Arogya Sanjeevani Policy is a standard indemnity health insurance product launched by the National Insurance Company to safeguard the medical requirements of the customers. The plan provides comprehensive protection by offering a variety of benefits such as pre and post-hospitalization, daycare treatments, AYUSH treatments, and ambulance charges along with a large sum of insured options ranging from Rs. 1 lakh to Rs. 5 lakhs. The policy is available in two types - Individual and Floater.
Let's explore more about this health insurance policy with a detailed explanation of its features, eligibility criteria, and exclusions. Read below.
This policy comes packed with a wide range of features for the customers. We've listed below all the key features of the plan. Let's have a look.
The plan offers a multitude of coverage options to adults between the age groups of 18 to 65 years. Customers can cover themselves, Spouse, Dependent legitimate or legally adopted children, Parents, Parents-in-law, new-born from the age of 3 months.
This policy is available within a variety of the sum insured amounts ranging between Rs. 1 Lakh to Rs. 5 Lakhs.
The expenses incurred on hospitalization of the insured person for a minimum period of 24 hours are covered under this plan. This includes pre-hospitalization expenses for 30 days and post-hospitalization expenses for 60 days.
With this plan, customers also get coverage for the expenses incurred during daycare treatments taken at a hospital or diagnostic center.
The policy also takes care of the medical expenses of the policyholder if treatment is done in any Ayush Hospital (India's medical hospitals and centers including Ayurveda, Yoga, and Naturopathy, Unani, Siddha, and Homeopathy).
This plan offers a maximum cover of Rs. 2000/- for the expenses incurred on road ambulance service availed for the hospitalization of the policyholder.
The plan also provides coverage for the cataract treatment of the insured person. The cover amount provided per eye in this option equals 25% of the sum insured or INR 40,000 whichever is less.
The plan provides an additional benefit where the sum insured amount increases annually by 5% for each claim-free year. The maximum increase in this amount can be up to 50% of the opted sum insured amount.
Another useful feature of this plan is that it allows customers to enjoy the cashless facility at any network hospital. So, if you opt for this feature you will be saved from paying the treatment expenses yourself as the company will take care of your hospital bills.
This plan provides a cover equal to 50% of the sum insured amount for getting medical treatment or hospitalisation for 12 listed modern treatments.
As per section 80D of the Income Tax Act of 1961, the premium paid by the policyholder towards this health insurance policy is liable to get the helpful tax benefits.
Another add on benefit of this plan is that it comes with a lifelong renewability option that allows customers to enjoy plan benefits for a long tenure.
The table given below highlights the conditions that are necessary for becoming eligible to buy this policy. Check the table to collect detailed information about the plan's eligibility conditions.
|Age at entry (adults)||18 years||64 years|
|Sum Insured||Rs. 1 Lakh||Rs. 5 Lakhs|
|Members covered||Self, Spouse, Dependent legitimate or legally adopted children, Parents, Parents-in-law, newborn from 3 months of age.|
|Pre & post-hospitalisation||30 & 60 days respectively|
For your convenience, we've created here a sample illustration chart that shows the premium rates of the plan according to the different age groups of the insured person. Note that the data for calculating the premium is taken for a fixed sum insured amount of Rs. 5 lakhs and the coverage opted on an individual. Also, the premium rates specified in the given illustration are standard premiums, inclusive of TPA charges and exclusive of taxes applicable.
Sample Premium Illustration of Arogya Sanjeevani Policy
The list here highlights the conditions which are excluded from getting a claim as per the policy terms and conditions. Go through this list to get a clear idea about when you can file a claim for your policy.
You can easily purchase health insurance from the company's official website. However, please note that the company sells only a few health insurance products online.
In the section below, we've given a step-by-step process for buying health insurance from the National Insurance company's website. Read along to find out.
Once done, you will get a soft copy of the policy on your registered email ID. You can also visit the nearest National Insurance company's branch to buy health plans.
National insurance company settles claims using two easy methods:
Cashless Claim processReimbursement Claim process
In the cashless claim process, the company settles all the hospitalization expenses of the policyholder. But in the reimbursement process, the policyholder has to make payment of the hospital expenses on his own and can later reimburse those expenses from the insurance company by submitting the hospital bills and other required documents.
Given below is a detailed explanation of both these claim processes. Let's find out.
The cashless facility is only for policies that are purchased via a Third-Party Administrator (TPA).
Note Submit all the required documents to the TPA within 15 days.
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Introduction About Ayushman Bharat Yojana or PMJAY
Common Exclusions In A Health Insurance Policy
Medical Indemnity Insurance
Health Insurance Claim Settlement Ratio
Health Insurance FAQs
Benefits Of Renewing Health Insurance On Time
Preventive Health Checkup
You will get a free-look period of 15-30 days under the Arogya Sanjeevani Policy. If you cancel your plan within this period, you would receive the entire amount after a few nominal deductions. The table below shows the amount of refund provided to the cancellation timing of the policy.
|Refund of Premium (basis Policy Period)|
|Timing of Cancellation||1 year|
|Up to 30 days||75.00%|
|31 to 90 days||50.00%|
|3 to 6 months||25.00%|
|6 to 12 months||0.00%|
Yes, the plan comes with the portability benefit. As per the IRDAI guidelines, customers can port their plan from one insurer to another.
Yes, the National Insurance company allows customers to migrate their policy to any of its other health insurance products/plans.
If you are already insured under Arogya Sanjeevani Policy, you can easily increase the sum insured at the time of renewal in case you want it.
The plan has a copayment clause of 5% that is applicable to claim amount admissible and payable as per the terms and conditions of the policy.
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