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Home / Health Insurance / Arogya Sanjeevani Policy
Arogya Sanjeevani Health Insurance Policy is a comprehensive health plan with an affordable premium. It covers medical expenses with a sum insured ranging from Rs. 5,00,000 to Rs. 10,00,000. The coverage includes costs for in-patient treatment, pre and post-hospitalisation, room rent, Intensive Care Unit (ICU) and alternative medicine treatments.
You can buy the Arogya Sanjeevani Policy from ACKO as an Individual Plan or a Family Floater Plan with the option to pay the premium monthly, quarterly, half-yearly or annually.
Here are some of the key benefits of buying the Arogya Sanjeevani Policy from ACKO.
From buying your health insurance plan to raising claims against it, all transactions are online. The process is straightforward with no paperwork.
You can customise your sum insured amount of the Arogya Insurance ranging from Rs. 50,000 to Rs. 10,00,000 based on your needs.
You don’t have to buy a separate health insurance policy for the COVID-19 treatment, ACKO covers it as part of the Arogya Sanjeevani Policy.
You can choose from our 6,500+ network hospitals in India for cashless treatment. You can also opt for the reimbursement claim process.
Our support team is available 24/7 to resolve your queries. They work round the clock to remain beside you at all times.
For each claim-free year, you get a cumulative bonus of 5% on the sum insured amount, subject to a maximum of 50% of the sum insured. For example, if you have chosen a sum insured of Rs. 5,00,000, and you don’t raise a claim during the policy year, your sum insured for the subsequent year can increase to Rs. 5,25,000.
You can raise your claim through our online platforms such as our website or mobile application for a hassle-free experience. You can also write to us at [email protected]
Here are the Arogya Sanjeevani Policy details.
|Sum insured||Rs. 5 lakh to Rs. 10 lakh|
|Premium||Starts from Rs. 3,099 (Price calculated based on a 19-year-old purchasing the individual plan with a sum insured amount of Rs. 5 lakh along with GST)|
|Entry age||18 years to 65 years|
|Freelook period without cancellation||15 days from the date of purchase.|
|Waiting period||Pre-existing diseases: 48 months, Initial waiting period: 30 days, except for accidents, Specific illnesses: 24/48 months|
|Tax benefits||Premiums paid up to Rs. 25,000 are exempted from tax under Section 80D*|
|Plan options||Individual/Family Floater|
|Health check-ups||Not required for people up to 45 years with no medical history|
|No Claim Bonus (NCB)||5% increase on the sum insured for each claim-free year (subject to a maximum of 50% of sum insured)|
|Hospital network||Over 6,500 hospitals across India (Check ACKO network hospital list)|
*Note: Tax savings and exemptions are subject to changes in tax laws.
What's not covered
Here are the coverage details of the ACKO Arogya Sanjeevani Policy. Note that this is an overview, please refer to the policy wordings for details.
✅Wide-ranging coverage: Medical expenses arising from accidents and illnesses are covered based on the terms and conditions of the plan.
✅Minimal co-payment: Just pay 5% of the claim amount from your pocket, and we shall pay the remaining 95% of the claim amount.
✅Covers COVID-19 treatment: The plan covers COVID-19 treatment after 30 days of the policy’s commencement date.
✅ICU/ICCU coverage: Get coverage for ICU/ICCU room rent of up to 5% of the sum insured, subject to a maximum of Rs. 10,000 per day.
✅Hospital room rent: Get coverage for room rent of up to 2% of the sum insured, subject to a maximum of Rs. 5,000 per day.
✅Pre-existing conditions: Pre-existing illnesses shall be covered after 48 months from the policy’s start date. Please note that this benefit is applicable only if you renew the plan for four consecutive years.
✅Pre and post-hospitalisation: Healthcare costs 30 days before and 60 days after any 24 hours (or more) extended hospitalisation are covered under the plan.
✅Day care treatments: Day care treatments that do not require 24 hours hospitalisation are covered under the Arogya Sanjeevani Policy’s terms and conditions.
✅Cataract surgery: Surgery and treatment expenses related to each eye’s cataracts are covered after 24 months from the policy start date. Get coverage of up to 25% of the sum insured amount, subject to a maximum of Rs. 40,000.
