United India Insurance Company Limited
Corporate Identity Number: U93090TN1938GOI000108
Registered Office: 24 Whites Road, Chennai – 600014
IRDAI REG NO.545
Arogya Sanjeevani Policy, United India Insurance Company Limited
CUSTOMER INFORMATION SHEET (CIS)
Guide to the CIS
This document provides key information about your Arogya Sanjeevani Policy. You are also advised to go through your policy document.
(Description is illustrative and not exhaustive )
POLICY
S.
TITLE DESCRIPTION CLAUSE
No.
NUMBER
Name of
1 Insurance Arogya Sanjeevani Policy, United India Insurance Company Ltd -
Policy
Policy {}
2 -
Number
Type of
3 Insurance Indemnity Based -
Policy
Sum
Insured {}
Basis
4 -
Sum
{}
Insured
Base Covers
1. Hospitalisation Expenses
i. Expenses incurred on hospitalisation for minimum period of
24 hours. 3.1
ii. All Day Care Treatments are covered
Policy
Coverage 2. Pre-Hospitalisation and Post-Hospitalisation Expenses
Covers expenses incurred in the 30 days prior to hospitalisation 3.3
5 (W hat
the Policy and in the 60 days post hospitalisation. &3.4
Covers?)
3. Modern Treatment Methods & Advancement in 3.5
Technologies
4. Ambulance Charges 3.1.1
Expenses on road ambulance subject to a maximum of Rs.
2000/- per hospitalisation
5. Home Care Treatment Expenses 3.7
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Arogya Sanjeevani Policy, United India Insurance Company Limited – Customer Information Sheet
UIN: UIIHLIP25039V022425
United India Insurance Company Limited
Corporate Identity Number: U93090TN1938GOI000108
Registered Office: 24 Whites Road, Chennai – 600014
IRDAI REG NO.545
We will indemnify the Reasonable and Customary Charges for
Home Care Treatment for any epidemic/ pandemic subject to a
maximum of 10% of the Sum Insured or Rs. 30,000 per person
per policy period, whichever is lower.
Please refer to Policy Wordings for the complete list of
exclusions.
1. Admission primarily for investigation & evaluation (Code – 5.1
Excl04)
2. Admission primarily for rest cure, rehabilitation, and respite 5.2
care (Code – Excl05)
3. Obesity/Weight Control (Code-Excl06) 5.3
5.4
4. Change-of-Gender treatments (Code – Excl07)
5.5
5. Cosmetic or Plastic Surgery (Code – Excl08)
5.6
6. Hazardous or Adventure Sports (Code – Excl09)
5.7
Exclusion 7. Breach of Law (Code – Excl10)
s 5.8
8. Excluded Providers (Code – Excl11)
6 (W hat the
hospital 9. Treatment for Alcoholism, drug or substance abuse or any 5.9
doesn’t
cover) addictive condition and consequences thereof.(Code – Excl12)
10. Treatments received in health hydros, nature cure clinics, spas 5.10
or similar establishments.(Code – Excl13)
11. Dietary supplements and substances that can be purchased 5.11
without a prescription. (Code – Excl14)
12. Expenses related to the treatment for correction of eyesight due 5.12
to refractive error less than 7.5 dioptres. (Code – Excl15)
13. Expenses related to any unproven treatment, services and 5.13
supplies for or in connection with any treatment.(Code –
Excl16)
5.14
14. Expenses related to sterility and infertility.(Code – Excl17)
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Arogya Sanjeevani Policy, United India Insurance Company Limited – Customer Information Sheet
UIN: UIIHLIP25039V022425
United India Insurance Company Limited
Corporate Identity Number: U93090TN1938GOI000108
Registered Office: 24 Whites Road, Chennai – 600014
IRDAI REG NO.545
5.15
15. Medical treatment expenses traceable to childbirth and
miscarriage. (Code – Excl18)
16. War (whether declared or not) and war like occurrence or 5.16
invasion, acts of foreign enemies, hostilities, civil war, rebellion,
revolutions, insurrections, mutiny, military or usurped power,
seizure, capture, arrest, restraints and detainment of all kinds
17. Nuclear, chemical or biological attack or weapons, contributed 5.17
to, caused by, resulting from or from any other cause or event
contributing concurrently or in any other sequence to the loss,
claim or expense.
5.18
18. Any expenses incurred on Domiciliary Hospitalisation and OPD
Treatment.
