Oriental Arogya Sanjeevani Policy

Oriental Arogya Sanjeevani Policy benefits

• Key features of Oriental Arogya Sanjeevani 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)	Uterine Artery Embolization and HIFU (High Intensity Focused Ultrasound) Balloon Sinuplasty Deep Brain Stimulation Oral Chemotherapy Immunotherapy – Monoclonal Antibody to be given as injection Intra Vitreal injections Robotic surgeries Stereotactic radio surgeries Bronchial Thermoplasty Vaporization of the prostrate (Green laser treatment or holmium laser treatment) IONM – (Intra Operative Neuro Monitoring) 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 Oriental 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 Oriental 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.

• How can one buy the Oriental 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.

• Oriental travel insurance - Claim Process

  Heritage Health TPA Pvt.Ltd.
  Elite Auto House, 54-A, Ground Floor (Rear Side),
  Behind Crisil House,
  Andheri-Kurla Road, Chakala,
  Mumbai - 400093.
  
  Tel : +91-22-61273891/ 92/ 93
  Fax : +91-22-61273890
  Toll Free : 1800 224004

  Oriental health insurance - Claim Process

  Assistance Contact Numbers:
  Call at: Toll Free 1800 118 485
  Call at: 011-33208485

• Policy cancellation and Rrefunds

  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 Oriental 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.