arogya sanjeevani policy india

Arogya Sanjeevani Policy: Eligibility, Features & Benefits to Buy

Health Insurance Insurance

Have you often been baffled or confused while going through all the different health insurance schemes? Trust me, you are not alone. We all have been there and here’s the end of all the confusion and overwhelm over the copious number of different health insurance schemes.

The Insurance Regulatory and Development Authority of India (IRDAI) had asked all the general and independent health insurance firms to create a standard health insurance scheme by April 1st, 2020. This is a new and standard health policy that would offer the same benefits, regardless of the insurance company you purchase it from. The policy came to be known as the ‘Arogya Sanjeevani Policy’.

The main point of the scheme is that all insurance companies are inclusive in the coverage, terms, and conditions of the Arogya Sanjeevani health policy. Hence the insurance buyer can buy the Arogya Sanjeevani policy from any insurer. Nonetheless, the rates of premium and customer care might differ from one insurer to another.

What is Arogya Sanjeevani Policy?

Arogya Sanjeevani plan is a recently launched health insurance policy working as the standard health policy. It is based on the guidelines set by the IRDAI and would provide coverage for all the basic hospitalization and other such expenses of a person and their entire family. This is a standard health insurance policy that would offer a universal cover of INR 1 lakh to INR 5 lakhs. A plus point is that the coverage, terms, benefits, and other details of this policy has been set up by the IRDAI and so, remain the same throughout all the health insurance providers in our country.

The only thing that would differ in terms of the insurer you are buying from, is their customer care service during the policy purchase and the amount claim process. The premium rates of the policy offered might also vary from one insurer to another.

Features of the policy:

The standard health insurance policy, ‘Arogya Sanjeevani’ policy has certain features that sets it apart from other health insurance policies. See for yourself:

  • The scheme is far more affordable than other health plans.
  • Insured sums will range from INR 1 to INR 5 lakh.
  • The coverage, terms, and conditions are identical for all health insurers.
  • It is available in both individual and family floater basis.
  • You can buy the Arogya Sanjeevani policy online.
  • Hospital expenses arising due to coronavirus contraction will be covered.

Details of the policy:

Features Specification
Assured sum INR 1 lakh to INR 5 lakhs
Term of Policy 1 year
Co-payment 5% of sum assured
Eligibility Criteria Adult: 18 to 65 years

Dependent Children who are 3 months to 25 years of age

No claim bonus 5 to 50%
Type of Policy Individual basis or Family Floater basis
Special Benefits Plastic Surgery and Dental Cover needed due to injury/ illness

 Benefits of Arogya Sanjeevani Policy

  • Zero Confusion: The scheme doesn’t allow people to get confused because all insurance providers will provide similar coverage, terms, and conditions.
  • Individual basis and Family floater basis: The policy comes with two standard plans:
    • Individual Policy: In this plan, every member of your family will have one policy per head, or you could just get one for yourself only.
    • Family Floater Policy: In this plan, there would just one policy that would provide coverage for the entire family.
  • Lower Co-Payment: Health insurance companies have very different copayment requirements and conditions. Some could ask for 10 to 20% copayment, while some need 0 copayments. The Arogya Sanjeevani policy offers a pretty low co-payment option, that is, only 5% of the amount claimed. This means that at the time of settlement, the applicant will have to pay just 5 percent of the total claim amount from your own pocket.
  • Free-Look Period: You are provided with a free-look window of 15 days after you buy the Arogya Sanjeevani policy. You have the option of terminating your policy within this period and you wouldn’t have to pay the cancelation fee.
  • Cumulative Bonus: For each claim-free year, the Arogya Sanjeevani health insurance policy also offers a cumulative benefit of 5 percent on the total amount insured. This feature is quite similar to other health insurance policies.
  • Low Premium: Arogya Sanjeevani is a standard health policy and has its rules and conditions set by the IRDAI. Hence, the premium for this policy is much lower when compared to all other health insurance schemes we have in the market.
  • Great for first-time buyers: A first-time purchaser of health insurance would be able to access a wide variety of cover at the least cost without having to go through all the pros and cons of different health plans. Hence, the first-time policy buyers will be at an advantageous position if they buy the Arogya Sanjeevani policy.
  • Renewability for Lifetime: The policy comes with a lifetime renewability option. Hence, the policyholders need to buy Arogya Sanjeevani policy only once and can keep renewing it for their entire life.

