Arogya Sanjeevani Mediclaim Insurance

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What is Arogya Sanjeevani Policy?

It’s a newly launched health insurance policy with standard features which is to be offered by all health insurance companies in India starting from 1st April, 2020 onwards. The name of the policy will be ‘Arogya Sanjeevani Policy – Insurance company name’. This plan is for individuals and families that provides coverage for hospitalization-related expenses. The coverage and terms & conditions of Arogya Sanjeevani health insurance policy have been set up by the IRDAI and hence, remain the same across all health insurance providers, while the premium may be set by the insurers on their own.

The intent of the IRDAI to launch such a plan was to Simplify Health insurance for the common man since many of the existing health insurance policies in the Indian market are rather complex, with long list of features coupled with varying terms and conditions that make it difficult for an individual to make up their mind on what plan to opt for.

Arogya Sanjeevani Policy as a plan offers Sum Insured coverage benefits within a range of Rs. 1 lac to Rs. 5 lacs. Arogya Saneevani can be easily purchased only from any of the health insurance providers. Some visible advantages of the plan include NIL deductibles while having a 5% co-pay for all insured for their claims . There is also a bonus of 5% for every claim-free year, subjected to a maximum of 50%

Arogya Sanjeevani Policy benefits

  • Features
  • Coverages
  • Terms and conditions
  • Cancellation
  • Exclusions
  • How to buy
  • Companies offered
  • Cashless claims

What are the Features of this Policy?

Feature Description
Sum Assured Minimum Sum Assured is ₹ 1 Lac
Maximum Sum Assured is ₹ 5 Lacs
(Sum Assured can be opted for in multiples of ₹50,000)
Minimum & Maximum Entry Age for Principal Assured Adult
  • Minimum Entry Age is 18 years
  • Maximum Entry Age is 65 years
Children
  • Minimum Entry Age is 3 months
  • Maximum Entry Age is 25 years
Policy Term 1 year
Policy Type Individual Plan / Family Floater Plan
Hospitalisation Benefit Limits
  • For hospitalization expenses like room, boarding, nursing expenses up to 2% of Sum Assured or a maximum of ₹5,000 per day.
  • ICU/ICCU expenses will also be provided up to 5% of sum assured or a maximum of ₹10,000 per day
  • Ambulance Charges upto ₹2,000 per hospitalisation
  • Sub-limits of cataract surgery are equal to actual expenses i.e. 25% sum assured or ₹4 lacs, whichever is lower.
Pre & Post Hospitalization Pre Hospitalization expenses upto – 30 days
Post Hospitalization expenses upto – 60 days
Initial Waiting Period 30 days waiting period. No claim will be paid in first 30 days after buying policy
Specific Waiting Period 24 months - Benign ENT disorders, Sinus, Cataract and age-related eye illnesses, Non-infective arthritis, tympanoplasty, Polyps, Gastric ulcer, Rheumatism, Gout, Tonsillectomy, Mastoidectomy, cysts, Spinal diseases except for accidental cases
48 months - Joint replacement treatment unless it is from an accident, Osteoporosis, etc
48 months - Pre-Existing Disease (pre-existing disease or medical condition)
Co-payment Co-pay fixed at 5% for all ages/sum insureds in this policy
AYUSH Treatment AYUSH treatments are covered
(AYUSH means all treatments related to Ayurvedic, Yoga, and Naturopathy, Unani, Siddha, Homeopathy)
NCB (No Claim Bonus) NCB (No Claim Bonus) of 5% for each year up to 50% of the sum assured is covered.
Other Policy Benefits
Family Members that can be covered under Floater Plan The policyholder can include dependents, such as their legally wedded spouse, parents, dependent children (including legally adopted children) and parents-in-law.
Note that any children who are above 18 yrs and financially independent will not be eligible for family floater coverage
Cashless Benefit Yes, Cashless Treatment is available under this policy at the respective insurance company’s Network Hospitals
Premium Payment Frequency Premiums can be paid on a Monthly, Quarterly, Half-yearly and Annual basis.
Renewability Lifetime Renewability available on this policy
Portability The policy offers the Portability option to other health insurance companies
Daycare Treatment It covers the expenses arising out of any day care treatment procedures
Specific Coverages under this Policy
Modern Treatment Methods
(Covered upto 50% of the Sum Insured)
  1. Uterine Artery Embolization and HIFU (High Intensity Focused Ultrasound)
  2. Balloon Sinuplasty
  3. Deep Brain Stimulation
  4. Oral Chemotherapy
  5. Immunotherapy – Monoclonal Antibody to be given as injection
  6. Intra Vitreal injections
  7. Robotic surgeries
  8. Stereotactic radio surgeries
  9. Bronchial Thermoplasty
  10. Vaporization of the prostrate (Green laser treatment or holmium laser treatment)
  11. IONM – (Intra Operative Neuro Monitoring)
  12. Stem Cell Therapy - Hematopoietic stem cells for bone marrow transplant for haematological conditions to be cover
Plastic Surgery and Dental Treatment Expenses The cost of any dental or plastic surgery treatment taken as a result of an illness or injury is covered under this policy


Expenses Covered under Arogya Sanjeevani Policy

Pre & Post Hospitalization Expenses
This policy will cover all the pre-hospitalization expenses (upto 30 days) and post-hospitalization expenses (upto 60 days) following an emergency illness or accidental injury.

