HDFC ERGO Arogya Sanjeevani Policy

A medical emergency can come anytime unannounced; therefore, planning ahead of any medical need is necessary. In the past few years, there has been a shift in the general attitude towards health insurance, and people are now more aware of the importance of health insurance. Addressing the need for pocket-friendly health insurance products, IRDAI has developed a standard health insurance policy across the industry, called Arogya Sanjeevani Policy which all health insurers offer.

HDFC ERGO Arogya Sanjeevani Policy is a basic health insurance plan that indemnifies medical expenses due to hospitalization, pre and post-hospitalizations, AYUSH treatment, and more. The policy also covers advanced treatments up to 50% of the sum assured.

Below is a list of key features of HDFC ERGO Arogya Sanjeevani Policy:

• Sum Insured - You get wide coverage from Rs. 50,000 to Rs. 10 lakhs under this policy.
• Eligibility - An adult from 18 to 65 years is eligible to avail of this policy for self and family.
• Covers your family - The policy also covers your entire family, including spouse, children, parents and parents-in-law.
• Policy Term - 1 year with a lifetime renewal facility.
• Premium Payment Options - You can pay premiums in monthly, quarterly, half-yearly or yearly instalments.
• Cumulative Bonus - For every claim-free policy year, you are rewarded with a 5 % increase in the sum insured subject to a maximum of 50% sum insured.
• Waiting Period - The waiting period in this policy is as follows
  • First 30 days from policy inception for treatment of any illness.
  • First 24 months from policy inception for any listed illness or procedures.
  • First 48 months from policy inception for any pre-existing disease.
• Portability - The policy is portable to other insurers as per IRDAI guidelines.
• Co-payment - 5% of the claim amount. The amount payable is the amount after the deduction of co-payment.
• What is Included - The policy covers hospitalization expenses upto the sum insured, room rent upto 2 % of the sum insures and ICU expenses up to 5% of the sum insured, pre and post-hospitalisation cover, day care treatments, ambulance expenses, AYUSH treatments, 12 specialized medical procedures upto 50% of the sum insured, cataract treatment cover upto 25% of the sum insured, and dental treatment and plastic surgery needed due to a disease or injury.
• What is not Included - Adventure sports injuries, obesity treatment or cosmetic surgery, gender-change surgery, hospitalisation for evaluation or rehabilitation purposes, etc. For more details, refer to the policy wordings.

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HDFC ERGO is known for its instant service, paperless buying and claim settlement with minimum documentation. Here is why you should choose an HDFC ERGO Arogya Sanjeevani policy:

• Comprehensive coverage at affordable rates.

• HDFC ERGO has a wide 13000+ cashless network of hospitals that offer treatment for health insurance policies by HDFC ERGO.

• You can have HDFC ERGO health insurance for as long as you live because the policy can be renewed for the lifetime of the insured.

• The HDFC ERGO general insurance offers many discounts under the Arogya Sanjeevani Policy, such as:

  • Family discount of 10% if 2 or more members of the same family are covered.
  • An online Policy discount of 5% is offered for policies purchased online.
  • An employee discount of 10% is offered to the company employees.
  • A loyalty discount of Rs. 250 is offered to existing policyholders.
  • A rural discount of 15% is offered for the policies sourced from the rural sector.
  • The total discount offered should not exceed 20%.

The Claim procedure for HDFC ERGO Sanjeevni Policy is simple and customer friendly. The Policy provides the options of using both Cashless and Reimbursement claims.

Cashless claim:

It is always suggested that the insured use the Cashless Claims mode. This saves quite an effort for the insured in preparing the documents. The following points should be kept in mind for Cashless Claims.

• Seek treatment in a hospital registered on the vast Hospital network of HDFC ERGO.

• In case of planned hospitalization, inform the insurance company at least 48 hours in advance, along with details of the medical procedure/treatment and that of the hospital.

• In case of emergency hospitalization, the insurance company should be informed within 24 hours of hospitalization.

• The network hospital will require the Health Card and a Photo ID of the insured to process the pre-authorization of medical expenses.

• The hospital will send a pre-authorization form, signed by the insured, to the insurance company along with Medical details.

• After verification and subsequent approval, the insurance company will send the Authorization Letter to the hospital.

• In case the Cashless Claim procedure is not authorized by the Insurance company, the insured can claim a reimbursement of the medical expenses as per the policy norms.

• The insured needs to verify and sign the discharge papers at the time of discharge. The Insurance company settles the bill for the insured.

Reimbursement claim:

This is when you need to pay the claim from your own pocket and then get the same reimbursed from the insurer. The process for the same is:

• The insured should send in a written intimation about the hospitalization to the insurance company within the specified time limit.

• The Reimbursement Claim, along with all required documents, should be submitted to the insurance company within 30 days of discharge from the hospital.

• The usual documents required for claim submission include copies of the Patients health card and photo ID, all details of the treatment or surgery, Discharge Summary, all payment receipts, original medical bills, diagnostic reports and NEFT details, and a cancelled cheque. The Insurance company may request additional documents in case of requirement.

• Once the insurance company verifies the documents and approves, the approved amount is transferred to the insured. This process takes less than 30 days from the submission date of all the required documents.

Get your family covered against any medical emergencies with HDFC ERGO Arogya Sanjeevani policy if you still do not have health insurance.

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.