Edelweiss Arogya Sanjeevani Plan

Edelweiss Arogya Sanjeevani Insurance Policy is introduced under the recent announcement of IRDAI, which is a basic health cover with sum insured ranging from Rs 1 lakh to 5 lakh. In order to maintain its uniqueness, the IRDAI has also restricted all the insurance providers to imposing deductibles and variants with this policy.

Edelweiss Arogya Sanjeevani Policy: Key Highlights

Type

Individual/Floater

Sum Insured

1 lakh-5 lakh

Pre-existing Illness Waiting Period

48 months

Claim Payment Type

Indemnity Basis (Cashless/Reimbursement)

Cumulative Bonus

5%-50% of the SI


Scope of Coverage

The scope of coverage under this policy starts from Rs 1 lakh, while the maximum sum insured to be availed is Rs 5 lakh. Increment in SI in allowed in multiples of Rs 50,000. The policy tenure is for 1 year. The scope of coverage under this policy can be categorized as:

  • Hospitalization Expenses: In-patient treatment expenses for a hospital stay in excess of 24 hours are reimbursed fully, subject to complying with the limits prescribed in the policy.
  • Day-Care Treatment: The cover is for treatment or procedures in a hospital where the hospital stay is less than 24 hours.
  • Pre Hospitalization: During 30 days before admission into a hospital, all medical expenses are reimbursed.
  • Post Hospitalization: The medical expenses incurred during 60 days from the discharge date are eligible for reimbursement.
  • Cataract Treatment: The insured is covered for expenses up to lower of 25% of the Sum Insured or Rs 40, 000, whichever is lower, per eye per policy year.  
  • Alternative Treatment: The Insured can avail of AYUSH Treatment with up to full reimbursement of incurred expenses.

Inclusions of the Edelweiss Arogya Sanjeevani Policy

The inclusions in the policy have a bearing on the decision to buy Edelweiss Arogya Sanjeevani. Though the premium is extremely affordable, the policy’s inclusion list is not with less coverage:

  • Hospitalization Expenses: All treatment costs are covered under hospitalization with an overnight stay or in a Day-Care facility with a stay of a few hours.
  • Pre and Post Hospitalization Expenses: The cover is for 30 and 60 days, respectively, for all incurred medical outgo.
  • Ambulance Charges: Emergency road Ambulance charges are reimbursed with a monetary cap of Rs.2000 per hospitalization.
  • Other Expenses: Dental treatment and plastic surgery expenses are reimbursed, provided they are essential for the treatment of a disease or accidental injury.   

Exclusions of the Edelweiss Arogya Sanjeevani Insurance Policy

The Insured must clearly understand the exclusions in the Edelweiss Arogya Sanjeevani Insurance Policy to obviate future complications in claim settlement.  Accordingly, the indicative list of exclusions is listed below for guidance, but the policy document lists them in greater detail.

  • Initial Waiting Period: Treatment of any illness is not covered in the first 30 days from the commencement of the policy, except for accidental injury.
  • Pre-Existing Disease(PED) Waiting Period: The treatment of these diseases is covered after the expiry of 48 months of continuous coverage from the policy commencement date.
  • Specific Disease Waiting Period: Health insurance policy of Edelweiss GI Co. Limited has prescribed specific ailments for delayed cover after the expiry of 24 / 48 months of continuous coverage.
  • Other Exclusions: A broad spectrum of conditions is not covered by the policy. It is sensible to check the policy document for a detailed list of exclusions.

Features & Benefits of the Edelweiss Arogya Sanjeevani Policy

The features and benefits are the essential parameters to study before buying Edelweiss Arogya Sanjeevani policy:

  • The policy tenure is only 1 year, and renewal before the expiry is compulsory for continued coverage.
  • There is a co-payment clause in each claim. The amount is 5% of the admissible claim.  Mandatorily applicable across all ages.
  • The Sum Insured is increased by 5% every claim-free year through a cumulative bonus, which is limited to up to 50% of the Sum Insured.
  • The Insured enjoys tax exemptions for the premium paid during a financial year as per extant laws under the Income Tax Act. 1961.

Eligibility Criteria

The minimum eligibility criteria to buy this policy are:

Minimum Entry Age

Adult: 18 years  

Maximum Entry Age

Adult: 65 years.

Lifelong policy renewability

Number of people covered

· Individual for self, spouse, dependent children, dependent parents, and dependent parents-in-law.

· Family Floater members can include up to 8 members: Self, spouse, dependent children from 3 months to 25 years of age, dependent parents, and dependent parents-in-law.

Residential Status

Residents of India, including citizens, and permanent residents


Information on Cancellation of the Policy

The Edelweiss Arogya Sanjeevani Insurance policy can be cancelled by the insured by giving a 15-day notice. The premium refund is governed by the term and conditions prescribed by the Insurer. It is applicable for both offline and online Edelweiss Arogya Sanjeevani Insurance Policy. 

FAQs

Written By: PolicyBazaar - Updated: 24 December 2020

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