{"uin":"IFFPMIP23040V012223","name":"Arogya Sanjeevani Policy (Micro Insurance) IFFCO-TOKIO GIC Ltd","url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223","insurer":{"slug":"iffco-tokio-general-insurance","name":"IFFCO TOKIO General Insurance Company Limited","url":"https://indiainsurances.com/insurer/iffco-tokio-general-insurance"},"line":"general","category":"health-indemnity","category_name":"Health insurance (hospitalisation)","irdai_type":null,"kind":"product","status":"active","approved_on":null,"withdrawn_on":null,"summary":"Arogya Sanjeevani Policy (Micro Insurance) is an indemnity health policy available on individual or floater basis for a 1 year policy period with medical treatment in India only. It covers hospitalisation for illness or injury with 30 days pre-hospitalisation, 60 days post-hospitalisation, 5% co-pay, room rent up to 2% of sum insured subject to Rs.5000 per day and ICU up to 5% of sum insured subject to Rs.10,000 per day.","analysis":{"state":"machine","analysed_at":"2026-10-20 03:52:27.484808+00","note":"First pass: one AI reading; every stated fact carries a verbatim quote found in the cited clause, but it has not been reviewed. Check the clause before relying on it."},"facts":[{"key":"plan_variants","label":"Plans and variants","section":"Overview","meaning":"The named plans inside this product (not cover types or payout options). Facts can differ between them.","status":"quote-verified","value":["Individual","Floater"],"display":"Individual / Floater","note":null,"quote":"Product Type | Individual/ Floater","sources":[{"clause":null,"heading":"13 TABLE OF BENEFITS","page":19,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-13-table-of-benefits"}],"law":[]},{"key":"policy_term","label":"Policy term","section":"Eligibility","meaning":"How long one policy runs before it ends or must be renewed.","status":"quote-verified","value":"One policy period is 1 year.","display":"1 year","note":null,"quote":"Policy Period | 1 year","sources":[{"clause":null,"heading":"13 TABLE OF BENEFITS","page":19,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-13-table-of-benefits"}],"law":[]},{"key":"claim_intimation","label":"Claim intimation deadline","section":"Claims","meaning":"How soon you must tell the insurer about a claim or hospitalisation.","status":"quote-verified","value":"For emergency hospitalisation, notice with full particulars must be sent within 24 hours from emergency hospitalisation or before discharge, whichever is earlier. For planned hospitalisation, notice must be sent at least 48 hours before admission.","display":"Emergency: within 24 hours or before discharge, whichever is earlier; planned: at least 48 hours before admission","note":null,"quote":"Notice with full particulars shall be sent to the Company/TPA (if applicable) as under:\ni) Within 24 hours from the date of emergency hospitalization required or before the Insured Person’s discharge from Hospital, whichever is earlier.\nii) At least 48 hours prior to admission in Hospital in case of a planned Hospitalization.","sources":[{"clause":"9.1","heading":"Notification of Claim","page":12,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-9-1"}],"law":[{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 20, 21","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"claim_documents","label":"Claim documents","section":"Claims","meaning":"Documents the insurer asks for when you claim.","status":"quote-verified","value":["Duly Completed claim form","Photo Identity proof of the patient","Medical practitioner’s prescription advising admission","Original bills with 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 attending medical practitioner","OT notes or Surgeon’s certificate giving details of the operation performed (for surgical cases).","Sticker/Invoice of the Implants, wherever applicable.","MLR (Medico Legal Report copy if carried out and FIR (First information report) if registered, where ever applicable.","NEFT Details (to enable direct credit of claim amount in 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 Company/TPA for assessment of the claim."],"display":"Claim form, identity proof, prescription, original bills, receipts, discharge summary, reports, surgical notes where applicable and other listed documents","note":null,"quote":"i) Duly Completed claim form\nii) Photo Identity proof of the patient\niii) Medical practitioner’s prescription advising admission\niv) Original bills with itemized break-up\nv) Payment receipts\nvi) Discharge summary including complete medical history of the patient along with other details.\nvii) Investigation/ Diagnostic test reports etc. supported by the prescription from attending medical practitioner\nviii) OT notes or Surgeon’s certificate giving details of the operation performed (for surgical cases).\nix) Sticker/Invoice of the Implants, wherever applicable.\nx) MLR (Medico Legal Report copy if carried out and FIR (First information report) if registered, where ever applicable.\nxi) NEFT Details (to enable direct credit of claim amount in bank account) and cancelled cheque\nxii) KYC (Identity proof with Address) of the proposer, where claim liability is above Rs 1 Lakh as per AML Guidelines\nxiii) Legal heir/succession certificate, wherever applicable\nxiv) Any other relevant document required by Company/TPA for assessment of the claim.","sources":[{"clause":"9.2","heading":"Documents to be submitted","page":12,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-9-2"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 17","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 22","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 23","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(iii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"claim_settlement_time","label":"Claim settlement time promised","section":"Claims","meaning":"How quickly the policy says a claim is decided or paid, and from when that is counted (intimation or last document).","status":"quote-verified","value":"The company shall settle or reject a claim within 30 days from receipt of the last necessary document. If investigation is warranted, it shall complete investigation not later than 30 days from receipt of the last necessary document and settle the claim within 45 days from that date.","display":"30 days from last necessary document; 45 days if investigation is required","note":null,"quote":"The Company shall settle or reject a claim, as the case may be, within 30 days from the date of