Tata AIG Arogya Sanjeevani policy

Tata AIG Arogya Sanjeevani policy benefits

• Key features of Tata AIG Arogya Sanjeevani policy

  Feature	Description
  Sum Assured	Minimum Sum Assured is ₹ 1 Lac Maximum Sum Assured is ₹ 5 Lacs (Sum Assured can be opted for in multiples of ₹50,000)
  Minimum & Maximum Entry Age for Principal Assured	Adult Minimum Entry Age is 18 years Maximum Entry Age is 65 years Children Minimum Entry Age is 3 months Maximum Entry Age is 25 years
  Policy Term	1 year
  Policy Type	Individual Plan / Family Floater Plan
  Hospitalisation Benefit Limits	For hospitalization expenses like room, boarding, nursing expenses up to 2% of Sum Assured or a maximum of ₹5,000 per day. ICU/ICCU expenses will also be provided up to 5% of sum assured or a maximum of ₹10,000 per day Ambulance Charges upto ₹2,000 per hospitalisation Sub-limits of cataract surgery are equal to actual expenses i.e. 25% sum assured or ₹4 lacs, whichever is lower.
  Pre & Post Hospitalization	Pre Hospitalization expenses upto – 30 days Post Hospitalization expenses upto – 60 days
  Initial Waiting Period	30 days waiting period. No claim will be paid in first 30 days after buying policy
  Specific Waiting Period	24 months - Benign ENT disorders, Sinus, Cataract and age-related eye illnesses, Non-infective arthritis, tympanoplasty, Polyps, Gastric ulcer, Rheumatism, Gout, Tonsillectomy, Mastoidectomy, cysts, Spinal diseases except for accidental cases 48 months - Joint replacement treatment unless it is from an accident, Osteoporosis, etc 48 months - Pre-Existing Disease (pre-existing disease or medical condition)
  Co-payment	Co-pay fixed at 5% for all ages/sum insureds in this policy
  AYUSH Treatment	AYUSH treatments are covered (AYUSH means all treatments related to Ayurvedic, Yoga, and Naturopathy, Unani, Siddha, Homeopathy)
  NCB (No Claim Bonus)	NCB (No Claim Bonus) of 5% for each year up to 50% of the sum assured is covered.
  Other Policy Benefits
  Family Members that can be covered under Floater Plan	The policyholder can include dependents, such as their legally wedded spouse, parents, dependent children (including legally adopted children) and parents-in-law. Note that any children who are above 18 yrs and financially independent will not be eligible for family floater coverage
  Cashless Benefit	Yes, Cashless Treatment is available under this policy at the respective insurance company’s Network Hospitals
  Premium Payment Frequency	Premiums can be paid on a Monthly, Quarterly, Half-yearly and Annual basis.
  Renewability	Lifetime Renewability available on this policy
  Portability	The policy offers the Portability option to other health insurance companies
  Daycare Treatment	It covers the expenses arising out of any day care treatment procedures
  Specific Coverages under this Policy
  Modern Treatment Methods (Covered upto 50% of the Sum Insured)	Uterine Artery Embolization and HIFU (High Intensity Focused Ultrasound) Balloon Sinuplasty Deep Brain Stimulation Oral Chemotherapy Immunotherapy – Monoclonal Antibody to be given as injection Intra Vitreal injections Robotic surgeries Stereotactic radio surgeries Bronchial Thermoplasty Vaporization of the prostrate (Green laser treatment or holmium laser treatment) IONM – (Intra Operative Neuro Monitoring) Stem Cell Therapy - Hematopoietic stem cells for bone marrow transplant for haematological conditions to be cover
  Plastic Surgery and Dental Treatment Expenses	The cost of any dental or plastic surgery treatment taken as a result of an illness or injury is covered under this policy

• Expenses covered under Tata AIG Arogya Sanjeevani policy

  • Pre & Post Hospitalization Expenses
    This policy will cover all the pre-hospitalization expenses (upto 30 days) and post-hospitalization expenses (upto 60 days) following an emergency illness or accidental injury.
  • ICU Charges
    The Arogya Sanjeevani policy pays ICU/ICCU expenses be provided up to 5% of sum assured or a maximum of ₹10,000 per day.
  • Room Rent
    It covers the room rent of the hospital to up to a maximum of ₹5,000 per day.
  • Ambulance Services
    It covers the cost of ambulance services up to a maximum of ₹2000 per hospitalization.
  • Cataract Surgery
    It also covers the cost of cataract surgery upto a maximum of ₹40,000 or 25% of the sum insured amount, whichever is less for each eye.
  • Coronavirus (COID-19) Expenses
    It covers any expenses incurred on hospitalization/treatment due to contracting COVID-19 or coronavirus disease.
  • AYUSH Treatment
    AYUSH treatments are covered at recognised medical centres. (AYUSH means all treatments related to Ayurvedic, Yoga, and Naturopathy, Unani, Siddha, Homeopathy).
  • New Age/ Modern Treatment
    This policy also covers the cost of modern/ new age treatment up to a maximum of 50% of the sum insured amount. The list of illnesses are in the table above.

