Bajaj Allianz General Insurance Co. Ltd.

Bajaj Allianz House, Airport Road, Yerawada, Pune - 411 006. Reg. No.: 113
For more details, log on to: [Link] | E-mail: bagichelp@[Link] or
Call at: Sales - 1800 209 0144 / Service - 1800 209 5858 (Toll Free No.)
IssuingOffice:

STAR PACKAGE
Policy Wordings

SECTION A) PREAMBLE
Whereas the Proposer/ Insured has made to Bajaj Allianz General Insurance Company Limited (hereinafter called the “
Company”), a proposal which is hereby agreed to be the basis of this Policy and has paid the premium specified in the
Schedule, now the Company agrees, subject always to the following terms, conditions, exclusions, and limitations, to
indemnify the Insured in excess of the amount of the Deductible and subject always to the Sum Insured and/or Sum Assured
and/or Limit of Indemnity against such loss as is herein provided.

SECTION B) DEFINITIONS- STANDARD DEFINITIONS

1. Definitions Applicable for Hospital Cash Daily Allowance, Health Guard, Critical Illness, Personal Accident And
Educational Grant Section

1) Accident, Accidental
An accident is a sudden, unforeseen and involuntary event caused by external, visible and violent means.

2) Any one illness

Any one illness means continuous Period of illness and includes relapse within 45 days from the date of last consultation with
the Hospital/Nursing Home where treatment was taken.

3) AYUSH Hospital
An AYUSH Hospital is a healthcare facility wherein medical/surgical/para-surgical treatment procedures and interventions are
carried out by AYUSH Medical Practitioner(s) comprising of any of the following:
a. Central or State Government AYUSH Hospital; or
b. Teaching hospital attached to AYUSH College recognized by the Central Government/Central Council of Indian
Medicine/Central Council for Homeopathy; or
c. AYUSH Hospital, standalone or co-located with in-patient healthcare facility of any recognized system of medicine, registered
with the local authorities, wherever applicable, and is under the supervision of a qualified registered AYUSH Medical
Practitioner and must comply with all the following criterion:
i. Having at least 5 in-patient beds;
ii. Having qualified AYUSH Medical Practitioner in charge round the clock;
iii. Having dedicated AYUSH therapy sections as required and/or has equipped operation theatre where surgical procedures are
to be carried out
iv. Maintaining daily records of the patients and making them accessible to the insurance company’s authorized representative.

4) AYUSH Day Care Centre

AYUSH Day Care Centre means and includes Community Health Centre (CHC), Primary Health Centre (PHC),
Dispensary, Clinic, Polyclinic or any such health centre which is registered with the local authorities, wherever
applicable and having facilities for carrying out treatment procedures and medical or surgical/para-surgical
interventions or both under the supervision of registered AYUSH Medical Practitioner (s) on day care basis
without in-patient services and must comply with all the following criterion:
i. Having qualified registered AYUSH Medical Practitioner(s) in charge;
ii. Having dedicated AYUSH therapy sections as required and/or has equipped operation theatre where surgical procedures
are to be carried out;
iii. Maintaining daily records of the patients and making them accessible to the insurance company’s authorized representative.

5) Cashless facility
Cashless facility means a facility extended by the Insurer to the Insured where the payments, of the costs of treatment
undergone by the Insured Person in accordance with the Policy terms and conditions, are directly made to the
Network Provider by the Insurer to the extent pre-authorization is approved.

6) Condition Precedent
Condition Precedent means a Policy term or condition upon which the Insurer’s liability under the Policy is conditional upon.

7) Co-Payment
A co-payment means a cost-sharing requirement under a health insurance Policy that provides that the
Policyholder/Insured Person will bear a specified percentage of the admissible claim amount. A co-payment does
not reduce the Sum Insured.

8) Congenital Anomaly:
Congenital Anomaly means a condition(s) which is present since birth, and which is abnormal with reference to form,
structure or position.
a. Internal Congenital Anomaly- Congenital anomaly which is not in the visible and accessible parts of the body
b. External Congenital Anomaly- Congenital anomaly which is in the visible and accessible parts of the body

9) Cumulative Bonus:
Cumulative Bonus means any increase or addition in the Sum Insured granted by the Insurer without an associated increase in
CIN: U66010PN2000PLC015329 • UIN: BAJHLIP25037V022425 1
Bajaj Allianz General Insurance Co. Ltd.
Bajaj Allianz House, Airport Road, Yerawada, Pune - 411 006. Reg. No.: 113
For more details, log on to: [Link] | E-mail: bagichelp@[Link] or
Call at: Sales - 1800 209 0144 / Service - 1800 209 5858 (Toll Free No.)
IssuingOffice:

premium.

10) Day care centre:

A day care centre means any institution established for day care treatment of illness and / or injuries or a medical set -up
with a hospital and which has been registered with the local authorities, wherever applicable, and is under the supervision
of a registered and qualified medical practitioner AND must comply with all minimum criteria as under:-
i. has qualified nursing staff under its employment,
ii. has qualified medical practitioner(s) in charge,
iii. has a fully equipped operation theatre of its own where surgical procedures are carried out
iv. maintains daily records of patients and will make these accessible to the Insurance Company’s authorized personnel.

11) Day Care Treatment:

Day care treatment means medical treatment, and/or surgical procedure which is:
i. undertaken under General or Local Anesthesia in a hospital/day care centre in less than 24 hrs because of technological
advancement, and
ii. Which would have otherwise required a hospitalization of more than 24 hours.
Treatment normally taken on an out-patient basis is not included in the scope of this definition.

12) Dental Treatment:

Dental treatment means a treatment related to teeth or structures supporting teeth including examinations, fillings (where
appropriate), crowns, extractions and surgery.

13) Disclosure to information norm:

The Policy shall be void and all premium paid thereon shall be forfeited to the Company, in the event of misrepresentation,
mis-description or non-disclosure of any material fact.

14) Emergency Care:

Emergency care means management of an illness or injury which results in symptoms which occur suddenly and
unexpectedly, and requires immediate care by a Medical Practitioner to prevent death or serious long term impairment of
the Insured Person’s health.

15) Grace Period:

Grace period means the specified period of time, immediately following the premium due date during which premium payment can be
made to renew or continue a policy in force without loss of continuity benefits pertaining to waiting periods and coverage of pre-
existing diseases. Coverage need not be available during the period for which no premium is received. 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.
Provided the insurers shall offer coverage during the grace period, if the premium is paid in instalments during the policy period.

16) Hospital:
A hospital means any institution established for in-patient care and day care treatment of illness and/or injuries and which has been
registered as a hospital with the local authorities under the Clinical Establishments (Registration and Regulation) Act, 2010 or under the
enactments specified under the Schedule of Section 56(1) of the said Act OR complies with all minimum criteria as under:
i. has qualified nursing staff under its employment round the clock;
ii. has at least 10 in-patient beds in towns having a population of less than 10,00,000 and at least 15 in-patient beds in all other places;
iii. has qualified medical practitioner(s) in charge round the clock;
iv. has a fully equipped operation theatre of its own where surgical procedures are carried out;
v. maintains daily records of patients and makes these accessible to the Insurance Company’s authorized personnel.

17) Hospitalization:
Hospitalization means admission in a Hospital for a minimum period of 24 consecutive In patient Care hours except for specified
procedures/ treatments, where such admission could be for a period of less than 24 consecutive hours.

18) Illness
Illness means a sickness or a disease or pathological condition leading to the impairment of normal physiological function and requires
medical treatment.
a. Acute condition - Acute condition is a disease, illness or injury that is likely to respond quickly to treatment which aims to return the
person to his or her state of health immediately before suffering the disease/illness/injury which leads to full recovery.
b. Chronic condition – A chronic condition is defined as a disease, illness, or injury that has one or more of the following characteristics:
i. it needs ongoing or long-term monitoring through consultations, examinations, check-ups, and /or tests
ii. it needs ongoing or long-term control for relief of symptoms
iii. it requires rehabilitation for the patient or for the patient to be specially trained to cope with it
iv. it continues indefinitely
v. it recurs or is likely to recur.

19) Inpatient Care

Inpatient care means treatment for which the Insured Person has to stay in a hospital for more than 24 hours for a covered event.

CIN: U66010PN2000PLC015329 • UIN: BAJHLIP25037V022425 40

Bajaj Allianz General Insurance Co. Ltd.
Bajaj Allianz House, Airport Road, Yerawada, Pune - 411 006. Reg. No.: 113
For more details, log on to: [Link] | E-mail: bagichelp@[Link] or
Call at: Sales - 1800 209 0144 / Service - 1800 209 5858 (Toll Free No.)
IssuingOffice:
20) Injury
Injury means accidental physical bodily harm, excluding Illness or disease, solely and directly caused by external, violent and visible and
evident means which is verified and certified by a Medical Practitioner.

21) Intensive Care Unit

Intensive care unit means an identified section, ward or wing of a hospital which is under the constant supervision of a dedicated
Medical Practitioner(s), and which is specially equipped for the continuous monitoring and treatment of patients who are in a critical
condition, or require life support facilities and where the level of care and supervision is considerably more sophisticated and intensive
than in the ordinary and other wards.

22) ICU Charges

ICU (Intensive Care Unit) Charges means the amount charged by a Hospital towards ICU expenses which shall include the expenses for
ICU bed, general medical support services provided to any ICU patient including monitoring devices, critical care nursing and intensivist
charges.

23) Kidney Failure Requiring Regular Dialysis :

End stage renal disease presenting as chronic irreversible failure of both kidneys to function, as a result of which either regular renal
dialysis (hemodialysis or peritoneal dialysis) is instituted or renal transplantation is carried out. Diagnosis has to be confirmed by a
Specialist Medical Practitioner.

24) Maternity expenses

Maternity expenses means;
a) medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred during
hospitalization);
b) expenses towards lawful medical termination of pregnancy during the Policy Period.

25) Medical Advice

Medical advice means any consultation or advice from a Medical Practitioner including the issuance of any prescription or follow up
prescription.

26) Medical expenses

Medical Expenses means those expenses that an Insured Person has necessarily and actually incurred for medical treatment on
account of Illness or Accident on the advice of a Medical Practitioner, as long as these are no more than would have been payable if
the Insured Person had not been Insured and no more than other hospitals or Medical practitioners in the same locality would have
charged for the same medical treatment.

27) Medical Practitioner/Doctor/ Physician

Medical Practitioner means a person who holds a valid registration from the Medical Council of any State or Medical Council of India or
Council for Indian Medicine or for Homeopathy or Ayurvedic and or such other authorities set up by the Government of India or a State
Government and is thereby entitled to practice medicine within its jurisdiction; and is acting within its scope and jurisdiction of license
and acceptable to Us.

28) Medically Necessary Treatment

Medically necessary treatment means any treatment, tests, medication, or stay in hospital or part of a stay in hospital which
i. is required for the medical management of the Illness or injury suffered by the Insured Person;
ii. must not exceed the level of care necessary to provide safe, adequate and appropriate medical care in scope, duration, or intensity;
iii. must have been prescribed by a Medical Practitioner,
iv. must conform to the professional standards widely accepted in international medical practice or by the medical community in India.

29) Migration
Migration means a facility provided to policyholders (including all members under family cover and group policies), to transfer the credits
gained for pre-existing diseases and specific waiting periods from one health insurance policy to another with the same insurer.

30) New Born Baby

Newborn baby means baby born during the Policy Period and is aged up to 90 days.

31) Network Provider

Network Provider means hospitals or health care providers enlisted by an Insurer, TPA or jointly by an Insurer and TPA to provide
medical services to an Insured Person by a Cashless Facility.

32) Non- Network Provider:

Non-Network provider means any hospital, day care center or other provider that is not part of the network of the Insurer.

33) Notification of Claim:

Notification of claim means the process of intimating a claim to the Insurer or TPA through any of the recognized modes of
communication.

34) OPD treatment:

OPD treatment means one in which the Insured Person visits a clinic / hospital or associated facility like a consultation room for
diagnosis and treatment based on the advice of a Medical Practitioner. The Insured Person is not admitted as a day care or in- patient.
CIN: U66010PN2000PLC015329 • UIN: BAJHLIP25037V022425 40
Bajaj Allianz General Insurance Co. Ltd.
Bajaj Allianz House, Airport Road, Yerawada, Pune - 411 006. Reg. No.: 113
For more details, log on to: [Link] | E-mail: bagichelp@[Link] or
Call at: Sales - 1800 209 0144 / Service - 1800 209 5858 (Toll Free No.)
IssuingOffice:

35) Pre-Existing Disease:

Pre- existing disease means any condition, ailment or injury or disease
a. That is/are diagnosed by a physician within 36 months prior to the effective date of the policy issued by the Insurer or its reinstatement Or
b. For which medical advice or treatment was recommended by, or received from, a physician within 36 months prior to the effective date
of the policy issued by the Insurer or its reinstatement.

36) Pre-hospitalization Medical Expenses:

Pre-hospitalization Medical Expenses means medical expenses incurred during predefined number of days preceding the hospitalization
of the Insured Person, provided that:
a. Such Medical Expenses are incurred for the same condition for which the Insured Person’s Hospitalization was required, and
b. The In-patient Hospitalization claim for such Hospitalization is admissible by the Insurance Company.

37) Post-hospitalization Medical Expenses:

Post-hospitalization Medical Expenses means medical expenses incurred during predefined number of days immediately after the
Insured Person is discharged from the hospital provided that:
a. Such Medical Expenses are for the same condition for which the Insured Person’s hospitalization was required, and
b. The inpatient hospitalization claim for such hospitalization is admissible by the Insurance Company.

38) Qualified Nurse:

Qualified nurse means a person who holds a valid registration from the Nursing Council of India or the Nursing Council of any state in
India.

39) Reasonable and Customary Charges/Expenses

Reasonable and Customary charges/expenses mean the charges for services or supplies, which are the standard charges for the
specific provider and consistent with the prevailing charges in the geographical area for identical or similar services, taking into account
the nature of the illness / injury involved.

40) Renewal
Renewal means the terms on which the contract of insurance can be renewed on mutual consent with a provision of Grace Period for
treating the renewal continuous for the purpose of gaining credit for pre-existing diseases, time-bound exclusions and for all waiting
periods.

41) Room rent

Room Rent means the amount charged by a Network Provider/Hospital towards Room and Boarding expenses and shall include the
associated medical expenses.

42) Subrogation (Applicable to “Public Liability” and “Loss of Baggage” Section only)
Subrogation means the right of the Insurer to assume the rights of the Insured Person to recover expenses paid out under the Policy that
may be recovered from any other source.

43) Surgery or Surgical Procedure

Surgery or Surgical Procedure means manual and / or operative procedure (s) required for treatment of an Illness or Injury, correction of
deformities and defects, diagnosis and cure of diseases, relief from suffering and prolongation of life, performed in a hospital or day
care centre by a medical practitioner.

SECTION B) DEFINITIONS- SPECIFIC DEFINITIONS

1) Act of Terrorism
Means an act or thing by any person or group(s) of persons, whether acting alone or on behalf of or in connection with or in
connivance with or at the instance or instigation of any person or group(s) or organisation(s) or associations(s), who are
committed or proclaimed to be committed for political, religious or ideological purposes, whether such person or group(s) of
persons or organisation(s) or association(s) are or are not banned any law, in such a manner or with intent to threaten the
unity, integrity, security or sovereignty of India or to strike terror in the people or any section of the people by using bombs,
dynamite or other explosive substances or inflammable substances or firearms or other lethal weapons or poisons or noxious
gases or other chemicals or by any other substances (whether biological or otherwise) of a hazardous nature or by any other
means whatsoever, with intend to cause, or likely to cause, death or, or injuries to any person or persons or loss of, or
damage to, or destruction of, property or disruption of any supplies or services essential to the life of the community or causes
damage or destruction of any property or equipment used or intended to be used for the defense of India or in connection with any
other purposes of the Government of India, any State Government or an of their agencies, or detains any person and threatens
to kill or injure such person in order to compel the Government or any other person to do or abstain from doing any act. Provided
further that for the above acts appropriate criminal prosecution has been initiated by police and charge sheet has been filed in
competent court of criminal jurisdiction, either under special law or under general law.

2) Aggregate Deductible
Aggregate deductible is a cost sharing requirement under this policy that provides the company will not be liable for a specified
rupee amount of the covered expenses, which will apply before any benefits are payable by the company. A deductible does not
reduce the Sum Insured. The deductible is applicable in aggregate towards hospitalization expenses incurred during the policy
period.
CIN: U66010PN2000PLC015329 • UIN: BAJHLIP25037V022425 40
Bajaj Allianz General Insurance Co. Ltd.
Bajaj Allianz House, Airport Road, Yerawada, Pune - 411 006. Reg. No.: 113
For more details, log on to: [Link] | E-mail: bagichelp@[Link] or
Call at: Sales - 1800 209 0144 / Service - 1800 209 5858 (Toll Free No.)
IssuingOffice:

3) AYUSH Treatment refers to medical expenses incurred on hospitalisation under Ayurveda, Yoga and Naturopathy Unani,
Siddha and Homeopathy systems

4) Bajaj Allianz Network Hospitals / Network Hospitals/Network Providers

Bajaj Allianz Network Hospitals / Network Hospitals means the Hospitals which have been empaneled by the Insurer as per the
latest version of the list of Hospitals maintained by the Insurer, which is available to You on request. For updated list please
visit Our website.

5) Bajaj Allianz Diagnostic Centre

Bajaj Allianz Diagnostic Centre means the diagnostic centers which have been empaneled by us as per the latest version of
the schedule of diagnostic centers maintained by Us, which is available to You on request.

6) Dependent child
A child is considered a dependent for insurance purposes until his 35th birthday (even if not enrolled in an educational
institution) provided he is financially dependent, on the proposer.

7) Endorsement
Endorsement means any writing on a Policy Schedule or Policy, in addition to its normal wording which supplements or modifies its
terms. It may be added when Policy is prepared, or subsequently. Provided however any Service Level Agreement [SLA] or
Agreement/MOU laying down various service levels shall not be treated as Endorsement.

8) Family or Family Members

For the purpose of Individual Sum Insured Policy- includes the Insured Person; his/her lawfully wedded spouse and Dependent
children, parents, Sister, Brother, In laws, Aunt, Uncle, Grandchildren.

For the purpose of Family Floater- includes the Insured Person; his/her lawfully wedded spouse and
dependent children. For Parents separate floater Policy can be taken.

9) Limit of Indemnity
Limit of Indemnity represents Our maximum liability to make payment for each and every claim per Insured Person and collectively/ for
all Insured Persons mentioned in the Schedule during the Policy Period and in the aggregate for the person(s) named in the
Schedule during the Policy Period, and means the amount stated in the Schedule against each Cover.

10) Medical Consumable

Medical consumables and equipment includes syringes, needles, sutures, staples, packaging, tubing, catheters, medical
gloves, gowns, masks, adhesives and sealants for wound dressing and a whole host of other devices and tools used with a
hospital or surgical environment.

11) Named Insured/ Insured/Insured Person

Insured means the persons, or his Family Members, named in the Schedule provided that an Insured or his Family Members has
attained the age of 3 months and is not older than 65 years of age at the commencement of the Policy Period.

12) Obesity means abnormal or excessive fat accumulation that may impair health. Obesity is measured in Body Mass Index.
Body mass index (BMI) is a simple index of weight-for-height that is commonly used to classify overweight and
obesity in adults. It is defined as a person's weight in kilograms divided by the square of his height in meters
(kg/m2).
The WHO definition is:
• BMI greater than or equal to 25 is overweight
• BMI greater than or equal to 30 is obesity

13) Policy or Contract means the Proposal, the Policy Schedule, along with these Terms and Conditions issued to the Insured
Person and any annexures and/or Endorsements attaching to and / or forming part thereof either at the commencement of
Policy Period or during the Policy Period.

14) Policy Schedule or Schedule means the Policy Schedule and any annexure or Endorsements to it, if any, as issued by the
Company, which forms part of Policy.