receipt of last necessary document. ... where the circumstances of a claim warrant an investigation in the opinion of the Company, it shall initiate and complete such investigation at the earliest in any case not later than 30 days from the date of receipt of last necessary document. In such cases, the Company shall settle the claim within 45 days from the date of receipt of last necessary document.","sources":[{"clause":"9.4(i)","heading":null,"page":13,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-9-4-i"},{"clause":"9.4(iii)","heading":null,"page":13,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-9-4-iii"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 64UM(4) to (6)","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 10","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 15","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 16","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 22","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(i), V.3(ii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(iii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.4","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 23","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"The Motor Vehicles Act, 1988: Chapter XI, insurance of motor vehicles against third party risks","section":"Section 149","url":"https://indiainsurances.com/law/motor-vehicles-act-1988"}]},{"key":"exclusions_main","label":"Main exclusions","section":"Exclusions","meaning":"What the policy does not pay for, in the policy's own words.","status":"quote-verified","value":["Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications","Expenses related to the treatment of any illness within 30 days from the first policy commencement date","Expenses related to the treatment of the following listed conditions, surgeries/treatments","Expenses related to any admission primarily for diagnostics and evaluation purposes.","Expenses related to any admission primarily for enforced bed rest and not for receiving treatment.","Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions","Expenses related to any treatment, including surgical management, to change characteristics of the body to those of the opposite sex.","Expenses for cosmetic or plastic surgery or any treatment to change appearance","Expenses related to any treatment necessitated due to participation as a professional in hazardous or adventure sports","Expenses for treatment directly arising from or consequent upon any Insured Person committing or attempting to commit a breach of law with criminal intent.","Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof.","Expenses related to sterility and infertility.","Medical treatment expenses traceable to childbirth","Any expenses incurred on Domiciliary Hospitalization and OPD treatment","Treatment taken outside the geographical limits of India"],"display":"Waiting-period exclusions, diagnostics/evaluation, rest cure, obesity surgery outside conditions, gender change, cosmetic surgery, professional hazardous sports, criminal breach of law, substance abuse, infertility, maternity, domiciliary/OPD and treatment outside India","note":null,"quote":"Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications shall be excluded until the expiry of 36 months of continuous coverage ... Expenses related to the treatment of any illness within 30 days from the first policy commencement date shall be excluded except claims arising due to an accident ... Expenses related to the treatment of the following listed conditions, surgeries/treatments shall be excluded until the expiry of 24/36 months of continuous coverage ... Expenses related to any admission primarily for diagnostics and evaluation purposes. ... Expenses related to any admission primarily for enforced bed rest and not for receiving treatment. ... Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions; ... Expenses related to any treatment, including surgical management, to change characteristics of the body to those of the opposite sex. ... Expenses for cosmetic or plastic surgery or any treatment to change appearance ... Expenses related to any treatment necessitated due to participation as a professional in hazardous or adventure sports ... Expenses for treatment directly arising from or consequent upon any Insured Person committing or attempting to commit a breach of law with criminal intent. ... Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof. ... Expenses related to sterility and infertility. ... Medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred during hospitalization) except ectopic pregnancy; ... Any expenses incurred on Domiciliary Hospitalization and OPD treatment ... Treatment taken outside the geographical limits of India","sources":[{"clause":"6.1","heading":"Pre-Existing Diseases (Code- Excl01)","page":8,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-6-1"},{"clause":"6.2","heading":"First Thirty Days Waiting Period (Code- Excl03)","page":8,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-6-2"},{"clause":"6.3","heading":"Specific Waiting Period: (Code- Excl02)","page":9,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-6-3"},{"clause":"7.1","heading":"Investigation & Evaluation (Code- Excl04)","page":9,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-7-1"},{"clause":"7.2","heading":"Rest Cure, rehabilitation and respite care","page":9,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-7-2"},{"clause":"7.3","heading":"Obesity/ Weight Control","page":10,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-7-3"},{"clause":"7.4","heading":"Change-of-Gender treatments: (Code- Excl07)","page":10,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-7-4"},{"clause":"7.5","heading":"Cosmetic or plastic Surgery: (Code- Excl08)","page":10,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-7-5"},{"clause":"7.6","heading":"Hazardous or Adventure sports","page":10,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-7-6"},{"clause":"7.7","heading":"Breach of law: (Code- Excl10)","page":10,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-7-7"},{"clause":"7.9","heading":null,"page":10,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-7-9"},{"clause":"7.14","heading":"Sterility and Infertility: (Code- Excl17)","page":11,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-7-14"},{"clause":"7.15","heading":"Maternity Expenses (Code - Excl 18)","page":11,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-7-15"},{"clause":"7.18","heading":"Any