Arogya Sanjeevani Health Insurance

A sudden medical emergency can make our financial planning go for a toss..!!!

In this market where plethora of policies make us confused on what to buy, there is a need for a simple, straightforward plan, which is easy on the pocket as well as it takes care of basic health insurance requirements.

What is Arogya Sanjeevani Policy?

Insurance Regulatory Development Authority of India (IRDAI) has approved Arogya Sanjeevani Health Policy on 1st April, 2020,  as an approach to simplify and standardise  health insurance by providing a basic, standard plan that will be offered by all general and health insurance companies, with the same benefits. Perhaps the only difference in the Arogya Sanjeevani health insurance policy offered by different health insurers is in the quoted premium by them because of the services offered during the purchase process, claim settlement and other related processes, number of network hospitals, etc.

The universal Arogya Sanjeevani Health Policy will offer financial support to you and your family during any medical emergency. In April 2020, initially this plan came up with Sum Insured option from ₹1 Lakh - ₹5 Lakh, but considering medical inflation and the pandemic situation, IRDAI brought in latest modifications in July 2020 to the product’s sum insured slabs which makes it compulsory for insurers to offer a sum insured of up to ₹10 Lakh, starting from ₹50,000 and in multiples of ₹50,000.

It covers pre & post hospitalisation expenses which includes bed charges, nursing charges, ICU & doctor consultation charges and many more. This plan comes in two types:

  • Individual Plan: Under this plan only 1 policyholder is the beneficiary.
  • Family Floater Plan: Arogya Sanjeevani Policy benefits can also be availed by other members of the family. The policyholder can include dependents, such as spouse, children, parents & parents-in-law in a single policy.

Benefits of Arogya Sanjeevani Plan

Affordable Premium

Arogya Sanjeevani policy premiums are low-cost. They are especially lower than the other different medical insurance plans. But before buying, you must do a comparison so that you can make the best buying decision.

No Confusion

It gets rid of the scope of any confusion that can arise within the minds of a policyholder as the same coverage and the terms & conditions are offered by all insurance companies in India.

Low Co-payment

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

Life-long Renewability

This plan comes with no restriction on the maximum age of renewal of the policy. So, you can get the policy renewed for your lifetime.

Tax Benefit

The premium paid for Aarogya Sanjeevani policy qualifies for tax benefit u/s 80D of the Income Tax Act, 1961. Tax deductions are up to ₹25,000 for individuals and for senior citizens up to ₹50,000.

Ideal for First Time Policy Buyer

It is a perfect preference and an ideal step for individuals buying health insurance for the first time. This is because it would assist the buyers in getting a variety of cover at a minimal rate and that too without having to undergo the hassles for understanding the pros and cons of diverse forms of health plans.

Eligibility criteria 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 with lifelong renewability option. Under the family floater type of Arogya Sanjeevani health insurance policy, the minimum age allowed for children is 91 days, whereas the maximum age permitted for dependent 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 under family floater plan, and he/she can buy individual type plan of Arogya Sanjeevani Policy.

List of New Age/Modern Treatments Covered Under Arogya Sanjeevani Policy

Due to advancement in medical science, modern treatments have become quite popular today. Such advanced 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
  • Green laser treatment or holmium laser treatment (The Vaporization of the Prostate)
  • ONM - (Intra Operative Neuro Monitoring)
  • Stem Cell Therapy: Hematopoietic stem cells for bone marrow transplant for haematological conditions to be covered.

Who should buy Arogya Sanjeevani Plan?

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

  • First-Time Health Insurance Buyers: The Arogya Sanjeevani Policy benefits are same across all insurers and is the most affordable health insurance policy in the market currently. So, 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 as it comes at an affordable premium.
  • People Looking for COVID-19 Cover: Since the COVID-19 outbreak, people are increasingly looking for a health insurance policy that will cover them if they’re infected with the same. If you too are looking for such a policy, the Arogya Sanjeevani Policy could be a better option given that it costs almost the same as coronavirus specific plans and covers the COVID-19 among other diseases and illnesses too. The best part is it comes with lifelong renewability as compared to individual coronavirus plans that expire in just a few months.
  • 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 it is currently one of the most affordable options in the market today with wider coverage.

How to Buy Arogya Sanjeevani Policy?

An Arogya Sanjeevani Policy can be purchased online. The IRDAI has permitted insurance companies to issue the Arogya Sanjeevani Policy online or electronically to the policyholders, making it more economical for the buyers.

Since the product features are the same for all companies, it’s advisable to compare the premium quotes from different companies. After this, the policyholder will have to fill up the proposal form and pay the premium online. Arogya Sanjeevani Policy will be issued online. However, it is mandatory for insurance providers to issue the policy document in physical form even if it has been purchased online. Moreover, the IRDAI has also directed all health insurance companies to offer a certificate of insurance to the policyholders specifying the Arogya Sanjeevani Policy details including the terms and conditions.

