Arogya Sanjeevani Health Insurance Policy

Launched by the IRDAI, Arogya Sanjeevani Policy is a standard health insurance product that can be purchased on an individual or family floater sum insured basis by paying an affordable premium. The comes with wide coverage features that are easy to understand as well as beneficial.

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Arogya Sanjeevani policy for health insurance is available with a sum insured from Rs.1 lakh to Rs. 5 Lakh & no medical check-ups.

What is Arogya Sanjeevani Policy?

Arogya Sanjeevani Policy is a Standard Health Insurance Product (SHIP) set by the Insurance Regulatory and Development Authority of India (IRDAI) from April 01, 2020. This new plan aims to simplify health insurance for people by providing them with a basic and standard plan that will be offered by all health insurance companies with exactly the same benefits.

The only difference in the Arogya Sanjeevani health insurance policy offered by different health providers is in the plan’s premium quoted by them and the services offered during the purchase process, claim settlement and other related processes.

Types of Arogya Sanjeevani Policy

The following two types of health insurance plans are offered under the Arogya Sanjeevani Health Insurance Policy:

1. Individual Plan

As the name suggests, this type of plan allows only 1 policyholder as the beneficiary.

2. Family Floater Plan

Under family health insurance plans, the proposer can include their legally wedded spouse, dependent children, parents, and parents-in-law under the plan for a fixed sum insured against a single premium.

A 5% discount is available when more than one member is covered under a single proposal with an individual sum insured.

Eligibility for Arogya Sanjeevani Policy

The minimum entry age for the Arogya Sanjeevani Policy is 18 years and the maximum entry age allowed under the plan is 65 years.

Under the family floater type of arogya sanjeevani health insurance policy, the minimum age allowed for children is 3 months, whereas the maximum age permitted for children is 25 years.

However, if the child above 18 years of age is financially independent, he or she shall be ineligible for the coverage in the subsequent renewals.

Key Features of Arogya Sanjeevani Plan

There are various features that distinguish an Arogya Sanjeevani Policy from different health insurance policies available in India. Some of the key features of the Arogya Sanjeevani Plan that sets it apart from the rest of the plans are as follows:

  • Affordable Policy: Arogya Sanjeevani Policy is much more economical in comparison to other health insurance covers. It is available on both individuals as well as on a family floater basis.
  • Sum Insured Option: The plan lets the policyholders choose from a sum insured ranging between Rs 1 Lakh to Rs. 5 Lakhs.
  • Cumulative Bonus: The policyholder gets 5% bonus on the sum insured as a reward for each claim-free year. The calculation of NCB or No Claim Bonus takes place on a cumulative basis and can maximum go up to 50%.
  • COVID- 19 Hospitalisation Expenses: Arogya Sanjeevani Policy offers hospitalisation expenses linked to Coronavirus (COVID-19).
  • Waiting Period: For all illnesses or diseases except for an accident, the plan comes with a waiting period of 30 days.
  • No Health Check-Up up to 45 Years of Age: For Arogya Sanjeevani Policy, there is no need to undergo medical check-up for individuals above 45 years of age and having no medical history.

Arogya Sanjeevani Policy Benefits

There are several Arogya Sanjeevani benefits that you can avail of if covered under the policy. Read some of them in detail below:

1. Affordable Premium

Arogya Sanjeevani policy premium rates are affordable. They are relatively lower than the premium of other health insurance plans. But before buying one, you must Arogya Sanjeevani policy premium comparison in order to make the best buying decision.

2. Low Co-payment

Co-payment refers to the share of the claim amount borne by the policyholder/insured at the time of claim settlement. However, a co-payment does not reduce the sum insured. Arogya Sanjeevani Policy comes with a co-payment of just 5%.

3. 15-Day Free Look Period

Arogya Sanjeevani Policy comes with a free look period of 15 days. During this period, the policyholder can review the terms and conditions of the policy, and return the same if not acceptable.

4. Life-long Renewability

The Arogya Sanjeevani Policy comes with no restriction on the age at the time of renewal of the policy. Thus, the policyholder(s) can get the policy renewed at all ages during their lifetime.

5. Tax Benefit

The premium paid for the Arogya Sanjeevani Policy qualifies for tax deduction benefit under Section 80D of the Income Tax Act, 1961. Read more here.

6. No Confusion

With the Arogya Sanjeevani Policy, the same level of coverage, terms and conditions is offered by all the insurance providers in India. Thus, it eliminates even any slightest scope of confusion that can arise in the mind of the policy buyer.

