National Arogya Sanjeevani Policy

National Arogya Sanjeevani Policy

National Arogya Sanjeevani Policy is a standard health insurance scheme (as per the IRDAI guidelines) with higher sum Insured options up to Rs 10 Lakh that too at a nominal premium. The policy features, benefits, and coverage details are given below:

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Arogya Sanjeevani health insurance policy offers coverage to everyone up to the age of 65 years.  Both Allopathic and Ayush treatments are covered. Moreover, the sum insured is available on both individual and family floater basis.

Eligibility Criteria

Key Features of National Arogya Sanjeevani Policy

National Arogya Sanjeevani policy offers the following features and benefits to the insured:

• The policy is available to adults within the age group of 18-65 years and dependent children from 3 months onwards
• Allopathy and AYUSH (Ayurveda, Unani, Yoga, Siddha, and Naturopathy) treatments are covered
• The sum insured is increased every year from 5% to 50% of the cumulative bonus
• The family members that can be covered include spouse, children, parents, and parents-in-law
• Cashless treatment at network hospitals can be availed through TPA
• Medical screening is only required for applicants above the age of 55-years
• Pre-negotiated package rates for specific  medical procedures/surgeries in cashless hospitals
• The policy is portable from/to similar insurance products
• The policyholder can avail tax benefits on the health insurance premium paid

Inclusions of National Arogya Sanjeevani Policy

Health insurance coverage benefits under the Arogya Sanjeevani health insurance policy are given below:

• In-patient hospitalization expenses such as room rent, ICU charges, surgeon, anesthetist, consultant fees as mentioned in the policy
• For treatment of cataract, the maximum coverage limit is Rs 40,000 or 25% of the sum insured
• Dental Treatment and Plastic Surgery as required during the treatment or accident or injury
• ICU and ICCU expenses are claimable equal to Rs 10,000 on daily basis or 5% of the coverage amount
• Modern medical treatments and advancements in technology  up to 50% of the insurance amount
• Ayush and allopathic hospitalization treatment expenses are compensated
• Pre- hospitalization coverage for 30 days and 60-days expense cover for post-hospitalization expenses
• Emergency Road Ambulance payment up to Rs 2000
• You can also file a claim for all the daycare medical procedures during the policy term

Exclusions of National Arogya Sanjeevani Policy

The limitations under the National Arogya Sanjeevani health plan are given below:

• Any expenses incurred on medical evaluation and investigation
• Hospital admission expense incurred on respite care, rest cure, and rehabilitation
• Any expense incurred on cosmetic and plastic surgery
• Sterility/Infertility/Maternity expenses also cannot be claimed
• Expenses related to hospitalization expenses incurred due to involvement in adventure/hazardous sports activities
• Gender treatments are also excluded
• Expenses related to the surgical treatment of obesity that does not fulfill certain conditions

Claim Process of Arogya Sanjeevani Policy- National

The policyholders can follow the claim procedure and the steps as given below:

Arogya Sanjeevani Reimbursement Claims:

For emergency hospitalizations you need to inform the insurer within the stipulated time-frame as given below:

• You need to share a written intimation/fax/call the TPA within 72-hours of hospitalization ( both emergency and planned)
• Pre and post hospitalization expenses are reimbursed separately post-treatment
• When you are leaving the hospital, do sign the Investigation report, discharge summary, and other relevant documents
• Submit all the required documents in original to the TPA within 15 days of hospital discharge

Arogya Sanjeevani Cashless Claims:

• To avail of cashless claims under your National Arogya Sanjeevani policy you need to fill the claim form
• Submit it to the TPA, and after verification, you will receive the authorization and can begin with the treatment
• Sign and verify your papers at the time of discharge
• If the insurer does not approve the cashless claim due to some reason, then you can get reimbursement of your expenses

Documents Required

For health claims, all the documents need to be submitted within the prescribed time limit

• Completed  National Arogya Sanjeevani claim form
• ID proof along with original medical bills and medical prescriptions mentioning that the hospital treatment is essential
• Diagnostic reports/ /OT notes/ Invoice of the implants
• Discharge summary
• Receipt of all the medical payments
• Medico legal report as per the case
• Details for NEFT
• Customer KYC
• Other documents as mentioned by the insurer

For more details, you can write to us at care@policybazaar.com or call us at 1800-708-8787.

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