, pre-hospitalization and post-hospitalization covers subject to the policy schedule. Sum insured is from Rs. 25,000 to Rs. 1 crore and the policy has individual and floater bases.","analysis":{"state":"machine","analysed_at":"2026-10-19 22:05:07.207276+00","note":"First pass: one AI reading; every stated fact carries a verbatim quote found in the cited clause, but it has not been reviewed. Check the clause before relying on it."},"facts":[{"key":"plan_variants","label":"Plans and variants","section":"Overview","meaning":"The named plans inside this product (not cover types or payout options). Facts can differ between them.","status":"quote-verified","value":["Individual basis","Floater basis"],"display":"Individual basis; Floater basis","note":"These are coverage bases printed in the prospectus, not named plan labels.","quote":"On Individual basis – SI shall apply to each individual family member On Floater basis – SI shall apply to the entire family","sources":[{"clause":"2","heading":"Coverage","page":1,"url":"https://indiainsurances.com/policy/raheja-qbe-general-insurance/group-health-insurance-rqbhlgp26042v022526/document/14705#c-2"}],"law":[]},{"key":"policy_term","label":"Policy term","section":"Eligibility","meaning":"How long one policy runs before it ends or must be renewed.","status":"quote-verified","value":"1 Year","display":"1 Year","note":"From the prospectus.","quote":"Period of Insurance\n\n1 Year","sources":[{"clause":null,"heading":"Period of Insurance","page":6,"url":"https://indiainsurances.com/policy/raheja-qbe-general-insurance/group-health-insurance-rqbhlgp26042v022526/document/14705#c-period-of-insurance"}],"law":[]},{"key":"claim_intimation","label":"Claim intimation deadline","section":"Claims","meaning":"How soon you must tell the insurer about a claim or hospitalisation.","status":"quote-verified","value":"Emergency hospitalization must be intimated within 24 hours from the date it is required or before discharge, whichever is earlier. Planned hospitalization must be intimated at least 48 hours before admission.","display":"Within 24 hours for emergency hospitalization or before discharge, whichever is earlier; at least 48 hours before planned hospitalization.","note":null,"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.","sources":[{"clause":"7.3","heading":"Notification of claim","page":44,"url":"https://indiainsurances.com/policy/raheja-qbe-general-insurance/group-health-insurance-rqbhlgp26042v022526/document/14707#c-7-3"}],"law":[{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 20, 21","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"claim_documents","label":"Claim documents","section":"Claims","meaning":"Documents the insurer asks for when you claim.","status":"quote-verified","value":["Claim form duly completed in all respects","Medical Case History / Summary","Medical Records (Optional Documents may be asked on need basis: Indoor case papers, OT notes, PAC notes etc.)","Original Hospital Main Bill","Original Hospital Bill Break Up","Original Pharmacy Bills","Prescriptions for the Medicines purchased (except hospital supply) and investigations done outside the Hospital","Consultation Papers","Investigation Reports","Digital Images/CDs of the Investigation Procedures (if required)","MLC/FIR Report (If applicable)","Inquest Panchanama report issued by the Police","Original Invoice/Sticker (If applicable)","Post Mortem Report (If applicable)","Disability Certificate (If applicable)","Attending Physician Certificate (If applicable)","Ante-natal Record (If applicable)","Birth discharge Summary (If applicable)","Death Certificate (If applicable)","*KYC (Photo ID card) (If applicable)","Bank Details with Cancelled Cheque"],"display":"Claim form, medical records and bills, prescriptions, consultation and investigation papers, applicable police/death/disability documents, KYC and bank details.","note":"The table applies documents by claim type and also says additional documents may be called for case by case.","quote":"1 | Claim form duly completed in all respects | √ | √ | √ | √ | √ ... 2 | Medical Case History / Summary | √ | X | √ | √ | √\n3 | Medical Records (Optional Documents may be asked on need basis: Indoor case papers, OT notes, PAC notes etc.) | √ | X | √ | √ | √\n4 | Original Hospital Main Bill | √ | X | x | x | x\n5 | Original Hospital Bill Break Up | √ | X | x | x | x\n6 | Original Pharmacy Bills | √ | √ | x | x | x\n7 | Prescriptions for the Medicines purchased (except hospital supply) and investigations done outside the Hospital | √ | √ | x | x | x\n8 | Consultation Papers | √ | √ | √ | x | √\n9 | Investigation Reports | √ | √ | √ | x | √\n10 | Digital Images/CDs of the Investigation Procedures (if required) | √ | √ | x | x | √\n11 | MLC/FIR Report (If applicable) | √ | X | √ | x | √\n12 | Inquest Panchanama report issued by the Police | √ | X | √ | x | √\n13 | Original Invoice/Sticker (If applicable) | √ | X | x | x | x\n14 | Post Mortem Report (If applicable) | √ | X | x | x | √\n15 | Disability Certificate (If applicable) | √ | X | √ | x | √\n16 | Attending Physician Certificate (If applicable) | √ | X | √ | x | √\n17 | Ante-natal Record (If applicable) | √ | X | x | x | x\n18 | Birth discharge Summary (If applicable) | √ | X | x | x | x\n19 | Death Certificate (If applicable) | √ | X | √ | x | √\n20 | *KYC (Photo ID card) (If applicable) | √ | √ | √ | √ | √\n21 | Bank Details with Cancelled Cheque | √ | √ | √ | √ | √","sources":[{"clause":"Row 1","heading":"Claim form duly completed in all respects","page":45,"url":"https://indiainsurances.com/policy/raheja-qbe-general-insurance/group-health-insurance-rqbhlgp26042v022526/document/14707#c-row-1-2"},{"clause":"Row 2","heading":"Medical Case History / Summary","page":45,"url":"https://indiainsurances.com/policy/raheja-qbe-general-insurance/group-health-insurance-rqbhlgp26042v022526/document/14707#c-row-2"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 17","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 22","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 23","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(iii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"claim_settlement_time","label":"Claim