AROGYA-SANJEEVANI

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Arogya Sanjeevani

‘Arogya Sanjeevani Policy’ provides health insurance coverage for you and your family at an affordable premium. The policy is a simple, easy to understand product which provides all essential benefits needed in a health insurance policy. Apart from offering you this health insurance cover, we are also committed to provide you with quality services when you need it the most.

  • Features
  • Policy Term
  • Waiting Periods
  • Exclusions (Permanent exclusion)
  • Claim Process
  • FAQs

In-patient Care (Hospitalisation)

We cover cost of medical treatment when you or your insured family members are hospitalised for treatment.

Hospital Accommodation

The room rent, boarding, nursing expenses (as provided by the Hospital/ Nursing Home) limit under this policy is up to 2% of sum insured, subject to a maximum of Rs. 5,000 per day.

ICU/ ICCU charges are covered up to 5% of sum insured, subject to a maximum of Rs. 10,000 per day.

Pre & Post Hospitalisation Medical Expenses

We will reimburse pre & post hospitalisation medical expenses incurred due to illness/injury. The period of the treatment covered is 30 days before you get admitted to the hospital and 60 days from the date of discharge from the hospital. This is subject to Max Bupa accepting the In-patient Care hospitalization.

Day care treatments covered

We will cover all the day care treatments under the product.

AYUSH Treatments

We will cover the medical expenses incurred on the insured person’s hospitalisation for Inpatient Care on treatment taken under Ayurveda, Yoga or Naturopathy, Unani, Siddha and Homeopathy.

Road Ambulance

We will also cover the ambulance expenses up to Rs. 2,000 per hospitalization only if we have accepted the In-patient claim.

Cataract Treatment

We will cover the expenses for a treatment of cataract, subject to a limit of 25% of sum insured or Rs. 40,000, whichever is lower,  per eye in one policy year. A specific waiting period of 24 months would also be applicable for cataract treatment.

Modern Treatments

The following treatments will be covered as in-patient or day care procedures up to a maximum of 50% of sum insured.

Uterine Artery Embolization and HIFU  (High  Intensity Focused  Ultrasound)

Balloon Sinuplasty

Deep Brain Stimulation

Oral Chemotherapy

lmmunotherapy-  Monoclonal  Antibody to be given as injection

Intra Vitreal Injections

Robotic  Surgeries

Stereotactic Radio Surgeries

Bronchical Thermoplasty

Vaporisation of the Prostrate (Green Laser treatment or Holmium  Laser Treatment)

IONM-(Intra Operative Neuro Monitoring)

Stem Cell Therapy: Hematopoietic stem cells for bone marrow transplant for haematological conditions to be covered.

Cumulative Bonus

For every claim free year, you will get an increase of 5% of expiring Sum Insured at renewal (without break), subject to a maximum of 50% of Sum Insured. The cumulative bonus accrued will be reduced at the same rate in case of a claim. However, sum insured will be maintained and will not be reduced.

Co-payment

Each and every claim, which is payable according to the terms and conditions of the policy, will be subject to a co-payment of 5% on the claim amount.

Entry Age and family coverage

The entry age for adults under this policy can be from 18 to 65 years. The entry age for dependent children is from 3 months to 25 years. There is no exit age under this Policy.

The policy can be taken individually or for the family on either individual or floater basis. The following members are allowed to be covered under the policy:

Self/Proposer

Legally wedded spouse

Parents and Parents-in-law

Dependent children (natural or legally adopted) aged between 3 months to 25 years. Further, if the child above 18 years of age is financially independent, he or she shall be ineligible for coverage in the subsequent renewals

Tax Benefit

Save tax under Section 80D of the Income Tax Act when you buy a Max Bupa health insurance policy. Tax benefits are subject to changes in the tax laws, please consult your tax advisor for more details.

Assured Policy Renewal for Life

Once insured with us, you will always remain our customers subject to continued payment of premium. We assure you renewability for life with no extra loadings based on your claim history.

Direct Claim Settlement

We believe you should focus on the treatment of your loved ones rather than running after claim settlement. Therefore, all claims are processed directly by our customer service team.

Cashless Facility

Cashless Facility can be availed only at our Network Providers or Service Providers. Please contact us for more details.

