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Arogya Sanjeevani Policy

Why buy Health Insurance from Liberty?

Health is precious! And it is instinctive to take care of your health, no matter the expense.

However, it is also true that taking good care of your health requires robust financial backing. Medical expenses in India have risen consistently over the years and paying for those out of your pocket can wear you down financially and expose you to future contingencies.

Therefore, it is wise and recommended to secure an affordable health insurance policy when the going is good to save yourself from a financial upheaval when having to cover up medical bills of yours or your loved ones.

The Arogya Sanjeevani Policy from Liberty General Insurance ensures that you are not on your own and have a financial cushion to fall back on during medical hardships.

Arogya Sanjeevani Policy – Key Features

The key features of this health insurance policy are –

  • Flexible sum insured option

    The sum insured for Arogya Sanjeevani Policy ranges from Rs.1 lakh to Rs.5 lakh, and you are privileged to choose any sum in between, provided it is a multiple of Rs. 50,000.

  • Types of plan

    You can either go solo with the Individual insurance plan or include your loved ones under the Family Floater insurance Plan.

  • Free-look period

    In case you find the insurance policy unsuitable to your needs after purchasing it, you can request for a policy cancellation within 15 days from the date of commencement.

  • Arogya Sanjeevani Policy premium installations

    You can pay your Arogya Sanjeevani Policy premium in monthly, quarterly, or semi-annual basis. Or else, you can prefer to pay annual premium in one go and save on extra premium.

  • Lifetime renewal

    Once you purchase the insurance policy, you can continue to renew it every year for a lifetime.

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Why Choose Arogya Sanjeevani Policy, Liberty General Insurance?

The Arogya Sanjeevani Policy was introduced by the “Insurance Regulatory and Development Authority of India (IRDAI) on 1st April 2020 to simplify and make health insurance plans more affordable for individuals.

Now, there are several reasons why you should go for this health insurance plan offered by Liberty General Insurance. Firstly, to ensure that medical crises do not have you struggle for finances when your sole focus should be to secure quality healthcare.

Secondly, with our extensive list of empanelled hospitals, you can avail cashless healthcare facilities and not worry about settling hefty medical bills. Therefore, it empowers you to alleviate your financial worries and face any health crisis head-on.

Thirdly, this health insurance plan allows you to choose from a wide range of sum insured amount, as per your requirements.

And finally, your family’s health is just as precious as yours. With the Arogya Sanjeevani health insurance plan, you can financially secure not only yours but your loved ones’ medical exigencies as well.

What is covered under the Arogya Sanjeevani Policy?

Hospitalisation

With the Arogya Sanjeevani Policy, expenses arising out of hospitalisation ranging from room rent, boarding charges to nursing expenses will be indemnified up to 2% of the sum insured subject to a maximum of Rs.5000/day. For ICU and ICCU, the sub-limit is 5% of the sum insured subject to a maximum of Rs.10,000/day.

AYUSH treatment

You might prefer the Vedic way of treatment through Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy over modern ways. All such expenses related to AYUSH treatments will be covered under the insurance plan up to the sum insured, as mentioned in the Arogya Sanjeevani policy covenant.

Cataract treatment

You can avail coverage under your Arogya Sanjeevani for cataract treatment up to 25% of the sum insured or Rs.40,000, whichever is lower, per eye in one policy year.

Plastic surgery and dental treatment

Defray medical expenses related to plastic surgery or dental treatment that is necessary owing to any disease or injury with our health insurance plan.

Daycare treatment

In the event your treatment or surgery gets over within a day or 24 hours of getting admitted, the medical expenses will be covered under the Arogya Sanjeevani Policy. Getting discharged early is a matter to rejoice, so we take care of the medical bills arising out of it.

Pre-hospitalisation expenses

IThere is a string of medical expenses that precedes hospitalisation like doctor’s fees, diagnoses costs, medicinal bills, etc. We cover all the pre-hospitalisation expenses immediately before 30 days of hospitalisation under our Arogya Sanjeevani policy.

Post-hospitalisation expenses

The period after hospitalisation also entails specific costs like doctor’s fees, rehabilitation expenses, etc. All such post-hospitalisation expenses up to 60 days from getting discharged is covered under this health insurance policy.

Ambulance costs

Expenses of availing a road ambulance will be covered under this policy subject to a maximum amount of Rs.2000 per hospitalisation.