settlement time promised","section":"Claims","meaning":"How quickly the policy says a claim is decided or paid, and from when that is counted (intimation or last document).","status":"quote-verified","value":"The company shall settle or reject a claim within 15 days from receipt of the last necessary document. If investigation is required, it must complete investigation within 30 days and settle the claim within 45 days from receipt of the last necessary document.","display":"15 days from last necessary document; if investigated, 30 days to investigate and 45 days to settle.","note":"Delay beyond the stipulated period carries interest at 2% above bank rate.","quote":"The Company shall settle or reject a claim, as may be the case, within 15 days from the date of receipt of last necessary document. ... where the circumstances of a claim warrant an investigation in the opinion of the Company, it shall initiate and complete such investigation at the earliest, in any case not later than 30 days from the date of receipt of last necessary document. In such cases, the Company shall settle the claim within 45 days from the date of receipt of last necessary document.","sources":[{"clause":"7.7(i)","heading":null,"page":47,"url":"https://indiainsurances.com/policy/raheja-qbe-general-insurance/group-health-insurance-rqbhlgp26042v022526/document/14707#c-7-7-i"},{"clause":"7.7(iii)","heading":null,"page":47,"url":"https://indiainsurances.com/policy/raheja-qbe-general-insurance/group-health-insurance-rqbhlgp26042v022526/document/14707#c-7-7-iii"}],"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":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 11","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 16","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grievance","label":"Grievance route","section":"Claims","meaning":"Who to complain to first, as stated in the policy, before going to the Insurance Ombudsman.","status":"quote-verified","value":"For a grievance, the insured person may first contact Raheja QBE through its website, toll-free number, email, telephone, branch or senior-citizen channels. If not satisfied, the insured person may contact the grievance officer at complaintsofficer@rahejaqbe.com before approaching IRDAI Bima Bharosa or the Insurance Ombudsman.","display":"First contact Raheja QBE customer care or a branch; then the grievance officer at complaintsofficer@rahejaqbe.com.","note":null,"quote":"In case of any grievance the Insured Person may contact the company through\nWebsite: | www.rahejaqbe.com\nToll free: | 1800-102- 7723 (9 am to 8 pm, Monday to Saturday)\nE-mail: | customercare@rahejaqbe.com ... If Insured person is not satisfied with the redressal of grievance through one of the above methods, insured person may contact the grievance officer at: ... Website: www.rahejaqbe.com Email: complaintsofficer@rahejaqbe.com","sources":[{"clause":"8","heading":"REDRESSAL OF GRIEVANCE","page":56,"url":"https://indiainsurances.com/policy/raheja-qbe-general-insurance/group-health-insurance-rqbhlgp26042v022526/document/14707#c-8"},{"clause":null,"heading":"RAHEJA QBE GENERAL INSURANCE COMPANY LIMITED","page":57,"url":"https://indiainsurances.com/policy/raheja-qbe-general-insurance/group-health-insurance-rqbhlgp26042v022526/document/14707#c-raheja-qbe-general-insurance-company-limited"}],"law":[{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 3","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 4","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 5","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(11)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(42)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 34","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 69","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Insurance Act, 1938","section":"Section 38","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 12","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 19","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 20","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 13","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 2","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(5), 5(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(9)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 25","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 26","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 11","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 3","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 13","url":"https://indiainsurances.com/law/ombudsman-rules-2017"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 14","url":"https://indiainsurances.com/law/ombudsman-rules-2017"}]},{"key":"sum_insured_options","label":"Sum insured options","section":"Cover","meaning":"The cover amounts you can choose from.","status":"quote-verified","value":"From Rs. 25,000 to Rs. 1 crore.","display":"From Rs. 25,000 to Rs. 1 crore","note":"From the prospectus; the selected amount is shown in the policy schedule or certificate.","quote":"Sum Insured | From Rs. 25,000 to Rs. 1 crore | On Individual basis – SI shall apply to each individual family member On Floater basis – SI shall apply to the entire family","sources":[{"clause":"2","heading":"Coverage","page":1,"url":"https://indiainsurances.com/policy/raheja-qbe-general-insurance/group-health-insurance-rqbhlgp26042v022526/document/14705#c-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":"quote-verified","value":{"unit":"days","amount":30},"display":"30 days","note":"Does not apply if the insured person has continuous coverage for more than twelve months.","quote":"Expenses related to the treatment of any illness within 30 days from the first policy commencement date shall be excluded except claims arising due to an accident, provided the same are covered.","sources":[{"clause":null,"heading":"6.1.C. 30-day waiting period: (Code- Excl03)","page":40,"url":"https://indiainsurances.com/policy/raheja-qbe-general-insurance/group-health-insurance-rqbhlgp26042v022526/document/14707#c-6-1-c-30-day-waiting-period-code-excl03"}],"law":[]},{"key":"ped_waiting","label":"Pre-existing disease waiting period","section":"Waiting