Arogya Sanjeevani Policy Details: Eligibility, Coverage, and Benefits

People safeguard their financial interests with the help of insurance that provides monetary support in the time of medical emergencies. Countries like the United States, France, Dubai, etc. provide mandatory health insurance to their citizens. The Insurance Regulatory and Development Authority of India (IRDAI) is urging insurance companies to create products that are affordable and easy to understand. Health insurance can be confusing due to many factors, one of which is the formal language used in policy documents. To avoid this, IRDAI issued certain guidelines for health insurance companies to create a standard health insurance product – Arogya Sanjeevani Policy. 

Arogya Sanjeevani Policy

Let’s take a look at all the things you need to know about the Arogya Sanjeevani Policy:

What is Arogya Sanjeevani Policy?

Arogya Sanjeevani is a standard health insurance plan that is offered by multiple health insurance companies in India. This policy is being sold as per the IRDA directives. The following two types of plans are available under Arogya Sanjeevani Insurance Policy:

  • Individual Plan: A single policyholder will be the beneficiary of Arogya Sanjeevani policy.
  • Family Floater Plan: Multiple family members of the policyholder can become the beneficiaries of Arogya Sanjeevani plan.

Arogya Sanjeevani Policy is an all-in-one health plan that will look after your financial needs in times of medical emergency.

Coverages: Inclusions of Arogya Sanjeevani:

This policy offers multiple benefits to the policyholder and his/her family depending upon the type of plan purchased. The Arogya Sanjeevani Policy launch date was 1st April 2020. People who wish to buy the policy can get covered with multiple insurance benefits. Let’s go through the coverages, features, and benefits of Arogya Sanjeevani health insurance policy:

What is Covered under Arogya Sanjeevani Policy?

Following are the Arogya Sanjeevani Standard Health Insurance Coverages:

1) Pre Hospitalization:

Your insurance company will cover the cost of treatment required as a preparation for hospitalization for a specific ailment. Depending on the terms of your insurance policy, you can receive this benefit for 30 days before hospitalization.

2) Hospitalization:

Under the Arogya Sanjeevani Policy, one can claim the cost of treatment during hospitalization from their insurer. Various things like nursing expenses, room rent, hospital stay, bed charges, etc. form a part of this coverage. Your insurer may put a cap of 2% of the sum insured up to Rs.5,000 per day on hospitalization.

If the patient is admitted in a critical care unit like Intensive Care Unit (ICU) or Intensive Cardiac Care Unit (ICCU), your insurer may pay 5% of the sum insured up to Rs. 10,000/- per day.

Fees of the medical practitioners like surgeons, consultants, anaesthetists, special attending doctors, etc will be covered under the Arogya Sanjeevani Policy. The coverage also includes charges for oxygen, operation theatre charges, surgical appliances, anaesthesia, blood, medicines and drugs, etc.

3) Post Hospitalization:

Some surgeries or ailments may require a patient to continue treatment after getting discharged from the hospital. Arogya Sanjeevani Policy will cover such expenses under Post Hospitalization. The period until when the insurer will be liable to pay these charges depends upon the terms and conditions of the policy. Usually, Post Hospitalization costs are covered for 60 days after discharge.

4) Room Rent/Doctor’s Fee And Nursing Expenses:

Room Rent usually has a cap on the percentage of sum insured of the policy. The Arogya Sanjeevani Policy will pay 2% of the sum insured up to Rs. 5000/- per day.

5) ICU and ICCU Expenses:

In case of intensive Care Unit (ICU), the room rent paid will be 5% of the sum insured up to Rs. 10,000/- per day.

6) Ambulance Charges:

The cost of transporting a patient with the help of an on-road Ambulance will be borne by the insurance company. The cap for this expense is Rs. 2000/- per hospitalization during the policy period.

7) Daycare Treatment:

For these out-patient treatments, 50% of the sum insured can be claimed.

8) Dental Treatment and Plastic Surgery:

The expenses related to Dental treatment and Plastic surgery will be covered up to the limit of sum insured of the policy.

9) AYUSH Care:

The expenses related to AYUSH treatment in a hospital offering these services will be covered up to the limit of sum insured.

10) Cataract Treatment:

The cost of this treatment will be covered up to 25% of the sum insured or Rs. 40,000/- (whichever is lower) by the insurance company for each eye.

