All you need to know about Arogya Sanjeevani Health Insurance Policy

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Health insurance is indispensable and the fact cannot be stressed enough after the outbreak of the second wave of Covid-19 across the country. However, buying a health insurance policy is not so easy as there are a plethora of options available with each policy having its own terms and conditions. Realizing the need, Insurance Regulatory and Development Authority (IRDAI) last year directed all insurers to offer Arogya Sanjeevani Health Insurance, which is a standard cover that is easy to understand with common features and exclusions across insurers.

Arogya Sanjeevani Health Insurance is an affordable and simple health insurance policy approved by IRDAI but not sponsored by the government. Under this policy, the entry age limit for adults is 18 years to 65 years. While for children when you buy a family floater plan, it is 3 months to 25 years. At the time of launch, the sum insured was fixed at Rs 5 lakh. Later it was increased to unlimited coverage but recently IRDAI has restricted the cover again up to Rs 10 lakh.

Here are salient features of the Arogya Sanjeevani Policy which you should know about before buying the policy:

Room rent sub-limit: Room rent tariff is covered only up to 2% of the sum insured, subject to a maximum of Rs 5,000 per day.

ICU Coverage: ICU charges are covered up to 5% of the sum insured, subject to a maximum of Rs. 10,000 per day.

Co-pay: You will need to pay 5% out of your pocket for any claim, rest 95% of the admissible claim amount will be paid by your insurer.

Cataract Surgery: Cataract treatment cost is covered after two years up to 25% of the sum insured, subject to a maximum of Rs 40,000.

Pre-existing Illnesses: Pre-existing conditions get covered after a waiting period of 48 months and continuous renewal for four years

Day Care Treatments: A few surgeries that require less than 24 hours of hospitalisation are covered under the policy.

Pre and Post Hospitalization: Medical expenses 30 days before and 60 days after the hospitalisation is covered.

AYUSH Treatment: Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homeopathy (AYUSH) treatment are covered in the policy.

Dental and Plastic Surgery: Dental treatments or plastic surgeries due to accidents or diseases are also covered.

Ambulance Expenses: Expenses incurred on road ambulance are covered up to a maximum of Rs2000 per hospitalisation.

Grace Period: For the yearly payment mode, a fixed period of 30 days is allowed as a grace period and for other modes of payment (monthly, quarterly, half-yearly) a fixed period of 15 days is allowed as a grace period.

Premium rates: While terms and conditions of the policy remain the same across insurers, the premium amount varies from policy to policy. To give you an idea Acko Insurance offers the policy at Rs 3,099 (GST included) for a 19-year-old with a sum insured of Rs 5 lakhs.

Given the sub-limits and capping on the sum insured, Arogya Sanjeevani Policy is a good option for base-level entry as it is simple and easy to understand.