periods","meaning":"How long you wait before conditions you already had when you bought the policy are covered. The law caps it at 36 months.","status":"quote-verified","value":{"unit":"months","amount":36},"display":"36/24/12 months","note":"The wording prints 36/24/12 months; the applicable period depends on the policy terms.","quote":"Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications shall be excluded until the expiry of 36/24/12 months of continuous coverage after the date of inception of the first policy with insurer.","sources":[{"clause":"Excl01","heading":"A. Pre-Existing Diseases","page":39,"url":"https://indiainsurances.com/policy/raheja-qbe-general-insurance/group-health-insurance-rqbhlgp26042v022526/document/14707#c-excl01"}],"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":"quote-verified","value":{"unit":"months","amount":12},"display":"12 months","note":"This exclusion does not apply for claims arising due to an accident.","quote":"Expenses related to the treatment of the listed conditions, surgeries/treatments shall be excluded until the expiry of 12 months of continuous coverage after the date of inception of the first policy with the Insurer.","sources":[{"clause":null,"heading":"6.1.B. Specific Illness Waiting Period: (Code- Excl02)","page":39,"url":"https://indiainsurances.com/policy/raheja-qbe-general-insurance/group-health-insurance-rqbhlgp26042v022526/document/14707#c-6-1-b-specific-illness-waiting-period-code-excl0"}],"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":"quote-verified","value":["Benign ENT disorders","Tonsillectomy","Adenoidectomy","Mastoidectomy","Tympanoplasty","Hysterectomy","All internal or external benign tumors, cyst, sinus, polyps of any kind including benign breast lump","Benign prostate hypertrophy","Cataract and Senile Cataract","Gastric and 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"],"display":"Benign ENT disorders, tonsillectomy, adenoidectomy, mastoidectomy, tympanoplasty, hysterectomy, benign tumours/cysts/polyps, benign prostate hypertrophy, cataract, ulcers, gout and rheumatism, hernia, hydrocele, arthritis, piles/fissures/fistula, pilonidal sinus/sinusitis, spinal disc/spinal diseases, calculi and varicose veins/ulcers.","note":null,"quote":"List of applicable disease for 12 months waiting period are:\ni) Benign ENT disorders\nii) Tonsillectomy\niii) Adenoidectomy\niv) Mastoidectomy\nv) Tympanoplasty\nvi) Hysterectomy\nvii) All internal or external benign tumors, cyst, sinus, polyps of any kind including benign breast lump\nviii) Benign prostate hypertrophy\nix) Cataract and Senile Cataract\nx) Gastric and Duodenal Ulcer\nxi) Gout and Rheumatism\nxii) Hernia of all types\nxiii) Hydrocele\nxiv) Non-Infective Arthritis\nxv) Piles, Fissures and Fistula in anus\nxvi) Pilonidal sinus, Sinusitis and related disorders\nxvii) Prolapse inter Vertebral Disc and Spinal Diseases unless arising from accident\nxviii) Calculi in urinary system, Gall Bladder and Bile duct, excluding malignancy.\nxix) Varicose Veins and Varicose Ulcers","sources":[{"clause":null,"heading":"6.1.B. Specific Illness Waiting Period: (Code- Excl02)","page":39,"url":"https://indiainsurances.com/policy/raheja-qbe-general-insurance/group-health-insurance-rqbhlgp26042v022526/document/14707#c-6-1-b-specific-illness-waiting-period-code-excl0"}],"law":[]},{"key":"moratorium","label":"Moratorium period","section":"Renewal and rights","meaning":"After this many months of continuous cover, the insurer cannot reject a claim for non-disclosure, except for proven fraud or permanent exclusions. The law sets 60 months.","status":"quote-verified","value":{"unit":"months","amount":60},"display":"sixty continuous months","note":"Enhanced sum insured gets a separate sixty-month period from the date of enhancement for enhanced limits.","quote":"After completion of sixty continuous months of coverage (including portability and migration) in health insurance policy, no claim shall be contestable by the insurer on grounds of non-disclosure, misrepresentation, except on grounds of established fraud. This period of sixty continuous months is called as moratorium period.","sources":[{"clause":"7.34","heading":"Moratorium Period","page":55,"url":"https://indiainsurances.com/policy/raheja-qbe-general-insurance/group-health-insurance-rqbhlgp26042v022526/document/14707#c-7-34"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 13","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 8","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"portability","label":"Portability","section":"Renewal and rights","meaning":"Whether you can move this policy to another insurer and keep waiting-period credit.","status":"quote-verified","value":"The insured person may port the policy to other insurers as per portability guidelines and gets accrued continuity benefits in waiting periods for continuous prior coverage.","display":"Can port to other insurers with accrued continuity benefits in waiting periods.","note":"Portability benefit is limited to the extent of previous sum insured and accrued bonus as part of base sum insured.","quote":"The Insured Person will have the option to port the Policy to other insurers as per extant Guidelines related to portability. If such person is presently covered and has been continuously covered without any lapses under any health insurance plan with an Indian General/Health insurer as per Guidelines on portability, the proposed Insured Person will get all the accrued continuity benefits in waiting periods","sources":[{"clause":"7.30","heading":"Portability","page":54,"url":"https://indiainsurances.com/policy/raheja-qbe-general-insurance/group-health-insurance-rqbhlgp26042v022526/document/14707#c-7-30"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 11","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.6","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, VII.