Other expenses

Treatment methods are evolving, and so is our health insurance policy. We provide coverage for treatment like balloon sinuplasty, deep brain stimulation, oral chemotherapy, bronchial thermoplasty and other procedure as specified upto 50% of Sum Insured.

Arogya Sanjeevani Policy – Key Benefits

The additional Arogya Sanjeevani Policy benefits you can enjoy are –

  • No-claim cumulative bonus

    For every claim-free year against your health insurance policy, you will be awarded an automated 5% hike in the sum insured amount subject to a maximum of 50% increase sans any change in the Arogya Sanjeevani policy premium.

  • Increase sum insured

    Apart from No-claim bonus, you can also voluntarily increase your sum insured upon renewal of your insurance plan provided you do not make any claims in the previous policy year.

  • Grace period

    You are allowed a grace period of 30 days within which you can renew your Arogya Sanjeevani Policy. If you have opted for instalment premium option then you get 15 days of Grace period instead of 30 days available in Annual payment option.

  • Portability benefits

    If before purchasing the insurance policy, you were continually insured under any other standard health insurance policy from any other general insurance provider, then under the Portability rules of IRDAI, waiting period for pre-existing diseases will be reduced to that extent.

  • Tax benefits

    You can claim tax deduction under Section 80D for the Arogya Sanjeevani Policy premiums paid in an Assessment Year.

Arogya Sanjeevani Policy – Eligibility

The eligibility criteria to avail coverage under this health insurance policy are –

  • Minimum age of entry
    The minimum age mandated under this insurance plan for adults is 18 years, and 3 months or 91 days for children.

  • Maximum age of entry
    The maximum age to be covered under this insurance plan for adults is 65 years, and for children, it is 25 years.

  • Renewability
    The insurance plan can be continually renewed yearly till lifetime of an insured person.

  • Persons allowed under the Individual Plan
    Policyholder or self, legally married spouse, financially dependent child, parent/s and parent(s)-in-law are entitled to avail coverage under the Arogya Sanjeevani Policy– Individual Plan. Maximum 5 members can be included in one Policy.

  • Persons allowed under the Family Floater Plan
    Policyholder or self, legally married spouse, parents, financially dependent children within the eligible age limits, and parents-in-law are allowed coverage under the Family Floater insurance plan.
    Children who are above the age of 18 and financially independent are not eligible for coverage under the health insurance plan.

  • Maximum number of children
    A maximum of 3 children within the specified age limits who are financially dependent, can be included for coverage under the Family Floater insurance plan.

  • Co-pay
    5% Co-pay is applicable on every claim across age bands.

Arogya Sanjeevani Policy – Claim Process

A. Cashless claim process

With the cashless claim facility in place, you do not need to shell out anything from your pocket. All your medical bills relating to hospitalisation are taken care of by us, up to the sum insured as pre-specified in the health insurance policy covenant. You just need to avail treatment in one of the vast numbers of our network hospitals, see through some formalities. Upon claim approval, you will only need to settle your share of co-payment of 5%, while the rest will be covered by us.
The procedure for a cashless claim against your Arogya Sanjeevani Policy is discussed below –
To obtain authorisation:

  • Step 1 - Furnish the cashless request form that is with the network hospital and submit it to Liberty General Insurance for authorisation.
  • Step 2 - Submit relevant documents like medical bills, doctor’s prescription necessitating hospitalisation, pre-hospitalisation diagnostic reports, ID proof, etc
    • After verification of the documents and checking the legitimacy of a claim against policy wordings, Liberty General Insurance will issue a pre-authorisation letter to the concerned network hospital within 6 hours from receiving the last necessary document.
    • Upon getting discharged, the concerned insured person shall verify the discharge papers and sign them and attach relevant documents for the final cashless settlement.

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It is also necessary to attach the relevant documents to substantiate the claim against your health insurance policy. Few of such necessary documents might include –
• Diagnostic test results during hospitalisation.
• Relevant medical bills.
• Discharge summary.
• MLR and FIR if carried and registered.
• Claimant’s KYC details in case total claim settlement exceed Rs.1 lakh


    B. Reimbursement process

    In the case of reimbursement, all of the expenses related to healthcare will be first paid by you. Then upon due submission of documents within the prescribed time limit, Liberty General Insurance will initiate reimbursement up to the extent of the Sum insured or sub-limit applicable, as mentioned in the Arogya Sanjeevani Policy.
    The time limits specified for sending necessary documents to claim reimbursement under this insurance policy are mentioned in the table below.

