Arogya Sanjeevani Policy

Arogya Sanjeevani policy for health insurance is available with a sum insured from Rs.1 lakh to Rs.5 lakh & no medical check-ups. Check eligibility, coverage, benefits, exclusions & FAQs.

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.

Features of Arogya Sanjeevani Policy

The Arogya Sanjeevani Health Insurance Policy comes with the following features:

1. No Medical Check-up Up To The Age of 45 Years

For this plan, no medical check-ups are required for people who are not older than 45 years and have no medical history.

2. Sum Insured Options

The sum insured under the Arogya Sanjeevani Policy ranges from a minimum of Rs. 1,00,000 to a maximum of Rs. 5,00,000 in multiples of Rs. 50,000.

3. Annual Policy

Arogya Sanjeevani Policy is an annual policy, i.e., it comes with a tenure of 1 year. However, the policy has a feature of lifetime renewability, thus, it can be renewed anytime without any restriction on the age of the policyholder.

4. Cumulative Bonus

For every claim-free year, the policyholder(s) gets rewarded with a 5% bonus of the sum Insured. No Claim Bonus (NCB) is calculated on a cumulative basis and can go up to 50%.

5. Waiting Period

Arogya Sanjeevani Policy comes with a waiting period of 30 days for all illnesses except accidents. This exclusion is however if the insured person has continuous coverage for more than 12 months. Pre-existing diseases declared at the time of application come with a waiting period of 48 months from the date of policy inception. 

Specific Waiting Period Under Arogya Sanjeevani Policy

The waiting period under arogya sanjeevani health insurance policy for the following conditions, surgeries and treatments is as follows:

24 Months Waiting Period

48 Months Waiting Period

Benign ENT disorder

Treatment for joint replacement unless arising from an accident

Tonsillectomy

Age-related Osteoarthritis & Osteoporosis

Adenoidectomy

Mastoidectomy

Tympanoplasty

Hysterectomy

All internal and external benign tumors, cysts, polyps of any kind, including benign breast lumps.

Benign prostate hypertrophy

Cataract and age-related eye ailments

Gastric/ Duodenal Ulcer

Gout and Rheumatism

Hernia of all types

Hydrocele

Non-Infective Arthritis

Piles, Fissures, and Fistula in Anus

Pilonidal Sinus, Sinusitis and related disorders

Prolapse Inter Vertebral Disc and Spinal Diseases unless arising from an accident

Calculi in urinary system, Gall Bladder and Bile duct, excluding malignancy.

Varicose Veins and Varicose Ulcers

Internal Congenital Anomalies

Arogya Sanjeevani Policy Benefits

There are several Arogya Sanjeevani benefits that you can avail 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 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.

What All Is Covered Under Arogya Sanjeevani Health Insurance Policy?

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

The plan covers the expenses incurred for inpatient care treatment under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems of medicines during 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, Intra vitreal 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 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 positive diagnosis of COVID-19, then you can opt for Arogya Sanjeevani Policy. Offered by all the general insurance companies, the policy comes with 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 the 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 a 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 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 nominal health insurance premium.

How to Claim Under Arogya Sanjeevani Policy?

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

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. 

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 claim management team
  • In case of any query from 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 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. 

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Health Insurance Arogya Sanjeevani Policy FAQs

  • 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.
  • What is the policy term of Arogya Sanjeevani Policy?

    Arogya Sanjeevani Health Insurance Policy is available with a policy tenure of 1 year, however, it comes with lifetime renewability features. Thus, policyholders can renew this policy at all ages during their lifetime.

  • 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 proper 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.

  • Does Arogya Sanjeevani Policy offer a free look period?

    Yes, Arogya Sanjeevani Policy offers a free look period of 15 days during which you can review the policy and return the same if not acceptable.

  • 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 Arogya Sanjeevani Policy?

    Arogya Sanjeevani Policy is an affordable and easy to understand standard health insurance policy that can be purchased on an individual or family floater basis. The policy aims to simplify the insurance process for people looking for basic health insurance coverage.

  • Is Arogya Sanjeevani Policy cashless?

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

  • What is eligibility for Arogya Sanjeevani Policy?

    People aged between 18 years and 65 years can purchase Arogya Sanjeevani Policy. You can also add dependent children aged between 3 months and 25 years under the policy.

  • Is there any waiting period under Arogya Sanjeevani Policy?

    Yes. To be able to avail benefits under Arogya Sanjeevani Policy, you are required to complete a waiting period of 30 days. Until then, you will not be covered for any illness except accidents. However, this exclusion is applicable if you are covered under the policy for more than 12 months. For pre-existing diseases, the waiting period is 48 months. Note that the waiting period is calculated from the date of inception of the policy.   

  • 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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