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 24","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.4 and 1.5","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 10","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"lifelong_renewal","label":"Lifelong renewal","section":"Renewal and rights","meaning":"Whether the policy can be renewed for life without a maximum age.","status":"quote-verified","value":true,"display":"Yes, maximum age: no limit and ordinarily renewable.","note":"The wording does not use the phrase lifelong renewal, but states no maximum age and ordinary renewability.","quote":"Age Limit | Adults covered from the age of 18 yrs. Maximum Age: No Limit ... The Policy shall ordinarily be renewable except on grounds of fraud, moral hazard, misrepresentation by the insured person provided that the policy is not withdrawn","sources":[{"clause":"2","heading":"Coverage","page":1,"url":"https://indiainsurances.com/policy/raheja-qbe-general-insurance/group-health-insurance-rqbhlgp26042v022526/document/14705#c-2"},{"clause":"7.31","heading":"Renewal of Policy","page":54,"url":"https://indiainsurances.com/policy/raheja-qbe-general-insurance/group-health-insurance-rqbhlgp26042v022526/document/14707#c-7-31"}],"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":"not-stated","value":null,"display":null,"note":"The wording says renewal shall not be denied because claims were made, but it does not state whether premium can be loaded because of claims.","quote":null,"sources":[],"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":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 16","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"cancellation_refund","label":"Cancellation by you","section":"Renewal and rights","meaning":"What you get back if you cancel during the year.","status":"quote-verified","value":"The policyholder may cancel by giving 7 days written notice. If no claims are made, the company refunds proportionate premium for the unexpired policy period on prorate basis; if claims are made, there is no refund.","display":"7 days written notice; pro-rata refund for unexpired period if no claims; no refund if claims made.","note":null,"quote":"a) The policyholder may cancel this policy by giving 7 days written notice.\nb) In case the Policyholder requests cancellation of the Policy, where no claims are made under the Policy, the Company shall refund proportionate premium for the unexpired policy period on prorate basis.\nc) In case the Policyholder requests for cancellation of the Policy, where there are claims made under the Policy, then there shall be no refund of premium for the unexpired policy period.","sources":[{"clause":"7.26","heading":"Cancellation","page":52,"url":"https://indiainsurances.com/policy/raheja-qbe-general-insurance/group-health-insurance-rqbhlgp26042v022526/document/14707#c-7-26"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 64VB","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 8","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 6","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 5","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 17","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(3) to 20(5)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.4","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, IV.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"territory","label":"Where it covers","section":"Overview","meaning":"Geographic area of cover: India only, worldwide, or listed countries. 'As stated in the schedule' is not an answer.","status":"quote-verified","value":"All medical treatment for this insurance must be taken in India only.","display":"India only","note":null,"quote":"All medical treatment for the purpose of this insurance will have to be taken in India only.","sources":[{"clause":"7.19","heading":"Territorial Limit","page":50,"url":"https://indiainsurances.com/policy/raheja-qbe-general-insurance/group-health-insurance-rqbhlgp26042v022526/document/14707#c-7-19"}],"law":[]},{"key":"free_look","label":"Free-look period","section":"Renewal and rights","meaning":"Days after you receive the policy in which you can return it for a refund if you do not agree with its terms.","status":"quote-verified","value":{"unit":"days","amount":30},"display":"thirty days","note":"Applicable at inception of the policy and not on renewals or at the time of porting.","quote":"The insured shall be allowed a period of thirty days from date of receipt of the Policy, whether received electronically or otherwise, to review the terms and conditions of the Policy.","sources":[{"clause":"7.35","heading":"Free look period","page":55,"url":"https://indiainsurances.com/policy/raheja-qbe-general-insurance/group-health-insurance-rqbhlgp26042v022526/document/14707#c-7-35"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 5","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 5","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(1), 20(2)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(3) to 20(5)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, II.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grace_period","label":"Grace period","section":"Renewal and rights","meaning":"Days you get after the due date to pay without losing cover or continuity.","status":"quote-verified","value":{"unit":"days","amount":30},"display":"30 days; 15 days for monthly","note":"The premium instalment table also states yearly, half yearly and quarterly have 30 Days and monthly has 15 Days.","quote":"A Grace Period of 30 days is available for Renewal of the Policy. ... The grace period for payment of the premium for all types of insurance policies shall be: fifteen days where premium payment mode is monthly and thirty days in all other cases.","sources":[{"clause":"7.24","heading":"Grace Period","page":51,"url":"https://indiainsurances.com/policy/raheja-qbe-general-insurance/group-health-insurance-rqbhlgp26042v022526/document/14707#c-7-24"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 50","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 8","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 9","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 8","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, IV.