What is Arogya Sanjeevani Policy?

Arogya Sanjeevani is a newly formed standard health insurance policy by the Insurance Regulatory and Development Authority of India (IRDAI). The insurance got regulated from 01-04-2020 from all general insurance providers across India, offering coverage from 1- 5 Lakhs.

Apart from covering the medical costs due to hospitalisation, it also covers Covid-19 treatment costs. Arogya Sanjeevani Health Insurance Policy offers the following two plans:

  • Individual: A single policyholder will be the beneficiary.
  • Family Floater: Multiple family members of the policyholder can become the beneficiaries.

Eligibility for Arogya Sanjeevani Plan:

Anyone between 18 and 65 years is eligible to buy the Arogya Sanjeevani Health insurance policy. One can buy this plan for dependent children between the age group of 3 months and 25 years (depending upon the family's size).

Independent people over the age of 18 years will have to buy the individual plan as they cannot be covered in a family policy.

Note: Arogya Sanjeevani Policy can be renewed for lifelong; however, people over 65 years cannot purchase a new policy. They can renew the existing one once they cross 65 years of age.

What are the Benefits of Arogya Sanjeevani Policy?

  • Income Tax Benefit One can claim a tax benefit under section 80D (ITA, 1961) after buying this policy.
  • No Claim Bonus One can get a bonus amount (5% of the sum insured) if the insured does not claim any benefits in a specific policy year.
  • Free Lookup Period Some insurance providers may offer a free lookup period on Arogya Sanjeevani Policy in which you can thoroughly read the terms and conditions of your health insurance policy and choose whether you want to continue with the policy. If you don't wish to continue, you will get the refund according to the insurance provider's policy.
  • Ambulance Charges The insurer bears the ambulance costs with the capping of 2000 INR per hospitalisation.
Inclusions of Arogya Sanjeevani Policy
  • Pre-Hospitalisation - Your insurance company will cover the treatment expenses required as a preparation for hospitalisation for a specific disease. Depending on the policy's T&C's, you can receive this benefit before hospitalisation for 30 days.
  • Hospitalisation -

    As per the Arogya Sanjeevani Policy, one can claim the treatment expenses during hospitalisation from their insurance company. Several things like room rent, bed charges, nursing expenses, etc., are included in this coverage.

    Arogya Sanjeevani Policy also covers the fees of medical practitioners like consultants, anaesthetists, special doctors, and surgeons. Moreover, the policy also includes OT charges, oxygen charges, medicines and drugs, blood, surgical appliances, anaesthesia, operation theatre charges, surgical appliances, etc.

  • Post-Hospitalisation - Some surgeries require a patient to extend treatment even after getting discharged. Arogya Sanjeevani Policy will cover such costs under Post-Hospitalization. The duration until when the insurer will be paying these charges depends upon the policy's T&C's.

    Other benefits include:

    • Doctor's Fees, Room & Nursing Expenses
    • ICU, ICCU, and Ambulance Expenses
    • Day-care, Dental, & Cataract Treatment
    • Plastic Surgery, AYUSH Care
    • Stem Cell Therapy
Exclusions of Arogya Sanjeevani Policy
  • Law Breach - If the policyholder requires medical treatment due to an event that broke the law, those expenses are not covered.
  • Diagnostics/Evaluation - The expenses of diagnostics/evaluation procedures are not covered.
  • Cosmetic Surgery - The costs of cosmetic treatments are not covered unless there are burns, an accident or cancer. In a situation like this, the attending doctor should certify the requirement of cosmetic surgery.
  • Gender Change Treatment - Treatments related to transforming a body's characteristics to match the opposite sex are not covered.
  • Adventure Activities - Treatment expenses arising from taking part in a Hazardous/Adventure sport are not covered.
  • Weight Management - Treatments related to weight management unless meeting the following:
    • Surgery
    • Patient > 18 years of age
    • Patient has a BMI (Body Mass Index) of the following conditions:
      • BMI > 40
      • BMI = 35 and has severe multiple health issues
    • Cardiomyopathy (Obesity-related)
    • Heart diseases
  • War - Any injuries related to biological, chemical, or nuclear wars in the country, are not covered.
  • Eyesight Treatment - Eyesight treatment correction due to refractive error < 7.5 dioptres.
  • Infertility - Treatment-related to IVF, ZIFT, GIFT, ICSI, sterilisation, surrogacy, etc.
  • Rehabilitation and Respiratory Care - Treatment taken in spa clinics, personal care nursing facilities, and rehabilitation centres is not covered.
  • Maternity Expenses - Any delivery (natural or caesarean,) is not covered.
  • Drug Abuse - Treatment expenses due to excessive consumption of drugs, alcohol, or any other intoxicating substance are not covered.

List of Top Health Insurance Companies in India are-

  • Star Family Health Insurance Plan - All daycare procedures, air ambulance (specified limit), domiciliary hospitalisation expenses (home treatment) and pre/post-hospitalization expenses for up to 60 to 90 days respectively. These are some of the coverage provided by the Star Family Health Insurance Plan. This plan can be regarded as a super saver that offers to cover the entire family at a nominal premium.
  • Apollo Munich Optima Restore Plan - Any person whose age ranges between 65 days to 91 days can be covered under this plan. Apollo Munich Optima Restore Plan is one of the most popular health insurance plans that provide some of the incredible benefits and the sum assured ranges between Rs 3 to 50 lakhs. Get lifetime renewability, cover for daycare procedures, in-patient hospital coverage, road ambulance cover and 100% increase in the sum assured for 2 claim-free years from Apollo Munich Optima Restore Plan
  • Max Bupa Health Companion Individual Plan - If you want a high coverage with minimum premium than Max Bupa Health Companion Individual plan is the ideal health insurance for you. This plan also offers a 12.5% discount on premium in the second year. Get coverage for in-patient hospitalization treatment, 30 to 60 days of pre/post-hospitalization cost, lifetime renewability option and 15 days free look period.
  • HDFC Ergo Health Suraksha Plan - One of the unique things about HDFC Ergo Health Suraksha Plan is that there is no maximum age limit and the plan offers several variants like-silver, gold, and platinum which comes with different features, benefits, and assured sum under them. Did you know? HDFC Ergo Health Suraksha Plan covers organ donor expenses, day-care procedures, and coverage for in-patient hospitalisation cost without any restriction on room rent and disease coverage.

Frequently Asked Questions

The things that one needs to look upon while purchasing a policy are claim process, pay-out mechanism, adequate cover, waiting-period and pre/post-hospitalization benefit.

The documents which are required to buy a health insurance plan include-age proof, identity proof, address proof, medical check-up reports(optional) and passport size photo.

Yes you can do so without waiting to get one through your employer. Online mode is the best way to purchase health insurance. When you buy insurance online you can understand the various policies, sitting at the comforts of your home, rather than moving around with agents (extra expense)

Depending on the medical history and age of the applicant many insurance policies might not issue the policy without asking for am medical test. In case, you are above the minimum age(varies from policy to policy) then the medical test will be required.

The sooner the better. As in the later stage of your life, you may get deprived of immediate coverage (waiting period) and the premium cost might rise as well.