7. Ideal Choice for First Time Policy Buyer

It is a perfect choice and an ideal step for individuals buying health insurance for the first time. This is because it would help the buyers in getting a wide range of cover at a minimum price and without needing to go through the hassles for understanding the pros and cons of various types of health plans.

What All Is Covered Under Arogya Sanjeevani Health Insurance Policy?

The key inclusions under the Arogya Sanjeevani Health Insurance plan are as follows:

1. Hospitalization Expenses

Under the Arogya Sanjeevani Health Insurance Policy, the policyholder can claim the cost of treatment incurred during hospitalization (for more than 24 hours) from their insurance provider. Hospitalization expenses include doctor’s fees, nursing expenses, room rent, bed charges, hospital stay, etc. Hospitalization expenses are covered up to 2% of the sum insured subject to a maximum of Rs. 5,000 per day of hospitalisation.

2. Pre-Hospitalization Expenses

The plan covers medical expenses incurred pre-hospitalization for a fixed period of 30 days prior to the date of admission to the hospital.

3. Post-Hospitalization Expenses

The plan covers medical expenses incurred for a fixed period of 60 days from the date of discharge from the hospital.

4. AYUSH Treatment

AYUSH health insurance covers the expenses incurred for inpatient care treatment under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems of medicines up to a specified limit of sum insured.

5. Daycare Treatment

Daycare treatment refers to medical treatment, and/or surgical procedure undertaken under general or local anesthesia in a hospital/daycare center in less than 24 hours because of technological advancement. Treatment normally taken on an out-patient basis is not included under daycare treatment. The plan covers medical expenses incurred on all daycare treatment up to 50% of sum insured.

6. Road Ambulance Cover

The policy covers expenses incurred on road ambulance up to Rs. 2,000 per hospitalization.

7. ICU/ICCU Charges

Expenses incurred for ICU/ICCU are covered up to 5% of the sum insured subject to a maximum of Rs. 10,000 per day.

8. Plastic Surgery and Dental Treatments

Expenses incurred on Plastic surgery and dental treatments necessitated due to a disease or an injury are covered under the policy.

9. Cataract Surgery

The plan covers medical expenses incurred for treatment of Cataract, subject to a limit of 25% of the sum insured or Rs. 40,000, whichever is lower, per each eye.

10. New Age Treatments

New-age/Modern treatment including Robotic surgeries, Bronchial Thermoplasty, Intravitreal injections, stem cell therapy etc.(listed below), will be covered under the policy up to a limit of 50% of the sum insured.

List of New Age Treatments Covered Under Arogya Sanjeevani Policy

The following advancement treatments are covered up to a limit of 50% of the sum insured under the Arogya Sanjeevani Health Insurance Policy:

  • Uterine Artery Embolization and HIFU (High-Intensity Focused Ultrasound)
  • Balloon Sinuplasty
  • Deep Brain stimulation
  • Oral Chemotherapy
  • Immunotherapy - Monoclonal Antibody to be given as an injection
  • Intra Vitreal Injections
  • Robotic Surgeries
  • Stereotactic Radio Surgeries
  • Bronchial Thermoplasty
  • The Vaporization of the Prostrate (green laser treatment or holmium laser treatment)
  • ONM - (Intra Operative Neuro Monitoring)
  • Stem Cell Therapy: Hematopoietic stem cells for bone marrow transplant for haematological conditions to be covered.

Best Health Insurance Companies Offering Arogya Sanjeevani Policy

Here is the list of health insurance companies offering the best Arogya Sanjeevani Policies to the customers:

S.No.

Insurance Company

1

Acko General Insurance Ltd.

2

Aditya Birla Health Insurance Co. Ltd.

3

HDFC ERGO Health Insurance Limited (Formerly Apollo Munich Health Insurance Company Limited)

4

Bajaj Allianz General Insurance Co. Ltd

5

Bharti AXA General Insurance Co. Ltd.

6

Cholamandalam MS General Insurance Co. Ltd.

7

Edelweiss General Insurance Co. Ltd.

8

Future Generali India Insurance Co. Ltd.

9

Go Digit General Insurance Ltd.

10

HDFC ERGO General Insurance Co.Ltd.

11

ICICI Lombard General Insurance Co. Ltd.

12

IFFCO Tokio General Insurance Co. Ltd.

13

Liberty General Insurance Ltd.

14

Magma HDI General Insurance Co. Ltd.

15

Manipal Cigna Health Insurance Company Limited

16

Max Bupa Health Insurance Co. Ltd

17

National Insurance Co. Ltd.

