Today there are several products offered under the Health Insurance category by various General and Standalone Health Insurance companies. Each product offered has its own unique feature which makes it challenged for a common man to opt the best plan. Therefore with the following objectives, IRDA has decided to mandate all the general and health insurers to offer the standard health insurance product:
• Insurance policy to take care of basic health needs
• To have a standard product with common policy wordings across the industry
• To facilitate seamless portability among insurers
Arogya Sanjeevani Policy has come into effect April 1, 2020 and is mandated to all insurers to be offered mandatorily.
Main Features of Arogya Sanjeevani :
1. Individual & Floater:
This product is be available under Individual and family floater basis. (Family as defined in the wordings)
2. Minimum & Maximum Sum Insured:
Available Sum Insured minimum Rs. 1 lac and maximum Rs. 5 lacs (in multiples of rupees fifty thousand there on)
3. Modes of premium payment:
All the modes (Yly,Hly,Qly,Mly) along with ECS (Auto debit facility) is also be allowed.
4. Entry Age & Renewability:
Minimum Entry age shall be 18yrs for principal insured and maximum age at entry shall be 65 yrs along with lifelong renewability. Dependent children can be added after completion of 3 months to 25 yrs subject to definition of family.
5. Hospital Expenses: Coverages are as follows –
• Room, Boarding, Nursing Expenses upto 2% of the sum insured subject to maximum of Rs. 5000 per day.
• Surgeon, Anesthetists, Medical Practitioner, consultants, Specialist Fees to the treating doctor / surgeon or to the hospital
• Intensive Care Unit (ICU) / Intensive Cardiac Care Unit (ICUU) expenses upto 5% of sum insured subject to maximum of Rs. 10,000 per day.
6. Other Expenses:
Coverages are as follows – Expenses incurred on treatment of Cataract subject to sub limits of 25% of sum insured or Rs. 40,000 whichever is lower per eye, Dental and Plastic surgery treatment necessitated due to disease or injury, All the day care treatments upto 50% of sum insured, Expenses incurred on road ambulance subject to a maximum of Rs. 2000/- per hospitalization.
7. AYUSH Treatment:
Expenses incurred for inpatient care treatment under Ayurveda, Yoga, and Naturopathy, Unani, Siddha and Homeopathy systems of medicine during each policy year upto the sum insured in any AYUSH Hospital.
8. Pre- Post Hospitalisation Expenses:
Medical expenses incurred for a period of 30 days prior to the date of hospitalisation and 60 days from the date of discharge from the
hospital shall be admissible and included.
9. Co Payment:
Fixed co-pay 5% shall be applicable across all the ages for all cliams.
10. Cumulative Bonus:
Sum Insured shall increase by 5% in respect of each claim free policy year provided policy is renewed without a break subject to 50% of the sum insured. If a claim is made in any particular year, the cumulative bonus is reduce at the same rate at which it was accrued.
11. Waiting Period:
Specified waiting period of 48 months to 24 months for defined diseases in the policy wordings.
12. New Age/Modern Treatments :
The policy covers the following modern age or new age treatments like – Oral Chemotherapy, Robotic surgeries, Bronchial Thermoplasty etc.
The policy won’t cover Cosmetic or plastic surgery, maternity, obesity treatment, OPD treatment, domiciliary hospitalisation, treatment outside India etc.
Claims can be made cashless at network hospitals and under reimbursement at non network hospitals. Notification of claim within 24 hours of emergency hospitalisation or before the insured is discharged whichever is earlier and atleast 48 hours prior to planned hospitalisation.
Overall there is be a standard product with features and pricing across insurers so that a common man can avail of Health Insurance.
Question: Will Covid 19 treatment be covered under Arogya Sanjeevani Policy?
Answer: Yes, Arogya Sanjeevani Policy shall cover the hospitalisation expenses arising out of Covid 19 disease.
Question: Can one opt for higher Sum Insured than the maximum limit under this policy?
Answer: No. The Sum insured available under Arogya Sanjeevani policy is from Rs.1 lac to Rs. 5 lacs only
Question: Can existing policy be ported to Arogya Sanjeevani Policy?
Answer: Yes. One can port their existing policy into Arogya Sanjeevani policy.