The Insurance Regulatory and Development Authority of India (IRDAI) on April 1 launched the Arogya Sanjeevani — a standard health insurance policy for individuals and families. The regulator mandated all insurance companies to offer this policy which provides coverage of up to Rs 5 lakh for basic hospitalisation-related expenses.
The IRDAI website said, “In the context of outbreak of COVID 19 pandemic, it is clarified to the Public, that indemnity based health insurance products that cover the treatment costs of hospitalization offered by all general and health insurance companies cover the costs of hospitalization treatment on account of COVID -19. All insurers have been advised by the Authority vide Circular dated 30th March, 2020 insurers to expedite settlement of COVID 19 related claims.”
The authority had issued guidelines on Standard Health Insurance Policy called Arogya Sanjeevani and had issued clearance to 29 General and Health Insurance companies to market this product.
What is Arogya Sanjeevani Policy?
Arogya Sanjeevani is a standard health insurance plan that is offered by multiple health insurance companies in India. This policy is being sold as per the IRDA directives. The following two types of plans are available under Arogya Sanjeevani Insurance Policy:
- Individual Plan: A single policyholder will be the beneficiary of Arogya Sanjeevani policy.
- Family Floater Plan: Multiple family members of the policyholder can become the beneficiaries of Arogya Sanjeevani plan.
Arogya Sanjeevani Policy is an all-in-one health plan that will look after your financial needs in times of medical emergency.
What is Covered under Arogya Sanjeevani Policy?
This policy offers multiple benefits to the policyholder and his/her family depending upon the type of plan purchased. The Arogya Sanjeevani Policy launch date was 1st April 2020. People who wish to buy the policy can get covered with multiple insurance benefits. Let’s go through the coverages, features, and benefits of Arogya Sanjeevani health insurance policy:
Coverages: Inclusions of Arogya Sanjeevani:
Following are the Arogya Sanjeevani Standard Health Insurance Coverages:
1) Pre Hospitalization:
Your insurance company will cover the cost of treatment required as a preparation for hospitalization for a specific ailment. Depending on the terms of your insurance policy, you can receive this benefit for 30 days before hospitalization.
Under the Arogya Sanjeevani Policy, one can claim the cost of treatment during hospitalization from their insurer. Various things like nursing expenses, room rent, hospital stay, bed charges, etc. form a part of this coverage. Your insurer may put a cap of 2% of the sum insured up to Rs.5,000 per day on hospitalization.
If the patient is admitted in a critical care unit like Intensive Care Unit (ICU) or Intensive Cardiac Care Unit (ICCU), your insurer may pay 5% of the sum insured up to Rs. 10,000/- per day.
Fees of the medical practitioners like surgeons, consultants, anaesthetists, special attending doctors, etc will be covered under the Arogya Sanjeevani Policy. The coverage also includes charges for oxygen, operation theatre charges, surgical appliances, anaesthesia, blood, medicines and drugs, etc.
3) Post Hospitalization:
Some surgeries or ailments may require a patient to continue treatment after getting discharged from the hospital. Arogya Sanjeevani Policy will cover such expenses under Post Hospitalization. The period until when the insurer will be liable to pay these charges depends upon the terms and conditions of the policy. Usually, Post Hospitalization costs are covered for 60 days after discharge.
4) Room Rent/Doctor’s Fee And Nursing Expenses:
Room Rent usually has a cap on the percentage of sum insured of the policy. The Arogya Sanjeevani Policy will pay 2% of the sum insured up to Rs. 5000/- per day.
5) ICU and ICCU Expenses:
In case of intensive Care Unit (ICU), the room rent paid will be 5% of the sum insured up to Rs. 10,000/- per day.
6) Ambulance Charges:
The cost of transporting a patient with the help of an on-road Ambulance will be borne by the insurance company. The cap for this expense is Rs. 2000/- per hospitalization during the policy period.
7) Daycare Treatment:
For these out-patient treatments, 50% of the sum insured can be claimed.
8) Dental Treatment and Plastic Surgery:
The expenses related to Dental treatment and Plastic surgery will be covered up to the limit of sum insured of the policy.
9) AYUSH Care:
The expenses related to AYUSH treatment in a hospital offering these services will be covered up to the limit of sum insured.
10) Cataract Treatment:
The cost of this treatment will be covered up to 25% of the sum insured or Rs. 40,000/- (whichever is lower) by the insurance company for each eye.
11) Stem Cell Therapy:
This comes under out-patient treatment and thus it has a cap of 50% of the sum insured during the policy period.
12) New-age/Modern Treatment:
A New-age/Modern treatment that is mentioned in the policy will be covered under out-patient treatment. It will have a cap of 50% of the sum insured.
Features of Arogya Sanjeevani health policy:
- It offers a standardised product that covers basic hospitalisation needs of customers.
- This policy comes with minimum sum insured of Rs 1 lakh and maximum of Rs 5 lakh.
- These are available for both individual and family.
- The minimum and maximum entry age are 18 and 65 years. For children under ‘Family Floater’ policies, the entry age is 3 months and exit is 25 years.
- This policy is annually renewable with a grace period of 30 days.
- A co-payment of 5 per cent is applicable across all ages meaning the policyholder is required to pay 5 per cent of the bill amount compulsorily.
- No add-ons and optional covers are available in Arogya Sanjeevani Policy.
Eligibility for Arogya Sanjeevani Plan:
A person between the age of 18 to 65 years is eligible to purchase the Arogya Sanjeevani Health insurance policy. Depending upon the size of your family, you can buy this plan for dependent children between 3 months and 25 years.
Independent children over the age of 18 years cannot be covered in a family policy, they will have to buy the individual plan. A Family Floater Arogya Sanjeevani Health plan may also cover parents and parents-in-law. Note that this health insurance policy has lifelong renewability however people above the age of 65 cannot buy a fresh policy. Existing policies can be renewed if the policyholder crosses 65 years of age.
You will receive the following benefits with Arogya Sanjeevani Policy: