What Does The Standard Health Insurance Plan ‘Arogya Sanjeevani’ Cover?

• Introduction
• How Does The Arogya Sanjeevani Policy Work?
• Expenses Covered By The Arogya Sanjeevani Plan
• How Much Does The Arogya Sanjeevani Policy Cost? 
• Comprehensive Health Insurance Vs. Arogya Sanjeevani: What’s The Difference?
• Premium Comparison Of Arogya Sanjeevani and Some Top Comprehensive Health Insurance Plans
• Do All Insurers Provide The Arogya Sanjeevani Policy?

The Insurance Regulatory and Development Authority of India (IRDAI) has mandated every insurance provider to offer Arogya Sanjeevani - a basic & standard health insurance policy for both individuals and families. Arogya Sanjeevani was launched by IRDAI on 1st April 2020. It is a basic indemnity health insurance policy, and the primary aim behind launching this policy was to make insurance more accessible, affordable, and less confusing for buyers. 

Now that we know what is Arogya Sanjeevani Policy, let’s understand how the policy works, what are the features it offers, and how is it different from a comprehensive health insurance policy.

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• Policy Type: You can buy the Arogya Sanjeevani plan either as an individual cover, that will cover one individual under one policy, or as a family floater, where your entire family can be covered under a single plan.
• Sum insured range: The sum insured range will vary across insurance companies. Generally, you can choose a minimum sum insured of INR 50,000 and a maximum sum insured of INR 10,00,000. 
• Policy term: The maximum duration under the Arogya Sanjeevani health insurance policy is one year. 
• Entry age: For adults, the entry age is 18 to 65 years. Adults can buy this standard policy either as a floater or an individual cover. The entry age for children is 3 months to 25 years. While children between the age of 3 months to 18 years can be covered under the policy only on a floater basis, 18 to 25-year-old children can take the cover either on an individual or a floater basis. 
• Members covered: Generally, you can cover yourself, your spouse, dependent children, parents, and parents-in-law under the Arogya Sanjeevani plan. The total number of members you can cover under one policy, however, might vary across insurance companies.

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Here's a list of expenses the Arogya Sanjeevani Plan will cover - 

• Pre and post-hospitalization expenses: The Arogya Sanjeevani policy will cover expenses you incur before and after a hospitalization. Pre-hospitalization expenses of up to 30 days and post-hospitalization expenses of up to 60 days will be covered. 
• Room rent, boarding, nursing expenses: These expenses charged by the hospital or the nursing home will be covered up to 2% of the sum insured for a maximum of INR 5000 per day. 
• ICU and ICCU charges: The Arogya Sanjeevani health insurance policy will cover Intensive Care Unit (ICU) and Intensive Cardiac Care Unit (ICCU) charges of up to 5% of the sum insured for a maximum of INR 10,000 per day. 
• Cataract treatment: Arogya Sanjeevani Policy will cover cataract treatment expenses (per eye) of up to 25% of the sum insured or INR 40,000 - whichever is lower. 
• AYUSH treatment: Alternative treatments, also known as AYUSH treatment, includes Ayurveda, Unani, Siddha, Homoeopathy, Naturopathy, etc. The cost of these treatments will be covered up to the sum insured you opt for. 
• Modern treatment: Expenses of treatments or surgeries carried out using advanced methods will be covered up to 50% of the policy sum insured. 
• Waiting period: Some diseases won’t be covered for a short period after the policy is issued. This period is called the ‘waiting period’. Arogya Sanjeevani policy has a waiting period of 4 years for pre-existing diseases and 2 years to 4 years for specific diseases. 
• No claim bonus: The insurance company will reward you with a No claim bonus for every claim-free year. Your sum insured will increase by 5% every year you don’t make a claim, and you can accumulate a bonus of up to 50% of your policy sum insured. 
• Co-payment: At the time of claim, you’ll have to pay a co-payment of 5% of your hospital bill out of your pocket and the insurance company will pay the balance amount.
• Freelook period: Arogya Sanjeevani policy comes with a free look period of 15 days. During this period, you can review your policy and if you’re not happy, you can return it to the insurer.
• COVID-19: Hospitalization expenses arising out of Coronavirus (COVID-19) will also be covered in the plan. 

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Here’s a comparison of the Arogya Sanjeevani Policy premium and the sum insured range offered by top insurance companies.

Please note: 

1- There are a few insurers in the market that offer the Arogya Sanjeevani policy for two individuals together. For instance, HDFC Ergo and Niva Bupa. 

2- The premiums in the table are calculated for two adults, age 30 years, individual cover, sum insured INR 5 Lakhs.

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Please note: The premiums in the table are calculated for two adults, age 20 years, individual cover, sum insured INR 5 Lakhs.

While IRDAI has made it mandatory for all insurance companies to sell the Arogya Sanjeevani policy, there are some insurers like Aditya Birla, TATA AIG, etc. who have the policy on their website but don’t have an online purchase option to buy the policy.

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