✅New-age treatments: New-age treatments such as Robotic surgeries, Oral Chemotherapy, etc., are covered under this plan.
✅AYUSH treatments: Medical costs under the Ayurveda, Yoga, Unani, Siddha and Homeopathy treatment, otherwise known as alternative medicine, are covered under this health plan.
✅Ambulance costs: Get up to Rs. 2,000 against ambulance charges for every hospitalisation.
Here are the exclusions under the Arogya Sanjeevani Policy by ACKO.
❌ Investigation and evaluation: Medical expenses related to diagnostics and evaluation purposes or any diagnostic expenses not associated with current diagnosis and treatment.
❌ Obesity or weight control: Medical expenses related to obesity treatment or comorbidities-related surgeries are not covered.
❌ Cosmetic and plastic surgery: Any medical costs incurred on cosmetic and plastic surgery unless it is due to an accident, burns, or cancer, are not covered.
❌ Gender change: Expenses related to a change of gender are not covered under the policy.
❌ Maternity costs: Medical treatment expenses related to childbirth, miscarriage (unless due to an accident), and lawful termination of pregnancy are not covered.
❌ Bed rest and rehabilitation: Bed rest or rehabilitation without medical treatment are excluded from the coverage.
❌ OPD treatment: The policy does not cover medical expenses incurred due to OPD or domiciliary hospitalisation.
❌ Breach of law: Any medical expenses arising from breaching the law with criminal intent are not covered.
❌ Hazardous or adventure sports: Expenses incurred for the medical treatment required due to participation in adventure or hazardous sports are not covered.
❌ Drug and alcohol addiction: The plan does not cover expenses arising from medical treatment for drug or substance abuse, alcohol addiction or any addictive condition.
❌ Eye refractive error: Expenses incurred for the treatment for correction of eyesight arising from a refractive error are covered under the policy. However, it does not cover the correction of eyesight less than 7.5 dioptres.
❌ Unproven treatments: The policy does not cover medical costs incurred from an unproven treatment.
❌ Infertility and sterility: Any type of sterilisation, assisted reproductive services, gestational surrogacy, reversal of sterilisation, etc., are not covered.
❌ War or nuclear attack: War-related (whether declared or not) health insurance claims are not covered.
❌ Treatment availed outside India: Any expenses incurred from hospitalisation outside India are not covered.
❌ Excluded providers: Any expenditure incurred towards the treatment provided by any hospital or medical practitioner excluded by the insurer and disclosed on the website or notified to the insured is not covered.
❌ Dietary supplements: Expenses arising from dietary supplements and substances that can be bought without prescription unless prescribed by a medical practitioner as part of hospitalisation or daycare treatment are not covered.
❌ Nature cure clinics: Expenses incurred from treatment received in nature care clinics, health hydros, spas, or similar establishments registered as nursing homes are not covered.
You can claim tax benefits on purchasing the Arogya Sanjeevani scheme, under Section 80D of the IT Act, 1961. Here are the health insurance deductions rules and limits. Note that the exact nature of these tax benefits is subject to changes based on Government regulations.
|Insured person||Premium paid - Self, spouse and dependent children||Premium paid - For parents||Tax exemption under Section 80D|
|Family members and parents are less than 60 years||Rs. 25,000||Rs. 25,000||Rs. 50,000|
|Family members are less than 60 years and parents are above 60 years||Rs. 25,000||Rs. 50,000||Rs. 75,000|
|Family members and parents are above 60 years||Rs. 50,000||Rs. 50,000||Rs. 1,00,000|
|Hindu Undivided Family (HUF) members and Non-resident Individuals (NRIs)||Rs. 25,000||Rs. 25,000||Rs. 25,000|
With an aim to offer a basic and standard health insurance plan, the Arogya Sanjeevani Policy is one of the best health plans since it is designed to meet the requirements of all income groups in India. Some of the benefits are already mentioned in the previous sections of this page; here are some other key benefits of the Arogya Sanjeevani scheme.
