Arogya Sanjeevani Health Insurance Policy: Features, Eligibility & Benefits
Arogya Sanjeevani health insurance policy is a basic health insurance plan that offers coverage of up to Rs.5 lakh. It covers medical expenses like ICU services, hospital room rent, hospitalisation expenses, etc. Since its launch on 1st April, 2020, the Insurance Regulatory and Development Authority of India (IRDAI) has mandated 29 general and health insurance companies to market this product.
Read on to know the features, benefits, eligibility, how to claim insurance, documents required and cancellation/refund process of Arogya Sanjeevani Health Insurance Plan.
How To Buy Arogya Sanjeevani Health Insurance Policy Online?
Follow these steps to buy Arogya Sanjeevani Health Insurance:
- Step 1: Go to Arogya Sanjeevani Policy – National
- Step 2: Click on “How to Take a Policy”.
- Step 3: Scroll down and click on “Buy Policy Online”.
- Step 4: Click on Register here or Continue as Guest.
- Step 5: Click on the Health tab.
- Step 6: Click on “Check Premium” under Arogya Sanjeevani Health Policy.
- Step 7: Fill in your details and click on Calculate Premium or Convert to Policy.
Arogya Sanjeevani Health Insurance Policy Details
You can choose between two types of Arogya Sanjeevani Health Insurance Policy:
- Family Floater Plan – If you want to have a health insurance plan for your entire family, choose the Arogya Sanjeevani Health Insurance Family Floater plan. Parents, children, spouse and in-laws can be insured under a single policy.
- Individual – Under this Arogya Sanjeevani Health Insurance Policy, only one person get insured.
Take a look at the details of the Arogya Sanjeevani Health Insurance Policy:
| Health Insurance Company | Niva Bupa Health Insurance (Formerly known as Max Bupa Health Insurance) | Care Health Insurance (Formerly known as Religare Health Insurance) | Raheja QBE Health Insurance |
| Policy Name | Arogya Sanjeevani Niva Bupa Health Insurance | Care Health Arogya Sanjeevani Health Insurance | Arogya Sanjeevani Raheja QBE Health Insurance |
| Plan Type | Indemnity | Indemnity | Indemnity |
| Sum Insured (Rs.) | 1-5 Lakhs | 5 Lakhs | 1-5 Lakhs |
| Premium (Rs.) | 3,148 – 4,722 p.a. | 6,013 p.a. | 2,579 – 3764 p.a. |
| Coverage | Individual/Family Floater | Individual/Family Floater | Individual/Family Floater |
Features of Arogya Sanjeevani Health Insurance Policy
- Sum insured ranges from 1 lakh – 5 lakh rupees.
- Premiums are economical compared to other health insurance.
- Common terms, conditions and coverage throughout India.
- Covers COVID-19 expenses.
- Individual and family floater plans are available.
Coverage Under Arogya Sanjeevani Health Insurance
1. Pre and Post Hospitalisation Expenses
The Arogya Sanjeevani scheme covers medical expenses 30 days before and 60 days after hospitalisation.
2. COVID-19 Cover
Arogya Insurance also extends coverage benefits for hospitalisation expenses for COVID-19 treatment.
3. Alternative Treatments
Arogya Sanjeevani Health insurance policy covers expenses for alternative treatments such as Ayurveda, homoeopathy, etc.
4. Intensive Care Unit (ICU) Charges
The policy covers 5% of the sum assured for ICU charges up to a limit of Rs. 10,000 per day.
5. Hospital Room Charges
Arogya Insurance policy covers room rent charges up to a maximum of Rs. 5000 daily.
6. Ambulance Cover
Ambulance charges up to a limit of Rs. 2,000 per hospitalisation are covered under this policy.
7. Daycare Treatments
It includes the expenses of any daycare procedure.
8. Dental and Plastic Surgery
This policy includes expenses from any dental or plastic surgery availed due to any illness or injury.
9. Cataract Surgery
It covers charges from cataract surgery for each eye up to a maximum cap of Rs.40,000 or 25% of the total sum assured, whichever is less.
Modern Treatments Covered Under Arogya Sanjeevani Health Insurance
Arogya Sanjeevani Health Insurance also includes expenses for modern or new-age treatments such as:
- Oral chemotherapy
- Stem cell therapy (Bone marrow transplant)
- Vaporisation of prostrate (Holmium Laser treatment/Green Laser)
- Intravitreal Injections
- Balloon sinuplasty
- Intraoperative Neuromonitoring
- Uterine Artery Embolization and High Intensity Focussed Ultrasound (HIFU)
- Robotic surgeries
- Bronchial thermoplasty
- Stereotactic Radio Surgeries
Benefits of Arogya Sanjeevani Health Insurance Policy
1. Ideal for First-Time Health Insurance Buyers
As Arogya insurance, this policy comes with several coverage benefits at minimal costs, first-time insurance buyers might want to consider this policy.
