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    Health Insurance

    Convalescence Benefit Under Health Insurance

    HealthGuard

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    • Hospitalisation & Day Care Expenses

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    Pre-hospitalisation expenses (up to 60 days) and post-hospitalisation expenses (up to 90 days) are covered as per policy terms

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    Exhausted sum insured exhausted or SI will be reinstated so that you can avail full coverage for your next claim in a policy year (as per policy terms) if needed

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    • Note

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    Exclusions

    What’s not covered?
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    • Initial Waiting Period

    Treatment expenses during the first 30 days except for treatment of accidental injuries

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    • Pre-Existing Diseases

    Treatment expenses for pre-existing diseases such as diabetes, asthma, thyroid and other PED, are excluded until 36 months from date of your first Health Guard Policy

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    • Specific Illness Treatment

    Treatment expenses for specified illnesses, including hernia, gout, endometriosis, and cataract are excluded until 24 months from date of your first Health Guard Policy

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    • Maternity Expenses

    Treatment expenses related to maternity are excluded until 72 months from date of your first Health Guard Policy

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    • Expenses for Medical Investigation & Evaluation

    Medical expenses primarily for diagnostic procedures and medical evaluation unrelated to the current diagnosis or treatment

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    • Dietary Supplements & Substances

    Cost of supplements that are purchased without a prescription by a certified doctor as a part of treatment, including vitamins, minerals and organic substances

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    Treatment to change appearance unless it is for reconstruction required for a medically essential treatment or following an accident or burns

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    • Voluntary Aggregate Deductible

    Covers medical expenses for in-patient hospitalisation beyond the voluntary aggregate deductible limit (INR 50,000/ INR 1,00,000/ INR 2,00,000/ INR 3,00,000) as opted as per policy terms for in-patient hospitalisation treatment

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    Wellness Discount

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    Reinstatement Benefits

    Unlimited reinstatement of the sum insured upto 100% SI after its depletion

    What is Convalescence Benefit?

    Convalescence is the name for the period of recovery from an illness or injury. Health Insurance providers do have provisions for your recuperating period, but due to lack of knowledge, many times this Convalescence Benefit goes unclaimed.

    Sometimes you may require hospitalization for a prolonged period of time. Health Insurance Companies do provide a lump sum for your recovery in the hospital. This period is usually considered as a term of 7-10 days, depending upon your health insurance provider or the health plan in which you are enrolled.

    At-A-Glance

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    Plans
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    Health Guard Silver

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    Health Guard Gold

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    Health Guard Platinum

    Hospital & Day Care SI INR 1.5/ 2 Lacs INR 3 Lacs to INR 50 Lacs INR 5 Lacs to INR 1 Cr.
    Room Limits Up to 1% of SI per day and ICU at actuals Single private AC room for sum insured of SI 3 Lacs to 7.5 Lacs | Actuals for SI 10 Lacs & above | ICU at Actuals Single private AC room for sum insured of SI 3 Lacs to 7.5 Lacs | Actuals for SI 10 Lacs & above | ICU at Actuals
    Pre- & Post-Hospitalisation Pre: 60 days & Post: 90 days Pre: 60 days & Post: 90 days Pre: 60 days & Post: 90 days
    Organ Donor, AYUSH, Modern Treatments Up to sum insured Up to sum insured Up to sum insured
    Road Ambulance INR 20,000/policy year INR 20,000/policy year INR 20,000/policy year
    Preventive Check-Up 1% of SI (max up to 2,000) once in 3 years 1% of SI (max up to 5,000) once in 3 years 1% of SI (max up to 5,000) once in 2 years
    Maternity & Newborn Care Not covered As per limits specified As per limits specified
    Convalescence Benefit INR 5,000/policy year INR 5,000/policy year for sum insured up to INR 5 lacs | INR 7,500/policy year for sum insured of 7.5 lacs and above INR 5,000/policy year for sum insured up to INR 5 lacs | INR 7,500/policy year for sum insured of 7.5 lacs and above
    Sum Insured Reinstatement 100% of the base sum insured 100% of the base sum insured 100% of the base sum insured
    Wellness Discount Up to 12.5% wellness discount for healthy habits on renewal Up to 12.5% wellness discount for healthy habits on renewal Up to 12.5% wellness discount for healthy habits on renewal
    More Covers See Policy documents for more details

    Convalescence Benefit in Health Insurance: Examples

    ●      Post-surgery hospitalisation: A patient recovering from knee replacement surgery spends 12 days in the hospital. Once discharged, they receive a lump-sum recovery benefit as part of their convalescence cover.

