Arogya Sanjeevani Policy

Medical emergencies often take away all our savings, so we avoid that by buying insurance that safeguards our financial interests.

There was always a need for insurance companies to create an affordable and easy-to-understand policy. IRDAI(Insurance Regulatory and Development Authority of India) has asked for the same from the companies.

When you are taking Health insurance for the first time can it is quite normal to get confused because they use a very formal language which we are not accustomed to, So IRDAI has formulated certain guidelines for all the health insurance companies to create a standardized health insurance product –called  “Arogya Sanjeevani Policy.”

What Is Arogya Sanjeevani Policy?

Arogya Sanjeevani policy is a recently launched, standard media claim policy set by the IRDAI to be accessible for everyone.

All health insurance companies in India will offer Arogya Sanjeevani sooner or later. The standard Arogya Sanjeevani policy will provide health insurance cover between Rs 1 lakh to Rs 5 lakhs, all having the same terms and conditions.

It is divided into two types.

• Individual Plan:- A single person will be the beneficiary for the insurance.
• Family Floater Plan:- Multiple members can take one single plan.

*IRDAI:- (Insurance Regulatory and Development Authority)

Benefits Of Arogya Sanjeevani Policy

1. You can claim a tax benefit in the Income Tax when you buy this health insurance policy.

2. All the terms and conditions and levels of coverage for all the insurance are the same; hence, there will be no confusion in the health insurance buyer’s minds.

3. When no claims are raised during a policy period, a No-claim bonus is offered. This means that you get back 5% of the premium paid when you renew the policy next year. This cumulative bonus percentage depends on the company and can reach up to 50%

4. Some insurance companies also facilitate the free look-up period on Arogya Sanjeevani Policy. In the free look-up period, you can thoroughly check the terms and conditions of the policy. You will even get your premium refunded if you wish to discontinue the health insurance policy.

5. This policy offers an option of lower co-payment, which means that the health insurance buyer has to pay on 5% of the total claim amount at the time of settlement.

Eligibility For Buying Arogya Sanjeevani Plan

i. Any person of age between can 18 to 65 can buy the policy. However, if your child is also included, he should be less than 25 years of age and greater than 3 months.

ii. People over 65 cannot buy a new policy. They can only renew their existing policies.

iii. Independent children over 18 cannot be included in family policy.

What Is Covered Under The Arogya Sanjeevani Plan Policy?

1. Pre and Post hospitalization:- The policy will cover all the expenses incurred during Pre and Post hospitalization due to illness or injury

2. COVID 19:- All the expenses incurred due to coronavirus will also be covered

3. Ayush care:- All the expenses are covered up to the sum insured.

4. Room Rent:- The room rent up to a maximum of Rs5000 will be covered

5. Day Care treatment:- It covers all the expenses arising out of these treatments.

6. ICU/ICCU treatment:- All the expenses arising out of ICU or ICCU are covered

7. Ambulance Services:- All the ambulance expense up to Rs2000 will be covered

8. Cataract Surgery:- cataract surgery expenses up to Rs 40,000 or 25% of the total sum incurred will be covered(whichever among the two is lower)

9. Stem Cell Therapy:-50% of the sum is insured

10. Dental Treatment and Plastic Surgery:-All the expenses related to dental treatment and Plastic surgery will be covered up to the limit of the sum insured of the policy

11. New-age/Modern Treatment: –A New-age/Modern treatment mentioned in the policy will be covered under out-patient treatment, and It will have a cap of 50% of the sum insured.

What Is Not Covered Under Arogya Sanjeevani Plan ?

Here is a list of things that are not covered under the policy

i. If the medical treatment expense is due to breaking the law

ii. The cost of cosmetic surgery is not covered unless a need arises due to burns, accidents, or cancer.

iii. Medical treatment is done due to hazardous/adventure sports.

iv. Any injuries due to a war-like situation

v. Treatment due to the correction of eyesight

vi. Treatment-related to I V F, ICSI, sterilization, ZI FT, GIFT, surrogacy, sterilization, and reversal of sterilization.

vii. Treatment taken in spa clinics, rehabilitation centers, nursing facilities for personal care will not be covered.

viii. If the medical treatment is not taken in India

ix. Treatment is done due to the excessive use of alcohol, drugs, or any other intoxicating substance that will not be covered.

x. The delivery cost is not covered.

xi. The cost of organic supplements, vitamins, proteins are not covered unless prescribed by a doctor during hospitalization.

List Of New Age/Modern Treatment Covered Under Arogya Sanjeevani Plan 

• AYUSH Treatment
• Cataract Treatment
• Uterine Artery Embolization and HIFU (High intensity focused ultrasound)
• Balloon Sinuplasty
• Deep Brain Stimulation
• Oral Chemotherapy
• Immunotherapy
• The Vaporization of The Prostate
• IONM – (Intra Operative Neuro Monitoring)
• Stem Cell Therapy
• Intravitreal Injections
• Robotic Surgeries
• Bronchial Thermoplasty
• Stereotactic Radio Surgeries

Note:- The expenses related to the treatments mentioned above will have a coverage of 50% of the sum insured.

Features Of Arogya Sanjeevani Health Insurance Policy

1. Insurance cover is given from 1 lakh to 5 lakh
2. More affordable, due to less premium.
3. Single terms and condition, coverage across all the insurance providers covers COVID 19 expenses also
4. Insurance and renewal can be done online
5. Available for an individual as well for family

Who Is Arogya Sanjeevani Policy Best Suited For?

With an ocean full of different health policies, choosing one is very difficult. Arogya Sanjeevani Policies help us avoid confusion by having the same terms and conditions and coverage, which are just given by different insurance providers. It is a boon for first-time medical buyers.