2. Simple and Easy
As the coverage benefits and terms and conditions are universal for all the insurance companies in India, members might find it easier to make their selection without any confusion.
3. Cumulative Bonus
For every claim-free year, insurers offer a cumulative bonus of 5% to policyholders of Arogya Sanjeevani.
4. Lower Co-Payment Option
At the time of claim settlement, this insurance option comes with a lower co-payment of only 5%.
5. Lifetime Renewability
Policyholders can avail lifetime renewability on their Arogya health insurance policy.
Eligibility Criteria for Buying Arogya Sanjeevani Health Insurance
- Individuals between 18 to 65 years of age can consider buying this policy.
- If you opt for a family floater plan, you can also include dependent children between 3 months and 25 years.
- Policyholders can also include their parents or parents-in-law under the Arogya Sanjeevani insurance family floater option.
- Individuals with pre-existing diseases, age-related osteoarthritis or osteoporosis, and joint replacement treatments can apply for this policy.
How to File a Claim for Arogya Sanjeevani Health Insurance Policy?
There are various ways to file a claim:
1. Cashless
If the hospital is under the Network Hospitals list of Arogya Sanjeevani Health Insurance, you can claim cashless at the hospital insurance claim desk. Submit all the documents within 24 hours of hospitalisation. For planned hospitalization, send an intimation to your insurer 3 days prior with the name and address of the Hospital and the treatment required. For post hospitalisation insurance claims, submit all the required documents within 15 days.
2. Reimbursement
Inform your insurer through email or fax about the hospitalisation within 72 hours in case of emergency hospitalisation. In case of planned hospitalisation, inform the insurer 72 hours in advance. Obtain claims from A and B from the hospital and mention the necessary details such as investigation reports and discharge summary and submit them to the TPA office within 15 days. You can claim pre and post-treatment expenses separately. For post hospitalisation, submit original documents within 15 days after completing treatment to claim insurance.
Documents Required
- Payment receipts
- Claim form
- Photo ID proof of the patient
- Original prescriptions
- Discharge summary with the complete medical history
- Investigation and diagnostic test reports
- KYC details (with address ID proof)
- OT notes and/or surgeon certificate for surgery
- All original bills
- Medico-Legal Report (MLR) copy, if carried out
- FIR (First information report), if registered
- NEFT details and a cancelled cheque
- Legal successor certificate
- Other documents as required by the TPA (Third Party Administrator).
Cancellation of Arogya Sanjeevani Plan
Policyholders of the arogya sanjeevani health insurance policy plan can avail of a 15-day free-look period wherein they can cancel their plans within 15 days without paying any cancellation charges. They will get back the paid premium amount as a refund other than the expenses incurred by the insurance company.
Further, individuals can cancel their plans even after a 15-day free-look period by giving a 15-days notice to the insurance provider. The premium refund amount will vary as per the cancellation time as follows:
| Cancellation time | Percentage of premium refund |
| Up to 30 days | 75% |
| 31-90 days | 50% |
| 3 -6 months | 25% |
| 6-12 months | 0% |
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Final Word
To conclude, Arogya Sanjeevani Health Insurance Policy is a low-cost premium health insurance that provides coverage for many medical expenses including COVID-19, certain surgeries and post-hospitalisation expenses. Claiming your insurance or cancelling and getting a refund can also be done easily. Check your eligibility and other details before applying for an Arogya Sanjeevani Health Insurance Policy.
FAQs
Ans: Yes. You can opt for cashless claims on your Arogya Sanjeevani health insurance. With this facility, policyholders can get treatment from a network hospital without making any upfront payments.
Ans: The default policy tenure of Arogya Sanjeevani is one year. However, policyholders can continue receiving coverage benefits for a lifetime as there is no renewal cap on this health insurance policy.
Ans: You can get coverage for your family members with the second and third variants of the Arogya Sanjeevani insurance plan. It extends coverage benefits to all family members, including 2 adults and up to 3 dependent children.
Ans: Yes. There are three variants of this plan, including individual plan, non-floater family plan and family floater plan.
Ans: Yes, you can port your existing plan to Arogya Sanjeevani health insurance.
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Disclaimer: This article has been prepared on the basis of internal data, publicly available information and other sources believed to be reliable. The information contained in this article is for general purposes only and not a complete disclosure of every material fact. It should not be construed as investment advice to any party. The article does not warrant the completeness or accuracy of the information, and disclaims all liabilities, losses and damages arising out of the use of this information. Readers shall be fully liable/responsible for any decision taken on the basis of this article.
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