18

Navi General Insurance Ltd. (Formerly DHFL General Insurance Company)

19

Raheja QBE General Insurance Co Ltd

20

Care Health Insurance formerly Religare Health Insurance Co. Ltd

21

Royal Sundaram General Insurance Co. Ltd.

22

SBI General Insurance Co. Ltd.

23

Star Health & Allied Insurance Co.Ltd.

24

Tata AIG General Insurance Co. Ltd.

25

The New India Assurance Co. Ltd

26

Oriental Insurance Co. Ltd.

27

United India Insurance Co. Ltd.

28

Universal Sompo General Insurance Co. Ltd.

What All Is Not Covered Under Arogya Sanjeevani Policy?

Arogya Sanjeevani Health Insurance Policy comes with the following exclusions:

  • Any condition, ailment, injury or related condition(s) for which the insured has been diagnosed, received medical treatment, had signs and/or symptoms, prior to the inception of their first policy until 48 months from the date of inception
  • Any disease contracted during the first 30 days from the commencement of the policy
  • Admission primarily for investigation & evaluation
  • Admission primarily for a rest cure, rehabilitation and respite care
  • Expenses related to the surgical treatment of obesity that does not fulfill certain conditions
  • Change of gender treatments
  • Expenses for cosmetic or plastic surgery
  • Expenses related to any treatment necessitated due to participation in hazardous or adventure sports
  • The treatment has taken outside India
  • Pre-existing diseases from the inception of the policy up to 4 years of continuous coverage
  • Maternity expenses
  • Treatment for alcoholism, drug or substance abuse, or any addictive condition.
  • War
  • Nuclear, chemical or biological weapons attack
  • Dietary supplements and substances that can be purchased without a prescription
  • Any expenses incurred on domiciliary hospitalisation and OPD treatment.

Please refer to the policy wording to read about exclusions in detail.

Difference Between Arogya Sanjeevani And Health Insurance

Arogya Sanjeevani benefits are similar to those offered by any basic health insurance policies. The difference is just that Arogya Sanjeevani Policy is a standard and a simplified health insurance policy that covers you for basic healthcare expenses in case of hospitalisation. Currently, it is the most affordable health insurance policy in the market that also covers treatment related to positive diagnosis of COVID-19. So, if you are looking for a reliable health insurance policy that protects you in case of a positive diagnosis of COVID-19, then you can opt for Arogya Sanjeevani Policy. Offered by all the general insurance companies, the policy comes with a sufficient sum insured of Rs. 5 lakh and covers you for not only COVID-19 related expenses, but other illnesses too.

Who Should Buy Arogya Sanjeevani Policy?

As said before, Arogya Sanjeevani Policy is a standard health insurance policy offered by all general insurance companies at an affordable premium. The policy is most suitable for the following:

1. First-Time Health Insurance Buyers
If you are young and are looking for sufficient health insurance cover, then buying a basic health insurance policy like Arogya Sanjeevani Policy can be a good option. It would be suitable as it offers sufficient coverage as well as comes at an affordable premium.

2. People Looking for COVID-19 Cover
Like many other people, if you are also looking for a COVID-19 health insurance cover, then Arogya Sanjeevani is a good option as it comes at almost the same premium as coronavirus-specific plans. The best part is that it offers lifetime renewability benefits, unlike short-term health insurance plans that expire within a few months.

3. People Looking for Basic, Affordable Health Insurance Policy
Arogya Sanjeevani Policy is best suited for people who are looking for an affordable health insurance policy to cover themselves as well as their family members without spending too much. This is because the policy offers them wide coverage at a nominal health insurance premium.

How to File a Claim Under Arogya Sanjeevani Health Insurance Policy?

Now that you know everything about Arogya Sanjeevani Policy, you must also know how to claim under it in case of an emergency.

1. Cashless Claim Settlement

To make a cashless claim, you must follow the steps given below:

  • Intimate the insurance company within 24 hours of hospitalisation in case of emergency, and 48 hours prior in case of planned hospitalisation.
  • Fill the pre-authorization form.
  • You will receive an approval letter once your documents have been verified.
  • The insurance company will settle the bill for you directly at the network hospital.

2. Reimbursement Claim

You will be required to follow the steps given below to make a reimbursement claim:

  • Submit the claim form and the relevant documents
  • You will receive an approval letter from the claim management team
  • In case of any query from the claim management team, you pr the hospital will be required to respond
  • The reason will be communicated to you in case the claim has been rejected.

