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What is Aarogya Sanjeevani Policy?

Aarogya Sanjeevani Policy is a basic, standard and affordable health insurance plan offered by all health insurance companies with similar benefits and policy terms. Even though the policy offers standard benefits as directed by the IRDAI, the differentiating factor is the service offered by the insurance company. In this approach, Generali Central assures you have a reliable partner when tough times strike.

Why buy Aarogya Sanjeevani Policy

Floater Benefit

We cover both your parents under the same policy.

Portability

Our doors are always open. So, port your existing senior citizen insurance policy with us without any hassle.

Free Look Period

We respect your choice. So, if you ever wish to cancel the policy, you can do it without any penalty within 30 days from purchase.

Grace Period for Renewal

We know you are busy. So, we give you 30 grace days to renew your plan after expiry.

What is in for you?

THERE ARE ADDITIONAL BENEFITS FOR YOU!

Family discount if you cover yourself and one more person in the same plan
Increase in sum insured by 5% in respect of each claim-free year subject to a maximum of 50% of Sum Insured
No loading on premium for adverse claims experience
Eligible for tax relief as provided under Section 80-D of the Income Tax Act.

What is covered?

INCLUSIONS

Hospitalization Expenses

All expenses incurred as a part of your hospital stay. Some examples include room stay, surgery, etc.
Pre-hospitalization Expenses

We cover for a period of 30 days prior to the date of admissible hospitalization covered under the policy.
Post-hospitalization Expenses

We cover for a period of 60 days from the date of discharge from the Hospital, following an admissible hospitalization covered under the policy.
Day Care Treatment expenses

All expenses incurred when you are hospitalized for less than 24-hours. Some examples include chemotherapy, dialysis, cataract, chemotherapy, etc.
Cataract Treatment

Up to 25% of Sum Insured or Rs. 40,000/-, whichever is lower, per eye in a policy year
AYUSH Treatment

Treatment with help Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy
Emergency Ambulance

Expenses incurred on road Ambulance subject to a maximum of Rs. 2000/- per hospitalization
Coverage for Modern Methods of treatment

Up to 50% of the Sum Insured for the listed methods

What is not covered?

EXCLUSIONS

Obesity or weight control related treatment
Change of gender treatments
Cosmetic and plastic surgeries
Treated required because of hazardous or adventure sports or substance abuse
Treatments without a doctor’s recommendation
Sterility and fertility operations
Maternity related expenses
Domiciliary care of OPD expenses.

What is the eligibility and family covered in Aarogya Sanjeevani Policy?

We secure

Legally wedded spouse
Parents and Parents-in-law
Dependent Children (i.e. naturally or legally adopted) between age 3 months to 25 years

Eligibility

Minimum entry age of Proposer - 18 years
Maximum entry age of Proposer - 65 years
Minimum entry age of Child - 3 months
Maximum entry age of Child - 25 years

Pre-Acceptance Medical Tests

No pre-insurance medical examination test is required if the Insured is up to 55 years of age, irrespective of the Sum Insured opted, subject to no medical declaration in the proposal form
Mandatory Pre-insurance medical examination if the Insured is 56 years and above
Insured is eligible for 50% reimbursement of pre-insurance medical tests charges, subject to policy issuance

Is there any waiting period?

WAITING PERIOD	DISEASES
30 days	Any illness, diagnosed or diagnosable except those incurred as a result of Injury
24 months	Benign ENT disorders, Tonsillectomy, Adenoidectomy, Mastoidectomy, Tympanoplasty, Hysterectomy, All internal or external benign tumors, cysts, polyps of any kind, including benign breast lumps, Benign Prostate Hypertrophy, Cataract and age related eye ailments, Gastric/ Duodenal Ulcer, Gout and Rheumatism, Hernia of all types, Hydrocele, Non Infective Arthritis, Piles, Fissures and Fistula in anus, Pilonidal sinus, Sinusitis and related disorders, Prolapse inter Vertebral Disc and Spinal Diseases unless arising from accident, Calculi in urinary system, Gall Bladder and bile duct, excluding malignancy, Varicose Veins and Varicose Ulcers, Internal Congenital Anomalies
36 months	Age related Osteoporosis and Joint replacement treatment, all Pre-existing Diseases.

