United India Arogya Sanjeevani Policy
The United India Arogya Sanjeevani Policy is one such policy that is unique in putting forth an effort to combat the recent status of hospitalization expenses which includes an Individual as well as a Family Floater plan providing insurance cover for the hospitalization expenses. The policy was introduced by the IRDAI to cover the health insurance related needs of an individual.
What is the United India Arogya Sanjeevani Policy?
Arogya Sanjeevani Policy offered by United Insurance Health Insurance was launched on April 1st, 2020. It is a standard policy designed to provide insurance coverage for the expenses acquired during hospitalization of up to Rs 5 Lakh. Arogya Sanjeevani Policy has been mandated by IRDAI to be a universal policy for all general and health insurance companies in India and for health insurers to develop standard plans for both families as well as individuals.
The plan offers several benefits for pre and post hospitalization, which includes nursing charges, bed charges, doctor consultation charges and ICU, among others. The policy offers coverage for daycare treatment, AYUSH treatment, cataract treatment, and other modern treatment methods.
The policy is available in two types of plans:
- Individual Plan- In this plan, a sum is insured to each individual separately. Only a single person will act as a beneficiary under this plan.
- Family Floater Plan- In such types of plans, the limit of the sum insured is shared by the whole family of the insured. The family members can be included under dependents such as a spouse, children, parents-in-law, etc.
Features of the United India Arogya Sanjeevani Policy
Some of the salient features of this policy are:
- Coverage for 30 days pre-hospitalization and 60 days post-hospitalization
- Policy type- Individual/Floater
- Category of cover- Indemnity
- Sum Insured- Rs 1 Lakh to 5 Lakh (going up in multiples of Rs 50,000)
- Policy Period- 1 year
- Grace Period- In case of an annual payment of premium, a grace period of 30 days is given to the policyholder while a period of 15 days is allotted in case of other payment modes.
- Coverage for expenses incurred due to hospitalization for a minimum period of 24 hours except in the case of treatment at a daycare facility.
- Coverage for room rent, boarding, nursing expenses, ICU expenses, or ICCU charges is provided with respect to the limit mentioned in the policy schedule.
- Coverage of up to 25% of the sum insured for the expenses incurred while undergoing cataract treatment.
- AYUSH benefits for treatment under Ayurveda,Yoga and neuropathy, Unani, Siddha, and Homeopathy systems of medicines.
- Ambulance cover subject to maximum Rs 2000 per hospitalization during the policy period.
- Provision of insurance cover for expenses during hospitalization due to COVID-19.
- A co-payment option is available, which is 5% of the total claim amount. It requires the applicant to pay only 5% of the total claim amount at the time of claim settlement.
- Cumulative bonus of 5% of the total sum insured rewarded for every claim-free policy year.
- Tax benefit under the Sec 80D.
Benefits of United India Arogya Sanjeevani Policy
The Arogya Sanjeevani Policy strives to simplify health insurances by providing basic and standard medical insurance with uniform coverage. The goal is to make the basic insurance benefits available to policyholders belonging to all income groups. The list of benefits that are available for the insured person includes:
- Hospitalization - This benefit provides coverage for expenses acquired during hospitalization of the person insured, during the policy period. It includes nursing, room rent, and boarding expenses.
- ICU Benefit - The policy covers expenses for admission in ICU in a network hospital to 5% of the sum insured with a limit up to Rs 10,000/day.
- AYUSH Treatment Benefit - The plan offers to cover the expenses incurred for treatments under Ayurveda, Yoga and neuropathy, Unani, Siddha, and Homeopathy systems of medicines during a single policy period.
- Cataract Treatment Benefit- The policy mandates the company to indemnify the expenses incurred for the treatment of cataract with a limit of 25% the sum insured (per eye per year).
- Pre-hospitalization Benefit- Under the Arogya Sanjeevani Policy, insurance cover is provided for the medical expenses incurred before the admission of the insured person to a hospital for a period of 30 days.
- Post-hospitalization Benefit- Along with offering coverage before the hospitalization of the individual, the policy also provides coverage of post-hospitalization for a period of 60 days after the discharge of the person from the hospital. However, it is important to note that the coverage is provided following an admissible hospitalization which is covered by the policy.
- Treatment Methods & Advancement in Technology - Some of the additional procedures for which the insured individual can claim the policy include:
- Balloon Sinuplasty
- immunotherapy - Monoclonal Antibody to be given as an injection
- Uterine Artery Embolization and High Intensity Focused Ultrasound)
- Stem Cell Therapy: Hematopoietic stem cells for bone marrow transplant
- Deep Brain Stimulation
- Cumulative Bonus- A cumulative bonus is generally a form of reward for the insured person for being fit and not filing a claim. The benefit of the bonus is granted in the year of renewal by making an increase in the amount of sum insured. Under this policy, about 5% Cumulative Bonus shall be applied to the sum insured for the next policy year following every claim-free policy year.
- Daycare Treatment- In this benefit, the policy gives cover for the listed Daycare treatment expenses due to disease/illness/injury during the policy period. Treatments normally taken on an out-patient basis is not included in this cover.
- Ambulance Benefit- It covers expenses required for transportation of the insured to the hospital for admission in case of emergencies or from one hospital to another to seek better medical care.
- Plastic Surgery and Dental Treatment Benefit- Any Dental treatment or Plastic Surgery necessitated due to disease or injury will also be covered under the policy.
Exclusions of United India Arogya Sanjeevani Policy
The coverage of expenses for the following treatments has been excluded from the policy:
- Any pre-existing diseases will be excluded from an insurance cover for a waiting period of 4 years from the date of inception of the policy.
- Expenses related to any treatment which takes place during the first 30 days of policy commencement shall not be up for claiming the policy.
