The Arogya Sanjeevani Health Insurance is a comprehensive health insurance plan introduced by the IRDAI (Insurance Regulatory and Development Authority of India) on April 1st, 2020. All the insurance companies in India offer this health insurance policy. The coverage provided under this policy ranges from Rs 1 lakh to Rs 5 lakh. This health insurance plan comes as an individual plan as well as a family floater plan. It also covers the hospitalization expenses that you can incur due to the Covid-19 (coronavirus) infection.
What is Arogya Sanjeevani Health Insurance?
Arogya Sanjeevani policy provides basic coverage against medical expenses that may arise up to Rs 5 lakh. The IRDAI has instructed all standalone health insurance companies and General Insurance Companies to provide standard and basic health insurance to individuals and families.
The health insurance policy is universal for all the insurance companies in India, and it offers many advantages to the policyholder like pre-and post-hospitalization expenses, nursing charges, expenses of doctor consultations, and a lot more. This policy provides financial assistance to you and your family in case a medical emergency arises.
There are two plans that you can choose from under this policy:
- Individual Plan: In this plan, the policy's benefits can be availed only by a single beneficiary.
- Family Floater Plan: Under this plan, the whole family is covered and any member can avail of the benefits of the family. The policyholder can include dependents like spouses, children, parents, and parents-in-law in the coverage of this plan.
What are the Inclusions In The Arogya Sanjeevani Policy?
The following are the inclusions that come under the Arogya Sanjeevani Policy:
- Pre Hospitalization Expenses: The policy covers the expenses that arise as a preparation for the hospitalization due to a specific illness. Depending upon the policy, these benefits can be availed for 30 days before you are hospitalized.
- Hospitalization Expenses: The policy covers the hospitalization charges that arise out of accidents or illness. Some of the charges covered under the policy include room rent, nursing expenses, bed charges, etc.
- Covid-19 Cover: The insurance policy also covers expenses arising from hospitalization due to the Covid-19 infection.
- Post Hospitalization: Some surgeries or illnesses require continuous treatment after discharge from the hospital. These expenses are also covered under the policy, but the period till which these expenses will be covered depends upon the terms and conditions of the policy.
- Room Rent: The Arogya Health Insurance policy covers room rent up to a maximum of Rs 5,000 per day.
- ICU/ICCU Charges: The policy pays the insured the charges up to 5% of the treatment that is taken in the ICU up to a maximum of Rs 10,000 per day.
- Ambulance Expenses: The ambulance charges have been capped to a maximum of Rs 2,000 per hospitalization.
- AYUSH Care: The policy also covers alternative treatment costs like Ayurveda, Siddhi, Homeopathy, etc.
- Cataract Surgery: The expenses incurred due to cataract surgery are covered up to a maximum of Rs 40,000 or 25% of the sum insured, whichever is lower.
- Plastic Surgery and Dental Treatment: There is a need for plastic surgery or dental treatment due to an illness or accident. Then, these are also covered under the policy.
- Day-care Treatment: It covers expenses due to day-care treatments up to a maximum of 50% of the sum insured.
- New Age/ Modern Treatment: Any new age or modern treatment mentioned in the policy is also covered up to a maximum of 50% of the sum insured.
What are the Exclusions of the Arogya Sanjeevani Policy?
Some situations are not covered under this policy. The following is the list of exclusions from the policy:
- Breach of Law: If the medical expenses arising out of a broken law, then that is not covered.
- Cosmetic and Plastic Surgery: The costs of cosmetic and plastic surgery are not covered. But if it is a result of burns, cancer, or an accident, the attending doctor must specify that surgery is needed.
- Investigation and Evaluation: The costs that arise out of investigation and evaluation are not covered.
- Sex Change Procedures: The cost of procedures relating to change of gender are not covered.
- Hazardous or Adventure Sports: The cost of treatment that is caused due to taking part in hazardous or adventure sports is not covered.
- Weight Control: Treatments that are related to weight control are not covered under the policy.
- Dietary Supplements: The expenses of organic supplements, minerals, vitamins, etc., are not covered under the policy unless the doctor prescribes the medicines under a medical treatment done during hospitalization.
- Maternity Costs: Any maternity expenses that arise out of natural or cesarean are not covered. Also, expenses arising due to voluntary termination are not covered.
- Substance Abuse: The expenses incurred due to treatment of excessive consumption of alcohol, intoxicating substances, or drugs are not covered.
- Geographical Boundaries: If the treatment is taken outside India, then that is not covered under this policy.
- Rehabilitation: Any treatment taken for personal care at spa clinics, rehabilitation centers, or other facilities is not covered.