ICU Charges
The Arogya Sanjeevani policy pays ICU/ICCU expenses be provided up to 5% of sum assured or a maximum of ₹10,000 per day.

Room Rent
It covers the room rent of the hospital to up to a maximum of ₹5,000 per day.

Ambulance Services
It covers the cost of ambulance services up to a maximum of ₹2000 per hospitalization.

Cataract Surgery
It also covers the cost of cataract surgery upto a maximum of ₹40,000 or 25% of the sum insured amount, whichever is less for each eye.

Coronavirus (COID-19) Expenses
It covers any expenses incurred on hospitalization/treatment due to contracting COVID-19 or coronavirus disease.

AYUSH Treatment
AYUSH treatments are covered at recognised medical centres. (AYUSH means all treatments related to Ayurvedic, Yoga, and Naturopathy, Unani, Siddha, Homeopathy).

New Age/ Modern Treatment
This policy also covers the cost of modern/ new age treatment up to a maximum of 50% of the sum insured amount. The list of illnesses are in the table above.

Terms and Conditions of Arogya Sanjeevani Policy

Sum Assured
This policy offers the multiple sum assured options from ₹1 lac to ₹5 lacs in the multiple of ₹50,000. The sum assured is available on both individual and family floater basis.

Policy Duration
This policy scheme offers policy term option of one year and is renewable on a lifetime basis.

Co-payment
For insureds of all age categories and sum insureds, this policy offers a standard co-payment option of 5% of the incurred claims amount payable at the time of settlement.

Cumulative Bonus
Arogya Sanjeevani policy also provides a bonus of 5% on the total sum insured amount for every claim-free year that is passed by the insured, and this is accumulated upto a maximum of 50% of the sum insured as a bonus.

Frequency of Premium Payment
The premium for this policy can be paid on a monthly, half-yearly, quarterly, and annual basis.

Portability
Arogya Sanjeevani policy is easily portable from one insurance company depending on the requirements of the insured.

Grace Period
For annual premium payment, 30 days grace period is allowed and for other modes (monthly, quarterly, half yearly) of premium payment 15 days grace period is allowed.

Free Look Period
The policy has a Free Look period of 15 days, within which the insure can cancel the policy and expect a full refund.

Policy Cancellation and Refunds

The insured can cancel the policy at anytime during the policy year, subject to following refund options:
Time of Cancellation % of Premium Refund
Free Look Period 100% refund
< 30 days 75% refund
31 days – 3 months 50% refund
3 months – 6 months 25% refund
> 6 months NIL Refund


Exclusions under the Arogya Sanjeevani Health Insurance Plan

The Arogya Sanjeevani health insurance policy excludes the following treatments:
  • Maternity Expenses - Cost of treatment related to pregnancy and child birth
  • Domiciliary hospitalization - Domiciliary hospitalization expenses
  • Outpatient Treatment – Policy covers only expenses incurred during Inpatient treatment (atleast 24 hours hospitalisation)
  • Adventure/ Hazardous Sports – Active Participation in a hazardous activities including scuba diving, rock climbing, sky diving, parasailing, deep-sea diving, mountaineering, etc, as a professional
  • Cosmetic or Plastic Surgery – Unnecessary expenses for cosmetic/plastic surgery following an accident, burn injury, other medically necessary treatment
  • Diagnostic or Investigative Tests - Diagnostic or Investigative tests done by the insured which are elective in nature
  • Alcohol/ Drug addiction- Treatment following addiction of alcohol or drug/substance abuse
  • Bed Rest or Rehabilitation Expenses
  • Expenses for Treatment of Sterility or Infertility
  • Claims due to a Nuclear Attack or War/ War-like situation
  • Expenses incurred for Weight Control/ Obesity Treatment
  • Any Treatment received by the insured outside the boundaries of India
  • Expenses relating to surgery or treatment of Gender change
Please review the Terms & Conditions/Policy Wordings for the complete list of exclusions under the Arogya Sanjeevani policy.

How can one buy the Arogya Sanjeevani Policy?