Eligibility Criteria of Arogya Sanjeevani Health Insurance Policy

The health insurance buyer can include the people who are financially dependent on them like a legally married spouse, parents, dependent children (legally adopted children too), and parents-in-law as well, in the policy.

Here is the tabulated form of the age of eligibility required for buying Arogya Sanjeevani policy:

Minimum age of entry Adults: 18 years

Dependent Children: 3 months

Maximum age of entry Adults: 65 years

Dependent Children: 25 years

Renewability Lifetime renewability allowed

Inclusions of Arogya Sanjeevani Policy

The Arogya Sanjeevani health insurance policy has the following inclusions:

  • Pre and Post-Hospitalization Expenses: This policy covers all your pre-hospitalization and post-hospitalization expenses if you happen to incur an emergency illness or an accidental injury.
  • COVID-19 Expenses: The policy would cover all your hospitalization expenses arising due to COVID-19 infection or coronavirus disease.
  • The benefit of AYUSH: This includes hospitalization expenses incurred under alternative treatments like homeopathy, Ayurveda, Siddha, etc, at any approved hospital.
  • ICU and ICCU Charges: The policy would cover the treatment expenses carried out in ICU (Intensive Care Unit) or ICCU (Intensive Coronary Care Unit)
  • Rent of Room: The scheme will also cover your hospital accommodation rent up to INR 5,000 per day.
  • Ambulance Service: Covers ambulance services cost up to a maximum of INR 2,000 per hospitalization.
  • Daycare Treatment: It covers the costs of daycare treatment procedures if any.
  • Plastic Surgery and Dental Treatment: The cost of all necessary dental or plastic surgery treatment as a result of some illness or injury will be covered.
  • Cataract Surgery: The cost of cataract surgery per eye will be covered for each eye up to a maximum of INR 40,000 or 25% of the insured sum, whichever is lesser.
  • New Age/ Modern Treatment: Covers up to a limit of 50 percent of the insured sum, for the expenses arising out of modern/new age care. All such procedures that will be covered are listed below:

New-Age/ Modern Treatments Covered Under Arogya Sanjeevani Policy

The Arogya Sanjeevani health insurance covers the following modern or new-age treatments:

  • Balloon Sinuplasty
  • Bronchial Thermoplasty
  • Oral Chemotherapy
  • Robotic Surgery
  • Stem Cell Therapy (Bone marrow transplant via Haematopoietic stem cells to treat hematological conditions).
  • Deep Brain Stimulation
  • Uterine Artery Embolization
  • High Intensity Focussed Ultrasound (HIFU)
  • Prostate Vaporization (Green Laser/ Holmium Laser treatment)
  • Immunotherapy (Monoclonal Antibody Injections)
  • Intraoperative Neuromonitoring (IONM)
  • Intravitreal Injections

Exclusions of Arogya Sanjeevani Policy

Arogya Sanjeevani Health Insurance has the following waiting periods:

  • Initial Waiting Period: For all claims except for accidental claims, there will be an initial waiting period of 30 days from the start date of the scheme.
  • Pre-Existing Disease: 4 years waiting period for pre-existing disease or medical condition coverage.
  • Specific Illness or Treatment: 2/4 years waiting period for coverage of Clinical procedures such as tonsillectomy, cataract, benign prostate hypertrophy, hernia, internal congenital abnormalities, age-related osteoporosis/osteoarthritis, joint replacement treatment, etc.