- Infertility or Sterility: Any therapy or treatment taken for sterilization, IVF, or surrogacy is not covered.
- Eyesight Correction: Any treatment taken for refractive error that is less than 7.5 dioptres is not covered.
- War: Any injuries arising out of war-like situations is not covered. All types of wars, including biological, nuclear, and chemicals, are included in the list of exclusions.
Features of Arogya Sanjeevani Policy:
- Economical: The premiums of the Arogya Sanjeevani Policy are economical than other health insurance policies.
- Universal: The coverage and the terms and conditions are universal across all the General Insurance or Standalone health insurance companies that operate in India.
- Sum Insured: The sum insured under the policy ranges from Rs 1 lakh to Rs 5 lakh.
- Plans: You can choose between an individual plan and a family floater plan.
- Covid-19: The hospitalization expenses that arise out of Covid-19 are also covered under this policy.
Benefits of Arogya Sanjeevani Policy:
- No Claim Bonus: An insurer gives a no-claim bonus is given to the policyholder by insurer if no claims are raised in a year. Under the Arogya Sanjeevani Policy, you can get a cumulative bonus of 5% of the sum insured if there are no claims in a particular year.
- Good for Buyers: This is a great policy for people buying a health insurance policy for the first time as this offers a variety of sum insured at an affordable price. Thus, this also reduces the time spent on understanding the advantages and disadvantages of the policy.
- Lifetime Renewability: One of the best things about buying the policy is that it comes with lifetime renewability. This means that the policyholder can renew their policy throughout their life.
- Eliminates Confusion: This policy excludes the scope of any confusion because the coverage and the terms and conditions remain the same across all the insurers.
- Free-Look Period: Some of the insurance companies offer a free-look period during which you can read the terms and conditions of the policy properly. During this period, you can choose to cancel the policy at no charge.
List of New-age or Modern Treatments covered under Arogya Sanjeevani Health Scheme:
- Uterine Artery Embolization and HIFU (High intensity focused ultrasound)
- Balloon Sinuplasty
- Deep Brain Stimulation
- Oral Chemotherapy
- The Vaporization of The Prostate
- IONM – (Intra Operative Neuro Monitoring)
- Stem Cell Therapy
- Intravitreal Injections
- Bronchial Thermoplasty
- Stereotactic Radio Surgeries
- Robotic Surgeries
Eligibility for Arogya Sanjeevani Plan:
Any person aged between 18 years and 65 years is eligible to buy the Arogya Sanjeevani policy. Under the policy, you can also buy the policy for your dependent children aged between 3 months and 25 years.
Independent children who are 18 years and above cannot be covered under the family floater plan. They can buy the individual plan if eligible.
The policy offers lifetime renewability, but anyone above 65 years of age cannot buy a new policy. However, existing policyholders can renew the policy even after they cross 65 years.
Arogya Sanjeevani Policy Renewal:
The policyholder must renew Arogya Sanjeevani Policy after the expiry but within the grace period offered by the insurer. This ensures that the policy continues so that you can avail the benefits in case a need arises.
If the child is financially independent and attains 18 years of age, they will be removed from the family floater plan at the time of renewal. They can purchase an individual policy for themselves (if eligible). Consecutive renewals are also eligible for a cumulative bonus for every claim-free year.
Arogya Sanjeevani Policy Cancellation and Refund Details:
You can cancel the policy at any given time if no claims have been made against the policy. For this purpose, a free-look period is offered to the policyholders to review the policy and read the terms and conditions carefully. If the policyholder cancels the policy within the free-look period, then no cancellation charges are levied.
To cancel the policy and receive a refund, the policyholder must submit a written request to the insurance company. A certain amount will be deducted from the premium depending upon the time that has passed since the purchase of the policy. Some processing charges will also be levied. The refund will be processed after calculating the final amount after deducting the amount from the premium.
1) Does the Arogya Sanjeevani Policy cover Covid-19 hospitalization?
Yes, hospitalization due to Covid-19 is covered under the Arogya Sanjeevani Policy.
2) Who is eligible to buy the Arogya Sanjeevani Policy?
Any individual between the age of 18 to 65 is eligible for the Arogya Sanjeevani Policy.
3) What is the maximum sum insured under the policy?
The maximum sum insured that one can avail is Rs 5 lakh.
4) What is the premium for Arogya Sanjeevani Policy?
The premium for Arogya Sanjeevani policy is different for different age groups, and it also depends upon the sum insured that you wish to purchase.
5) Are pre-existing conditions covered under the Arogya Sanjeevani Policy?
Yes, pre-existing conditions are covered under the policy but after a waiting period of 4 years.