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.

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.

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.

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.

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.

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 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.

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.

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 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.