HealthGain
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Arogya Sanjeevani
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Health Total
Vital
Superior
Premier
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Arogya Sanjeevani
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In-patient Treatment | |||||
Covers hospitalisation expenses due to an disease/illness/injury | Covered | Covered up to Sum Insured | Covered up to Sum Insured | ||
Room Rent | |||||
Covered | 2% of sum insured, maximum up to Rs.5,000 per day | NIL cap on room rent across all plans | Up to 2% of the sum insured subject to maximum of Rs.5,000 per day. | ||
ICU Charges | |||||
Covered | 5% of sum insured, maximum up to Rs.10,000 per day | Covered | Up to 5% of the sum insured subject to maximum of Rs.10,000 per day. | ||
Pre-hospitalization | |||||
Up to 60 days | Up to 30 days | 60 days before the date of admission to the hospital | 30 days before the date of admission to the hospital | ||
Post-hospitalization | |||||
Up to 60 days | Up to 60 days | 90 days after discharge from the hospital | 60 days after discharge from the hospital | ||
Day care Procedures | |||||
Covered | All day care procedures are covered | Covered | Covered | ||
Domiciliary Treatment | |||||
Up to 10% of base sum insured,subject to maximum of Rs.50,000 | Not Covered | Covered up to 10% sum insured | Not Covered | ||
Emergency Ambulance | |||||
Plan A: Up to Rs.1,500 Plan B: Rs.3,000 per hospitalisation |
Up to Rs.2,000 per hospitalisation | Vital: Network Hospital - Rs.1,500 per hospitalisation Non-network Hospital: Covered up to Rs.1,500 per hospitalisation Superior: Network Hospital - Actuals Non-network Hospital: Covered up to Rs.2,000 per hospitalisation Premier: Network Hospital - Actuals Non-network Hospital: Covered up to Rs.5,000 per hospitalisation |
maximum of Rs.2,000 per hospitalization | ||
Dental Treatment | |||||
Not Covered | Dental treatment, necessitated due to disease or an injury | Vital : Not Covered Superior: In case of dental consultations and diagnostics, our liability will be restricted to 70% of admissible bills Premier: In case of dental consultations and diagnostics, our liability will be restricted to 70% of admissible bills |
Dental treatment, necessitated due to disease or injury | ||
Bariatric Surgery | |||||
Not covered | Not covered | Not Covered | Not Covered | ||
Ayush Benefit | |||||
Not Covered | Covered | Covered | Covered | ||
Maternity Benefits | |||||
Not covered | Not covered | Vital (3 to 10 Lakhs): Normal delivery - 15,000 to 25,000 Caesarian - 25,000 to 45,000 Superior (15 to 25 Lakhs): Normal delivery - 30,000 to 40,000 Caesarian - 50,000 to 60,000 Premier (50 Lakhs to 1 Crore): Normal delivery - 50,000 Caesarian - 1,00,000 (waiting period : 2 years) |
Not Covered | ||
New Born baby cover | |||||
Not covered | Not covered | Vital: Not Covered Superior: Covered Premier: Covered |
Not Covered | ||
Daily Cash for Accompanying an Insured Child | |||||
Not covered | Not covered | Covered up to Rs.500 per day to maximum of 30 days | Not Covered | ||
Organ Donor Expenses | |||||
50% of Sum Insured up to maximum Rs.5 Lakhs | Not Covered | Covered | Not Covered | ||
Vaccination (In case of post bite treatment) | |||||
Not covered | Not covered | Not Covered | Not Covered | ||
Health Check-up | |||||
Covered(Pre-Policy medical check-up) | Not Covered | Not Available | Not Available | ||
Hospital daily allowance | |||||
Not Covered | Not Covered | Not Covered | Not Covered | ||
Co-pay | |||||
NIL for insureds below 61 years/ 20% co-pay for ages above 61 years | 5% Co-pay applicable on all claims | 60 to 64 years: 20% Co-pay 65 to 69 years: 25% Co-pay 70 to 74 years: 30% Co-pay 75 and above years: 40% Co-pay |
5% co-pay on all claims | ||
Pre-existing diseases coverage | |||||
Covered after a waiting period of 3 years | Covered after a waiting period of 4 years | Pre-existing diseases covered after 2 years of continuous coverage | Pre-existing diseases covered after 4 years of continuous coverage | ||
Restore Benefit | |||||
Up to 100% of Base Sum Insured per year under certain plans | NIL restoration benefit | 100% of base sum insured for all types of illnesses | Not Covered | ||
General waiting period | |||||
30 days | 30 days | 30 days | 30 days | ||
Renewal Benefit / Cumulative Bonus | |||||
33.33% increase in Base Sum Insured for every claim free year; maximum up to 100% | 5% on base sum insured for every claim free year and up to 50% | 50% for every claims free year to a maximum of 100% | 5% on base sum insured for every claim free year and up to 50% | ||
Emergency Air Ambulance | |||||
Not covered | Not covered | Not Covered | Not Covered | ||
Available sum insured options | |||||
Plan A: Rs.3 to 9 Lakhs Plan B: Rs.12 lac,15 lac & 18 Lakhs |
Rs.1 to 5 Lakhs | Vital: 3 to 10 Lakhs Superior : 15 to 20 Lakhs Premier : 50 to 1 Crore |
1 to 5 Lakhs | ||
Policy can be purchased for | |||||
1 year | 1 year | 1/2/3 years | 1 year | ||
Eligibility criteria | |||||
5 years onwards, Dependent children between 91 days to 5 years can be covered only if both parents are covered under the policy | Adults from 18 to 65 years (dependents 3 months to less than 25 years) | 1 day to lifelong,dependent children (Unmarried and up to the age of 25 years) | Adults from 18 to 65 years (dependents 91 days to 25 years).If the child above 18 years of age is financially independent, he or she shall be ineligible for coverage in the subsequent renewals | ||
Renewability | |||||
Renewal for whole life | Renewal for whole life | Renewal for whole life | Renewal for whole life | ||
Claims loading | |||||
No Loading | No Loading | No Loading | No Loading | ||
Portablity (At the time of renewal) | |||||
Yes | Yes | Yes | Yes | ||
Tax Benefits Limit | |||||
Income tax benefit under section 80D | Income tax benefit under section 80D | Income tax benefit under section 80D | Income tax benefit under section 80D | ||
Useful Links | |||||
Reliance | Future Generali | |
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Claims Settlement Ratio** | 80.61% | 94.79% |
Number of Lives covered* | 22,48,000 | 48,38,000 |
Network Hospitals | 4,000 + | 5,400 + |
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