Arogya Sanjeevani Policy, Kotak Mahindra General Insurance Company Ltd.

Overview

IMPORTANT FEATURES

 

Sum Insured:

The minimum sum insured  is Rs 1 Lac and maximum sum insured  is Rs 5 Lacs (in multiples of Rs 50,000)

On Individual basis – Sum Insured shall apply to each individual family member

On Floater basis – Sum Insured shall apply to the entire family

 

Minimum & Maximum Age

The minimum entry age is 18 years and the maximum entry age is 65 years.

 

Persons Covered

Policy can be availed for Self and the following family members

i. legally wedded spouse.

ii. Parents and Parents-in-law.

iii. Dependent Children (i.e. natural or legally adopted) between the ages 3 months to 25 years. If the child above 18 years of age is financially independent, he or she shall be ineligible for coverage in the subsequent renewals

 

Policy Period

1 year

 

Renewability

Lifetime renewability is available in this policy.

 

Portability

Offers portability option to other health insurance policies

 

Features

Hospitalisation & Day Care Treatments

In-patient Hospitalisation and Day Care Treatments are covered upto the opted Sum Insured subject to the sub-limits mentioned below.

 

Ambulance Charges

Max Rs 2000 per hospitalization

 

Pre & post Hospitalization

30 days Pre Hospitalization & 60 days Post Hospitalization expenses

 

AYUSH Benefit

Expenses incurred on hospitalisation under AYUSH treatment

 

Cumulative BonusCumulative Bonus of 5% of the Sum Insured, upto a maximum of 50% will be provided for each claim free year, It will get reduced in case of Claim at the same rate.

 

Sub Limits

  • Sublimit for room/doctors fee:
    • For hospitalization expenses like room, boarding, nursing expenses up to 2% of Sum Insured  or a maximum of Rs 5,000 per day.
    • ICU/ICCU expenses will also be provided up to 5% of sum insured  or a maximum of Rs 10,000 per day.
  • Sub-limit for cataract surgery - 25% sum insured  or Rs 40,000/- , whichever is lower per eye, under one policy year.
  • Modern treatment methods and Advancements in technology: Up to 50% of the Sum insured.

 

Co-payment

  • A fixed co-pay for 5% is applicable for all claims and ages in this policy.

Waiting Period/Exclusions

 

Waiting Periods

 

Pre-Existing Diseases will be covered after a waiting period of forty eight (48) months of continuous coverage

 

Expenses related to the treatment of any illness within 30 days from the first policy commencement date shall be excluded except claims arising due to an accident.

 

Specified surgeries/treatments/diseases are covered after specific waiting period of 24 months/ 48 months

 

* Please refer to the policy wordings for complete details on the waiting period

 

Major exclusions in the policy

 

Following is a partial list of the policy exclusions. Please refer to the policy document for the complete list of exclusions:

 

• Admission primarily for investigation & evaluation

• Admission primarily for rest Cure, rehabilitation and respite care

• Expenses related to the surgical treatment of obesity that do not fulfill certain conditions

• Change-of-Gender treatments

• Expenses for cosmetic or plastic surgery

• Expenses related to any treatment necessitated due to participation in hazardous or adventure sports

 

Statutory Warning - Prohibition Of Rebates (Under Section 41 of Insurance Act 1938)

1)    No person shall allow or offer to allow, either directly or indirectly as an inducement to any person to take out or renew or continue an insurance in respect of any kind of risk relating to lives or property, in India, any rebate of the whole or part of the commission payable or any rebate of the premium shown on the Policy, nor shall any person taking out or renewing or continuing a Policy accept any rebate, except such rebate as may be allowed in accordance with the published prospectuses or tables  of  the Insurer.

2)    Any person making default in complying with the provisions of this section shall be liable for a penalty which may extend to ten lakh rupees.

 

UIN: KOTHLIP20159V011920

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