Inclusions & Exclusion in Arogya Sanjeevani Policy

Inclusions of Arogya Sanjeevani Policy

An Arogya Sanjeevani Health Insurance Policy comes with the following inclusions:

• Pre & Post Hospitalization Expenses

This policy will cover all the pre and post hospitalization expenses in case of any medical emergency due to an illness or accidental injury. It also offers coverage for medical & hospitalisation expenses occurs due to Coronavirus (COVID-19).

• COVID-19 Cover

It also offers corona insurance protection and pays for any expenses incurred on hospitalization due to contracting COVID-19 or coronavirus disease.

• AYUSH Benefit

It includes hospitalization expenses incurred on obtaining alternative treatments, such as Ayurveda, homeopathy, Siddha, etc, at an approved hospital.

• ICU/ ICCU Charges

The policy pays up to 5% charges of the treatment taken in the ICU (Intensive Care Unit) or ICCU (Intensive Coronary Care Unit) of the total sum insured up to a maximum Rs. 10,000 per day.

• Room Rent

It covers the room rent of the hospital up to a maximum of Rs. 5,000 per day.

• Ambulance Services -

It covers the cost of ambulance services up to a maximum cap of Rs. 2,000 per hospitalization.

• Daycare Treatment

It covers the expenses arising out of any daycare treatment procedures.

• Plastic Surgery and Dental Treatment

The cost of any dental or plastic surgery treatment taken as a result of an illness or injury is also covered.

• Cataract Surgery

It also covers the cost of cataract surgery for each eye up to a maximum of Rs. 40,000 or 25% of the total sum insured amount, whichever is less.

• New Age/ Modern Treatment

This policy also covers the cost of modern/ new age treatment up to a maximum of 50% of the total sum insured amount.

The Arogya Sanjeevani Insurance Policy covers the following modern or new-age treatments:

• Balloon Sinuplasty
• Bronchial Thermoplasty
• Intraoperative Neuromonitoring (IONM)
• Intravitreal Injections
• Oral Chemotherapy
• Robotic Surgeries
• Stem Cell Therapy (Bone marrow transplant through Hematopoietic stem cells for hematological conditions)
• Stereotactic Radio Surgeries
• Uterine Artery Embolization and High Intensity Focussed Ultrasound (HIFU)
• Vaporisation of the Prostate (Green Laser/ Holmium Laser treatment)

Exclusions of Arogya Sanjeevani Policy

• Diagnostic or Investigative Tests

It will not cover the expenses incurred on getting any diagnostic or investigative tests done.

• Bed Rest or Rehabilitation Expenses

It will not cover any expenses incurred due to enforced bed rest in the absence of treatment. It will also not cover any expenses arising out of rehabilitation needs.

• Weight Control/ Obesity Treatment

Any expenses arising out of the treatment taken for obesity or weight management will not be covered.

• Gender-change Treatment

- It will not cover the cost of taking any treatment for changing the gender.

• Cosmetic or Plastic Surgery

Any expenses incurred on cosmetic or plastic surgery which is not required as a result of an accident, cancer, burn injury or medically necessary treatment will not be covered.

• Maternity Expenses

It will not cover the cost of any treatment related to pregnancy and child birth.

• OPD Treatment -

It will not cover the cost of any OPD or out-patient treatment taken by the policyholder.

• Adventure/ Hazardous Sports

Under this medical insurance does not cover any medical treatment expenses arising due to participation in a hazardous or adventure sports, such as rock climbing, sky diving, para-jumping, deep-sea diving, mountaineering, etc, as a professional.

• Breach of Law

It will not cover any expenses incurred due to breaching the law with a criminal intention.

• Alcohol/ Drug addiction

Any expenses arising out of the treatment for addiction of alcohol or drug or substance abuse will not be covered.

• Dietary Supplements

It will not cover the cost of purchasing any dietary substance or supplements, such as minerals, vitamins, etc., without a prescription.

• Unproven Treatment

This policy will not cover the cost of any unproven treatment taken by the policyholder.

• Infertility and Sterility

It will not cover any expenses arising out of infertility or sterility.

• Domiciliary hospitalization

Any expenses arising out of domiciliary hospitalization will not be covered.

• Nuclear attack or War

This policy will not cover any claims arising out of a nuclear attack or a war/ war-like situation.

• Treatment outside India

It will not cover the expenses incurred on receiving any outside India.

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