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5 Important Things You Must Know About Arogya Sanjeevani Health Policy

As quality healthcare expenses are continually increasing in an upward direction, people have now started to understand the absolute necessity of having an emergency fund created exclusively to meet healthcare costs. 

It is where buying health insurance comes into the picture. If you’re contemplating purchasing health insurance that covers you or your full family for basic healthcare expenses, you can easily get confused seeing the wide array of health insurance products in the market.  

Arogya SanjeevaniHence, to make insurance simple and easy for people like you, IRDAI asked all insurance companies to include the Arogya Sanjeevani policy as one of their health insurance products. It is a standard health insurance policy covering peoples’ basic healthcare needs. If you want to stay away from the insurance jargons and buy a simple policy that covers your current health requirements, the Arogya Sanjeevani policy is for you.

Also read: Is Buying A Senior Citizen Travel Insurance Worth It?

Depending on your precise requirements, it can be purchased as a family floater plan or an individual policy. To make your work relatively easier, we’ve listed down five essential points about the Arogya Sanjeevani policy that you should know before buying it for yourself or your family.

What is Arogya Sanjeevani Policy? 

This policy is for anyone who wants to secure their future healthcare needs by creating a fund they can rely on during times of medical emergencies. However, there is an entry barrier that you should be aware of. Individuals 18 years and above can only purchase this policy, and the maximum age limit is capped at 65. If you’re opting for a family floater option, remember that you cannot include your children in the coverage who are 18+ years of age and are financially independent.

Inclusions Covered in the Policy

You wouldn’t want to invest in a health insurance product without knowing what it exactly offers. Hence, to cut back on your research time, we’ve listed down what is mostly covered in the Arogya Sanjeevani policy.

  • Room Rent

A hospital has different room types, and the patient gets to choose where he wants to stay, depending on his budget. The Arogya Sanjeevani policy will cover room rent up to a maximum of Rs.5, 000/day.  

  • ICU/ICCU Charges

Serious medical cases require treatment in ICU/ICCU, which is relatively more expensive than normal treatment costs. It is where the Arogya policy can come to your rescue by covering the daily ICU/ICCU expenses of up to 5% of the total policy’s sum insured value, subject to a maximum of Rs.10, 000/day.  

Also read: National Health Insurance Schemes In India

  • Pre & Post-Hospitalization Expenses

The pre and post-hospitalization expenses incurred due to an accident or illness is covered under this policy. Pre and post-hospitalization expenses refer to the costs generated from a hospital stay, medicines, diagnostics, doctor’s charges, operation costs, etc. Such pre and post-hospitalization expenses 30 days before and 60 days after hospitalization are covered in the Arogya Sanjeevani health insurance policy.

  • Ambulance Charges

If you ever had to use an ambulance to take the covered person in the policy to a hospital, you can claim ambulance charges up to a maximum of Rs.2, 000 per hospitalization.  

  • Daycare Treatments

One of the best parts of the Arogya health insurance policy is it covers the daycare treatment expenses of its policyholders. For the uninitiated, daycare treatments refer to the treatments or surgeries that require less than 24 hours of hospitalization. Not all health insurance policies cover daycare treatments, but the Arogya policy does.  

  • AYUSH

Not all people prefer getting treated using mainstream treatment options; hence, they look for alternative treatments like Homeopathy, Ayurveda, Unani, and/or Siddha. If this sounds like you, you can claim healthcare expenses incurred on such treatments, provided the treatment is done in a certified hospital in any of these alternative treatment fields.

  • New Age Treatment

The advancement in medical science technology has given rise to various new-age treatments like Stem Cell Therapy, Balloon Sinuplasty, IntraVitreal Injections, Robotic surgeries, Oral Chemotherapy, Immunotherapy, and many more. If you’re health condition requires you to undergo any of the new age treatments, as specified in the policy, you can claim the treatment expenses for the same.    

  • Cataract Surgery

Policyholders of the Arogya Sanjeevani policy can avail claims for their surgery of up to 25% of the total policy’s sum insured value or Rs.40, 000 – whichever is lower.

  • Plastic & Dental Surgery

If you had to undergo dental or plastic surgery necessitated by a road accident or an illness, the cost towards such surgery will be covered under the policy.

Also read: What Is Group Health Insurance & Why Must You Consider It?

The coverage offered under the Arogya Sanjeevani policy is pretty straightforward and the same across insurance companies. The only differentiating factor is the customer support provided by the insurance company, the premium charged, and the list of partner or network hospitals. So choose your insurance company wisely.  

The Benefit of Cumulative Bonus

An excellent benefit of the Arogya Sanjeevani policy is its cumulative bonus. If you purchased the Arogya policy for yourself or your family but didn’t file any claim in a year, the insurance company will reward you with a cumulative bonus. The bonus will be added to your policy’s total sum insured for every claim-free year.

Low Co-Payment Clause & Low Premium

When you file for a claim with the insurance company, you’re supposed to pay a certain percentage of the claim value, known as co-payment. The insurance company pays the remaining and significant part of the claim. If you don’t want to pay a higher sum during medical emergencies, you should opt for health policies that have a low co-payment clause. Luckily, the Arogya Sanjeevani policy has a low co-payment clause, which means you won’t have to bear the burden of high medical expenses at a future date.

Besides the low co-payment, Arogya Sanjeevani is also deemed as one of the most affordable health insurance policies available in the market. It’s premiums are comparatively lower, but they will vary from one insurance company to another. Some people tend to incline towards the Arogya Sanjeevani health policy due to the relatively lower premiums, but they fail to see that lower premiums come with limited coverage.

Exclusions in the Policy

Now that you’re aware of the inclusions already, you should also be aware of the policy’s exclusions. The Arogya Sanjeevani policy doesn’t cover treatment expenses for the following:

  • Treatments for gender change
  • Medical expenses related to participation in adventurous sports or hazardous activities    
  • Sterility and fertility treatment expenses
  • Medical costs arising due to substance abuse
  • Treatment without a doctor’s recommendation
  • Claims resulting from attempting to commit a criminal act
  • Any pre and post-hospitalization expenses not related to the medical claim
  • OPD expenses or domiciliary expenses
  • Maternity related expenses
  • Cosmetic surgeries, unless necessitated by an accident or illness, and more

Though most of the exclusions have been listed above, it will be wise to read the list of exclusions mentioned on the insurer’s website or policy documents. Doing so will remove any guesswork or doubts, ensuring you’re clear with the policy terms from day 1.

Also read: What Expats Need To Know About Health Insurance In Australia

Choose Comprehensive Health Insurance for Maximised Coverage:

In a world of complexities, the Arogya Sanjeevani policy is like a breath of fresh air. It is simple to understand with straightforward terms and offers basic coverage for individuals and family members. 

The only downside to this policy is its limited coverage. For those looking for maximised coverage benefits, opting for a health insurance policy is the best option. Its coverage is maximised to all kinds of medical expenses, including hospitalization expenses along with surgery, medical treatments and beneficial add-ons. It is advisable to buy comprehensive health insurance cover over Arogya Sanjeevani policy if you are looking for better health insurance benefits.

To help you decide if the Arogya policy is right for you or not, we’ve listed above all the important information you should have before buying this standard health insurance policy. To make your experience the best, always purchase this policy from a reliable insurance company known for offering the best customer support, a good claim settlement ratio, and a good reputation.

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