13 May, 2022 | Health Insurance

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

Aakansha Jain
By Aakansha Jain
Budding Content Developer at Beshak
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Introduction

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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How Does The Arogya Sanjeevani Policy Work?

  • 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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Expenses Covered By The Arogya Sanjeevani Plan

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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How Much Does The Arogya Sanjeevani Policy Cost?

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

Name of the InsurerRange of sum insured availablePremium (for sum insured of ₹ 5 Lakhs)
Care Insurance50,000 to 10 Lakhs₹ 9,932
HDFC Ergo3 Lakhs to 10 Lakhs₹ 10,363
ICICI Lombard1 Lakh to 5 Lakhs₹ 7,956
Manipal Cigna50,000 to 10 Lakhs₹ 12,636
Niva Bupa50,000 to 10 Lakhs₹ 8,501

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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Comprehensive Health Insurance Vs. Arogya Sanjeevani: What’s The Difference?

ParameterComprehensive Health InsuranceArogya Sanjeevani
Sum insuredThe sum insured ranges from INR 50,000 to 1 Crore and above.The sum insured ranges from INR 50,000 to 10 Lakhs.
Room rent limitThe room rent limit may vary from insurer to insurer. The room rent limit is 2% of the sum insured with a ceiling of INR 5,000 per day.
ICU chargesCoverage of ICU charges may vary across insurers. Generally, insurers cover ICU charges for a certain % of the sum insured up to the total sum insured.  The policy will cover ICU charges of up to 5% of the sum insured or INR 10,000 per day, whichever is lower.
Restoration benefitIn some policies, this feature is available by default, while in others, it is available as an optional benefit.This policy does not provide the restoration benefit feature.
No claim bonusSome policies allow you to accumulate the cumulative bonus up to 100% or more of the sum insured.The maximum bonus you can accumulate is up to 50% of the sum insured.
Free health check-upSome health insurance policies provide a free health check-up benefit.Free health check-up benefit is not available under this policy.
Co-paymentCo-payment is not mandatory in every policy. Co-pay of 10% to 30% is sometimes applicable for people above 60 years.This policy has a mandatory co-pay of 5%.
PED waiting periodThe waiting period for pre-existing diseases may vary from 2 years to 4 years depending on the insurer.A waiting period of 4 years will be applicable for pre-existing illnesses.
Maternity expensesSome policies cover maternity expenses.Maternity expenses are not covered.
PremiumThe premiums may depend on the sum insured you choose as well as the zone you belong to. The premiums are relatively less than comprehensive policies, and they remain the same across zones.

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Premium Comparison Of Arogya Sanjeevani and Some Top Comprehensive Health Insurance Plans

Name of the InsurerPremium of Comprehensive Health Plan available with the InsurerPremium of Arogya Sanjeevani Policy offered by the Insurer
Care Insurance Care: ₹12,839₹9,932
HDFC Ergo Optima Restore: 12,392₹10,363
ICICI LombardiHealth: ₹10,425₹7,956
Manipal Cigna ProHealth-protect: ₹10,494₹12,636
Niva BupaReassure: ₹13,853₹8,501

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

Do All Insurers Provide The Arogya Sanjeevani Policy?

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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Key takeaways
  1. Arogya Sanjeevani policy was launched by the Insurance Regulatory and Development Authority of India (IRDAI) on 1st April 2020.
  2. All insurers who sell health insurance are mandated to offer this basic and standard health policy. 
  3. Arogya Sanjeevani is a basic indemnity health insurance policy and is available as an individual as well as a floater cover.
  4. The sum insured ranges from INR 50,000 10 Lakhs and the entry age of this policy for adults is 18 years to 65 years and for children, it is 3 months to 25 years.
  5. The policy can cover a maximum of 5 members - 2 adults (self and spouse) and up to 3 dependent children.
  6. It covers expenses incurred for modern treatment, AYUSH treatment, pre-hospitalization, post-hospitalization, cataract treatment, etc. up to specific limits.
  7. Arogya Sanjeevani policy premiums are comparatively cheaper than comprehensive health insurance premiums.
Aakansha Jain
Written by,
Aakansha Jain, Budding Content Developer at Beshak

Aakansha is a Content Ideator and Writer at Beshak. With her easy-to-understand content, she makes insurance simple for everyone. She comes with a strong background in finance and commerce and wants to help families make positive insurance decisions that are good for a lifetime.

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