expenses incurred on Domiciliary Hospitalization and OPD treatment","page":11,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-7-18"},{"clause":"7.19","heading":"Treatment taken outside the geographical limits of India","page":11,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-7-19"}],"law":[{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 11","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 16","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grievance","label":"Grievance route","section":"Claims","meaning":"Who to complain to first, as stated in the policy, before going to the Insurance Ombudsman.","status":"quote-verified","value":"For grievances, the insured may contact IFFCO-Tokio through the grievance redressal website, toll free number, email or Gurgaon address; they may also approach the grievance cell at branches. If not satisfied, they may contact the grievance officer at chiefgrievanceofficer@iffcotokio.co.in before approaching the Insurance Ombudsman.","display":"Contact IFFCO-Tokio grievance channels first; then grievance officer if not satisfied","note":null,"quote":"In case of any grievance, Youmay contact Us through:\nWebsite: | https://www.iffcotokio.co.in/customer-services/grievance-redressal\nToll free: | 1800-103-5499\nE-mail: | support@iffcotokio.co.in\nAddress: IFFCO-Tokio General Insurance Co Ltd IFFCO Tower, Plot no. 3 Sector -29, Gurgaon – 122001 ... If Insured person is not satisfied with the redressal of grievance through one of the above methods, insured person may contact the grievance officer at chiefgrievanceofficer@iffcotokio.co.in","sources":[{"clause":"12","heading":"REDRESSAL OF GRIEVANCE","page":17,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-12"},{"clause":null,"heading":"Provision for Senior Citizens","page":17,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-provision-for-senior-citizens"}],"law":[{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 3","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 4","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 5","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(11)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(42)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 34","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 69","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Insurance Act, 1938","section":"Section 38","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 12","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 19","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 20","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 13","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 2","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(5), 5(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(9)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 25","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 26","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 11","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 3","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 13","url":"https://indiainsurances.com/law/ombudsman-rules-2017"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 14","url":"https://indiainsurances.com/law/ombudsman-rules-2017"}]},{"key":"perils","label":"What is covered","section":"Cover","meaning":"The events or risks covered.","status":"quote-verified","value":["hospitalized for treatment of an Illness or Injury at a Hospital/ Day Care Centre","Hospitalization","AYUSH Treatment","Cataract Treatment","Pre-Hospitalization","Post Hospitalisation","procedures will be covered (wherever medically indicated) either as in patient or as part of day care treatment"],"display":"Hospitalisation for illness or injury, AYUSH, cataract, pre- and post-hospitalisation and listed day-care/in-patient procedures","note":null,"quote":"required to be hospitalized for treatment of an Illness or Injury at a Hospital/ Day Care Centre ... The Company shall indemnify medical expenses incurred for Hospitalization ... The Company shall indemnify medical expenses incurred for inpatient care treatment under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems ... The Company shall indemnify medical expenses incurred for treatment of Cataract ... pre-hospitalization medical expenses ... post hospitalization medical expenses ... The following procedures will be covered (wherever medically indicated) either as in patient or as part of day care treatment","sources":[{"clause":"2","heading":"OPERATIVE CLAUSE","page":1,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-2"},{"clause":"4.1","heading":"Hospitalization","page":6,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-4-1"},{"clause":"4.2","heading":"AYUSH Treatment","page":7,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-4-2"},{"clause":"4.3","heading":"Cataract Treatment","page":7,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-4-3"},{"clause":"4.4","heading":"Pre-Hospitalization","page":7,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-4-4"},{"clause":"4.5","heading":"Post Hospitalisation","page":7,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-4-5"},{"clause":"4.6","heading":null,"page":7,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-4-6"}],"law":[]},{"key":"cancellation_refund","label":"Cancellation by you","section":"Renewal and rights","meaning":"What you get back if you cancel during the year.","status":"quote-verified","value":"The policyholder may cancel at any time during the term by giving 7 days’ written notice. For a policy term up to one year, the insurer refunds proportionate premium for the unexpired policy period if no claim has been made during the policy period.","display":"7 days’ notice; proportionate refund for unexpired period if term is up to 1 year and no claim has been made","note":null,"quote":"The policyholder may cancel his/her policy at any time during the term, by giving 7 days’ notice in writing. The Insurer shall a. refund proportionate premium for unexpired policy period, if the term of policy upto one year and there is no claim (s) made during the policy period.","sources":[{"clause":"10.10(a)","heading":null,"page":14,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-10-10-a"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 64VB","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 8","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 6","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 5","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 17","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(3) to 20(5)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.4","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, IV.