Arogya Sanjeevani - Standard Health Insurance Plan

With the aim of simplifying and making health insurance more accessible for customers, the IRDAI (Insurance Regulatory and Development Authority of India) launched Arogya Sanjeevani on 1st April 2020. Arogya Sanjeevani is a basic and standard health insurance plan that every health insurance company is required to offer.

In this article, let’s take a look at the features and basic conditions under the Arogya Sanjeevani Policy, and how it differs from a comprehensive health insurance policy.

Let’s dive right in!

Basic Conditions Under Arogya Sanjeevani

Here are some basic conditions under the Arogya Sanjeevani Policy that you must be aware of -

Here’s why -

  • Type of cover

    Arogya Sanjeevani can either be purchased as an individual cover or as a family floater cover. An individual plan offers coverage to only one individual whereas, a floater allows you to cover multiple family members under a single plan.

  • Range of sum insured

    While the sum insured range will differ across insurers, you may pick a sum insured between a minimum of Rs. 50,000 and a maximum of Rs. 10,00,000.

  • Policy duration

    The maximum policy term available under the Arogya Sanjeevani plan is 1 year.

  • Age-related limits

    Adults between the ages of 18 and 65 are eligible to purchase the Arogya Sanjeevani plan. And, they can purchase this either as an individual or a floater cover. Speaking of children, the entry age is 3 to 25 years. Children from 3 months to 18 years can only be protected under the plan on a floater basis, whereas children aged 18 to 25 years can be covered either under an individual or a floater plan.

  • Members covered

    Insurance companies allow you to cover yourself, your spouse, dependent children, parents, and parents-in-law under the Arogya Sanjeevani policy. The total number of members you can cover, however, will vary across insurers.

  • Waiting period

    After the policy is issued, there are some diseases that won’t be covered under the policy for a specific period of time. This time period is known as the ‘waiting period’. Pre-existing diseases are subject to a 4-year waiting period under the Arogya Sanjeevani policy, whereas some specific diseases are subject to a waiting period of 2 to 4 years.

  • No claim bonus

    No Claim Bonus (NCB) is the reward the insurer gives you for not making a claim in a policy year. Every year you don’t make a claim under Arogya Sanjeevani, your sum insured will increase by 5%. And, a maximum NCB of up to 50% of the sum insured can be accumulated under the policy.

    For instance, Lakshmi buys the Arogya Sanjeevani Plan for a sum insured of Rs. 5,00,000. Her sum insured will increase by 5% every year she doesn’t make a claim under the plan.

    So, if she doesn’t make a claim this year, her base cover will increase to Rs. 5,25,000 Lakhs when she renews the policy next year. If she doesn’t make a claim in the next year, her policy cover amount will increase to Rs. 5,50,000. Since the cap is 50% of the sum insured, her sum insured can increase up to a maximum of Rs. 7,50,000.

  • Free look period

    During the free look period, you can evaluate the policy you purchased - and, if you’re unsatisfied, you may return it to the insurance company. The insurer will not charge you any penalties or cancellation fees. A 15-day free look period is applicable under the Arogya Sanjeevani policy.

  • Co-payment

    Co-payment is the amount you’ll have to pay out of your pocket at the time of claim before the insurer starts paying. Under Arogya Sanjeevani, you’ll have to pay a co-payment of 5% of the hospital bill out of your pocket first, and the insurer will then pay the remaining amount.

    For instance, Rohan is covered under Rs. 10 Lakhs Arogya Sanjeevani Plan. A few years after buying the plan, he undergoes hospitalisation for a kidney surgery and his hospital bill amounts to Rs. 5 lakhs.

    Since the co-pay percentage under the Arogya Sanjeevani Plan is 5%, Rohan will have to pay 5% of his hospital bill, i.e. Rs. 25,000 out of his pocket. The insurer will then pay the remaining 95% of the bill, i.e. Rs. 4,75,000.

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What Does Arogya Sanjeevani Cover?

Here’s a list of expenses covered under an Arogya Sanjeevani Plan -

Pre-Hospitalisation Expenses

These include expenses incurred prior to hospitalisation. Pre-hospitalisation expenses of up to 30 days before the hospitalisation are covered under Arogya Sanjeevani.

Post-Hospitalisation Expenses

These include costs incurred after hospitalisation. Arogya Sanjeevani covers post-hospitalisation expenses of up to 60 days after hospitalisation.

Boarding, Nursing, Room Rent Expenses

The policy covers boarding, room rent, and nursing expenses charged by hospitals or nursing homes. The expenses are covered up to 2% of the total sum insured, up to a maximum of Rs. 5000 per day.

ICU And ICCU Costs

Intensive Care Unit (ICU) and Intensive Cardiac Care Unit (ICCU) expenses are covered under Arogya Sanjeevani too. These expenses are covered up to 5% of the sum insured, for a maximum of Rs. 10,000 per day.

Cataract Treatment

Expenses incurred for cataract treatment (per eye) are covered by Arogya Sanjeevani up to 25% of the sum insured or Rs. 40,000 - whichever is lower.

AYUSH Treatment

Cost of AYUSH treatment, i.e., alternative treatments that include Ayurveda, Unani, Siddha, Homoeopathy, Naturopathy, etc. are covered up to the sum insured you choose.

Modern Treatment

Modern treatment costs, i.e., the cost of treatments or surgeries performed using advanced methods are covered up to 50% of the policy sum insured.

COVID-19 Expenses

COVID-19 hospitalisation expenses are covered under Arogya Sanjeevani too.

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Arogya Sanjeevani Vs. Comprehensive Health Insurance

Here’s a quick comparison of some of the conditions and features offered by Arogya Sanjeevani and Comprehensive Health Insurance Policies.

Arogya Sanjeevani Policy Comprehensive Health Insurance
Sum insured You can choose a sum insured between from Rs. 50,000 to Rs. 10 Lakhs. Here, you can opt for a sum insured between Rs. 50,000 to 1 Crore, and even more.
Room rent limit The room rent limit under this plan is 2% of the basic sum insured with a maximum of Rs. 5,000 per day. The room rent limit applicable under comprehensive plans may vary across insurers.
ICU costs ICU charges of up to 5% of the sum insured or Rs. 10,000 per day, whichever is lesser, are covered. The coverage limit for ICU expenses may vary across insurers. It is generally a certain % of the sum insured.
Restoration benefit The restoration benefit feature is not available with the Arogya Sanjeevani plan. This feature is included by default in certain policies, while it is an optional feature in others.
No claim bonus A maximum No Claim Bonus of up to 50% of the sum insured can be accumulated under the policy. In some policies, you can accumulate a No Claim Bonus of up to 100% of the sum insured or more.
Free health check-up benefit Free health check-up benefit is not available under this plan. Free health check-up benefit is available with some comprehensive policies.
Co-payment A mandatory co-pay of 5% is applicable under this policy. Co-pay is not mandatory under every policy. A Co-pay of 10% to 30% may be applicable for individuals above the age of 60 years.
Pre-existing disease waiting period Pre-existing diseases are subject to a 4-year waiting period. The waiting period for pre-existing diseases can range between 2 to 4 years, depending on the insurer.
Maternity expenses Maternity expenses are not covered. Some policies cover maternity costs.
Cost The premiums of Arogya Sanjeevani are relatively less than comprehensive plans. Also, the premiums remain the same across zones. The premiums are comparatively higher. The premium amount may depend on the sum insured you opt for and the zone you reside in.

That is all about Arogya Sanjeevani Plans. We hope this article helped you gain enough clarity on the conditions and features of the Arogya Sanjeevani Policy, and how it differs from a comprehensive health insurance plan.

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