United India Arogya Sanjeevani Policy

Due to the sudden increase in healthcare costs, complex health coverage and high premiums, IRDAI launched a standardised health insurance policy which is uniform across the industry. The policy is called the Arogya Sanjeevani Policy and is provided by all general insurance companies. The policy's purpose is to make the health insurance purchasing process simple and affordable.

United India Arogya Sanjeevani Policy is a basic indemnity health insurance plan that provides wider coverage against hospitalisation expenses and daycare procedures expenses, including pre and post-hospitalizations and AYUSH treatment expenses. The policy provides comprehensive coverage at affordable premiums and is a stepping stone for first-time buyers.

The covers mentioned in the policy are built-in benefits available to all insured individuals under the policy.

• In-patient Hospitalisation, Daycare Treatments, Pre and Post-Hospitalisation - The company indemnifies medical expenses due to more than 24 hours of hospitalisation of the insured during the policy year. It also covers pre and post-hospitalisation expenses for a period of 30 and 60 days, respectively. Daycare procedures which require less than 24 hours of hospitalisation are also covered.

Expenses that are covered for hospitalisation include room rent, boarding and nursing charges, ICU/ICCU and OT charges, doctor’s fee, surgeon or any other medical practitioner's fee, blood, oxygen, medical equipment or any other related expenses.

• AYUSH Treatment - The company covers any expenses for inpatient care treatment under Ayurveda, Yoga, Unani, Siddha, Homeopathy and Naturopathy systems upto the limit of the sum insured.

• Cataract Treatment - The company covers the cost of the cataract treatment upto the limit of 25% of the total sum insured upto a maximum of Rs. 40,000. The lower of the two would be payable per cataract operation of one eye in a single policy year.

• Modern Treatments - Modern treatments specified in the policy are covered as inpatient care or day care procedure up to 50% of the sum insured during the policy year.

• Other Treatments - Any dental treatment or plastic surgery required due to a disease or for reconstruction purposes due to an injury are covered under the policy.

• Ambulance Expense - Expenses incurred on road ambulance per hospitalisation are covered upto the limit specified in the policy

Here are some important things you should know about the United India Arogya Sanjeevani Policy.

• Sum Insured - The coverage under this policy starts from a sum insured of Rs. 50,000 to Rs. 10 lakhs in multiples of 50,000.

• Entry Age - The minimum entry age to purchase this policy is 18 years, and the maximum age is 65 years. It covers dependent children from the age of 3 months to 25 years.

• Premium Payment Mode - A policyholder can choose to pay premiums on a monthly, bi-annual, quarterly or annual basis.

• Policy Type - The policy is available on both an individual and floater basis. An individual policy has a separate individual sum insured for each family member, and a family floater policy has a single sum insured shared by all family members.

• Policy Term - The policy has a term of 1 year and a lifetime renewal facility.

• Waiting Period - There is a waiting period of the first 30 days from receiving policy for any illness except for accidental hospitalisation. Any listed illness or medical procedure is not covered till a period of 24/48 months, and a declared pre-existing disease or a listed illness is not covered till 48 months from the receipt of the policy.

• Cumulative Bonus - Cumulative bonus is increased by 5% for a claim-free policy year, subject to a maximum of 50% sum insured, provided that the policy is renewed with the company without a break.

There are several reasons why you should opt for a United India Arogya Sanjeevani policy:

• Lower Premiums - The premiums payable under the policy are very low compared to other plans offering similar coverage. A wider coverage at a low cost makes the policy very affordable.

• Flexible Coverage - The policy allows coverage on both an individual and floater basis, thus extending coverage to your parents and parents-in-law under one policy.

• Lower Co-payment - The policy only has a lower co-payment of 5% compared to other plans. So at the time of claim settlement, you need to pay only 5% of the sum insured from your own pocket. It is ideal for first-time buyers offering wide coverage at a low cost.

• Portability - United India Health Insurance allows policy portability, and the policy can be ported to other insurers as per IRDAI guidelines.

• Discounts - The United India General Insurance offers many discounts under the Arogya Sanjeevani Policy, such as a family discount of 5% for more than 1 eligible family member covered on an individual policy. An online Policy discount of 10% is offered for policies purchased online and also for online policy renewals.

The claim procedure for health insurance policies by United India is simple and fast.

Cashless Claim:

All Network Hospitals provide a cashless facility. The patient must show his health card and photo Id at the time of hospitalisation and get a pre-authorisation form. A duly filled and signed pre-authorisation form is sent to the insurance company, which accepts or rejects the claim after verification. Once the claim is accepted, an authorisation letter is issued. The hospital sends the final bill, and the discharge paper to the insurance company, and the claim is settled.

Claim Notification:

In case of planned hospitalization, the insurance company should be notified at least 48 hrs in advance with details of the hospital and treatment. In case of emergency hospitalization, the company should be notified within 24 hrs of the hospitalization.

Reimbursement claim:

A reimbursement request should be raised by the insured to the company/TPA within the time limit. The insured should submit all the necessary documents within 30 days of discharge for verification, and the claim is settled according to the policy’s conditions as specified in the policy bond. There are several documents required to raise a reimbursement request, such as claim form, patient’s photo id, medical prescription advising hospitalization, payment receipts and original medical bills, discharge summary, test reports, NEFT details and cancelled cheque, KYC details of the proposer, and any other relevant document required by the insurer.