Health insurance companies have been charging exorbitant prices on their policies in recent years. A study by the World Health Organization (WHO) found that out-of-pocket healthcare expenses push an estimated 55 million Indians into poverty every year.
The Government of India has launched the Aarogya Sanjeevani Yojana to provide access to affordable health insurance coverage to all Indians. Everything you need to know about Aarogya Sanjeevani’s policy and how it can help you will be covered in this post.
What is Arogya Sanjeevani’s policy?
Arogya Sanjeevani Policy is a basic health insurance policy launched by the Insurance Regulatory and Development Authority of India (IRDAI) in 2020. This policy was implemented to make health insurance affordable and accessible to a large number of Indian people.
Arogya Sanjeevani policy is a basic health insurance policy that covers hospitalization expenses for the treatment of illnesses or injuries. The policy covers pre and post-hospitalization expenses, ambulance charges and day-care procedures.
The policy also covers AYUSH treatments (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy). the minimum sum assured in the policy is Rs 1 lakh and the maximum sum assured is Rs 5 lakh.
All general insurance companies in India offer a policy that has a standard set of features and benefits. If you understand what Arogya Sanjeevani Policy is, we will proceed to learn the key features of Arogya Sanjeevani Policy.
Key Features of the Arogya Sanjeevani Policy
Arogya Sanjeevani policy has many features. The key features of the Arogya Sanjeevani Policy are:
- Standardized benefits across all insurers in India: This feature guarantees that customers get the same benefits and features, irrespective of their chosen insurance provider. This enables policyholders to compare insurance and choose the best one for their needs.
- Affordable premiums: The policy offers an affordable premium, making it an excellent option for individuals and families on a tight budget.
- No-claim bonus of up to 50%: The policy offers a no-claim bonus of 5% of the sum assured for every claim-free year, up to a maximum of 50%. It encourages policyholders to maintain a healthy lifestyle and avoid hospitalization.
- Renewal options for a lifetime: The policy can be renewed annually for life, ensuring long-term coverage and peace of mind for policyholders. This facility provides financial protection against future healthcare expenses.
Benefits of the Arogya Sanjeevani Policy
- Easy comparison of policies for policyholders: All the insurance companies offering the policy have the same basic features and benefits. This makes it easy for policyholders to compare policies and make informed decisions based on their needs.
- Essential health coverage at an affordable cost: Aarogya Sanjeevani’s policy provides necessary health coverage at a reasonable price. The policy covers hospitalization expenses including room rent, nursing expenses, surgeon fees, anaesthesia fees and medical practitioner fees. It also includes expenses related to diagnostics, prosthetics and medical equipment.
- Comprehensive coverage for hospitalization expenses and treatments: Arogya Sanjeevani’s policy provides comprehensive coverage for hospitalization expenses and treatment. The policy covers expenses related to room rent, boarding and nursing expenses up to a certain limit. It also covers the expenses related to surgery, anaesthesia and medical practitioner’s fees.
- Coverage for AYUSH treatments: Arogya Sanjeevani policy also covers alternative treatments like Ayurveda, Yoga, Naturopathy, Unani, Siddha and Homeopathy (AYUSH). The policy covers the expenses incurred on AYUSH treatment up to a certain limit.
- Incentives for a healthy lifestyle through the no-claim bonus: Arogya Sanjeevani policy protects you with no-claim bonuses to encourage healthy living. If the policyholder does not file a claim during the entire policy term, the insurance company will pay a no-claim bonus. The incentive is usually in the form of a discount on the premium for the next insurance term.
- Long-term coverage and financial protection through renewal options: Aarogya Sanjeevani’s policy provides long-term coverage and financial security through renewal options. The policy can be renewed for a period of one year to three years. By opting for a long-term policy, the policyholder can avail of a discount on the premiums payable. The policy also provides financial protection in case of medical emergencies, thus providing peace of mind to the policyholder.