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"territory","label":"Where it covers","section":"Overview","meaning":"Geographic area of cover: India only, worldwide, or listed countries. 'As stated in the schedule' is not an answer.","status":"quote-verified","value":"All medical treatment for the purpose of this insurance must be taken in India only.","display":"India only","note":null,"quote":"All medical treatment for the purpose of this insurance will have to be taken in India only.","sources":[{"clause":"10.7","heading":"Territorial Limit","page":14,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-10-7"}],"law":[]},{"key":"room_rent","label":"Room rent limit","section":"Limits and co-pay","meaning":"The most the policy pays per day for the hospital room, or the room category allowed. If you take a costlier room, other bills can be cut in proportion.","status":"quote-verified","value":"Room rent, boarding and nursing expenses are covered up to 2% of the sum insured, subject to a maximum of Rs.5000/- per day.","display":"Up to 2% of sum insured, maximum Rs.5000/- per day","note":null,"quote":"Room Rent, Boarding, Nursing Expenses as provided by the Hospital / Nursing Home up to 2% of the sum insured subject to maximum of Rs.5000/-, per day.","sources":[{"clause":"4.1","heading":"Hospitalization","page":6,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-4-1"}],"law":[]},{"key":"room_category","label":"Room category allowed","section":"Limits and co-pay","meaning":"Shared room, single private room or any room, by plan, when the limit is a room type rather than a rupee amount.","status":"not-applicable","value":null,"display":null,"note":"The policy states a percentage/rupee room rent limit, not a room category limit.","quote":null,"sources":[],"law":[]},{"key":"icu_limit","label":"ICU limit","section":"Limits and co-pay","meaning":"The most the policy pays per day for intensive care.","status":"quote-verified","value":"ICU/ICCU expenses are covered up to 5% of sum insured, subject to a maximum of Rs.10,000/- per day.","display":"Up to 5% of sum insured, maximum Rs.10,000/- per day","note":null,"quote":"Intensive Care Unit (ICU) / Intensive Cardiac Care Unit (ICCU) expenses up to 5% of sum insured subject to maximum of Rs.10,000/- per day.","sources":[{"clause":"4.1","heading":"Hospitalization","page":6,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-4-1"}],"law":[]},{"key":"proportionate_deduction","label":"Proportionate deduction","section":"Limits and co-pay","meaning":"If you choose a room above your limit, whether the insurer reduces associated charges (doctor fees, tests, procedures) by the same proportion.","status":"quote-verified","value":"If admission is to a room, ICU or ICCU with rates exceeding the policy limits, reimbursement/payment of all other hospital expenses except cost of medicines is reduced in the same proportion as the admissible rate per day bears to the actual room/ICU/ICCU rate.","display":"Yes, for room/ICU/ICCU above limits; all other hospital expenses except medicines are reduced proportionately","note":null,"quote":"In case of admission to a room/ICU/ICCU at rates exceeding the aforesaid limits, the reimbursement/payment of all other expenses incurred at the Hospital, with the exception of cost of medicines, shall be affected in the same proportion as the admissible rate per day bears to the actual rate per day of Room Rent/ICU/ICCU charges.","sources":[{"clause":"4.1.1","heading":"Other expenses","page":6,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-4-1-1"}],"law":[]},{"key":"copay","label":"Co-payment","section":"Limits and co-pay","meaning":"The share of every admissible claim you pay yourself, and when it applies (age, zone, choice of hospital).","status":"quote-verified","value":"Each and every claim is subject to a 5% co-payment on the admissible and payable claim amount; the amount payable is after deduction of the co-payment.","display":"5% co-pay on each and every claim","note":null,"quote":"Each and every claim under the Policy shall be subject to a Co-payment of 5% applicable to claim amount admissible and payable as per the terms and conditions of the Policy. The amount payable shall be after deduction of the co-payment.","sources":[{"clause":"9.3","heading":"Co-payment","page":13,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-9-3"}],"law":[]},{"key":"deductible","label":"Deductible","section":"Limits and co-pay","meaning":"An amount of each claim or each year that you bear before the policy pays.","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[]},{"key":"disease_sublimits","label":"Disease or procedure sub-limits","section":"Limits and co-pay","meaning":"Caps on what is paid for named treatments (cataract, knee replacement...), even if the sum insured is higher.","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[]},{"key":"pre_hospitalisation","label":"Pre-hospitalisation cover","section":"Cover","meaning":"Medical costs in the days before admission that are paid if related to the hospitalisation.","status":"quote-verified","value":{"unit":"days","amount":30},"display":"30 days prior to admissible hospitalisation","note":null,"quote":"for a fixed period of 30 days prior to the date of admissible hospitalization covered under the policy.","sources":[{"clause":"4.4","heading":"Pre-Hospitalization","page":7,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-4-4"}],"law":[]},{"key":"post_hospitalisation","label":"Post-hospitalisation cover","section":"Cover","meaning":"Medical costs in the days after discharge that are paid if related to the hospitalisation.","status":"quote-verified","value":{"unit":"days","amount":60},"display":"60 days from discharge","note":null,"quote":"for a fixed period of 60 days from the date of discharge from the hospital, following an admissible hospitalization covered under the policy.","sources":[{"clause":"4.5","heading":"Post Hospitalisation","page":7,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-4-5"}],"law":[]},{"key":"day_care","label":"Day-care treatments","section":"Cover","meaning":"Treatments needing less than 24 hours in hospital (chemotherapy, dialysis, cataract) and whether all or only listed ones are covered.","status":"quote-verified","value":"All the day care