Arogya Sanjeevani Policy
About Arogya Sanjeevani Policy, Royal Sundaram General Insurance Co. limited
Arogya Sanjeevani Policy, Royal Sundaram General Insurance Co. limited is a standard health insurance policy for your family. It’s a Health Insurance Policy, mandated by the Insurance Regulatory and Development Authority of India (IRDAI) to remove ambiguity in different products by different insurance companies and bring in uniformity in features and structure of the Health Insurance Product.
Who can be covered?
Policy can be availed for Self and the following family members
- Legally wedded spouse.
- Parents and Parents- in-law.
- Dependent Children (i.e. natural or legally adopted) between the age 3 months to 25 years.
Should the proposer also be covered in the policy?
Proposer needs to be mandatorily covered in the Policy, up to the age of 65. In case the proposer is more than 65 years can obtain policy for family, without covering self.
What is the minimum and maximum age allowed?
- Minimum entry age is 18 years and maximum entry age is 65 years.
- The minimum entry age under this policy is between 3 months and 25 years.
Individual or Floater Sum Insured?
The policy can be purchased on an Individual basis or on a Family Floater basis. In case of a family floater policy, one family will share a single sum insured as opted.
Only one member can be covered under an individual sum insured policy. A floater policy can cover a maximum of 6 adults and there is no limit on the number of children in a floater policy.
What will be the policy tenure?
Customer can buy the policy for one year. 'One Policy Year' shall mean a period of one year from the date of issuance of the policy.
What are the available sum insured options?
Customer has the option to choose from a wide range of Sum Insured's available:
Rs.1lakh, Rs.1.5lakhs, Rs. 2 lakhs, Rs. 2.5 lakhs, Rs. 3 lakhs, Rs. 3.5 lakhs, Rs.4 lakhs, Rs. 4.5 lakhs, Rs. 5 lakhs
What are the Key Benefits of this policy?
Key Benefits of the Policy are
- Hospitalization Expenses and other Expenses
- Ayush Treatment
- Cataract Treatment
- Post Hospitalization
- Modern Treatments
- Cumulative Bonus
Can you give some details of the Modern Treatments available in this policy?
The following procedures will be covered (wherever medically indicated) either as in patient or as part of day care treatment in a hospital up to 50% of Sum Insured, specified in the policy schedule, during the policy period:
Can you give some details on the Ayush treatment available in this policy?
The Company shall indemnify medical expenses incurred for inpatient care treatment Under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy system of medicines during each Policy Year up to the limit of sum insured as specified in the policy schedule in any AYUSH Hospital.
Can you give some details on the Cumulative Bonus available in this policy?
Cumulative Bonus will be increased by 5% in respect of each claim free policy year (where no claims are reported), provided the policy is renewed with the company without a break subject to maximum of 50% of the sum insured under the current policy year. If a claim is made in any particular year, the cumulative bonus accrued shall be reduced at the same rate at which it has accrued. However, sum insured will be maintained and will not be reduced in the policy year.
What are the sub limits in this policy?
- Room Rent, Boarding, Nursing Expenses as provided by the Hospital / Nursing Horne up to 2% of the sum insured subject to maximum of Rs.5000/-, per day.
- Intensive Care Unit (ICU) / Intensive Cardiac Care Unit (ICCU) expenses up to 5% of sum insured subject to maximum of Rs. 10,000/- per day.
- The Company shall indemnify medical expenses incurred for treatment of Cataract, subject to a limit of 25% of Sum insured or Rs. 40,000/-, whichever is lower, per each eye in one policy year.
- Each claim under the Policy shall be subject to a Co-payment of 5% applicable to claim amount admissible and payable as per the terms and conditions of the Policy.
What are the waiting periods in this policy?
The Company shall not be liable under this Policy for any claim in connection with or in respect of:
- 30 Days Initial Waiting Period: We will not cover any treatment taken during the first 30 days from the first commencement of the Policy, unless the treatment is due to an Accident. This waiting period does not apply for any subsequent and continuous renewals of your Policy or Policy is enforced with any other Insurance Company (Non-Life/Health Insurance Company).
- Pre-Existing Diseases: Expenses related to the Pre-existing Disease until 48 months of continuous coverage have elapsed since the inception of the first Policy with us or Policy is enforced with any other Insurance Company (Non-Life/Health Insurance Company).
- Specific Waiting Periods: For all insured persons the 20 conditions listed below will be subject to a waiting period of 24 months and will be covered in the third policy year as long as the insured person has been insured continuously under the Policy without any break:
What are the exclusions in this policy?
The Company shall not be liable to make any payment under the policy, in respect of any expenses incurred in connection with or in respect of:
Investigation & Evaluation (Code- Excl04)
Rest Cure, rehabilitation and respite care (Code- ExcI05)
Obesity/ Weight Control (Code- ExcI06)
Change-of-Gender treatments: (Code- Excl07)
Cosmetic or plastic Surgery: (Code- Excl08)
Hazardous or Adventure sports: (Code- ExcI09)
Breach of law: (Code- Excl10)
Excluded Providers: (Code-Excl11)
Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof. (Code- Excl12)
Treatments received in heath hydro’s, nature cure clinics, spas or similar establishments or private beds registered as a nursing home attached to such establishments or where admission is arranged wholly or partly for domestic reasons. (Code- Excl13)
Dietary supplements and substances that can be purchased without prescription, including but not limited to Vitamins, minerals and organic substances unless prescribed by a medical practitioner as part of hospitalization claim or day care procedure. (Code- Excl14)
Refractive Error. -(Code- Excll5)
Unproven Treatments:(Code- Exc116)
Sterility and Infertility: (Code- Excll7)
Maternity Expenses (Code - Excl18):
War (whether declared or not) and war like occurrence or invasion, acts of foreign enemies, hostilities, civil war, rebellion, revolutions, insurrections, mutiny, military or usurped power, seizure, capture, arrest, restraints and detainment of all kinds.
Nuclear, chemical or biological attack or weapons, contributed to, caused by, resulting from or from any other cause or event contributing concurrently or in any other sequence to the loss, claim or expense.
Any expenses incurred on Domiciliary Hospitalization and OPD treatment
Treatments taken outside the geographical limits in India
1n respect of the existing diseases, disclosed by the insured and mentioned in the policy schedule (based on insured’s consent), policyholder is not entitled to get the coverage for specified ICD codes.
What are the cancellation conditions is this policy?