To make a claim, you would require the following documents:

  • Duly completed pre-authorization form
  • Photo ID proof
  • Medical practitioner's prescription advising admission
  • Original medical bills and payment receipts
  • Original discharge summary
  • Investigating/Diagnostic test reports, etc.

Note that every claim settlement under Arogya Sanjeevani Policy is subject to a co-payment of 5%. So, the amount payable by the insurance company in case of a claim shall be after deduction of the co-payment. Which means that the insurance company will settle the remaining 95% as the final claim amount.

Arogya Sanjeevani Refunds and Cancellation of Policy

A free-look period of 15 days is offered to the policy buyer of Arogya Sanjeevani Policy. It simply means that the policyholder can terminate their policy within the first 15 days without having to pay any cancellation charges. Moreover, the premium paid by the policyholder after subtracting any expenses incurred by the insurance provider will be refunded to the policyholder, subject to no claims being made during this duration.

However, in case the 15 days free-look period ends, still, the policyholder is given the option to cancel his/her Arogya Sanjeevani Policy. For this, the insured needs to provide 15 days written notice to the insurance company for cancellation of the policy. The premium paid by the policyholder will get refunded for the remaining policy duration according to the rates mentioned below:

Cancellation Time Premium Refund Percentage
Up to 30 days 75%
31 – 90 days 50%
3-6 months 25%
6-12 months 0%

Note: Please make a note that no free look period is applicable during the time of insurance renewals.

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FAQ About Arogya Sanjeevani Policy

  • Does Arogya Sanjeevani Policy cover COVID-19 hospitalization cost?

    Yes, the Arogya Sanjeevani health insurance policy covers the hospitalization treatment costs of COVID-19 (Coronavirus Disease).
  • Are maternity expenses covered under the Arogya Sanjeevani Policy?

    No, maternity expenses are not covered under the Arogya Sanjeevani Policy.
  • Do I need to undergo a health check-up to purchase Arogya Sanjeevani Policy?

    In majority of the cases, wherein you are not having any existing healthcare conditions and you follow healthy lifestyle habits, you are not required to undergo a medical check-up to purchase the policy. Also, before buying the policy, make sure to confirm the need for going through a medical check up from your respective insurance provider. As any wrong information to any of the medical questions can result in claim rejection later.

  • Are there any plan variants under the Arogya Sanjeevani Policy?

    Arogya Sanjeevani Health Insurance Policy is available in two plan types namely Individual Plan and Family Floater Plan. Under the Individual Plan, only the proposer is covered whereas, under the Family Floater Plan, the proposer can include their legally-wedded spouse, dependent children, parents, and parents-in-law with themselves under the fixed sum insured.

  • Can NRIs buy Arogya Sanjeevani Policy?

    Yes, Non-Resident Indians (NRIs) can also buy Arogya Sanjeevani Policy. However, the premium for the plan has to be paid in Indian currency and through an Indian Bank Account only. Also, the NRI must be present in India at the time of purchase of policy.

  • Can I opt for a higher sum insured than the maximum limit under this policy?

    The maximum sum insured available under Arogya Sanjeevani Health Insurance Policy is Rs. 5 lakh. You cannot opt for a sum insured higher than the maximum limit under this plan.

  • Are pre-existing diseases covered under Arogya Sanjeevani Policy?

    Pre-existing conditions/diseases declared and/or accepted at the time of application come with a waiting period of 48 months from the date of policy inception and are thus covered after the first 4 years of continual renewals.

  • Can I port my existing health insurance policy to Arogya Sanjeevani Policy?

    Yes, you can port your existing health insurance policy to Arogya Sanjeevani Policy.

  • Is there any free-look period offered under Arogya Sanjeevani Policy?

     Yes, the policy comes with a free look period of 15 days. The policy buyer is not required to pay any cancellation amount in case he/she cancels their policy within the first 15 days of buying the policy. However, there is no free look period available on policy renewals.

  • Can Arogya Sanjeevani Policy be availed outside India?

    No, medical treatments taken outside India are not covered under Arogya Sanjeevani Policy.

  • What is the eligibility criteria to buy Arogya Sanjeevani Policy?

    The minimum and maximum entry age under the Arogya Sanjeevani Policy is 18 years and 65 years respectively. The policy allows the inclusion of children aged 3 months to 25 years under the family floater type. However, if the child above 18 years of age is financially independent, he or she shall not be eligible for the coverage in the subsequent renewals.

  • What are the inclusions under Arogya Sanjeevani Policy?