treatments are covered; the 24-hour hospitalisation time limit does not apply to Day Care Treatment.","display":"All the day care treatments covered; 24-hour limit does not apply","note":null,"quote":"All the day care treatments ... Expenses of Hospitalization for a minimum period of 24 consecutive hours only shall be admissible. However, the time limit shall not apply in respect of Day Care Treatment","sources":[{"clause":"4.1.1","heading":"Other expenses","page":6,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-4-1-1"}],"law":[]},{"key":"domiciliary","label":"Treatment at home","section":"Cover","meaning":"Whether treatment at home is covered when hospital admission is not possible or a doctor advises it.","status":"quote-verified","value":"Domiciliary hospitalisation expenses are not covered.","display":"Not covered","note":null,"quote":"Any expenses incurred on Domiciliary Hospitalization and OPD treatment","sources":[{"clause":"7.18","heading":"Any expenses incurred on Domiciliary Hospitalization and OPD treatment","page":11,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-7-18"}],"law":[]},{"key":"ayush","label":"AYUSH treatment","section":"Cover","meaning":"Ayurveda, Yoga, Unani, Siddha and Homeopathy treatment in a recognised hospital, and any limit.","status":"quote-verified","value":"Inpatient care treatment under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems is covered during each policy year up to the sum insured in any AYUSH Hospital.","display":"Covered up to sum insured in any AYUSH Hospital","note":null,"quote":"The Company shall indemnify medical expenses incurred for inpatient care treatment under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems of medicines during each Policy Year up to the limit of sum insured as specified in the policy schedule in any AYUSH Hospital.","sources":[{"clause":"4.2","heading":"AYUSH Treatment","page":7,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-4-2"}],"law":[{"title":"Guidelines on providing AYUSH coverage in Health Insurance policies, 2024","section":"Para 1","url":"https://indiainsurances.com/law/irdai-ayush-2024"},{"title":"Guidelines on providing AYUSH coverage in Health Insurance policies, 2024","section":"Para 2","url":"https://indiainsurances.com/law/irdai-ayush-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 1","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch II A.I(1)","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 5","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"modern_treatments","label":"Modern treatments","section":"Cover","meaning":"Robotic surgery, immunotherapy, oral chemotherapy, stem cell therapy and the like, and any cap on them.","status":"quote-verified","value":"Listed procedures including Uterine Artery Embolization and HIFU, Balloon Sinuplasty, Deep Brain stimulation, Oral chemotherapy, Immunotherapy, Robotic surgeries, Stereotactic radio surgeries, Bronchical Thermoplasty, Green/holmium laser prostate treatment, IONM and specified Hematopoietic stem cell therapy are covered up to 50% of Sum Insured.","display":"Listed modern treatments covered up to 50% of Sum Insured","note":null,"quote":"The following procedures will be covered (wherever medically indicated) either as in patient or as part of day care treatment in a hospital upto 50% of Sum Insured, specified in the policy schedule, during the policy period:\nA. Uterine Artery Embolization and HIFU (High intensity focused ultrasound)\nB. Balloon Sinuplasty\nC. Deep Brain stimulation\nD. Oral chemotherapy\nE. Immunotherapy- Monoclonal Antibody to be given as injection\nF. Intra vitreal injections\nG. Robotic surgeries\nH. Stereotactic radio surgeries ... I) Bronchical Thermoplasty\nJ. Vaporisation of the prostrate (Green laser treatment or holmium laser treatment)\nK. IONM - (Intra Operative Neuro Monitoring)\nL. Stem cell therapy: Hematopoietic stem cells for bone marrow transplant for haematological conditions to be covered.","sources":[{"clause":"4.6","heading":null,"page":7,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-4-6"},{"clause":"4.6(I)","heading":null,"page":7,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-4-6-i"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 2","url":"https://indiainsurances.com/law/irdai-health-mc-2024"}]},{"key":"organ_donor","label":"Organ donor expenses","section":"Cover","meaning":"Whether the donor's hospital costs for an organ transplant are paid.","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[]},{"key":"ambulance","label":"Ambulance cover","section":"Cover","meaning":"Road (and air) ambulance cover and its limit.","status":"quote-verified","value":"Road ambulance expenses are covered up to a maximum of Rs.2000/- per hospitalisation.","display":"Road ambulance up to Rs.2000/- per hospitalisation","note":null,"quote":"Expenses incurred on road Ambulance subject to a maximum of Rs.2000/- per hospitalisation.","sources":[{"clause":"4.1.1","heading":"Other expenses","page":6,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-4-1-1"}],"law":[]},{"key":"restoration","label":"Restoration of sum insured","section":"Cover","meaning":"Whether the sum insured is refilled after it is used up in a year, how much, how often, and whether it works for the same illness.","status":"quote-verified","value":"There is no restoration benefit stated; coverage automatically terminates for the policy year upon exhaustion of sum insured and cumulative bonus.","display":"No restoration stated; cover terminates for the policy year after exhaustion of sum insured and cumulative bonus","note":null,"quote":"Upon exhaustion of sum insured and cumulative bonus, for the policy year. However, the policy is subject to renewal on the due date as per the applicable terms and conditions.","sources":[{"clause":"10.11","heading":"Automatic change in Coverage under the policy","page":15,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-10-11"}],"law":[]},{"key":"no_claim_bonus","label":"No-claim or cumulative bonus","section":"Cover","meaning":"How much the cover grows each year, the maximum, whether it depends on not claiming, and what happens after a claim.","status":"quote-verified","value":"Cumulative Bonus increases by 5% for each claim-free policy year if renewed without a break, up to 50% of the sum insured under the current policy year. If a claim is made in a year, the accrued bonus is reduced at the same rate, while the sum insured is maintained for that policy year.","display":"5% for each claim-free