What is Arogya Sanjeevani Policy

If you get confused when considering different health plans by the many insurance companies, then you are not alone. The different plans of so many companies can confuse anyone. Keeping this in mind, the Insurance Regulatory and Development Authority of India (IRDAI) launched the Arogya Sanjeevani Policy. It is a simple health insurance policy, under which all health insurance companies offer the same benefits to their customers. Even though the features of the Arogya Sanjeevani policy of different companies are similar, they may differ in terms of purchase, claim and number of cashless network hospitals.

(Read more: What is not covered in health insurance)

In the midst of rising inflation, the cost of healthcare is also increasing. The expenditure on diseases and health services is increasing day by day in our country. In such a situation, it is very important for everyone to have health insurance so that there is no impact on their savings in times of need. Arogya Sanjeevani Policy is one such health insurance policy. 

Arogya Sanjeevani Policy is one of the cheapest health insurance policies in the present era. However, myUpchar Bima Plus policy also provides good health cover at very low premiums. You can buy myUpchar Bima Plus policy for an individual for less than Rs 4,200. Every individual needs at least one basic health insurance plan to keep their financial planning and investments in good shape.

(Read More: Health Insurance Plans for family)

Like other health insurance policies, many types of services are covered under the Arogya Sanjeevani health insurance policy. Some of them are listed below:

• Hospitalization Expenses: Expenses like bed charges, nursing charges, blood tests, ICU and doctor consultation fees come under hospitalization expenses and are covered under the policy. Under this policy, 2% of the sum insured of your policy or up to Rs 5,000 (whichever is less) is covered as room rent. Similarly, on admission to the ICU, up to 5% of the sum insured (maximum Rs 10,000) is covered. (Read more: Room rent capping)
• Pre-hospitalization cover: Usually, one is not directly admitted to the hospital as soon as they show symptoms of a disease. Before a hospitalisation, they have to see the doctor, take the prescribed medication, get tests etc. After this, if the doctor advises so, you are admitted to the hospital. All expenses before hospitalisation are covered under the Arogya Sanjeevani policy, as long as they were incurred during the 30 days before the admission.
• Post-hospitalization cover: After discharge from the hospital, there are many types of expenses incurred, including consultation fees, costs of lab tests, etc. Under the Arogya Sanjeevani policy, after being discharged from the hospital, all the expenses related to the same condition can be claimed for the next 60 days.
• Cataract cover: If the Arogya Sanjeevani policyholder gets a cataract, then they can get a cataract operation done under this policy. For this, you can get a cover of up to 25% of the sum insured or a maximum of Rs 40,000 once a year for one eye.
• Daycare treatment: What if you need a treatment or surgery that does not require 24 hours of hospitalization and can be wrapped up within a few hours? Arogya Sanjeevani Policy also provides cover for such daycare treatments.
• Ayurveda, Homeopathy, Unani, Siddha Treatment: If you want to get treatment through the AYUSH (Ayurveda, Yoga, Unani, Siddha and Homeopathy) system, you’ll be pleased to know that it is covered under Arogya Sanjeevani Policy. Whether you get Western treatment or under AYUSH, if you have Arogya Sanjeevani Policy, then there is nothing to worry about.
• Dental treatment and plastic surgery: If due to any disease or accident, you need dental treatment or plastic surgery on any part of the body, then you can get treatment under the Arogya Sanjeevani Policy. However, doing so for aesthetic purposes will not get the claim.
• Road ambulance: Road Ambulance coverage up to a maximum of Rs 2,000 is also provided during each hospitalization under the Arogya Sanjeevani Policy.
• Other diseases in which coverage of up to 50% of sum-insured is available: There is a list of 12 diseases for which you can claim up to 50% of the sum insured. This includes modern treatment procedures such as balloon sinoplasty, immunotherapy and stem cell therapy.
• Cumulative bonus: If you do not make a claim in a year, then your sum insured will be increased by 5% the following year.

(Read more: Hospital Cash in Health Insurance)

Below are some of the new-age treatment procedures that can be covered for up to 50% of the sum insured:

• Uterine artery embolization and HIFU (High-Intensity Focused Ultrasound)
• Balloon sinuplasty
• Deep brain stimulation
• Oral chemotherapy
• Immunotherapy (monoclonal antibodies given as an injection)
• Intravitreal injection
• Robotic surgery
• Stereotactic radiosurgery
• Bronchial thermoplasty
• Vaporization of the prostate (green laser treatment or holmium laser treatment)
• IONM or Intra Operative NeuroMonitoring
• Stem-cell therapy (hematopoietic stem cells for bone marrow transplantation to cover hematological conditions)

(Read more: Pre-existing diseases covered in health insurance)

Following are some of the things that are not covered under the Arogya Sanjeevani Policy:

• Any hospitalization or pre-hospitalization expenses not related to medical claims are not covered under this policy.
• Treatment that is related to obesity or weight control is not covered under the policy. Coverage can be obtained if it is necessary to do so due to other illnesses.
• Procedures associated with sex change are not covered.
• Cosmetic and plastic surgeries are not covered under the policy.
• Conditions arising due to substance abuse are not covered in the Arogya Sanjeevani policy.
• You will not get a claim for treatment done without the consent of the doctor or even when it is not needed.
• Infertility and fertility related treatments are not covered in the Arogya Sanjeevani policy.
• Maternity-related expenses are not covered under this policy.
• OPD expenses of domiciliary care are not covered under Arogya Sanjeevani policy.
• If an accident occurs while participating in adventure sports, treatment is not covered under the policy.
• Self-injury or attempted suicide cannot be claimed under the policy.
• If you get caught in a combat situation, the claim due to war is not covered.
• There will be no claim cover in case of accident due to participation in any operation of the Army, Navy or Airforce.
• Cases of sexually transmitted diseases also cannot be claimed under this policy.

(Read more: Important dates related to health insurance plan)

Any person in the age group of 18 to 65 years can take Arogya Sanjeevani Health Insurance Policy and keep renewing it for the rest of their life. This is a basic, standard policy, designed by IRDAI itself and, therefore, its premium is lower compared to policies offered by health insurance companies.

• Waiting period: Whenever you buy a health insurance policy, there are many terms and conditions attached to it, one of them being the waiting period. Like other health insurance policies, in the Arogya Sanjeevani policy, the policy cover starts only 30 days after taking the policy. However, in case of an accident, a claim can be taken from the first day itself. Apart from this, there is a list of diseases for which you may have to wait at least 24 months and up to 48 months (4 years) to be covered.
• Condition of copayment: Under the Arogya Sanjeevani policy, copayment has been made mandatory. Simply put, copayment refers to self-payment of some part of the hospitalization expenses. Under this policy, you will have to compulsorily make a payment of 5% and the remaining 95% of the claim will be settled by the insurance company directly with the hospital.
• Portability benefits: If you have a health insurance plan and are not satisfied with your company or policy, then you can avail the features of the Arogya Sanjeevani policy by porting your existing health insurance policy to it.
• Who can be covered: In the family floater plan of the Arogya Sanjeevani Policy, you can give the benefit of coverage to your spouse, parents and mother-in-law. Apart from these, along with your own children, any legally adopted child between the age of 3 months to 25 years can also be included.

(Read more: Top-up health insurance)