11) Stem Cell Therapy:

This comes under out-patient treatment and thus it has a cap of 50% of the sum insured during the policy period.

12) New-age/Modern Treatment:

A New-age/Modern treatment that is mentioned in the policy will be covered under out-patient treatment. It will have a cap of 50% of the sum insured.

Benefits:

You will receive the following benefits with Arogya Sanjeevani Policy:

Income Tax Benefit

You can claim a tax benefit under section 80D of the Income Tax Act, 1961 when you buy this health insurance policy.

No Claim Bonus

As the name suggests, a No-claim bonus is offered by the insurance company when no claims are raised during a policy period. This benefit is awarded at the time of policy renewal of the next consecutive year. You can get a cumulative bonus of 5% of the sum insured if you do not raise any claims in a particular policy year. This discount can reach a maximum of 50%.

Free Lookup Period

Some insurers may offer a free look-up period on Arogya Sanjeevani Policy. This is the time frame during which you can meticulously review the terms and conditions of your health insurance policy and decide whether or not you wish to continue the coverage. You will get a refund as per the company policy if you wish to discontinue the plan

Ambulance Charges

The cost of hiring an Ambulance will be borne by the insurance company. It will be capped at Rs. 2000/hospitalization.

List of New-age or Modern Treatments covered under Arogya Sanjeevani Health Scheme:

One of the major benefits of Arogya Sanjeevani Health policy is that it provides coverage for AYUSH treatments. The following treatments are also covered under this policy:

1) AYUSH Treatment:

AYUSH is an abbreviation of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy. These are alternative treatments offered at various hospitals across India. The expenses of such treatments will be covered if the policyholder chooses to go for alternative treatment instead of the normal allopathic one.

2) Cataract Treatment:

Cataracts are formed when the lens of your eye becomes cloudy. It may lead to loss of vision, faded colours, halos around light, blurry or double vision, vision issues at night, etc. A cataract needs to be surgically removed and thanks to technological advancements, this surgery can be performed within a few hours and the patient may be sent home. You will receive either Rs. 40,000 or 25% of the sum insured for this treatment under the Arogya Sanjeevani Health Scheme.

3) Uterine Artery Embolization and HIFU (High intensity focused ultrasound):

These procedures are used to reduce the blockage of blood through arteries.

4) Balloon Sinuplasty:

This medical procedure is performed in extreme cases of rhinosinusitis or sinus inflammation, and blockages in the nasal cavity of a patient.

5) Deep Brain Stimulation:

It involves the placement of electrodes that send electric signals for performing various body functions. It is used in the treatment of Parkinson’s Disease and Tourette syndrome.

6) Oral Chemotherapy:

This is a chemotherapy medicine received orally for fighting cancer.

7) Immunotherapy:

This treatment helps in the improvement of the immune system to make your body fight cancer better.

8) The Vaporization of The Prostate:

This is used to treat men with benign prostatic enlargement. The Vaporization is carried out with the help of either laser energy or electrosurgery.

9) IONM – (Intra Operative Neuro Monitoring):

During surgery, certain neural structures need to be monitored. This can be done with IONM. This treatment uses electrophysiological methods like ElectroEncephaloGraphy (EEG), ElectroMyoGraphy (EMG)

10) Stem Cell Therapy:

Stem cells are cells of the body that do have a fixed function. Thus they can be used in the treatment or prevention of an ailment or a disease.

11) Intravitreal Injections:

This treatment is used to treat various issues related to the retina of the eye. Intra vitreal injections are administered directly in the patient’s eye by a medical professional on regular intervals of time.

12) Robotic Surgeries:

As the name suggests, these are surgeries that are performed with the help of robotic tools. These are mostly used to bring precision in a complicated  medical surgery.

13) Bronchial Thermoplasty:

This is used in the treatment of a severe case of Asthma. It uses controlled, therapeutic radiofrequency energy on the patient’s airway. This helps in clearing the congestion that causes an Asthma attack.

14) Stereotactic Radio Surgeries:

This is an operative treatment used to perform various functions like administering an injection, biopsy, implantation, ablation, etc. It uses a three-dimensional coordinate system to target a small area.

The expenses related to the treatmentents mentioned above will have a cap of 50% of the sum insured. In case of any balance amount, it needs to be borne by the policyholder.