5.19
19. Treatment taken outside the geographical limits of India.
20. In respect of the existing diseases, disclosed by the insured and 5.20
mentioned in the policy schedule (based on insured’s consent),
policyholder is not entitled to get the coverage for specified ICD
Codes.
1. Pre-Existing diseases will be covered after a waiting period of
4.1
36 months of continuous coverage
2. Expenses related to the treatment of any illness within 30 days
4.2
from the first policy commencement date shall be excluded
W aiting except claims arising due to an accident.
7
Period
3. Specified surgeries/treatments/diseases are covered after 4.3
specific waiting period 24 months
4. Specified surgeries/treatments/diseases are covered after
specific waiting period 36 months 4.3
Financial The policy will pay only you to the limits specified
8 Limits of hereunder for the following diseases/procedures:
Coverage
i. Room Rent, Boarding, nursing expenses all -
inclusive as provided by the Hospital/Nursing
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Arogya Sanjeevani Policy, United India Insurance Company Limited – Customer Information Sheet
UIN: UIIHLIP25039V022425
United India Insurance Company Limited
Corporate Identity Number: U93090TN1938GOI000108
Registered Office: 24 Whites Road, Chennai – 600014
IRDAI REG NO.545
Sub-Limits Home up to 2% of the sum insured subject to 3.1
maximum of Rs. 5000/ - per day.
ii. Intensive Care Unit (ICU) charges/Intensive
Cardiac Care Unit (ICCU) charges all -inclusive as
provided by the Hospital/Nursing Home up to 5%
of the sum insured subject to a maximum of Rs. 3.1
10,000/- per day.
iii. Cataract – 25% of SI or Rs. 40,000, per eye,
whichever is lower
iv. MTMATs – 50% of Sum Insured 3.2
v. Road Ambulance - 2000/- hospitalisation
vi. Home Care Treatment Expenses: a maximum of 10% of S.I, 3.5
3.1.1.5
subject to Rs. 30,000 per person per policy period
3.7
Every claim under the Policy shall be subject to a Co-
Co-pay payment of 5% applicable to a claim amount admissible 11
and payable as per the terms and conditions of the
Policy.
Deductible NA
Proportionate Payment Clause:
In case of admission to a room at rates exceeding the aforesaid 3.1
Any Other limits, the payment of all associated medical expenses incurred at
Limit
the Hospital shall be effected in the same proportion as the
admissible rate per day bears to the actual rate per day of Room
Rent.
i. Notification of Claim
Upon the happening of any event which may give rise to a claim
under this Policy, the Insured Person/Insured Person’s
representative shall notify the TPA /company in writing
providing all relevant information relating to claim including the
plan of treatment, policy number etc. within the prescribed time
limit as under:
a. Within 24 hours from the date of emergency hospitalisation
Claims required or before the Insured Person’s discharge from 7
9
Procedure Hospital, whichever is earlier.
b. At least 48 hours before admission in Hospital in case of a
planned Hospitalisation
ii. Procedure for Cashless Claims
a. Cashless facility for treatment taken in a hospital is subject to
pre-authorization by the TPA.
b. A booklet containing list of network provider/PPN hospitals
shall be provided by the TPA. The updated list of network
providers/PPNs is available on the website of the company
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Arogya Sanjeevani Policy, United India Insurance Company Limited – Customer Information Sheet
UIN: UIIHLIP25039V022425
United India Insurance Company Limited
Corporate Identity Number: U93090TN1938GOI000108
Registered Office: 24 Whites Road, Chennai – 600014
IRDAI REG NO.545
(https://uiic.co.in/en/tpa-ppn-network-hospitals) and the TPA
mentioned in the schedule.
c. The customer may call the TPA’s toll-free phone number
provided in the policy copy/on the health ID card for intimation
of the claim and related assistance. Please keep the ID
number handy for easy reference.
d. On admission to the network provider/PPN hospital, please
produce the ID card issued by the TPA at the Hospital
Helpdesk. The cashless request form available on the
Company’s website/with the network provider/PPN and TPA
shall be filled and submitted to the TPA for authorisation.
e. The TPA upon getting the cashless request form and related
medical information from the Insured Person/ network
provider/PPN shall issue a pre-authorization letter to the
hospital after verification.
f. At the time of discharge, the Insured Person shall verify and
sign the discharge papers and pay for non-medical and
inadmissible expenses.