It is best suited for individuals and the family as it provides complete coverage for basic hospitalization to new age treatments.

Who Should Avoid Buying The Arogya Sanjeevani Plan ?

Even when you want health insurance where the amount covered is greater than 5 lakhs, Arogya Sanjeevni Policy is not appropriate.

When you want health insurance for your children, parents, and yourself, the covered amount of 5 lakhs may not be enough, so in that case, you should consider other health insurance options.

How To Buy Arogya Sanjeevani Policy?

Arogya Sanjeevani Policy can be purchased online or from the insurance agent.

The policyholder can compare premium rates of different companies online and go ahead with what best suits them and their needs.

Even if you have purchased the insurance online, you must issue the documents physically.

After you have submitted the document physically and the complete procedure is over, the insurance provider will provide you with a Certificate of insurance, Including the T&C and details of Arogya Sanjeevani policy.

Companies Offering Arogya Sanjeevani Policies

Even though all the insurance companies must introduce Arogya Sanjeevani Policy, some are still yet to launch it.

Here is the list of companies currently offering Arogya Sanjeevani Policy:-

• Universal Sompo General Insurance
• United India Insurance
• Tata AIG Insurance
• SBI Insurance
• Royal Sundaram General Insurance
• Religare Health Insurance
• Navi General Insurance
• Max Bupa Health Insurance
• Manipal Cigna Health Insurance
• Magma HDI General Insurance
• Kotak Health Insurance
• Bajaj Allianz General Insurance
• Digit General Insurance
• Edelweiss General Insurance
• Future Generali India Insurance
• HDFC ERGO General Insurance
• HDFC ERGO Health Insurance

Premium Comparison

We are giving a list of cheapest health insurance policies for a 30-year-old and coverage of 3 lakhs.

*source:-policy bazaar.com

Procedure For Claims

1. Treatment may be taken in a network provider and is subject to pre-authorization by the Company or its authorized TPA(Third Party Administrator).

2. The form is available with the insurance provider and TPA(Third Party Administrator)when you want a cashless claim, which shall be completed and sent to the Company/TPA for authorization.

3. When the Company or TPA (Third Party Administrator) will receive a cashless request form and all related medical documents and information from you or the network provider, the company has to circulate a pre-authorization letter hospital after verification.

4. At the time of discharge, the insured person has to pay for the non-medical and all the expenses that are not covered in the insurance, and then he has to verify and sign the discharge papers.

5. If the insured person cannot provide all the medical documents, then the company or TPA has a complete right to deny pre-authorization.

6. If the company denies cashless access, then after his/her treatment is over, he may submit all the claim documents to the TPA or the company for reimbursement

Arogya Sanjeevani Policy Renewal

The insurer cannot deny policy renewal except on the grounds of fraud, moral hazard, misrepresentation by the insured person

i. Renewal of policy shall not be denied on the ground that the insurer had made one or multiple claims in the preceding policy years

ii. The Company shall receive a request for renewal and the necessary premium before the end of the Policy.

iii. At the end of the Policy Period, the policy will be terminated. It can be renewed within the Grace Period to maintain continuity of benefits without a Break in Policy.

iv. Coverage is not available during the grace period or whenever the premium is not paid.

v. If a previously dependent child covered under the Arogya Sanjeevani policy attains 18 years and is now financially independent. At the time of renewal, he/she will be removed from the policy.

vi. If you renew the policy again and the previous year was claim-free, then the company will provide you a cumulative bonus of 5%

Waiting Period

The waiting period is of 24 to 48 months, depending on the types of disease. The insurance will be covered only when the waiting period for the specific disease is over

Months waiting period are given for these diseases:-

1. Benign ENT disorders

2. Tonsillectomy

3. Adenoidectomy

4. Mastoidectomy

5. Tympanoplasty

6. Hysterectomy

7. All internal and external benign tumors, cysts, polyps of any kind, including benign breast lumps 8) Benign prostate hypertrophy

9. Cataract and age-related eye ailments

10. Gastric/ Duodenal Ulcer

11. Gout and Rheumatism

12. Hernia of all types

13. Hydrocele

14. Non-Infective Arthritis

15. Piles, Fissures, and Fistula in the anus

16. Pilonidal sinus, Sinusitis, and related disorders

17. Prolapse inter Vertebral Disc and Spinal Diseases unless arising from an accident

18. Calculi in the urinary system, Gall Bladder, and Bile duct, excluding malignancy.

19. Varicose Veins and Varicose Ulcers

20. Internal Congenital Anomalies

48months waiting period is given for these diseases:-

• Replacement of joints
• Age-related Osteoarthritis & Osteoporosis

Arogya Sanjeevani Policy Refunds And Cancellations

All the insurance policyholders are given a ‘free look’ for 15 days. The insurer can cancel the insurance in its free look period, and the insurer will be given a full refund of its premium.

Note:- Refund is not applicable on policy renewal

After the lookup period is the policy, providers can refund the premium (if canceled)on small interest rates, as mentioned below.

1. Up to 30 days:- 75% of the premium will be refunded
2. 31 to 90 days:- 50% of the premium will be refunded
3. 91 days to 6 months:-25%  of the premium will be refunded
4. 6 months to 1 year:- 0% of the premium will be refunded

FAQs

Conclusion

Medical Insurance is a must in this uncertain world. Arogya Sanjeevani Policy is being proved as a boon in the field, which provides the same features as normal health insurance with a lower premium and some extra features. You should also cheque out some other government schemes like atal pension, Sukanya Samridhi scheme, and Pradhan Mantri Awas Yojana, Thank You.