What Generali Central Health Insurance Offers

94%

Claim Settlement Ratio
3 hr

Cashless Settlement
6000

Cashless Hospitals

How to buy Aarogya Sanjeevani Policy

You can purchase our policies in several ways:

You Can Call On Our HELPLINE

1800-220-233 / 1860-500-3333 / 022-67837800

SEND US AN EMAIL

GCIcare@generalicentral.com

VISIT BRANCH

Walk-in to any of our nearest branches

BRANCH LOCATOR

What happens after purchase?

Once you secure the insurance cover, you get a financial assurance for all your health needs. You also get documents for your better understanding and convenience.

Health Card for Cashless Treatment It is for utilising cashless facility at network hospitals. You can even avail discounts which are offered by our allied partners. Check out the GCH Privilege section for getting more details.
Policy Schedule You will receive the policy schedule. It is an outline of the cover which is provided by the purchased policy. Details of the policyholder, coverage amount, additional clauses, exclusions, warranties etc will be given in this policy.
Premiums Receipt You will receive the receipt of the premium amount you have paid to purchase this policy.
80D Tax Deduction Certificate Tax deduction if the premium is paid via Credit Card/Debit Card, Net Banking, or Cheque except cash payment.
Policy Coverage and Terms & Conditions This is a comprehensive document which lists down the coverage offered by the policy along with terms and conditions. It is better to read this thoroughly and highlight important points. In case of any discrepancy or doubt, do get in touch with us immediately.
Claim Form You can either intimate your claim online or submit the form to a branch of your choice. You can also email the claim details to us.
Complaint / Feedback Form Should you have any complaints/feedback, you can fill in the form and submit it to the nearest branch or email us.
Grievance Redressal In case you aren’t satisfied with the resolution provided by us to your complaint, then you can approach the Insurance Ombudsman. This form will have details about the procedure to approach the insurance ombudsman along with the addresses of the ombudsman.

What is the reimbursement claim process?

Our claim settlement process is fast and relaible

1

Collate Documents

Upon discharge, pay all hospital bills and collect all original documents of treatment undergone and expenses incurred
2

Claim Form

Download and fill the GCI health claim form
3

Document Submission

Submit original documents to the nearest Generali Central branch
4

Claim Settlement

We will settle the claim in subject to policy terms and conditions

What is cashless claim process?

File your claim in minutes with Generali Central's easy four-step claim process

1

Visit Hospital

Approach an insurance desk of your nearest GCI Network Hospitals and show your health card for Cashless Treatment
2

Verify Yourself

The Network Hospital will verify your identity and submit duly filled pre-authorization form with Generali Central
3

Get Admitted

You get admitted without any deposit and get cashless treatment
4

Peace of Mind

Once you are discharged, the hospital will send your claim documents to GCI and the authorized amount will be settled directly with the hospital

FAQs – Frequently asked questions

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What are Network /Non-network provider?

Network Provider means hospitals or health care providers enlisted by Generali Central to provide medical services to an insured on payment by a Cashless Facility. (Please note: The Hospitals which have been empanelled by Us as Network Providers are as per the latest version of the schedule of Hospitals maintained by Us, which is available to You on request.) Non-Network Provider means any hospital, day care centre or other provider that is not part of the network.

What is a Co-pay? Is there any Co-payment associated with Arogya Sanjeevani Policy, Generali Central Insurance?

Co-payment means a cost sharing requirement under a health insurance policy that provides that the policyholder/insured will bear a specified percentage of the admissible claims amount. There is a 5% co-pay for each and every claim made under the policy.

Do I need to undergo Pre-insurance medical examination for taking this policy?

You can be advised Pre-insurance medical examination, on the basis of your Age, Sum Insured opted, and any health declaration in the proposal form. In case there is a health declaration, pre-insurance medical tests maybe advised.

Are there any sub limits applicable in the product?

Yes, following Sub limits are applicable under the policy:
a. Room Rent – Up to 2% of SI, subject to max of INR 5,000 per day
b. ICU charges – Up to 5% of SI, subject to max of INR 10,000 per day
c. Modern treatment methods and Advancements in technology (for listed procedures): Up to 50% of the Sum Insured.
d. 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.

What are the Sum Insureds available in the product?