g. The TPA reserves the right to deny pre-authorization in case
the Insured Person is unable to provide the relevant medical
details.
h. Denial of a Pre-authorization request is in no way to be
construed as a denial of treatment or denial of coverage. The
Insured Person may get the treatment as per the treating
doctor’s advice and submit the claim documents to the TPA
for possible reimbursement.
iii. Procedure for reimbursement of Claims
a. In non-network hospitals payment must be made up-front and
for reimbursement of claims the Insured Person may submit
the necessary documents to TPA within the prescribed time
limit.
b. Claims for Pre- and Post-Hospitalisation will be settled on
reimbursement basis on production of relevant claim papers
and cash receipts within the prescribed time limit.
iv. Documents
The claim is to be supported with the following original
documents and submitted within the prescribed time limit:
a. Duly completed claim form
b. Attending medical practitioner’s / surgeon’s certificate
regarding diagnosis/ nature of operation performed, along
with date of diagnosis, advise for admission, investigation
test reports etc. supported by the prescription from attending
medical practitioner.
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Arogya Sanjeevani Policy, United India Insurance Company Limited – Customer Information Sheet
UIN: UIIHLIP25039V022425
United India Insurance Company Limited
Corporate Identity Number: U93090TN1938GOI000108
Registered Office: 24 Whites Road, Chennai – 600014
IRDAI REG NO.545
c. Medical history of the patient as recorded, bills (including
break up of charges) and payment receipts duly supported by
the prescription from attending medical practitioner/ hospital.
d. Discharge certificate/ summary from the hospital.
e. Cash-memos from the Diagnostic Centre(s)/ hospital(s)/
chemist(s) supported by proper prescription.
f. Payment receipts from doctors, surgeons and anesthetists.
g. Bills, receipts, Stickers of the Implants.
h. Any other document required by company/ TPA
Note: In the event of a claim lodged as per Settlement under the
multiple policies clause and the original documents having been
submitted to the other Insurer, the company may accept the duly
certified documents listed under Clause V.B.4.iv and claim
settlement advice duly certified by the other Insurer subject to
satisfaction of the company.
v. Time Limit for submission of documents
Type of Claim Time Limit for submission
of documents to
company/TPA
Reimbursement of
hospitalisation, Within 15 (fifteen) days of the
daycare and date of discharge from the
pre-hospitalisation hospital.
expenses
Reimbursement of post- Within 15 (fifteen) days from
hospitalisation completion of post-
expenses hospitalisation treatment.
Notes:
a. The company shall only accept bills/invoices/medical
treatment-related documents only in the Insured Person’s
name for whom the claim is submitted.
b. Waiver of clause V.B.4.v of the policy may be considered in
extreme cases of hardship where it is proved to the
satisfaction of the Company that under the circumstances in
which the Insured was placed, it was not possible for him or
any other person to give such notice or file claim within the
prescribed time-limit.
c. The Insured Person shall also give the TPA / Company such
additional information and assistance as the TPA / Company
may require in dealing with the claim including an
authorisation to obtain Medical and other records from the
hospital, lab, etc.
d. All the documents submitted to TPA shall be electronically
collected by us for settlement/denial of the claims by the
appropriate authority.
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Arogya Sanjeevani Policy, United India Insurance Company Limited – Customer Information Sheet
UIN: UIIHLIP25039V022425
United India Insurance Company Limited
Corporate Identity Number: U93090TN1938GOI000108
Registered Office: 24 Whites Road, Chennai – 600014
IRDAI REG NO.545
e. Any medical practitioner or Authorised Person authorised by
the TPA / Company shall be allowed to examine the Insured
Person in case of any alleged injury or disease leading to
Hospitalisation if so required.
vi. Services offered by TPA
Servicing of claims i.e., claim admissions and assessments,
under this Policy by way of preauthorization of cashless
treatment or processing of claims, as per the terms and
conditions of the policy.
The services offered by a TPA shall not include:
a. Claim settlement and claim rejection;
b. Any services directly to any Insured Person or to any other
person unless such service is in accordance with the terms
and conditions of the Agreement entered into with the
Company.
Turn Around Time (TAT) for claims settlement:
i. TAT for preauthorization of cashless facility 1
hour
ii. TAT for cashless final bill authorization 3 hours
Link for below:
i. Network Hospitals details:
https://uiic.co.in/en/tpa -ppn-network-hospitals
ii. Helpline number:Kindly contact TPA as mentioned in
the Policy schedule
iii. Excluded Providers:
https://uiic.co.in/sites/default/files/excluded_provi
ders.pdf
Downloading claim form:
https://uiic.co.in/en/claims/claim -forms
Policy Please contact your Policy issuing office, details of which are
10 -
Servicing mentioned in your Policy Schedule.
