Does Arogya Sanjeevani Health Insurance take care of all your health needs?

Having a health insurance policy is a great way to get financial safety in case of a medical emergency. The Arogya Sanjeevani Health Insurance Policy is one standard health insurance policy. After being mandated by the Insurance Regulatory Authority of India (IRDAI), it provides cover for you and your loved ones. The low premiums along with additional features develop a unique selling point for this health insurance policy for many. 

For a long time, health insurance coverage for the average person in India has statistically been very low. The variety and mixture of the various covers along with expensive premiums are the two major reasons in the market leading to less buyers for health insurance plans. This motivated the state to curate the standard— Arogya Sanjeevani healthcare policy, a basic, yet an affordable healthcare product having all the common characteristics. 

Its differentiating factor from other health insurance plans is that Arogya Sanjeevani does not provide any additional riders or other complex  terminologies. Under the welfare motto of “Health Insurance for All”, this policy is estimated to increase the reach and accepting of health insurance covers across the country, specifically targeted at the tier 2 and tier 3 cities.

When considering to buy the Arogya Sanjeevani Health Insurance plan, knowing its benefits for health cover and even the limitations are required to enable the buyer to  make it the right buy. First let us have a look at terms of the Arogya Sanjeevani Policy in general.

Terms of the policy

• Minimum Entry Age
  • For an Individual: 5 years
  • Family Floater: 3 months for children, with at least one being of age 18 years or above
• Upper age limit for enrolment- NONE
• Life long Renewability- Available for the nearest substitute approved by IRDAI.
• Option for co-payment- 5% on each claim in the policy
• Premium Payment- Premiums to be paid on renewal and the on continuation of cover can be changed after approval from IRDAI.
• Waiting Period- 30 day waiting period for claims made for all illnesses, other than injury.
• Grace period for renewal-  30 days grace for renewal of your policy after it expires.
• Waiting period for ailments- While few of the diseases have 24 months as waiting period other set of diseases have 48 months waiting period
• Pre existing disease wait period- Upto 48 months

Benefits of Arogya Sanjeevani Health Insurance Policy

• Simplicity: Arogya Sanjeevani health insurance policy has a standard set of features and linear coverage. Being available for both individual and family floater options, the policy was brought into action to make health insurance simple and clear. There is a limited number of terms and conditions in Arogya Sanjeevani, that clearly mention which treatments are included and which aren’t. With such simplicity, one will never have any confusion when it comes to making claims or even buying a policy.

• It’s affordable: If affordability is what is keeping from buying a health cover, then, Arogya Sanjeevani may be a good choice. It provides extended coverage in the range of Rs.1-5 lakhs per annum at fair premiums. Thus, being a fairly priced policy, makes quality healthcare for all possible. Your financial shortcomings will never bar you from availing good medical facilities and proper medical attention.

• Exhaustive coverage: The most meaningful benefits of Arogya Sanjeevani is its whole variety of coverages. Hospitalisation expenses like ICU cost or room rent, advanced treatments are all included under the policy. If the insured  wants an optional method of treatment like the AYUSH, they can avail it with Arogya Sanjeevani. Also, cataract surgeries are included, and the insured can make a claim for them. 

Along with these, the healthcare policy also covers any pre- and post-hospitalisation bills. Be it thirty days before hospitalisation to sixty days after the discharge, one benefits from Arogya Sanjeevani healthcare policy. Although being a back health cover, it proved to be a comprehensive health insurance plan, as it provides financial aid from various types of medical bills. 

• It’s flexible : Another benefit that Arogya Sanjeevani health insurance policy brings in is flexibility. Affordable premiums combined with flexible instalments; it makes the policy very appealing to the masses. Being a term-based policy, Arogya Sanjeevani health insurance plans have validity of one year. After this term gets over, the policy holder can continue with the plan for the next year, or they may now pursue renewing it. Apart from providing cover for individuals, the policy provides coverage for their family relatives. In general, Arogya Sanjeevani policy enables you to extend the coverage to your in-laws. Thus, with your family even the policy grows.

• It offers no-claim bonus or NCB: If no claims are made under Arogya Sanjeevani in a year, you can avail the no claim bonus of 5%. It helps policy holders get a discount of 5 per cent when they renew the policy in the consecutive year. Normally, these are not paid out as discounts on the premium but instead they are given out as higher policy plan coverage.

New age health cover benefits under the Arogya Health Insurance Scheme-

To make the policy relevant for the modern age, covers for new-age treatments is provided under the plan. Coverage for such expenses is limited to half the amount of the sum insured. Treatments under the  new-age treatments and are covered by the plan include the following –

• Uterine Artery Embolisation and High intensity focused ultrasound (HIFU)
• Balloon Sinuplasty 
• Deep Brain Stimulation
• Immunotherapy
• Oral Chemotherapy
• Vaporisation of The Prostate
• Intra Operative Neuro Monitoring (IONM)
• Intravitreal Injections
• Stem cell therapy 
• Robotic surgeries
• Stereotactic Radio Surgeries
• Bronchial Thermoplasty

Exclusions and Limitations under Arogya Sanjeevani

 Arogya Sanjeevani also has certain exclusions and limitations similar to any other health insurance cover. These limitations are made with considerations ensuring that health insurance policy continues to serve their purposes while maintaining the standards, the limitations in Arogya Sanjeevani are merely few. Waiting periods, sub-limits, caps on claims amounts in the amounts are standard and stated in clear terms.  There are waiting periods for some pre-existing conditions, as discussed above and covers are valid after 24 months or 48 months. 

Some new age treatments NOT covered under this scheme are—

• Diagnostic expenses
• Medical costs due to activities which breach common law, participating in hazardous activities and undergoing substance abuse
• Any type of cosmetic surgery
• Treatments for weight control
• Vision correction treatments
• Medical emergencies caused due to war
• Rehabilitation costs
• Maternity costs
• Medical treatments undergone outside the county and its medical expenses
• Investigation & Evaluation
• Rest Cure, respite care
• Obesity/ Weight Control
• Change-of-Gender treatments 
• Plastic Surgery 
• Costs due to hazardous or adventure sports 
• Excluded providers 
• Refractive errors
• Unproven treatments 
• Sterility
• Treatments for, Alcoholism, drugs or any addictive illness and reactions thereof 
• Treatments undergone in heath plants, nature cure clinics, spas or similar units or private facilities registered as nursing home attached to such entities or where treatments are arranged fully or partly for private reasons. 
• Dietary supplement and substances that can be brought without official prescription, including but not limiting to Vitamins, minerals and organic substances until prescribed by an authentic medicine practitioner this being part of hospitalisation claim or a day care procedure.
• Any costs on Domiciliary hospitalisation and availing OPD facilities
• War and war like happenings or any invasion, actions of other foreign enemies, hostile situations, civil war, rebellion acts, revolutions or marches, insurrections, mutiny, military or usurped power, seizure, capture, arrest, restraints and detainment of all kinds are excluded from cover under this policy.
• Similarly, nuclear, chemical or biological attacks or weapons, contributed to, caused by, resulting from or from any other cause or event contributing concurrently or in any other sequence to any loss, claim or expense.
• In case of existing diseases, affecting the insured and mentioned in the policy schedule with insured’s consent, policyholder is not liable to be covered under specified ICD codes.

Conclusion

After you analyse the pros and cons of the Arogya Sanjeevani Health Insurance Plan, you can have a better idea about its offerings and its fitment for your needs. Importance of health insurance is growing sharply as healthcare expenses are on rise. In order to prevent medical bills from making a dent on your savings and ensuring peace of mind, a reasonable health insurance coverage is mandatory.