15) Policy Period means period from risk inception date [RID] to risk end date [RED], as mentioned in the Policy Schedule.

16) Policy Year means the period of 12 months. In case of long-term Policy for more than one year, then each year viz. 1st
year, 2nd year, 3rd year etc., shall be treated as a separate Policy Year.

17) Single Private room

Single Private Room means a single occupancy air-conditioned room with an attached washroom/toilet. Such room must be the
most economical of all accommodation available as single occupancy in that hospital and excludes a suite.

18) Insured, Insured Person, You, Your, Yourself, Your Family named in the Policy Schedule means the Insured Person or Insured
Person’s Family Members named in the Policy Schedule that We insure and who are beneficiaries under this Policy .
CIN: U66010PN2000PLC015329 • UIN: BAJHLIP25037V022425 40
Bajaj Allianz General Insurance Co. Ltd.
Bajaj Allianz House, Airport Road, Yerawada, Pune - 411 006. Reg. No.: 113
For more details, log on to: [Link] | E-mail: bagichelp@[Link] or
Call at: Sales - 1800 209 0144 / Service - 1800 209 5858 (Toll Free No.)
IssuingOffice:

19) “Valuables” means

i. gold or silver or any precious metals or articles made from any precious metals;
ii. watches or Jewellery or Precious Stones or models or coins or curios, sculptures, manuscripts, stamps, collections of
stamps, rare books, medals, moulds, designs or any other collectibles;
iii. deeds, ATM cards, credit cards, charge cards, bonds, bills of exchange, bank, treasury or promissory notes, cheques,
money, securities, or any other negotiable instrument;

20) We, Our, Ours, Insurer means the Bajaj Allianz General Insurance Company Limited.

SECTION C) COVERAGE

SECTION C1: HOSPITAL CASH DAILY ALLOWANCE (UIN: BAJHLIP23078V032223)

In the event of Accidental Bodily Injury or Illness first occurring or manifesting itself during the Policy Period and causing the
Insured Person’s or the Named Insured Person’s Hospitalisation within the Policy Period, the Company will pay:

1. The Daily Allowance for each continuous and completed period of 24 hours of Hospitalisation necessitated solely by reason of the
said Accidental Bodily Injury or Illness for a maximum period as specified in Policy Schedule , or
2. Two times the Daily Allowance for each continuous and completed period of 24 hours required to be spent by the Insured Person
in the Intensive Care Unit of a Hospital during any period of Hospitalisation necessitated solely by reason of the said Accidental
Bodily Injury or Illness for a maximum period of 7 days for each Hospitalisation.

SECTION C2. HEALTH GUARD (UIN: BAJHLIP25035V072425 )

You can opt for one of the below listed plan under Health Guard Section and below terms and conditions of respective section
will be applicable for covers which are opted by you and displayed on your Policy Schedule read with the Certificate of
Insurance:
There are three plans available
• Silver
• Gold
• Platinum

Scope of cover
The Company hereby agrees to pay/indemnify in respect of an admissible claim, under any or all of the following covers
subject to the Sum Insured, limits, terms, conditions and definitions, exclusions contained or otherwise expressed in this
Policy.

1. In-patient Hospitalization Treatment

If you are hospitalized on the advice of a Medical Practitioner because of Illness or Accidental Bodily Injury sustained or
contracted during the Policy Period, then We will pay/ indemnify You, Reasonable and Customary Medical Expenses incurred
subject to
i) below limits on Room rent and Boarding expenses as provided by the Hospital/Nursing Home
• Silver Plan
- Up to 1% of Sum Insured per day (Excluding Cumulative Bonus)

• Gold Plan and Platinum Plan

- Sum Insured 3 lacs to 7.5 lacs- maximum eligible room is Single private Air-Conditioned room
- Sum Insured 10 Lacs and above - eligible for any room category

ii) If admitted in ICU, the Company will pay up to actual ICU expenses provided by Hospital.
iii) Nursing Expenses as provided by the Hospital
iv) Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialists Fees.
v) Anesthesia, Blood, Oxygen, Operation Theatre Charges, surgical appliances, Medicines & Drugs, Dialysis, Chemotherapy,
Radiotherapy, cost of Artificial Limbs, cost of prosthetic devices implanted during surgical procedure like Pacemaker,
orthopedic implants, infra cardiac valve replacements, vascular stents.
vi) Relevant laboratory diagnostic tests, X-ray and such similar expenses that are medically necessary prescribed by the treating
Medical Practitioner.

Note:
i. In case of admission to a room at rates exceeding the limits as mentioned under (i) hereinabove, the reimbursement of all
other expenses incurred at the Hospital, with the exception of cost of Pharmacy/medicines, consumables, implants, medical
devices & diagnostics, shall be payable in the same proportion as the admissible rate per day bears to the actual rate per day
of room rent charges
ii. Proportionate deductions shall not apply in respect of the Hospitals which do not follow differential billings or for
those expenses in respect of which differential billing is not adopted based on the room category

2. Pre-Hospitalization
The Medical Expenses incurred during the 60 days immediately before You were hospitalized, provided that: Such Medical
Expenses were incurred for the same Illness/Injury for which subsequent Hospitalization was required, and We have accepted
an inpatient Hospitalization claim under In-patient Hospitalization Treatment. (Section C2-1)
CIN: U66010PN2000PLC015329 • UIN: BAJHLIP25037V022425 40
Bajaj Allianz General Insurance Co. Ltd.
Bajaj Allianz House, Airport Road, Yerawada, Pune - 411 006. Reg. No.: 113
For more details, log on to: [Link] | E-mail: bagichelp@[Link] or
Call at: Sales - 1800 209 0144 / Service - 1800 209 5858 (Toll Free No.)
IssuingOffice:

3. Post-Hospitalization
The Medical Expenses incurred during the 90 days immediately after You were discharged post Hospitalization provided that:
such Medical Expenses are incurred in respect of the same Illness/Injury for which the earlier Hospitalization was required, and We
have accepted an In-patient Hospitalization claim under In-patient Hospitalization Treatment. (Section C2-1)

4. Road Ambulance
We will pay/indemnify you the reasonable cost to a maximum of INR 20,000/- per Policy Year incurred on an ambulance offered by
a healthcare or ambulance service provider for transferring You to the nearest Hospital with adequate emergency facilities for the
provision of health services following an Emergency.
We will also reimburse the expenses incurred on an ambulance offered by a healthcare or ambulance service provider for
transferring You from the hospital where You were admitted initially to another hospital with higher medical facilities.
Claim under this section shall be payable by Us only when:
i. Such life-threatening emergency condition is certified by the Medical Practitioner, and
ii. We have accepted Your Claim under "In-patient Hospitalization Treatment" or "Day Care Procedures" section of the
Policy. Subject otherwise to the terms, conditions and exclusions of the Policy.

This benefit will be applicable each year for policies with term more than 1 year.

5. Day Care Procedures

We will pay/indemnify You the medical expenses as listed above under Section C2-1- In-patient Hospitalization Treatment for Day
care procedures / Surgeries taken as an inpatient in a Hospital or Day Care Center but not in the outpatient department.
Indicative list of Day Care Procedures is given in the Annexure I of this Policy.

6. Organ Donor Expenses:

We will pay/indemnify You the expenses incurred towards organ donor’s treatment for harvesting of the donated organ, provided
that,
i. The organ donor is any person whose organ has been made available in accordance and in compliance with THE
TRANSPLANTATION OF [HUMAN ORGANS AND TISSUES] ACT, 1994 (as amended from time to time) and the organ
donated is for the use of the Insured Person, and
ii. We have accepted an In-patient Hospitalization claim for the Insured Person under In-Patient Hospitalization Treatment (Section C2-1).

7. Convalescence Benefit:
In the event of Insured Person Hospitalized for a disease/Illness/Injury for a continuous period exceeding 10 days, We will pay
benefit amount as per the plan opted subject to below limits.

Silver Plan
INR 5,000 per Policy Year

Gold and Platinum Plan

• INR 5,000 for Sum Insured up to INR 5 lacs per Policy Year
• INR 7,500 for Sum Insured 7.5 lacs and above per Policy Year.

This benefit will be triggered provided that the In-Patient Hospitalization claim is accepted under Section C2-1. Payment
under this benefit will not reduce the base Sum Insured mentioned in Policy Schedule.
This benefit will be applicable each year for policies with term more than 1 year.

8. Daily Cash Benefit for Accompanying an Insured Child

We will pay Daily Cash Benefit of INR 500 per day maximum up to 10 days during each Policy Year for reasonable
accommodation expenses in respect of one parent/legal guardian, to stay with any minor Insured (under the Age of 12), provided the
Hospitalization claim is accepted/ paid under Section C2-1- In-patient Hospitalization Treatment.

Payment under this benefit will not reduce the base Sum Insured mentioned in Policy Schedule. This benefit will be applicable each
year for policies with term more than 1 year.

9. Sum Insured Reinstatement Benefit:

If Section C2-1- In-patient Hospitalization Treatment Sum Insured and Cumulative Bonus or Super Cumulative Bonus (if any) is
exhausted due to claims registered and paid during the Policy Year, then it is agreed that 100% of the Base Sum Insured
specified under In-patient Hospitalization Treatment would be reinstated for the particular Policy Year provided that:
i. The reinstated Sum Insured will be triggered only after the Inpatient Hospitalization Treatment Sum Insured inclusive of
the Cumulative Bonus or Super Cumulative Bonus (If applicable) has been completely exhausted during the Policy Year;
ii. The reinstated Sum Insured can be used for claims made by the Insured Person in respect of the benefits stated in
Inpatient Hospitalization Treatment.
iii. If the claimed amount is higher than the balance Sum Insured inclusive of the Cumulative Bonus or Super Cumulative Bonus (If
applicable) under the Policy, then this benefit will not be triggered for the same claim, however Sum Insured reinstatement would
be triggered for subsequent claims for the same member or other Insured Person (s).
iv. This benefit is applicable only once during each Policy Year and will not be carried forward to the subsequent Policy
Year/ renewals if the benefit is not utilized.
v. This benefit is applicable only once in life time of Insured Person covered under this Policy for claims regarding
CANCER and KIDNEY FAILURE REQUIRING REGULAR DIALYSIS as defined under the Policy, however the Insured
CIN: U66010PN2000PLC015329 • UIN: BAJHLIP25037V022425 40
Bajaj Allianz General Insurance Co. Ltd.
Bajaj Allianz House, Airport Road, Yerawada, Pune - 411 006. Reg. No.: 113
For more details, log on to: [Link] | E-mail: bagichelp@[Link] or
Call at: Sales - 1800 209 0144 / Service - 1800 209 5858 (Toll Free No.)
IssuingOffice:
Person is eligible for re-instatement benefit every year for other admissible conditions.
vi. This benefit will be applicable each Policy Year for long term policies.
vii. Additional premium would not be charged for reinstatement of the Sum Insured.
viii. Incase Family Floater policy, Reinstatement of Sum Insured will be available for all Insured Persons in the Policy

Understanding Sum Insured Reinstatement made easy-

Sum Accumulated Sum Hospitalizat Reinstated Payable Balance

Insured at Cumulative Insured ion Sum Claim Sum
the Bonus with CB Amount Insured Amount Insured
beginning
1st Claim g
300,000 10% 330,000 350,000 0 330,000 0

2nd Claim - - - 200,000 300,000 200,000 100,000

3rd Claim - - - 200,000 0 100,000 0

10. Preventive Health Check Up

At the end of block of every continuous period as mentioned in coverage during which You have held Our Star Package
Policy covering Health Guard section, You are eligible for a free Preventive Health checkup. We will reimburse the amount as
per the plan opted, subject to below limits

• Silver Plan
1% of the Sum Insured maximum up to INR 2000/- for each Insured in Individual Policy during the block of 3 years

• Gold Plan
1% of the Sum Insured max up to INR 5000/- for each Insured Person in Individual Policy during the block of 3 years.

• Platinum Plan
1% of the Sum Insured max up to INR 5,000 for each Insured Person in Individual Policy during the block of 2 years.
This benefit can be availed by by Insured (Self) & spouse only under Floater Sum Insured Policies.

You may approach Us for the arrangement of the Health Checkup. For the avoidance of doubt, We shall not be liable for any
other ancillary or peripheral costs or expenses (including but not limited to those for transportation, accommodation or
sustenance).

Contact Email id- healthcheck@[Link]

Note: Payment under this benefit will not reduce the base Sum Insured mentioned in Policy Schedule.

11. Bariatric Surgery Cover

If You are hospitalized on the advice of a Medical Practitioner because of conditions mentioned below which required You to
undergo Bariatric Surgery during the Policy Period, then We will pay You, Reasonable and Customary Expenses related to
Bariatric Surgery

• Eligibility:
For adults aged 18 years or older, presence of severe documented in contemporaneous clinical records, defined as any of
the following: Body Mass Index (BMI);
a) greater than or equal to 40 or
b) greater than or equal to 35 in conjunction with any of the following severe co-morbidities following failure of less
invasive methods of weight loss:
i. Obesity-related cardiomyopathy
ii. Coronary heart disease
iii. Severe Sleep Apnea
iv. Uncontrolled Type 2 Diabetes

Our obligation to make payment in respect of Bariatric Surgery after the expiry of the 36 months period, shall be restricted to 25% of the Sum
Insured in Silver Plan and 50% of the Sum Insured subject to maximum of Rs 5 lac in Gold and Platinum Plan.

12. Wellness Benefits

At each renewal of Your Star Package Policy covering Health Guard section with Us, You will be entitled for a wellness discount
subject to below mentioned criteria being fulfilled by You during the preceding Policy Year. The below mentioned criteria
should be fulfilled each Policy Year in case of long-term policies.

Sr. No Health Parameter Reading

Complete the online health risk assessment
1 Health Risk Assessment
2 HbA1c (%) Up to 6.5%
CIN: U66010PN2000PLC015329 • UIN: BAJHLIP25037V022425 40
Bajaj Allianz General Insurance Co. Ltd.
Bajaj Allianz House, Airport Road, Yerawada, Pune - 411 006. Reg. No.: 113
For more details, log on to: [Link] | E-mail: bagichelp@[Link] or
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3 Fasting Blood Sugar Up to 120 mg/dl

4 Systolic Diastolic
Blood Pressure (mm of Hg)
Up to 140 Up to 90

5 Body Mass Index (BMI) 18 – 25

6 Serum Cholesterol 200mg/dl

7 Steps Count 5,000 steps daily – 20 days every month

8 Male-13-18 g/dl
Hemoglobin
Female- 11-15
Parameters Achieved Discount Offered

4/5 out of 8 5%
6/7 out of 8 7.5%
8 out of 8 10%

Wellness Eligibility Criteria:

1. Wellness discount is applicable for members age 25 years and above
2. If the Insured Person(s) meets 4/5 out of 8 criteria, he/she is eligible for 5% discount, 6/7 out of 8 criteria he /she is
eligible for 7.5% discount & meets with 8 criteria he / she is eligible for 10% discount.
3. If an Insured Person meets 8 out of 8 above mentioned parameters and in addition he/she walks for 10000 steps for 20
days every month then they will be eligible for additional discount of 2.5%.
4. In Floater Policies, discount will be offered basis the average of number of Parameters Achieved by all Insured
Person(s) age 25 years & above.

Discount under Floater Policy = Total no. of parameters achieved by eligible members
Total no. of eligible members in the family

In addition to the above parameters, if the eligible members walk for 10000 steps each for 20 days every month then they will
be eligible for additional discount of 2.5%.

13. AYUSH Hospitalization Expenses

If You are Hospitalized for not less than 24 hrs., in an AYUSH Hospital which is a government hospital or in any institute
recognized by government and/or accredited by Quality Council of India/National Accreditation Board on Health on the advice
of a Medical practitioner because of Illness or Accidental Bodily Injury sustained or contracted during the Policy Period then
We will indemnify You for:

In-patient Treatment- Medical Expenses for AYUSH treatment:

• Room rent, boarding expenses
• Nursing care
• Consultation fees
• Medicines, drugs and Medical consumables,
• AYUSH treatment procedures Our maximum liability per Policy Year is up to the limit of Sum Insured as specified in the
Policy Schedule in any AYUSH Hospital

This cover will be applicable each year for policies with term more than 1 year. The claim will be admissible under the Policy
provided that,
i. The Illness/Injury requires inpatient admission and the procedure performed on the Insured Person cannot be carried out on out-
patient basis

14. Maternity Expenses (Applicable for Gold and Platinum Plan only)
We will indemnify You for the Medical Expenses for the delivery of a baby (including caesarean section) and/or expenses
related to medically recommended and lawful termination of pregnancy, limited to maximum 2 deliveries or termination(s) or
either.
a. Our maximum liability per delivery or termination shall be limited to the amount specified in the Policy Schedule as per Sum Insured
opted.
i. We will pay the Medical Expenses of pre-natal and post-natal hospitalization (90 days post-delivery) per delivery or
termination up to the maternity limit.
ii. Waiting period of 72 months as mentioned in the Policy Schedule would apply from the date of commencement of
Your first Star Package Policy covering Health Guard section with Us,
iii. If the Insured Person is continuously covered without any break as defined under the portability norms of the extant
IRDAI (Health Insurance) Regulations then waiting period for the same would be reduced to the extent of prior
coverage where Insured Person is having policy with Maternity Expense benefit.
iv. Fresh Waiting period of 72 months as mentioned in the Policy Schedule would apply for all the policies issued with
continuity from other Health Indemnity product/plans of Our Company where maternity expenses are not covered.
v. Any complications arising, within 90 days post-delivery, out of or as a consequence of maternity/child birth will be

CIN: U66010PN2000PLC015329 • UIN: BAJHLIP25037V022425 40

Bajaj Allianz General Insurance Co. Ltd.
Bajaj Allianz House, Airport Road, Yerawada, Pune - 411 006. Reg. No.: 113
For more details, log on to: [Link] | E-mail: bagichelp@[Link] or
Call at: Sales - 1800 209 0144 / Service - 1800 209 5858 (Toll Free No.)
IssuingOffice:
covered up to the maternity limit.
vi. Payment under this cover will not reduce the base Sum Insured mentioned in Policy Schedule.

15. New Born Baby Cover (Applicable for Gold and Platinum Plan only)
Coverage for new born baby will be considered subject to a claim being accepted under Maternity Expenses (Section C2-
14). We will indemnify You the following expenses within the limit of the Sum Insured available under the Maternity Expenses
section. We will pay for,
a. Medical Expenses towards treatment of Your new born baby while You are Hospitalized as an inpatient for delivery for the
Hospitalization,
b. Hospitalization charges incurred on the new born baby during post birth including any complications shall be covered up
to a period of 90 days from the date of birth and within limit of the Sum Insured under Maternity Expenses without
payment of any additional premium
c. Mandatory Vaccinations of the new born baby up to 90 days, as recommended by the Indian Pediatric Association will
be covered under the Maternity Expenses Sum Insured.

COVERS APPLICABLE FOR PLATINUM PLAN ONLY

16. Super Cumulative Bonus
This benefit would be extended if You renew Your Star Package Policy covering Health Guard section with Us without any
break and there has been no claim in the preceding year,
I. We will increase the Limit of Indemnity by 50% of base Sum Insured per annum for first 2 years and later 10% of base
Sum Insured per annum for next 5 years.
II. Maximum bonus will not exceed 150% of the Hospitalization Sum Insured
III. If a claim is made in any year where a Super Cumulative Bonus has been applied, then the increased Limit of Indemnity in
the Policy Period of the subsequent “Health Guard” shall be reduced to previous slab. However, the Sum Insured would not
be decreased.
IV. In case of any increase or decrease of Sum Insured at renewal the Super Cumulative Bonus % would be calculated on the lesser
Sum Insured.

