Arogya Sanjeevani Policy, ManipalCigna

What is Health Insurance?

Insurance coverage that pays for medical and surgical expenses that are incurred by the insured person during the treatment of a disease or injury. Health insurance can either reimburse the insured for expenses incurred from illness or injury or pay the care provider directly.

What is Arogya Sanjeevani Policy?

Arogya Sanjeevani Policy is a standard health insurance product developed by IRDAI and made available by ManipalCigna Health Insurance company to take care of basic health care needs of insuring public. It takes care of your hospitalization needs due to illness, injury.

What are the key benefits available in Arogya Sanjeevani Policy?

Following are the key benefits available under Arogya Sanjeevani Policy

I. In-patient hospitalization VI. Ambulance cover
II. Pre-hospitalization VII. Cataract Treatment
III. Post hospitalization VIII. Cumulative Bonus
IV. AYUSH Cover (in-patient only) IX. Modern Treatments
V. Day care treatment

What is meant by Exclusions under Arogya Sanjeevani Policy?

Exclusions are conditions where ManipalCigna is not liable to pay for expenses incurred by the insured person in the event of a claim. List of exclusion forms a part of Policy terms & conditions.

What are the Sum Insured options available under Arogya Sanjeevani Policy?

I. Rs. 1 lac IV. Rs. 2.5 lacs VII. Rs. 4 lacs
II. Rs. 1.5 lacs V. Rs. 3 lacs VIII. Rs. 4.5 lacs
III. Rs. 2 lacs VI. Rs. 3.5 lacs IX. Rs. 5 lacs

Is floater option available under Arogya Sanjeevani Policy?

Yes, there is an option of including up to 2 adults and 3 children under floater policy.

What is the minimum and maximum entry age in Arogya Sanjeevani Policy?

Minimum entry age for Adult is 18 years and for children it is 3 months (91 days)
Maximum entry age for Adult is 65 years and for children it is 25 years (Children should be financially dependent).

Which relationships are covered under Arogya Sanjeevani Policy?

Relationships covered are: self, legally wedded spouse, parents, parents-in-laws, dependent children.

Is there any pre policy medical checkup requirement for purchasing this policy?

Pre policy medical checkup will be required for the insured aged 55 years and above and for the rest of the ages will be required subject to underwriting (on case to case basis).

Is there any room rent capping under Arogya Sanjeevani Policy?

We will cover hospital accommodation expenses with limit of 2% subject to maximum of Rs. 5,000/- per day for room rent, and charges for stay in Intensive Care Unit with limit of 5% subject to maximum of Rs. 10,000/- per day.

Is there any loading or any special conditions applicable for Pre-existing diseases?

There will be waiting period of 48 months for pre-existing diseases. Loading (if any) will be subject to the underwriting decision and applicable on acceptance by the policy holder.

Are there any waiting periods?

The applicable waiting periods are listed below:
Pre-existing Diseases Waiting Period: Pre-existing diseases will be covered after 48 months of continuous coverage under this plan.
First 30 days Waiting Period: A waiting period of 30 days from the Inception Date of the Policy will be applicable for all hospitalization claims except in case of accidents and policies accepted under portability norms.
Waiting Period for specific illness: Waiting Period of 24/48 months will be applicable for some specific illnesses as mentioned in policy terms and conditions.

What is AYUSH Benefit?

We will cover in-patient medical expenses up to the limit of Sum Insured towards non-allopathic treatments such as Ayurveda, Yoga & Naturopathy, Unani, Siddha & Homeopathy for hospitalization arising due to accident or illness undertaken in a government hospital or government recognized institute.

Does Arogya Sanjeevani Policy cover maternity expenses?

No, maternity and related expenses are not covered under this policy except ectopic pregnancy.

Are Day care treatments covered under this policy?

Yes, all Day care treatments are covered under this policy.

What treatments or procedures are covered under Modern Treatment methods?

The following procedures will be covered (wherever medically indicated) either as inpatient or as a part of day care treatment in a hospital up to 50% of Sum Insured, specified in the policy schedule, during the policy period:
A. Uterine Artery Embolization and HIFU (High intensity focused ultrasound)
B. Balloon Sinuplasty
C. Deep Brain stimulation
D. Oral chemotherapy
E. immunotherapy- Monoclonal Antibody to be given as injection
F. Intra vitreal injections
G. Robotic surgeries
H. Stereotactic radio surgeries
I. Bronchical Thermoplasty
J. Vaporization of the prostrate (Green laser treatment or holmium laser treatment)
K. IONM - (Intra Operative Neuro Monitoring)
L. Stem cell therapy: Hematopoietic stem cells for bone marrow transplant for hematological conditions to be covered.

Is there any sub limit on any specific illness?

Yes, we will indemnify medical expenses incurred for treatment of Cataract, subject to a limit of 25% of Sum Insured or Rs. 40,000/-, whichever is lower, per each eye in one policy year.

Is this policy renewable for lifetime?

Yes, you can renew this policy for lifetime except on grounds of fraud, moral hazard, misrepresentation by the insured person.

Can NRI and Foreign nationals buy this policy?