year, maximum 50% of sum insured; reduced at the same rate after a claim","note":null,"quote":"Cumulative Bonus will be increased by 5% in respect of each claim free policy year (where no claims are reported), provided the policy is renewed with the company without a break subject to maximum of 50% of the sum insured under the current policy year. If a claim is made in any particular year, the cumulative bonus accrued shall be reduced at the same rate at which it has accrued. However, sum insured will be maintained and will not be reduced in the policy year.","sources":[{"clause":null,"heading":"5 Cumulative Bonus (CB)","page":8,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-5-cumulative-bonus-cb"}],"law":[]},{"key":"consumables","label":"Consumables and non-medical items","section":"Cover","meaning":"Gloves, PPE, syringes and other items hospitals bill that standard policies exclude; whether this policy pays them.","status":"quote-verified","value":"List-I items are not covered, including listed consumables/non-medical items such as GLOVES and MASK; other listed items are to be subsumed into room charges, procedure charges or costs of treatment.","display":"List-I non-medical items not covered; other listed items are subsumed into room/procedure/treatment costs","note":null,"quote":"The expenses that are not covered in this policy are placed under List-I of Annexure-A. The list of expenses that are to be subsumed into room charges, or procedure charges or costs of treatment are placed under List- II, List-III and List-IV of Annexure-A respectively. ... 56 | GLOVES ... 60 | MASK","sources":[{"clause":"4.7","heading":null,"page":8,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-4-7"},{"clause":"Annexure A","heading":null,"page":20,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-annexure-a"}],"law":[]},{"key":"maternity","label":"Maternity cover","section":"Cover","meaning":"Whether childbirth costs are covered, the limit and the waiting period.","status":"quote-verified","value":"Maternity expenses are excluded, including medical treatment expenses traceable to childbirth, complicated deliveries and caesarean sections during hospitalisation, except ectopic pregnancy; miscarriage expenses are excluded unless due to an accident, and lawful medical termination of pregnancy during the policy period is excluded.","display":"Not covered, except ectopic pregnancy and miscarriage due to accident","note":null,"quote":"Medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred during hospitalization) except ectopic pregnancy;\nii) expenses towards miscarriage (unless due to an accident) and lawful medical termination of pregnancy during the policy period.","sources":[{"clause":"7.15","heading":"Maternity Expenses (Code - Excl 18)","page":11,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-7-15"}],"law":[]},{"key":"newborn","label":"Newborn baby cover","section":"Cover","meaning":"Whether a newborn is covered from birth and for what.","status":"quote-verified","value":"Newborn cover from birth is not stated; dependent children are eligible only between the age 3 months to 25 years.","display":"Not from birth; dependent children eligible from 3 months to 25 years","note":null,"quote":"dependent Children (i.e. natural or legally adopted) between the age 3 months to 25 years.","sources":[{"clause":"3.18","heading":"Family","page":3,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-3-18"}],"law":[]},{"key":"mental_illness","label":"Mental illness","section":"Cover","meaning":"Cover for in-patient treatment of mental illness.","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 3","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch III I","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"The Mental Healthcare Act, 2017","section":"Section 21(4)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"},{"title":"The Mental Healthcare Act, 2017","section":"Section 2(1)(s)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"},{"title":"The Mental Healthcare Act, 2017","section":"Section 21(1)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"}]},{"key":"health_checkup","label":"Health check-up","section":"Cover","meaning":"Free preventive check-ups and how often.","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[]},{"key":"opd","label":"Out-patient (OPD) cover","section":"Cover","meaning":"Doctor consultations, tests and medicines without admission, and the limit.","status":"quote-verified","value":"OPD treatment expenses are not covered.","display":"Not covered","note":null,"quote":"Any expenses incurred on Domiciliary Hospitalization and OPD treatment","sources":[{"clause":"7.18","heading":"Any expenses incurred on Domiciliary Hospitalization and OPD treatment","page":11,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-7-18"}],"law":[]},{"key":"zone_pricing","label":"Zone or city-based premium","section":"Premium","meaning":"Whether premium or co-pay depends on the city you are treated in.","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[]},{"key":"cashless","label":"Cashless treatment","section":"Claims","meaning":"Whether and where the insurer pays the hospital directly instead of you paying and claiming back.","status":"quote-verified","value":"Cashless facility is available at a network provider, subject to pre-authorisation by the company or its authorised TPA. The insurer directly pays the network provider to the extent pre-authorisation is approved.","display":"Available at network providers, subject to pre-authorisation","note":null,"quote":"Cashless Facility means a facility extended by the insurer to the insured where the payments, of the costs of treatment undergone by the insured person in accordance with the Policy terms and conditions, are directly made to the network provider by the insurer to the extent pre-authorization is approved. ... Treatment may be taken in a network provider and is subject to pre authorization by the Company or its authorized TPA.","sources":[{"clause":"3.8","heading":"Cashless Facility","page":2,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-3-8"},{"clause":"9(i)","heading":null,"page":12,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-9-i"}],"law":[]},{"key":"claims_handled_by","label":"Claims handled by","section":"Claims","meaning":"The insurer itself or a third-party administrator (TPA).","status":"quote-verified","value":"Claims are handled by the Company or TPA for cashless pre-authorisation and processing, but TPA services do not include