• Terms and Conditions of Tata AIG Arogya Sanjeevani Policy

  • Sum Assured
    This policy offers the multiple sum assured options from ₹1 lac to ₹5 lacs in the multiple of ₹50,000. The sum assured is available on both individual and family floater basis.
  • Policy Duration
    This policy scheme offers policy term option of one year and is renewable on a lifetime basis.
  • Co-payment
    For insureds of all age categories and sum insureds, this policy offers a standard co-payment option of 5% of the incurred claims amount payable at the time of settlement.
  • Cumulative Bonus
    Arogya Sanjeevani policy also provides a bonus of 5% on the total sum insured amount for every claim-free year that is passed by the insured, and this is accumulated upto a maximum of 50% of the sum insured as a bonus.
  • Frequency of Premium Payment
    The premium for this policy can be paid on a monthly, half-yearly, quarterly, and annual basis.
  • Portability
    Arogya Sanjeevani policy is easily portable from one insurance company depending on the requirements of the insured.
  • Grace Period
    For annual premium payment, 30 days grace period is allowed and for other modes (monthly, quarterly, half yearly) of premium payment 15 days grace period is allowed.
  • Free Look Period
    The policy has a Free Look period of 15 days, within which the insure can cancel the policy and expect a full refund.

• How can one buy the Tata AIG Arogya Sanjeevani policy?

  Perhaps the easiest way to purchase a Arogya Sanjeevani health insurance policy will be online because the IRDAI has allowed insurance companies to issue the Arogya Sanjeevani electronically to the policyholders. This means that the insurance company can only share a online pdf document as an insurance policy to the insured unlike all other insurance plans currently in the Indian market. The simple process to be followed is:

  • Go online to a comparison website like eindiainsurance
  • Compare the quotes across all the insurance companies – Importantly since all insurance companies, will be offering exactly the same set of benefits for this plan, the individual can compare the premiums and also review the financial parameters of the insurance company while making a final decision
  • Fill up the Arogya Sanjeevani proposal form of the respective insurance company
  • Make a payment directly online through the payment gateway and then the policy will get issued by the respective insurance company

  Moreover, the IRDAI has also directed all health insurance companies to provide a certificate of insurance to each policyholder for the benefits, terms and conditions of their Arogya Sanjeevani policy.

• Tata AIG health insurance claims

  Claim related information:

  TATA AIG Travel Insurance - 24 Hour Assistance Contact

  Assistance Company Details: Europ Assistance India Pvt. Ltd.

  For Cashless Claims (For Insured Only) - USA/Canada

  • Number: +1-833-440-1575 (Tollfree within US and Canada)
  • Email: [email protected]

  For Cashless Claims (For Insured Only) - Countries Other Than USA/Canada & India

  • Number: +91-22-68227600 (Call back facility available)
  • Email: [email protected]

  For Reimbursement Claims (For Insured Only)

  • Email: [email protected]
  • Customers calling from India: 022-64898282 (24×7)
  • Senior Citizens Helpline: 1800-267-1955
  • Customers calling from outside India: +91-22-66939500
  • Website: www.tataaig.com

  Claims Department Address
  TATA AIG General Insurance Company Ltd.
  7th and 8th Floor, Romell Tech Park,
  Cama Industrial Estate, Western Express Highway,
  Goregaon (E),
  Mumbai, Maharashtra - 400063.

  For Availing Optional Assistance Services

  • USA/Canada: +1-833-440-1575 (Tollfree within US and Canada)
  • Email: [email protected]

  • Other Countries: +91-22-68227600 (Call back facility available)
  • Email: [email protected]

  It is however important to call the customer support number in the event of a claim. In the event of outpatient treatment (where hospitalization is not necessary), the insured should keep all the relevant bills and receipts and file the same for reimbursement with Tata AIG Claims Department.
  
  eindiainsurance markets TATA AIG's various insurance products. However, eindiainsurance is not responsible for any claims. Claims are settled directly by TATA AIG General Insurance Company Ltd.

