Arogya Sanjeevani Policy

Arogya Sanjeevani Insurance Scheme is a government initiative to make health services well within the reach of everyone. This is a standardhealth insurancepolicy which has to be mandatorily offered by all health insurance companies in India. The sum insured ranges between INR 50,000 to INR 10 lakhs. Arogya Sanjeevani policy can help you manage the expenses incurred if you or an insured family member requires hospitalisation. The scheme covers treatment with AYUSH as well, along with ambulance cover, pre and post-hospitalisation, ICU charges.

Eligibility Criteria for Arogya Sanjeevani Scheme

Find out if you are eligible for the Arogya Sanjeevani Insurance policy. Here’s a list of criteria:

 

• A person between the age of 18 to 65 years is eligible to purchase the Arogya Sanjeevani Insurance policy. Depending upon the family size, one can also purchase the plan for dependent children between 3 months and 25 years.

• Independent children over the age of 18 years cannot be covered under the Arogya Sanjeevani Insurance family floater policy. An individual policy for this purpose is required.

• People above the age of 65 cannot purchase a fresh Arogya Sanjeevani policy. However, existing plans can be renewed if the policyholder crosses 65 years.

New-Age Treatment Under Arogya Sanjeevani Insurance

List of new-age or modern treatments covered under the Arogya Sanjeevani Health Scheme:

 

1.  AYUSH treatment

2. Cataract treatment

3. Uterine Artery Embolization and HIFU (High intensity focused ultrasound)

4. Balloon sinuplasty

5. Deep brain stimulation

6. Oral chemotherapy

7. Immunotherapy

8. The vaporisation of the prostate

9. IONM (Intra Operative Neuro Monitoring)

10. Stem cell therapy

11. Intravitreal injections

12. Robotic surgeries

13. Bronchial thermoplasty

14. Stereotactic radio surgeries

Features of the Arogya Sanjeevani Insurance Policy

Here are some key features of the Arogya Sanjeevani Insurance scheme that you should know:

• Wide Range of Insurance Coverage

The sum insured of the Arogya Sanjeevani Insurance scheme ranges between ₹50,000 and ₹10 Lakh, offering a wider sum insured scope to policyholders.

• Alternative Treatment

Under the Arogya Sanjeevani Insurance, the insured individuals have the choice of opting for alternative treatment such as AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Sidha and Homeopathy).

• Family Floater Option

The dependents of the policyholder such as the spouse, parents, children, etc. can also be covered under the Arogya Sanjeevani Insurance

• Coverage for Cataract Treatment

25% of the sum insured or ₹40,000, whichever is lower, can be utilised for cataract treatment of one eye per policy period under Arogya Sanjeevani Insurance.

• Lifetime Renewability

Arogya Sanjeevani insurance offers policyholders lifetime renewability.

• Easy Policy Porting

You can port your Arogya Sanjeevani insurance plan to similar IRDAI products.

Inclusions Under Arogya Sanjeevani Insurance Policy

Following is the list of expenses that are covered in the Arogya Sanjeevani policy.

1. Hospitalisation

Under the Arogya Sanjeevani Insurance policy, the insurance company covers the treatment cost for hospitalisation. Expenses such as nursing expenses, room rent, hospital stay, and bed charges are covered by the policy. Fees charged by medical practitioners are also covered under the Arogya Sanjeevani policy.

2. ICU Charges

Your insurer may pay 5% of the sum insured up to ₹10,000 per day, if the policyholder is admitted in a critical care unit like ICU or ICCU. Besides, other charges such as oxygen, operation theatre charges, and surgical appliances among others are also covered under Arogya Sanjeevani Insurance policy.

3. Pre and Post-Hospitalisation

The Arogya Sanjeevani insurance plan covers the expenses up to 30 days before hospitalisation. Certain ailments require patients to continue treatment even after being discharged from the hospital. Arogya Sanjeevani Policy covers post-hospitalisation expenses up to 60 days after discharge.

