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National Insurance Divyangjan Sanjeevani Policy

The National Divyangjan Sanjeevani Policy is an indemnity health insurance plan specially created for those who fall into the following categories and who will be covered by the policy as Insured Persons. The National Arogya Sanjeevani Policy covers the costs that the policyholder is charged for Day Care Treatment or In-Patient Care as a result of a disease or injury sustained during the policy period. The policy also includes coverage for ambulance fees and pre and post-hospitalization (30 and 60 days) costs.

Read below to understand more in detail about the benefits of the National Divyangjan Sanjeevani Insurance Policy.

Eligibility Criteria

Here are the eligibility criteria for the National Divyangjan Sanjeevani Insurance Policy.

ParametersDetails
Age

For Adults:

Minimum- 18 Years

Maximum- 65 Years

For Children:

Newborn to 18 years

Policy Period1 Year
Sum InsuredRs. 4 lacs and Rs. 5 lacs on an Individual Basis.
Dental TreatmentYes

Coverage Details

Here are the coverage details for the National Divyangjan Sanjeevani Insurance Plan.

ParametersDetails
TreatmentsAll AYUSH Treatment and Modern Treatment covers up to 50% of SI.
Day Care ProceduresCoverage of 537 listed Day Care Procedures.
Pre and Post HospitalizationPre Hospitalization (30 days) and Post Hospitalization (60 days)
Cataract SurgeryExpenses incurred on treatment of Cataract Surgery subject to Rs 40,000/-
Ambulance ChargesEmergency ground ambulance charges up to Rs 2000/- hospitalization, max 7000/- in a policy.
Pre-existing diseasesPre-existing diseases are covered after a period of 4 years (48 months) and pre-existing disability after a period of 2 years.
Discount for Direct SaleA discount of 10% shall be allowed on the final payable premium for new and subsequent renewals.
Tax Rebatetax benefits for the premium paid, under Section 80D of the Income Tax Act 1961.

Features and Benefits of the National Divyangjan Sanjeevani Insurance Policy

The following are the key features and benefits of considering the National Divyagjan Sanjeevani Insurance Policy.

  • AYUSH Treatment: One of the major reasons to buy the National Divyangjan Sanjeevani Insurance policy is it reimburse Medical Expenses up to 50% of the Sum Insured as specified in the Policy Schedule for Inpatient Care under the Ayurvedic, Yoga and Naturopathic, Unani, Siddha, and Homoeopathic systems of medicine during each Policy Period.
  • Pre-Hospitalization Medical Expenses: For a fixed period of 30 days before the date of the admissible hospitalisation covered by the policy, the Company shall indemnify Pre-Hospitalization Medical Expenses incurred, related to an admissible hospitalisation requiring inpatient care.
  • Inpatient Care: Other than any sub-limits or co-pays specified in the policy, the Company will reimburse Medical Expenses incurred for the Insured Person’s Hospitalisation up to the Sum Insured as specified in the Policy Schedule for Room Rent, Boarding, and Nursing Expenses as provided by the Hospital / Nursing Home, up to a maximum of 1% of the Sum Insured per day.
  • Post-Hospitalization Medical Expenses: For a set period of 60 days following the date of discharge from the hospital, the company will cover any post-hospitalization medical costs incurred in connection with an admissible hospitalisation requiring inpatient care.
  • Emergency Ground Ambulance: When an insured person needs to be transported by ambulance during a hospitalisation, the company will pay reasonable and customary charges up to the allotted limit.
  • Cataract Treatment: Treatment of cataracts Up to a maximum of Rs. 40,000 for each eye during a Policy Period, the plan will reimburse Medical Expenses incurred for Cataract treatment.
  • Free Look Period: The Free Look Period will only be available for brand-new individual health insurance policies, not ones that are renewed. Following receipt of the policy document, the insured person has fifteen days to rethink the terms and conditions and return the document if they are not satisfactory.
  • Change of Sum Insured: Only at renewal time, or at any time after that, subject to underwriting by the company, is the Sum Insured subject to change (increase/decrease). The Waiting Period will only begin again for the portion of the Sum Insured that has increased in the event of any increase in the Sum Insured.
  • Tax Rebate: Under Section 80D of the Income Tax Act of 1961, the Proposer may be eligible for tax benefits for the premiums paid when the user purchases the National Divyaangjan Sanjeevani plan.

What are the Exclusions Under the National Divyangjan Sanjeevani Policy?

Here are the things not included under the National Divyangjan Sanjeevani Policy.

  • Any medical care received outside of India.
  • Circumcision, unless it is required for the treatment of a disease, illness, or accident-related injury.
  • Treatment, whether conventional, alternative, or experimental, includes reflexology, aromatherapy, acupuncture, acupressure, magnetic therapy, osteopathy, naturopathy, and other modalities.
  • Lawbreaking, including suicide, self-inflicted injury (including, but not limited to, the use or abuse of any intoxicating substance, including alcohol or drugs), and suicide.
  • Immunisation or vaccination, excluding post-animal bite care.
  • Rest cure, general debility, “run-down” condition, congenital external illness, disease, or defect.
  • Hormone replacement therapy, outpatient diagnostic, medical, and surgical procedures or treatments, as well as costs associated with domiciliary hospitalisation, are not covered.
  • Sexually transmitted and venereal diseases
  • Storage of stem cells.
  • Any service fees or additional charges imposed by the hospital.
  • Goods and services for your comfort and convenience, such as television, phones, barber or other guest services, and similar incidental services and supplies.