  Procedure for reimbursement of medical expenses

  • The TPA (Third Party Administrator) must be informed no later than 7 days of completion of such treatment, consultation or procedure using the Claim Intimation Form.
  • Please send the duly signed claim form and all the information/documents mentioned therein to your designated TPA within 15 days of the occurrence of the Incident. Please refer to claim form for complete documentation.
  • If there is any deficiency in the documents/information submitted by the insured, the TPA will send the deficiency letter within 7 days of receipt of the claim documents.
  • On receipt of the complete set of claim documents, Tata AIG will send the payment for the admissible amount, along with a settlement statement within 30 days.
  • The payment will be sent in the name of the proposer.
  (Note: Payment will only be made for items covered under your policy and upto the limits therein.)
  

  Procedure to avail cashless treatment

  • For any emergency Hospitalisation, the designated TPA must be informed no later than 24 hours after hospitalization.
  • For any planned hospitalization, kindly seek cashless authorization from the designated TPA atleast 48 hours prior to the hospitalization.
  • TPA will check your coverage as per the eligibility and send an authorization letter to the provider. In case there is any deficiency in the documents sent, the same shall be communicated to the hospital within 6 hours of receipt of documents.
  • Please pay the non-medical and expenses not covered to the hospital prior to the discharge.
  • In case the ailment /treatment is not covered under the policy a rejection letter would be sent to the provider within 6 hours.
  (Note: n Insured person is entitled for cashless coverage only in our empanelled hospitals.)

  Grievance Redressal Procedure

  Tata AIG is committed to extend the best possible services to the insured. However, if you are not satisfied with our services and wish to lodge a complaint, please call our 24X7 Toll free number 1800266-7780 or 022-66939500 (toll number) or 1800 22 9966 (For Senior Citizens) or you may email to the customer service desk at [email protected].
  After examining the issue and subsequent closure, Tata AIG will send our response within 10 days from the date of receipt of the complaint by them. In case the resolution is likely to take a longer time, we will inform you of the same through an interim reply.
  Escalation Level 1
  In case you do not receive a resolution within 10 days or if the resolution still does not meet your expectations, you can write to [email protected] . After analysing the matter internally and subsequent closure, we will send our response within a period of 8 days from the date of receipt at this email id.
  Escalation Level 2
  In case you do not receive a resolution within 8 days or if the resolution still does not meet your expectations, you can write to Head - Customer Services at [email protected] . After examining the matter, we will send you our final response within 7 days from the date of receipt of your complaint on this email id.

• Policy cancellation and refunds

  The insured can cancel the policy at anytime during the policy year, subject to following refund options:

  a) The Policyholder may cancel this Policy by giving 7days' written notice, and in such an event, the Company shall refund proportionate premium for unexpired policy period. No refunds of premium shall be made in respect of Cancellation where, any claim has been admitted or has been lodged or any benefit under this Policy has been availed by the Insured Person.
  b) The Company may cancel the Policy at any time on grounds of established fraud, misrepresentation or non disclosure of material facts by the Policyholder/Insured Person, by giving 15 days' written notice. There would be no refund of premium on cancellation on grounds of established fraud, misrepresentation or non disclosure of material facts

• Exclusions under the Tata AIG Arogya Sanjeevani health insurance plan

  • Maternity Expenses - Cost of treatment related to pregnancy and child birth
  • Domiciliary hospitalization - Domiciliary hospitalization expenses
  • Outpatient Treatment – Policy covers only expenses incurred during Inpatient treatment (atleast 24 hours hospitalisation)
  • Adventure/ Hazardous Sports – Active Participation in a hazardous activities including scuba diving, rock climbing, sky diving, parasailing, deep-sea diving, mountaineering, etc, as a professional
  • Cosmetic or Plastic Surgery – Unnecessary expenses for cosmetic/plastic surgery following an accident, burn injury, other medically necessary treatment
  • Diagnostic or Investigative Tests - Diagnostic or Investigative tests done by the insured which are elective in nature
  • Alcohol/ Drug addiction- Treatment following addiction of alcohol or drug/substance abuse
  • Bed Rest or Rehabilitation Expenses
  • Expenses for Treatment of Sterility or Infertility
  • Claims due to a Nuclear Attack or War/ War-like situation
  • Expenses incurred for Weight Control/ Obesity Treatment
  • Any Treatment received by the insured outside the boundaries of India
  • Expenses relating to surgery or treatment of Gender change