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All you need to know about Arogya Sanjeevani Health Insurance Policy

Today health insurance policies are necessary, in times during which medical expenses are now too expensive to pay for. The middle-income group is in a financial problem and if in case a medical emergency calls on these members of the group it can be a traumatising situation. Today the costly medical expenditure creates a hole  in the pockets of the middle-income man, so a health insurance plan is required to prevent this from happening.

Considering  this requirement for a health insurance plan, people are now becoming more and more aware on the significance of having a health insurance policy and are spending in a policy which covers most of their medical needs. But, in the insurance business each health insurance provider promises to cover something better in their health insurance policy when compared to its competitors. This could be sales talk, but it is enticing nevertheless. 

Due to this kind of a sales pitch, the layman is found in a fix while choosing a good and affordable health insurance policy for then and their families. So, for this, the Insurance Regulatory and Development Authority of India (IRDAI) put forth a basic and standard health insurance policy and it mandated all insurance companies to provide this policy to its prospects. Thus, according to this mandate of IRDAI, the Arogya Sanjeevani health insurance plan came into existence and now, many or almost every insurance company is offering this plan to people. Let us try to get to the know how’s of this policy and its features 

All About Arogya Sanjeevani policy

Arogya Sanjeevani health insurance policy is a health insurance policy that offers a standard coverage and benefits and has the same characteristics across all the insurance companies. Although all insurance companies provide same features, coverage and benefits for the Arogya Sanjeevani policy,  premium of the policy is, however,  not the same across insurers and is found according to the companies pricing policies.

Features of Arogya Sanjeevani

The Arogya Sanjeevani policy is a unique and a standard health insurance policy, provided in the Indian health insurance industry. Following are some of the salient features of the policy which one should know about.

  • The Arogya Sanjeevani policy is provided for a term of one year after which it can be renewed in order to get a continued coverage.
  • The policy offers an individual plan as well as a family-floater plan.
  • No claim bonus or NCB is provided by the insurer if no claim is made in a policy year. The bonus amount is nothing but a 5% increase in the sum insured with no additional premium. Discount on premium is normally not offered.
  • A waiting period of four years for pre-existing illnesses, joint replacement surgeries and age-related osteoporosis and osteoarthritis is required to be maintained. For other illnesses, the waiting period is two years.
  • Premium of the plan varies among different insurance providers and depends on  age, medical history, number of members covered and the sum insured chosen by the insured.
  • No health check-ups are needed unless the person applying for the Arogya Sanjeevani policy is 45 years of age or above.

Coverage provided in Arogya Sanjeevani plan

The Arogya Sanjeevani policy covers only basic medical costs and the costs incurred on medical treatments. The coverages are as follows –

  1. Pre and post hospitalisation costs

Costs due before hospitalisation are called pre-hospitalisation expenses. These expenses are covered upto thirty days prior to hospitalisation. Also,  post hospitalisation expenses are those which are pending for recovery after the hospitalised person is discharged from the hospital. And these expenses are covered till sixty days after discharge from hospitalisation.

  1. In-patient hospitalisation expenses 

This is the hospitalisation expense incurred when a person is hospitalised for 24 hours or more. This can include the room rent, nurse fee, doctors fee, surgeon’s fee, blood, glucose, medicine, oxygen, etc. All these bills are taken care up to the sum insured. And, there is a certain limit for room rent including for ICUs. Limit on room rent is two percent  of total sum insured and can go upto a maximum of Rs.5000/ day, for ICU it is 5% of the sum insured as well and covers a maximum of Rs.10,000/ day.

  1. Ambulance charges

The charges for availing an ambulance to take the sick person to the hospital are covered under this plan. Maximum coverage limit is restricted to Rs.2,000 for each instance of hospitalisation.

  1. Day-care treatment charges

Treatments that does not require 24-hour of a person being hospitalised and is taken care by advanced medical techniques is called day-care treatment. Such coverage is provided in the Arogya Sanjeevani health insurance policy for up to half of the total sum insured.