Arogya Sanjeevani Refunds and Cancellation of Policy

A free-look period of 15 days is offered to the policy buyer of Arogya Sanjeevani Policy, which means that the policyholder can cancel their policy within the first 15 days without having to pay for any cancellation charges. The paid premium will be refunded to the policyholder by the insurance company, provided no claims were made during this period.

However, in case the 15 days free-look period is over, 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%

Coverage Offered By Arogya Sanjeevani Policy?

In-patient Hospitalization

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. This includes surgeon’s fee, doctor’s fee, anaesthesia, blood, oxygen, operation theatre charges, etc.

Pre and Post Hospitalization Expense

This policy will cover all the pre and post hospitalization expenses for a specific period in case of any medical emergency due to an illness or accidental injury. It also offers coverage for medical & hospitalisation expenses due to Coronavirus (COVID-19).

Room Rent Charges

Covered up to 2% of sum insured, subject to a maximum of ₹5,000/- per day

ICU/ICCU Charges

The policy pays up to 5% charges of the treatment taken in the ICU (Intensive Care Unit) or ICCU (Intensive Coronary Care Unit) of the total sum insured up to a maximum ₹10,000/- per day.

AYUSH Treatment

Many seniors prefer opting for alternative treatments. This policy covers those treatments if done in certified hospitals of Ayurveda, Unani, Siddha and/or Homeopathy.

Daycare Treatment

Some surgeries and treatments that require less than 24 hrs of hospitalisation are also covered as per the policy terms.

Cataract Surgery

Arogya Sanjeevani includes cataract surgery expenses for each eye up to 25% of the total Sum Insured or ₹40,000/-, whichever is lesser.

Road Ambulance Cover

Ambulance charges with a maximum cap of ₹2,000/- per hospitalization are included in the policy.

Dental and Plastic Surgery

Plastic surgery or dental treatments necessitated owing to an injury, or a disease are covered.

Modern Treatment

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

Diagnostic or Investigative Tests

This policy will not cover the expenses incurred

Bed Rest or Rehabilitation Expenses

It will not cover any expenses for bed rest in the absence of treatment or any expenses arising out of rehabilitation needs.

Weight Control/ Obesity Treatment

Any expenses arising out of the treatment taken for obesity or weight management will not be covered.

Gender-change Treatment

It will not cover the cost of taking any treatment for changing the gender.

Cosmetic or Plastic Surgery

Any expenses incurred on cosmetic or plastic surgery which is not required as a result of an accident, cancer, burn injury or medically necessary treatment will not be covered.

Maternity Expenses

It will not cover the cost of any treatment related to pregnancy and childbirth.

OPD Treatment

It will not cover the cost of any OPD or out-patient treatment taken by the policyholder.

Adventure/ Hazardous Sports

This plan does not cover any treatment costs arising due to participation in adventure sports, such as rock climbing, skydiving, para-jumping, deep-sea diving, mountaineering, etc, as a profession.

Breach of Law

It will not cover any expenses incurred due to breaching the law with a criminal intention

10 Alcohol/ Drug addiction

Any expenses arising out of the treatment for addiction of alcohol or drug or substance abuse will not be covered.

11 Dietary Supplements

It will not cover the cost of purchasing any dietary substance or supplements, such as minerals, vitamins, etc., without a prescription.

12 Unproven Treatment

This policy will not cover the cost of any unproven treatment taken by the policyholder.

13 Infertility and Sterility

It will not cover any expenses arising out of infertility or sterility.

14 Domiciliary Hospitalization

Any expenses arising out of domiciliary hospitalization will not be covered.

Features of Arogya Sanjeevani Plan

Some of the key features of Arogya Sanjeevani Plan are:

1 Universal Plan

It provides universal coverage, terms & conditions across all general and health insurance companies in India

2 Affordable Policy

Arogya Sanjeevani Policy is much more economical in
comparison to other health insurance plans. It is available on both individuals as well as on a family floater basis.

3 Limited Sum Insured Option

The plan lets the policyholders choose from a Sum Insured ranging between ₹50,000 to ₹10,00,000.

4 Cumulative Bonus

The policyholder gets a 5% bonus on the sum insured as a reward for each claim-free year. This No Claim Bonus takes place on a cumulative basis and can maximum go up to 50% of base cover.

5 COVID- 19 Hospitalisation Expenses

Arogya Sanjeevani Policy covers hospitalisation expenses related to Coronavirus (COVID-19).

6 Waiting Period

For all injuries or diseases except for an accident, the plan comes with a waiting period of 30 days.

7 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 up to 45 years of age and having no medical history.

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

It is very important that you know how to claim under it in case of an emergency.

Cashless claims can be made by following the steps given below:

Step 1: Intimate the insurance company or TPA within 24 hours of hospitalisation in case of emergency, and 48 hours prior in case of planned hospitalisation. Customer Care will guide you through the required process.

Step 2: Fill the pre-authorization form.

Step 3: You will receive an approval letter once your documents have been verified.

Step 4: The insurance company will settle the bill for you directly at the network hospital.

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

Step 1: Go to the Claims Section in the company website and download the claim form or contact the TPA.

Step 2: Submit the claim form and the relevant documents. You can also call up the toll free customer care number to get proper guidance.

