Oriental Arogya Sanjeevani Policy

Oriental Arogya Sanjeevani is a simple insurance policy that is provided as per the IRDAI guidelines. Being a standard health insurance product the premium is affordable and the features and benefits are also regularized across the industry.

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Oriental Arogya Sanjeevani Policy

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    Oriental Arogya Sanjeevani policy is available to everyone up to the age of 65 years.  The sum insured options are wide as they go up to Rs 20 lakh. This plan covers inpatient hospitalization expenses, modern treatments, and Ayush treatments expenses incurred by the insured and their family members

    Eligibility Criteria

    Parameters

    Specifications

    Entry Age for Adults

    18-65 years

    Entry Age for Children

    3 months- 25 years

    Sum Insured

    Rs 1 lakh- Rs 20 lakh

    Policy Type

    Individual/Family Floater

    Policy Term

    1-year

    Room Rent Limit

    · For Rs 5 Lakh SI: up to 2% of the SI or Rs. 5000/day

    · For Rs 6/8/10 Lakh SI: up to 2% of the SI or Rs. 10,000/day

    · For Rs 15/20 Lakh SI: up to 2% of the SI or Rs. 20,000/day

    ICU Charges

    · For Rs 5 Lakh SI: up to 5% of the SI or Rs. 10,000/day

    · For Rs 6/8/10 Lakh SI: up to 5% of the SI or Rs. 20,000/day

    · For Rs 15/20 Lakh SI: up to 2% of the SI or Rs. 20,000/day

               Note: (Sum Insured=SI)

    Features of Oriental Arogya Sanjeevani Policy

    Oriental Arogya Sanjeevani policy comes with the following features and benefits for the policyholders:

    • The policy sum insured ranges from Rs 1 lakh to Rs 20 lakh
    • No pre-medical screening is required up to the age of 55-years
    • The policy helps you pay for any daycare medical procedure during the policy term
    • 5% cumulative bonus is added for not filing a claim during the policy term
    • After completion of 48-months of the waiting period, you can file a claim for pre-existing disease treatment as well
    • The policy premium can be paid in installments
    • There is a free-look period of 15 days during which you can cancel or continue with the policy

    Inclusions of Oriental Arogya Sanjeevani Policy

    Oriental Arogya Sanjeevani policy provides the following coverage benefits to the policyholder:

    • In-patient hospitalization expenses are covered
    • The coverage limit for ICU and ICCU expense is Rs 10,000 or 5% of the sum insured
    • Cataract Treatment expenses are claimable up to Rs 40,000 or 25% of Sum insured
    • Ayush treatment expenses including Unani, Ayurveda, homeopathy, Siddha are covered up to the coverage amount
    • Pre- hospitalization expenses are covered for a maximum of 30 days and post-hospitalization expenses are covered for a maximum of 60 days
    • Ambulance charges for each hospitalization are payable up to Rs 2000  
    • The policy also covers dental treatment charges if required as a part of the treatment, accident or injury
    • Expenses incurred on Ayush hospitalization are covered up to the sum insured limit
    • The policy also includes coverage for modern treatments up to 50% of the sum insured as given below:
    • Balloon Sinuplasty
    • Intra vitreal injections
    • Oral chemotherapy
    • Deep Brain stimulation
    • Stem cell therapy ( as required in bone marrow transplant procedure)
    • Immunotherapy
    • Stereotactic radio surgeries
    • Robotic surgeries
    • Intra Operative Neuro Monitoring
    • Green laser treatment/ Prostate Vaporization
    • Bronchial Thermoplasty
    • Uterine Artery Embolization/High intensity focused ultrasound tests

    Exclusions of Oriental Arogya Sanjeevani Policy

    Oriental Arogya Sanjeevani Policy does not compensate for the following expenses:

    • Specific diseases till the waiting period of 24 months is over
    • Pre-existing diseases are not covered until the completion of 48 months
    • OPD charges and domiciliary treatment charges are not claimable
    • Obesity and weight control treatments are excluded
    • Rehabilitation, rest cure, and respite care expenses are also not paid by the insurer
    • War related and adventure sports-related medical emergencies are not covered

    Oriental Arogya Sanjeevani Policy Claim Process  

    For both cashless and reimbursement claims the process is given below:

    • You need to seek authorization and for that you need to fill the complete claim form, which is available with the network provider and the TPA
    • On getting the claim form for cashless treatment the TPA/Company sends the pre-authorization letter to the hospital after verification
    • For reimbursement claims of hospitalization, daycare treatments, and pre-hospitalization expenses you need to inform the insurer within 30 days of getting discharged from the hospital
    • For reimbursement of post hospitalization expense the insurer needs to be informed 15 days from post-hospitalization treatment
    • Please check with the hospital for any inadmissible expenses and do not forget to sign the hospital discharge form
    • Once all the documents are submitted your cashless claim will be processed else you can file for reimbursement also

    Documents Required

    For claim keep the following documents handy:

    • Complete and signed health claim form
    • ID proof of the patient/ medical bills/prescription of the doctor suggesting hospital  admission
    • Payment receipts
    • Medico legal report, if required
    • Diagnostic reports /OT notes/ Discharge summary/ Invoice of the implants
    • Customer KYC
    • NEFT Details
    • Any other documents as required

    To buy or know more about Oriental Arogya Sanjeevani policy you can write to us at care@policybazaar.com or speak to us at 1800-708-8787.

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