Claim free Year Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Year 7

% Increase in Limit of Indemnity 50% 50% 10% 10% 10% 10% 10%

17. Recharge Benefit

i. In event of claim amount exceeding the limit of indemnity, Sum Insured would be increased by 20% maximum up to 5 Lacs.

Sum Insured Limit (INR)

5 Lacs 1 Lac
7.5 Lacs 1.5 Lacs
10 Lacs 2 Lacs
15 Lacs 3 Lacs
20 Lacs 4 Lacs
25 Lacs to 1 Crore 5 Lacs

ii. In case of Individual Sum Insured policies, this benefit will be applicable once in a Policy Year for each Insured Person.
iii. For a Floater Policy, this benefit will be applicable cumulatively to all Insured Person(s), once in a Policy Year.
iv. The unutilized Recharge amount cannot be carried forward to the subsequent renewal.

OPTIONAL COVERS
18. Air Ambulance (Optional available for SI 5Lacs and above)
In consideration of payment of additional premium by the Proposer/Insured to the Company and realization thereof by the
Company, We will indemnify You against the expenses incurred for rapid ambulance transportation in an airplane or
helicopter from the site of first occurrence of the Illness / Accident to the nearest Hospital during Policy Period necessitated
due to emergency life threatening health conditions provided such Hospitalization claim is admissible under SECTION C2.
“Health Guard cover” under this Policy.

The claim would be reimbursed up to the actual expenses subject to a maximum Sum Insured limits as specified under the
Air Ambulance Cover in the Policy Schedule, subject otherwise to all other terms, conditions and Exclusions of the Policy.
Specific Conditions applicable to Air Ambulance Cover
a. Return transportation to the Insured Person’s home by air ambulance is excluded.
b. Such air ambulance should have valid license to operate as such by competent authorities of the Government/s.

Air Ambulance Cover Sub limit options

Base Sum Insured 5L 7.5L 10L 15L 20L 25L 30L 35L 40L 45L 50L 75L 1Cr
Air Ambulance
Cover Sum Insured 5L 5L/10L/15 L/20 L/25L 5L/10L/15 L/20 L/25L/50 L
limit

CIN: U66010PN2000PLC015329 • UIN: BAJHLIP25037V022425 40

Bajaj Allianz General Insurance Co. Ltd.
Bajaj Allianz House, Airport Road, Yerawada, Pune - 411 006. Reg. No.: 113
For more details, log on to: [Link] | E-mail: bagichelp@[Link] or
Call at: Sales - 1800 209 0144 / Service - 1800 209 5858 (Toll Free No.)
IssuingOffice:

SECTION C3. CRITICAL ILLNESS OPERATIVE PART

If the Insured Person is diagnosed as suffering from a Critical Illness (as specified below) which first occurs or manifests itself
during the Policy Period, and if the Insured Person survives for a minimum of 30 days from the date of diagnosis, the
Company shall pay a Critical Illness Benefit, as specified under the Policy Schedule.

1. Myocardial Infarction (First Heart Attack of specific severity)

I. The first occurrence of heart attack or myocardial infarction which means the death of a portion of the heart muscle as a
result of inadequate blood supply to the relevant area. The diagnosis for this should be evidenced by all of the following
criteria:
i. a history of typical clinical symptoms consistent with the diagnosis of Acute Myocardial Infarction (for e.g. typical chest pain)
ii. new characteristic electrocardiogram changes
iii. elevation of infarction specific enzymes, Troponins or other specific biochemical markers.
II. The following are excluded:
i. A rise in cardiac biomarkers or Troponin T or I in absence of overt ischemic heart disease OR following an intra-arterial cardiac
procedure.
ii. Other acute Coronary Syndromes
iii. Any type of angina pectoris.

2. Open Chest CABG (Coronary Artery Disease Requiring Surgery)

I. The actual undergoing of heart surgery to correct blockage or narrowing in one or more coronary artery(s), by coronary artery
bypass grafting done via a sternotomy (cutting through the breast bone) or minimally invasive keyhole coronary artery
bypass procedures. The diagnosis must be supported by a coronary angiography and the realization of surgery has to be
confirmed by a cardiologist.
II. The following are excluded:
Angioplasty and/or any other intra-arterial procedures

3. Stroke Resulting in Permanent Symptoms

I. Any cerebrovascular incident producing permanent neurological sequelae. This includes infarction of brain tissue, thrombosis
in an intracranial vessel, haemorrhage and embolisation from an extracranial source. Diagnosis has to be confirmed by a
specialist medical practitioner and evidenced by typical clinical symptoms as well as typical findings in CT Scan or MRI of the
brain. Evidence of permanent neurological deficit lasting for at least 3 months has to be produced.
II. The following are excluded:
i. Transient ischemic attacks (TIA)
ii. Traumatic injury of the brain
iii. Vascular disease affecting only the eye or optic nerve or vestibular functions.

4. Cancer of Specified Severity

I. A malignant tumour characterized by the uncontrolled growth & spread of malignant cells with invasion & destruction of
normal tissues. This diagnosis must be supported by histological evidence of malignancy & confirmed by a pathologist. The
term cancer includes leukemia, lymphoma and sarcoma.
II. The following are excluded -
i. All tumors which are histologically described as benign, carcinoma premalignant, borderline malignant, or non-
invasive, including but not limited to: Carcinoma in situ of breasts, cervical dysplasia CIN-1, CIN -2 & CIN-3.
ii. Any non-melanoma skin carcinoma unless there is evidence of metastases to lymph nodes or beyond;
iii. Malignant melanoma that has not caused invasion beyond the epidermis;
iv. All tumors of the prostate unless histologically classified as having a Gleason score greater than 6 or having
progressed to at least clinical TNM classification T2N0M0
v. All Thyroid cancers histologically classified as T1N0M0 (TNM Classification) or below;
vi. Chronic lymphocytic leukaemia less than RAI stage 3
vii. Non-invasive papillary cancer of the bladder histologically described as TaN0M0 or of a lesser classification,
viii. All Gastro-Intestinal Stromal Tumors histologically classified as T1N0M0 (TNM Classification) or below and with mitotic
count of less than or equal to 5/50 HPFs;

5. Kidney Failure Requiring Regular Dialysis

End stage renal disease presenting as chronic irreversible failure of both kidneys to function, as a result of which either
regular renal dialysis (hemodialysis or peritoneal dialysis) is instituted or renal transplantation is carried out. Diagnosis has to
be confirmed by a specialist medical practitioner.

6. Major Organ Transplantation

I. The actual undergoing of a transplant of:
i. One of the following human organs: heart, lung, liver, kidney, pancreas, that resulted from irreversible end-stage failure of the
relevant organ, or
ii. Human bone marrow using haematopoietic stem cells. The undergoing of a transplant has to be confirmed by a specialist
medical practitioner.
II. The following are excluded:
i. Other stem-cell transplants
ii. Where only islets of langerhans are transplanted
CIN: U66010PN2000PLC015329 • UIN: BAJHLIP25037V022425 40
Bajaj Allianz General Insurance Co. Ltd.
Bajaj Allianz House, Airport Road, Yerawada, Pune - 411 006. Reg. No.: 113
For more details, log on to: [Link] | E-mail: bagichelp@[Link] or
Call at: Sales - 1800 209 0144 / Service - 1800 209 5858 (Toll Free No.)
IssuingOffice:

7. Multiple Sclerosis with Persisting Symptoms

I. The unequivocal diagnosis of Definite Multiple Sclerosis confirmed and evidenced by all of the following:
i. investigations including typical MRI findings which unequivocally confirm the diagnosis to be multiple sclerosis and
ii. there must be current clinical impairment of motor or sensory function, which must have persisted for a continuous period of at
least 6 months.
II. Neurological damage due to SLE is excluded.

8. Surgery of Aorta
The actual undergoing of surgery for a disease of the aorta (meaning the thoracic and abdominal aorta but not its branches, and
excluding traumatic injury of the aorta and congenital narrowing of the aorta) needing excision and surgical replacement of the
diseased aorta with a graft.

9. Primary Pulmonary Arterial Hypertension

I. An unequivocal diagnosis of Primary (Idiopathic) Pulmonary Hypertension by a Cardiologist or specialist in respiratory medicine
with evidence of right ventricular enlargement and the pulmonary artery pressure above 30 mm of Hg on Cardiac
Cauterization. There must be permanent irreversible physical impairment to the degree of at least Class IV of the New York
Heart Association Classification of cardiac impairment.
II. The NYHA Classification of Cardiac Impairment are as follows:
i. Class III: Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity causes symptoms.
ii. Class IV: Unable to engage in any physical activity without discomfort. Symptoms may be present even at rest.
III. Pulmonary hypertension associated with lung disease, chronic hypoventilation, pulmonary thromboembolic disease, drugs and
toxins, diseases of the left side of the heart, congenital heart disease and any secondary cause are specifically excluded.

10. Permanent Paralysis of Limbs

Total and irreversible loss of use of two or more limbs as a result of injury or disease of the brain or spinal cord. A specialist
medical practitioner must be of the opinion that the paralysis will be permanent with no hope of recovery and must be present for
more than 3 months.

11. Neuro Surgery

Surgery for the treatment of a disease of the spinal cord / brain, which has resulted in neurological damage / pressure effects on
spinal cord / brain. However, the diseases of external / adjacent structures responsible for spinal cord or brain surgery will be
excluded unless as a result of an accidental injury.

12. Joint Replacement

Surgery on major joints of hip/ knee/shoulder for total first-time replacement of damaged/diseased joint by prosthesis /artificial
device.

SECTION C4. PERSONAL ACCIDENT (UIN - BAJHLIP21218V022021)

1. Insured Event
a) In the event of any Accidental Bodily Injury sustained by the Insured Person during the Policy Period, the Company will make
payment under such Coverage Part(s) as specified in the Schedule as being operative.
b) The Company’s liability to make payment shall be limited to the Sum Assured for each Coverage Part.

2. Coverage Parts
a) Coverage Part A: Death
In the event of Accidental Bodily Injury causing the Insured Person’s Death within 12 months of the Accidental Bodily Injury being
sustained, the Company will pay 100% Sum Assured as specified in Policy Schedule, after which this Policy shall terminate.

i. The Company will also, in addition to the Coverage Part A: Death Sum Assured, pay up to 2% of the Sum Assured or INR 5,000
(whichever is lower) towards the actual cost of transporting the Insured Person’s remains from the place of death to the
hospital/residence and/or cremation and/or burial ground.

b) Coverage Part B: Permanent Total Disability

1. In the event of Accidental Bodily Injury causing the Insured Person’s Permanent Total Disability within 12 months of the
Accidental Bodily Injury being sustained, the Company will pay 125% of the Sum Assured, after which this Policy shall
terminate.

c) Coverage Part C: Permanent Partial Disability

i) In the event of Accidental Bodily Injury causing the Insured Person’s Permanent Partial Disability as mentioned in the PPD
Table below within 12 months of the Accidental Bodily Injury being sustained, the Company will pay the percentage of the
Sum Assured specified for each and every form of impairment mentioned in the PPD Table:

Type of Permanent Partial Disability Percentage of the Sum Assured

An arm at the shoulder joint 70%

An arm above the elbow joint 65%

CIN: U66010PN2000PLC015329 • UIN: BAJHLIP25037V022425 40

Bajaj Allianz General Insurance Co. Ltd.
Bajaj Allianz House, Airport Road, Yerawada, Pune - 411 006. Reg. No.: 113
For more details, log on to: [Link] | E-mail: bagichelp@[Link] or
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An arm beneath the elbow joint 60%

A hand at the wrist 55%

A thumb 20%

An index finger 10%

Any other finger 5%

A leg above mid-thigh 70%

A leg up to mid-thigh 60%

A leg up to beneath the knee 50%

A leg up to mid-calf 45%

A foot at the ankle 40%

A large toe 5%
Any other toe 2%

An eye 50%
Hearing of one ear 30%

Hearing of both ears 75%

Sense of smell 10%

Sense of taste 5%

ii) If the Accidental Bodily Injury causes the Insured Person’s Permanent Partial Disability within 12 months of the Accidental
Bodily Injury being sustained other than as specified in the PPD Table above, the Company’s liability to make payment shall
be as follows:

a. In the case of the Insured Person’s Permanent Partial Disability of a nature not detailed in the PPD Table, the Company will
pay a proportion of the Sum Assured by reference to the degree to which the Insured Person’s normal functional physical
capacity has been impaired, as advised by the Company’s medical advisors.
b. If the Insured Person was suffering from any Permanent Partial Disability prior to the date upon which Accidental Bodily Injury
was sustained, then the Company’s liability to make payment hereunder shall be reduced by the extent of the same as advised
by the Company’s medical advisors.

Note-
If the Accidental Bodily Injury sustained by the Insured Person causes a subsequent Claim by the Insured Person under Coverage
Parts A or B, then this Coverage Part shall not be operative and the amounts payable under either Coverage Parts A or B shall
be reduced by the amount of any payment made under this Coverage Part.

d) Coverage Part D: Temporary Total Disability

i. If the Accidental Bodily Injury sustained by the Insured Person causes his complete inability to engage in his employment as
specified in the Schedule, the Company will pay 1% of the Sum Assured maximum up to INR 5,000 per week for a period not
exceeding 100 weeks from the date upon which the Bodily Injury was sustained.
ii. The Company shall not be under any liability to make any payment hereunder until such time as the Insured Person has
established to the Company’s satisfaction that he is completely unable to engage in his employment as specified in the
Schedule.

e) Coverage Part E: Medical Expenses Extension

The Company will reimburse the actual medical expenses incurred up to 40% of the admissible claim or INR 500,000; whichever is
lower, towards the cost of treatment of accidental bodily injury sustained by the Insured Person.

SECTION C5. EDUCATION GRANT

(As A Result Of Accidental Death/Permanent Total Disability)
The company will pay the amount shown under section C5 of the Schedule in the event of -
a) Accidental Bodily Injury causing the Insured Person’s death within 12 months of the Accidental Bodily Injury being sustained,
b) In the event of Accidental Bodily Injury causing the Insured Person’s Permanent Total Disability within 12 months of the Accidental
Bodily Injury being sustained.
The Amount would be payable to the nominee under the Policy for the continuing education of the deceased Insured Person’s child/
children.

SECTION C6. PUBLIC LIABILITY (UIN: IRDAN113RP0018V02200102)

The Company will indemnify the Insured Person against:
1. his legal liability to pay Damages for civil claims of Bodily Injury or Property Damage arising out of the Insured Person’s use,
ownership or occupation of the Insured Premises for solely domestic purposes and caused by the negligent act, error or omission
CIN: U66010PN2000PLC015329 • UIN: BAJHLIP25037V022425 40
Bajaj Allianz General Insurance Co. Ltd.
Bajaj Allianz House, Airport Road, Yerawada, Pune - 411 006. Reg. No.: 113
For more details, log on to: [Link] | E-mail: bagichelp@[Link] or
Call at: Sales - 1800 209 0144 / Service - 1800 209 5858 (Toll Free No.)
IssuingOffice:
of the Insured Person, the Insured Person’s Family or the Insured Person’s Household Staff, save that no indemnity is available
hereunder for any liability that may be incurred under the Public Liability Insurance Act 1991 or any other statute or law based on
no fault or strict liability, or for any civil claim brought by the Insured Person or his Family; and
2. his legal liability to pay compensation under the Fatal Accidents Act 1855, the Workmen’s Compensation Act 1923 or any
amendment thereto or under common law in respect of personal injury by accident or disease sustained, to any person employed by
You and
3. as the keeper and owner of domestic pets.
Subject otherwise to all the other terms, conditions, limitations, exclusions and exceptions of the Policy

SECTION C7 – LOSS OF BAGGAGE (BAJTIDP22129V022122)

The Company will indemnify Reasonable and Customary Expenses in respect of an admissible claim for loss of baggage of the Insured
due to theft, larceny, robbery or hold up during the journey during Policy Period.

Specific Condition:
It also hereby agreed and declared that the Insured Person shall bear a co-payment of 10% of the admissible claim amount in respect of
each and every claim.
Subject otherwise to all the other terms, conditions, limitations, exclusions and exceptions of the Policy.

SECTION D) EXCLUSIONS UNDER THE POLICY - STANDARD EXCLUSIONS

No indemnity is available hereunder this Policy and no payment will be made by the Company for any claim directly or indirectly
caused by, based on, arising out of or howsoever attributable to any of the following

1. Exclusions specific to Section C1: Hospital Cash Daily Allowance

No indemnity is available hereunder and no payment will be made by the Company for any claim directly or indirectly caused by, based
on, arising out of or howsoever attributable to any of the following:

I. Waiting Period
I. Pre-existing Diseases waiting period (Excl01) :
a. Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications shall be excluded until the expiry
of 36 months of continuous coverage after the date of inception of the first Star Package Policy covering Hospital Cash Daily
Allowance Policy with us.
b. In case of enhancement of Sum Insured the exclusion shall apply afresh to the extent of Sum Insured increase.
c. If the Insured Person is continuously covered without any break as defined under the portability norms of the extant IRDAI
(Health Insurance) Regulations then waiting period for the same would be reduced to the extent of prior coverage.
d. Coverage under the Policy after the expiry of 36 months for any pre-existing disease is subject to the same being declared at the
time of application and accepted by Us.

II. Specified disease/procedure waiting period (Excl02) :

a. 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 Star Package Policy covering Hospital Cash Daily Allowance Policy with
Us. This exclusion shall not be applicable for claims arising due to an accident.
b. In case of enhancement of Sum Insured the exclusion shall apply afresh to the extent of Sum Insured increase.
c. If any of the specified disease/procedure falls under the waiting period specified for Pre-Existing diseases, then the longer of the
two waiting periods shall apply.
d. The waiting period for listed conditions shall apply even if contracted after the Policy or declared and accepted without a specific
exclusion.
e. If the Insured Person is continuously covered without any break as defined under the applicable norms on portability stipulated by
IRDAI, then waiting period for the same would be reduced to the extent of prior coverage.
f. List of specific diseases/procedures is as below:

1. Treatment of cataracts 2. Haemorrhoids

3. Benign Prostatic Hypertrophy 4. Fissure in ano
5. Hysterectomy 6. Stones in the Urinary and Biliary systems
7. Menorrhagia 8. Surgery on ears
9. Fibromyoma 10. Tonsils or Sinuses
11. D&C 12. Skin and all internal tumours/cysts/nodules/polyps of any
kind including breast lumps
13. Endometriosis 14. Gastric or Duodenal ulcer
15. Hernia of all types 16. Backache
17. Hydrocele 18. Prolapsed Intervertebral disc
19. Fistulae

III. 30-day waiting period (Excl03) :

a. Expenses related to the treatment of any Illness within 30 days from the first Star Package Policy commencement date shall be
excluded except claims arising due to an accident, provided the same are covered.

CIN: U66010PN2000PLC015329 • UIN: BAJHLIP25037V022425 40

Bajaj Allianz General Insurance Co. Ltd.
Bajaj Allianz House, Airport Road, Yerawada, Pune - 411 006. Reg. No.: 113
For more details, log on to: [Link] | E-mail: bagichelp@[Link] or
Call at: Sales - 1800 209 0144 / Service - 1800 209 5858 (Toll Free No.)
IssuingOffice:
b. This exclusion shall not, however apply if the Insured Person has Continuous Coverage for more than twelve months.
c. The within referred waiting period is made applicable to the enhanced Sum Insured in the event of
granting higher Sum Insured subsequently

II. Standard Exclusions:

I. Investigation & Evaluation (Excl04) :
i. Expenses related to any admission primarily for diagnostics and evaluation purposes only are excluded
ii. Any diagnostic expenses which are not related or not incidental to the current diagnosis and treatment are excluded

II. Rest Cure, rehabilitation and respite care- (Excl05) :

Expenses related to any admission primarily for enforced bed rest and not for receiving treatment. This also includes:
i. Custodial care either at home or in a nursing facility for personal care such as help with activities of daily living
such as bathing, dressing, moving around either by skilled nurses or assistant or non-skilled persons.
ii. Any services for people who are terminally ill to address medical, physical, social, emotional and spiritual needs

III. Obesity/Weight Control (Excl06) :

Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions:
i. Surgery to be conducted is upon the advice of the Doctor
[Link] surgery/Procedure conducted should be supported by clinical protocols
The member has to be 18 years of age or older and
iii.
[Link] Mass Index (BMI);
• greater than or equal to 40 or
• greater than or equal to 35 in conjunction with any of the following severe co-morbidities following failure of
less invasive methods of weight loss:
i. Obesity-related cardiomyopathy
ii. Coronary heart disease
iii. Severe Sleep Apnea
iv. Uncontrolled Type2 Diabetes

IV. Change-of-gender treatments (Excl07) :

Expenses related to any treatment, including surgical management, to change characteristics of the body to those of the
opposite sex.