4. Room Rent

The Arogya Sanjeevani Insurance policy pays a maximum amount of ₹5,000 per day. In the case of the intensive Care Unit (ICU), the room rent paid will be 5% of the sum insured up to ₹10,000 per day.

5. COVID-19 Cover

Any expenses incurred on hospitalisation or treatment for COVID-19 are covered under the Arogya Sanjeevani Insurance policy.

6. Ambulance Charges

Up to ₹2,000 per hospitalisation is covered under the plan as the cost of transporting a patient with the help of an ambulance.

7. Cataract Treatment

Under Arogya Sanjeevani Insurance, the cost of cataract treatment is covered up to 25% of the sum insured or ₹40,000, whichever is lower, by the insurance company for each eye.

8. New Age Treatment

New-age treatments will be covered under the Arogya Sanjeevani Insurance scheme and will have a cap of 50% of the sum insured.

Exclusions Under Arogya Sanjeevani Insurance Policy

• If the policyholder has had any condition or ailment prior to the inception of their policy until 48 months, it will not be covered by the Arogya Sanjeevani Insurance.

• Expenses for cosmetic or plastic surgery, and treatment necessitated due to participation in hazardous or adventure sports are not covered.

• Treatment outside India is also excluded from the policy coverage.

• OPD treatment or domiciliary care is not covered.

• Treatments related to gender change are not included in the plan.

• Weight management or any medical treatment for obesity is excluded from the Arogya Sanjeevani Insurance policy.

• A waiting period of 2-4 years is applicable for coverage of specific diseases.

• Dental treatment is not covered unless required due to an accident.

• Sterility, infertility or maternity expenses are not covered.

Arogya Sanjeevani Insurance Renewal

Arogya Sanjeevani Policy can be renewed after the expiry date within the grace period as mentioned in the policy. A policyholder can change the amount of the sum insured while renewing this Arogya Sanjeevani insurance.

 

For instance, if a dependent child covered under the policy attains the age of 18 years and is financially independent, he/she will be removed from the policy at the time of renewal. Besides, the policyholders get a 5% cumulative bonus in case the previous policy year was claim-free.

How to File a Claim Under Arogya Sanjeevani Insurance

To raise an Arogya Sanjeevani insurance policy claim, you can either make a cashless or a reimbursement health insurance claim. In case of planned treatments, an intimation must be sent to the insurer or the third party administrator in health insurance (TPA) within 72 hours. For emergency treatments, you must inform the insurer or the TPA regarding the claim within 24 hours of admission. Follow these steps to make a successful claim:

Cashless Health Insurance Claim for Arogya Sanjeevani Insurance

• Step 1: Visit the network hospital. Provide policy details and take the pre-authorisation form for Arogya Sanjeevani Insurance.

• Step 2: The insurance provider verifies the form and the hospital is notified about the details of the policy.

• Step 3: Once discharged, the hospital will send the bill along with discharge papers to the insurer.

• Step 4: The claim will be directly settled with the hospital, after paying the co-payment, if any.

Reimbursement Health Insurance Claim for Arogya Sanjeevani Insurance

• Step 1: Submit all original medical documents and hospital bills.

• Step 2: The insurance provider evaluates the details and may ask for any additional information if required.

• Step 3: On receiving all the documents, your claim decision is made.

• Step 4: You will receive the claim amount based on the policy terms and conditions.

Documents Required for Arogya Sanjeevani Insurance Claim

• Duly filled claim form

• Identity proof of the patient

• Medical practitioner’s prescription advising admission

• OT notes or surgeon's certificate giving details of the operation performed (for surgical cases)

• Original bills and payment receipts

• Discharge summary

• Investigation or diagnostic test reports supported by the prescription from attending medical practitioner

• Any other relevant document required by the insurance company or TPA for assessment of the claim

Important Forms Needed for Arogya Sanjeevani Insurance

• Customer Information Sheet

• Claim Form

• Jacket

• Policy Wordings

• Proposal Form

• Prospectus

• Rate Chart up to 10 lakh SI

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