Bajaj Allianz Arogya Sanjeevani Policy

Health is precious if you want to live a life of your choice. You can achieve your goals and utilize your full potential if you are fit. But being fit does not mean you become careless; you need to be prepared for any medical emergency or illness in future. Planning ahead of any medical need can save your finances and will help you get immediate medical attention without worrying about expenses. To make health insurance more affordable and accessible, IRDAI has developed a standard health insurance policy across the industry, called Arogya Sanjeevani Policy which all health insurers are mandatorily required to offer.

Bajaj Allianz Arogya Sanjeevani Policy is a basic indemnity health insurance plan that covers expenses incurred due to hospitalisation, and daycare procedures, including pre and post-hospitalizations and AYUSH treatment. The policy also covers many new-age specialized treatments like stem cell treatment and robotic surgery, covering up to 50% of the sum assured.

Bajaj Allianz Arogya Sanjeevani Policy offers the following features to protect you financially during a medical need.

• Sum Insured - The sum insured under this policy ranges from Rs. 1 lakh to Rs. 25 lakhs.

• Coverage for the entire family - The policy offers to cover the entire family, including spouse, children, parents and parents-in-law. A financially independent child above 18 years is not eligible for coverage.

• Policy Term - It is an annual policy with a term of 1 year and a lifetime renewal facility.

• Premium Payment Options - Premiums can be paid on an instalment basis like monthly, quarterly, half-yearly or yearly payments.

• Eligibility - An individual from 18 to 65 years is eligible to avail of this policy for self and family.

• Cumulative Bonus - Cumulative bonus is increased by 5% for a claim-free policy year, subject to a maximum of 50% sum insured. CB is available only if the policy is continuously renewed within the grace period of 4 years.

• Waiting Period - The waiting period in this policy is as follows

  • First 30 days from policy inception for treatment of any illness. Only accidental hospitalizations shall be covered.

  • First 24/48 months from policy inception for any listed ailments and procedures.

  • First 48 months from policy inception for any listed procedure or declared pre-existing disease.

• Portability - The policy is portable and can be migrated to other insurers as per IRDAI guidelines.

• Co-payment - Each and every claim under the policy is subject to a co-payment of 5% of the claim amount. The amount payable is the amount after the deduction of co-payment.

There are several reasons why you should opt for a Bajaj Allianz Arogya Sanjeevani policy:

• The policy offers comprehensive coverage at affordable rates.
• The policy is offered on an individual as well as floater basis.
• It has a lower co-payment of 5% only.
• It is ideal for first-time buyers offering wide coverage at a low cost.
• The policy is lifetime renewable, so you can have Bajaj Allianz health insurance for as long as you live.
• No pre-policy medical check-up is required till 45 years of age.

• The Bajaj Allianz General Insurance offers many discounts under the Arogya Sanjeevani Policy, such as:

  • Family discount of 10% if 2 eligible members of the same family are included within the same plan. However, if more than 2 people are covered, then there is a discount of 15%.
  • An online Policy discount of 5% is offered for policies purchased online.
  • An employee discount of 20% is offered to the company employees if the policy is booked in the direct office code.

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Coverage under the policy includes:

• Hospital room charges, boarding charges and doctor fees
• Operation theatre and ICU/ICCU expenses and Nursing charges
• Medicine expenses during the hospital stay
• Ambulance charges
• Pre and Post hospitalization expenses upto 30 and 60 days, respectively
• Cataract Treatment upto 25% of the sum assured.
• AYUSH Treatment
• Modern specialized treatments as listed in the policy.

However, there are some exclusions under this plan as well:

• Pre-existing diseases upto 4 years from policy inception if the policy is active continuously
• Admission for evaluation and investigation purposes.
• Admission for rehabilitation, rest etc.
• Treatment outside India
• Surgery for obesity treatment
• Gender change procedure
• Cosmetic surgery.

The claim for Bajaj Allianz Arogya Sanjeevani Policy can be either cashless or as a reimbursement.

Cashless claim:

A cashless facility at network hospitals can be availed 24/7 for any of the health insurance policies by Bajaj Allianz. For planned hospitalization, inform the insurance company at least 48 hrs in advance with details of the hospital and treatment. For emergency hospitalization, the company should be informed within 24 hrs of the hospitalization.

• On showing your health card and a valid photo id at the network hospital, you will get a pre-authorization form.
• Get the pre-authorization form duly signed by the treating doctor and the patient.
• The network hospital will send the form to the Health Administration Team (HAT)
• They will verify the cashless treatment request and all the medical details as per policy guidelines.
• Once approved, an authorization letter is issued within 3 hours as per the policy.
• On discharge, the insured verifies and signs the discharge paper, and the hospital sends the final bill with discharge details to the claim desk, and the claim is directly settled by the insurance company. Only the consumables portion needs to be paid by you, which is not admitted by the insurer.

Reimbursement claim:

When you are admitted to a hospital not within the network zone of the insurer, you need to pay for the treatment out of your own pocket and then claim for the same after the treatment is done as a reimbursement.

• For reimbursement, the insured should send an intimation to the insurer within the time limit. The insured should submit all the necessary documents within 30 days of discharge.
• The company will verify all the documents and the reimbursement request and settle the claim per the policy.

Documents required for a claim:

In a cashless claim, only the health card, your KYC details, and the doctor’s advice for hospitalisation need to be submitted. The rest of the documents would be submitted by the hospital itself.

However, for a reimbursement claim, all documents need to be provided by you. The following list of documents should be provided along with the claim request:

• Duly filled claim form
• Patient’s photo id
• Medical prescription advising hospitalization.
• Original medical bills
• Payment receipts
• Discharge summary with a medical history of the patient
• Diagnostic test reports as per the prescription from the treating medical practitioner
• In case of surgery, surgeon’s certificates with complete details of the surgery.
• NEFT details and cancelled cheque
• KYC details of the proposer
• The insurer requires any other relevant document.

This is all about Bajaj Allianz Arogya Sanjeevani Policy. If you have not yet taken a health insurance cover and have no idea which health cover is best for you, this is the best policy with comprehensive coverage for your entire family.