Arogya Sanjeevani Policy

Chola MS
 Agenda

Product Key Features

Overall Product Features
Waiting Period
Discounts
Premium Payment & Conditions
Exclusions
Important Points to note
Competition Analysis
2
Product Key Points

Coverage for all Day care procedures

Coverage for all Dental treatment & Plastic Surgery

No Sub Limits on AYUSH coverage

Cashless Treatment facility in 8400+ Hospitals

 Product Features

Family Floater On an Individual basis

• Insured person, spouse and
maximum of 4 children can be
covered.
• Coverage for Proposer is not
mandatory
• Insured person, spouse,
children, parents and parents-
in-laws can be covered.
• Coverage for Proposer is not
mandatory
 Age Limits

Age Limits

Minimum Entry Age Maximum Entry Age

Child: 3 Adult: 18 Child: 25 Adult: Up to

Months Years Years 65 Years

5
 Sum Insured

1 1.5 2
LAC LACS LACS

2.5 3
LACS LACS
 Product Features
Inpatient care, doctor fees, nursing
Hospitalization Expenses expenses, surgical fees, operating
theatre etc.. covered up to sum insured.

AYUSH
Covered without Sublimit for Inpatient
Ayurveda, Yoga and Naturopathy,
PRODUCT Unani, Siddha and Homeopathy & Day care procedures.
FEATURES
Pre & Post Pre hospitalization (30 days) and post
Hospitalization hospitalization (60 days) covered up to
Expenses sum insured.

Medical Checkup Above the age of 50 years

Medical Check up Applicable:
CBC with EST, ECG,HbA1C, Total
Cholesterol,SGPT & Routine Urine
Analysis.
 Product Features contd..

Policy Term 1 Year Policy

Cumulative 5% - 50%
PRODUCT Bonus Reduction in cumulative bonus 5%

FEATURES
Road Ambulance - max. upto Rs.2000/-
Ambulance Expenses
per hospitalization.

Plastic Surgery Plastic Surgery, necessitated due to

disease or injury.
 Product Features contd..

Room Limits 2% of SI subject to a maximum of

Rs.5000/- per day

ICU Room Limit 5% of SI subject to a maximum of

Rs.10000/- per day
PRODUCT
FEATURES
Co-Payment 5% on every admissible claim

Dental Treatment Dental Treatment necessitated due to

disease or injury.

Note : Domiciliary treatment , Organ Donor and Maternity expenses are not covered under the policy.
 Product Features contd..

Disease Specific limits - either as IP or as day care treatment

1. Uterine Artery Embolization and HIFU (High intensity focused ultrasound)

2. Balloon
Sinuplasty
3. Deep Brain Stimulation
Up to 50% 4. Oral chemotherapy
5. Immunotherapy-Monoclonal Antibody to be
given as injection 6. Intra Vitreal injections
Sum Insured Surgeries
7. Robotic

8. Stereotactic radio surgeries

9. Bronchial Thermoplasty
10. Vaporisation of the prostrate (Green
laser treatment or holmium laser treatment)
11. IONM - (Intra Operative Neuro Monitoring)
12. Stem cell therapy:
 Waiting Periods

Initial Waiting Specific Waiting Pre Existing Diseases

30 days Initial Waiting Period for 24 & 48 months waiting period 48 months waiting period for
illness. Day one cover for for listed Specified Illness. Pre-existing Condition / Disease
accident claims.
 Waiting Periods contd..
24 Months Waiting period 24 Months Waiting period
1. Benign ENT disorders 11. Gout and Rheumatism
2. Tonsillectomy 12. Hernia of all types
3. Adenoidectomy 13. Hydrocele
4. Mastoidectomy 14. Non-infective Arthritis
5. Tympanoplasty 15. Piles, Fissures and Fistula in anus
6. Hysterectomy 16. Pilonidal sinus, Sinusitis and related disorders
7. All internal and external benign 17. Prolapse inter Vertebral Disc and Spinal Diseases
tumours,cysts,polyps of any kind, including unless arising from accident
benign breast lumps 18. Calculi in urinary system, Gall Bladder and Bile duct,
8. Benign prostate hypertrophy excluding malignancy
9. Cataract and age related eye ailments 19. Varicose Veins and Varicose ulcers
10. Gastric/Duodenal Ulcer 20. Internal Congenital Anomalies