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule I, Para 1.2","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.3","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"eligibility_entry_age","label":"Entry age","section":"Eligibility","meaning":"The youngest and oldest age at which you can buy this policy.","status":"quote-verified","value":"Adults are covered from age 18 years with no maximum age. Children are covered from 91 days up to age 25 years, with no upper age limit for a widow daughter and disabled child.","display":"Adults from 18 yrs, maximum age no limit; child from 91 Days upto 25 yrs.","note":"From the prospectus.","quote":"Age Limit | Adults covered from the age of 18 yrs. Maximum Age: No Limit Child covered: From 91 Days upto the age of 25 yrs (no upper age limit for widow daughter and disabled child)","sources":[{"clause":"2","heading":"Coverage","page":1,"url":"https://indiainsurances.com/policy/raheja-qbe-general-insurance/group-health-insurance-rqbhlgp26042v022526/document/14705#c-2"}],"law":[]},{"key":"premium_modes","label":"Premium payment options","section":"Premium","meaning":"How often you can pay: yearly, half-yearly, quarterly, monthly.","status":"quote-verified","value":["Yearly","Half Yearly","Quarterly","Monthly"],"display":"Yearly, Half Yearly, Quarterly, Monthly","note":null,"quote":"Options | Instalment Premium Option | Grace Period Applicable\nOption 1 | Yearly | 30 Days\nOption 2 | Half Yearly | 30 Days\nOption 3 | Quarterly | 30 Days\nOption 4 | Monthly | 15 Days","sources":[{"clause":"7.25","heading":"Premium Payment Options","page":52,"url":"https://indiainsurances.com/policy/raheja-qbe-general-insurance/group-health-insurance-rqbhlgp26042v022526/document/14707#c-7-25"}],"law":[]},{"key":"optional_covers","label":"Optional covers","section":"Cover","meaning":"Covers you can add for an extra premium. They change the answers above only if you buy them.","status":"quote-verified","value":["Home Care treatment","Organ Donor Cover","Health Check up","Maternity","Baby Day One cover","Pre and Post Natal Expenses","Reinstatement of Sum Insured","Recharge of Sum Insured","Emergency Ambulance","Air Ambulance","Corporate Buffer","Outpatient Cover","Well Child Cover","Well Women Cover","Wellness benefit","Disease wise sublimit","Accidental Death","Permanent Total Disablement","Permanent Partial Disablement","Convalescence benefit","Critical illness Indemnity cover","Critical illness benefit Cover","Vaccination","Family Transportation","Daily Hospital Cash Benefit","Lasik Cover","Infertility treatment","Super Top up","Tele Consultation","Assistance Services","Co-payment","Excess/deductible","Second Opinion"],"display":"Home care, organ donor, health check-up, maternity, baby day one, pre/post natal, reinstatement/recharge, ambulances, corporate buffer, outpatient, wellness and other add-on covers.","note":"The prospectus states these can be opted in combination with base cover by paying premium for the opted cover.","quote":"Addon covers ... 3 | Home Care treatment | ... 4 | Organ Donor Cover | ... 5 | Health Check up | ... 6 | Maternity a) With 9 months waiting period b) Without 9 months waiting period | ... 7 | Baby Day One cover | ... 8 | Pre and Post Natal Expenses | ... 9 | Reinstatement of Sum Insured | ... 10 | Recharge of Sum Insured | ... 11 | Emergency Ambulance | ... 12 | Air Ambulance | ... 13 | Corporate Buffer | ... 14 | Outpatient Cover | ... 15 | Well Child Cover | ... 16 | Well Women Cover | ... 17 | Wellness benefit | ... 18 | Disease wise sublimit | ... 19 | Accidental Death | ... 20 | Permanent Total Disablement | ... 21 | Permanent Partial Disablement | ... 22 | Convalescence benefit | ... 23 | Critical illness Indemnity cover | ... 24 | Critical illness benefit Cover | ... 25 | Vaccination | ... 26 | Family Transportation | ... 27 | Daily Hospital Cash Benefit | ... 28 | Lasik Cover | ... 29 | Infertility treatment | ... 30 | Super Top up | ... 31 | Tele Consultation | ... 32 | Assistance Services | ... 33 | Co-payment a) All claims b) Parents claims only | ... 34 | Excess/deductible | ... 35 | Second Opinion |","sources":[{"clause":null,"heading":"Addon covers","page":2,"url":"https://indiainsurances.com/policy/raheja-qbe-general-insurance/group-health-insurance-rqbhlgp26042v022526/document/14705#c-addon-covers"}],"law":[]},{"key":"grace_cover","label":"Cover during the grace period","section":"Renewal and rights","meaning":"Whether a claim during the grace period is paid.","status":"quote-verified","value":"Coverage is stated as not available during the grace period at renewal, but the grace-period clause also states coverage will be offered during the grace period if premium is paid in instalments during the policy period.","display":"Coverage is not available during the grace period; instalment policies are stated to get coverage during grace if premium is paid.","note":"The wording contains these statements in different clauses; this is not marked as a document conflict because both are in the policy wording.","quote":"At the end of the policy period, the policy shall terminate and can be renewed within the Grace Period to maintain continuity of benefits without Breakin Policy. Coverage is not available during the grace period. ... Any Illness, disease or condition contracted during Grace Period will not be covered and will be treated as Pre-existing diseases. ... Provided the insurers shall offer coverage during the grace period, if the premium is paid in instalments during the policy period.","sources":[{"clause":"7.31","heading":"Renewal of Policy","page":54,"url":"https://indiainsurances.com/policy/raheja-qbe-general-insurance/group-health-insurance-rqbhlgp26042v022526/document/14707#c-7-31"},{"clause":"7.24","heading":"Grace Period","page":51,"url":"https://indiainsurances.com/policy/raheja-qbe-general-insurance/group-health-insurance-rqbhlgp26042v022526/document/14707#c-7-24"}],"law":[]},{"key":"room_rent","label":"Room rent limit","section":"Limits and co-pay","meaning":"Daily room limit, if any.","status":"not-stated","value":null,"display":null,"note":"The wording only says room rent is covered up to the limits specified in the Policy Schedule/Certificate of Insurance.","quote":null,"sources":[],"law":[]},{"key":"maternity","label":"Maternity cover","section":"Cover","meaning":"Childbirth cover and any waiting period.","status":"quote-verified","value":"Maternity is an optional cover. If