Arogya Sanjeevani is a newly designed health insurance policy which was launched by the IRDAI (Insurance Regulatory and Development Authority of India) on 1st April 2020. It is offered by most general insurance providers in India. This policy covers basic health insurance ranging between Rs. 1 Lakh to Rs. 5 Lakhs. Other than medical expenses related to hospitalization, it also provides cover for treatment expenses related to COVID-19.
The Insurance Regulatory and Development Authority of India (IRDAI) is reaching out to insurance companies for creating affordable products that are also easy to understand for the customers. Health insurance can confuse consumers and one such is the legal language that is used in policy documents. To address this issue, IRDAI has issued a few guidelines to health insurance providers for creating a standardised health insurance product in the form of Arogya Sanjeevani Policy.
Types of Plans Under Arogya Sanjeevani Policy
Mentioned below are the two key plans available as part of the Arogya Sanjeevani Health Insurance Plan:
Individual Plan: Under this, an individual policyholder is considered the beneficiary of Arogya Sanjeevani policy.
Family Floater Plan: Here, more than one family member of the primary policyholder can register as a beneficiary of the Arogya Sanjeevani policy.
This policy is an all-encompassing health insurance plan which assures to look after the financial needs of the policyholder in case of any medical emergency.
Arogya Sanjeevani comes with multiple benefits for the policyholder and his/her dependents depending on the type of plan chosen. People who want to buy this policy can avail multiple insurance benefits under one blanket. Mentioned below are the various coverages, benefits, and key features of Arogya Sanjeevani insurance plan:
1) Pre-Hospitalization: The insurance provider covers the treatment cost as part of any hospitalization preparation for a specific illness. Depending on the terms and conditions of the policy, the beneficiary can get this reimbursement for up to 30 days before hospitalization.
2) Hospitalization: As part of Arogya Sanjeevani Policy, a beneficiary can claim the treatment expenses incurred during hospitalization. Various expense categories such as nursing expenses, room rentals, bed fees, etc. are covered under this. Many insurers may set a cap of 2% of the sum insured maximum up to Rs.5,000 available per day upon hospitalization.
If the patient has been admitted in Intensive Care Unit (ICU) or for some cases in Intensive Cardiac Care Unit (ICCU), the insurer can pay 5% of the sum insured maximum up to Rs. 10,000/- per day. Fees charged by medical practitioners such as surgeons, anaesthetists, attending doctors, consultants, etc are covered as part of the Arogya Sanjeevani Policy. The coverage includes expenses towards oxygen, surgical equipment, operation theatre fees, anaesthesia, medicines, blood, and also drugs, etc.
3) Post Hospitalization: During some surgeries, patients may need to continue treatment even after discharge. Arogya Sanjeevani Policy covers such expenses as part of Post Hospitalization cover. The period for such cover is dependent on the terms and conditions of the plan chosen. In most cases, Post Hospitalization expenses are covered for 60 days post-discharge.
4) Room Rental/Doctor’s Charges and Nursing Fees: Room rentals are generally capped as a percentage of the total sum insured under the policy. The Arogya Sanjeevani Policy pays 2% of the sum insured maximum up to Rs. 5000/- per day.
5) ICU and ICCU Charges: For intensive Care Unit (ICU), the room expenses covered are 5% of the total sum insured, maximum up to Rs. 10,000/- per day.
6) Ambulance Charges: Transportation cost of a patient in an on-road ambulance is to be borne by the insurance provider. Maximum expense in such cases is Rs. 2,000/- per hospitalization within the policy term.
7) Daycare Treatment: For any out-patient treatment expenses, maximum 50% of the total sum insured can be claimed.
8) Dental Treatment and Plastic Surgery: The charges related to Dental treatment or Plastic surgery are covered as per the limit of sum insured in the policy.
9) AYUSH Care: Any expenses related to AYUSH treatment availed in a hospital are covered depending on the limit of sum insured.
10) Cataract Treatment: Costs of this treatment are covered maximum up to 25% of the total sum insured or Rs. 40,000/- (whichever is lower) by the insurance provider. The amount is considered for each eye.
11) Stem Cell Treatment: This falls under out-patient treatment and therefore it has a limit of 50% of the total sum insured during the policy term.
12) New-age Treatment: Any new-age treatment which forms part of the policy gets covered as part of the out-patient treatment. Up to 50% of the sum insured is considered in this case.
Additional Reading: 5 Tips for choosing a Health Insurance Plan
Here are some of the main benefits of the Arogya Sanjeevani Policy:
Income Tax Benefit - Income tax benefits can be claimed under section 80D of the Income Tax Act, 1961 for investing in this health insurance policy.
No Claim Bonus - A No-claim bonus is provided by the insurance company if no claims are made during the policy term. It is awarded during policy renewal in a consecutive year. A cumulative bonus of 5% of the total sum insured is provided if no claims are made in a policy year. Maximum 50% discount can be availed.
Free Lookup Period – Some insurance providers offer a free look-up period in Arogya Sanjeevani Policy. This period allows the beneficiary to review the terms and conditions of the policy and finalize on its continuation. If one wishes to discontinue, then refund is provided as per the terms of the policy.
Ambulance Charges – Ambulance-related fees are provided by the insurance company. Maximum of Rs. 2,000 per hospitalization can be availed under this cover.
Eligibility Criteria - Who can apply for Arogya Sanjeevani health policy?
A person must be between the age of 18 to 65 years to be eligible for Arogya Sanjeevani Health insurance plan. Depending upon the family size, one can purchase this plan for dependent children in the age range of 3 months to 25 years.
Independent children who are above 18 years of age are not covered in a family policy. They must buy an individual plan to get covered. A Family Floater as part of Arogya Sanjeevani Health policy can cover parents and also in-laws. This policy comes with lifelong renewability except for people above 65 years of age. They can opt to renew existing policies after crossing 65 years of age.
It is easy to get confused while choosing from the various health insurances options online. This is why Arogya Sanjeevani policy was created by the IRDAI help in simplifying health insurance by offering a basic plan with similar benefits offered by all insurance providers. The only aspect which could differ across insurance providers is the level and quality of service offered.