Features of the Arogya Sanjeevani Insurance Policy
Here are some key features of the Arogya Sanjeevani 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.
Insured individuals have the choice of opting for alternative treatment such as AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Sidha and Homeopathy).
The dependents of the policyholder such as the spouse, parents, children, etc. can also be covered under the Arogya Sanjeevani scheme.
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.
The Arogya Sanjeevani insurance offers policyholders lifetime renewability.
You can port your Arogya Sanjeevani insurance plan to similar IRDAI products.
Eligibility Criteria for Arogya Sanjeevani Scheme
Find out if you are eligible for the Arogya Sanjeevani policy. Here’s a list of criteria:
A person between the age of 18 to 65 years is eligible to purchase the Arogya Sanjeevani 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 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.
Inclusions Under Arogya Sanjeevani Insurance Policy
Following is the list of expenses that are covered in the Arogya Sanjeevani policy.
Under the policy, the insurance company covers the treatment cost for hospitalisation. Expenses such as nursing expenses, room rent, hospital stay, bed charges are covered by the policy. Fees charged by the 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, surgical appliances among others are also covered under the 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 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 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
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 scheme and will have a cap of 50% of the sum insured.
Exclusions Under Arogya Sanjeevani 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 policy.
Expenses for cosmetic or plastic surgery, 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 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.
New-Age Treatment Under Arogya Sanjeevani Insurance
List of new-age or modern treatments covered under the Arogya Sanjeevani Health Scheme:
Uterine Artery Embolization and HIFU (High intensity focused ultrasound)
Deep brain stimulation
The vaporisation of the prostate
IONM (Intra Operative Neuro Monitoring)
Stem cell therapy
Stereotactic radio surgeries
Arogya Sanjeevani Policy 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 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 (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
Step 1: Visit the network hospital. Provide policy details and take the pre-authorisation form.
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
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
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
Wrapping it Up!
Arogya Sanjeevani policy is a Standard Health Insurance Product (SHIP) and has been started as a key policy measure to provide relief from the medical charges owing to the COVID-19 infection. During these times, you must have realised how crucial health insurance is when it comes to healthcare and medical emergencies. Now, with the help of Arogya Sanjeevani insurance plan, you can get the right health coverage.
Similarly, you can avail a simplified health plan available on Bajaj MARKETS that provides swift claim settlements within 60 minutes and cashless facilities in more than 6500 hospitals. Get access to lucrative add-on covers, NCB reward, affordable premiums, and speedy renewals only with us!