National Insurance Arogya Sanjeevani Policy

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.

Key Features of Arogya Sanjeevani Policy

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.

1. Comprehensive Cover

   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.

2. Sum Insured Range

   This policy is available within a variety of the sum insured amounts ranging between Rs. 1 Lakh to Rs. 5 Lakhs.

3. Hospitalization Cover

   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.

4. Day Care Procedures

   With this plan, customers also get coverage for the expenses incurred during daycare treatments taken at a hospital or diagnostic center.

5. AYUSH Coverage

   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).

6. Ambulance Cover

   This plan offers a maximum cover of Rs. 2000/- for the expenses incurred on road ambulance service availed for the hospitalization of the policyholder.

7. Cataract Treatment

   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.

8. Annual Increase in Sum Insured

   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.

9. Cashless Facility

   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.

10. Modern Treatment

    This plan provides a cover equal to 50% of the sum insured amount for getting medical treatment or hospitalisation for 12 listed modern treatments.

11. Tax Benefits

    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.

12. Lifetime Renewability

    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.

Eligibility Criteria of Arogya Sanjeevani Policy

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.

Sample Premium Illustration of Arogya Sanjeevani Policy

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

Exclusions 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.

• Expenses related to the surgical treatment of obesity
• Change-of-Gender treatments
• Expenses for cosmetic or plastic surgery
• Expenses related to any treatment necessitated due to participation in hazardous or adventure sports
• Sterility and Infertility & Maternity expenses
• Refractive error surgery due to refractive error less than 7.5 dioptres.
• Drug/alcohol abuse
• Dental treatment (unless arising out of an accident and requiring hospitalization)
• Any expenses incurred on Domiciliary Hospitalization and OPD treatment
• Treatment performed outside the geographical limits of India

How to Purchase National Arogya Sanjeevani 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.

• Visit the official website of the company.
• Click on 'Products' and select the 'Health' tab.
• Click on the 'Get Quote/Buy Policy' menu.
• Select your desired plan and click on it.
• Fill in all the required information and make an online payment for the premium amount.

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.

What Is the Claim Procedure of National Arogya Sanjeevani Policy?

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.

Cashless Claim

The cashless facility is only for policies that are purchased via a Third-Party Administrator (TPA).

• One has to check whether the selected hospital falls under the list of network hospitals as the cashless claim facility is available at the network hospital only.
• In planned hospitalisation, the insured has to inform TPA/company in advance (72 hours prior) about the case.
• In emergency hospitalisation of the insured, (s)he must inform the TPA/company within 24 hours of the hospitalization.
• On getting admitted, a pre-authorisation request will be shared with the TPA by the hospital along with the duly signed documents.
• The TPA will settle all the bills with the hospital.

Note Submit all the required documents to the TPA within 15 days.

Reimbursement Claims

• One has to submit a written intimation (through the mail/fax) about the hospitalisation to the Third-Party Administrator (TPA)/company within 72 hours of emergency/planned hospitalisation.
• Don't forget to collect the discharge summary, investigation report, and required documents from the hospital.
• All original documents should be submitted to TPA/company within 15 days from the date of discharge.
• The company will verify all the documents and approve the claim amount.

What is the Renewal process for the National Arogya Sanjeevani Policy?

• Visit the official website of the company.
• Click on "Quick Renewal" and a new tab will open.
• Enter your current policy number.
• Answer the given CAPTCHA and click on the "Renew Policy" option.
• Make an online payment for the premium and your policy will be renewed.