Perhaps the easiest way to purchase a Arogya Sanjeevani health insurance policy will be online because the IRDAI has allowed insurance companies to issue the Arogya Sanjeevani electronically to the policyholders. This means that the insurance company can only share a online pdf document as an insurance policy to the insured unlike all other insurance plans currently in the Indian market. The simple process to be followed is:
  • Go online to a comparison website like eindiainsurance
  • Compare the quotes across all the insurance companies – Importantly since all insurance companies, will be offering exactly the same set of benefits for this plan, the individual can compare the premiums and also review the financial parameters of the insurance company while making a final decision
  • Fill up the Arogya Sanjeevani proposal form of the respective insurance company
  • Make a payment directly online through the payment gateway and then the policy will get issued by the respective insurance company

Moreover, the IRDAI has also directed all health insurance companies to provide a certificate of insurance to each policyholder for the benefits, terms and conditions of their Arogya Sanjeevani policy.

Insurance Companies Offering Arogya Sanjeevani Policy

As per IRDAI, all the Indian insurance companies have to mandatorily roll out the Arogya Sanjeevani policy, some of the players are in the process of doing so. The insurance companies offering the Arogya Sanjeevani health insurance policy are:
  • Bajaj Allianz General Insurance
  • New India Assurance
  • Star Health Insurance Co
  • Future Generali India Insurance
  • HDFC ERGO General Insurance
  • HDFC ERGO Health Insurance
  • Kotak General Insurance
  • SBI General Insurance
  • ManipalCigna Health Insurance
  • Max Bupa Health Insurance
  • Reliance General Insurance Company
  • Oriental Insurance Company
  • Raheja QBE Insurance Company
  • Universal Sompo General Insurance

The other insurance companies will have the plan for sure in the coming months to ensure compliance with the regulator.

Step by Step Process for Cashless Claims of Arogya Sanjeevani Policy

  1. Contact the Insurance Company’s Toll Free Number to report/register the claim byr providing basic information regarding the illness.
  2. Insured must get admitted to a network hospital of the insurance company to be entitled for cashless treatment.
  3. The hospital will send the insurer the necessary preauthorization request form which contains details of diagnosis and treatment, medical history, proposed treatment approach and estimated cost. Based on the eligibility, the authorization letter is shared by the insurance company with the hospital.
  4. Post discharge of the insured, the hospital will send the original claim documents supported by the bills to the insurer. The claim will be assessed and payment will be made to the hospital accordingly.


FAQ’s on Arogya Sanjeevani

Arogya Sanjeevani is a health insurance policy that protects one at the time of hospitalization following an accident or sickness. It’s a newly launched health insurance policy with standard features which is to be offered by all health insurance companies in India starting from 1st April, 2020 onwards.

Yes, under the Family Floater variance of the Arogya Sanjeevani Policy, one can get coverage for themselves, their legally wedded spouse, dependent children, parents, parents in laws. One can also choose to buy individual policies for each of these family members. Note that any children who are above 18 yrs and financially independent will not be eligible for family floater coverage.

The eligibility criteria is as follows for the Entry age of the Primary Insured:

  • Adult
    • Minimum Entry Age is 18 years
    • Maximum Entry Age is 65 years
  • Children
    • Minimum Entry Age is 3 months
    • Maximum Entry Age is 25 years

The sum insured options available under the Arogya Sanjeevani plan range from ₹1 lac to ₹5 lacs with multiples of ₹50,000.

The coverage is as follows:

  • Pre Hospitalization expenses upto – 30 days
  • Post Hospitalization expenses upto – 60 days

Yes, this plan covers treatment related to Coronavirus, subject to the expenses not being incurred during the initial waiting period under the policy.

All day care treatments are covered under this plan.

No, while the IRDAI has allowed the insurance companies the flexibility to charge premium according to it’s portfolio and claims experience, the premium charged will however be the same for the insurance companies across India.

Arogya Sanjeevani policy comes with a policy term of one year only, but renewable on a lifetime basis.

Yes, even NRIs (Non-Resident Indians) can buy Arogya Sanjeevani policy. Although the customer needs to be in India at the time of policy buying and should pay the premium in Indian currency through an Indian bank account. Importantly, expenses incurred only for treatment in India will be paid under this policy.

Yes. You can port your existing health insurance policy into Arogya Sanjeevani.

The Arogya Sanjeevani policy comes with a co-pay of 5%, which means that at the time of claim settlement, the insured will need to pay 5% of the claims amount towards the settlement. This is irrespective of the age of the insured.

Arogya Sanjeevani policy also provides a bonus of 5% on the total sum insured amount for every claim-free year that is passed by the insured, and this is accumulated upto a maximum of 50% of the sum insured as a bonus.

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