    Arogya Sanjeevani Policy covers you against in-patient expenses for AYUSH treatment, road ambulance expenses for up to Rs. 2,000 per hospitalisation, 30 days pre-hospitalisation expenses, 60 days post-hospitalisation expenses, plastic surgery and dental treatment due to a disease or injury, expenses incurred due to treatment of cataract up to a specific limit, expenses related to daycare procedures, etc. To understand the policy inclusions in detail, you can read the policy document thoroughly.

  • What are the exclusions under Arogya Sanjeevani Policy?

    Arogya Sanjeevani Policy does not offer you cover against all healthcare expenses. Some exclusions under the policy are expenses related to domiciliary hospitalisation expenses, expenses related to OPD treatment, maternity expenses related to miscarriage and unlawful medical pregnancy termination, treatment taken outside the geographical boundaries of India, expenses incurred due to treatment for alcoholism, drug, or substance abuse, medical expenses incurred due to nuclear, biological, or chemical attack or weapons.

  • Can I cancel my Arogya Sanjeevani Policy?

    If insured under Arogya Sanjeevani Policy, you will get a free look period of 15 days to understand the policy better. In case you find that you are not satisfied with the policy features, then you can cancel your policy during this period without having to pay any cancellation charges. You can also cancel the policy after the free look period but for that you will be required to give a 15 days written notice to the insurance provider. The insurance provider will refund you the premium for the remaining policy period.

  • What is the difference between purchasing policy on an Individual basis as compared to purchasing it on a family floater basis?

     At the time of purchasing a policy on an individual basis, you need to cover all your family members separately. While, on the flip side, if you purchase the policy on a family floater basis, then you can get your whole family covered including self, legally wedded spouse, children and parents under a single policy with a maximum sum insured of Rs. 10 Lakh.

  • Is Arogya Sanjeevani Policy cashless?

    Yes. Arogya Sanjeevani Policy offers the benefit of cashless hospitalisation to the policyholders.

  • What is the criteria for entry age under the Arogya Sanjeevani Plan?

     The criteria for entry age under the Arogya Sanjeevani Plan is 18 years to 65 years for adults. While, for the children, the criteria for entry age is 3 months to 35 years.

  • Am I allowed to opt for a higher sum insured than the maximum limit under the Arogya Sanjeevani Policy?

     No, under Arogya Sanjeevani policy, you cannot opt for a higher sum insured limit. The sum insured limit ranges between Rs 1 Lakh to Rs. 5 Lakh. If you want a higher sum insured amount, then you need to go for a different policy offering a higher sum insured.

  • What are the sum insured options available under Arogya Sanjeevani Policy?

    Sum insured options available under Arogya Sanjeevani Policy are of Rs. 1 lakh, Rs. 1.5 lakh, Rs. 2 lakh, Rs. 2.5 lakh, Rs. 3 lakh, Rs. 3.5 lakh, Rs. 4 lakh, Rs. 4.5 lakh, and Rs. 5 lakh. You can not increase the sum insured more than Rs. 5 lakh under Arogya Sanjeevani Policy. The sum insured options range between Rs. 1 lakh and Rs. 5 lakh. The limit is set by the IRDAI (Insurance Regulatory and Development Authority of India).  

  • Which insurance companies are offering Arogya Sanjeevani Policy?

    IRDAI (Insurance regulatory and Development Authority of India) has made it mandatory for all the insurers offering health insurance to offer Arogya Sanjeevani Policy. Some popular insurance companies offering this policy are HDFC ERGO Health Insurance Limited (Formerly Apollo Munich Health Insurance Company Limited), Universal Sompo General Insurance Co. Ltd., Manipal Cigna Health Insurance Company Limited, Navi General Insurance Ltd. (Formerly DHFL General Insurance Company), Care Health Insurance formerly Religare Health Insurance Co. Ltd, etc.  

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*Standard T&C Apply. All savings/offers are provided by the Insurers, which are subject to modification .For more details on risk factors, terms and conditions, please read the sales brochure of respective insurers carefully before concluding a sale. Tax benefits are subject to changes in applicable tax laws. Girnar Insurance Brokers Private Limited, (CIN: U66010RJ2016PTC054811, Regd .Off: Girnar 21, Govind Marg, Moti Doongari Road, Dharam Singh Circle, Jaipur, Rajasthan- 302004; Corp. Off: 11th Floor, Tower B, Emaar Digital Greens, Golf Course Extension Road, Sector-61, Gurugram-122102, Haryana. IRDAI License no 588. Direct Broker (Life & General) valid till 19th March 2023. Email - support@insurancedekho.com ; Helpline number: 7551196989.
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