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Arogya Sanjeevani Policy - National : Features
- Sum Insured range – INR 1L, 1.5L, 2L, 2.5L, 3L, 3.5L, 4L, 4.5L, 5L
- Entry Age – 18 to 65 years
- Who can be covered – Self, Spouse, Dependent legitimate or legally adopted children, Parents, Parent-in-laws, new born from 3 months age.
- Lines of treatment covered – Allopathy &AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Sidha and Homeopathy)
- Treatment Room Rent/ICU charges, Medical practitioners, surgeon, anaesthetist, consultants, specialist’s fees and other charges as per limits mentioned in the policy.
- 50% of the Sum Insured for getting medical treatment or hospitalisation for 12 listed procedures (Modern treatments)
- Ambulance Charges: INR 2,000 per hospitalization.
- 25% of the Sum Insured or INR 40,000 whichever is less per eye in one policy year to get treatment for cataract.
- Pre and Post Hospitalization up to 30 days and 60 days respectively for same disease/illness/injury for which Hospitalization occurred.
- Cashless Facility available at Network Hospitals Only through TPA.
- Pre Negotiated Package rates for specific surgeries/procedure in network hospitals.
- Life Long Renewability.
- Portability (migration) allowed from/to similar products as per IRDAI guidelines.
Arogya Sanjeevani Policy - National : Coverage
Why buy ASP-N:
- Annual Increase in SI by 5% for each claim free year up to maximum 50% of SI opted.
- Policy can be availed both as an individual as well as a floater.
- Enhanced limits for room rents and ICU.
- Online Discounts for purchasing policy online without any intermediary.
- Instalment facility available for payment of premium.
- Tax Rebate under Section 80D of Income Tax Act 1961 for premium paid
Pre Policy Check Up
For Whom –Proposers aged 55 years and above (including dependents) and availing the policy for the first time.
List of Tests/Reports:
- Physical examination (report to be signed by the Doctor with minimum MD (Medicine) qualification)
- Blood sugar (fasting/ post prandial), HbA1c in some policies
- Lipid profile
- Serum creatinine
- Urine routine and microscopic examination
- Eye check-up (including retinoscopy)
- Any other test required by the company and considered necessary
Note: The date of medical reports should not exceed 30 days prior to the date of proposal. 50% of the expenses incurred for pre policy check-up shall be reimbursed, if the proposal is accepted. Terms and conditions apply.
Arogya Sanjeevani Policy - National : Exclusions
- Only claims arising out of accidents are payable for the first 30 days of Inception of the Policy
- All pre-existing diseases included after first forty eight months (48) of Policy
- Two and Four Years waiting period for specific diseases
- Our policy does not cover accidents encountered while participating in adventure sports
- Sterility and Infertility & Maternity expenses
- Refractive error surgery due to refractive error less than 7.5 dioptres.
- Cosmetic, plastic surgery, change of gender
- Drug/alcohol abuse
- Dental treatment (unless arising out of accident and requiring hospitalization).
Arogya Sanjeevani Policy - National : Claims Procedure
How to report a claim? For Cashless Facility – available only for policies serviced by a Third Party Administrator (TPA)
- Check if the hospital falls under the networked hospitals (Preferred provider network/other network Hospitals), as cashless is available only for empanelled network hospitals of the Company/TPA.
- For planned hospitalisation, intimation is to be sent to the TPA/Company in advance (72 hours prior) with details of Name and address of the hospital and condition requiring hospitalization.
- In case of an emergency hospitalisation, intimation is to be sent to the TPA/Company within 24 hours of admission.
- On admission, a Pre-Authorisation Request for cashless will be sent to the TPA by the hospital – duly signed by the insured and Hospital Authorities giving the details of admission, illness, proposed line of treatment and the estimated expenses. Pre and post hospitalisation expenses can be claimed separately after treatment.
- All documents in original are to be submitted within 15 days to TPA, after completion of Post Hospitalisation treatment. For Reimbursement Claims:
- Written intimation/mail/fax about hospitalisation is to be sent to TPA /Company within 72 hours of hospitalisation in the case of emergency hospitalisation and 72 hours prior in case of planned admission.
- Before leaving the hospital, Discharge Summary, investigation report and other relevant documents (Claim form – Part A & Part B) may be obtained from the hospital authorities. All the documents in original are to be submitted to TPA / Office within 15 days from date of discharge.
- Pre and post hospitalisation expenses can be claimed separately after treatment.
- All documents in original to be submitted within 15 days after completion of Post Hospitalisation treatment. What are the Documents required (originals)? The reimbursement claim is to be supported with the following documents and submitted within the prescribed time limit.
- Duly completed claim form
- Photo Identity proof of the patient
- Medical practitioner’s prescription advising admission.
- Original bills with itemized break-up
- Payment receipts
- Discharge summary including complete medical history of the patient along with other details.
- Investigation/ Diagnostic test reports etc. supported by the prescription from attending medical practitioner
- OT notes or Surgeon's certificate giving details of the operation performed (for surgical cases).
- Sticker/Invoice of the Implants, wherever applicable.
- MLR (Medico Legal Report copy if carried out and FIR (First information report) if registered, where ever applicable.
- NEFT Details (to enable direct credit of claim amount in bank account) and cancelled cheque
- KYC (Identity proof with Address) of the proposer, where claim liability is above Rs. 1 Lakh as per AML Guidelines
- Legal heir/succession certificate, wherever applicable
- Any other relevant document required by Company/TPA for assessment of the claim.
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