All about “Arogya Sanjeevani” Policy

Ashish M. Shaji

01 Dec, 2020

The Insurance Regulatory and Development Authority of India has formulated a new standard health insurance policy. It is called the Arogya Sanjeevani Policy. It was introduced amidst the Covid-19 pandemic on 1st April 2020. In this article, we will cover this newly formulated policy.

What is Arogya Sanjeevani Policy?

Arogya Sanjeevani is a basic health insurance policy that provides medical/hospitalization expenses up to 5 lakh rupees. This health insurance policy comes as an individual plan and family floater plan that covers the hospitalization expenses arising due to Coronavirus.

It may be noted that this health policy is universal for all general and health insurance companies in India and comes with various benefits as well. It covers pre as well as post hospitalization expenses that include bed and nursing charges, ICU and doctor consultation charges etc.

Plans under the Arogya Sanjeevani Policy

There are two types of plan under this policy. They are:

• Individual Plan– only 1 policyholder will be as the beneficiary; and
• Family floater plan– here entire family members may avail the benefits of this policy. The policyholder may include in a single policy dependents like spouse, children, parents and parents in law.

What does the policy cover?

This health insurance policy comes with following inclusions:

• Pre and Post Hospitalization

As stated earlier this policy covers expenses due to Pre and Post Hospitalization in case of any medical emergency due to any illness or an accidental injury. It will also cover medical and hospitalization expenses due to coronavirus.

• Covid-19 Cover

It shall also offer corona insurance protection and shall pay for any expenses due to hospitalization on contracting coronavirus.

• AYUSH benefit

It shall cover hospitalization expenses incurred due to obtaining alternative treatments like ayurveda, homeopathy etc at an approved hospital.

• ICU & ICCU Expenses

In case of treatment taken in ICU (Intensive Care Unit) and ICCU (Intensive Coronary Care Unit), the policy shall pay up to 5% charges of such treatment of the total sum insured up to a maximum of 10000 rupees per day.

• Room Rent

This policy shall cover the room rent of the hospital as well up to a maximum of 5000 rupees per day.

• Ambulance charges

It shall cover the cost of ambulance service up to a maximum 2000 rupees per hospitalization.

• Plastic surgery and dental treatment

The expenses of any dental or plastic surgery treatment that is taken due to an illness or injury will also be covered.

• Day care treatment

This policy shall cover the expenses incurred due to any daycare treatment procedures. Daycare treatment means medical treatment/surgical procedure which are undertaken under general or local anesthesia in a hospital in less than 24 hours and which would have required a hospitalization of more than 24 hours.

• Cataract surgery

It shall cover the cost of cataract surgery for each eye up to a maximum of 40000 rupees or 25% of the total sum insured amount, whichever is lower.

• New age/Modern treatment

This health insurance policy shall also cover the cost of modern/new age treatment up to a maximum of 50%.

What this policy doesn’t cover?

The exclusions of this policy are as mentioned blow:

• Weight control

Any expense due to treatment for obesity or weight management shall not be covered.

• Gender change treatment

This policy shall not cover any cost associated with the treatment for changing the gender.

• Cosmetic or Plastic surgery

Expenses arising out of cosmetic or plastic surgery which is not needed as a result of an accident, cancer, or burn injury or medical required treatment shall not be covered.

• Maternity expenses

This policy shall not cover the treatment cost of pregnancy and child birth.

• Diagnostic or investigative tests

It shall also not cover the expenses due to any diagnostic or investigative tests.

• Infertility and sterility

Any expense incurred due to Infertility and sterility shall not be covered.

• Nuclear attack or war

The policy will not cover any claims from nuclear attack or war.

Features of Arogya Sanjeevani Policy

The features of this new health insurance policy separate it from other health insurance plans. Some of its attractive features are as follows:

• Sum insured ranging from 1 lakh rupees to 5 lakh rupees;
• Available in individual and family floater basis;
• It covers expenses incurred related to coronavirus;
• Universal coverage, terms and conditions in all health insurance companies in India; and
• It’s more economical than other health insurance plans.

What is the eligibility for Arogya Sanjeevani Policy?

The eligibility requirements are:

• A person of age 18 to 65 years can purchase this health insurance policy;
• Depending on the size of your family, you may buy this plan for dependent children between three to twenty five years; and
• Independent children more than 18 years can’t be covered in a family policy; they are required to buy an individual plan.

What are the benefits of Arogya Sanjeevani Policy?

This policy aims to simplify the health insurance in India.

There are many benefits that can be availed by a policy holder such as:

• Lower Co-payment option

It provides lower co-payment option that means the applicant shall require paying only 5% of the total claim amount.

• Cumulative Bonus

This policy just like any other health insurance plan also rewards a 5%

Cumulative bonus on the total sum insured amount for every claim-free year.

• Benefits for first time buyers

A first time health insurance buyer can get a wide range of coverage at minimum cost without the need to know the advantages and disadvantages of various health plans.

• Lifetime renewability

It comes with renewability of lifetime that permits policyholders to renew their policies for their lifetime.

Conclusion

Read our article:Regulatory Compliances of IRDA for Insurance Companies