Arogya Sanjeevani Policy

Arogya Sanjeevani Policy is a basic health insurance plan that provides coverage to protect you and your family from any financial problem caused due to hospital expenses. The Arogya Sanjeevani policy is provided by all the govt. as well as private insurance companies.

Arogya Sanjeevani Plans is affordable health insurance that protects the insurer from any hospital expenses like hospitalisation, room rent, ICU services, Nursing/ Boarding Charge, and even from expensive medical treatments etc.

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.

The minimum age allowed for children under the family floater type of Arogya Sanjeevani health insurance policy is 3 months, while the maximum age allowed 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 Scheme from different health insurance policies available in India. Some of the key features of the Arogya Sanjeevani Plan that set it apart from the rest of the plans are as follows:

• Affordable Policy: In contrast to other health insurance policies, the Arogya Sanjeevani Policy is significantly less expensive. It is offered as an individual floater as well as a family floater.
• 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 a 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 Insurance 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: People over 45 years of age with no medical history are not required to have a medical examination under the Arogya Sanjeevani Policy.
  

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

The premium prices for Arogya Sanjeevani policies are reasonable. They are less expensive than other health insurance plans' premiums. However, before purchasing one, you should compare Arogya Sanjeevani policy premiums to make the best purchasing option.

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 Policy comes with a co-payment of just 5%.

3. 15-Day Free Look Period

The Arogya Sanjeevani Policy has a 15-day free look period. During this time, the policyholder can evaluate the policy's terms and conditions and return it if they are 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 Policy qualifies for tax deduction benefit under Section 80D of the Income Tax Act, 1961. Read more here.

6. No Confusion

All insurance companies in India offer the same amount of coverage, terms, and conditions under the Arogya Sanjeevani Policy. As a result, it removes even the tiniest possibility of uncertainty in the mind of the insurance 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 get a wide range of coverage at a minimum price and without needing to go through the hassles of 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

The policyholder can claim the treatment costs incurred during hospitalisation (for more than 24 hours) from their insurance company under the Arogya Sanjeevani Health Insurance Policy. Doctor's costs, nursing expenses, room rent, bed charges, and hospital stays are all examples of hospitalisation expenses.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 the sum insured.

5. Daycare Treatment

Because of technical advancements, daycare treatment refers to medical treatment and/or surgical procedures performed in a hospital/daycare center under general or local anesthetic in less than 24 hours. Daycare treatment does not involve treatment that would ordinarily be done as an outpatient. The plan covers medical expenses incurred on all day care treatment up to 50% of the sum insured.

6. Road Ambulance Cover

The policy covers expenses incurred on road ambulances 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

Plastic surgery and dental procedures that are required as a result of a disease or an injury are covered by the coverage.

9. Cataract Surgery

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

What All Is Not Covered Under Arogya Sanjeevani Policy?

Arogya Sanjeevani Health Insurance Policy comes with the following exclusions:

• Prior to the start of their first policy, the insured was diagnosed, got medical treatment, and had signs and/or symptoms for any condition, ailment, injury, or related condition(s).
• 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 for any therapy required as a result of participating in dangerous or adventure sports.
• The treatment has been 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

The benefits of Arogya Sanjeevani are identical to those of any basic health insurance policy. The only distinction is that Arogya Sanjeevani Policy is a regular and basic health insurance policy that protects basic healthcare costs in the event of hospitalisation. It is presently the most economical health insurance coverage on the market that also includes therapy for COVID-19 positive. 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 the 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, the 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 need a basic health insurance policy, such as the Arogya Sanjeevani Policy, getting a basic health insurance policy can be a suitable solution. It would be appropriate because it provides adequate coverage at a reasonable price.

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
The Arogya Sanjeevani Policy is ideal for anyone seeking a low-cost health insurance policy to protect themselves and their family members. 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 the 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 out 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 or 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 the 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 the deduction of the co-payment. This means that the insurance company will settle the remaining 95% as the final claim amount.

Arogya Sanjeevani Refunds and Cancellation of Policy

The policy buyer of the Arogya Sanjeevani Policy has a 15-day free-look period. It basically means that the policyholder can cancel their insurance without incurring any cancellation fees within the first 15 days. Furthermore, the policyholder's payment, after deducting any expenses incurred by the insurance provider, will be reimbursed to the policyholder if no claims are filed during this time.

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

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