Arogya Sanjeevani Policy, Navi General Insurance Limited

Health is the most important asset you have in your life. Every part of your life is dependent on you having good health. Rising medical costs and host of lifestyle diseases have increased the financial burden on everyone. It is therefore essential to have a health insurance product in place and protect yourself and / or your family against medical expenses due to inpatient hospitalization.

Hence, we brought you Arogya Sanjeevani Policy which is a standard health insurance product mandated by IRDAI, with basic mandatory covers and features which are uniform across market.

Features you'll appreciate

Coverage - This policy is designed to offer below coverage's.



Sum Insured Options - You have the option to choose the sum insured from 1 Lac to 5 Lacs. Minimum sum insured is 1 Lac; thereafter in the multiples of 50,000 up to a maximum of 5 Lacs is available.

[B]Age Eligibility - Minimum age at entry under this Policy is 18 years for principal insured and maximum age at entry shall be 65 years. Dependent children shall be covered from the age of 3 months to 25 years. If a child above 18 years is financially independent, he or she will be ineligible for coverage in subsequent renewals.

There is no maximum cover ceasing age on renewals.

Policy Period Option - Policy can be issued with a term of one (1) year.
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Type of Policy - This policy can be issued to an individual on an Individual Sum Insured basis and/or to a family on an Individual Sum Insured basis or on a Family Floater Sum Insured basis.
Number of members covered under each type of policy are



Pre-Policy Medical Check Up (PPMC) - We will require you to undergo a medical check-up based on your Age (grid mentioned below). Wherever any pre-existing disease or any other adverse medical history is declared, we may ask such member to undergo specific tests, as we may deem fit to evaluate such member, irrespective of Age.

Medical tests will be facilitated by us and conducted at our network of diagnostic centres. We will contact You and fix an appointment for the Medical tests to be conducted at a time convenient to you. Medical tests will be valid for a period of 3 month only. 50% of cost of all such tests will be borne by us for all accepted proposals. In case of rejected proposals or where a counter offer is not accepted by You, then You have to bear the full cost of medical tests.

Geography - Policy covers for events within the territorial limits of India .All payments under the Policy will be made in Indian Rupees.

Waiting Period - We shall not be liable to make any payment under this Policy in connection with or in respect of following expenses till the expiry of the waiting period mentioned below.
a) First 30 days waiting period - 30 days

b) Specific Waiting Period - 24 months / 48 months

c) Pre-Existing Disease Waiting Period - 48 months

Premium - The Premium charged on the Policy will depend on the Age and Sum Insured. Additionally, the health status of the individual will also be considered. Premiums will be payable either by Single premium mode or in installments. The options are available with loading as described below



In case of installments, premium shall be payable on or before the due date for continuity of coverage under the policy.

You will have a grace period of 15 days from the due date for payment of installment. We will not charge interest on the installment premium paid during the grace period and there will be no impact on applicable waiting periods. In case, We do not receive the premium within this grace period, the policy will be terminated.

In the event of a claim, all the subsequent premium installments shall immediate become due and payable. We shall have the right to recover and deduct any or all the pending installments from the claim amount due under the Policy.

What are the Exclusions?
The Company shall not be liable to make any payment under the policy, in respect of any expenses incurred in connection with or in respect of:

Investigation & Evaluation
a) Expenses related to any admission primarily for diagnostics and evaluation purposes.

b) Any diagnostic expenses which are not related or not incidental to the current diagnosis and treatment.

Rest Cure, rehabilitation and respite care
a) Expenses related to any admission primarily for enforced bed rest and not for receiving treatment. This also includes :

i. Custodial care either at home or in a nursing facility for personal care such as help with activities of daily living such as bathing , dressing , moving around either by skilled nurses or assistant or non-skilled persons.
ii. Any services for people who are terminally ill to address physical , social, emotional and spiritual needs.

Obesity/ Weight Control
Expenses related to the surgical treatment of obesity that does not fulfill all the below conditions:

1) Surgery to be conducted is upon the advice of the Doctor

2) The surgery/ Procedure conducted should be supported by clinical protocols

3) The member has to be 18 years of age or older and

4) Body Mass Index (BMI);
a) greater than or equal to 40 or
b) greater than or equal to 35 in conjunction with any of the following severe co- morbidities following failure of less invasive methods of weight loss:
i. Obesity-related cardiomyopathy
ii. Coronary heart disease
iii. Severe Sleep Apnea
iv. Uncontrolled Type2 Diabetes

Change-of-Gender treatments
Expenses related to any treatment, including surgical management , to change characteristics of the body to those of the opposite sex.

Cosmetic or plastic Surgery
Expenses for cosmetic or plastic surgery or any treatment to change appearance unless for reconstruction following an Accident , Burn(s) or Cancer or as part of medically necessary treatment to remove a direct and immediate health risk to the insured. For this to be considered a medical necessity, it must be certified by the attending Medical Practitioner.

Hazardous or Adventure sports
Expenses related to any treatment necessitated due to participation as a professional in hazardous or adventure sports, including but not limited to, para-jumping, rock climbing, mountaineering, rafting, motor racing , horse racing or scuba diving, hand gliding, sky diving, deep-sea diving.

Breach of law
Expenses for treatment directly arising from or consequent upon any Insured Person committing or attempting to commit a breach of law with criminal intent.

Excluded Providers
Expenses incurred towards treatment in any hospital or by any Medical Practitioner or any other provider specifically excluded by the Insurer and disclosed in its website / notified to the
policyholders are not admissible. However, in case of life threatening situations or following an accident, expenses up to the stage of stabilization are payable but not the complete claim.

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.

Refractive Error
Expenses related to the treatment for correction of eye sight due to refractive error less than 7.5 dioptres.

Unproven Treatments
Expenses related to any unproven treatment, services and supplies for or in connection with any treatment. Unproven treatments are treatments, procedures or supplies that lack significant medical documentation to support their effectiveness.

Sterility and Infertility
Expenses related to sterility and infertility. This includes:
(i) Any type of contraception, sterilization
(ii) Assisted Reproduction services including artificial insemination and advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI
(iii) Gestational Surrogacy
(iv) Reversal of sterilization

Maternity Expenses
i. Medical treatment expenses traceable to childbirth (including complicated deliveries and cesarean sections incurred during hospitalization) except ectopic pregnancy;
ii. expenses towards miscarriage (unless due to an accident) and lawful medical termination of pregnancy during the policy period.

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. For the purpose of this exclusion:

a) Nuclear attack or weapons means the use of any nuclear weapon or device or waste or combustion of nuclear fuel or the emission, discharge, dispersal, release or escape of fissile/ fusion material emitting a level of radioactivity capable of causing any Illness, incapacitating disablement or death.

b) Chemical attack or weapons means the emission, discharge, dispersal, release or escape of any solid, liquid or gaseous chemical compound which, when suitably distributed, is capable of causing any Illness, incapacitating disablement or death.

c) Biological attack or weapons means the emission, discharge, dispersal, release or escape of any pathogenic (disease producing) micro-organisms and/or biologically produced toxins (including genetically modified organisms and chemically synthesized toxins) which are capable of causing any Illness, incapacitating disablement or death.

Any expenses incurred on Domiciliary Hospitalization and OPD treatment.

Treatment taken outside the geographical limits of India

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.