How to Buy the National Divyangjan Sanjeevani Insurance Plan?

The National Divyangjan Sanjeevani Policy, which provides basic & standard medical insurance with coverage, was introduced to streamline health insurance in India. It works to offer the policyholder in India basic indemnity insurance benefits across all income groups. You can still purchase the plan through Probus Insurance since it cannot be purchased online through the National Insurance official website.

Probus Insurance Broker Private Limited is a specialized insurance broker that operates throughout India and offers a large variety of insurance plans (including life and non-life) to meet the exploding demands of the populace.

The actions to take into consideration before purchasing the National Divyangjan Sanjeevani Policy through Probus Insurance are listed below.

  • On the right side of this page is where you can find the “We Are Here” chatbot.
  • Before entering your full name, email address, and phone number and clicking the “Start Chat” button, you must first choose your department.
  • By clicking it, you can start a conversation with any of the company’s customer service representatives. After that, they will assist you in purchasing the National Divyaangjan Sanjeevani Policy by answering any questions you may have.

Do you still have trouble buying the policy? If so, don’t worry! To purchase a National Divyangjan Sanjeevani Policy at Probus Insurance right away, just get in touch with a customer service agent. The details for getting in touch are given below.

ParametersDetails
Call+91 7304332968
WhatsAppSay “Hi” to 7304332968
Mailcare@probusinsurance.com

How to File a Claim?

Procedure for Cashless Claims:

  • Treatment may be received from a network provider with prior authorisation from the Company or its designated TPA,
  • Fill out the cashless request form provided by the network provider and TPA, then send it to the company or TPA for approval.
  • The Company/TPA is going to send a pre-authorization letter to the hospital after verification once it has received the cashless request form and pertinent medical information from the insured person/network provider.
  • If the insured person’s request for cashless access is denied, they may still receive treatment on the advice of their doctor and submit their claim paperwork to the company or TPA for reimbursement.

Procedure for Reimbursement of Claims:

The insured person may provide the Company with the required paperwork for claim reimbursement within the time frame specified in this agreement.

  • Let your insurance company, i.e., National Insurance, know about the procedure and the hospital.
  • Receive treatment and pay for it out of your pocket.
  • Submit a claim to your insurance provider.
  • Distribute all hospitalization-related paperwork, including invoices for medical care, prescriptions from the doctor, and other pertinent records.
  • Your documents will be verified by the insurance provider, National Insurance. Your claim will be handled by the terms of your policy and the range of coverage.

Points to Remember:

  • Send the required paperwork for reimbursement of pre-hospitalization, daycare, and hospitalisation costs within 30 days of the date of discharge from the hospital.
  • Send the necessary paperwork for post-hospitalization expenses reimbursement within 30 days of the end of post-hospitalization care.

What are the Documents required?

The following are the documents required to file a claim for National Divyangjan Sanjeevani Insurance Plan.

  • Duly Completed claim form.
  • Photo Identity proof of the patient
  • Medical Practitioner’s prescription advising admission.
  • Original bills with the itemized break-up
  • Payment receipts
  • Discharge summary including complete medical history of the patient along with other details.
  • Investigation/ Diagnostic test reports etc. supported by the prescription from the attending medical practitioner
  • OT notes or Surgeon’s certificate giving details of the operation performed (for surgical cases).
  • Sticker/invoices of the Implants, wherever applicable.
  • MLR (Medico-Legal Report copy if carried out and FIR (First information report) if registered, wherever applicable. NEFT Details (to enable direct credit of claim amount in a bank account) and cancelled cheque.
  • KYC (Identity proof with Address) of the proposer, where claim liability is above Rs 1 Lakh as per AML Guidelines
  • Legal heir/succession certificate, wherever applicable
  • Any other relevant document required by the Company/TPA for assessment of the claim.

How to Renew Your National Divyangjan Sanjeevani Policy?

The insured person will forfeit all accrued benefits, including waiting period benefits if the policy fails to be renewed promptly and it lapses. Therefore, it is crucial that you renew your National Divyangjan Sanjeevani Insurance policy.

Listed below are the steps to renew your National Divyangjan Sanjeevani policy.

  • Visit the National Insurance website.
  • “Quick Renewal” is displayed at the top. Toggle it on.
  • You will be taken to a page where you must first enter your policy number and then the “Captcha” code as soon as you click on it. Click “Renew Policy” after filling out all the fields.
  • After that, you must pay the renewal premium for your insurance. You can then renew your policy using a credit or debit card at that point.
  • Your registered email address and phone number will receive a message with information about your policy after you make the payment.

Frequently Asked Questions

Contrary to popular belief, the National Divyangjan Sanjeevani policy does not cover maternity or fertility care.

The National Arogya Divyangjan Sanjeevani Policy is a reasonably priced option that is available as a family floater as well as an individual policy.

Yes, Ayurvedic and homeopathic treatments are covered by the National Arogya Sanjeevani Policy.

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