As the Arogya Sanjeevani Policy is a standard policy set by the IRDAI (Insurance Regulatory and Development Authority of India), the premium for the plan is comparatively lower than other health insurance plans in India.
You can renew the Arogya Sanjeevani Policy for as long as you live.
One of the plan's main benefits is that it offers a limited sum insured. You can choose from as low as Rs. 50,000 to a maximum of Rs. 1,00,000.
The Arogya Sanjeevani Policy is a standard health insurance plan with an affordable premium. The plan is perfect for first-time buyers since it offers wide-ranging benefits at a low cost.
The Arogya Sanjeevani Policy comes with two types of plans, an Individual Plan (for a single person) and a Family Floater Plan (for the entire family).
You can avail of tax benefits under Section 80D of the IT Act, 1961 of up to Rs. 1 lakh (if family and parents are above 60 years of age).
The IRDAI has allowed insurers to issue the policy through online platforms such as the mobile app or website. Here is the process to buy or renew Arogya Sanjeevani Policy from ACKO’s online platform.
Arogya Sanjeevani Insurance purchase process
Step 1: Visit our website or mobile app and select ‘Arogya Sanjeevani’ from the ‘Products’ drop-down menu.
Step 2: Provide your mobile number and answer a few questions.
Step 3: Select your sum insured, pay the premium and receive the policy document in your inbox.
Arogya Sanjeevani Policy renewal process
Step 1: ACKO shall send a renewal notification via our email address ([email protected]) before the expiry date.
Step 2: The email has the payment link for the renewal of the policy. Once the premium is received, you shall receive the policy document within 24 hours.
ACKO’s online setup helps ease the process of purchasing a health plan. Here are the key benefits of buying Arogya Sanjeevani Policy online from ACKO.
You can buy/renew the policy and raise claims online when you purchase insurance from ACKO. It helps save time and effort when you buy online.
Since buying, renewing, and raising claims are online, our operational costs are low, allowing us to offer affordable health insurance plans.
When you buy insurance from ACKO, the entire process is paperless. Just answer a few simple questions online, and you can purchase the Arogya Sanjeevani Policy in a paperless way.
The following section highlights the working of the ACKO Arogya Sanjeevani Policy in India.
Purchase of the plan: The process begins when you purchase the Arogya Sanjeevani Health Plan. That’s when your relationship with the ACKO begins.
Payable premium: The premium is based on age, dependents, location, etc. There could be medical tests to assess your general health. Depending upon these factors, ACKO sets the premium and issues the policy. Any claims made shall be based on the sum insured and other conditions such as co-payments and deductibles.
Coverage: The coverage offered by the Arogya Sanjeevani scheme is standard. Thus, it remains the same across all insurance companies.
Hospitalisation: If you or the covered beneficiaries are hospitalised, you/they can avail of the cashless hospitlisation feature. Approach the network hospital's Third Party Administrator (TPA) to initiate the cashless hospitalisation. If the treatment is not cashless, pay the bill from your pocket and apply for the reimbursement of the medical expenses.
Claims: If you have availed of the cashless hospitalisation, ACKO shall settle the claim with the hospital. You have to pay the required deductibles and co-payments. However, in case of reimbursement, you have to pay the hospital bill yourself and then submit the necessary documents to us for a reimbursement claim.
Cumulative bonus: If you have not raised claims during the policy period, ACKO shall offer the benefit of a cumulative bonus of 5% on the sum insured.
*Disclaimer: The premium is calculated for a single male adult with no present/past medical conditions. The rate also includes GST (rounded off).
Refer to the below table for the eligibility criteria for Arogya Sanjeevani Policy.
|Entry age||18 years to 65 years|
|Children||3 months to 25 years|
|Renewability||Lifelong (You can renew the policy even if you cross 65 years of age)|
|Who can buy?||Self, spouse, dependent children, parents or parents-in-law|
If children are above the age of 18 years, and are financially independent, they are ineligible for coverage under the Arogya Sanjeevani Policy.
You can buy the Arogya Sanjeevani Policy online on ACKO’s platforms without unecessary paperwork. The entire process is paperless. Just provide a few personal details and answer some questions to purchase the plan instantly. It is that simple!
