Information about Arogya Sanjeev’s policy

To date, various general insurance companies and only health insurance companies have a number of health insurance products. Each product has its own characteristics and makes it difficult for the general public to understand each policy. With this in mind, the Insurance Regulatory and Development Authority of India (IRDI) makes it mandatory for all the above companies to issue a standard health insurance policy.
Information about Arogya Sanjeev's policy
Arogya Sanjeev’s policy, which is being given following the order of IRDA, has started to be given from April 1, 2020. Some of its features are as follows:

Individual and floater

This policy is offered on an individual basis and on a family floater basis. The definition of family is also fixed in it.

Minimum and maximum insurance

In this insurance health insurance of minimum 1 lakh and maximum 3 lakh rupees is given. If you want to take more than 1 lakh insurance, 20-30 thousand is added to the amount.

The means of payment of premium

The insured can pay premium every month, three months, six months or twelve months. This payment can also be made through ECS (Electronic Clearing Service).

Criteria for age and policy renewal

The minimum age of the policyholder at the time of taking the policy is 18 years and the maximum age is 8 years. This policy can be renewed for life. Depending on the family definition, dependent children can be added to the policy. Dependent children from 3 months to 3 years are covered in this policy.
Hospital expenses
The costs covered when a patient is admitted to a hospital are covered as follows:
  • Room, boarding, nursing expenses, the maximum daily limit of which is 5% of the sum insured, which can be availed up to a maximum of Rs. 5,000.
  • Hospitals cover fees of surgeons, anesthetists, medical practitioners, consultants, specialists, treating doctors / surgeons.
  • The daily expenses of the Intensive Care Unit (ICU) / Intensive Cardiac Care Unit (ICCU) are covered up to 5% of the sum insured, with a maximum limit of Rs. 10,000.

Other expenses

The cost of cataract treatment per eye is 5% of the sum insured and Rs.50,000 whichever is less. Dental treatment and plastic surgery are covered if there is an illness or injury. The cost of one day treatment is up to 50% of the sum insured. A maximum of Rs 5,000 is sanctioned for each hospitalization for road ambulance.

AYUSH treatment

If inpatient treatment is done in any AYUSH hospital, there is a cost. AYUSH includes Ayurveda, Yoga, Naturopathy, Unani, Siddha and Homeopathy.

Expenses before and after hospitalization

Medical expenses up to 60 days prior to hospitalization and up to 30 days from the date of discharge from the hospital are covered.

Co-payment

In all claims, the insured has to pay 5% as co-payment for all ages.

Cumulative bonus

For the year in which the claim is not received, an amount equal to 5% of the sum insured is added. However, for this the policy should be continued without interruption and it is necessary to take a policy amounting to 50% of the sum insured while continuing the policy. In the year in which the cum comes, it is reduced according to the percentage of cum utility bonus accrued.

Waiting period

There is a waiting period of 6 months to 6 months for illnesses written in the policy.

Modern treatment

The policy covers advanced treatments like oral chemotherapy, robotic surgery, bronchial thermoplasty, etc.

Exclusion

This policy does not cover cosmetic surgery, plastic surgery, maternity, treatment of obesity, treatment in OPD (outpatient department), domiciliary hospitalization, treatment outside India, etc.

Claim

Claims can be made on a cashless basis in a network hospital and on a reimbursement basis in a hospital outside the network. In case of urgent hospitalization, the claim has to be reported within 2 hours or the patient is discharged whichever is shorter. If the hospitalization is pre-determined, the claim has to be reported at least 3 hours in advance. As mentioned above, this policy has been introduced by the insurance regulator for the convenience of the people. It also has a premium that is affordable to the common man.

Leave a Comment

Your email address will not be published. Required fields are marked *

Scroll to Top