A Complete Guide to Arogya Sanjeevani Policy

Health insurance purchase in the midst of the pandemic is on everyone’s mind these days. However, a common question people are asking is about the policy benefits during medical emergencies resulting from Covid-19 disease. Besides this, people also want to buy an affordable health plan that can cover the entire family. Witnessing the dwindling situation in the country and the increasing need for a health insurance plan, the Insurance Regulatory Development Authority of India (IRDAI) introduced Arogya Sanjeevani policy. 

Before you buy this plan, it is important to get the required Insurance Gyan about Arogya Sanjeevani policy. Let’s get into the details. 

What is Arogya Sanjeevani Policy? 

Arogya Sanjeevani policy is a standard health insurance plan that provides hospitalization expense coverage up to the upper limit of Rs. 5 Lakhs. As per the IRDAI mandate, all the health insurance and general insurance providers in India are asked to offer this basic health insurance plan for both families and individuals.  

It is a universal plan that covers pre- and post-hospitalization expenses incurred for ICU, doctor’s consultation, nursing, beds, and many others. Buying Arogya Sanjeevani policy can protect you and your family members from the monetary stress resulting from healthcare emergencies.  

Arogya Sanjeevani health plan is available in two types: individual to cover one person and family floater to cover all the family members, including spouse, parents, children, and parents in law under one policy. 

Brief Summary of Arogya Sanjeevani Policy 

What are the Features of Arogya Sanjeevani Policy? 

Arogya Sanjeevani policy has been designed with exclusive features that make it unique and different from many other health insurance plans. Some of the primary features of this policy are: 

• Affordable plan that perfectly fits almost every budget 
• Standard coverage terms across all the health insurers 
• Sum insured from Rs. 1 lakh to 5 Lakhs 
• Individual and family floater plan types available 
• Coronavirus treatment expenses covered 

What are the Benefits of Arogya Sanjeevani Policy? 

Arogya Sanjeevani policy aims to make it easier for people in India to buy health insurance. It provides basic indemnity benefits to the policyholders irrespective of their income. Here is a list of benefits of Arogya Sanjeevani policy to help you understand it better: 

• Standardized Coverage 

Individuals who buy Arogya Sanjeevani policy receive the same level of insurance coverage, no matter which insurance company they choose. This tends to eliminate doubts and confusion that may arise in their minds. 

• Cumulative Bonus 

Like other medical insurance policies, you can also get a cumulative bonus of 5% of the total sum insured you choose under Arogya Sanjeevani policy for every claim-free policy period.  

• Lower Co-pay Clause 

Arogya Sanjeevani policy comes with a lower co-pay clause, i.e., the insured only needs to pay 5% of the total claim amount while asking for insurance benefits under this policy. 

• Lifetime renewability 

As a policyholder, you can renew Arogya Sanjeevani policy every year as long as you live, making it easier for you to keep your health insured the right way. 

Also Read: All About Coronavirus Health Insurance

What are the Arogya Sanjeevani Policy Inclusions? 

The inclusions of Arogya Sanjeevani policy that covers the insurance benefits given to a policyholder are as follows: 

• Coverage for Pre- and Post-Hospitalization Expenses 

The policy covers all the pre- and post-hospitalization expenses resulting from any medical emergency – illness or accidental injury as per the chosen sum insured limits. It also covers the expenses incurred from Covid-19 treatment. 

• AYUSH Coverage 

Arogya Sanjeevani policy also covers the expenses related to alternative treatments, such as homeopathy, Ayurveda, Siddha, and others at a government-approved hospital. 

• ICU/ICCU Rent Coverage 

Under the policy, you can get up to 5% charges of the medical treatment received in an ICU or ICCU up to the limit of Rs. 10,000 per day. 

• Room Rent Cover 

The policy also covers the room rent payable in a hospital subject to the limit of 2% of the sum insured or Rs. 5,000 per day. 

• Day Care Treatment Coverage 

You will also get insurance coverage for the expenses incurred for any daycare treatment procedures. 

• Ambulance Charges 

Arogya Sanjeevani policy also covers the cost of ambulance services, capped at Rs. 2,000 per hospitalization 

• Cataract Surgery Cover 

It also provides insurance coverage for the cataract surgery of each eye, with a limit of Rs. 40,000 maximum or 25% of the sum insured amount, whichever is less. 

• Dental Treatment and Plastic Surgery 

Arogya Sanjeevani policy also covers the cost of dental or plastic surgery procedure resulting from an injury or illness.  

Which New Age/Modern Treatments are Covered Under Arogya Sanjeevani Policy? 

The following modern/new age treatments are also covered under this policy: 

• Bronchial thermoplasty 
• Balloon sinuplasty 
• Intravitreal injections 
• Intraoperative Neuromonitoring 

• Robotic surgeries 
• Oral chemotherapy 
• Stereotactic radio surgeries 
• Stem cell therapy 
• High Intensity Focused Ultrasound (HIFU), etc. 

