To simplify health insurance, IRDAI launched a standard indemnity health insurance policy called Arogya Sanjeevani Policy. It is a basic health insurance policy with comprehensive coverage offered by all insurance companies with similar features. The only difference is the buying and claim settlement process of different insurance companies.
National Insurance Arogya Sanjeevani Policy is a health insurance plan that covers costs of in-patient hospitalization, pre and post-hospitalizations, daycare procedures and AYUSH treatment. The policy also covers all medical expenses related to hospitalisation along with many advanced treatments.
Some of the key highlights of the National Insurance Arogya Sanjeevani Policy are as follows:
Type of Policy - The policy is an indemnity policy which can be purchased for an individual sum insured or a floater sum insured.
Sum Insured - Rs. 50,000 to Rs. 10 lakhs available in multiple of Rs. 50,000.
Who can be covered - The policy covers self, spouse, dependent children, parents and parents-in-law. The children are covered from the age of 3 months up to 25 yrs (if dependent).
Policy Term - 1 year with lifetime renewal facility.
Instalment Facility - Premiums can be paid on an instalment basis like monthly, quarterly, half-yearly or yearly payments. Any instalment other than a yearly instalment is allowed only if the minimum value is Rs. 1000.
Eligibility - 18 to 65 years.
Pre-policy medical check-up - required for 55 years or above age.
Cumulative Bonus - There is an increase of 5% of the sum insured for every claim-free year with a maximum increase of upto 50%. However, the cumulative bonus is applicable only if the policy is renewed every time within the grace period for a continuous tenure of 4 years.
Waiting Period - The waiting period in this policy is
Portability - The policy can be ported to similar products from other insurers according to IRDAI guidelines.
Co-payment - 5% of the claim amount. The claim amount payable is the amount after the deduction of co-payment.
Following policy Inclusions are available to all the insured individuals as specified in the policy document.
Hospitalisation expenses of the insured during the policy year up to the sum insured covering:
room charges, boarding charges, and nursing fees upto Rs. 5000 per day.
Pre and Post hospitalization expenses upto 30 and 60 days, respectively
Here are some key benefits of buying an Arogya Sanjeevani policy from National Insurance.
The claim process is simple and straightforward, as mentioned below:
A cashless facility is available only for policies serviced by Third Party Administrator (TPA) at network hospitals only. If the hospitalization is planned, inform the insurance company at least 48 hrs in advance with details of the hospital and treatment. In case of emergency hospitalization, inform within 24 hrs of the hospitalization.
On hospitalisation, a pre-authorization form for cashless claim request is sent to the TPA by the hospital, duly signed by the treating doctor and the patient with all the medical details.
The company/TPA will verify the cashless treatment request as per policy guidelines.
After the request is approved, an authorization letter is issued by the hospital.
After discharge, the hospital sends the final bill with discharge paper signed by the insured to the company/TPA, and the insurance company settles the claim.
When you pay the claim initially from your own pocket and then apply for the reimbursement from the insurer based on certain documents that you need to submit, here is the process:
For reimbursement, the insured should send a written intimation to the company/TPA within the time limit and 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.
The documents you need to submit include all original bills and receipts along with the hospital's discharge summary mentioning the exact line of treatment, KYC and bank details of the policyholder, original reports of all diagnostic tests, etc.
All insurance companies are authorised to sell the Arogya Sanjeevani Policy as per IRDAI guidelines. To choose an insurance company for buying the policy, keep in mind the claim settlement ratio and claim process of the company. Also, look for network hospitals; the one with the widest network in your location will be the most suitable choice. If you are still not insured, get National Insurance Arogya Sanjeevani Policy immediately.
Ans: No, maternity expenses are not covered under this policy.
Ans: You can increase the sum insured upto the maximum limit of Rs. 10 Lakhs.
Ans: The waiting period is the initial period a policyholder is required to wait before availing of a benefit under the policy. For example, If you purchase a policy on 1st July 2022, you can claim any benefits only after 31st July 2022.
Ans: The pre-existing diseases have a waiting period of 48 months.