You can either choose the cashless hospitalisation or opt for the reimbursement option. Here is how you must file a claim against the policy.
Step 1: Choose the network hospital from our 6,500+ hospitals. You can view ACKO’s Network Hospital list here.
Step 2: Provide your E-card and UHID number to the hospital help desk and request them to initiate cashless hospitalisation. Your claim shall be settled based on the terms and conditions of the policy.
Step 1: Inform us about the hospitalisation by writing to us at [email protected].
Step 2: Pay the medical bills from your pocket.
Step 3: Submit a few documents required by our support team to process your claim. Once the documents are verified, your claim will be settled based on the terms and conditions of the policy.
In the case of cashless claims, there is no requirement for documents; however, in the case of reimbursement claims, you have to submit the following documents (as applicable).
Original medical bills with itemised break-up
Original payment receipts
Photo identity of the patient
Operation Theatre (OT) notes or surgeon’s certificate
Invoice of the implants
A copy of the Medico-Legal Report (MLR) (If required)
First Information Report (FIR) (If required)
Investigative or diagnostic test reports supported by doctor’s prescription
NEFT details and cancelled cheque to credit claim amount in the bank account
Other documents as required by our support team.
While the Arogya Sanjeevani Policy coverage is a standard offering, you can choose between Individual and Family Floater Plans and the sum insured per your requirements. Here are some key factors you must consider while selecting the right Arogya Sanjeevani Plan.
Choose the Individual Plan if you want the policy only for a person (self).
Choose the Family Floater Plan if you want to include your spouse, dependent children and parents/parents-in-law.
You can choose between Rs. 50,000 to Rs. 10,00,000 as the sum insured. So, make sure you choose the right sum insured based on your choice of Individual or Family Floater Plans.
Opt for digital insurers such as ACKO for a faster and hassle-free insurance experience.
Here is the list of new-age treatments covered under the Arogya Sanjeevani Policy.
|Balloon Sinuplasty||Uterine Artery Embolisation and HIFU||Deep Brain Stimulation||Immunotherapy - Monoclonal Antibody (injection)|
|Intravitreal injections||Oral Chemotherapy||Robotic Surgeries||Stem Cell Therapy|
|Stereotactic Radio Surgeries||Intra Operative Neuro Monitoring (IONM)||Vaporisation of the prostrate (Green/Holmium Laser Treatment)||Bronchial Thermoplasty|
You can cancel Arogya Sanjeevani insurance online within 15 days of policy issuance without any charges. You also have the option to cancel the plan after a 15-day free-look period and get a refund of the premium as applicable. The refund for an unexpired policy shall be as per the below rates.
|Time of cancellation||Refund of the Arogya Sanjeevani Policy premium|
|Up to 30 days||75%|
|31 to 90 days||50%|
|91 days to 6 months||25%|
|6 to 12 months||Nil|
Here are the commonly asked questions about Arogya Sanjeevani Policy by ACKO.
The Insurance Regulatory and Development Authority of India (IRDAI) regulates the insurance industry in India. ‘Arogya Sanjeevani’ is an affordable and simple health insurance policy approved by IRDAI. All general insurance companies, including ACKO, have been authorised to provide this policy to their customers. Even though it is approved by IRDAI, it is not ‘sponsored’ by the government. People who want Arogya Sanjeevani health insurance policy, need to purchase it on their own.
The tenure for this policy is 1 year.
No, you can select the sum insured only up to a maximum of Rs. 10 lakh, and in multiples of Rs. 50,000. You cannot increase coverage beyond Rs. 10 lakh.
In most cases, where you don’t have any existing medical conditions and your lifestyle habits are healthy, you don’t have to go for a medical test to buy the policy. If medical tests are required, we’ll inform you about it before you make any payments to us. Note: It’s very important to be truthful while answering the questions about your health while making a purchase and not shy away from medical tests. Incorrect information to medical questions can lead to rejections of claims.
Yes. Under this policy, the entry age limit for adults is 18 years to 65 years. While for children when you buy a family floater plan, it is 3 months to 25 years.
No. Only children cannot be covered in this policy, although you can cover your children along with yourself and your spouse.