    Claim type Pre-specified time limit
    For reimbursement of hospitalisation expenses, pre-hospitalisation expenses, and day-care treatment Shall submit relevant documents within 30 days from the date when the insured person was discharged from the hospital
    For reimbursement of post-hospitalisation expenses Shall submit relevant documents within 15 days from the date when post-hospitalisation treatment is completed.

    Some of the documents that you will submit for a reimbursement claim are –
    • Furnished claim form.
    • Photo ID of the insured person.
    • Original medical bills.
    • Notes from OT prepared by a surgeon if surgery was involved.
    • NEFT details and a cancelled cheque.
    • Doctor’s prescription necessitating hospitalisation.
    • Receipts of payments.
    • Diagnostic reports from before hospitalisation, during hospitalisation, and after hospitalisation.

    The full set of documents can be learnt in due course.

Pre-Policy Health Check-Ups

Before you can subscribe to the Arogya Sanjeevani insurance policy, you need to undergo medical check-ups. However, you need not worry about carrying these check-up costs alone; Liberty General Insurance will bear 50% of the expenses incurred if your proposal is accepted by us.
The Pre-policy health check-up for this insurance policy will be conducted at our empanelled network providers according to the table mentioned below.

Age group Medical tests Cost borne
18 – 45 years Nil Nil
46 – 55 years Blood group, Routine Urine Analysis, Complete Blood Count (CBC), Serum Cholesterol level, Fasting Blood Sugar level, ESR, Electro Cardiogram (ECG), SGPT, and Creatinine 50% borne for accepted cases
56 – 60 years Medical examination (ME), ECG, CBC, Serum Cholesterol level, Glycated Haemoglobin (HbA1c), Triglycerides 50% borne for accepted cases
Above 60 years ME, Serum Cholesterol level, HbA1c, CBC, Prostate-Specific Antigen (males) and Ultra Sonogram (females), Triglycerides, Tread Mill Test, Sr. Creat 50% borne for accepted cases

Exclusions under the Arogya Sanjeevani Policy

  • Pre-existing diseases
    If at or before the time of buying the Arogya Sanjeevani policy, you are diagnosed with any disease, it will not be covered before the lapse of 48 months from the date of policy commencement.

  • Diseases/treatments subject to waiting periods
    Treatments, surgeries, and diseases prescribed under the insurance policy wordings will not be covered before the expiry of either 24 months or 48 months, as applicable.

  • Medical bills within 30 days of policy commencement
    Medical bills arising due to illness within the first 30 days of policy commencement will not be covered under the Arogya Sanjeevani Policy. However, Accidental medical expenses will get covered from Day 1 of the policy.

  • Adventure sports
    Injuries sustained, or hospitalisation due to adventure sports is not covered under this insurance plan.

  • War
    Injuries or hospitalisation caused due to war, or war-like situations are not covered.

  • Gender-reversal treatments
    Medical bills related to gender-reversal treatments are excluded from the Arogya Sanjeevani policy.

  • Self-inflicted injuries
    Hospitalisation or medical bills due to injuries you have inflicted on yourself are not eligible to be covered under the insurance policy.

  • Cosmetic or obesity surgery
    Medical bills arising out of cosmetic surgeries and treatment for obesity or weight control are not entertained for coverage, according to the insurance plan wordings.

For a detailed list of exclusions refer to the Arogya Sanjeevani policy wordings.

Frequently Asked Questions

General

Q.1. Is Arogya Sanjeevani Policy offers same covers across all Insurance Companies or it’s company based?

A) Arogya Sanjeevani Policy is designed as mandated by the Insurance Authority of India, The IRDAI. As per the mandate, all General Insurance companies and Health Insurance Companies of India abide to offer standard covers. The difference is only the premium which would be payable as per the Company you select for your Insurance needs.

Q.2. Is the novel coronavirus disease or Covid-19 covered under Arogya Sanjeevani Policy?

A) Yes, hospitalisation due to the novel coronavirus disease is covered under this health insurance policy.

Q.3. Who can be covered under the Family Floater insurance plan?

A) The policyholder or self, legally married spouse, children within the age range of 3 months and 25 years, parents, and parents-in-law are eligible to be included under the Family Floater insurance plan. However, a child who is above 18 years of age and also financially independent cannot be included under this insurance policy.

Q.4. What is the maximum and minimum entry age to the health insurance policy?

A) The maximum age to be included in the Arogya Sanjeevani Policy for adults is 65 years and for children is 25 years. The minimum age to be included is 18 years for adults and 91 days for children.