Exclusions under Arogya Sanjeevani

Even though the scope of the plan under the Arogya Sanjeevani health insurance policy is bit exhaustive, this policy  has certain exclusions under such conditions claims are not settled. Some of these common exclusions under this plan are as follows:

  1. Cost of diagnosis 
  2. Cost for medical needs which occurred by some activities which are contrary to societal law. This is a broad definition and can include taking part in hazardous programmes and others like the act of substance abuse
  3. Going under any kind of cosmetic surgery or gender reversal treatments
  4. Undergoing inorganic weight control treatments
  5. Surgically undergoing treatments for correction of vision
  6. Performing infertility treatments
  7. Medical conditions caused due to war
  8. Mental or physical rehabilitation expenses
  9. Expenses under maternity treatments 

Benefits of Arogya Sanjeevani health insurance policy 

Arogya Sanjeevani health insurance offers these benefits to its insured ones and is thus recommended.

  • For people looking for an inexpensive and also an exhaustive health insurance policy- you can opt for Arogya Sanjeevani health insurance policy and get you and your family covered
  • This plan covers many of the new age modern treatments that will usually not get covered for you under many other basic health insurance plans owing to their simplicity and price effectiveness
  • In this plan, since the major coverage characters are quiet basic, one can get the policy online through any available insurance providers after judicial comparison on the premium rates charged
  • The premium amount for the Arogya Sanjeevani plan can be made eligible for deductions under Section 80D of the Income Tax Act, 1961. The cap on maximum deduction which a policy holder can claim is Rs.25,000 which transforms into Rs.50,000 if the person is a senior citizen.


Should I Buy the Arogya Sanjeevani Health Plan?

According to majority of well-known financial planners, this type of a health insurance policy is a great basic level product. Whereas, there are many financial experts consider this plan which covers sums upto Rs.5 lakh, kind of a low coverage since it is not enough for covering a family of two adults and two children, which is generally the case.

Arogya Sanjeevani policy is a plain vanilla and basic type of a health insurance policy which is available at a cheaper rate. The above policy offers with the option of getting a Sum Insured up to only Five lakh. Also, it has some additional features that a fully functional version of an exhaustive health policy doesn't offer. Like for example, it provides a co-payment of 5% which will not be there in a fully-loaded health cover.

The IRDAI has mandated a 5% increase in the total Sum Insured for every claim-free year, upto to a maximum of 50% of the total Sum Insured, given that the policy is continued without any break.

Who Is Best Buyer for the Arogya Sanjeevani Health Insurance?

The Arogya Sanjeevani Health Insurance Plan is best for first-time health insurance buyers since it not only provides with exhaustive coverage cheaper premium but also the cover, terms & conditions of this policy are set across all insurance providers. This section of the policy is much easier for everyone to understand.
The policy can be effective for young people, looking for an exhaustive health cover for them at an economical cost.
People who are working but do not have dependents or are not married, can consider buying Arogya Sanjeevani Health Insurance Plan.

Arogya Sanjeevani Policy May Not Be Suitable for—

The total Sum Insured under the Arogya Sanjeevani policy is limited to Rs.5 lakh. But considering high costs of healthcare today, a plan of Rs.5 lakh can not suffice, specifically for people in metropolitan cities.

Thus, it is suggested to someone living in these cities to go with the capacity to pay higher premiums and go for a health plan along with the Arogya Sanjeevani Plan to make sure that the policy is sufficient. In this case, one can go with other health insurance policies with higher Sum Insured (SI). Also, one can consider getting a family floater plan in case the bread-winner has dependents.

In a nutshell, if you are looking for a health plan with a higher amount of total Sum Insured or if you have a proper pre-existing health insurance policy , then, Arogya Sanjeevani health insurance policy may not be the best choice for you. In this case, you should think of getting a super top-up healthcare plan.

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