Arogya Sanjeevani Policy – Standard Health Insurance Features and Benefits

Are you confused while buying health insurance for your family or yourself with so many features? The answer is Arogya Sanjeevani Policy.

When we are buying health insurance, many of the plan features will go out of our heads. To make it simple, IRDA announced the standard product with all basic features understandable to all of us. This product is labeled as “Arogya Sanjeevani Policy <name of insurer>. For example, if Apollo Munich company is offering this standard health insurance for you, then the product name will be like Arogya Sanjeevani Policy Apollo Munich.

By making it a universal name, you can easily find out the features unique. Because the product is not company-specific but the features are standardized.

This Arogya Sanjeevani Policy offers basically three benefits to all buyers.

# It takes care of the basic health insurance requirements of the public.

# It will have common policy wordings across all the industries.

# It provides a seamless portability feature.

Features and Benefits of Arogya Sanjeevani Policy

Let us now look at the features of the Arogya Sanjeevani Policy.

• This standard product is available as an individual as well as family floater health insurance.
• Family means Spouse, Parents, Parents-In-Law and dependent children between 3 months to 18 years.
• If the child above 18 years of age is independent, then he or she is not eligible to be included.
• It is offered as indemnity insurance without any riders like Critical Illness cover.
• For a yearly premium payment, 30 days grace period is allowed and for other modes 15 days grace period.
• Minimum Sum Assured is Rs.1 lakh and the maximum sum assured is Rs.5 lakh.
• The policy period is for one year.
• You can pay the premium as Yly, Hly, Qly, or Mly.
• The minimum entry age for the principal insured is 18 years and the maximum entry age is 65 years.
• The policy offers a lifelong renewable option.
• 5% Co-Payment clause is applicable for all ages.
• Sub limits for cataract surgery is actual expenses, 25% sum assured or Rs.40,000 (whichever is lower).
• There are two types of waiting periods. One type of waiting period is for 24 months and another type is 48 months.
• The plan offers the portability option also.
• The premium will be based on India basis but not based on geographic or zone-based pricing.
• It covers the hospitalization expenses like Room, Boarding, Nursing expenses up to 2% of Sum Assured or the maximum of Rs.5,000 per day.
• ICU/ICCU expenses up to 5% of Sum Assured or the maximum of Rs.10,000 per day.
• It covers Ayush Treatment.
• 30 days Pre Hospitalization expenses.
• 60 days Post Hospitalization expenses.
• NCB (No Claim Bonus) of 5% for each year up to 50% of the Sum Assured.
• No deductible.
• This product is available to all from 1st April 2020.
• There is 30 days waiting period also from the date of issue of the policy.
• There are certain exclusions also like treatments related to weight loss, change of gender, plastic surgery, hazardous adventure sports, breach of law or due to war etc.
• Maternity benefit is not available in this plan.
• TPA facility is available and also cashless benefits.
• One can have multiple Arogya Sanjeevani Policies. In such cases, policyholder have a rights to choose the insurance company or policy for a claim.
• You can cancel the policy also. If you cancel within 30 days, then you will get 75% of the premium, 31 to 90 days means 50%, 3 to 6 months means 25% and 6 to 12 months means 0%.
• You can migrate to the other products of the same company.

Arogya Sanjeevani Policy – Should you buy?

I feel the features are easy to understand for many of us. Hence, once you thoroughly understood the features of Arogya Sanjeevani Policy, then you can opt the product from any non-life insurance company of your choice as the product features will remain the same.

However, as per the guidelines, I understand that the premium fixing is left with insurance companies. Hence, even though product feature remains same, the premium may vary from company to company.

In the age of no co-payment products, this product offers 5% co-payment, which I think a hindrance.

There is a 2% room rent cap or a maximum of Rs.5,000 per day and 5% or Rs.10,000 ICU and ICCU cap. This is again one more hindrance as based on room rent cap, your billing will be done.

The best part of this product is that the premium will not be fixed based on zone. Instead, it will remain same throughout India.

I think there are no daycare treatment listings. Hence, I feel all the daycare treatments are eligible for the claim.

Restricting sum assured to Rs.5 lakh is one more hindrance. However, guidelines state that there is no such restriction if one has to buy multiple Arogya Sanjeevani Policies. In such a situation, I think putting the maximum limit is useless. Instead, one is allowed to choose his own sum assured.

Overall, it looks fine for me as of now. However, let us see how the insurance companies take this product seriously and sell it.

Refer our latest post on Non Life Insurance companies:-

• Health Insurance Incurred Claim Settlement Ratio 2018-19
• Health Insurance Claims can’t be rejected after 8 Yrs !!