Q.5. Is the Arogya Sanjeevani Policy premium set based on location?

A) The geographical location of the policyholder has no bearing over the premium of the insurance policy.

Q.6. On what does the premium for Arogya health insurance policy depend?

A) The premium for this insurance policy depends on the Sum insured & age of the members proposed for insurance.

Q. 7. Is Pre-Policy check-up mandatory?

A) Yes, the Pre-policy health check-up is mandatory before a health insurance policy can be purchased for age bands above 45 years and those having any adverse medical health.

Q.8. Who bears the cost for Pre-Policy health check-up?

A) 50% of the cost for Pre-Policy health check-up will be borne by Liberty General Insurance for accepted policies, while the other half shall be borne by the prospective policyholder.

Q.9. Is there a waiting period for pre-existing diseases?

A) Yes, the waiting period for pre-existing disease/s is 48 months or 4 years from the date of policy commencement.

Q.10. Is there a Co-pay applicable in the Policy?

A) Yes, there is a flat 5% Co-pay applicable across age bands and on every claim.

Q.1. Is Arogya Sanjeevani Policy offers same covers across all Insurance Companies or it’s company based?

A) Arogya Sanjeevani Policy is designed as mandated by the Insurance Authority of India, The IRDAI. As per the mandate, all General Insurance companies and Health Insurance Companies of India abide to offer standard covers. The difference is only the premium which would be payable as per the Company you select for your Insurance needs.

Q.2. Is the novel coronavirus disease or Covid-19 covered under Arogya Sanjeevani Policy?

A) Yes, hospitalisation due to the novel coronavirus disease is covered under this health insurance policy.

Q.3. Who can be covered under the Family Floater insurance plan?

A) The policyholder or self, legally married spouse, children within the age range of 3 months and 25 years, parents, and parents-in-law are eligible to be included under the Family Floater insurance plan. However, a child who is above 18 years of age and also financially independent cannot be included under this insurance policy.

Q.4. What is the maximum and minimum entry age to the health insurance policy?

A) The maximum age to be included in the Arogya Sanjeevani Policy for adults is 65 years and for children is 25 years. The minimum age to be included is 18 years for adults and 91 days for children.

Q.5. Is the Arogya Sanjeevani Policy premium set based on location?

A) The geographical location of the policyholder has no bearing over the premium of the insurance policy.

Q.6. On what does the premium for Arogya health insurance policy depend?

A) The premium for this insurance policy depends on the Sum insured & age of the members proposed for insurance.

Q. 7. Is Pre-Policy check-up mandatory?

A) Yes, the Pre-policy health check-up is mandatory before a health insurance policy can be purchased for age bands above 45 years and those having any adverse medical health.

Q.8. Who bears the cost for Pre-Policy health check-up?

A) 50% of the cost for Pre-Policy health check-up will be borne by Liberty General Insurance for accepted policies, while the other half shall be borne by the prospective policyholder.

Q.9. Is there a waiting period for pre-existing diseases?

A) Yes, the waiting period for pre-existing disease/s is 48 months or 4 years from the date of policy commencement.

Q.10. Is there a Co-pay applicable in the Policy?

A) Yes, there is a flat 5% Co-pay applicable across age bands and on every claim.

Q.1.Is there a time-period under which I should inform the LGI of Hospitalization?

A) You need to inform us of within 24hours in case of unexpected hospitalization and at least 48 hours before any planned hospitalization.

Q.2.What should I do in case of an accident or illness that will lead to filing of a claim?

  • You should immediately notify the TPA or company by calling toll-free number specified in the health insurance policy document with the particulars below:
  • i. Policy Number / Health Card No
  • ii. Name of the Insured / Insured Person availing treatment
  • iii. Details of the disease / illness / injury
  • iv. Name and address of the Hospital
  • v. Any other relevant information

Q.3.Can I cancel my health insurance policy during its tenure?

A) You can cancel the insurance policy by giving 15 days’ notice in writing to the company. If no claim is made during the policy then LGI shall from the date of receipt of notice to cancel the medical insurance policy and refund the premium for the balance policy as per the terms and condition laid in the health insurance policy document.

Q.4.Is there a free look period available under the health insurance policy?

A) Yes, like most of the best medical insurance policies there is a 15 day free look period available. The period starts from the date of receipt of health insurance policy document and allows you to review the terms, conditions and exclusions of the policy.

Q.5.Is there an age limit?