48 Months waiting period

1. Treatment for joint replacement unless arising from accident
2. Age-related Osteoarthritis and Osteoporosis
Family Discounts
Individual Policies

Size of the Family Discount (%) on base Premium

1 to 2 members 0
3 to 5 members 5%
6 to 7 members 7%
> 7 members 10%
 Premium Payment Options

HALF ANNUALLY
MONTHLY QUARTERLY
YEARLY

If the insured person has opted for payment of premium on an installment basis i.e. Half Yearly, Quarterly or Monthly the
following conditions shall apply (notwithstanding any terms contrary elsewhere in the policy)
I. Grace period of 15days would be given to pay
II. During such grace period, coverage will not be available from the installment premium payment due date till the date of
receipt of premium by Company.
III. The benefits provided under – ‘waiting periods’, ‘specific waiting periods’ section of the policy shall continue in the event of
payment of premium within the stipulated grace period.
IV. No interest will be charged if the installment premium is not paid on due date
V. In case of installment premium due not received within the grace period, the policy will get cancelled
Health Premium – Options Contd..
Premium Payment Options Charges

Single upfront Premium payment prior to

policy commencement.

Half yearly (2% Loading)

Quarterly (3% Loading)

Monthly (4% Loading)

Exclusion
Investigation & Evaluation

Obesity/Weight Control

Cosmetic or plastic Surgery unless medically

necessary

Hazardous or Adventure sports

Sterility and Infertility

Maternity Expenses
 Important Points to note

Organ Donor not covered

Domiciliary treatment not covered

Moratorium period included

Moratorium Period: After completion of eight continuous years under this policy no look back period would be
applied. This period of eight years is called as moratorium period. The moratorium would be applicable for the sums
insured of the first policy and subsequently completion of eight continuous years would be applicable from date of
enhancement of sums insured only on the enhanced limits.
Income Tax Benefit

80 D CERTIFICATE

Tax Exemption Certificate under section 80 D for the

premium paid towards the policy
In House Claim Processing

In House Claim Processing

No TPA , In- House Health claim processing

 Competition Analysis
Sum Insured : 3 Lac Policy Type: 2 Adult

CMS Vs
Age CMS Star Bharti-AXA Go Digit TATA AIG National Navi CMS Vs Bharti- CMS Vs CMS v CMS Vs CMS Vs
Star Go Digit TATA AIG National Navi
AXA

25 6829 8325 5544 6034 11543 13462 6324 -22% 19% 12% -69% -97% 7%
35 8124 8325 7272 6867 11544 15391 8121 -2% 10% 15% -42% -89% 0%
45 9474 9880 8152 9418 12806 19196 9713 -4% 14% 1% -35% -103% -3%
50 12788 12570 10789 11951 16795 23879 12605 2% 16% 7% -31% -87% 1%
55 15459 15400 14944 15703 19856 30611 16534 0% 3% -2% -28% -98% -7%
60 20666 19075 21788 20997 25452 38708 25856 8% -5% -2% -23% -87% -25%

Market
Comparison
 Competition Analysis
Sum Insured : 3 Lac Policy Type: 2A + 2C

CMS Vs CMS Vs CMS Vs CMS v CMS Vs CMS Vs

Age CMS Star Bharti-AXA Go Digit TATA AIG National Navi Star Bharti- Go Digit TATA AIG National Navi
AXA

25 4340 5180 3762 4291 7896 8382 3621 -19% 13% 1% -82% -93% 17%
35 5641 5180 5199 4983 7896 10311 5257 8% 8% 12% -40% -83% 7%
45 7250 6735 6363 7516 9380.8 14116 6702 7% 12% -4% -29% -95% 8%
50 10313 9425 8124 9933 14073 18799 9743 9% 21% 4% -36% -82% 6%
55 13027 12255 11245 13472 17675 25531 14287 6% 14% -3% -36% -96% -10%
60 17919 15930 17657 18510 24259 33628 24317 11% 1% -3% -35% -88% -36%

Market
Comparison
 Sample Proposal Form

Note : In this case assuming Ramesh

1 Ramesh has Diabetes, While capturing
2 Sumithra Medical information we would tick
3 Kamalesh “Y” and tick “1” in insured column as
Ramesh name is captured in S. No 1.

If there are multiple people with

medical history, corresponding nos in
isured details has to be ticked.

Proposal Form
THANK YOU