Also, read: 5 Dos and Don’ts of Buying Health Insurance

Eligibility for Arogya Sanjeevani Plan:

A person between the age of 18 to 65 years is eligible to purchase the Arogya Sanjeevani Health insurance policy. Depending upon the size of your family, you can buy this plan for dependent children between 3 months and 25 years.

Independent children over the age of 18 years cannot be covered in a family policy, they will have to buy the individual plan. A Family Floater Arogya Sanjeevani Health plan may also cover parents and parents-in-law. Note that this health insurance policy has lifelong renewability however people above the age of 65 cannot buy a fresh policy. Existing policies can be renewed if the policyholder crosses 65 years of age.

Arogya Sanjeevani Policy Renewal:

Arogya Sanjeevani Policy can be renewed after the expiry date within the grace period as mentioned in the policy. This facilitates continuation of coverage for various medical benefits. The following changes can happen at the time of renewal. 

  1. One can change the amount of sum insured while renewing this Arogya policy. The change in sum insured should depend upon the lifestyle of the policyholder. He/she should increase or decrease the amount to suit their medical needs. 
  1. If a dependent child covered under the policy attains the age of 18 years and is financially independent, he/she will be removed from the policy at the time of renewal. They can buy a separate policy if eligible. 
  1. Consecutive renewals also provide a 5% Cumulative Bonus in case the previous policy year was claim-free.

Note that the policy will get terminated if not renewed even after the grace period is over. Also, the insurer can deny renewal on the basis of misrepresentation, moral hazard, or fraud. 

Arogya Sanjeevani Policy Premium Rates:

As mentioned earlier this policy is a standard health insurance product available across multiple insurance companies in India. The premium amount of Arogya Sanjeevani Policy will be slightly different for each plan.

The price of Individual policies starts at approximately Rs. 3000 and Family Floaters start at approximately Rs. 15000. You will find the exact policy premium chart and rates at your preferred insurer’s website along with various details related to your Arogya Sanjeevani Policy.

Arogya Sanjeevani Policy Cancellation and Refund Details:

It is possible to cancel the Arogya Sanjeevani Policy any time if no claims are made against the policy. To reduce the chances of cancellation, a free look-up period of 15 days is provided to the policyholder. During this period the policyholder should thoroughly review the policy for its coverage and exclusions, or terms and conditions. If a policy is cancelled within the free look-up period, the policyholder will not have to pay a cancellation charge.

The policyholder needs to give written notice to the insurance company to request a cancellation and receive a refund. Note that a certain amount will be deducted from the premium paid depending upon the number of days or months passed after purchasing the policy. Processing charges will also be deducted. A refund will be processed after calculating the deducted amount from the premium. The following table will help you understand these deductions:

Time period after policy purchaseDeduction in premium amount
30 days or less25%
More than 30 days less than 90 days50%
More than 90 days less than 6 months75%
More than 6 months100%

What is Standard Health insurance?

As the name suggests, a Standard Health Insurance plan is a policy that will be offered across all health insurance companies. The features and benefits of this policy would be similar irrespective of the insurance company. One of the first examples of standard health insurance in India is the newly launched Arogya Sanjeevani Policy.

The benefit of having a standard product is that people will not get into a tangle of confusions about health insurance. They can avail proper medical treatment at a low cost and one can easily switch between insurance companies when unhappy with the service provided.

Learn more about: Standard Health Insurance

Things to be aware of about Arogya Sanjeevani Policy:

Sum Insured:

The Sum Insured of a health insurance policy is the amount of money your insurer is liable to pay against medical emergencies that you face. The sum insured will be paid only if the policy is active. The sum insured of Arogya Sanjeevani Policy ranges between 1 lakh to 5 lakh rupees.

Policy Period:

This is the time when your Arogya Sanjeevani Policy will be active. The policy period of this plan is 1 year.

Grace Period:

It is the time after the expiration of the policy where you need to renew the plan. The grace period for annual payments of the Arogya Sanjeevani Policy is 30 days and for other payments, it is 15 days. Note that you cannot claim against the policy during the grace period.