A) Yes, the minimum entry age is 18 years for adult and 91 days for children. The maximum entry age is 65 years and children below 25 years of age can also be covered given that either of the parent is insured under the best medical insurance policy.

Q.6.Does the health insurance policy covers AYUSH treatment?

A) Yes, AYUSH treatments are covered under the health insurance provided you get the optional coverage by paying a nominal amount extra on your premium.

Q.7 What is the waiting period in the policy, 45 days or 30 days?

A) The health insurance has waiting period of 30 days from the commencement of the medical policy and will apply to all disease / illness contracted other than accidental bodily injury requiring hospitalization.

Q.8. Are there any loyalty perks for renewing the medical health insurance policy with LGI?

A) As the best health insurance policy in India, there is a clause that benefits the loyal customers. Health insurance provides for auto increase in sum insured by 10% on the sum insured for every claim free. This auto increase is capped at 100% of the sum insured and is only applicable if the health insurance policy is renewed with us without any break or within the grace period.

Q.9.Does the policy covers pre-existing conditions? Is there a waiting period on pre-existing diseases?

A) One of the best medical insurance policies, this health insurance policy also provides coverage for pre-existing conditions after 36 months of continuous coverage have elapsed, since inception of your first Policy with Us.

Q.10. Are there any optional covers available under the policy?

A) In our endeavor to offer the best health policy, we provide optional covers, to allow the customer to mould the policy as per his/her needs. As mentioned earlier, AYUSH treatments will be covered only if the optional cover is availed under the insurance policy. There are other optional covers too. You can read more about them in the policy wordings.

Health Insurance Glossary (A)

  • Accident/Accidental – Is to be defined as a sudden and unforeseen, involuntary act caused by external and violent means.
  • Age – The completed age of the Insured Person as on his/her last birthday.
  • Alternative treatments - Alternative treatments means any forms of treatments other than “Allopathy” or “modem medicine” and will include Ayurveda, Unani, Sidha and Homeopathy in the Indian context.

Health Insurance Glossary (C)

  • Cashless facility – It means a facility extended by the Insurer to the Insured where the payments, of the costs of treatment undergone by the policyholder in accordance with the policy terms and conditions and exclusions, are directly made to the network provider by the Insurer to the extent pre-authorization approved.
  • Congenital Anomaly - It refers to a condition(s) which is present since birth, and which is abnormal with reference to form, structure or position.

Health Insurance Glossary (D)

  • Day Care Centre – It means any institution established for daycare treatment of illness and /or injuries or a medical set up within a hospital and which has been registered with the local authorities, wherever applicable, and is under the supervision of a registered and qualified medical practitioner
  • Domiciliary Hospitalization - Any medical treatment for an illness/disease/injury which in the normal course would require care and treatment at a hospital but is actually taken while confined at home

Health Insurance Glossary (I)

  • Inpatient Care - Any treatment for which the Insured Person has to stay in a hospital for more than 24 hours for a covered event.

Health Insurance Glossary (M)

  • Medical expenses - Those expenses that an Insured Person has necessarily and actually incurred for medical treatment on account of Illness or Accident on the advice of a Medical Practitioner.
  • Medical Practitioner - Any person who holds a valid registration from the medical council of any state or Medical Council of India or Council for Indian Medicine or for Homeopathy set up by the Government of India or a State Government and is thereby entitled to practice medicine within its jurisdiction.

Health Insurance Glossary (N)

  • Network Provider - Any hospitals or health care providers enlisted by an Insurer or by a TPA and Insurer together to provide medical services to an insured on payment by a Cashless Facility.
  • Non-Network - Any hospital, day care center or other provider that is not a part of the Network.
  • Nominee - It means the person named in the proposal or schedule to whom the benefits under the Policy is nominated by the Insured Person.

Health Insurance Glossary (P)

  • Pre-existing Condition - Any condition, ailment or Injury or related conditions for which the Insured Person had signs or symptoms, and/ or were diagnosed, and or received medical advice or treatment within 48 months prior to the first policy issued by the Insurer.
  • Pre-hospitalization - Any medical expenses incurred immediately before the Insured Person is Hospitalised.
  • Post-hospitalization Medical Expenses – Any medical expenses incurred immediately after the Insured Person is discharged from the hospital.

Health Insurance Glossary (T)

  • Third Party Administrator or TPA -Any person who is licensed under the IRDA (Third Party Administrator-Health Services) Regulations, 2001 by the Authority, and is engaged, for a fee or remuneration by an Insurance Company, for the purpose of providing health Services.