Yes, you can claim tax benefits under Section 80D of the Income Tax Act, 1961. An individual can claim a deduction on the premium paid for the insurance of self, spouse, and dependent children up to Rs. 25,000.
The waiting period is the time you need to wait before you can avail of a specific benefit from the date your policy or coverage starts. For example, If you bought a policy on 1st August 2020, you’ll only be able to claim for hospitalisation costs against Coronavirus after 31st August 2020. You can check the waiting period in the policy schedule here.
Learn more about the waiting period in health insurance.
When you purchase a family floater plan, you can cover your entire family (spouse, children, parents) under one plan with the sum insured of a maximum of Rs. 10 lakh. On the other hand, if you buy an individual poly, you need to purchase a policy separately for each family member.
Anyone between the age of 18 and 65 years can buy the policy.
You can buy the policy with a minimum cover of Rs. 50,000 and a maximum of Rs. 10,00,000.
Yes, you need to pay 5% of the claim amount as a co-payment under the plan.
The hospital room rent is capped at 2% of the sum insured or a maximum of Rs. 5,000 per day.
No, treatment availed outside of India is not covered under the plan.
No, maternity benefits related to pregnancy and childbirth are not covered under the plan.
The policy tenure is one year. For continuous coverage of the policy, it is crucial that you renew the plan before it expires.
Type of plan (Individual or floater), age of the beneficiaries, and the sum insured amount are the key factors considered for calculating the premium.
Yes, Covid-19 is covered under the hospitalisation benefit.
Yes, you can make cashless claims if you get hospitalised in any of the hospitals in our network.
If you get hospitalised at any of the network hospitals, ACKO will settle the bill directly with the hospital. You just have to pay the co-pay amount and any other amount applicable as per the policy terms and conditions.
Yes, 5% co-pay is mandatory under this policy. Meaning, you need to pay 5% of the total admissible expenses, while ACKO will handle the rest 95%. The amount you need to pay is subject to standard terms and conditions mentioned in your policy document and will be communicated to you along with billing details.
IRDAI decided to expand the sum insured amount to Rs. 10 lakh from Rs. 5 lakh to widen the plan's coverage. Furthermore, keeping in mind the ongoing pandemic, IRDAI mandated all health insurers to offer this policy between Rs. 50,000 to Rs. 10 lakh, in multiples of Rs. 50,000.
– July 7, 2020
Today, the Insurance Regulatory and Development Authority of India (IRDAI) issued a circular regarding the Arogya Sanjeevani Policy. As per the circular, General Insurance Companies and Health Insurance Companies can offer the Arogya Sanjeevani Policy for a minimum Sum Insured of INR 50,000 and maximum Sum Insured of over INR 5,00,000 based on their underwriting policy. Currently, the policy’s minimum Sum Insured is INR 1,00,000 and maximum Sum Insured is INR 5,00,000. Therefore, the modification means that insurers can offer a policy for Sum Insured as low as INR 50,000 instead of INR 1,00,000, and not restrict the higher limit to a Sum Insured of INR 5,00,000. This lends more flexibility to the potential policyholder as well as the insurance company. The Arogya Sanjeevani Policy is a standard health insurance product that covers basic requirements. The modified policy can be offered by the insurers after successful filing and receipt of UIN from IRDAI.
– May 21, 2020
The Insurance Regulatory and Development Authority (IRDAI) has announced that policyholders can pay their premium in Equated Monthly Installments (EMIs). It has directed all health insurance companies to offer the same to policyholders to ease the situation. In the wake of the lockdown to contain the spread of COVID-19 in the country, the IRDAI has extended this benefit to health insurance policyholders. They can pay the premium on a monthly, quarterly or half-yearly basis for those policies, which is due for renewal up to 31 March 2021. Insurance companies will notify the applicable conditions and policyholders will be asked for their consent before the EMI options will be provided. Last year, the IRDAI had already notified insurance companies to provide the EMI facility from 1 October 2020. But with the COVID-19 situation in the country, the option has been fast-tracked.
Disclaimer: Please check the applicable policy wordings before making any insurance-related decisions. Feel free to reach out to us at [email protected] for any queries.