The policy does not include the following conditions or treatments:

  • Diagnostic or Investigative Tests: The scheme does not cover the costs resulting from any diagnostic or investigative tests performed.
  • Bed Rest Expenses/ Rehabilitation Expenses: If you are asked to stay in bed rest and not given any treatment, then the related costs incurred during that time will not be covered by this policy. The policy also would not cover any costs related to rehabilitation treatment.
  • Weight Control/ Obesity Treatment: Any costs related to obesity or weight loss treatment will not be compensated.
  • Alcohol/ Drug addiction: Expenses arising out of substance abuse treatment like alcohol addiction treatment will not be covered under the policy.
  • Dietary Supplements: This does not cover the expense of buying any dietary substance or supplements, like vitamins, minerals, etc. without a prescription.
  • Unproven Treatments: The scheme does not bear the expenses of any unproven treatment received by the policyholder.
  • Gender-change Treatment: It won’t cover the cost of gender-change treatment.
  • Cosmetic or Plastic Surgery: Expenditures on cosmetic or plastic surgery not needed as a result of an accident, cancer, burn injury or medically necessary care shall not be protected.
  • Maternity Expenses: Pregnancy and childbirth costs would not be covered.
  • OPD Treatment: Any OPD or out-patient treatment cost will not be covered.
  • Domiciliary Hospitalization: The policy won’t cover any expenses due to domiciliary hospitalization.
  • Nuclear attack or War: The policy won’t compensate for any claims arising due to a nuclear attack or a war/ war-like situation.
  • Adventure/ Hazardous Sports: Medical service costs related to involvement in dangerous or adventure activities, such as climbing rock, sky diving, deep-sea diving, para-jumping, mountaineering, etc., will not be covered under the scheme.
  • Breach of Law: Expenses incurred upon breaching the law with a criminal intention will not be covered.
  • Infertility and Sterility: The policy will not cover expenses due to infertility or sterility.
  • Treatment Outside India: The cost of any treatment received outside of India will not be incurred.

How to Renew Arogya Sanjeevani Policy

The policy is loaded with lifelong renewals. This means that the insurance buyer can renew the Arogya Sanjeevani policy for their entire lifetime. You can renew the policy online by filling in the necessary details and by paying the premium for the policy.

But, an individual needs to renew the policy before its expiry date. If the policyholder does not cancel the policy even after the 30 days grace period, then it will get terminated.

Arogya Sanjeevani Health Insurance Policy Cancellation and Refunds

Arogya Sanjeevani health insurance scheme provides you with a free-look period of 15 days. This ensures that you can terminate your contract within this period if you don’t like the features or anything else about the policy. You won’t have to pay any cancelation fees if you terminate the policy within the free-look period. The premium they charge will be paid back to the policyholder after deducting any costs borne the insurance company, provided you do not make any claims during this time.

Nonetheless, at the time of policy renewals, the free-look window is not offered. You can cancel the policy even after the 15 day free-look period gets over. A 15-days written notice needs to be submitted by the policyholder to the insurance provider to cancel the health insurance policy. The premium for the remaining policy shall be refunded to the policyholder according to the rates given below:

Sl. No. Cancellation time Premium Refund
1. Within 30 days of policy purchase 75% of the premium
2. From the 31st day to 90 days 50% of the premium
3. From 3 months to 6 months 25% of the premium
4. From 6 months to 12 months 0% of the premium

Who Should buy Arogya Sanjeevani Insurance Policy?

You can buy the Arogya Sanjeevani policy for yourself (by buying the individual plan) and for your entire family too (by purchasing the family floater plan). This plan is best suited for all those individuals who are buying health insurance for the first time. This is because this policy saves the new buyers from all sorts of confusion related to what type of policy they need and what type of policy to look for in the market.

Why should you buy the Arogya Sanjeevani Insurance Policy?

The policy will act as a blessing to all first-time buyers because they won’t have to face any confusion while buying the Arogya Sanjeevani health policy. You will get all the coverage provided under this health insurance program, starting with the coverage for basic hospitalization costs, COVID-19 treatment costs to cover for the new-age treatments in addition to several other medical coverages. Apart from all that, the policy comes packed with a long list of benefits like lifelong renewability, free look period of 15 days, low premium, low co-payment, and more.