claim settlement or claim rejection.","display":"Company/TPA for pre-authorisation and processing; settlement/rejection not by TPA","note":null,"quote":"Cashless request form available with the network provider and TPA shall be completed and sent to the Company/TPA for authorization. ... Servicing of claims, i.e., claim admissions and assessments, under this Policy by way of pre-authorization of cashless treatment or processing of claims other than cashless claims or both ... The services offered by a TPA shall not include\ni) Claim settlement and claim rejection;","sources":[{"clause":"9(i)","heading":null,"page":12,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-9-i"},{"clause":"9.5","heading":"Services Offered by TPA","page":13,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-9-5"}],"law":[]},{"key":"family_floater","label":"Family floater available","section":"Cover","meaning":"Whether one sum insured can be shared by the whole family.","status":"quote-verified","value":true,"display":"Yes, floater basis available","note":null,"quote":"Product Type | Individual/ Floater ... On Floater basis – SI shall apply to the entire family INR 50,000/ 1,00,000/ 1,50,000/ 2,00,000/ 2,50,000","sources":[{"clause":null,"heading":"13 TABLE OF BENEFITS","page":19,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669#c-13-table-of-benefits"}],"law":[]}],"documents":[{"kind":"wording","label":"Arogya Sanjeevani Policy (Micro Insurance)","pages":43,"fetched_at":"2026-10-17 19:46:04+00","source_url":"https://www.iffcotokio.co.in/content/dam/iffcotokio/policy-wordings/health/wording-arogya-sanjeevani-mi-itgi.pdf","url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8669"},{"kind":"prospectus","label":"Arogya Sanjeevani Policy (Micro Insurance) IFFCO-TOKIO GIC Ltd","pages":20,"fetched_at":"2026-10-17 19:44:33+00","source_url":"https://www.iffcotokio.co.in/content/dam/iffcotokio/prospectus/health/prospectus_arogya_sanjeevani_ITGI_Micro.pdf","url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223/document/8620"}],"versions":[],"where_to_buy":[{"purpose":"buy","kind":"insurer","name":"IFFCO TOKIO General Insurance official website","url":"https://www.iffcotokio.co.in/","note":"Buy directly from the insurer."},{"purpose":"buy","kind":"ours","name":"Get free help from IndiaInsurances","url":"/help","note":"Free. We do not sell insurance and earn no commission; your request is not passed to anyone."}],"claims_and_complaints":[{"purpose":"claim","kind":"insurer","name":"Claims","url":"https://www.iffcotokio.co.in/claims","note":null},{"purpose":"claim","kind":"insurer","name":"Register a claim","url":"https://www.iffcotokio.co.in/claims/register-a-claim","note":null},{"purpose":"claim","kind":"ours","name":"Get free help from IndiaInsurances","url":"/help","note":"Free. We do not sell insurance and earn no commission; your request is not passed to anyone."},{"purpose":"grievance","kind":"insurer","name":"Grievance redressal","url":"https://www.iffcotokio.co.in/contact-us/customer-services/grievance-redressal","note":null},{"purpose":"grievance","kind":"official","name":"Bima Bharosa (IRDAI grievance portal)","url":"https://bimabharosa.irdai.gov.in/","note":"Register and track a complaint against any insurer with IRDAI. Complain to the insurer first; escalate here if the reply is late or unsatisfactory."},{"purpose":"grievance","kind":"official","name":"e-Daakhil (consumer commission e-filing)","url":"https://edaakhil.nic.in/","note":"Not reachable from our crawler on 2026-10-19; use e-Jagriti if this link does not open."},{"purpose":"grievance","kind":"official","name":"e-Jagriti (consumer commission filing)","url":"https://e-jagriti.gov.in/","note":"Ministry of Consumer Affairs platform for consumer commission cases, a route for insurance disputes that the Ombudsman does not settle."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Ahmedabad","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Gujarat, Dadra & Nagar Haveli, Daman and Diu. Email: oio.ahmedabad@cioins.co.in. Phone: 079 - 25501201/02. Address: Office of the Insurance Ombudsman, Jeevan Prakash Building, 6th floor, Tilak Marg, Relief Road, AHMEDABAD – 380 001."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Bengaluru","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Karnataka. Email: oio.bengaluru@cioins.co.in. Phone: 080 - 26652048 / 26652049. Address: Office of the Insurance Ombudsman, Jeevan Soudha Building,PID No. 57-27-N-19 Ground Floor, 19/19, 24th Main Road, JP Nagar, Ist Phase, Bengaluru – 560 078."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Bhopal","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Madhya Pradesh, Chhattisgarh. Email: oio.bhopal@cioins.co.in. Phone: 0755 - 2769201 / 2769202 / 2769203. Address: Office of the Insurance Ombudsman, 1st floor,\"Jeevan Shikha\", 60-B,Hoshangabad Road, Opp. Gayatri Mandir,Arera Hills Bhopal – 462 011."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Bhubaneswar","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Odisha. Email: oio.bhubaneswar@cioins.co.in. Phone: 0674 - 2596461 /2596455/2596429/2596003. Address: Office of the Insurance Ombudsman, 62, Forest park, Bhubaneswar – 751 009."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Chandigarh","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Punjab, Haryana (excluding Gurugram, Faridabad, Sonepat and Bahadurgarh), Himachal Pradesh, Union Territories of Jammu & Kashmir,Ladakh & Chandigarh. Email: oio.chandigarh@cioins.co.in. Phone: 0172-2706468. Address: Office Of The Insurance Ombudsman, Jeevan Deep Building SCO 20-27, Ground Floor Sector- 17 A, Chandigarh – 160 017."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Chennai","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Tamil Nadu, PuducherryTown and Karaikal (which are part of Puducherry). Email: oio.chennai@cioins.co.in. Phone: 044 - 24333668 / 24333678. Address: Office of the Insurance Ombudsman, Fatima Akhtar Court, 4th Floor, 453, Anna Salai, Teynampet, CHENNAI – 600 018."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Delhi","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Delhi & following Districts of Haryana - Gurugram, Faridabad, Sonepat & Bahadurgarh. Email: oio.delhi@cioins.co.in. Phone: 011 - 46013992/23213504/23232481. Address: Office of the Insurance Ombudsman, 2/2 A, Universal Insurance Building, Asaf Ali Road, New Delhi – 110 002."