Arogya Sanjeevani Policy Details: Eligibility, Coverage, Benefits

One fine morning, Ravi, an executive in a large private bank read about the Introduction of the Arogya Sanjeevani Policy by the IRDAI. Since he hailed from a small town, the quoted coverage of this policy – Tier 2 and Tier 3 cities being the target interested him. 

Upon further research he understood that the policy provided a standard coverage especially for first-time health insurance buyers. 

To get a better insight, he asked the following questions to the insurance service provider: 

1. What is the basic eligibility required to opt for insurance coverage under the scheme?
2. What would be the features & extensive coverage of the plan?
3. Key benefits of the policy and some major exclusions
4. If any new-age treatments are made available as a part of the policy?

Let us read on to find out more about the newly mandated scheme. 

Arogya Sanjeevani policy and it is Eligibility

Boasting of a standard coverage and having benefits and same characteristics across major insurance companies; Arogya Sanjeevani health insurance policy aims at providing huge relief to standard insurance buyers. Though majority of the companies provide the same set of features, benefits and cater to the needs of the ones covered under the plan, the premium does differ. The premium is often based on the pricing policies of individual insurance companies. 

• The policy provides an exhaustive coverage – quite effective for young people. It does not burn a hole in the pocket as the sum assured falls under the mass affordability category.
• Usually, the employed not having any dependents or who are not yet married go in for this plan as it is best suited to them.
• As the policy provides both Individual and Family Floater plan options, it becomes convenient for policy seekers.
• The basic eligibility for the plan is as follows:

1. It can be availed by any individual between the age group of 18 to 65 years
2. In case of Family floater plans, policies for the dependent children in the age group of 3 months to 25 years can be bought
3. Both parents and parents-in-law can be included under a Family Floater Plan
4. One prime point in case of eligibility is that independent children above the age of 18 years cannot be included under a Family Floater Plan. For them, they are required to get a separate individual insurance cover. 

Features of Arogya Sanjeevani

Let us look at some of the salient features of the policy which one should be aware of:

• Term Limit is that of one year after which it can be renewed to get continued coverage. 
• Both an Individual as well as a Family floater plan are offered under the aegis of this policy. 
• In case of no claims being made by the policyholder in any particular year; they are entitled to a no-claim bonus by the insurer. It is generally a 5% increase in sum assured with no additional premium cost. 
• Minimum waiting period in case of pre-existing illnesses, joint replacement surgeries and age-related osteoporosis and osteoarthritis is 4 years. Otherwise, the general waiting period is 2 years. 
• The premium cost is one such factor which varies from company to company and depends on age, medical history, number of members covered, and the sum insured chosen by the insured.
• Health check-ups are needed only for people of the age of 45 years and above. 

Coverage provided in Arogya Sanjeevani plan

Ravi moves a step ahead and inquires’ about the extent of coverage of the policy. This is what he finds out from his research:

1. Pre and post hospitalisation costs—

Costs due before hospitalisation are called pre-hospitalisation expenses. These expenses are covered up to thirty days prior to hospitalisation. After the patient is discharged from the hospital – any and all expenses fall under the category of post hospitalization charges & are covered up to sixty days from discharge period. 

2. In-patient hospitalisation expenses— 

These expenses are included when a patient is admitted in the hospital for beyond 24 hours. Right from the doctor’s consultation, the nurse fees, room rent, medical expenses, glucose, blood & oxygen supply etc. are all a part of the same.  There are certain limits – like in case of room rent of the ICUs. Limit on room rent is 2% of total sum insured and can go up to a maximum of Rs.5,000/ day. For ICU it is 5% of the sum insured and covers a maximum limit of Rs.10,000/ day.

3. Ambulance charges— 

The cost of the ambulance to carry a patient from their place of residence to the hospital for treatment purpose is covered as a part of the policy. The maximum cost that can be claimed here is Rs.2,000 for each instance of hospitalisation. 

4. Day-care treatment charges—

Treatments that do not require 24-hour of hospitalization and can be taken care of by advanced medical techniques is called day-care treatment. This facility is available up to the monetary limit of half of the total sum assured. 

Benefits of Arogya Sanjeevani health insurance policy

Out of the various benefits being offered to the policy holders; the below are few crucial advantages of an Arogya Sanjeevani Health Insurance policy. 

• For people looking for an inexpensive and an exhaustive health insurance policy- you can opt for Arogya Sanjeevani health insurance policy and get yourself and your family covered.

• This plan covers many of the new age modern treatments that will usually not get covered for you under many other basic health insurance plans owning to their simplicity and price effectiveness.

• In this plan, since the major coverage characters are quite basic, one can get the policy online through any available insurance providers after judicious comparison of the premium rates charged and other features.

• The premium amount for the Arogya Sanjeevani plan is eligible for deductions under Section 80D of the Income Tax Act. The maximum deduction that a policyholder can claim is Rs.25,000 which changes to Rs. 50,000 in case of senior citizens. Thus, if a person takes a regular policy and a senior citizen policy for parents, the total tax deduction can go up to Rs.75,000 per year.

Exclusions

The plan is quite comprehensive and takes care of decent medical conditions. However, it does have certain exclusions – the claims made under which are not accepted by the insurance company. Even though the scope of the plan under the Arogya Sanjeevani health insurance policy is fairly exhaustive, this policy has certain exclusions and under such conditions claims are not settled. The basic exclusions from this plan are given as under – 

1. Diagnosis costs
2. Medical costs arising out of acts of substance abuse or after taking part in hazardous programmes 
3. Gender reversal treatments or any cosmetic surgeries 
4. Undergoing inorganic weight control treatments
5. Surgical costs – incurred to correct vision 
6. Infertility treatments
7. Medical conditions arising out of war-like scenarios 
8. Rehabilitation expenses: both mental and physical 
9. Maternity cost expenses 

New Age treatments covered are as below-

• Intra Operative Neuro Monitoring (IONM)- While a surgery is conducted, there are certain neural structures which require constant monitoring. This can be done with the help of IONM. 

• During this treatment electrophysiological methods like Electro Encephalography (EEG), electromyography (EMG) is used.

• Intravitreal Injections- These injections are given directly in the patient’s eye by the medical practitioner to cure issues related to the retina of the eye. This is not a one-time process and is done in regular intervals as the medical practitioner deems fit. 

• Stem cell therapy – Since the cells of the body have a fixed function they are used in treatment or in prevention of any illness or disease. 

• Robotic surgeries are also included.