opted, it pays maternity expenses for delivery, pregnancy complications or medically necessary termination up to the sum insured stated for that section, for the first two living children, with the waiting period as mentioned in the policy schedule and a possible waiting-period waiver if opted.","display":"Optional maternity cover for first two living children; waiting period as mentioned in Policy Schedule, unless waiver is opted.","note":"Maternity expenses are otherwise listed as an exclusion that can be waived off on payment of additional premium.","quote":"If Insured has opted for this Cover, we will pay the Maternity Expenses incurred towards the delivery of a baby and/or treatment related to any complication of pregnancy or medically necessary termination. This is up to the Sum Insured opted by Insured and as mentioned in the Policy Schedule against this Section, during the Policy Period provided that:\na) Medical Expenses are covered for the delivery of first two living children of the Insured person ... b) A waiting period as mentioned in the Policy schedule shall apply to the Primary Insured and his/her spouse from the date both are covered under the Policy.\nc) A waiting period shall not apply to the Primary Insured and his/her spouse if waiver of waiting period is opted and mentioned in the Policy schedule.","sources":[{"clause":"5.4","heading":"Maternity","page":17,"url":"https://indiainsurances.com/policy/raheja-qbe-general-insurance/group-health-insurance-rqbhlgp26042v022526/document/14707#c-5-4"}],"law":[]},{"key":"ped_cover_group","label":"Pre-existing diseases","section":"Waiting periods","meaning":"Whether pre-existing diseases are covered from day one for the group.","status":"quote-verified","value":"Pre-existing diseases are not automatically covered from day one under the base wording; PED treatment and direct complications are excluded until 36/24/12 months of continuous coverage, unless the exclusion is waived on payment of additional premium.","display":"No day-one PED cover unless waived; otherwise excluded for 36/24/12 months.","note":"The policy does not state a general day-one PED cover for all groups.","quote":"Exclusions* (which can be waived off on payment of additional premium) ... Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications shall be excluded until the expiry of 36/24/12 months of continuous coverage after the date of inception of the first policy with insurer.","sources":[{"clause":null,"heading":"Exclusions* (which can be waived off on payment of additional premium)","page":39,"url":"https://indiainsurances.com/policy/raheja-qbe-general-insurance/group-health-insurance-rqbhlgp26042v022526/document/14707#c-exclusions-which-can-be-waived-off-on-payment-of"},{"clause":"Excl01","heading":"A. Pre-Existing Diseases","page":39,"url":"https://indiainsurances.com/policy/raheja-qbe-general-insurance/group-health-insurance-rqbhlgp26042v022526/document/14707#c-excl01"}],"law":[]},{"key":"cashless","label":"Cashless treatment","section":"Claims","meaning":"Whether and where the insurer pays the hospital directly instead of you paying and claiming back.","status":"quote-verified","value":"Cashless treatment may be taken in a network provider and is subject to pre-authorization by the company or its authorized TPA. If cashless is denied, the insured may take treatment and submit documents for reimbursement.","display":"Available at network providers, subject to pre-authorization by the Company or authorized TPA.","note":null,"quote":"Treatment may be taken in a network provider and is subject to pre authorization by the Company or its authorized TPA. ... In case of denial of cashless access, the insured person may obtain the treatment as per treating doctor’s advice and submit the claim documents to the Company / TPA for reimbursement.","sources":[{"clause":"7.1(i)","heading":null,"page":43,"url":"https://indiainsurances.com/policy/raheja-qbe-general-insurance/group-health-insurance-rqbhlgp26042v022526/document/14707#c-7-1-i"},{"clause":"7.1(ii)","heading":null,"page":44,"url":"https://indiainsurances.com/policy/raheja-qbe-general-insurance/group-health-insurance-rqbhlgp26042v022526/document/14707#c-7-1-ii"}],"law":[]},{"key":"claims_handled_by","label":"Claims handled by","section":"Claims","meaning":"The insurer itself or a third-party administrator (TPA).","status":"quote-verified","value":"Claims may be handled by the company or its authorized TPA for cashless pre-authorization and processing, but TPA services do not include claim settlement or claim rejection.","display":"Company or authorized TPA; TPA does not settle or reject claims.","note":null,"quote":"Treatment may be taken in a network provider and is subject to pre authorization by the Company or its authorized TPA. ... Servicing of claims, i.e., claim admissions and assessments, under this Policy by way of pre-authorization of cashless treatment or processing of claims other than cashless claims or both, as per the underlying terms and conditions of the policy. The services offered by a TPA shall not include\n• Claim settlement and claim rejection;","sources":[{"clause":"7.1(i)","heading":null,"page":43,"url":"https://indiainsurances.com/policy/raheja-qbe-general-insurance/group-health-insurance-rqbhlgp26042v022526/document/14707#c-7-1-i"},{"clause":"7.9","heading":"Services Offered by TPA","page":48,"url":"https://indiainsurances.com/policy/raheja-qbe-general-insurance/group-health-insurance-rqbhlgp26042v022526/document/14707#c-7-9"}],"law":[]},{"key":"family_floater","label":"Family floater available","section":"Cover","meaning":"Whether one sum insured can be shared by the whole family.","status":"quote-verified","value":true,"display":"Yes, floater basis available.","note":null,"quote":"On Floater basis – SI shall apply to the entire family ... Family Floater - means a Policy described as such in the Policy Schedule where You and Your Dependents named in the Policy Schedule are covered under this Policy as at the Commencement Date. The Sum Insured for a Family Floater is the amount shown in the Policy Schedule which represents Our maximum liability for any and all claims made by You and/or all of Your Dependents during each Policy