Exclusions of the Arogya Sanjeevani Policy
Like all health insurance policies, the Arogya Sanjeevani Policy also has certain exclusions. The exclusions of the policy are as follows:
- Pre-existing diseases/conditions for a specified waiting period: A pre-existing disease or condition is a medical condition that you had prior to purchasing the policy. Aarogya Sanjeevani’s policy covers pre-existing conditions but requires you to complete a specified waiting period before making a claim for the same.
- Cosmetic or plastic surgery: Arogya Sanjeevani’s policy does not cover cosmetic or plastic surgeries unless they are necessary due to an accident or injury.
- Self-inflicted injuries or attempted suicide: Injuries caused due to self-harm or attempted suicide are not covered under Aarogya Sanjeevani policy.
- Injuries resulting from adventure sports or activities: Any injury or hospitalization resulting from participation in adventure sports or activities such as bungee jumping, rock climbing, paragliding etc. is not covered under the Arogya Sanjeevani policy.
- HIV/AIDS and related diseases: Arogya Sanjeevani Policy does not cover expenses related to HIV/AIDS or any other sexually transmitted diseases.
- Non-allopathic treatments: The Arogya Sanjeevani policy covers only allopathic treatments and does not cover alternative or traditional treatments such as Ayurveda, Unani or Homeopathy.
- Pregnancy and childbirth-related expenses: Arogya Sanjeevani’s policy does not cover expenses related to pregnancy and delivery, which includes pre-natal and post-natal care.
- War or war-like situations: Any medical expenses incurred as a result of war or war-like conditions, such as riots or civil disturbances, are not covered under the Aarogya Sanjeevani policy.
- Nuclear contamination and related events: Any medical expenses arising due to nuclear contamination or radiation exposure, including expenses due to nuclear reactor or nuclear explosion, are not covered under Aarogya Sanjeevani Policy.
- Experimental and unproven treatments: Arogya Sanjeevani’s policy does not cover expenses related to experimental or unproven treatments which are not yet approved by the government or medical authorities.
It is important to note that the above list is not exhaustive, and policyholders are advised to read the policy documents carefully to understand the complete list of exclusions.
Arogya Sanjeevani Policy or Regular Health Insurance: Which is Better for You?
Choosing between an Arogya Sanjeevani policy and a regular health insurance policy depends on various factors such as your budget, healthcare needs and personal preferences. Here are some of the key differences between the two that can help you make an informed decision:
Coverage: The Arogya Sanjeevani policy provides coverage for hospitalization expenses, pre and post-hospitalization expenses, day-care procedures and AYUSH treatments. Regular health insurance policies, on the other hand, offer a wide range of coverage options including critical illness coverage, personal accident cover, and more.
Cost: Aarogya Sanjeevani policy is designed to provide affordable health insurance coverage, with premiums that are lower than most regular health insurance policies. However, regular health insurance policies may offer more comprehensive coverage options but with higher premiums.
Add-ons: Some regular health insurance policies offer add-ons such as maternity cover, personal accident cover, and more. These add-ons are not available with Arogya Sanjeevani Policy.
Network hospitals: Most regular health insurance policies have a larger network of hospitals and healthcare providers as compared to Aarogya Sanjeevani policy, which is still a relatively new product in the market.
If you are looking for a low-cost health insurance policy that covers hospitalization and related charges, then Arogya Sanjeevani policy is a great option. On the other hand, a general health insurance policy may be a better option if you have specific health needs or want more complete coverage options. When making a decision, it is important to carefully examine the features, benefits and rates of multiple insurances.
Eligibility and Documents Required
The eligibility criteria for Arogya Sanjeevani Policy are straightforward and easy to fulfil.
- Age: The minimum age for purchasing the policy is 18 years, and the maximum age is 65 years.
- Family floater option: The policy can be purchased on an individual basis or as a family floater policy covering two adults and up to three children.