What are the Exclusions Related to Arogya Sanjeevani Policy? 

Arogya Sanjeevani policy does not provide insurance coverage under the following conditions or situations: 

• Expenses related to diagnostic tests 
• Expenses incurred for enforced bed rest or rehabilitation 
• Cost of treatment required for weight control or obesity 
• Cost of gender change treatment 
• Expenses related to cosmetic surgery which is not required as a result of injury or accident 
• Maternity expenses 
• Law breach with criminal intention 
• Treatment cost for drug or alcohol addiction 
• Unproved treatment 
• Expenses incurred for treatment received outside India 

What are the Waiting Periods Related to Arogya Sanjeevani Policy? 

There are three types of waiting periods associated with Arogya Sanjeevani policy, which include: 

• Initial waiting period of 30 days from the policy inception date for all claims except accidental claims 
• Waiting period of two or four years for specific treatments like hernia, benign prostate hypertrophy, osteoarthritis, and many other ailments 
• Waiting period of four years for pre-existing disease 

What are the Eligibility Criteria for Buying Arogya Sanjeevani Policy? 

Any individual being covered under Arogya Sanjeevani policy need to fulfill the following criteria: 

• Age between 18 and 65 years 
• Dependents between the age of 3 months and 25 years to be covered under Arogya Sanjeevani family floater policy  
• Children above the age of 18 to be covered under individual Arogya Sanjeevani policy  
• Inclusion of parents and parents-in-law under the Arogya Sanjeevani family floater policy permissible 

How Should You Buy Arogya Sanjeevani Policy? 

You can easily buy Arogya Sanjeevani policy online, which is more economical than buying it offline. IRDAI has permitted various insurers to issue this policy online. Before you buy the policy with an adequate sum insured, you are advised to use online premium calculators to get an estimate of the payable premium. 

Furthermore, you should know that it is mandatory for the insurance companies to issue physical Arogya Sanjeevani policy document even if you buy it online. So, make sure you ask for it if you do not receive it in physical format on time.  

You May Like to Read: A Complete Guide to Health Insurance

How to Renew Arogya Sanjeevani Health Insurance Policy? 

With this policy, you can avail lifetime renewal facility, which means that you can renew it for as long as you live. You need to make sure the renewal happens before the policy expires. Failing to renew Arogya Sanjeevani policy even after its grace period of 30 days can cause termination. 

The policy can be easily renewed online by using the policy details and paying the premium.  

What is the Cancellation and Refunds Policy related to Arogya Sanjeevani Health Plan? 

With this policy, you get a free-look period of 15 days, which means you can cancel the policy during this period without worrying about any cancelation charges. You will get the premium refunded to you after deducting some expenses incurred by the insurer, provided you have not filed any claim. 

In case you want to cancel Arogya Sanjeevani policy after the 15 days free-look period, you need to give 15-days prior notice to the insurer for the same. You will get the premium refund as per the refund rates given below: 

 Read More About: Saral Jeevan Bima in India

Arogya Sanjeevani Policy FAQs 

• What is Arogya Sanjeevani policy period

You can buy this policy for a one-year tenure only, after which you need to renew it timely. 

• Is there any variant of Arogya Sanjeevani health plan also available? 

There is no such variant available for this standardized health insurance plan. 

• Can I get coverage for Covid-19 treatment under this policy? 

Yes. Arogya Sanjeevani policy covers the hospitalization expenses incurred for Coronavirus infection treatment. 

• Is Arogya Sanjeevani policy available for NRIs? 

Even NRIs can buy this policy, provided they are in India while buying it and pay the premium in INR. 

• Does Arogya Sanjeevani health insurance cover pre-existing diseases? 

Pre-existing diseases are covered in this policy after the waiting period of 4 years. 

• What are the portability terms related to Arogya Sanjeevani policy? 

It is possible to port your existing health insurance plan into Arogya Sanjeevani. 

• What is the free-look period related to Arogya Sanjeevani insurance? 

The policy comes with a free-look period of 15 days. However, there is no such period available during policy renewals. 

• What is the co-pay clause related to Arogya Sanjeevani plan? 

During claim settlement, you need to pay 5% of the total amount of claim filed.  

• Can I buy Arogya Sanjeevani policy as a group policy? 

IRDAI has now permitted insurance companies to offer Arogya Sanjeevani policy as a group plan so that organizations/employers can buy it for their workforce.  

• Is Arogya Sanjeevani policy provide cashless treatment? 

Yes. You can get cashless treatment in the network hospitals under this policy. 

• Does Arogya Sanjeevani policy cover critical illnesses? 

For specific details about the coverage of critical illness under this policy, please contact your insurer.