Arogya Sanjeevani Health Insurance Policy: Features, Eligibility & Benefits

Health Insurance

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. 

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:

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

Pre and Post Hospitalisation Expenses

The Arogya Sanjeevani scheme covers medical expenses 30 days before and 60 days after hospitalisation. 

COVID-19 Cover

Arogya Insurance also extends coverage benefits for hospitalisation expenses for COVID-19 treatment. 

Alternative Treatments

Arogya Sanjeevani Health insurance policy covers expenses for alternative treatments such as Ayurveda, homoeopathy, etc. 

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. 

Hospital Room Charges

Arogya Insurance policy covers room rent charges up to a maximum of Rs. 5000 daily.

Ambulance Cover

Ambulance charges up to a limit of Rs. 2,000 per hospitalisation are covered under this policy. 

Daycare Treatments

It includes the expenses of any daycare procedure. 

Dental and Plastic Surgery

This policy includes expenses from any dental or plastic surgery availed due to any illness or injury. 

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

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. 

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. 

Cumulative Bonus

For every claim-free year, insurers offer a cumulative bonus of 5% to policyholders of Arogya Sanjeevani. 

Lower Co-Payment Option

At the time of claim settlement, this insurance option comes with a lower co-payment of only 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 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.

How to File a Claim for Arogya Sanjeevani Health Insurance Policy?

There are various ways to file a claim:

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.

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:

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Benefits of Navi Health Insurance

Paperless Procedure

Members can enjoy a paperless procedure while applying for health insurance due to the technology-driven process. 

Wide Network of Hospitals

There are more than 10,000 Navi-authorised network hospitals in over 400 locations in India. 

High Claim Settlement Ratio

They have a high claim settlement ratio of 97%. 

Comprehensive Health Benefits

You can get a range of coverage benefits by choosing Navi insurance. 

Cashless Claims

You can get cashless claims within 20 minutes by raising claims through the Navi mobile app. 

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 on Arogya Sanjeevani Health Insurance Policy

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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.