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Know All About Arogya Sanjeevani Health Insurance Policy

Posted On : 18 February 2021, 3 Years Ago. Health-Insurance Total Read 409

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As of April 2020, the Insurance Regulatory and Development Authority of India has directed all health and general insurance firms to provide the Aarogya Sanjeevani Policy, which is a regular health insurance policy for individuals and families that covers basic hospitalization-related costs up to Rs 5 lakh, along with hospitalization costs for COVID-19 patients. The regulator has forbidden insurers from implementing deductibles or providing riders and variants with the policy to make it easier to understand for someone who is looking to buy the policy.

This blog will discuss the plans, policy premiums, and benefits of the Arogya Sanjeevani scheme.

Plans and Policy Available Under Arogya Sanjeevani Scheme

Under the Arogya Sanjeevani Policy, there are two types of Plans Available:

An individual plan where the Sum Insured will be separate for each member.
A family floater plan where Sum Insured will be shared among all members.

Arogya Sanjeevani Policy Premium

This policy is a regular health insurance plan available in India from a number of insurers. The benefits and product features will be same across however the premium will vary for each insurer.

The individual plan start at around Rs. 3000, while Family Floaters two member plan start at around Rs. 4,500. The actual premium will depend on age, Sum Insured chosen and family members covered under the policy. Your chosen insurer's website will have the exact insurance premium chart and prices, as well as other information about your Arogya Sanjeevani Policy.

Arogya Sanjeevani Health Policy Eligibility

The Arogya Sanjeevani Health insurance policy is applicable to everyone between the ages of 18 and 65. You can also include dependent children aged 3 months to 25 years in the policy.

The family members allowed under this policy are self, spouse, children, parents, and parents-in-law. This health insurance policy can be renewed lifelong subject to payment of due renewal premium.

Benefits of Arogya Sanjeevani Policy

The policy covers pre- and post-hospitalisation, hospitalisation, doctors' and nurses' fees, and intensive care expenses, among other things and medical conditions. A complete list of coverage should be obtained from your insurance provider.

1. Hospitalization cover

Inpatient care at a hospital, including room rent and ICU charges.
Room rent limits:

a. Room rent: up to 2% of sum insured subject to a maximum of Rs.5,000 per day.

b. ICU/ICCU: up to 5% of sum insured subject to a maximum of Rs.10,000 per day.

2. Pre & Post hospitalization

Expenses for Pre hospitalization up to 30 days prior to hospitalization and Post hospitalization up to 60 days post discharge from a hospital will be covered

3. Tax Benefit

If you purchase this health insurance policy, you may claim a tax advantage under section 80D of the Income Tax Act of 1961.

4. Cumulative bonus

Cumulative bonus of 5% in respect of each claim free policy year, maximum up to 50% of sum insured. In case of a claim, the accrued cumulative bonus will be reduced at the same rate.

5. Free Look Period

On Arogya Sanjeevani Policy, you will have a free look-up period. This is the window of opportunity for you to thoroughly review the terms and conditions of your health insurance policy and determine whether or not to retain it. If you want to cancel the contract, you can obtain a refund according to the term and conditions of the policy.

6. Ambulance Costs

Under the Arogya Sanjeevani Policy Road Ambulance charges up to Rs.2,000 per hospitalization is also covered on.

Inclusions Under Arogya Sanjeevani Scheme

The following are the limitations of the National Arogya Sanjeevani health plan:

Any costs associated with medical evaluation and investigation.
Hospitalisation costs for respite care, rest cure, and rehabilitation.
Any costs associated with cosmetic and plastic surgery.
Sterility/Infertility/Maternity expenses are also ineligible for reimbursement.
Expenses for hospitalisation incurred as a result of participation in adventure/risky sports activities.
Gender treatments are also prohibited.
Expenses for surgical treatment of obesity that do not meet certain criteria.

Claim Settlement Process

The claim settlement process under this policy is categorised under two types: Payment claims and Cashless claims. Policyholders can use the claim procedure and steps outlined below:

Arogya Sanjeevani Payment Claims

For emergency hospitalisations, you must notify the insurer within the time frame specified below:

Within 72 hours of hospitalisation, you must share a written notification/fax/call the TPA (both emergency and planned).
Post-treatment expenses for pre- and post-hospitalization are reimbursed separately.
Sign the Investigation report, discharge summary, and other relevant documents before leaving the hospital.
Submit all required documents to the TPA in original within 15 days of hospital discharge.

Cashless Claims Made by Arogya Sanjeevani

To make a cashless claim under your National Arogya Sanjeevani policy, fill out the claim form.
Submit it to the TPA, and after verification, you will be granted authorisation to begin treatment.
At the time of discharge, sign and verify your papers.
If the insurer does not approve the cashless claim for any reason, you can get your expenses reimbursed.

Conclusion:

Arogya Sanjeevani Policy is offered by all health and general insurance firms in India, and they offer a range of advantages. It includes hospitalization cover, pre- and post-hospitalization costs, ambulance charges among other items. Arogya Sanjeevani Policy shields you and your loved ones from financial catastrophe in the event of a medical emergency.

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