Arogya Sanjeevani Policy

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Arogya Sanjeevani Health Insurance

Home / Health Insurance / Arogya Sanjeevani Policy

What is 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. 50,000 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.

Why should you buy ACKO Arogya Sanjeevani Health Insurance Policy?

Here are some of the key benefits of buying the Arogya Sanjeevani Policy from ACKO.

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Easy online process

From buying your health insurance plan to raising claims against it, all transactions are online. The process is straightforward with no paperwork.

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Customisable sum insured

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.

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Covers COVID-19

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.

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Huge list of network hospitals

You can choose from our 6,500+ network hospitals in India for cashless treatment. You can also opt for the reimbursement claim process.

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Get 24/7 support

Our support team is available 24/7 to resolve your queries. They work round the clock to remain beside you at all times.

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Get cumulative bonus

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.

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Straightforward claims

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]

Key features of the ACKO Arogya Sanjeevani Health Insurance Policy

Here are the Arogya Sanjeevani Policy details.

Key features Details
Sum insured Rs. 50,000 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
Lifetime renewability Lifelong
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 covered

What's not covered

Inclusions: What is covered in the Arogya Sanjeevani Policy by ACKO?

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.

Exclusions: What is not covered in the Arogya Sanjeevani Policy by ACKO?

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.

Arogya Sanjeevani Policy with tax benefits

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

Benefits of Arogya Sanjeevani Policy in India

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.

Low premium

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.

Lifelong renewability

You can renew the Arogya Sanjeevani Policy for as long as you live.

Low sum insured

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.

Ideal for first-time buyers

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.

Available as Individual and Family Floater

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).

Tax deductions

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).

How to buy/renew ACKO’s Arogya Sanjeevani Health Insurance Policy online

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

Arogya Sanjeevani Policy renewal process

Benefits of buying ACKO Arogya Sanjeevani Policy online

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.

Save time

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.

Optimise savings

Since buying, renewing, and raising claims are online, our operational costs are low, allowing us to offer affordable health insurance plans.

Paperless process

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.

How does ACKO Arogya Sanjeevani Policy work?

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.

Arogya Sanjeevani Policy premium chart rates and calculator

ACKO’s Arogya Sanjeevani Insurance has a sum insured amount ranging between Rs. 50,000 and Rs. 10,00,000. Here is the comparison of the Arogya Sanjeevani Policy premium for a sum insured of Rs. 5 lakh and Rs. 10 lakh coverage for one adult*.

Age group Arogya Sanjeevani Policy premium (Sum insured Rs. 5 lakh) Arogya Sanjeevani Policy premium (Sum insured Rs. 10 lakh)
16 - 20 Rs. 3,099 Rs. 4,149
21 - 25 Rs. 3,149 Rs. 4,199
26 - 30 Rs. 3,249 Rs. 4,349
31 - 35 Rs. 3,649 Rs. 4,899
36 - 40 Rs. 4,349 Rs. 5,799
41 - 45 Rs. 4,899 Rs. 6,549
46 - 50 Rs. 7,449 Rs. 9,949
51 - 55 Rs. 8,399 Rs. 11,249
56 - 60 Rs. 10,649 Rs. 14,199
61 - 65 Rs. 12,749 Rs. 17,049
66 - 70 Rs. 13,449 Rs. 17,999
71 - 75 Rs. 18,249 Rs. 24,399
76+ Rs. 18,249 Rs. 24,399

*Disclaimer: The premium is calculated for a single male adult with no present/past medical conditions. The rate also includes GST (rounded off).

Eligibility for Arogya Sanjeevani Plan

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.

Documents required:

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!

How to raise a claim against Arogya Sanjeevani Policy

You can either choose the cashless hospitalisation or opt for the reimbursement option. Here is how you must file a claim against the policy.

Cashless claims

Reimbursement claims

Documents required

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).

How to choose the best Arogya Sanjeevani plan

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.

List of new-age or modern treatments covered under the Arogya Sanjeevani scheme

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

Arogya Sanjeevani Policy cancellation and refund process

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

FAQs about ACKO's Arogya Sanjeevani Policy

Here are the commonly asked questions about Arogya Sanjeevani Policy by ACKO.

Buying related FAQs

What is Arogya Sanjeevani? Is it a government-sponsored insurance policy?

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.

What is the policy tenure of Arogya Sanjeevani policy by ACKO?

The tenure for this policy is 1 year. 

Can I increase my coverage?

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.

Do I need a medical test to buy this policy?

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.

Is there any age limit to buy this policy?

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.

Can I buy this policy only for my children?

No. Only children cannot be covered in this policy, although you can cover your children along with yourself and your spouse.

Can I claim tax benefits with Arogya Sanjeevani health policy by ACKO?

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.

What is the meaning of the waiting period?

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.

What is the difference between the Family Floater plan and the Individual policy?

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.

Who can buy the Arogya Sanjeevani Insurance Policy?

Anyone between the age of 18 and 65 years can buy the policy.

What is the maximum sum insured I can choose under the Arogya Sanjeevani Policy?

You can buy the policy with a minimum cover of Rs. 50,000 and a maximum of Rs. 10,00,000.

Do I need to pay from my pocket during claims against the Arogya Sanjeevani Policy?

Yes, you need to pay 5% of the claim amount as a co-payment under the plan.

What is the room rent limit for Arogya Insurance?

The hospital room rent is capped at 2% of the sum insured or a maximum of Rs. 5,000 per day.

Is overseas treatment covered under the Arogya Sanjeevani Health Plan?

No, treatment availed outside of India is not covered under the plan.

Does the Arogya Sanjeevani Policy cover maternity benefits?

No, maternity benefits related to pregnancy and childbirth are not covered under the plan.

What is the Arogya Sanjeevani Health Insurance Policy tenure?

The policy tenure is one year. For continuous coverage of the policy, it is crucial that you renew the plan before it expires. 

What factors are considered for calculating the Arogya Sanjeevani Policy premium?

Type of plan (Individual or floater), age of the beneficiaries, and the sum insured amount are the key factors considered for calculating the premium.

Coverage and claims related FAQs

Is coronavirus covered under this policy?

Yes, Covid-19 is covered under the hospitalisation benefit. 

Can I make cashless claims with this policy?

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. 

Is co-pay compulsory?

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 Hikes Maximum Sum Insured Amount to Rs. 10 lakh

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.

IRDAI Issues Guidelines Related to Arogya Sanjeevani Policy

– 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.

COVID-19: Pay Health Insurance Premium in Equated Monthly Installments (EMIs)

– 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.

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ACKO General Insurance Limited

2nd Floor, #36/5, Hustlehub One East, Somasandrapalya, 27th Main Rd, Sector 2, HSR Layout, Bengaluru, Karnataka 560102

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CIN: U66000KA2016PLC138288

IRDAI Registration No: 157

Category: Non-Life Insurance

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