You can opt for below sum insured options on individual and floater sum insured basis: ₹ 50000, 1 Lac, 1.5 Lacs, 2 Lacs, 2.5 Lacs, 3 Lacs, 3.5 Lacs, 4 Lacs, 4.5 Lacs, 5 Lacs, 5.5 Lacs, 6 Lacs, 6.5 Lacs, 7 Lacs, 7.5 Lacs, 8 Lacs, 8.5 Lacs, 9 Lacs, 9.5 Lacs, 10 Lacs.

What are the steps for submitting a claim?

You may call on 1800 103 8889 to connect with our 24x7 call centre, or Fax us on 1800 103 9998,Or mail us on GCIH@generalicentral.com
You can submit your claim documents at our nearest branch office or you may even send documents at the following address

Claims Department
Generali Central Health (GCH)
Generali Central Insurance.
Office No. 3, 3rd Floor, “A” Building , G - O – Square
S. No. 249 & 250, Aundh Hinjewadi Link Road, Wakad, Pune - 411 057.
Toll Free Number: 1800 103 8889
Toll Free Fax: 1800 103 9998
Email: GCIH@generalicentral.com

Can I get covered for treatment taken under Non-Allopathic systems of medicine?

You can get covered for expenses incurred for hospitalization under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems of medicines. The treatment has to be undergone in a government hospital or in any institute recognized by government and / or accredited by Quality Council of India / National Accreditation Board on Health for that Alternative treatment.

Why Should I choose Arogya Sanjeevani Policy, Generali Central Insurance?

Arogya Sanjeevani Policy, Generali Central Insurance is a standard Health Insurance Product with wider coverage for the whole family.

Are there any waiting periods applicable?

Waiting Period	Diseases
30 days	Any illness, diagnosed or diagnosable except those incurred as a result of Injury
24 months	Benign ENT disorders, Tonsillectomy, Adenoidectomy, Mastoidectomy, Tympanoplasty, Hysterectomy, All internal or external benign tumors, cysts, polyps of any kind, including benign breast lumps, Benign Prostate Hypertrophy, Cataract and age related eye ailments, Gastric/ Duodenal Ulcer, Gout and Rheumatism, Hernia of all types, Hydrocele, Non Infective Arthritis, Piles, Fissures and Fistula in anus, Pilonidal sinus, Sinusitis and related disorders, Prolapse inter Vertebral Disc and Spinal Diseases unless arising from accident, Calculi in urinary system, Gall Bladder and bile duct, excluding malignancy, Varicose Veins and Varicose Ulcers, Internal Congenital Anomalies
36 months	Age related Osteoporosis and Joint replacement treatment, all Pre-existing Diseases.

Who will be paying for the Pre-insurance medical examination?

If you are advised Pre-insurance medical examination, you have to first pay for the tests charges directly to the diagnostic centre. Upon acceptance of the proposal by Generali Central and issuance of policy for that member, you can claim for 50% reimbursement by submitting the original payment receipt.

What are the entry age limits under Arogya Sanjeevani Policy, Generali Central Insurance?

The minimum age required for entry is 3 months. The Maximum age for entry is 65 years with Lifelong renewability. Children will be covered as dependents up to 25 years of age. If the child above 18 years of age is financially independent, he or she shall be ineligible for coverage in the subsequent renewals

Do I get any tax benefit if I purchase this policy?

If you pay the premium by any mode other than Cash / DD under the Policy, You shall be eligible for income tax benefit under Sec 80 D of the Income Tax Act and any amendments there on.

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PRODUCT NAME: Arogya Sanjeevani Policy, Generali Central Insurance Co. Ltd. | UIN NO: GCIHLIP20160V011920 | LAUNCH DATE: 6TH MAY 2021

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Protect your family against illnesses

Get attractive deals on a family cover

What is Aarogya Sanjeevani Policy?

Why buy Aarogya Sanjeevani Policy

Floater Benefit

Portability

Free Look Period

Grace Period for Renewal

What is in for you?

What is covered?

What is not covered?

What is the eligibility and family covered in Aarogya Sanjeevani Policy?

Is there any waiting period?

What Generali Central Health Insurance Offers

How to buy Aarogya Sanjeevani Policy

What is the reimbursement claim process?

What is cashless claim process?

FAQs – Frequently asked questions

Need to know more about Health Insurance?

Download documents