Waiting Period:

This is the time where certain coverages are not active. One can claim for those coverages after the waiting period is over. The following table covers the waiting period for Arogya Sanjeevani Policy:

CoverageWaiting Period (excluding accidents)
Joint Replacement treatments48 months
Pre-Existing Diseases48 months
Age-related Osteoarthritis & Osteoporosis48 months
Certain Specific illnesses24 months
After buying the policy30 days

What is Not Covered? Exclusions of Arogya Sanjeevani:

Certain situations which are not covered under a health insurance plan are called the exclusions of the policy. Take a look at the following list of things that are not covered under the Arogya Sanjeevani Policy.

Breach of Law:

The insurance company is not liable to settle a claim if the insured person requires medical treatment due to an action that broke the law.

Investigation & Evaluation:

The cost of diagnostics and evaluation procedures is not covered under this policy.

Cosmetic or Plastic Surgery:

The cost of cosmetic treatments will not be covered unless a need arises as a result of an accident, burns, or cancer. In this case, the requirement of cosmetic surgery should be certified by the attending doctor.

Change-of-Gender Treatments:

Treatments related to changing the characteristics of the body to resemble the opposite sex shall not be covered under this policy.

Hazardous or Adventure Sports:

Cost of treatment arising from taking part in a Hazardous or Adventure sport as a professional, will not be covered.

Weight Control:

Treatments related to weight control unless fulfilling the following conditions:

  1. Surgery as per the doctor’s advice and conducted under clinical protocols
  2. The patient should be above 18 years of age
  3. The patient has a Body Mass Index (BMI) of the following conditions: 
    • BMI more than 40
    • BMI 35 and has severe comorbidities
  4. Obesity-related cardiomyopathy
  5. Sleep Apnea
  6. Heart disease
  7. Type2 Diabetes

War:

Any injuries related to a war-like situation in the country are not covered. This includes Nuclear, chemical or biological war.

EyeSight Correction:

Treatment-related to correction of eyesight due to refractive error that is less than 7.5 dioptres.

Infertility or Sterility:

Treatment-related to I V F, ZI FT, GIFT, ICSI, sterilization, surrogacy, sterilization and reversal of sterilization.

Rest Cure, Rehabilitation and Respite Care:

Treatment taken in rehabilitation centers, spa clinics, nursing facility for personal care will not be covered.

Dietary Supplements:

The cost of organic substances, Vitamins, minerals, etc. unless prescribed by an authorised medical practitioner as a part of the medical treatment availed during hospitalization.

Maternity Expenses:

Any type of delivery whether natural or cesarean is not covered. Expenses related to voluntary termination of pregnancy are also not covered.

Substance Abuse:

The cost of treatment arising out of excessive use of alcohol, drugs, or any other intoxicating substance is not covered.

Geographical Limits:

Any medical treatment taken outside India will not be covered under the plan.

Also, read: Corona Kavach and Corona Rakshak Insurance for COVID-19

Arogya Sanjeevani Policy Wordings PDF:

Policy Wordings of Arogya Sanjeevani Policy is available: PDF Download. Here you can learn all details of “Arogya Sanjeevani Policy – Acko General Insurance Limited,” including list of inclusion and exclusions, and other terms and conditions of the policy.

Frequently Asked Questions:

What would be the premium for Arogya Sanjeevani health policy for a family floater containing a spouse and two children?

The approximate price of Arogya Sanjeevani Family Floater that covers policyholder, spouse and two children will range from Rs. 6000 to 20000 depending upon the age of each person covered under this plan.

What are pre-existing diseases?

Any type of disease that the insured person suffers from before buying a health insurance policy is called a pre-existing disease. Examples of the pre-existing disease are diabetes, blood pressure issues, asthma, arthritis, etc.

How to get the Arogya Sanjeevani policy application?

Getting the application form for Arogya Sanjeevani policy is very easy. You can either get in touch with an insurance agent or download it directly from the website of your preferred insurance company like Acko.

Arogya Sanjeevani Health Insurance plan will cover the COVID-19 hospitalization?

Yes, Arogya Sanjeevani Insurance plan offers coverage for hospitalization due to (Coronavirus) COVID-19 disease.

Are maternity expenses covered under the Arogya Sanjeevani Plan?

The expenses of maternity and childbirth are not covered under this plan. However, complications and treatment related to ectopic pregnancy, and miscarriage due to an accident are covered in the policy.

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News Related to Arogya Sanjeevani Policy:

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.