In case of any grievance, you may contact UIIC through:
a. Website: www.uiic.co.in
b. Toll Free Number: 1800 425 333 33
11 Grievance/ c. E-Mail: [email protected]
Complaint You may also approach the grievance cell at any of our branches 10
with details of the grievance.
Alternatively, you may lodge a complaint at the IRDAI Integrated
Grievance Management System (https://igms.irda.gov.in/) OR
approach the Office of the Insurance Ombudsman in your
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Arogya Sanjeevani Policy, United India Insurance Company Limited – Customer Information Sheet
UIN: UIIHLIP25039V022425
United India Insurance Company Limited
Corporate Identity Number: U93090TN1938GOI000108
Registered Office: 24 Whites Road, Chennai – 600014
IRDAI REG NO.545
respective Area/Region. Details of Insurance Ombudsman offices
have been provided as Annexure – 3 in the Policy Wordings.
Free Look cancellation : You are allowed a period of 30 days
from date of receipt of the policy document, whether received
electronically or otherwise, to review its terms and conditions and 11.18
to return the policy if not acceptable to you. This is not applicable
12 Things to
on renewals.
remember
If the Insured has not made any claim during the free look period,
the Insured shall be entitled to a refund of the premium paid
subject only to a deduction of a proportionate risk premium for the
period of cover and the expenses, if any, incurred by the insurer
on medical examination of the proposer and stamp duty charges.
Polic y renew al: Except on grounds of fraud, moral
hazard or non-disclosure or misrepresentation or non -
11.15
cooperation, renewal of your policy sh all not be denied,
provided the policy is not withdrawn.
Migration: Insured Person will be provided facility to migrate the
policy to other health insurance products/plans offered by UIIC by 11.13
applying before the policy renewal date.
Portability: Insured Person will be provided facility to port the
entire policy to an individual health insurance product offered by 11.14
another Insurer by before policy renewal date. Portability is
subject to underwriting.
Change in Sum Insured: Sum Insured can be changed
(increased/decreased) only at the time of renewal or at any times
subject to underwriting by the Company. For increase in S.I, the 11.20
waiting period if any shall start afresh only for the enhanced
portion of the sum insured.
Moratorium Period: After completion of sixty continuous months
of coverage (including portability and migration) in health
insurance policy, no policy and claim shall be contestable by the
6
insurer on grounds of non-disclosure, misrepresentation, except
on grounds of established fraud. This period of sixty continuous
months is called as moratorium period. The moratorium would be
applicable for the sums insured of the first policy. Wherever, the
sum insured is enhanced, completion of sixty continuous months
would be applicable from the date of enhancement of sums
insured only on the enhanced limits
13 Disclosure of Information: Please disclose all pre -existing
Yo ur disease/s or condition/s. Policyholder is required to disclose 11.1
O b l ig at i o ns all material information such as, but not limited to, pre-existing
diseases/conditions, medical history, etc. as sought in the
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Arogya Sanjeevani Policy, United India Insurance Company Limited – Customer Information Sheet
UIN: UIIHLIP25039V022425
United India Insurance Company Limited
Corporate Identity Number: U93090TN1938GOI000108
Registered Office: 24 Whites Road, Chennai – 600014
IRDAI REG NO.545
Proposal form and other connected documents. Non-disclosure,
misrepresentation or misdescription of such information may
result in claim not being paid and shall make the policy void and
all premium paid thereon shall be forfeited to UIIC.
Nomination: Policyholder is required at the inception of the policy
to make a nomination for the purpose of payment of claims under
the policy in the event of death of the Policyholder. 11.22
Declaration by the Policy Holder
I have read the above and confirm having noted the details.
Place:
Date: Signature of Policy Holder
Legal Disclaimer Note: The information must be read in conjunction with the policy document. In case of any conflict between
the CIS and the policy document, the terms and conditions mentioned in the policy shall prevail. The product related documents
including the Customer Information sheet are available on https://uiic.co.in/en/downloadforms/downloads
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Arogya Sanjeevani Policy, United India Insurance Company Limited – Customer Information Sheet
UIN: UIIHLIP25039V022425