V. Cosmetic or plastic Surgery (Excl08) :

Expenses for cosmetic or plastic surgery or any treatment to change appearance unless for reconstruction following an
Accident, Burn(s) or Cancer or as part of medically necessary treatment to remove a direct and immediate health risk to the
Insured Person. For this to be considered a medical necessity, it must be certified by the attending Medical Practitioner.

VI. Breach of law (Excl10) :

Expenses for treatment directly arising from or consequent upon any Insured Person committing or attempting to
commit a breach of law with criminal intent

VII. Excluded Providers (Excl11) :

Expenses incurred towards treatment in any hospital or by any Medical Practitioner or any other provider specifically
excluded by the Insurer and disclosed in its website / notified to the policyholders are not admissible. However, in
case of life threatening situations or following an accident, expenses up to the stage of stabilization are payable but
not the complete claim.

VIII. Treatment for Alcoholism, drug or substance abuse or any addictive condition and consequences thereof. (Excl12)

IX. Treatments received in heath hydros, nature cure clinics, spas or similar establishments or private beds registered as a nursing
home attached to such establishments or where admission is arranged wholly or partly for domestic reasons. (Excl13)

X. Dietary supplements and substances that can be purchased without prescription, including but not limited to Vitamins, minerals
and organic substances unless prescribed by a medical practitioner as part of hospitalization claim or day care procedure.
(Excl14)

XI. Refractive Error (Excl15) Expenses related to the treatment for correction of eye sight due to refractive error less than 7.5
dioptres.

XII. Unproven Treatments (Excl16) :

Expenses related to any unproven treatment, services and supplies for or in connection with any treatment. Unproven
treatments are treatments, procedures or supplies that lack significant medical documentation to support their effectiveness.

XIII. Sterility and Infertility (Excl17) Expenses related to sterility and infertility. This includes: a) Any type of contraception,
sterilization b) Assisted Reproduction services including artificial insemination and advanced reproductive technologies
such as IVF, ZIFT, GIFT, ICSI c) Gestational Surrogacy d) Reversal of sterilization

XIV. Maternity (Excl 18) :

CIN: U66010PN2000PLC015329 • UIN: BAJHLIP25037V022425 40
Bajaj Allianz General Insurance Co. Ltd.
Bajaj Allianz House, Airport Road, Yerawada, Pune - 411 006. Reg. No.: 113
For more details, log on to: [Link] | E-mail: bagichelp@[Link] or
Call at: Sales - 1800 209 0144 / Service - 1800 209 5858 (Toll Free No.)
IssuingOffice:
a. Medical Treatment Expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred
during hospitalization) except ectopic pregnancy.
b. Expenses towards miscarriage (unless due to an accident) and lawful medical termination of pregnancy during the Policy
Period.

III. General Exclusions

i. Any dental treatment that comprises of cosmetic surgery, dentures, dental prosthesis, dental implants, orthodontics, surgery
of any kind unless as a result of Accidental Bodily Injury to natural teeth and also requiring hospitalization.
ii. Medical expenses where Inpatient care is not warranted and does not require supervision of qualified nursing staff and
qualified Medical Practitioner round the clock
iii. War, invasion, acts of foreign enemies, hostilities (whether war be declared or not), civil war, commotion, unrest, rebellion,
revolution, insurrection, military or usurped power or confiscation or nationalization or requisition of or damage by or under
the order of any government or public local authority. Any Medical expenses incurred due to Act of Terrorism will be
covered under the Policy.
iv. The cost of spectacles, contact lenses, hearing aids, crutches, dentures, artificial teeth and all other external appliances
and/or devices whether for diagnosis or treatment except for Cost of Artificial Limbs, cost of prosthetic devices implanted
during surgical procedure like Pacemaker, orthopedic implants, infra cardiac valve replacements, vascular stents etc.
v. External medical equipment of any kind used at home as post Hospitalization care including cost of instrument used in the
treatment of Sleep Apnoea Syndrome (C.P.A.P), Continuous Peritoneal Ambulatory Dialysis (C.P.A.D) and Oxygen
concentrator for Bronchial Asthmatic condition.
vi. Congenital external diseases or defects or anomalies, growth hormone therapy, stem cell implantation or surgery except for
Hematopoietic stem cells for bone marrow transplant for haematological conditions.
vii. Intentional self-injury (including but not limited to the use or misuse of any intoxicating drugs or alcohol)
viii. Vaccination or inoculation unless forming a part of post bite treatment or if medically necessary and
forming a part of treatment recommended by the treating Medical practitioner.
ix. All non-medical Items as per Annexure II
x. Any treatment received outside India is not covered under this Policy.
xi. Circumcision unless required for the treatment of Illness or Accidental bodily injury.
xii. Treatment for any other system other than modern medicine (allopathy) and AYUSH therapies

2. Exclusion Specific to Section C2: Health Guard

No indemnity is available hereunder and no payment will be made by the Company for any claim directly or indirectly caused by,
based on, arising out of or howsoever attributable to any of the following:

I. Waiting Period (Applicable for Silver, Gold and Platinum Plan)

1) Pre-existing Diseases waiting period (Excl01)
a) Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications shall be excluded until the
expiry of 36 months of continuous coverage after the date of inception of the first Star Package Policy covering Health Guard
section with us.
b) In case of enhancement of Sum Insured the exclusion shall apply afresh to the extent of Sum Insured increase.
c) If the Insured Person is continuously covered without any break as defined under the portability norms of the extant IRDAI
(Health Insurance) Regulations then waiting period for the same would be reduced to the extent of prior coverage.
d) Coverage under the Policy after the expiry of 36 months for any pre-existing disease is subject to the same being declared at the
time of application and accepted by Us.

2) Specified disease/procedure waiting period (Excl02)

a) 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 Star Package Policy covering Health Guard section with
Us. This exclusion shall not be applicable for claims arising due to an accident.
b) In case of enhancement of Sum Insured the exclusion shall apply afresh to the extent of Sum Insured increase.
c) If any of the specified disease/procedure falls under the waiting period specified for Pre-Existing diseases, then the longer of the
two waiting periods shall apply.
d) The waiting period for listed conditions shall apply even if contracted after the Policy or declared and accepted without a specific
exclusion.
e) If the Insured Person is continuously covered without any break as defined under the applicable norms on portability stipulated
by IRDAI, then waiting period for the same would be reduced to the extent of prior coverage.
f) List of specific diseases/procedures is as below

1. Any type gastrointestinal ulcers 2. Cataracts,

3. Any type of fistula 4. Macular Degeneration

5. Benign prostatic hypertrophy 6. Hernia of all types

7. All types of sinuses 8. Fissure in ano

9. Haemorrhoids, piles 10. Hydrocele

11. Dysfunctional uterine bleeding 12. Fibromyoma

13. Endometriosis 14. Hysterectomy

CIN: U66010PN2000PLC015329 • UIN: BAJHLIP25037V022425 40

Bajaj Allianz General Insurance Co. Ltd.
Bajaj Allianz House, Airport Road, Yerawada, Pune - 411 006. Reg. No.: 113
For more details, log on to: [Link] | E-mail: bagichelp@[Link] or
Call at: Sales - 1800 209 0144 / Service - 1800 209 5858 (Toll Free No.)
IssuingOffice:
15. Uterine Prolapse 16. Stones in the urinary and biliary systems

18. Surgery on all internal or external tumours/cysts/

17. Surgery on ears/tonsils/ adenoids/ paranasal sinuses
nodules/polyps of any kind including breast lumps.
19. Mental Illness 20. Diseases of gall bladder including cholecystitis

21. Pancreatitis 22. All forms of Cirrhosis

23. Gout and rheumatism 24. Tonsillitis

25. Surgery for varicose veins and varicose ulcers 26. Chronic Kidney Disease

27. Alzheimer’s Disease

3) Any Medical Expenses incurred during the first three consecutive annual periods during which You have the Star Package
Policy covering Health Guard section with Us in connection with:
a. Joint replacement surgery,
b. Surgery for vertebral column disorders (unless necessitated due to an accident)
c. Surgery to correct deviated nasal septum
d. Hypertrophied turbinate
e. Congenital internal diseases or anomalies
f. Treatment for correction of eye sight due to refractive error recommended by Ophthalmologist for medical reasons with
refractive error greater or equal to 7.5
g. Bariatric Surgery
h. Parkinson’s Disease
i. Genetic disorders

4) 30-day waiting period (Excl03)

a. Expenses related to the treatment of any illness within 30 days from the commencement date of Your first Policy shall be
excluded except claims arising due to an accident, provided the same are covered.
b. This exclusion shall not, however apply if the Insured Person has Continuous Coverage for more than twelve months.
c. The within referred waiting period is made applicable to the enhanced Sum Insured in the event of granting higher Sum Insured
subsequently.

II. Standard Exclusions (Applicable for Silver, Gold and Platinum Plan)
1) Investigation & Evaluation (Excl04)
a) Expenses related to any admission primarily for diagnostics and evaluation purposes only are excluded even if the same
requires confinement at a Hospital.
b) Any diagnostic expenses which are not related or not incidental to the current diagnosis and treatment are excluded.

2) Rest Cure, rehabilitation and respite care (Excl05)

a) Expenses related to any admission primarily for enforced bed rest and not for receiving treatment. This also includes:
i. Custodial care either at home or in a nursing facility for personal care such as help with activities of daily living such as bathing,
dressing, moving around either by skilled nurses or assistant or non-skilled persons.
ii. Any services for people who are terminally ill to address medical, physical, social, emotional and spiritual needs.

3) Obesity/Weight Control (Excl06)

Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions:
1. Surgery to be conducted is upon the advice of the Doctor
2. The surgery/Procedure conducted should be supported by clinical protocols
3. The member has to be 18 years of age or older and
4. Body Mass Index (BMI);
a) greater than or equal to 40 or
b) greater than or equal to 35 in conjunction with any of the following severe co-morbidities following failure of less
invasive methods of weight loss:
i. Obesity-related cardiomyopathy
ii. Coronary heart disease
iii. Severe Sleep Apnea
i. Uncontrolled Type2 Diabetes

4) Change-of-gender treatments (Excl07)

Expenses related to any treatment, including surgical management, to change characteristics of the body to those of the opposite
sex.

5) Cosmetic or plastic Surgery (Excl08)

Expenses for cosmetic or plastic surgery or any treatment to change appearance unless for reconstruction following an Accident,
Burn(s) or Cancer or as part of medically necessary treatment to remove a direct and immediate health risk to the Insured
Person. For this to be considered a medical necessity, it must be certified by the attending Medical Practitioner.
CIN: U66010PN2000PLC015329 • UIN: BAJHLIP25037V022425 40
Bajaj Allianz General Insurance Co. Ltd.
Bajaj Allianz House, Airport Road, Yerawada, Pune - 411 006. Reg. No.: 113
For more details, log on to: [Link] | E-mail: bagichelp@[Link] or
Call at: Sales - 1800 209 0144 / Service - 1800 209 5858 (Toll Free No.)
IssuingOffice:

6) Breach of law (Excl10)

Expenses for treatment directly arising from or consequent upon any Insured Person committing or attempting to commit a
breach of law with criminal intent.

7) Excluded Providers (Excl11)

Expenses incurred towards treatment in any Hospital or by any Medical Practitioner or any other provider specifically excluded
by the Insurer and disclosed in its website / notified to the policyholders are not admissible. However, in case of life-threatening
situations or following an accident, expenses up to the stage of stabilization are payable but not the complete claim.

8) Treatment for Alcoholism, drug or substance abuse or any addictive condition and consequences thereof. (Excl12)

9) Treatments received in heath hydro’s, nature cure clinics, spas or similar establishments or private beds registered as a
nursing home attached to such establishments or where admission is arranged wholly or partly for domestic reasons. (Excl13)

10) Dietary supplements and substances that can be purchased without prescription, including but not limited to Vitamins,
minerals and organic substances unless prescribed by a Medical Practitioner as part of Hospitalization claim or day care
procedure. (Excl14)

11) Refractive Error (Excl15)

Expenses related to the treatment for correction of eye sight due to refractive error less than 7.5 diopters.
12) Unproven Treatments (Excl16)
Expenses related to any unproven treatment, services and supplies for or in connection with any treatment. Unproven treatments
are treatments, procedures or supplies that lack significant medical documentation to support their effectiveness.

13) Sterility and Infertility (Excl17)

Expenses related to sterility and infertility. This includes:
a) Any type of contraception, sterilization
b) Assisted Reproduction services including artificial insemination and advanced reproductive technologies such as IVF, ZIFT,
GIFT, ICSI
c) Gestational Surrogacy
d) Reversal of sterilization

14) Maternity (Excl18) (Applicable for Silver Plan only):

a) Medical Treatment Expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred
during hospitalization) except ectopic pregnancy.
b) Expenses towards miscarriage (unless due to an Accident) and lawful medical termination of pregnancy during the
policy period.

III. Specific Exclusion

No indemnity is available hereunder and no payment will be made by the Company for any claim directly or indirectly caused by,
based on, arising out of or howsoever attributable to any of the following:

I. Waiting Period for Maternity Expenses (Applicable only for Gold and Platinum Plan)
Any treatment arising from or traceable to pregnancy, child birth including cesarean section and/or any treatment related to
pre and postnatal care and complications arising out of Pregnancy and Childbirth until 72 months continuous period has elapsed
since the inception of the first Star Package Policy covering Health Guard section with Us. However, this exclusion will not
apply to Ectopic Pregnancy proved by diagnostic means and certified to be life threatening by the attending medical practitioner.

II. General Exclusions (Applicable for Silver, Gold and Platinum Plan)
1) Any dental treatment that comprises of cosmetic surgery, dentures, dental prosthesis, dental implants, orthodontics, surgery
of any kind unless as a result of Accidental Bodily Injury to natural teeth and also requiring hospitalization.
2) Medical expenses where Inpatient care is not warranted and does not require supervision of qualified nursing staff and
qualified medical practitioner round the clock
3) War, invasion, acts of foreign enemies, hostilities (whether war be declared or not), civil war, commotion, unrest, rebellion,
revolution, insurrection, military or usurped power or confiscation or nationalization or requisition of or damage by or under
the order of any government or public local authority. Any Medical expenses incurred due to Act of Terrorism will be covered
under the Policy.
4) The cost of spectacles, contact lenses, hearing aids, crutches, dentures, artificial teeth and all other external appliances and/or
devices whether for diagnosis or treatment except for Cost of Artificial Limbs, cost of prosthetic devices implanted during
surgical procedure like Pacemaker, orthopedic implants, infra cardiac valve replacements, vascular stents etc.
5) External medical equipment of any kind used at home as post Hospitalization care including cost of instrument used in the
treatment of Sleep Apnea Syndrome (C.P.A.P), Continuous Peritoneal Ambulatory Dialysis (C.P.A.D) and Oxygen
concentrator for Bronchial Asthmatic condition.
6) Congenital external diseases or defects or anomalies, growth hormone therapy, stem cell implantation or surgery except for
Hematopoietic stem cells for bone marrow transplant for haematological conditions.
7) Intentional self-injury (including but not limited to the use or misuse of any intoxicating drugs or alcohol)
8) Vaccination or inoculation unless forming a part of post bite treatment or if medically necessary and forming a part of treatment
CIN: U66010PN2000PLC015329 • UIN: BAJHLIP25037V022425 40
Bajaj Allianz General Insurance Co. Ltd.
Bajaj Allianz House, Airport Road, Yerawada, Pune - 411 006. Reg. No.: 113
For more details, log on to: [Link] | E-mail: bagichelp@[Link] or
Call at: Sales - 1800 209 0144 / Service - 1800 209 5858 (Toll Free No.)
IssuingOffice:
recommended by the treating Medical practitioner.
9) All non-medical Items as per Annexure II
10) Any treatment received outside India is not covered under this Policy.
11) Circumcision unless required for the treatment of Illness or Accidental bodily Injury.
12) Treatment for any other system other than modern medicine (allopathy) and AYUSH therapies

3. Exclusion Specific To Section C3: Critical Illness

No payment will be made by the Company for any claim directly or indirectly caused by, based on, arising out of or howsoever
attributable to any of the following:
I. Waiting Period
1) Any Critical Illness diagnosed within the first 90 days of the date of commencement of the Policy is excluded. This exclusion
shall not apply to an Insured Person for whom coverage has been renewed without a break, for subsequent years.

II. General Exclusions

1) Any Critical Illness for which care, treatment, or advice was recommended by or received from a Physician, or which first
manifested itself or was contracted before the start of the Policy Period, or for which a claim has or could have been made
under any earlier policy.
2) Any sexually transmitted diseases or any condition directly or indirectly caused by or associated with Human T-Cell
Lymphotropic Virus type III (III LB III) or Lymphadenopathy Associated Virus (LAV) or the Mutants Derivative or Variations
Deficiency Syndrome or any Syndrome or condition of a similar kind commonly referred to as AIDS.
3) Treatment arising from or traceable to pregnancy, childbirth postpartum complications including but not limited to caesarian
section, birth defects and congenital anomalies.
4) Occupational diseases.
5) War, whether war be declared or not, invasion, act of foreign enemy, hostilities, civil war, insurrection, terrorism or terrorist
acts or activities, rebellion, revolution, mutiny, military or usurped power, riot, strike, lockout, military or popular uprising, civil
commotion, martial law or loot, sack or pillage in connection therewith, confiscation or destruction by any government or public
authority or any act or condition incidental to any of the above.
6) Naval or military operations of the armed forces or air force and participation in operations requiring the use of arms or
which are ordered by military authorities for combating terrorists, rebels and the like.
7) Any natural peril (including but not limited to storm, tempest, avalanche, earthquake, volcanic eruptions, hurricane, or any
other kind of natural hazard).
8) Radioactive contamination.
9) Consequential losses of any kind, be they by way of loss of profit, loss of opportunity, loss of gain, business interruption,
market loss or otherwise, or any claims arising out of loss of a pure financial nature such as loss of goodwill or any legal
liability of any kind whatsoever.
10) Intentional self-injury and/or the use or misuse of intoxicating drugs and/or alcohol.

4. Exclusion Specific To Section C4: Personal Accident And Section C5 Education Grant
No indemnity is available hereunder and no payment will be made by the Company for any Claim directly or indirectly
caused by, based on, arising out of or howsoever attributable to any of the following:

I. Standard Exclusions
1. Maternity (Excl 18)
a) Medical Treatment Expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred during
hospitalization) except ectopic pregnancy.
b) Expenses towards miscarriage (unless due to an accident) and lawful medical termination of pregnancy during the Policy
Period.