    ●      Severe infection: If a dengue patient requires 9 days of continuous care, the benefit becomes payable, even though the medical bill was already settled.

    ●      ICU treatment and slow recovery: In case of a cardiac ICU stay extending beyond 10 days, the convalescence payout supports income loss or helps hire post-discharge caregivers.

    ●      Children’s education support: Some insurers extend this benefit to cover ongoing school fees during the policyholder's hospital recovery, easing family burdens.

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    Convalescence Benefit: Family Visit Coverage

    The insurer may also agree to cover ‘Compassionate visits’ by family members under Convalescence Benefit. What this means is that if you have family members living far away, their conveyance for coming to see you at the hospital will be taken care of by the insurer.

    Convalescence Benefit could be called a Hidden Benefit, which you have to fish out from the fine print of your policy documents, and the search will be worth it.

    Why Does the Insurer Pay the Lump Sum?

    Most people who have Health Insurance policies are unaware of the Convalescence feature. This provision compensates you for loss of income since you are unable to attend work during your recovery period.

    Where to Claim Convalescence Benefit in Health Insurance?

    To claim the convalescence benefit, you need to submit a claim request to your health insurance provider along with discharge summary and proof of hospitalisation exceeding the minimum required duration (usually 7–10 days). The payout is made separately from hospital expenses and is typically offered as a lump sum. With Bajaj General Insurance, this benefit can be claimed through their online portal or mobile app, depending on policy terms.

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    Convalescence Benefit Claim Amount: How Much Can You Get?

    The claim amount for convalescence benefit in health insurance is usually fixed in the policy and ranges from ₹5,000 to ₹20,000 per instance. Some insurers offer it as a fixed lump sum per hospitalisation exceeding the defined number of days, while others may pay a daily recovery allowance. The actual payout varies based on plan type, sum insured and rider options. Importantly, this benefit does not reduce your overall sum insured—it’s paid in addition to your medical claim.

    Key Things to Know Before Buying Convalescence Benefit Cover

    ●        Look for policies that offer convalescence as a built-in or optional rider

    ●        Check the hospitalisation duration required to trigger the benefit (usually 7–10 days)

    ●        Confirm whether the benefit is fixed or paid per day of extended stay

    ●        Ensure the payout is additional, not deducted from the sum insured

    ●        Some policies cover lost income, home recovery or children’s education

    ●        Group policies may or may not include it—always check your employer cover

    ●        With 18,400+ cashless hospitals with Bajaj General Insurance, you can focus on recovery, not paperwork

    ●        Read the terms carefully—certain illnesses or planned procedures may be excluded

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    Non-Medical Expenses

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    Covers non-medical items

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    Waiver of Room Capping

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    FAQ's

    Is Convalescence Benefit Included in Regular Health Insurance?

    Not always. It is usually an add-on or included only in comprehensive or premium plans.

    Why Is Convalescence Benefit Considered a Hidden Feature?

    Many policyholders are unaware of it because it’s a fixed payout separate from hospital bills and not linked to treatment expenses.

    Does Convalescence Benefit Cover Family Visit Expenses?

    Generally no. It supports recovery-related expenses, not travel or lodging for family members.

    Is There a Limit on Convalescence Benefit Coverage?

    Yes. Insurers set a fixed maximum amount per claim or per year, typically between ₹5,000 and ₹20,000.

    Is Convalescence Benefit Given as a Lump-Sum Payment?

    Yes. It is usually paid as a one-time fixed amount after a qualifying hospital stay.

    Can You Purchase Convalescence Benefit Online with Health Insurance?

    Yes. Many insurers allow adding this rider during purchase or renewal, depending on your health profile.

    When Does Convalescence Benefit Become Payable?

    It is payable after continuous hospitalisation for a specified duration (typically 7–10 days), based on policy terms.

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