- Medical history: Applicants must disclose any pre-existing medical conditions, illnesses, or surgeries they have undergone in the past while purchasing the policy.
- Waiting period: The policy has a waiting period of 30 days from the date of purchase, during which no claims can be made. However, the waiting period is waived in case of an accidental hospitalization.
- Renewal age: The policy offers lifetime renewability, which means that it can be renewed for as long as the policyholder wants, subject to the terms and conditions of the insurer.
- Payment of premiums: Applicants must pay the policy premiums in full and on time, as per the payment schedule specified by the insurer.
- Coverage: The policy offers coverage for hospitalization expenses, pre and post-hospitalization expenses, day-care procedures, and AYUSH treatments up to the sum insured limit chosen by the policyholder.
- Medical check-up: Depending on the age and medical history of the applicant, a medical check-up may be required before purchasing the policy.
Claiming Against Arogya Sanjeevani Policy
To make a claim against an Arogya Sanjeevani Policy, you need to follow the below steps:
Intimate the insurer: You must inform the insurer about the hospitalization or the planned medical procedure as soon as possible, usually within 24-48 hours. You can do this by calling the customer care number or by emailing the insurer.
Provide details: You will need to submit all relevant information to the insurer including policy number, policyholder name, date of admission, medical condition details and treatment cost estimate.
Submit documents: You will need to submit all required documents, such as a hospitalization/discharge summary, bills and receipts, prescriptions, diagnostic reports, and other relevant documents as requested by the insurer.
Get approval: Once the insurer receives your claim request and verifies the details, they will accept or reject the claim based on the terms and conditions of the policy.
Reimbursement or cashless: If your claim is approved, you can either opt for reimbursement of the expenses incurred, or you can avail of the cashless facility offered by the insurer, where they pay the bill directly with the hospital.
It is important to note that you must follow the claim process as per the recommendations of the insurer to ensure a smooth and hassle-free claim settlement process. In case you have any doubts or queries, you can always contact the customer care of the insurer.
Requirements and documents needed for the claim process
You must submit the following documentation to begin the claim procedure for an Arogya Sanjeevani Policy:
Duly filled claim form: You must fill the claim form with accurate and complete information. The form can be downloaded from the insurer’s website or obtained from their office.
Original hospital bills: You will need to submit the original bills issued by the hospital, which include the breakup of expenses for various services, such as room rent, consultation fees, diagnostic tests, medicines, etc.
Hospital discharge summary: The hospital discharge summary provides an overview of the treatment given, diagnosis, medications prescribed, and the course of treatment. This document is essential for the claim processing.
Doctor’s prescriptions: You will need to present the original prescriptions provided by the doctor, indicating the drugs prescribed, dosage and duration of the medication.
Diagnostic reports: Any diagnostic reports such as x-rays, blood tests, CT scans, MRI reports, etc., need to be submitted along with the claim.
KYC documents: You need to provide your KYC documents like your Aadhaar Card, PAN Card, Passport, Voter ID Card etc. to establish your identity.
Other documents: The insurer may require additional documents such as referral letters, pre-authorization forms and other documents specific to the medical condition and treatment.
To begin the claim procedure for Arogya Sanjeevani Insurance, you must submit the following documents. It is important to keep original copies of all documents on hand for future reference. To avoid claim rejection, make sure you follow the insurer’s claim submission process and give accurate information.
In conclusion, Aarogya Sanjeevani Policy is a useful health insurance policy for consumers who are looking for affordable and comprehensive coverage for critical health needs. It offers a variety of benefits, including hospitalization and AYUSH treatment coverage, encouragement for a healthy lifestyle, and long-term financial security through renewal options.
It also makes it easier for policyholders to compare plans and select the one that best meets their needs as it is standardised. Overall, Aarogya Sanjeevani Insurance is a sound investment in one’s health and wellness, providing peace of mind and security in case of unforeseen medical emergencies.
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