Year.","sources":[{"clause":"2","heading":"Coverage","page":1,"url":"https://indiainsurances.com/policy/raheja-qbe-general-insurance/group-health-insurance-rqbhlgp26042v022526/document/14705#c-2"},{"clause":null,"heading":"Note","page":3,"url":"https://indiainsurances.com/policy/raheja-qbe-general-insurance/group-health-insurance-rqbhlgp26042v022526/document/14707#c-note"}],"law":[]}],"documents":[{"kind":"wording","label":"Group Health Insurance - Policy wordings","pages":64,"fetched_at":"2026-10-17 19:58:57+00","source_url":"https://rahejaqbe.com/uploads/images/group-health/pdf/download/group-health-insurance-policy-wording-V03.pdf","url":"https://indiainsurances.com/policy/raheja-qbe-general-insurance/group-health-insurance-rqbhlgp26042v022526/document/14707"},{"kind":"wording","label":"Group Health Insurance Policy (IRDAI copy)","pages":56,"fetched_at":"2026-10-20 02:32:42+00","source_url":"https://irdai.gov.in/documents/37343/931203/RQBHLGP21566V012021_2020-2021.pdf/bc6b48e7-c87b-ae67-d304-04a2a32b7798?version=1.1&t=1668748506060&download=true","url":"https://indiainsurances.com/policy/raheja-qbe-general-insurance/group-health-insurance-rqbhlgp26042v022526/document/28708"},{"kind":"prospectus","label":"Group Health Insurance - Prospectus","pages":24,"fetched_at":"2026-10-17 19:58:49+00","source_url":"https://rahejaqbe.com/uploads/images/group-health/pdf/download/group-health-insurance-prospectus-V01.pdf","url":"https://indiainsurances.com/policy/raheja-qbe-general-insurance/group-health-insurance-rqbhlgp26042v022526/document/14705"},{"kind":"cis","label":"Group Health Insurance - Customer information sheet","pages":12,"fetched_at":"2026-10-17 19:56:42+00","source_url":"https://rahejaqbe.com/uploads/images/group-health/pdf/download/group-health-insurance-cis-V02.pdf","url":"https://indiainsurances.com/policy/raheja-qbe-general-insurance/group-health-insurance-rqbhlgp26042v022526/document/14662"}],"versions":[{"uin":"RQBHLGP21566V012021","version":null,"approved_on":null},{"uin":"RQBHLGP26042V022526","version":null,"approved_on":null}],"where_to_buy":[{"purpose":"buy","kind":"insurer","name":"Raheja QBE General Insurance official website","url":"https://www.rahejaqbe.com/","note":"Buy directly from the insurer."},{"purpose":"buy","kind":"ours","name":"Get free help from IndiaInsurances","url":"/help","note":"Free. We do not sell insurance and earn no commission; your request is not passed to anyone."}],"claims_and_complaints":[{"purpose":"claim","kind":"insurer","name":"Claims","url":"https://rahejaqbe.com/claims","note":null},{"purpose":"claim","kind":"ours","name":"Get free help from IndiaInsurances","url":"/help","note":"Free. We do not sell insurance and earn no commission; your request is not passed to anyone."},{"purpose":"grievance","kind":"insurer","name":"Grievance redressal","url":"https://rahejaqbe.com/grievance-redressal","note":null},{"purpose":"grievance","kind":"official","name":"Bima Bharosa (IRDAI grievance portal)","url":"https://bimabharosa.irdai.gov.in/","note":"Register and track a complaint against any insurer with IRDAI. Complain to the insurer first; escalate here if the reply is late or unsatisfactory."},{"purpose":"grievance","kind":"official","name":"e-Daakhil (consumer commission e-filing)","url":"https://edaakhil.nic.in/","note":"Not reachable from our crawler on 2026-10-19; use e-Jagriti if this link does not open."},{"purpose":"grievance","kind":"official","name":"e-Jagriti (consumer commission filing)","url":"https://e-jagriti.gov.in/","note":"Ministry of Consumer Affairs platform for consumer commission cases, a route for insurance disputes that the Ombudsman does not settle."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Ahmedabad","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Gujarat, Dadra & Nagar Haveli, Daman and Diu. Email: oio.ahmedabad@cioins.co.in. Phone: 079 - 25501201/02. Address: Office of the Insurance Ombudsman, Jeevan Prakash Building, 6th floor, Tilak Marg, Relief Road, AHMEDABAD – 380 001."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Bengaluru","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Karnataka. Email: oio.bengaluru@cioins.co.in. Phone: 080 - 26652048 / 26652049. Address: Office of the Insurance Ombudsman, Jeevan Soudha Building,PID No. 57-27-N-19 Ground Floor, 19/19, 24th Main Road, JP Nagar, Ist Phase, Bengaluru – 560 078."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Bhopal","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Madhya Pradesh, Chhattisgarh. Email: oio.bhopal@cioins.co.in. Phone: 0755 - 2769201 / 2769202 / 2769203. Address: Office of the Insurance Ombudsman, 1st floor,\"Jeevan Shikha\", 60-B,Hoshangabad Road, Opp. Gayatri Mandir,Arera Hills Bhopal – 462 011."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Bhubaneswar","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Odisha. Email: oio.bhubaneswar@cioins.co.in. Phone: 0674 - 2596461 /2596455/2596429/2596003. Address: Office of the Insurance Ombudsman, 62, Forest park, Bhubaneswar – 751 009."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Chandigarh","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Punjab, Haryana (excluding Gurugram, Faridabad, Sonepat and Bahadurgarh), Himachal Pradesh, Union Territories of Jammu & Kashmir,Ladakh & Chandigarh. Email: oio.chandigarh@cioins.co.in. Phone: 0172-2706468. Address: Office Of The Insurance Ombudsman, Jeevan Deep Building SCO 20-27, Ground Floor Sector- 17 A, Chandigarh – 160 017."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Chennai","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Tamil Nadu, PuducherryTown and Karaikal (which are part of Puducherry). Email: oio.chennai@cioins.co.in. Phone: 044 - 24333668 / 24333678. Address: Office of the Insurance Ombudsman, Fatima Akhtar Court, 4th Floor, 453, Anna Salai, Teynampet, CHENNAI – 600 018."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Delhi","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Delhi & following Districts of Haryana - Gurugram, Faridabad, Sonepat & Bahadurgarh. Email: oio.delhi@cioins.co.in. Phone: 011 - 46013992/23213504/23232481. Address: Office of the Insurance Ombudsman, 2/2 A, Universal Insurance Building, Asaf Ali Road, New Delhi – 110 002."