- The expenses incurred by the individual purely regarding diagnostic and evaluation purposes are excluded.
- The policy does not offer coverage for hospitalization for purposes like enforced bed rest without receiving any treatment.
- Treatments of obesity-related health conditions like, surgery, obesity-related cardiomyopathy, coronary heart disease, sleep apnea uncontrolled diabetes of type2 will not be covered if the individual is less than 18 years of age.
- Surgical management, to change characteristics of the body to those of the opposite sex are excluded from the policy cover.
- Expenses of treatment due to any hazardous or adventure sports activity.
- Expenses of treatment as a result of the insured person committing or attempting a breach of law.
- Treatment for drug abuse, Alcoholism, or any addictive condition.
- Expenses arising due to maternity causes during pregnancy or child-birth.
- No coverage for outpatient treatment.
- Expenses in regards to the treatment of infertility or sterility.
- Expenses from the domiciliary hospitalization are excluded.
- No coverage for treatment occurring outside of India.
- The policy does not cover expenses of buying dietary supplements like minerals, vitamins, etc. without a prescription.
- Under the circumstances of nuclear war or civil war, the individual cannot claim the insurance cover for the treatment of any injuries or disease.
Eligibility Required to Buy the United India Arogya Sanjeevani Policy
The minimum eligibility requirements for buying this plan are:
- The policy can be purchased by any person between the ages of 18 years and 65 years either for himself/herself under the individual plan or for dependent members such as a spouse, children, parents, and parents-in-law, under the family floater policy plan. For the individuals who are beyond the age of 65 years, there is provision for only renewals.
- To purchase the policy for dependent children, it is important to note that children between the ages of 3 months and 18 years shall be covered only when either/both the parents are covered under the policy. The children above 18 years of age will be covered along with the parents until the attaining the age of 25 years.
- In case the child is above the age of 18 years and is financially independent, he/she will not be included under the policy covering the parent for subsequent renewals. He/she has to opt for a separate insurance cover.
Claim Process for United India Arogya Sanjeevani Policy
The policyholder can claim the policy either for cashless for reimbursement facilities.
Procedure for cashless claims is as follows:
- A requirement of pre-authorization by the company in needed.
- The applicant has to fill the cashless claim request form and deposit it either online on the company website or given directly to the insurer’s office.
- The company then issues a pre-authorization letter to the hospital after verification.
- The insurer needs to verify and sign the discharge papers at the time of discharge. The bills are settled directly with the hospital authority by the insurance company.
Procedure for Reimbursement Claim
In case of a reimbursement claim, the applicant is required to deposit all the documents necessary to the company within the prescribed time (as described in the policy wordings). This type of claim is registered if the treatment is availed from a non-network hospital, where the insured has to pay the bills initially and claim the policy later for reimbursement.
The applicant will be informed regarding the acceptance or rejection of the claim within a period of 30 days.
The required documents while claiming United India Arogya Sanjeevani Policy are:
- Duly filled claim form
- Photo identity proof of the insured
- Medical practitioner's prescription that advises admission
- Medical history of the applicant along with discharge summary details if available
- Investigation/diagnostic test reports
- KYC (Identity proof with Address) of the proposer
- Any other document mentioned by the insurance company
How to Buy the United India Arogya Sanjeevani Policy?
The Arogya Sanjeevani Policy can be purchased both online as well as offline.
The offline purchase involves the applicant to fill out the proposal form and submit it to the branch office of United India Insurance Co. Ltd.
The online availability of the policy makes the claim procedure faster and more convenient. For purchasing the policy online, one can visit paisawiki.com as well:
- After visiting the website, the applicant is required to fill a proposal form by submitting some required details such as name, members to be added, location, coverage etc.
- The website will suggest some of the plans as per the insurance requirement. One can choose Arogya Sanjeevani policy from there or opt to compare the policies as well.
- In the next step, the premiums will be suggested along with the plan details.
- Select a suitable mode of premium payment from net banking or credit/debit card.
- A receipt of the payment is sent to the registered email id of the applicant.
- The policy is issued after the successful payment. The hard copy will be delivered to the registered mailing address.
NOTE: policyholders are still required to issue the policy documents in physical form even if the policy is purchased online.
Renewal of United India Arogya Sanjeevani Policy
The policy offers a lifelong renewal to the insured person which means the individual can renew the policy throughout life. The renewal can be done online by following simple steps at Paisawiki.com:
- Go to the official website of paisawiki.com.
- Select the policy which requires renewal.
- Enter the details such as policy number and plan name and proceed for the premium payment.
- Pay the premium via online net banking or credit/debit card mode of payment.
- The receipt of the renewal payment is sent to the policyholder’s registered email.
- The policy is not cancelled immediately after the last date of premium due and allows a grace period of either 15 or 30 days depending on the mode of premium payment (annual/monthly).
Ans: The sub-limit in the policy for the expenses like boarding, room rent, and nursing expenses is 2% of the sum insured with a maximum limit of Rs 5000 per day. For ICU/ICCU charges the sub-limit is 5% of the insured sum subject to a maximum Rs 10,000.
Ans: United India Arogya Sanjeevani Policy offers the sum insured between the ranges Rs 1 lakh to 5 lakh inclusing Rs 1.5 Lakh, 2 Lakh, 2.5 Lakh, 3 Lakh, 3.5 Lakh, 4 Lakh, 4.5 Lakh, 5 Lakh.
Ans: Yes, the policy comes with a tax benefit against the premium paid under the policy.
Ans: The Arogya Sanjeevani Policy comes with a grace period of 30 days after the expiration of policy in case of annual premium payment and 15 days period in case of a monthly payment of premium.
Ans: Yes, the policy provides insurance coverage for expenses arising in case of hospitalization due to COVID-19.
Written By: Paisawiki - Updated: 09 April 2021