II. Specific Exclusion

1) Accidental Bodily Injury that You meet with:
a. Through suicide, attempted suicide or self-inflicted injury or illness.
b. While under the influence of liquor or drugs.
c. Through deliberate or intentional, unlawful or criminal act, error, or omission.
d. Whilst engaging in aviation or ballooning, whilst mounting into, dismounting from or traveling in any balloon or aircraft
other than as a passenger (fare paying or otherwise) in any duly licensed standard type of aircraft anywhere in the world.
e. Whilst participating as the driver, co-driver or passenger of a motor vehicle during motor racing or trial runs.
f. As a result of any curative treatments or interventions that you carry out or have carried out on your body.
g. Arising out of your participation in any naval, military or air force operations whether in the form of military exercises or
war games or actual engagement with the enemy, Whether foreign or domestic.
2) Your consequential losses of any kind or your actual or alleged legal liability.
3) Venereal or sexually transmitted diseases.
4) Pregnancy, resulting childbirth, miscarriage, abortion, or complications arising out of any of these.
5) War (whether declared or not), civil war, invasion, act of foreign enemies, rebellion, revolution, insurrection, mutiny, militaryor
usurped power, seizure, capture, arrest, restraint or detainment, confiscation or nationalization or requisition of or damage by or
under the order of any government or public local authority.
6) Nuclear energy, radiation.

5. Exclusions Specific To Section C6: Public Liability

No indemnity is available hereunder and no payment will be made by the Company for any claim directly or indirectly caused by,
CIN: U66010PN2000PLC015329 • UIN: BAJHLIP25037V022425 40
Bajaj Allianz General Insurance Co. Ltd.
Bajaj Allianz House, Airport Road, Yerawada, Pune - 411 006. Reg. No.: 113
For more details, log on to: [Link] | E-mail: bagichelp@[Link] or
Call at: Sales - 1800 209 0144 / Service - 1800 209 5858 (Toll Free No.)
IssuingOffice:
based on, arising out of or howsoever attributable to any of the following:

I. General Exclusion
1) any voluntarily assumed liability unless such liability would have attached to the Insured Person in
the absence of such agreement;
2) any liability arising out of a deliberate, willful or intentional act, error, omission, or non-compliance with any statutory provision;
3) liability arising out of the ownership, possession or use by or on behalf of the Insured or his Family or Household Staff of any
motor vehicle or trailer for which compulsory insurance is required, save that cover shall be provided for claims arising out
of Bodily Injury or Property Damage caused by the loading or unloading of any motor vehicle or trailer beyond the limits of any
carriageway or thoroughfare;
4) liability arising out of the ownership, possession or use by or on behalf of the Insured Person or his Family or Household Staff of
any watercraft, hovercraft, air- or spacecraft;
5) any interest and/or penalty imposed on the Insured Person on account of his failure to comply with the requirements laid down
under the Workmen’s Compensation Act 1923 or any amendment thereto;
6) the transmission of any communicable disease or virus;
7) occupation or business, trade or employment

6. Exclusion Specific To Section C7: Loss Of Baggage

The Company shall not be liable for and no indemnity is available hereunder in respect of:
I. General Exclusion
1) loss or damage due to cracking scratching or breakage of lens or glass whether part of china, marble, gramophone records
or otherwise and other articles of a brittle or fragile nature, unless such loss or damage arises from an accident to a vessel,
train, or other mechanised vehicle or aircraft by which such baggage is conveyed by the Insured Person and/or the Insured
Person’s Family;
2) Loss or damage caused by or any process of cleaning, dyeing repairing or restoring to which the baggage is subjected;
3) Loss or damage caused by moth, mildew or vermin;
4) Loss or damage to any electrical machines, apparatus, fixtures or fittings (including wireless sets, radio, television sets and
tape recorders) arising from over running, excessive pressure, short circuiting arcing self- heating or leakage or electricity
from whatever cause (lightning included);
5) loss or damage caused by mechanical derangement or over winding of watches and clocks;
6) the ft from cars except from fully enclosed saloon cars having all the doors, windows and other openings securely locked and
properly fastened, and any other security aid properly applied;
7) loss or damage whilst being conveyed by any carrier under contract of affreightment;
8) loss of or damage to Jewellery or Valuables;
9) loss of or damage to article which did not form part of the Contents of the baggage when the journey commenced unless
specifically declared and accepted by the Company;
10) loss or destruction of or damage to baggage of a consumable nature;
11) loss of or damage to carried loose articles such as sticks, straps, umbrellas, sunshades, deck chairs, property in use on the
journey or articles of clothing whilst being worn on the person or carried about;
12) loss destruction or damage caused by or arising from the leakage spilling or exploding of liquid, oils or material of a like
nature or articles of a dangerous or damaging nature;
13) any tour or travel undertaken within the municipal limits of the village, town or city wherein the Insured permanently resides.

7. Exclusions Applicable To All Sections

No indemnity is available hereunder and no payment will be made by the Company for any claim directly or indirectly caused by,
based on, arising out of or howsoever attributable to any of the following:
1) War, invasion, act of foreign enemy, hostilities (whether war be declared or not), civil war, rebellion, revolution,
insurrection military or usurped power of civil commotion or loot or pillage in connection herewith.
2) Loss or damage caused by depreciation or wear and tear.
3) Consequential loss of any kind or description.
4) Loss or damage directly or indirectly caused by or arising from or in consequence of or contributed to nuclear weapons material
by or arising from or in consequence of or contributed to by ionising radiation or contamination by radioactivity from any nuclear
fuel or from any nuclear waste from the combustion of nuclear fuel (including any self-sustaining process of nuclear fission).

SECTION E) GENERAL TERMS AND CLAUSES - STANDARD GENERAL TERMS AND CLAUSES

1. Disclosure of information
The Policy shall be void ab initio and all premium paid thereon shall be forfeited to the Company in the event of
misrepresentation, mis description or non-disclosure of any material fact by the proposer/Insured Person.

2. Condition Precedent to Admission of Liability

The terms and conditions of the Policy must be fulfilled by the Insured Person for the Company to make any payment for
claim(s) arising under the Policy.

3. Premium Payment in Instalments (Wherever applicable)

If the Insured Person has opted for Payment of Premium on an instalment basis i.e. Annual (for long term polices only), Half
Yearly, Quarterly or Monthly, as mentioned in the Policy Schedule, the following Conditions shall apply (notwithstanding any
terms contrary elsewhere in the Policy)
CIN: U66010PN2000PLC015329 • UIN: BAJHLIP25037V022425 40
Bajaj Allianz General Insurance Co. Ltd.
Bajaj Allianz House, Airport Road, Yerawada, Pune - 411 006. Reg. No.: 113
For more details, log on to: [Link] | E-mail: bagichelp@[Link] or
Call at: Sales - 1800 209 0144 / Service - 1800 209 5858 (Toll Free No.)
IssuingOffice:
i. The Grace Period of fifteen days (where premium is paid on a monthly instalments) and thirty days (where premium is paid in
quarterly/half-yearly/annual instalments) is available on the premium due date, to pay the premium.
ii. If the Policy is renewed during Grace Period, all the credits (Sum Insured, No Claim Bonus, Specific Waiting periods, waiting
periods for pre-existing diseases, Moratorium period etc.) accrued under the Policy shall be protected.
iii. If the premium is paid in instalments during the Policy Period, coverage will be available for the grace period also. The Insured
Person will get the accrued continuity benefit in respect of the “Waiting Periods”, “Specific Waiting Periods” in the event of
payment of premium within the stipulated Grace Period.
iv. The Insured Person will get the accrued continuity benefit in respect of the “Waiting Periods”, “Specific Waiting Periods” in the
event of payment of premium within the stipulated grace Period.
v. No interest will be charged If the instalment premium is not paid on due date.
vi. In case of instalment premium due not received within the Grace Period, the Policy will get cancelled.
vii. In the event of a claim, all subsequent premium instalments shall immediately become due and payable.
viii. The Company has the right to recover and deduct all the pending installments from the claim amount due under the policy.

4. Moratorium Period:
After completion of sixty continuous months of coverage (including portability and migration) no look back would be applied.
This period of sixty months is called as moratorium period. The moratorium would be applicable for the Sums Insured of the
first Policy and wherever, the Sum Insured is enhanced, completion of sixty continuous months would be applicable from the
date of enhancement of Sums Insured only on the enhanced limits. After the expiry of Moratorium Period no claim under this
Policy shall be contestable on any grounds of non-disclosure and/or misrepresentation except for proven fraud and
permanent exclusions specified in the Policy contract. The Policy/ies would however be subject to all limits, sub limits, co-
payments, deductibles as per the Policy contract.

5. Claim Settlement. (provision for Penal interest)

i. The Company shall settle or reject a claim, as the case may be, within 15 days from the date of receipt of last necessary document.
ii. ln the case of delay in the payment of a claim, the Company shall be liable to pay interest to the Insured Person from the
date of receipt of last necessary document to the date of payment of claim at a rate 2% above the bank rate.
iii. However, 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- ln such cases, the Company shall settle or reject the claim within 15 days from the date of receipt of last
necessary document.
iv. ln case of delay beyond stipulated 15 days, the Company shall be liable to pay interest to the Insured at a rate 2% above
the bank rate from the date of receipt of last necessary document to the date of payment of claim.

6. Complete Discharge
Any payment to the Insured Person, or his/ her nominees or his/ her legal representative or assignee or to the Hospital, as the
case may be, for any benefit under the Policy shall be a valid discharge towards payment of claim by the Company to the
extent of that amount for the particular claim

7. Fraud
i. If any claim made by the Insured Person, is in any respect fraudulent, or if any false statement, or declaration is made or used
in support thereof, or if any fraudulent means or devices are used by the Insured Person or anyone acting on his/her behalf to
obtain any benefit under this Policy, all benefits under this Policy and the premium paid shall be forfeited.
ii. Any amount already paid against claims made under this Policy but which are found fraudulent later shall be repaid by all
recipient(s)/Insured Person (s), who has made that particular claim, who shall be jointly and severally liable for such
repayment to the Insurer.
iii. For the purpose of this clause, the expression “fraud” means any of the following acts committed by the Insured Person or by his
agent or the Hospital/ doctor/any other party acting on behalf of the Insured Person , with intent to deceive the Insurer or to induce
the Insurer to issue an insurance policy:
a) the suggestion, as a fact of that which is not true and which the Insured does not believe to be true;
b) the active concealment of a fact by the Insured Person having knowledge or belief of the fact;
c) any other act fitted to deceive; and
d) any such actor omission as the law specially declares to be fraudulent

The Company shall not repudiate the claim and / or forfeit the Policy benefits on the ground of Fraud, if the Insured Person can
prove that the misstatement was true to the best of his knowledge and there was no deliberate intention to suppress the fact
or that such misstatement of or suppression of material fact are within the knowledge of the Insurer

8. Multiple Policies
i. ln case of multiple policies taken by an Insured Person during a Policy Period from one or more insurers to indemnify treatment costs,
the Insured Person shall have the right to require a settlement of his/her claim in terms of any of his/her policies. In all such cases the
Insurer chosen by the Insured Person shall be obliged to settle the claim as long as the claim is within the limits of and according to the
terms of the chosen policy.
ii. lnsured person having multiple policies shall also have the right to prefer claims under this Policy for the amounts disallowed under any
other policy / policies even if the Sum Insured is not exhausted. Then the Insurer shall independently settle the claim subject to the
terms and conditions of this Policy.
iii. lf the amount to be claimed exceeds the Sum Insured under a single policy, the Insured Person shall have the right to choose insurer
from whom he/ she wants to claim the balance amount.
iv. Where an Insured Person has policies from more than one insurer to cover the same risk on indemnity basis, the Insured Person shall
only be indemnified the treatment costs in accordance with the terms and conditions of the chosen policy.

CIN: U66010PN2000PLC015329 • UIN: BAJHLIP25037V022425 40

Bajaj Allianz General Insurance Co. Ltd.
Bajaj Allianz House, Airport Road, Yerawada, Pune - 411 006. Reg. No.: 113
For more details, log on to: [Link] | E-mail: bagichelp@[Link] or
Call at: Sales - 1800 209 0144 / Service - 1800 209 5858 (Toll Free No.)
IssuingOffice:
9. Renewal of Policy
The Policy shall ordinarily be renewable provided the product is not withdrawn, except in case of Established Fraud, Non-Disclosure or
misrepresentation by the Insured Person.
i. The Company shall endeavor to give notice for renewal. However, the Company is not under obligation to give any notice for
renewal.
ii. Renewal shall not be denied on the ground that the Insured Person 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 policy.
iii. Request for renewal along with requisite premium shall be received by the Company before the end of the Policy Period.
iv. At the end of the Policy Period, the Policy shall terminate and can be renewed within the Grace Period of 30 days to
maintain continuity of benefits without break in policy.
v. No loading shall apply on renewals based on individual claims experience

10. Cancellation
(A) Cancellation by the Policyholder: The Policyholder can cancel this Policy by providing a written notice of 7 days. In such a
case, the Company will refund the premium for the unexpired policy period as detailed below:

1. Cancellation of policy where full premium received at policy inception -

Annual Policy: The premium refund for the unexpired risk period will be on a pro-rata basis, provided no claim has been made
during the policy year.
Multi-year Policy:
For any policy year where the risk date has not yet started, the premium will be refunded without any deduction.
For any policy year where the risk has started, the premium will be refunded on a pro-rata basis for that policy year, provided no
claim has been made during the policy year and in full for future policy years.

2. Cancellation of policy where Premium Received on Instalment Basis

The premium refund for the unexpired risk period will be on a pro-rata basis, provided no claim has been made during the
policy year.

(B) Additional Deductions : Notwithstanding the above, if (i) the risk under the Policy has already commenced, or (ii) only a part
of the insurance coverage has commenced, and the option of Policy cancellation is exercised by the Policyholder, then
expenses incurred by the Company on medical examination of the Policyholder will also be deducted before refunding of
premium.

(C) Cancellation by the Company: The Company may cancel the Policy at any time on the grounds of misrepresentation, non-
disclosure of material facts, or fraud by the Policyholder/insured person, by providing 15 days’ written notice. There will be no
refund of premium for cancellations on these grounds.

11. Free Look Period

The Free Look Period shall be applicable on new individual health insurance policies and not on renewals or at the time of
porting/migrating the policy.
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 cancel/return the same if not acceptable.
If the Insured Person has not made any claim during the Free Look Period, the Insured Person shall be entitled to

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

ii. where the risk has already commenced and the option of return of the Policy is exercised by the Insured Person, a deduction
towards the proportionate risk premium for period of cover and expenses incurred by the Company on medical examination of the
Insured Person or

iii. Where only a part of the insurance coverage has commenced, such proportionate premium commensurate with the insurance
coverage during such period and expenses incurred by the Company on medical examination of the Insured Person;

12. 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 45 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.
For Detailed Guidelines on portability, kindly refer the link [Link]
(Please note referred link is of the IRDAI website and subject to change from time to time.)

13. Possibility of Revision of Terms of the Policy including the Premium Rates:
The Company, with prior approval of lRDAl, may revise or modify the terms of the Policy including the premium rates. The
Insured Person shall be notified three months before the changes are effected.

14. Migration
The Insured Person will have the option to migrate the Policy to other health insurance products/plans offered by the Company by
applying for migration of the Policy at least 30 days before the Policy renewal date as per IRDAI guidelines on Migration. If such
person is presently covered and has been continuously covered without any lapses under any health insurance product/plan offered
CIN: U66010PN2000PLC015329 • UIN: BAJHLIP25037V022425 40
Bajaj Allianz General Insurance Co. Ltd.
Bajaj Allianz House, Airport Road, Yerawada, Pune - 411 006. Reg. No.: 113
For more details, log on to: [Link] | E-mail: bagichelp@[Link] or
Call at: Sales - 1800 209 0144 / Service - 1800 209 5858 (Toll Free No.)
IssuingOffice:
by the company, the Insured Person will get the accrued continuity benefits in waiting periods as per IRDAI guidelines on migration.
For Detailed Guidelines on migration, kindly refer the link [Link] (Please note
referred link is of the IRDAI website and subject to change from time to time.)

15. Withdrawal of Policy

i. ln the likelihood of this product being withdrawn in future, the Company will intimate the Insured Person about the same 90 days
prior to expiry of the Policy.
ii. lnsured Person will have the option to migrate to similar health insurance product available with the Company at the time of renewal
with all the accrued continuity benefits such as cumulative bonus, waiver of waiting period as per IRDAI guidelines, provided the
Policy has been maintained without a break.

16. Grievance Redressal Procedure

The Company has always been known as a forward-looking customer centric organization. It takes immense pride in its approach of
“Caringly Yours”. To provide you with top-notch service on all fronts, the company has provided with multiple platforms via which
you can always reach out to us at below mentioned touch points
1. Our toll-free number 1-800-209- 5858 or 020-30305858, Say “Hi” on WhatsApp on +91 7507245858
2. Branches for resolution of your grievances / complaints, the Branch details can be found on
our website [Link]/[Link]
3. Register your grievances / complaints on our website
[Link]/about-us/[Link]
4. E-mail
a) Level 1: Write to bagichelp@[Link] and for senior citizens to seniorcitizen@[Link]
b) Level 2: In case you are not satisfied with the response given to you at Level 1 you may write to our Grievance
Redressal Officer at ggro@[Link]
c) Level 3: If in case, your grievance is still not resolved, and you wish to talk to our care specialist, please give a missed call on
+91 80809 45060 OR SMS To 575758 and our care specialist will call you back
5. If you are still not satisfied with the decision of the Insurance Company, you may approach the Insurance Ombudsman,
established by the Central Government for redressal of grievance. Detailed process along with list of Ombudsman offices
are available at [Link]/ombudsman
The contact details of the Ombudsman offices are mentioned in Annexure V

17. Nomination
The Insured Person is required at the inception of the Policy to make a nomination for the purpose of payment of claims
under the Policy in the event of death of the Insured Person. Any change of nomination shall be communicated to the
Company in writing and such change shall be effective only when an endorsement on the Policy is made. In the event of
death of the Insured Person, the Company will pay the nominee {as named in the Policy Schedule /Endorsement (if any)}
and in case there is no subsisting nominee, to the legal heirs or legal representatives of the Insured Person whose
discharge shall be treated as full and final discharge of its liability under the Policy.

SECTION E) GENERAL TERMS AND CLAUSES - SPECIFIC TERMS AND CLAUSES

18. Insured Person

Only those persons named as the Insured in the Schedule shall be covered under this Policy. Cover under this Policy shall be
withdrawn from any Insured Person upon such person giving 14 days written notice to be received by Us.

19. Notice/Communications
i. Any notice or any other communication related to the Policy should be made in writing.
ii. Such communication shall be sent to the address of the Company or through any other electronic modes specified in the Policy
Schedule.
iii. The Company shall communicate to the Insured Person at the address or through any other electronic mode mentioned in the Policy
Schedule.

20. Basis of Claims Payment

i. If You suffer a relapse within 45 days of the date when You last obtained medical treatment or consulted a Doctor and for
which a claim has been made, then such relapse shall be deemed to be part of the same claim.
ii. We shall not make any payment to You for any period of Hospitalization of less than 24 hours, except for the Day Care Procedures.
iii. The Day Care Procedures listed are subject to the exclusions, terms and conditions of the Policy and will not be treated as
independent coverage under the Policy.
iv. We shall make payment in Indian Rupees only.

