|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
|Policy Term||1 year|
|Policy Type||Individual Plan / Family Floater Plan|
|Hospitalisation Benefit Limits||
|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)
|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|
|Do make sure you take out your insurance before you travel.||Don't think that buying travel insurance is an unnecessary extra expense on top of your holiday cost.|
|Do make sure that you have disclosed any pre-existing medical conditions to your insurer when you take out the policy (including yourself and your dependent family).||Don't arrange your own evacuations/repatriation unless your life is in danger without it and you and your companions cannot talk to the insurer in time.|
|Do ensure that you take all documentation of your travel policy with you on holiday, especially the emergency assistance telephone number.||Don't keep your properties, travel documents unattended.|
|DO contact the Assistance & claim-settling Co. for assistance and inform immediately, with full details. The insured can contact Falck India Pvt Ltd which will provide emergency assistance and claims administration services guidance.||Don't get admitted in a hospital merely for investigation, evaluation or health checkups- It will not be approved.|
|In extreme emergency medical conditions prohibiting getting in touch with assistance co., get admitted to the nearest facility/hospital. Request your representative to contact the assistance and claim settling co for further process.||Don't forget to record the details of damage caused to any property or injury to anyone involved..|
|For reimbursement claim please intimate ASAP to Falck India Pvt Ltd via fax/ email and seek documentation advice before return from abroad.||Don't claim the following expenses:- Telephone/fax , food and beverages , documentation charges|
|DO keep all Original bills and receipts, travel documents, original medical reports for easy process of reimbursement claim.||Don't panic, If you receive a bill or notice from a provider or collection agency, simply forward it to Falck India Pvt Ltd by the quickest means possible (fax or e-mail), and to take action directly with the provider.|
|In case of loss of passport, the police authorities to be informed, contact the nearest Indian embassy for further guidelines?||Don't admit any liability without written consent of Falck India Pvt Ltd to any party in what so ever form.|
|In case of Out Patient treatment (OPD) kindly forward the original papers to Falck India Pvt Ltd Haryana office.||Don't be reckless and always safeguard yourself from unhealthy event or circumstance as if the insurance is not in force.|
|Do take and keep detailed notes of all conversations with insurance company representatives, and get names, phone numbers, and job titles of people you speak with.|
|DO be honest and forthcoming with your insurer. Even if it is embarrassing, it is better if your insurer knows all the facts. Failing to be candid with your insurer might invalidate your policy or cause a denial of coverage.|
|Please send claim papers for reimbursement cases within 30 days from the date of return to India.|
|Time of Cancellation||% of Premium Refund|
|Free Look Period||100% refund|
|30 days||75% refund|
|31 days – 3 months||50% refund|
|3 months – 6 months||25% refund|
|> 6 months||NIL Refund|
Arogya Sanjeevani is a health insurance policy that protects one at the time of hospitalization following an accident or sickness. It’s a newly launched health insurance policy with standard features which is to be offered by all health insurance companies in India starting from 1st April, 2020 onwards.
Yes, under the Family Floater variance of the Arogya Sanjeevani Policy, one can get coverage for themselves, their legally wedded spouse, dependent children, parents, parents in laws. One can also choose to buy individual policies for each of these family members. Note that any children who are above 18 yrs and financially independent will not be eligible for family floater coverage.
The sum insured options available under the Arogya Sanjeevani plan range from ₹1 lac to ₹5 lacs with multiples of ₹50,000.
Yes, this plan covers treatment related to Coronavirus, subject to the expenses not being incurred during the initial waiting period under the policy.
All day care treatments are covered under this plan.
No, while the IRDAI has allowed the insurance companies the flexibility to charge premium according to it’s portfolio and claims experience, the premium charged will however be the same for the insurance companies across India.
Arogya Sanjeevani policy comes with a policy term of one year only, but renewable on a lifetime basis.
Yes, even NRIs (Non-Resident Indians) can buy Arogya Sanjeevani policy. Although the customer needs to be in India at the time of policy buying and should pay the premium in Indian currency through an Indian bank account. Importantly, expenses incurred only for treatment in India will be paid under this policy.
Yes. You can port your existing health insurance policy into Arogya Sanjeevani.
The Arogya Sanjeevani policy comes with a co-pay of 5%, which means that at the time of claim settlement, the insured will need to pay 5% of the claims amount towards the settlement. This is irrespective of the age of the insured.
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.
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