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Everything you need to know about Arogya Sanjeevani Policy

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What is Arogya Sanjeevani Policy?
Arogya Sanjeevani insurance policy is a standard health insurance policy that was introduced by the Insurance Regulatory and Development Authority of India (IRDAI). This was introduced on the 1st of April 2020 in response to the growing number of COVID-19 cases in India, and to better help, the citizens cope with the medical costs.

This insurance policy is mandated by the IRDA for every insurer to provide this plan. So you can universally avail of this plan with any insurance company in India. The premium could vary from company to company as it depends on the customer service, purchase process, claim settlement process, etc.

What is the sum insured amount of this policy?
Under Arogya Sanjeevani health insurance, the minimum amount is Rs. 1 lakh and the maximum amount is Rs.5 lakh. It has a tenure year of 1 year. You can also renew it for a lifetime as well.

What are the types of Arogya Sanjeevani policy?
There are mainly two types of Arogya Sanjeevani policy.

  • Individual Plan – Here, only one person can be enrolled in the policy. Only an individual can get the sum insured. 
  • Family Floater Plan – The entire family can be enrolled in this plan. All the family members, including parents, spouse, children, and parents-in-law, can be added to this plan.

Read more: The difference between Individual Health Insurance Plans and Family Floater plans 

What are the basic coverages in this plan?

  • Hospitalization expenses – All pre and post hospitalization charges are covered in this plan. That is, both COVID-19 hospitalization and other hospitalization due to illnesses or accidents are covered under this policy. 
  • COVID-19 cover – The policy was mainly intended for COVI-19 coverage. It is a comprehensive policy that covers your other medical needs as well. 
  • AYUSH cover – Alternate treatment plans such as Ayurveda, Homoeopathy, Unani, etc. are also covered in this plan. 
  • Room rent – You can get a maximum of Rs.5000 per day as room rent allowances. The rent will be capped at this amount. 
  • ICU/ICC charges – 5% of ICU treatment charges of up to a maximum of Rs. 10,00 per day will be borne by the insurer. 
  • Ambulance Services – A maximum of Rs.2000/ per hospitalization is covered. 
  • Plastic Surgery and Dental Treatments – Any plastic surgery or dental treatment that you have to undertake because of an injury or disease is covered. 
  • Cataract Surgery – 25% of the total sum insured with a maximum of Rs.40000 can be availed for any cataract related surgery for each eye. 
  • Modern Treatment Method – You can also take the help of modern treatment methods such as balloon Sinuplasty, Immunotherapy and Stem Cell Therapy, etc. 50% of the total sum insured can be used for this.
What is not covered in this policy?
  • Diagnostic tests – Diagnostics and investigative test expenses are not covered in this policy. 
  • Rehabilitation expenses – Bed rest and expenses during rehabilitation are excluded. 
  • Gender change treatment – Gender changing treatments are not covered.  
  • Cosmetic Plastic surgery – Surgeries which are not related to an accident or disease-related plastic surgeries are not covered under this policy.
  • Maternity benefits – Pregnancy and child coverage are not included. 
  • Out-patient treatment – Only in-patient treatments are included in the policy. 
  • Unproven treatment – Any treatments which are taken without the prescription of doctors will not be covered. 
  • Treatment outside India – This policy is only valid for getting treated in India. It is invalid outside India. 
  • Dietary Supplement expenses – Any dietary supplements such as minerals, vitamins, etc. which need to be taken outside of doctor’s prescription are not covered.

What are the standard benefits of Arogya Sanjeevani?
Arogya Sangeevani covers accidental, illness and COVID-19 hospitalization – With this policy, COVID-19 hospitalization is also covered along with your standard medical insurance coverage. Your standalone individual insurance policy might not have the provision for COVID-19 coverage. This policy will thus give you comprehensive coverage to help you through these tough times. If you take a standalone COVID-19 policy, then you will not be covered for your other medical expenses.

Read more: COVID -19 test results now available online in Karnataka

  • Lower Premium – Because it is a standard policy stipulated by the IRDA, the premium is comparatively lower than other standard insurance policies.
  • Lifetime renewability- You can either opt for the one year plan that will give you over in the hopes that the pandemic will get over in a year or opt for a lifetime renewability option if you are unsure about how everything will pan out.
  • Cover for individuals and family – Depending on the need, you can choose the policy for individual or family. The adaptable types make it easier to choose an affordable, depending on your requirement.
  • Cumulative Bonus is available – Argoya Sanjeevani will also give you a 5% bonus for every claim-free year. This is a standard method in the usual health insurance policy. Arogya Sanjeevani too, has adopted this policy to reward the health policyholders.
  • Low co-payment option – Co-payment is when the policyholder will have to bear a portion of the expenses from their own hand. But with Arogya Sanjeevani, you will only have to bear 5% of the total claim amount during the claim settlement process.

Who should buy this policy?
This policy is best suited for first-time insurance buyers. The policy is affordable for individuals and families alike. It is on par with other standard insurance policies while also being affordable. The policy wordings are easier to understand, and you will not have much trouble navigating through the process. This will be highly suitable for unmarried individuals with fairly good health records who don’t have to cover their dependents.

Disadvantages of this policy

  • Since the maximum sum insured is Rs. 5 lakhs, it could be unsuitable for people who have ailing parents and family members who need to visit the hospital frequently. 
  • Since it doesn’t cover maternity expenses, it will not be suitable for expectant mothers and people wanting to start a family. 
  • It does not cover critical illnesses. 
  • Not suitable for senior citizens as the premium will be higher compared to the benefits offered.
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