Arogya Sanjeevani Yojana


When you consider buying a health insurance policy, there are various companies, offering the same, and they also have various plans with different features. This often leads to confusion as to which health plan to opt. The Insurance Regulatory and Development Authority of India (IRDAI) has announced a standard product with all the basic understandable features. This product is named ‘Arogya Sanjeevani Yojana’, followed by the name of the insurer. Say, for instance, if Max Bupa is providing this standard health insurance plan then the name of the product would be ‘Arogya Sanjeevani Policy – Max Bupa’. A universal name makes it easier for people to determine its unique features, as the product is standardized and not company-specific.

Features of Arogya Sanjeevani Policy

  • You can buy this standard product as an individual plan as well as a family floater plan.
  • A family is defined as the spouse, mother, father, mother-in-law, father-in-law, and dependent children of age group between 3 months to 18 years. In case, you have an independent child of over 18 years of age, he or she is not eligible to be included in the plan.
  • The policy is offered as indemnity insurance and one cannot add a rider, such as critical illness cover.
  • A 30 days grace period is allowed for the yearly premium payment and a 15-day grace period for other modes.
  • The minimum sum assured is Rs 1 lakh and the maximum sum assured is restricted to Rs 5 lakhs.
  • Like the other health insurance policy, the period for this policy is also one year. This means that you need to renew the policy every year. Having said that, the policy offers a lifelong renewable option as well.
  • The premiums can be paid yearly, half-yearly, quarterly, or monthly.
  • The minimum entry age for the principal insured is 18 years and the maximum entry age is restricted to 65 years.
  • They have a 5 per cent co-payment clause, which applies to all age groups.
  • For cataract surgery, sub-limits are actual expenses, 25 per cent of the sum assured or Rs 4 lakh, whichever is lower.
  • This product will have two kinds of waiting periods. One waiting period would be of 24 months and another would be of 48 months, depending upon the illness.
  • You get a portability option with this policy.
  • The premium is not specific to any geography or zone. The pricing would be standard pan India.
  • Although it covers the hospitalization expenses, such as room, boarding, and nursing expenses, they are capped up to 2 per cent of the sum assured or a maximum of up to Rs 5,000 per day.
  • ICU/ICCU expenses are also capped up to 5 per cent of the sum assured or a maximum of up to Rs 10,000 per day.
  • This policy also covers AYUSH (Ayurvedic, Yoga, and Naturopathy, Unani, Siddha, Homeopathy) treatments.
  • This policy covers 30 days of pre-hospitalization expenses and 60 days of post-hospitalization expenses.
  • This policy also offers ‘No Claim Bonus’ (NCB) of 5 per cent and up to 50 per cent of the sum assured for each claim-free year.
  • The premiums paid for this policy are not eligible for deduction under Section 80D of the Income Tax Act.
  • Also, there is a waiting period of 30 days from the date of issue of the policy.
  • There are certain exclusions as well, such as treatments related to weight loss, change of gender, plastic surgery, hazardous adventure sports, breach of the law, or due to war.
  • This policy does not cover maternity benefit.
  • Third-party administrator (TPA) facility and cashless benefit are available with this policy.
  • You can have multiple Arogya Sanjeevani Policies and, in such cases, you have a right to choose the insurance company or policy for the claim.
  • You have the facility to cancel the policy. So, if you opt to cancel the policy within 30 days, then you will get 75 per cent of the premiums paid, by 31 to 90 days you will receive 50 per cent of the premiums, by 3 to 6 months you will get 25 per cent, and if you cancel by 6 to 12 months, you would not get anything in return.
  • You also have the facility to migrate to the other products of the same company.
  • This product is available to all from April 01, 2020.

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