The COVID-19 pandemic has instilled medical uncertainty in the hearts of millions of people. At times like these, the Arogya Sanjeevani policy is a boon for all of us as it promises to cover for all the costly medical, hospitalization, and other expenses.

Claim process of the Arogya Sanjeevani Policy

The claim process of the policy is easy, quick, and hassle-free. It is of two types:

  1. Cashless Claim Process: This facility is available in all network hospitals. To opt for the cashless claim, you need to follow the steps listed below:
    • Get a pre-authorization request form. Fill it up and get it signed by the treating doctor or hospital and by the patient.
    • This request will be sent to the Health Administration Team (HAT) by the network hospital.
    • The HAT doctors will go through the pre-authorization request form and decide on cashless availability.
    • An Authorization letter or a denial letter or an additional requirement letter shall be issued by 3 hours.
    • The hospital is expected to share with HAT the final bill and other information. The final settlement shall be assessed based on the HAT’s assessment.
  1. Reimbursement Claim Process: For the reimbursement of claims, the policyholder needs to submit the necessary documents to the HAT team within the prescribed time limit. The procedure can be executed either online or offline. Documents needed are as follows:
    • Duly filled claim form
    • Photo ID proof of the patient
    • Medical practitioner’s prescription advising hospital admission
    • Original bills with full break up of items.
    • Payment receipts
    • Discharge summary
    • Diagnostic test reports
    • For surgical cases, OT notes or Surgeon’s certificate
    • MLR copy and FIR
    • KYC, if the claim liability is more than INR 1 lakh
    • Legal heir/ succession certificate
    • Any other relevant document
Sl. No. Claim Type Time Limit Prescribed
1. Reimbursement of expenses related to hospitalization, daycare, and pre-hospitalization treatment. Within 30 days of the date of discharge
2. Reimbursement of post-hospitalization costs. Within 15 days of the completion of post-hospitalization treatment.

Arogya Sanjeevani Policy FAQ s

What is the policy term of Arogya Sanjeevani insurance?

Ans. The policy term of the Arogya Sanjeevani policy is of one year only. But, it comes with lifelong renewability, so you can buy it once and then keep renewing it as long as you are alive.

How many types of plan variants are available under the Arogya Sanjeevani policy?

Ans. There are no variations under health insurance Arogya Sanjeevani. But, you can purchase it in any of these two ways:

  • Individual basis (one policy for a person), and
  • Family Floater basis (One policy for your entire family).

Does the policyholder need to make any sort of payment while claim settlement?

Ans. Yes, you need to pay at least 5% of the total claim amount as co-payment at the time of claim settlement.

Can we avail of the policy outside India for medical treatments?

Ans. No. You cannot make use of the Arogya Sanjeevani policy outside India for coverage of medical treatment.

What are the amounts insured available under this policy?

Ans. When you buy the Arogya Sanjeevani policy, you have the option of getting insurance for a sum between INR 1 lakh to INR 5 lakhs.

Can we opt for a higher sum insured than the maximum limit given under the Arogya Sanjeevani policy?

Ans. No. The Arogya Snajeevani policy offers an insured sum between INR 1 lakh to INR 5 lakhs. If you want insurance with a higher sum, then you need to look at some other health insurance policies.

Can I transfer my current health insurance to Arogya Sanjeevani insurance?

Ans. Yeah, you can switch your current health insurance policy to the Arogya Sanjeevani health policy.

Does the policy provide a free-look period?

Ans. Yes, the policy offers a 15-day free-look period. You would not need to pay any cancellation charges if you cancel your Arogya Sanjeevani policy within the first 15 days of purchase. But, the policy renewals do not provide this free-look period.

Is the treatment for COVID-19 infection included under the Arogya Sanjeevani policy?

Ans. Yes. If you buy the Arogya Sanjeevani policy, then it will cover the hospitalization and other medical expenses arising as a result of coronavirus contraction.

Can NRIs purchase this policy?

Ans. Yes, NRIs too can buy Arogya Sanjeevani policy. But, the customer can buy the policy from India only and the premium payment needs to be made in Indian currency only.

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