Free Look Period

We endeavor for transparency and complete satisfaction and therefore, our policies are transparent and easy to understand. If you are not satisfied, we provide a 15-day free look period (30 days if the policy has been sold through distance marketing) within which you can cancel your plan stating the reason.

Information at your fingertips

Get quick and easy access to your claims history, your health information, your health profile, including records of tests and other details on our website.

The policy term is one year

Pre-existing disease waiting period of 48 months since inception of the policy and subject to continuous renewal.

Initial waiting period of 30 days unless the treatment needed is the result of an Accident.

Specific waiting period of 24/48 months, since the inception of the first policy with us, for some conditions as specified in policy terms and conditions, unless the condition is directly caused by Accident (covered from day 1).

Please do read more about the common exclusions and specific waiting period in the policy terms & conditions.

Investigation & Evaluation

Rest Cure, rehabilitation and respite care

Obesity/ Weight Control

Change-of-Gender treatments

Cosmetic or plastic Surgery

Hazardous or Adventure sports

Breach of law

Excluded Providers

Refractive Error

Unproven Treatments

Sterility and Infertility

Maternity Expenses

Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof

Treatments received in heath hydros, nature cure clinics, spas or similar establishments or private beds registered as a nursing home attached to such establishments or where admission is arranged wholly or partly for domestic reasons.

Dietary supplements and substances that can be purchased without prescription, including but not limited to Vitamins, minerals and organic substances unless prescribed by a medical practitioner as part of hospitalization claim or day care procedure.

Any expenses incurred on Domiciliary Hospitalization and OPD treatment

Treatment taken outside the geographical limits of India.

War (whether declared or not) and war like occurrence or invasion, acts of foreign enemies, hostilities, civil war, rebellion, revolutions, insurrections, mutiny, military or usurped power, seizure, capture, arrest, restraints and detainment of all kinds.

Nuclear, chemical or biological attack or weapons, contributed to, caused by, resulting from or from any other cause or event contributing concurrently or in any other sequence to the loss, claim or expense.

In respect of the existing diseases, disclosed by the insured and mentioned in the policy schedule (based on insured's consent), policyholder is not entitled to get the coverage for specified ICD codes.

Select and approach insurer/corporate/TPA helpdesk of our network hospital [recommended at least 72 hours before treatment].

For identification purpose, use passport, voter card, PAN card or driver's licence along with your Max Bupa health card or policy number.

Network hospital will check your identity for validation and submit a pre-authorisation form to us.

We provide our decision to the hospital within 4 hours, when no further document is required.

Get admitted for treatment and sign all documents, forms and invoices on discharge.

We make payments to the hospital for pre-approved treatment and as per policy terms and conditions.

How can I buy this policy?

There are various ways in which you can purchase this policy:

Online :- On buying this plan online, your policy will be generated instantly along with your policy kit and card. This is applicable for cases which do not require further underwriting or medical checkup. If you wish to know more about Max Bupa’s Health Insurance Plans, feel free to get in touch with our trained sales team or your local advisor. Call us on 1860 500 8888 between 9 am and 6 pm India time (Monday to Saturday) or click on ‘Click to arrange a call’ to buy the policy over the phone or to fix up an appointment.

Branch :- Please visit our branch in your city. The complete list of branch locations is available in the ‘Contact Us’ section of the website.

Is there any tax benefit that one can avail while purchasing Health Insurance?

Yes, you may avail a tax benefit available under Section 80D of the Income Tax Act 1961 by buying a health insurance policy as per applicable tax laws, which can amend from time to time. We advise you to consult your tax advisor for further details or clarifications.

Is a medical checkup necessary before buying a policy?

A medical checkup may be necessary when you sign up for a new health insurance policy, depending upon the age of the proposed applicant to be insured and the sum insured opting for. In case your proposal gets rejected by us, we will deduct the full cost of medical tests from your premium and the balance premium would be refunded.

My wife and children are residing at Chandigarh while I am here in Delhi. Can I cover all of us in one policy?

Of course, you can cover your family residing in India under one policy. You can use your health insurance policy across India. For cashless hospitalisation, all you need to do is check for a Max Bupa network hospital near your place of residence. You can also present your claim for reimbursement if you get treated at a hospital which is not a Max Bupa network hospital.