The Product may be offered to the above person, subject to the following criteria being met.
• NRI Proposer/Proposed Insured Persons must have an Indian Address for communication.
• Foreign nationals desirous of this product must be residing in India for a period of 180 days at least. Valid Visa, all pages of passport, employment details and residence proof need to be submitted in all such cases.
• Proposer must be in India at the time of signing the proposal form
• Those currently working or settled in India are eligible for the cover. Eg. NRI/PIO who has returned back to India and gainfully employed.
• Medical tests wherever applicable will be conducted in India only and Proposal Form to be signed in India by the Proposer Only.

What will be the geographical coverage for this policy?

Policy will be applicable all over India. Policy will not cover any treatments taken outside India. All claims under the policy shall be payable in Indian currency only.

Is there any zonal copay in Arogya Sanjeevani Policy?

No, there will not be any zonal copay in Arogya Sanjeevani Policy.

What is the policy term for Arogya Sanjeevani Policy?

Policy term for Arogya Sanjeevani policy will be 1 year.

Is cashless claim settlement available under Arogya Sanjeevani Policy?

Yes, Insured can avail the cashless claim facility from over 6500+ ManipalCigna network hospitals.

What is the procedure for lodging a claim?

You must notify us either at the call center or in writing, in the event of planned or emergency hospitalization.

What will happen if hospital is not a ManipalCigna network hospital?

Claim will be settled on reimbursement basis when all the necessary documents are submitted and subject to the validity of the claim as per policy terms and conditions.

What is Co-Payment?

Co-payment is a cost-sharing method under a health insurance policy that provides that the policyholder/insured will bear a specified percentage of the admissible claim amount. A co-payment does not reduce the Sum Insured.

How Co-Payment will impact Arogya Sanjeevani Policy?

A fixed co-pay of 5% shall be applicable across all the ages for every claim under this policy.

Can I claim for out-patient expenses under Arogya Sanjeevani Policy?

No, out-patient expenses are not covered under Arogya Sanjeevani Policy.

Is there Deductible option available under Arogya Sanjeevani Policy?

Deductible option is not available with Arogya Sanjeevani Policy.

What are the optional covers available under Arogya Sanjeevani Policy?

There is no optional cover available under Arogya Sanjeevani Policy.

How to buy Arogya Sanjeevani Policy?

You can call us at 1-800-10-24462, visit the nearest branch or visit ManipalCigna
website www.manipalcigna.com and we will help you with the purchase process.

Are there any discounts available?

The below mentioned discounts are available:
Family Discount-
15% for covering 2 or more family members under single individual policy
Worksite Discount-
A discount of 15% will be available on polices which are sourced through worksite marketing channel
Online Renewal Discount-
A discount of 3% p.a. on the premium from next renewal, if the premium is received through NACH or Standing Instruction (where payment is made either by direct debit of bank account or credit card.)

Is there any tax benefit?

You can claim tax deduction u/s 80D as per IT Act 1961 for premium paid towards this policy. For premiums paid in cash, tax benefit u/s 80D shall not be applicable. Please consult your tax advisor for more details.

Is there any bonus available on renewal of Arogya Sanjeevani Policy?

We will increase the sum insured by 5% for every claim free year up to a maximum of 50%. For example, if you have coverage of Rs. 5 Lacs, an additional Sum Insured of Rs. 25,000 will be allowed as Cumulative Bonus every year, maximum up to 50%. Similarly, if a claim is made in any particular year, the cumulative bonus accrued will be reduced at the same rate at which it has accrued.

Can I port from other health insurance policy to Arogya Sanjeevani Policy?

Yes, you can port from other health insurance policy to this policy if you have been covered under an Indian retail health insurance policy, from Non-Life Insurance or Health Insurance company registered with IRDAI, without any break in the immediate previous policy and subject to satisfying all the terms and conditions related to portability guidelines.

Can I migrate from Arogya Sanjeevani Policy to other ManipalCigna policy?

Yes, you can migrate from Arogya Sanjeevani Policy to other ManipalCigna policy subject to satisfying all the terms and conditions related to migration.

What are the payment frequencies available?

The payment frequencies available are: annual, half-yearly, quarterly and monthly.

Is there any specific condition applicable on payment frequencies?

For monthly payment frequency, 2 months premium to be paid in advance and instalment/renewal premium payment through NACH or standing instruction (where payment is made either by direct debit of bank account or credit card).

What is the Grace Period for Arogya Sanjeevani Policy?

For Yearly mode of payment, a fixed period of 30 days is to be allowed as Grace Period and for all other modes of payment (monthly, quarterly, half yearly) a fixed period of 15 days will be allowed as grace period.

Do the List of Hospital change or remains the same?

The Company at its sole discretion, reserves the right to modify, add or restrict any network hospital for cashless services available under the policy. Before availing the cashless service, the policy/holder insured person is advised to check the applicable list of network hospitals. Please contact our Customer Care no. 1800-102- 4462 or you can write to us at customercare@manipalcigna.com for assistance.

Can I cancel my Arogya Sanjeevani Policy?

The Insured may cancel this Policy by giving 15 days’ written notice, and in such an event, the Company shall refund premium on short term rates for the unexpired Policy Period as per he rates detailed below. There will not be any refund for payment frequency other than annual mode.

Refund %
Refund of Premium ( basis Policy Period )
Timing of Cancellation 1 Y r
Up to 30 days 75.00%
31 to 90 days 50.00%
3 to 6 months 25.00%
6 to 12 months 0.00%

No refunds of premium shall be made in respect of Cancellation where, any claim has been admitted or has been lodged or any benefit has been availed by the Insured person under the Policy.