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Guwahati","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Assam, Meghalaya, Manipur, Mizoram, Arunachal Pradesh, Nagaland and Tripura. Email: oio.guwahati@cioins.co.in. Phone: 0361 - 2632204 / 2602205 / 2631307. Address: Office of the Insurance Ombudsman, Jeevan Nivesh, 5th Floor, Near Pan Bazar , S.S. Road, Guwahati – 781001(ASSAM)."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Hyderabad","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Andhra Pradesh, Telangana, Yanam and part of Union Territory of Puducherry. Email: oio.hyderabad@cioins.co.in. Phone: 040 - 23312122 / 23376991 / 23376599 / 23328709 / 23325325. Address: Office of the Insurance Ombudsman, 6-2-46, 1st floor, \"Moin Court\", Lane Opp.Hyundai Showroom , A. C. Guards, Lakdi-Ka-Pool, Hyderabad - 500 004."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Jaipur","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Rajasthan. Email: oio.jaipur@cioins.co.in. Phone: 0141- 2740363. Address: Office of the Insurance Ombudsman, Jeevan Nidhi – II Bldg., Gr. Floor, Bhawani Singh Marg, Jaipur - 302 005."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Kochi","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Kerala, Lakshadweep, Mahe-a part of Union Territory of Puducherry. Email: oio.ernakulam@cioins.co.in. Phone: 0484 - 2358759. Address: Office of the Insurance Ombudsman, 10th Floor, Jeevan Prakash,LIC Building, Opp to Maharaja's College Ground,M.G.Road, Kochi - 682 011."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Kolkata","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: West Bengal, Sikkim, Andaman & Nicobar Islands. Email: oio.kolkata@cioins.co.in. Phone: 033 - 22124339 / 22124341. Address: Office of the Insurance Ombudsman, Hindustan Bldg. Annexe, 7th Floor, 4, C.R. Avenue, KOLKATA - 700 072."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Lucknow","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Districts of Uttar Pradesh : Lalitpur, Jhansi, Mahoba, Hamirpur, Banda, Chitrakoot, Allahabad, Mirzapur, Sonbhabdra, Fatehpur, Pratapgarh, Jaunpur,Varanasi, Gazipur, Jalaun, Kanpur, Lucknow, Unnao, Sitapur, Lakhimpur, Bahraich, Barabanki, Raebareli, Sravasti, Gonda, Faizabad, Amethi, Kaushambi, Balrampur, Basti, Ambedkarnagar, Sultanpur, Maharajgang, Santkabirnagar, Azamgarh, Kushinagar, Gorkhpur, Deoria, Mau, Ghazipur, Chandauli, Ballia, Sidharathnagar. Email: oio.lucknow@cioins.co.in. Phone: 0522 - 4002082 / 3500613. Address: Office of the Insurance Ombudsman, 6th Floor, Jeevan Bhawan, Phase-II, Nawal Kishore Road, Hazratganj, Lucknow - 226 001."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Mumbai","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: List of wards under Mumbai Metropolitan Region excluding wards in Mumbai – i.e M/E, M/W, N , S and T covered under Office of Insurance Ombudsman Thane and excluding areas of Navi Mumbai. Email: oio.mumbai@cioins.co.in. Phone: 022 - 69038800/27/29/31/32/33. Address: Office of the Insurance Ombudsman, 3rd Floor, Jeevan Seva Annexe, S. V. Road, Santacruz (W), Mumbai - 400 054."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Noida","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: State of Uttarakhand and the following Districts of Uttar Pradesh: Agra, Aligarh, Bagpat, Bareilly, Bijnor, Budaun, Bulandshehar, Etah, Kannauj, Mainpuri, Mathura, Meerut, Moradabad, Muzaffarnagar, Oraiyya, Pilibhit, Etawah, Farrukhabad, Firozbad, Gautam Buddh nagar, Ghaziabad, Hardoi, Shahjahanpur, Hapur, Shamli, Rampur, Kashganj, Sambhal, Amroha, Hathras, Kanshiramnagar, Saharanpur. Email: oio.noida@cioins.co.in. Phone: 0120-4027589. Address: Office of the Insurance Ombudsman, Bhagwan Sahai Palace 4th Floor, Main Road, Naya Bans, Sector 15, Distt: Gautam Buddh Nagar, U.P-201301."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman: offices and jurisdiction","url":"https://www.cioins.co.in/Ombudsman","note":"Addresses, phone numbers, e-mail and the states or districts each Ombudsman office covers."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Patna","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Bihar, Jharkhand. Email: oio.patna@cioins.co.in. Phone: 0612-2547068. Address: Office of the Insurance Ombudsman, 2nd Floor, Lalit Bhawan, Bailey Road, Patna 800 001."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Pune","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: State of Goa and State of Maharashtra excluding areas of Navi Mumbai, Thane district,Palghar District, Raigad district & Mumbai Metropolitan Region. Email: oio.pune@cioins.co.in. Phone: 020-24471175. Address: Office of the Insurance Ombudsman, Jeevan Darshan Bldg., 3rd Floor, C.T.S. No.s. 195 to 198, N.C. Kelkar Road, Narayan Peth, Pune – 411 030."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman: register a complaint online","url":"https://cioins.co.in/Complaint/Online","note":"Council for Insurance Ombudsmen. Free. For disputes with an insurer after its own grievance process; the office is chosen by where you live (see the offices list)."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Thane","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Area of Navi Mumbai, Thane District, Raigad District, Palghar District and wards of Mumbai , M/East, M/West, N, S and T. Email: oio.thane@cioins.co.in. Phone: 022-20812868/69. Address: Office of the Insurance Ombudsman, Jeevan Chintamani Building, 2nd Floor,Near New RTO Office, Louis Wadi,Vasantrao Naik Mahamarg, Thane (West)- 400604."},{"purpose":"grievance","kind":"official","name":"National Consumer Helpline","url":"https://consumerhelpline.gov.in/public/","note":"Government consumer helpline; can take up a complaint before you go to a consumer commission."},{"purpose":"port","kind":"ours","name":"Get free help from IndiaInsurances","url":"/help","note":"Free. We do not sell insurance and earn no commission; your request is not passed to anyone."}],"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":"Group Health Insurance (UIN RQBHLGP26042V022526), IndiaInsurances, https://indiainsurances.com/policy/raheja-qbe-general-insurance/group-health-insurance-rqbhlgp26042v022526"}