Royal Sundaram Arogya Sanjeevani Policy

Arogya Sanjeevani insurance policy offered by Royal Sundaram General Insurance Company is a standard health insurance plan that is suggested by the Insurance Regulatory and Development Authority of India. In this policy one gets coverage for modern treatment expenses and various day-care procedures. One can buy this policy on family floater basis or individual basis. It is a health insurance policy for those who are looking for a cost-effective health insurance solution during this time of the pandemic.

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Royal Sundaram Arogya Sanjeevani Policy

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    Eligibility Criteria

    In order to buy this policy, one must fall under the below mentioned eligibility criteria:

    Criteria

    Specifications

    Sum Insured

    Rs.One Lakh to Rs.Five Lakh

    Entry Age

    18-65 years

    Dependent Children

    3 months -25 years

    Co-payment

    5%

    Coverage Type

    Individual/ Family Floater

    Cumulative Bonus

    5% - 50%

    Key Features of Royal Sundaram Arogya Sanjeevani Policy

    The key features of the Arogya Sanjeevani policy offered by Royal Sundaram are as follows:

    • Painless Claim Settlement Process: The claim settlement process of the Royal Sundaram Arogya Sanjeevani policy is simple and hassle-free.
    • Covers Wide Age Group: This is a health insurance policy that provides insurance coverage for a wide age group that ranges from 18 years to 65 years.
    • Flexible Options for Sum Insured: The sum insured ranges from Rs.one lakh to Rs.five lakhs and hence provides flexibility to choose it between this range.
    • Covers Parents and Parents-in-Law: In Royal Sundaram Arogya Sanjeevani policy one can also include his/her parents and parents-in-law.
    • Tax-Benefit: The premiums that one pays for this policy are eligible for tax benefits under section 80D of the Income Tax Act.

    Inclusions of Royal Sundaram Arogya Sanjeevani Policy

    The Royal Sundaram Arogya Sanjeevani policy covers the below-mentioned expenses during its tenure:

    • Covers Hospitalization: The policy covers entire hospitalization expenses that include room rent, nursing expenses, boarding, etc.
    • Covers ICU and ICCU Expenses: The policy also covers the expenses of ICU and ICCU.
    • Provides the Facility of Co-Payment: All the claims that are made under this policy are subject to co-payment of 5% as per the admissible claim amount and are payable as per the terms and conditions of the policy.
    • Covers Pre and Post-Hospitalization Expenses: Covers the medical expenses incurred for pre-hospitalization of 30 days and post-hospitalization of 60 days.
    • Covers AYUSH Expenses: The expenses incurred for inpatient treatment under AYUSH system medicines are also covered.
    • Covers Cataract Treatment: The policy also covers cataract surgery with the limit of Rs.40, 000 to 25% of the sum insured.
    • Covers Modern New Age Treatment: The policy also covers various modern new-age treatments as per the policy wordings.

    Exclusions of Royal Sundaram Arogya Sanjeevani Policy

    The exclusions under this policy are as follows:

    • Any pre-existing medical condition for which the treatment has been taken before 48 months from the inception date of the policy.
    • Obesity or weight control treatments are not covered.
    • Treatment for change of gender is not covered.
    • Plastic or cosmetic surgeries are also not covered.
    • Hospitalization for any type of evaluation or investigation is not covered.
    • Any kind of medical expenses incurred due to involvement in hazardous activities or adventure sports is not covered.
    • Treatment of infertility is not covered.
    • Maternity expenses are also not covered.
    • OPD expenses and domiciliary hospitalization are not covered.

    These are some of the exclusions under this policy. For a detailed list, one must check the policy wordings.

    How to file Health Insurance Claim for Royal Sundaram Arogya Sanjeevani Policy?

    In case of emergency hospitalization, the policyholder has to inform the Royal Sundaram General Insurance Company within 24 hours of the hospitalization. While for planned hospitalization, the policyholder has to inform the insurance company at least 48 hours before the hospitalization. However, the processes of cashless and reimbursement claims are different, which are as follows:

    Reimbursement Claims:

    In case of reimbursement claims, a policyholder has to submit the required documents to the insurance company or TPA within the predefined timeline that are mentioned hereunder:

    • For reimbursement of daycare treatment, hospitalization, or pre-hospitalization, one has to file the reimbursement claim within 30-days of discharge from the hospital.
    • For reimbursement of post-hospitalization expenses, one has to file the claim within 15-days of post-hospitalization treatment.

    Cashless Claims:

    • The benefit of a cashless claim can be filed by a policyholder who has availed the treatment in-network hospital of the insurance company.
    • For the same one has to fill the cashless claim form first. This form is available at the TPA desk at the network hospital.
    • This claim form is shared with the insurance company/ TPA for authorization. Upon its verification, a pre-authorization letter is sent to the network hospital by the TPA.
    • After this, the policyholder has to cross-check the discharge papers from the hospital and sign them.
    • Now the insured has to submit all the required documents such as medical bills, ID proof, diagnostic reports, details of NEFT as needed.
    • If the cashless claim is denied because of some reason, then the policyholder has to file for the reimbursement of his/her hospitalization expenses.

    To know more about Royal Sundaram Arogya Sanjeevani policy one can write to us at care@policybazaar.com or speak to us at 1800-708-8787.

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