Step 3: You will receive an approval letter from the claim management team of the insurer.

Documents Required For Reimbursement Claim

  • Valid Identity Proof
  • Duly signed Claim Form
  • Doctor’s prescription recommending hospitalization
  • Original pharmacy bills
  • Prescription for medicines and diagnostic tests
  • Ambulance Receipt
  • First Information Report (FIR), in case of accidental hospitalization and wherever applicable
  • Policy Document
  • Any other document specified by the insurer/TPA

Arogya Sanjeevani Policy Renewal

The Arogya Sanjeevani Policy comes with lifetime renewals. This means that you can renew your Arogya Sanjeevani Health Insurance Policy till the time you’re alive. However, you should make sure to renew this policy before its date of expiry. If the policy is not cancelled even after the grace period of 30 days, it will be terminated. The Arogya Sanjeevani Policy can be renewed online by entering the required details like registered mobile number, previous policy number, etc., and finally paying the premium.

Save Up to 20%* on Health Insurance Premium

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*Standard Terms & Condition Apply. Premium discount is provided by insurer for a 3-year policy and 4 or above insured family members. CIBPL/Health/WebBanner/English/Dec-21/001

FAQs related to Arogya Sanjeevani Plan

What is Arogya Sanjeevani? Is it a government sponsored insurance policy?

Insurance Regulatory and Development Authority of India (IRDAI) regulates the insurance industry in India. Arogya Sanjeevani is an affordable and simple health insurance policy approved by IRDAI. All general and health insurance companies have been authorized to provide this policy to their customers. Even though it is approved by IRDAI, it is not sponsored by the government. People who want Arogya Sanjeevani health insurance policy, need to purchase it on their own.

What is the policy tenure of Arogya Sanjeevani policy?

Insurance Regulatory and Development Authority of India (IRDAI) regulates the insurance industry in India. Arogya Sanjeevani is an affordable and simple health insurance policy approved by IRDAI. All general and health insurance companies have been authorized to provide this policy to their customers. Even though it is approved by IRDAI, it is not ‘sponsored’ by the government. People who want Arogya Sanjeevani health insurance policy, need to purchase it on their own.

Can I increase my coverage?

You can select the sum insured only up to a maximum of ₹10 lakhs, and in multiples of ₹50,000. You cannot increase coverage beyond Rs. 10 lakhs.

Do I need to undergo a medical test to buy this policy?

If you don’t have any existing medical issues and your lifestyle habits are healthy, you don’t have to go for any PMT (Pre-Medical Test). If medical tests are required, you will be informed before you make any payments. Incorrect information related to health queries can lead to rejections of claims.

Is there any age limit to buy this policy?

Yes. Under this policy, the entry age limit for adults is 18-65 years. While for children when you buy a family floater plan, it is 91 days to 25 years.

Can I buy this policy only for my children?

No. Only children cannot be covered in this policy, at least one adult must be included in the policy.

Can I claim tax benefits with Arogya Sanjeevani health policy?

Yes, tax benefits can be claimed under Section 80D of the Income Tax Act, 1961. An individual can claim a deduction on the premium paid for the insurance of self, spouse, and dependent children up to ₹25,000 and for senior citizens it is up to ₹50,000.

What is the meaning of the waiting period?

The waiting period is the time you need to wait before you can avail of a specific benefit from the date your policy or coverage starts. For example, If you bought a policy on the 1st of August, 2020, you’ll only be able to claim for hospitalization costs against Coronavirus after 31st of August, 2020. You can check the waiting period in the policy schedule.

What is the difference between the Family Floater plan and the individual policy?

When you purchase a family floater plan, you can cover your entire family (spouse, children, parents) under one plan with the sum insured of a maximum of ₹10 lakhs. On the other hand, if you buy an individual poly, you need to purchase a policy separately for each family member.

Is coronavirus covered under this policy?

Yes, Covid-19 is covered under the hospitalisation benefit in this plan.

Can I make cashless claims with this policy?

Yes, you can make cashless claims if you get hospitalised in any of the network hospitals where the company will settle the bill directly with the hospital. You just have to pay the copay amount and any other amount applicable as per the policy terms and conditions.

Is co-pay compulsory?

Yes, 5% co-pay is mandatory under this policy. Meaning, you need to pay 5% of the total admissible expenses, while the health insurer will handle the rest 95%. The amount you need to pay will be communicated to you along with your billing details.

Can NRIs buy Arogya Sanjeevani Policy?

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

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 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.

Can Arogya Sanjeevani Policy be available outside India?

No, any treatment taken outside India are not covered under Arogya Sanjeevani Policy.

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 do I do if my claim is rejected?

A claim can be rejected for several reasons like an incomplete waiting period, incorrect information provided and delay in making a claim. If your claim is rejected, you can ask for the reason for such rejection. If you’re not convinced, you can challenge the decision.

Can I customize Arogya Sanjeevani Plan as per my requirements?

No, the Arogya Sanjeevani policy only comes with standard benefits included in the plan. There are no add-ons or covers you can opt for.

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