In addition to above terms specific conditions applicable to below sections are as below-

Section C2- Health Guard

A. Cost Sharing
i. Voluntary co-payment: If opted voluntarily by you, You shall bear 10% / 20% of co-payment for each and every claim payable under the
Inpatient Hospitalization Treatment section and Our liability, if any, shall only be in excess of that sum.

ii. Voluntary Aggregate Deductible:

We shall pay Reasonable & Customary Medical Expenses in respect of an admissible Hospitalization claim in excess of the Annual
Aggregate Deductible limit of ₹ 50,000 / ₹ 1,00,000 / ₹ 2,00,000 / ₹ 3,00,000, as opted by You, subject to the ”In-patient Hospitalization
Treatment” section Sum Insured, terms, conditions and definitions, exclusions contained or otherwise. The deductible is applicable in
CIN: U66010PN2000PLC015329 • UIN: BAJHLIP25037V022425 40
Bajaj Allianz General Insurance Co. Ltd.
Bajaj Allianz House, Airport Road, Yerawada, Pune - 411 006. Reg. No.: 113
For more details, log on to: [Link] | E-mail: bagichelp@[Link] or
Call at: Sales - 1800 209 0144 / Service - 1800 209 5858 (Toll Free No.)
IssuingOffice:
aggregate towards all claims falling under ”In-patient Hospitalization Treatment” Sum Insured incurred during the policy period.
This Deductible will not be applied on the claim admissible under Maternity and New Born Baby Cover.

iii. Cataract Limit: Our obligation to make payment in respect of surgeries for cataracts (after the expiry of the 24 months period referred
to in Exclusion Specific to Section C2: Health Guard Exclusion I, 2) above, shall be restricted to 20% of the Sum Insured for each eye,
subject to maximum of Rs 1,00,000/- for each of You.

iv. Bariatric Surgery Limit: Our obligation to make payment in respect of Bariatric Surgery after the expiry of the 36 months period,
shall be restricted to 25% of the Sum Insured in Silver Plan and 50% of the Sum Insured subject to maximum of Rs 5 lac in
Gold and Platinum Plan.

v. Maternity Limit: Maternity is covered under Gold & Platinum plan only
a. For Sum Insured 3 lacs up to 7.5 lacs the limit for Normal delivery is 15000 INR & 25000 INR for caesarian delivery
b. For Sum Insured above 7.5 lacs the limit for Normal delivery is 25000 INR & 35000 INR for caesarian delivery

vi. In-patient Treatment for Mental Illness: (As specified in Annexure IV) shall be covered up to Base Sum Insured subject to
Policy Terms, Conditions, coverages, Waiting Period and exclusions.

vii. Modern Treatment Methods and Advancement in Technologies (as per list in Annexure III) shall be covered up to Base Sum
Insured, subject to Policy Terms, Conditions, coverages, Waiting Period and exclusions.

B. Cumulative Bonus for Silver and Gold Plan: (Applicable to Section C2. Health Guard)
If You renew Your Star Package Policy covering Health Guard section with Us without any break and there has been no claim in
the preceding year, We will increase the Limit of Indemnity by 10% of base Sum Insured per annum, but:
i. The maximum cumulative increase in the Limit of Indemnity will be limited to 10 years and 100% of base Sum
Insured of Your first Star Package Policy covering Health Guard section with Us.
ii. This clause does not alter the annual character of this insurance
iii. If a claim is made in any year where a cumulative increase has been applied, then the increased Limit of Indemnity in the
Policy Period of the subsequent Star Package Policy covering Health Guard section shall be reduced by 10%, save that
the limit of indemnity applicable to Your first Star Package Policy covering Health Guard section with Us shall be
preserved.

Section C3 - Critical Illness

Subject to the terms, conditions and exclusions of this Policy,
i. “Critical Illness Insurance” Policy where Sum Insured is above INR 500,000, Sub-limit of INR 500,000 will be applicable to
“Joint Replacement” Benefit.
ii. Claim for Joint Replacement, either unilateral or bilateral, would be payable as per the opted Sum Insured or 5 Lacs,
whichever is lower of the two,
iii. The above (i) would be payable only once in a lifetime of a person.
iv. If the first claim payable is of Joint Replacement, then the liability for any subsequent claim for the remaining listed critical
illnesses (other than Joint Replacement) will be reduced by the amount paid under Joint Replacement benefit, post which
the policy would cease.

Illustrations:
For 1 year Policy Period
Scenario 1 – Critical Illness Policy opted with Sum Insured 3 Lac. If first claim of Joint Replacement arises, then 3 Lac gets
paid out and policy ceases.

Scenario 2 – Critical Illness Policy opted with Sum Insured 20 Lac (of which Sum Insured for Joint Replacement is 5 lac). If
first claim of Joint Replacement arises, then 5 Lac gets paid out and policy continues for remaining 11 Critical Illnesses with
Sum Insured 15 Lac. If second claim of CABG arises in the same Policy Period, then 15 Lac gets paid and policy ceases.

Scenario 3 – Critical Illness Policy opted with Sum Insured 20 Lac (of which Sum Insured for Joint Replacement is 5 lac). If
first claim of Joint Replacement arises in the Policy Period, then 5 Lac gets paid out and policy continues for remaining 11
Critical Illnesses with Sum Insured 15 Lac. There is no other claim in the Policy.
At the time of renewal, this Policy will be renewed with Sum Insured 20 Lac (as per expiring policy Sum Insured). However,
the renewed policy will not cover Joint Replacement.

For 2 or 3 Year Long Term Policy Period

Scenario 1 – Critical Illness Policy opted with Sum Insured 3 Lac. If first claim of Joint Replacement arises in Year 1, then 3
Lac gets paid out and policy ceases.

Scenario 2 – Critical Illness Policy opted with Sum Insured 20 Lac (of which Sum Insured for Joint Replacement is 5 lac). If
first claim of Joint Replacement arises in Year 1, then 5 Lac gets paid out and policy continues for remaining 11 Critical
Illnesses with Sum Insured 15 Lac for rest of the Policy Period.
If second claim of CABG arises in Year 2 of the Long Term Policy, then 15 Lac gets paid out and policy ceases.

Scenario 3 – Critical Illness Policy opted with Sum Insured 20 Lac (of which Sum Insured for Joint Replacement is 5 lac). If
first claim of Joint Replacement arises in Year 1, then 5 Lac gets paid out and policy continues for remaining 11 Critical
Illnesses with Sum Insured 15 Lac for the rest of the Policy Period. There is no other claim in the Policy.
At the time of renewal, this Policy will be renewed with Sum Insured 20 Lac (as per expiring policy Sum Insured). However,
the renewed policy will not cover Joint Replacement

CIN: U66010PN2000PLC015329 • UIN: BAJHLIP25037V022425 40

Bajaj Allianz General Insurance Co. Ltd.
Bajaj Allianz House, Airport Road, Yerawada, Pune - 411 006. Reg. No.: 113
For more details, log on to: [Link] | E-mail: bagichelp@[Link] or
Call at: Sales - 1800 209 0144 / Service - 1800 209 5858 (Toll Free No.)
IssuingOffice:
21. Endorsements
This Policy constitutes the complete contract of insurance. This Policy cannot be changed by anyone (including an insurance
agent or broker) except Us. Any change that We make will be evidenced by a written endorsement signed and stamped by
Us.

22. Discounts applicable for Sections under “Star Package” Policy are as below-
i. Co-pay Discount: (Applicable to Section C2. Health Guard only)
a. If opted voluntarily and mentioned on the Policy Schedule that a Co-payment is effective by the Insured Person then he/she
will be eligible of additional 10% or 20% discount on the Policy premium.
b. If a claim has been admitted under Section C2. Health Guard – (In-patient Hospitalization Treatment) then, the Insured Person
shall bear 10% or 20% respectively of the eligible claim amount payable under this section and Our liability, if any, shall
only be in excess of that sum and would be subject to the Sum Insured.

ii. Voluntary Aggregate Deductible: (Applicable to Section C2. Health Guard only)
If opted voluntarily and mentioned on the Policy Schedule than a discount on the Policy premium shall be apply basis the
Sum insured and deductible limits opted under the policy

iii. Room Rent capping discount: (Applicable to Section C2. Health Guard only)
If You opt for this cover You will be entitled for a per day room rent limit of 1.5% of Hospitalization Sum Insured up to
maximum INR 7,500 per day. By opting for this cover, You will be eligible for discount on premium as per below grid-

Base SI Gold Plan Platinum Plan

300,000 and above 5% 8%
Note:
[Link] room rent does not include nursing charges.
[Link] the availed room category is higher than the eligible room category or if the room rent opted exceeds the eligible room rent then, a
proportionate co-payment would be applied on all the expenses of the Hospitalization except for cost of Medical consumables and
Medicines.

iv. Wellness Discount (Applicable to Section C2. Health Guard only)

As detailed in Section C2 – Under Health Guard, depending on number of parameters met by Insured Person during a Policy
Year discount will be offered on subsequent renewal premium.

Parameters Achieved Discount

4 out of 8 5%
6 out of 8 7.5%
8 out of 8 10%

Note- If an Insured Person meets 8 out of 8 above mentioned parameters and he/she walks for 10000 steps for 20 days every month then
they will be eligible for additional discount of 2.5%.

v. Zone Discount (Applicable to Section C2. Health Guard only)

a) If You opt for coverage under Zone B, then You will be eligible for 20% discount on the premium
b) If You opt for coverage under Zone C, then You will be eligible for 30% discount on the premium

Premium payment Zone

Zone A: Delhi / NCR, Mumbai including (Navi Mumbai, Thane and Kalyan), Hyderabad and Secunderabad, Kolkata, Ahmedabad,
Vadodara and Surat.
Zone B : Rest of India apart, from the states/UTs/cities classified under Zone A and Zone C, are classified as Zone B.
Zone C : Andaman & Nicobar Islands, Arunachal Pradesh, Bihar, Chandigarh, Chattisgarh, Goa, Himachal Pradesh, Jammu & Kashmir,
Jharkhand, Manipur, Meghalaya, Mizoram, Nagaland, Odisha, Punjab, Sikkim, Tripura, Uttarakhand

Note: -
• Policyholders paying Zone A premium rates can avail treatment allover India without any co-payment.
• Those, who pay Zone B premium rates and avail treatment in Zone A city will have to pay 15% co-payment on admissible claim amount.
• Those, who pay Zone C premium rates and avail treatment in Zone A city will have to pay 20% co-payment on admissible claim amount.
• Those, who pay Zone C premium rates and avail treatment in Zone B city will have to pay 5% co-payment on admissible claim amount
• This Co – payment will not be applicable for Accidental Hospitalization cases.
• Policyholder residing in Zone B and Zone C can choose to pay premium for Zone A and avail treatment all over India without any co-payment

vi. Family Discount (Applicable to Section C1 “Hospital Cash Daily Allowance” only)
5% family discount shall be offered if 2 or more than 2 of any of the Dependent family members are covered under a single policy

vii. Sectional Discount: (Applicable to all Sections)

25% discount would be offered on sections other than Health Guard if 4 or more sections are opted.

viii. Long Term policy Discount:

• 4% discount applicable if policy is opted for 2 years
• 8% discount applicable if policy is opted for 3 years
Note: This will not apply to policies where premium is paid in instalments.

CIN: U66010PN2000PLC015329 • UIN: BAJHLIP25037V022425 40

Bajaj Allianz General Insurance Co. Ltd.
Bajaj Allianz House, Airport Road, Yerawada, Pune - 411 006. Reg. No.: 113
For more details, log on to: [Link] | E-mail: bagichelp@[Link] or
Call at: Sales - 1800 209 0144 / Service - 1800 209 5858 (Toll Free No.)
IssuingOffice:
ix. Loyalty Discount : 5% Discount maximum up to INR 1000 shall be offered if the Insured Person is having any of the listed active
Bajaj Allianz General Insurance Co. Ltd.’s retail policy of Motor, Health, Home, Cyber and Pet Insurance with a minimum premium of
INR 2500.
x. Employee Discount : 20% discount on published premium rates to employees of Bajaj Allianz & its group companies, this discount
is applicable only if the Policy is booked in direct code

23. Sum Insured Enhancement:

i. The Insured Person can apply for enhancement of Sum Insured at the time of renewal. You can apply for enhancement of Sum
Insured by submitting a fresh proposal form to the Company.
ii. The acceptance of enhancement of Sum Insured would be at the discretion of the Company, based on the health condition of the
Insured Person & claim history of the Policy.
iii. All waiting periods as defined in the Policy shall apply for this enhanced Sum Insured limit from the effective date of enhancement of
such Sum Insured considering such Policy Period as the first Policy with the Company.

24. Territorial Limits & Governing Law and Jurisdiction

i. We cover Insured Person events arising during the Policy Period for treatment availed within India only. Our liability to make any
payment shall be to make payment within India and in Indian Rupees only.
ii. This Policy shall be exclusively governed and construed as per laws of India and all disputes or differences under or in relation to
the interpretation of the terms, conditions, validity, construct, limitations and/or exclusions contained in the Policy shall be,
determined by the Indian court and in accordance to Indian laws.
iii. The section headings of this Policy are included for descriptive purposes only and do not form part of this Policy for the purpose of
its construction or interpretation

25. Arbitration and Reconciliation:

Arbitration Clause shall not be applicable.

26. Subrogation (Applicable to “Public Liability” and “Loss of Baggage” Section only)
The Insured Person and any claimant under this Policy shall at the expense of the Company do or concur in doing or permit to
be done all such acts and things that may be necessary or reasonably required by the Company for the purpose of
enforcing any civil or criminal rights and remedies or obtaining relief or indemnity from other parties to which the Company
shall be or would become entitled or subrogated upon the Company paying for or making good any loss or damage under
this Policy whether such acts and things shall be or become necessary or required before or after the Insured Person’s
indemnification by the Company.

27. Duties and Obligations after Occurrence of an Insured Event (Applicable to Section C7 LOSS OF BAGGAGE and Section C6
PUBLIC LIABILITY)
It is a condition precedent to the Company’s liability under this Policy that, upon the happening of any event giving rise to or
likely to give rise to a claim under this Policy:

i. the Insured Person shall immediately and in any event within 14 days give written notice of the same to the address
shown in the Schedule for this purpose, and in case of notification of an event likely to give rise to a claim to specify the
grounds for such belief, and
ii. in respect of any claim under any Cover as advised by the Company, immediately lodge a complaint with the police detailing
the items lost and/or damaged and in respect of which the Insured Person intends to claim, and provide a copy of that written
complaint, the First Information Report and/or Final Report to the Company, and
iii. the Insured Person shall within 30 days deliver to the Company its completed claim form detailing the loss or damage that has
occurred and an estimate of the quantum of any claim along with all documentation required to support and substantiate the
amount sought from the Company, and
iv. the Insured Person shall expeditiously provide the Company and its representatives and appointees with all the
information, assistance, records and documentation that they might reasonably require, and
v. the Insured Person shall not admit liability or settle or make or promise any payment in respect of any claim which may
be the subject of indemnity hereunder, or incur any costs or expenses in connection therewith, without the written consent of
the Company which shall be entitled to take over and conduct in the name of the Insured Person the defence and/or settlement of
any such claim, for which purpose the Insured Person shall give all the information and assistance that the Company may
reasonably require.

28. Consideration
The Policy is issued subject to payment of premium in advance. No payment shall be valid unless made under our
official receipt. The Policy shall not be valid prior to the date and time of receipt of premium.
29. Duties and Obligations of the Insured Person
After the Occurrence of an Insured Event It is a condition precedent to the Company’s liability under this Policy that in the
event of any Accidental Bodily Injury or Illness that may give rise to a claim:

1. the Insured Person shall immediately and in any event within 14 days provide the Company with written notification of
a claim, and

2. the Insured Person shall take every other reasonable step and/or measure to minimise the consequence of the
Bodily Injury or Illness, and

3. the Insured Person shall expeditiously provide the Company with or arrange for the Company to be provided with any and all
information and documentation in respect of the claim and/or the Company’s liability hereunder that may be requested, and
submit himself for examination by the Company’s medical advisors as often as may be considered necessary by the
Company.

CIN: U66010PN2000PLC015329 • UIN: BAJHLIP25037V022425 40

Bajaj Allianz General Insurance Co. Ltd.
Bajaj Allianz House, Airport Road, Yerawada, Pune - 411 006. Reg. No.: 113
For more details, log on to: [Link] | E-mail: bagichelp@[Link] or
Call at: Sales - 1800 209 0144 / Service - 1800 209 5858 (Toll Free No.)
IssuingOffice:
SECTION E) GENERAL TERMS AND CLAUSES -OTHER TERMS AND CLAUSES

30. Claims Procedure

All Claims will be settled by In house claims settlement team of the company and no TPA is engaged.
If You meet with any Accidental Bodily Injury or suffer an Illness that may result in a claim, then as a condition
precedent to Our liability, You must comply with the following:

A. Cashless Claims Procedure: (Applicable to Section C2. Health Guard Only)

Medical treatment under Cashless facility is only available at Network Hospitals. In order to avail of medical treatment under
cashless facility, the following procedure must be followed by You:

i. For planned treatment or Hospitalization, prior to taking treatment and/or incurring Medical Expenses at a Network
Hospital, You or Your representative must intimate Us 48 hours before the planned Hospitalization and request pre-
authorisation by way of the written form.

ii. After considering Your request and after obtaining any further information or documentation We have sought, We may, if
satisfied, send You or the Network Hospital, an authorisation letter. The authorisation letter, the ID card issued to You along
with this Policy and any other information or documentation that We have specified must be produced to the Network Hospital
identified in the pre-authorization letter at the time of Your admission to the same.

iii. If the procedure above is followed, You will not be required to directly pay for the bill amount in the Network Hospital that We are
liable under Section C2 In-Patient Hospitalisation Treatment above and the original bills and evidence of treatment in respect of
the same shall be left with the Network Hospital. Pre-authorisation does not guarantee that all costs and expenses will be
covered. We reserve the right to review each claim for Medical Expenses and accordingly coverage will be determined according
to the terms and conditions of this Policy.

iv. In case any treatment or procedure is to be taken on an Emergency basis, You or Your representative must intimate Us in
writing immediately within 24 hours of hospitalization.

B. Reimbursement Claims Procedure: (Applicable to Section C1. Hospital Cash Daily Allowance, Section C2. Health Guard,
Section C3. Critical Illness Section C4. Personal Accident and Section C5. Education Grant)
If Pre-authorisation as per Cashless Claims Procedure above is denied by Us or if treatment is taken in a Hospital other than a
Network Hospital or if You do not wish to avail cashless facility, then:
i. You or someone claiming on Your behalf must inform Us in writing immediately within 48 hours of
hospitalization in case of emergency hospitalization and 48 hours prior to hospitalization in case of
planned hospitalization*
ii. You must immediately consult a Doctor and follow the advice and treatment that he recommends.
iii. You must take reasonable steps or measures to minimize the quantum of any claim that may be made under this Policy.
iv. You must have Yourself examined by Our medical advisors if We ask for this, and as often as We consider this to be
necessary at our cost
v. You or someone claiming on Your behalf must promptly and in any event within 30 days of discharge from a
Hospital give Us the documentation as listed out in greater detail below and other information We ask for to
investigate the claim or Our obligation to make payment for it.
vi. In the event of the death of the Insured Person, someone claiming on his behalf must inform Us in writing
immediately and send Us a copy of the post mortem report (if any) within 30 days*
vii. If the original documents are submitted with the co-insurer, the Xerox copies attested by the co-insurer should be submitted.
*Note: In case You are claiming for the same event under an indemnity-based policy of another insurer and are required to
submit the original documents related to Your treatment with that particular insurer, then You may provide Us with the
attested Xerox copies of such documents along with a declaration from the particular insurer specifying the availability of the
original copies of the specified treatment documents with it.

*Note: Waiver of conditions (i), (v) and (vi) may be considered in extreme cases of hardship where it is proved to Our satisfaction
that under the circumstances in which You were placed, it was not possible for You or any other person to give notice or file
claim within the prescribed time limit.