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Guwahati","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Assam, Meghalaya, Manipur, Mizoram, Arunachal Pradesh, Nagaland and Tripura. Email: oio.guwahati@cioins.co.in. Phone: 0361 - 2632204 / 2602205 / 2631307. Address: Office of the Insurance Ombudsman, Jeevan Nivesh, 5th Floor, Near Pan Bazar , S.S. Road, Guwahati – 781001(ASSAM)."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Hyderabad","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Andhra Pradesh, Telangana, Yanam and part of Union Territory of Puducherry. Email: oio.hyderabad@cioins.co.in. Phone: 040 - 23312122 / 23376991 / 23376599 / 23328709 / 23325325. Address: Office of the Insurance Ombudsman, 6-2-46, 1st floor, \"Moin Court\", Lane Opp.Hyundai Showroom , A. C. Guards, Lakdi-Ka-Pool, Hyderabad - 500 004."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Jaipur","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Rajasthan. Email: oio.jaipur@cioins.co.in. Phone: 0141- 2740363. Address: Office of the Insurance Ombudsman, Jeevan Nidhi – II Bldg., Gr. Floor, Bhawani Singh Marg, Jaipur - 302 005."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Kochi","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Kerala, Lakshadweep, Mahe-a part of Union Territory of Puducherry. Email: oio.ernakulam@cioins.co.in. Phone: 0484 - 2358759. Address: Office of the Insurance Ombudsman, 10th Floor, Jeevan Prakash,LIC Building, Opp to Maharaja's College Ground,M.G.Road, Kochi - 682 011."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Kolkata","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: West Bengal, Sikkim, Andaman & Nicobar Islands. Email: oio.kolkata@cioins.co.in. Phone: 033 - 22124339 / 22124341. Address: Office of the Insurance Ombudsman, Hindustan Bldg. Annexe, 7th Floor, 4, C.R. Avenue, KOLKATA - 700 072."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Lucknow","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Districts of Uttar Pradesh : Lalitpur, Jhansi, Mahoba, Hamirpur, Banda, Chitrakoot, Allahabad, Mirzapur, Sonbhabdra, Fatehpur, Pratapgarh, Jaunpur,Varanasi, Gazipur, Jalaun, Kanpur, Lucknow, Unnao, Sitapur, Lakhimpur, Bahraich, Barabanki, Raebareli, Sravasti, Gonda, Faizabad, Amethi, Kaushambi, Balrampur, Basti, Ambedkarnagar, Sultanpur, Maharajgang, Santkabirnagar, Azamgarh, Kushinagar, Gorkhpur, Deoria, Mau, Ghazipur, Chandauli, Ballia, Sidharathnagar. Email: oio.lucknow@cioins.co.in. Phone: 0522 - 4002082 / 3500613. Address: Office of the Insurance Ombudsman, 6th Floor, Jeevan Bhawan, Phase-II, Nawal Kishore Road, Hazratganj, Lucknow - 226 001."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Mumbai","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: List of wards under Mumbai Metropolitan Region excluding wards in Mumbai – i.e M/E, M/W, N , S and T covered under Office of Insurance Ombudsman Thane and excluding areas of Navi Mumbai. Email: oio.mumbai@cioins.co.in. Phone: 022 - 69038800/27/29/31/32/33. Address: Office of the Insurance Ombudsman, 3rd Floor, Jeevan Seva Annexe, S. V. Road, Santacruz (W), Mumbai - 400 054."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Noida","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: State of Uttarakhand and the following Districts of Uttar Pradesh: Agra, Aligarh, Bagpat, Bareilly, Bijnor, Budaun, Bulandshehar, Etah, Kannauj, Mainpuri, Mathura, Meerut, Moradabad, Muzaffarnagar, Oraiyya, Pilibhit, Etawah, Farrukhabad, Firozbad, Gautam Buddh nagar, Ghaziabad, Hardoi, Shahjahanpur, Hapur, Shamli, Rampur, Kashganj, Sambhal, Amroha, Hathras, Kanshiramnagar, Saharanpur. Email: oio.noida@cioins.co.in. Phone: 0120-4027589. Address: Office of the Insurance Ombudsman, Bhagwan Sahai Palace 4th Floor, Main Road, Naya Bans, Sector 15, Distt: Gautam Buddh Nagar, U.P-201301."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman: offices and jurisdiction","url":"https://www.cioins.co.in/Ombudsman","note":"Addresses, phone numbers, e-mail and the states or districts each Ombudsman office covers."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Patna","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Bihar, Jharkhand. Email: oio.patna@cioins.co.in. Phone: 0612-2547068. Address: Office of the Insurance Ombudsman, 2nd Floor, Lalit Bhawan, Bailey Road, Patna 800 001."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Pune","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: State of Goa and State of Maharashtra excluding areas of Navi Mumbai, Thane district,Palghar District, Raigad district & Mumbai Metropolitan Region. Email: oio.pune@cioins.co.in. Phone: 020-24471175. Address: Office of the Insurance Ombudsman, Jeevan Darshan Bldg., 3rd Floor, C.T.S. No.s. 195 to 198, N.C. Kelkar Road, Narayan Peth, Pune – 411 030."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman: register a complaint online","url":"https://cioins.co.in/Complaint/Online","note":"Council for Insurance Ombudsmen. Free. For disputes with an insurer after its own grievance process; the office is chosen by where you live (see the offices list)."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Thane","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Area of Navi Mumbai, Thane District, Raigad District, Palghar District and wards of Mumbai , M/East, M/West, N, S and T. Email: oio.thane@cioins.co.in. Phone: 022-20812868/69. Address: Office of the Insurance Ombudsman, Jeevan Chintamani Building, 2nd Floor,Near New RTO Office, Louis Wadi,Vasantrao Naik Mahamarg, Thane (West)- 400604."},{"purpose":"grievance","kind":"official","name":"National Consumer Helpline","url":"https://consumerhelpline.gov.in/public/","note":"Government consumer helpline; can take up a complaint before you go to a consumer commission."},{"purpose":"port","kind":"ours","name":"Get free help from IndiaInsurances","url":"/help","note":"Free. We do not sell insurance and earn no commission; your request is not passed to anyone."},{"purpose":"renew","kind":"insurer","name":"Renew policy","url":"https://www.iffcotokio.co.in/renew-policy","note":null}],"notice":"Information, not advice. IndiaInsurances is not an insurer or an insurance intermediary, does not sell insurance and earns no commission. Policy terms change and your own policy schedule can differ: always confirm with the policy document and the insurer before you buy or claim.","cite_as":"Arogya Sanjeevani Policy (Micro Insurance) IFFCO-TOKIO GIC Ltd (UIN IFFPMIP23040V012223), IndiaInsurances, https://indiainsurances.com/policy/iffco-tokio-general-insurance/arogya-sanjeevani-policy-micro-insurance-iffco-tokio-gic-ltd-iffpmip23040v012223"}