List of Claim documents: For Section C1 Hospital Cash Daily Allowance

1. Hospital Cash Claim Form duly signed by the Insured Person.
2. Copy of Discharge Summary / Discharge Certificate.
3. Copy of Final Hospital Bill
4. Aadhar card & PAN card Copies (Not mandatory if the same is linked with the policy while issuance or in previous claim)

For Section C2 Health Guard (Silver, Gold & Platinum Plan)

1. Claim form with NEFT details & cancelled cheque duly signed by Insured Person
2. Original/Attested copies of Discharge Summary / Discharge Certificate / Death Summary with Surgical & anesthetics notes
3. Attested copies of Indoor case papers
4. Original/Attested copies Final Hospital Bill with breakup of surgical charges, surgeon’s fees, OT charges etc.
5. Original Paid Receipt against the final Hospital Bill.
6. Original bills towards Investigations done / Laboratory Bills.
7. Original/Attested copies of Investigation Reports against Investigations done.
8. Original bills and receipts paid for the transportation from Registered Ambulance Service Provider. Treating Doctor
Certificate to transfer the Injured person to a higher medical center for further treatment (if Applicable).
9. Cashless settlement letter or other company settlement letter
10. First consultation letter for the current ailment.
11. In case of implant surgery, invoice & sticker.
CIN: U66010PN2000PLC015329 • UIN: BAJHLIP25037V022425 40
Bajaj Allianz General Insurance Co. Ltd.
Bajaj Allianz House, Airport Road, Yerawada, Pune - 411 006. Reg. No.: 113
For more details, log on to: [Link] | E-mail: bagichelp@[Link] or
Call at: Sales - 1800 209 0144 / Service - 1800 209 5858 (Toll Free No.)
IssuingOffice:

For Section C3 Critical illness

1. Critical Illness Claim Form duly signed by the Insured Person along with
2. NEFT Form signed by the Claimant
3. Copy of Discharge Summary / Discharge Certificate.
4. Copy of Final Hospital Bill
5. First consultation letter for Illness
6. Medical certificate for the duration of illness
7. All required Investigation Reports as per the Illness
8. Medical certification from specialist

For Section C4 Personal Accident and Section C5 Education Grant

I. Death
i. Duly Completed Personal Accident Claim Form signed by nominee.
ii. Copy of address proof (Ration card or electricity bill copy).
iii. Legal heir certificate containing affidavit and indemnity bond both duly signed by all legal heirs and notarized (If nominee
name not mentioned on Policy Schedule.).
iv. Attested copy of Death Certificate.
v. Burial Certificate (wherever applicable).
vi. Attested copy of Statement of Witness, if any lodged with police authorities.
vii. Attested copy of FIR / Panchanama / Inquest Panchanama.
viii. Attested copy of Post Mortem Report (if performed).
ix. Attested copy of Viscera report if any.
x. Photo identity proof

II. Permanent Partial /Total Disablement cover

i. Duly Completed Personal Accident Claim Form signed by Insured Person.
ii. Attested copy of disability certificate from certified Civil Surgeon of a Government Hospital stating percentage of disability.
iii. Attested copy of FIR. (If required)
iv. All X-Ray / Investigation reports and films supporting to disablement.

III. Temporary Total Disablement

i. Duly Completed Personal Accident Claim Form signed by Insured Person.
ii. Medical fitness certificate from treating doctor mentioning the type of disability and period of rest with date of fitness.
iii. Leave certificate from the employer for disablement period
iv. Attested copy of FIR. (If required)
v. All X-Ray reports and films.

Please send the documents on below address

Bajaj Allianz General Insurance Company 2nd Floor, Bajaj Finserv Building,
Behind Weikfield IT park, Off Nagar Road, Viman Nagar
Pune 411014| Toll free: 1800-103-2529, 1800-22-5858

Annexure I
ENT General Surgery

1 Stapedotomy 204 Infected Keloid Excision

2 Myringoplasty (Type I Tympanoplasty) 205 Incision of a pilonidal sinus / abscess

3 Revision stapedectomy 206 Axillary lymphadenectomy

4 Labyrinthectomy for severe Vertigo 207 W o u n d debridement and Cover

5 Stapedectomy under GA 208 A b s c e s s -Decompression

6 Ossiculoplasty 209 Cervical lymphadenectomy

7 Myringotomy with Grommet Insertion 210 infected sebaceous cyst

8 Tympanoplasty (Type III) 211 Inguinal lymphadenectomy

9 Stapedectomy under LA 212 Incision and drainage of Abscess

10 Revision of the fenestration of the inner ear. 213 Suturing of lacerations

11 Tympanoplasty (Type IV) 214 Scalp Suturing

12 Endolymphatic Sac Surgery for Meniere's Disease 215 Infected lipoma excision

13 Turbinectomy 216 Maximal anal dilatation

CIN: U66010PN2000PLC015329 • UIN: BAJHLIP25037V022425 40

Bajaj Allianz General Insurance Co. Ltd.
Bajaj Allianz House, Airport Road, Yerawada, Pune - 411 006. Reg. No.: 113
For more details, log on to: [Link] | E-mail: bagichelp@[Link] or
Call at: Sales - 1800 209 0144 / Service - 1800 209 5858 (Toll Free No.)
IssuingOffice:
14 Removal of Tympanic Drain under LA 217 Piles
A. Injection Sclerotherapy
15 Endoscopic Stapedectomy B. Piles banding

16 Fenestration of the inner ear

17 Incision and drainage of perichondritis 218 Liver Abscess- catheter drainage

18 Septoplasty 219 Fissure in Ano- fissurectomy

19 Vestibular Nerve section 220 Fibroadenoma breast excision

20 Thyroplasty Type I 221 Oesophageal varices Sclerotherapy

21 Pseudocyst of the Pinna – Excision 222 ERCP - pancreatic duct stone removal

22 Incision and drainage - Haematoma Auricle 223 Perianal abscess I&D

23 Tympanoplasty (Type II) 224 Perianal hematoma Evacuation

24 Keratosis removal under GA 225 Fissure in ano sphincterotomy

25 Ron of fracture of Nasal Bone 226 UGI scopy and Polypectomy oesophagus

26 Excision and destruction of lingual tonsils 227 Breast abscess I& D

27 Conchoplasty 228 Feeding Gastrostomy

28 Thyroplasty Type II 229 Oesophagoscopy and biopsy of growth oesophagus

29 Tracheostomy 230 UGI scopy and injection of adrenaline, sclerosants - bleeding

ulcers
30 Excision of Angioma Septum 231 ERCP - Bile duct stone removal

31 Turbinoplasty 232 Ileostomy closure

32 Incision & Drainage of Retro Pharyngeal Abscess 233 Colonoscopy

33 UvuloPalatoPharyngoPlasty 234 Polypectomy colon

34 Palatoplasty 235 Splenic abscesses Laparoscopic Drainage

35 Tonsillectomy without adenoidectomy 236 UGI SCOPY and Polypectomy stomach

36 Adenoidectomy with Grommet insertion 237 Rigid Oesophagoscopy for FB removal

37 Adenoidectomy without Grommet insertion 238 Feeding Jejunostomy

38 Vocal Cord lateralisation Procedure 239 Colostomy

39 Incision & Drainage of Para Pharyngeal Abscess 240 Ileostomy

40 Transoral incision and drainage of a pharyngeal abscess 241 colostomy closure

41 Tonsillectomy with adenoidectomy 242 Submandibular salivary duct stone removal

42 Tracheoplasty Ophthalmology 243 Pneumatic reduction of intussusception

43 Incision of tear glands 244 Varicose veins legs - Injection sclerotherapy

44 Other operation on the tear ducts 245 Rigid Oesophagoscopy for Plummer vinson syndrome

45 Incision of diseased eyelids 246 Pancreatic Pseudocysts Endoscopic Drainage

46 Excision and destruction of the diseased tissue of the 247 ZADEK's Nail bed excision
eyelid
47 Removal of foreign body from the lens of the eye. 248 Subcutaneous mastectomy

48 Corrective surgery of the entropion and ectropion 249 Excision of Ranula under GA

49 Operations for pterygium 250 Rigid Oesophagoscopy for dilation of benign Strictures

50 Corrective surgery of blepharoptosis 251 Eversion of Sac

CIN: U66010PN2000PLC015329 • UIN: BAJHLIP25037V022425 40

Bajaj Allianz General Insurance Co. Ltd.
Bajaj Allianz House, Airport Road, Yerawada, Pune - 411 006. Reg. No.: 113
For more details, log on to: [Link] | E-mail: bagichelp@[Link] or
Call at: Sales - 1800 209 0144 / Service - 1800 209 5858 (Toll Free No.)
IssuingOffice:
51 Removal of foreign body from conjunctiva a) Unilateral
b) Bilateral
52 Biopsy of tear gland

53 Removal of Foreign body from cornea 252 Lord's plication

54 Incision of the cornea 253 Jaboulay's Procedure

55 Other operations on the cornea 254 Scrotoplasty

56 Operation on the canthus and epicanthus 255 Surgical treatment of varicocele

57 Removal of foreign body from the orbit and the eye ball. 256 Epididymectomy

58 Surgery for cataract 257 Circumcision for Trauma

59 Treatment of retinal lesion 258 Meatoplasty

60 Removal of foreign body from the posterior chamber of 259 Intersphincteric abscess incision and drainage
the eye
Oncology 260 Psoas Abscess Incision and Drainage

61 IV Push Chemotherapy 261 Thyroid abscess Incision and Drainage

62 HBI-Hemibody Radiotherapy 262 TIPS procedure for portal hypertension

63 Infusional Targeted therapy 263 Esophageal Growth stent

64 SRT-Stereotactic Arc Therapy 264 PAIR Procedure of Hydatid Cyst liver

65 SC administration of Growth Factors 265 Tru cut liver biopsy

66 Continuous Infusional Chemotherapy 266 Photodynamic therapy or esophageal tumour and Lung
tumour
67 Infusional Chemotherapy 267 Excision of Cervical RIB

68 CCRT-Concurrent Chemo + RT 268 laparoscopic reduction of intussusception

69 2D Radiotherapy 269 Microdochectomy breast

70 3D Conformal Radiotherapy 270 Surgery for fracture Penis

71 IGRT- Image Guided Radiotherapy 271 Sentinel node biopsy

72 IMRT- Step & Shoot 272 Parastomal hernia

73 Infusional Bisphosphonates 273 Revision colostomy

74 IMRT- DMLC 274 Prolapsed colostomy- Correction

75 Rotational Arc Therapy 275 Testicular biopsy

76 Tele gamma therapy 276 laparoscopic cardiomyotomy( Hellers)

77 FSRT-Fractionated SRT 277 Sentinel node biopsy malignant melanoma

78 VMAT-Volumetric Modulated Arc Therapy 278 laparoscopic pyloromyotomy( Ramstedt)

79 SBRT-Stereotactic Body Radiotherapy Orthopedics

80 Helical Tomotherapy 279 Arthroscopic Repair of ACL tear knee

81 SRS-Stereotactic Radiosurgery 280 Closed reduction of minor Fractures

82 X-Knife SRS 281 Arthroscopic repair of PCL tear knee

83 Gammaknife SRS 282 Tendon shortening

84 TBI- Total Body Radiotherapy 283 Arthroscopic Meniscectomy - Knee

85 intraluminal Brachytherapy 284 Treatment of clavicle dislocation

86 Electron Therapy 285 Arthroscopic meniscus repair

87 TSET-Total Electron Skin Therapy 286 Haemarthrosis knee- lavage

CIN: U66010PN2000PLC015329 • UIN: BAJHLIP25037V022425 40

Bajaj Allianz General Insurance Co. Ltd.
Bajaj Allianz House, Airport Road, Yerawada, Pune - 411 006. Reg. No.: 113
For more details, log on to: [Link] | E-mail: bagichelp@[Link] or
Call at: Sales - 1800 209 0144 / Service - 1800 209 5858 (Toll Free No.)
IssuingOffice:
88 Extracorporeal Irradiation of Blood Products 287 Abscess knee joint drainage

89 Telecobalt Therapy 288 Carpal tunnel release

90 Telecesium Therapy 289 Closed reduction of minor dislocation

91 External mould Brachytherapy 290 Repair of knee cap tendon

92 Interstitial Brachytherapy 291 ORIF with K wire fixation- small bones

93 Intracavity Brachytherapy 292 Release of midfoot joint

94 3D Brachytherapy 293 ORIF with plating- Small long bones

95 Implant Brachytherapy 294 Implant removal minor

96 Intravesical Brachytherapy 295 K wire removal

97 Adjuvant Radiotherapy 296 POP application

98 Afterloading Catheter Brachytherapy 297 Closed reduction and external fixation

99 Conditioning Radiothearpy for BMT 298 Arthrotomy Hip joint

100 Extracorporeal Irradiation to the Homologous Bone 299 Syme's amputation

grafts
101 Radical chemotherapy 300 Arthroplasty

102 Neoadjuvant radiotherapy 301 Partial removal of rib

103 LDR Brachytherapy 302 Treatment of sesamoid bone fracture

104 Palliative Radiotherapy 303 Shoulder arthroscopy / surgery

105 Radical Radiotherapy 304 Elbow arthroscopy

106 Palliative chemotherapy 305 Amputation of metacarpal bone

107 Template Brachytherapy 306 Release of thumb contracture

108 Neoadjuvant chemotherapy 307 Incision of foot fascia

109 Adjuvant chemotherapy 308 calcaneum spur hydrocort injection

110 Induction chemotherapy 309 Ganglion wrist hyalase injection

111 Consolidation chemotherapy 310 Partial removal of metatarsal

112 Maintenance chemotherapy 311 Repair / graft of foot tendon

113 HDR Brachytherapy 312 Revision/Removal of Knee cap

Plastic Surgery 313 Amputation follow-up surgery

114 Construction skin pedicle flap 314 Exploration of ankle joint

115 Gluteal pressure ulcer-Excision 315 Remove/graft leg bone lesion

116 Muscle-skin graft, leg 316 Repair/graft achilles tendon

117 Removal of bone for graft 317 Remove of tissue expander

118 Muscle-skin graft duct fistula 318 Biopsy elbow joint lining

119 Removal cartilage graft 319 Removal of wrist prosthesis

120 Myocutaneous flap 320 Biopsy finger joint lining

121 Fibro myocutaneous flap 321 Tendon lengthening

122 Breast reconstruction surgery after mastectomy 322 Treatment of shoulder dislocation

123 Sling operation for facial palsy 323 Lengthening of hand tendon

124 Split Skin Grafting under RA 324 Removal of elbow bursa

CIN: U66010PN2000PLC015329 • UIN: BAJHLIP25037V022425 40

Bajaj Allianz General Insurance Co. Ltd.
Bajaj Allianz House, Airport Road, Yerawada, Pune - 411 006. Reg. No.: 113
For more details, log on to: [Link] | E-mail: bagichelp@[Link] or
Call at: Sales - 1800 209 0144 / Service - 1800 209 5858 (Toll Free No.)
IssuingOffice:
125 Wolfe skin graft 325 Fixation of knee joint

126 Plastic surgery to the floor of the mouth under GA 326 Treatment of foot dislocation

Urology 327 Surgery of bunion

127 AV fistula – wrist 328 intra articular steroid injection

128 URSL with stenting 329 Tendon transfer procedure

129 URSL with lithotripsy 330 Removal of knee cap bursa

130 CystoscopicLitholapaxy 331 Treatment of fracture of ulna

131 ESWL 332 Treatment of scapula fracture

132 Haemodialysis 333 Removal of tumor of arm/ elbow under RA/GA

133 Bladder Neck Incision 334 Repair of ruptured tendon

134 Cystoscopy & Biopsy 335 Decompress forearm space

135 Cystoscopy and removal of polyp 336 Revision of neck muscle ( Torticollis release )

136 Suprapubiccystostomy 337 Lengthening of thigh tendons

137 percutaneous nephrostomy 338 Treatment fracture of radius & ulna

139 Cystoscopy and "SLING" procedure. 339 Repair of knee joint Paediatric surgery

140 TUNA- prostate 340 Excision Juvenile polyps rectum

141 Excision of urethral diverticulum 341 Vaginoplasty

142 Removal of urethral Stone 342 Dilatation of accidental caustic stricture oesophageal

143 Excision of urethral prolapse 343 Presacral Teratomas Excision

144 Mega-ureter reconstruction 344 Removal of vesical stone

145 Kidney renoscopy and biopsy 345 Excision Sigmoid Polyp

146 Ureter endoscopy and treatment 346 Sternomastoid Tenotomy

147 Vesico ureteric reflux correction 347 Infantile Hypertrophic Pyloric Stenosis pyloromyotomy

148 Surgery for pelvi ureteric junction obstruction 348 Excision of soft tissue rhabdomyosarcoma

149 Anderson hynes operation 349 Mediastinal lymph node biopsy

150 Kidney endoscopy and biopsy 350 High Orchidectomy for testis tumours

151 Paraphimosis surgery 351 Excision of cervical teratoma

152 injury prepuce- circumcision 352 Rectal-Myomectomy

153 Frenular tear repair 353 Rectal prolapse (Delorme's procedure)

154 Meatotomy for meatal stenosis 354 Orchidopexy for undescended testis

155 surgery for fournier's gangrene scrotum 355 Detorsion of torsion Testis

156 surgery filarial scrotum 356 [Link] exploration in cryptorchidism

157 surgery for watering can perineum 357 EUA + biopsy multiple fistula in ano

158 Repair of penile torsion 358 Cystic hygroma - Injection treatment

159 Drainage of prostate abscess 359 Excision of fistula-in-ano

160 Orchiectomy Gynaecology

161 Cystoscopy and removal of FB 360 Hysteroscopic removal of myoma

Neurology 361 D&C

CIN: U66010PN2000PLC015329 • UIN: BAJHLIP25037V022425 40

Bajaj Allianz General Insurance Co. Ltd.
Bajaj Allianz House, Airport Road, Yerawada, Pune - 411 006. Reg. No.: 113
For more details, log on to: [Link] | E-mail: bagichelp@[Link] or
Call at: Sales - 1800 209 0144 / Service - 1800 209 5858 (Toll Free No.)
IssuingOffice:
162 Facial nerve physiotherapy 362 Hysteroscopic resection of septum

163 Nerve biopsy 363 thermal Cauterisation of Cervix

164 Muscle biopsy 364 MIRENA insertion

165 Epidural steroid injection 365 Hysteroscopic adhesiolysis

166 Glycerol rhizotomy 366 LEEP

167 Spinal cord stimulation 367 Cryocauterisation of Cervix

168 Motor cortex stimulation 368 Polypectomy Endometrium

169 Stereotactic Radiosurgery 369 Hysteroscopic resection of fibroid

170 Percutaneous Cordotomy 370 LLETZ

171 Intrathecal Baclofen therapy 371 Conization

172 Entrapment neuropathy Release 372 polypectomy cervix

173 Diagnostic cerebral angiography 373 Hysteroscopic resection of endometrial polyp

174 VP shunt 374 Vulval wart excision

175 Ventriculoatrial shunt 375 Laparoscopic paraovarian cyst excision

Thoracic surgery 376 uterine artery embolization

176 Thoracoscopy and Lung Biopsy 377 Bartholin Cyst excision

177 Excision of cervical sympathetic Chain Thoracoscopic 378 Laparoscopic cystectomy

178 Laser Ablation of Barrett's oesophagus 379 Hymenectomy( imperforate Hymen)

179 Pleurodesis 380 Endometrial ablation

180 Thoracoscopy and pleural biopsy 381 vaginal wall cyst excision

181 EBUS + Biopsy 382 Vulval cyst Excision

182 Thoracoscopy ligation thoracic duct 383 Laparoscopic paratubal cyst excision

183 Thoracoscopy assisted empyaema drainage 384 Repair of vagina ( vaginal atresia )

Gastroenterology 385 Hysteroscopy, removal of myoma

184 Pancreatic pseudocyst EUS & drainage 386 TURBT

185 RF ablation for barrett's Oesophagus 387 Ureterocoele repair - congenital internal

186 ERCP and papillotomy 388 Vaginal mesh For POP

187 Esophagoscope and sclerosant injection 389 Laparoscopic Myomectomy

188 EUS + submucosal resection 390 Surgery for SUI

189 Construction of gastrostomy tube 391 Repair recto- vagina fistula

190 EUS + aspiration pancreatic cyst 392 Pelvic floor repair( excluding Fistula repair)

191 Small bowel endoscopy (therapeutic) 393 URS + LL

192 Colonoscopy ,lesion removal 394 Laparoscopic oophorectomy

193 ERCP Critical care

194 Colonscopy stenting of stricture 395 Insert non- tunnel CV cath

195 Percutaneous Endoscopic Gastrostomy 396 Insert PICC cath ( peripherally inserted central catheter )

196 EUS and pancreatic pseudo cyst drainage 397 Replace PICC cath ( peripherally inserted central catheter )

197 ERCP and choledochoscopy 398 Insertion catheter, intra anterior

198 Proctosigmoidoscopy volvulus detorsion 399 Insertion of Portacath

CIN: U66010PN2000PLC015329 • UIN: BAJHLIP25037V022425 40

Bajaj Allianz General Insurance Co. Ltd.
Bajaj Allianz House, Airport Road, Yerawada, Pune - 411 006. Reg. No.: 113
For more details, log on to: [Link] | E-mail: bagichelp@[Link] or
Call at: Sales - 1800 209 0144 / Service - 1800 209 5858 (Toll Free No.)
IssuingOffice:
199 ERCP and sphincterotomy

200 Esophageal stent placement

201 ERCP + placement of biliary stents

202 Sigmoidoscopy w / stent

203 EUS + coeliac node biopsy

(i) The standard exclusions and waiting periods are applicable to all of the above procedures depending on the
medical condition/disease under treatment. Only 24 hours hospitalization is not mandatory.

Annexure II:-

List I: List of Non-Medical Items

SL No Item
1 Baby Food Not Payable
2 Baby Utilities Charges Not Payable
3 Beauty Services Not Payable
4 Belts/ Braces Not Payable
5 Buds Not Payable
6 Cold Pack/Hot Pack Not Payable

7 Carry Bags Not Payable

8 Email I Internet Charges Not Payable
9 Food Charges (Other Than Patient's Diet Provided By Hospital) Not Payable
10 Leggings Essential in bariatric and varicose vein surgery and
should be Considered For These Conditions Where
Surgery Itself Is Payable.
11 Laundry Charges Not Payable
12 Mineral Water Not Payable
13 Sanitary Pad Not Payable
14 Telephone Charges Not Payable
15 Guest Services Not Payable
16 Crepe Bandage Not Payable
17 Diaper Of Any Type Not Payable
18 Eyelet Collar Not Payable
19 Slings Not Payable
20 Blood Grouping And Cross Matching Of Donors Samples Not Payable
21 Service Charges Where Nursing Charges Also Charged Not Payable
22 Television Charges Not Payable
23 Surcha Rges Not Payable
24 Attendant Charges Not Payable
25 Extra Diet Of Patient (Other Than That Which Forms Part Of Bed Not Payable
Charge)
26 Birth Certificate Not Payable
27 Certificate Charges Not Payable
28 Courier Charges Not Payable
29 Conveyance Charges Not Payable
30 Medical Certificate Not Payable
31 Medical Records Not Payable
32 Photocopies Charges Not Payable
33 Mortuary Charges Not Payable

CIN: U66010PN2000PLC015329 • UIN: BAJHLIP25037V022425 40

Bajaj Allianz General Insurance Co. Ltd.
Bajaj Allianz House, Airport Road, Yerawada, Pune - 411 006. Reg. No.: 113
For more details, log on to: [Link] | E-mail: bagichelp@[Link] or
Call at: Sales - 1800 209 0144 / Service - 1800 209 5858 (Toll Free No.)
IssuingOffice:
34 Walking Aids Charges Not Payable
35 Oxygen Cylinder (For Usage Outside The Hospital) Not Payable
36 Spacer Not Payable
37 Spirometre Not Payable
38 Nebulizer Kit Not Payable
39 Steam Inhaler Not Payable
40 Armsling Not Payable
41 Thermometer Not Payable
42 Cervical Collar Not Payable
43 Splint Not Payable
44 Diabetic Foot Wear Not Payable
45 Knee Braces (Long/ Short/ Hinged) Not Payable
46 Knee Immobilizer/S Houlder Immobilizer Not Payable
47 Lumbosacral Belt Not Payable
48 Nimbus Bed Or Water Or Air Bed Charges Not Payable
49 Ambulance Collar Not Payable
50 Ambulance Equipment Not Payable
51 Abdominal Binder Not Payable
52 Private Nurses Charges - Special Nursing Not Payable
53 Sugar Free Tablets Not Payable
54 Creams Powders Lotions (Toiletries Are Not Payable, Not Payable
Only Prescribed Medical Pharmaceuticals Payable)
55 Ecg Electrodes Not Payable
56 Gloves Not Payable
57 Nebulisation Kit Not Payable
58 Any Kit With No Details Mentioned [Delivery Kit, Not Payable
59 Kidney Tray Not Payable
60 Mask Not Payable
61 Ounce Glass Not Payable
62 Oxygen Mask Not Payable
63 Pelvic Traction Belt Not Payable
64 Pan Can Not Payable
65 Trolly Cover Not Payable
66 Urometer , Urine Jug Not Payable
68 Vasofix Safety Not Payable

List ll - ltems that are to be subsumed into Room Charges

S. No. Item

1 Baby Charges (Unless Specified /Indicated)

2 Hand Wash
3 Shoe Cover
4 Caps
5 Cardle Charges
6 Comb
7 Eau-De-Cologne/Room Freshners
8 Foot Cover

9 Gown

10 Slippers

11 Tissue Papper

CIN: U66010PN2000PLC015329 • UIN: BAJHLIP25037V022425 40

Bajaj Allianz General Insurance Co. Ltd.
Bajaj Allianz House, Airport Road, Yerawada, Pune - 411 006. Reg. No.: 113
For more details, log on to: [Link] | E-mail: bagichelp@[Link] or
Call at: Sales - 1800 209 0144 / Service - 1800 209 5858 (Toll Free No.)
IssuingOffice:
12 Tooth Paste

13 Tooth Brush

14 Bed Pan

15 Face Mask

16 Flexi Mask

17 Hand Holder

18 Sputum Cup

19 Disinfectant Lotions

20 Luxury Tax

21 Hvac

22 House Keeping Charges

23 Air Conditioner Charges

24 Im Iv Injection Charges

25 Clean Sheet

26 Blanket/Warmer Blanket

27 Admission Kit

28 Diabetic Chart Charges

29 Documentation Charges/Administrative Expenses

30 Discharge Procedure Charges

31 Daily Chart Charges

32 Entrance Pass / Visitors Pass Charges

33 Expenses Related To Prescription On Discharge

34 File Opening Charges

35 INCTDENTAL EXPENSES / Mtsc. CHARGES (NOT EXPLATNED)

36 Patient Identification Band / Name Tag

37 Pulseoxymeter Charges

List lll- ltems that are to be subsumed into Procedure Charges

S. No. Item

1 Hair Removal Cream

2 DISPOSABLES RAZORS CHARGES(For Site Preparations)

3 Eye Pad

4 Eye Sheild

5 Camera Cover

6 Dvd ,Cd Charges

7 Gause Soft

8 GAUZE
9 WARD AND THEATRE BOOKING CHARGES

10 ARTHROSCOPE AND ENDOSCOPY INSTRUMENTS

11 MICROSCOPE COVER

CIN: U66010PN2000PLC015329 • UIN: BAJHLIP25037V022425 40

Bajaj Allianz General Insurance Co. Ltd.
Bajaj Allianz House, Airport Road, Yerawada, Pune - 411 006. Reg. No.: 113
For more details, log on to: [Link] | E-mail: bagichelp@[Link] or
Call at: Sales - 1800 209 0144 / Service - 1800 209 5858 (Toll Free No.)
IssuingOffice:
12 SURGICAL BLADES,HARMONICSCALPEL,SHAVER

13 SURGICAL DRILL

14 EYE KIT

15 EYE DRAPE

16 X-RAY FILM

17 BOYLES APPARATUS CHARGES

18 COTTON

19 COTTON BANDAGE

20 SURGICAL TAPE

21 APRON

22 TORNIQUET

23 ORTHOBUNDLE, GYNAEC BUNDLE

List lV - ltems that are to be subsumed into costs of treatment

S. No. Item

1 ADMISSION/REGISTRATION CHARGES

2 HOSPITALIZATION FOR EVALUATION/DIAGNOSTIC PURPOSE

3 URINE CONTAINER

4 BLOOD RESERVATION CHARGES AND ANTE NATAL BOOKING CHARGES

5 BIPAP MACHINE

6 CPAP/CAPD EQUIPMENTS

7 INFUSION PUMP-COST

8 HYDROGEN PERPOXIDE\SPIRIT\DISINFECTION ETC

9 NUTTRITION PLANNING CHARGES - DIETICIAN CHARGES - DIET CHARGES

10 HIV KIT

11 ANTISEPTIC MOUTHWASH

12 LOZENGES

13 MOUTH PAINT

14 VACCINATION CHARGES

15 ALCOHOL SWABES

16 SCRUB SOLUTION / STERILLIUM

17 GLUCOMETER & STRIPS

18 URINE BAG

CIN: U66010PN2000PLC015329 • UIN: BAJHLIP25037V022425 40

Bajaj Allianz General Insurance Co. Ltd.
Bajaj Allianz House, Airport Road, Yerawada, Pune - 411 006. Reg. No.: 113
For more details, log on to: [Link] | E-mail: bagichelp@[Link] or
Call at: Sales - 1800 209 0144 / Service - 1800 209 5858 (Toll Free No.)
IssuingOffice:

Annexure III: Modern Treatment Methods and Advancement in Technologies

A. Uterine Artery Embolization and HIFU

B. Balloon Sinuplasty
C. Deep Brain stimulation
D. Oral chemotherapy
E. Immunotherapy- Monoclonal Antibody to be given as injection
F. Intra vitreal injections
G. Robotic surgeries
H. Stereotactic radio surgeries
I. Bronchical Thermoplasty
J. Vaporisation of the prostrate (Green laser treatment or holmium laser treatment)
K. IONM -(Intra Operative Neuro Monitoring)
L. Stem cell therapy: Hematopoietic stem cells for bone marrow transplant for haematological conditions to be covered

Annexure IV: ICD specific for Mental Illness

ICD Codes ICD Description

F00 Dementia in Alzheimer disease

F02 Dementia in other diseases classified elsewhere

F03 Unspecified dementia

F05 Delirium, not induced by alcohol and other psychoactive substances

F07 Personality and behavioural disorders due to brain disease, damage and dysfunction

F09 Unspecified organic or symptomatic mental disorder

F20 Schizophrenia

F21 Schizotypal disorder

F22 Persistent delusional disorders

F23 Acute and transient psychotic disorders

F24 Induced delusional disorder

F25 Schizoaffective disorders

F31 Bipolar affective disorder

F32 Depressive episode

F33 Recurrent depressive disorder

F40 Phobic anxiety disorders

CIN: U66010PN2000PLC015329 • UIN: IXXXXXXXXXXXXXXXXXXXXXXXX 41

Bajaj Allianz General Insurance Co. Ltd.
Bajaj Allianz House, Airport Road, Yerawada, Pune - 411 006. Reg. No.: 113
For more details, log on to: [Link] | E-mail: bagichelp@[Link] or
Call at: Sales - 1800 209 0144 / Service - 1800 209 5858 (Toll Free No.)
IssuingOffice:

Annexure V: Contact details of the Ombudsman offices

Jurisdiction of Office
Office Details
Union Territory, District)

AHMEDABAD -
Insurance Ombudsman
Office of the Insurance Ombudsman,
Jeevan Prakash Building, 6th floor,
Gujarat, Dadra & Nagar Haveli, Daman and Diu
Tilak Marg, Relief Road,
AHMEDABAD – 380 001.
Tel.: 079 – 25501201 /02 /05/06
Email: [Link]@[Link]

BENGALURU -
Insurance Ombudsman
Office of the Insurance Ombudsman,
Jeevan Soudha Building,PID No. 57-27-N-19
Karnataka.
Ground Floor, 19/19, 24th Main Road,
JP Nagar, Ist Phase, Bengaluru – 560 078.
Tel.: 080 - 26652048 / 26652049
Email: [Link]@[Link]

BHOPAL -
Insurance Ombudsman
Office of the Insurance Ombudsman,
1st floor, “Jeevan Shikha", Madhya Pradesh
60-B,Hoshangabad Road, Opp. Gayatri Mandir, Chattisgarh.
Bhopal – 462 011.
Tel.: 0755 - 2769201 / 2769202
Email: [Link]@[Link]

BHUBANESHWAR –
Insurance Ombudsman
Office of the Insurance Ombudsman,
62, Forest park, Orissa.
Bhubaneswar – 751 009.
Tel.: 0674 – 2596461 / 2596455
Email: [Link]@[Link]

CHANDIGARH -
Insurance Ombudsman
Office of the Insurance Ombudsman,
Punjab, Haryana (excluding Gurugram, Faridabad,
Jeevan Deep Building SCO 20-27,
Sonepat and Bahadurgarh), Himachal Pradesh, Union
Ground Floor Sector- 17 A,
Territories of Jammu & Kashmir,Ladakh & Chandigarh.
Chandigarh – 160 017
Tel.: 0172 – 4646394 / 2706468
Email: [Link]@[Link]

CHENNAI -
Insurance Ombudsman
Office of the Insurance Ombudsman,
Fatima Akhtar Court, 4th Floor, 453, Tamil Nadu, Puducherry Town and Karaikal (which are
Anna Salai, Teynampet, part of Puducherry)
CHENNAI – 600 018.
Tel.: 044 - 24333668 / 24333678
Email: [Link]@[Link]

DELHI –
Insurance Ombudsman
Office of the Insurance Ombudsman,
2/2 A, Universal Insurance Building, Delhi & following Districts of Haryana - Gurugram,
Asaf Ali Road, Faridabad, Sonepat & Bahadurgarh.
New Delhi – 110 002.
Tel.: 011 - 23237539
Email: [Link]@[Link]

CIN: U66010PN2000PLC015329 • UIN: IXXXXXXXXXXXXXXXXXXXXXXXX 42

Bajaj Allianz General Insurance Co. Ltd.
Bajaj Allianz House, Airport Road, Yerawada, Pune - 411 006. Reg. No.: 113
For more details, log on to: [Link] | E-mail: bagichelp@[Link] or
Call at: Sales - 1800 209 0144 / Service - 1800 209 5858 (Toll Free No.)
IssuingOffice:

Jurisdiction of Office
Office Details
Union Territory, District)

GUWAHATI -
Insurance Ombudsman
Office of the Insurance Ombudsman,
Jeevan Nivesh, 5th Floor, Assam, Meghalaya, Manipur, Mizoram, Arunachal
Nr. Panbazar over bridge, S.S. Road, Pradesh, Nagaland and Tripura.
Guwahati – 781001(ASSAM).
Tel.: 0361 - 2632204 / 2602205
Email: [Link]@[Link]

HYDERABAD -
Insurance Ombudsman
Office of the Insurance Ombudsman,
6-2-46, 1st floor, "Moin Court", Andhra Pradesh, Telangana, Yanam and part of Union
Lane Opp. Saleem Function Palace, Territory of Puducherry.
A. C. Guards, Lakdi-Ka-Pool, Hyderabad - 500 004.
Tel.: 040 - 23312122
Email: [Link]@[Link]

JAIPUR -
Insurance Ombudsman
Office of the Insurance Ombudsman,
Jeevan Nidhi – II Bldg., Gr. Floor,
Rajasthan.
Bhawani Singh Marg,
Jaipur - 302 005.
Tel.: 0141 –2740363 / 2740798
Email: [Link]@[Link]

KOCHI –
Insurance Ombudsman
Office of the Insurance Ombudsman,
10th Floor, Jeevan Prakash,LIC Building, Kerala, Lakshadweep, Mahe-a part of Union Territory
Opp to Maharaja's College Ground,[Link], of Puducherry.
Kochi - 682 011.
Tel.: 0484 - 2358759
Email: [Link]@[Link]

KOLKATA –
Insurance Ombudsman
Office of the Insurance Ombudsman,
Hindustan Bldg. Annexe, 7th Floor,
West Bengal, Sikkim, Andaman & Nicobar Islands.
4, C.R. Avenue,
KOLKATA - 700 072.
Tel.: 033 - 22124339 / 22124341
Email: [Link]@[Link]

LUCKNOW – Districts of Uttar Pradesh : Lalitpur, Jhansi, Mahoba,

Insurance Ombudsman Hamirpur, Banda, Chitrakoot, Allahabad, Mirzapur,
Office of the Insurance Ombudsman, Sonbhabdra, Fatehpur, Pratapgarh, Jaunpur,Varanasi,
6th Floor, Jeevan Bhawan, Phase-II, Gazipur, Jalaun, Kanpur, Lucknow, Unnao, Sitapur,
Nawal Kishore Road, Hazratganj, Lakhimpur, Bahraich, Barabanki, Raebareli, Sravasti,
Lucknow - 226 001. Gonda, Faizabad, Amethi, Kaushambi, Balrampur,
Tel.: 0522 - 4002082 / 3500613 Basti, Ambedkarnagar, Sultanpur, Maharajgang,
Email: [Link]@[Link] Santkabirnagar, Azamgarh, Kushinagar, Gorkhpur,
Deoria, Mau, Ghazipur, Chandauli, Ballia,
Sidharathnagar..

MUMBAI -
Insurance Ombudsman
Office of the Insurance Ombudsman,
3rd Floor, Jeevan Seva Annexe, Goa, Mumbai Metropolitan Region (excluding Navi
S. V. Road, Santacruz (W), Mumbai & Thane).
Mumbai - 400 054.
Tel.: 022 - 69038800/ 27/ 29/ 31/ 32/ 33
Email: [Link]@[Link]

NOIDA - State of Uttarakhand and the following Districts of Uttar

CIN: U66010PN2000PLC015329 • UIN: IXXXXXXXXXXXXXXXXXXXXXXXX 43

Bajaj Allianz General Insurance Co. Ltd.
Bajaj Allianz House, Airport Road, Yerawada, Pune - 411 006. Reg. No.: 113
For more details, log on to: [Link] | E-mail: bagichelp@[Link] or
Call at: Sales - 1800 209 0144 / Service - 1800 209 5858 (Toll Free No.)
IssuingOffice:

Jurisdiction of Office
Office Details
Union Territory, District)

Insurance Ombudsman Pradesh: Agra, Aligarh, Bagpat, Bareilly, Bijnor,

Office of the Insurance Ombudsman, Budaun, Bulandshehar, Etah, Kannauj, Mainpuri,
Bhagwan Sahai Palace Mathura, Meerut, Moradabad, Muzaffarnagar, Oraiyya,
4th Floor, Main Road, Naya Bans, Sector 15, Pilibhit, Etawah, Farrukhabad, Firozbad, Gautam
Distt: Gautam Buddh Nagar, U.P-201301. Buddh nagar, Ghaziabad, Hardoi, Shahjahanpur,
Tel.: 0120-2514252 / 2514253 Hapur, Shamli, Rampur, Kashganj, Sambhal, Amroha,
Email: [Link]@[Link] Hathras, Kanshiramnagar, Saharanpur.

PATNA –
Insurance Ombudsman
Office of the Insurance Ombudsman,
2nd Floor, Lalit Bhawan, Bihar,
Bailey Road, Jharkhand.
Patna 800 001.
Tel.: 0612-2547068
Email: [Link]@[Link]

PUNE -
Insurance Ombudsman
Office of the Insurance Ombudsman,
Jeevan Darshan Bldg., 3rd Floor, Maharashtra, Areas of Navi Mumbai and Thane
C.T.S. No.s. 195 to 198, N.C. Kelkar Road, (excluding Mumbai Metropolitan Region).
Narayan Peth, Pune – 411 030.
Tel.: 020- 24471175
Email: [Link]@[Link]

Note: Address and contact number of Governing Body of Insurance Council:

Council for Insurance Ombudsmen,
3rd Floor, Jeevan Seva Annexe, S. V. Road, Santacruz (W),Mumbai - 400 054.
E-mail: inscoun@[Link] , Tel: 022 -69038800/69038812
Website: [Link]

CIN: U66010PN2000PLC015329 • UIN: IXXXXXXXXXXXXXXXXXXXXXXXX 44