The Indian Insurance Regulating and Development Authority of India (IRDAI) has mandated all health insurance providers to offer a standard health insurance product - Arogya Sanjeevani Policy. This policy provides similar benefits as other health insurance policies, as its features are the same as other health insurance policies.

Major features and benefits

All insurance providers will be offering the same benefits under the Arogya Sanjeevani Policy, since the policy features are essentially the same.

  • Age eligibility: A person can purchase the Arogya Sanjeevani Policy if the person(s) are between the age group of 18 and 65 years. The children under Family Floater policies can be covered from the age of 90 days to 25 years.
  • Sum insured: The minimum sum insured for the Arogya Sanjeevani Policy is Rs. 1 lakh and the maximum sum insured is Rs. 5 lakhs (in the multiple of Rs. 50,000). For individuals, the sum assured will be applicable for one member, whereas in a floater plan the sum assured would be applicable for the entire family.
  • Individual & Family Floater Plans: The Arogya Sanjeevani Policy is available in two plans - Individual Health Policy (separate sum insured for each family member), and Family Floater Health Insurance (one sum insured that floats for the entire family).
  • Who can be insured: The policy can be availed for self and the following family members:
    • His/her legally wedded spouse.
    • Dependent children (i.e. natural or legally adopted) between the age of 3 months and 25 years.
    • Parents
    • Parents-in-law.
  • Like other Health Insurance policies, Arogya Sanjeevani Policy also offers:
    • Cashless hospitalization: The policy offers the benefit of cashless hospitalization to policyholders.
    • Policy period: The policy is valid for one year after which it needs to be renewed.
    • Lifelong renewal facility: The policy offers the benefit of lifelong renewals.
  • Co-payment clause: The policy comes with a co-payment clause. Policyholders filing insurance claims under this policy will have to pay 5% of the total claim amount, whereas the insurance provider will bear the remaining amount.
  • As available in other Health Insurance policies provided by General and Health Insurers, Arogya Sanjeevani Policy also provides for:
    • Pre and post hospitalization: All insurance plans offer coverage for a specific number of days before hospitalization and after treatment. As per the Arogya Sanjeevani plan, policyholders would be eligible for pre hospitalization from 30 days before the admission date, and post hospitalization costs for up to 60 days after the discharge date.
    • Cover for road ambulance expenses: The plan also provides coverage for road ambulance expenses incurred up to a limit of Rs. 2000 per hospitalization.
    • Cover for AYUSH treatments: The expenses incurred for alternate treatment methods like AYUSH which comprises Ayurveda, Yoga, Unani, Siddha and Homeopathy systems are also payable without any sub limits.
    • Cover for day care procedures: The policy provides coverage for 116 day care procedures.
    • Earn rewards for zero claim: In the case of a claim-free policy year, the sum insured is increased by 5% provided the Arogya Sanjeevani Policy is renewed every year continuously for 5 years, subject to a maximum of 50% of the sum insured.

For more detailed Terms and Conditions of Policy Cover, please contact the nearest General or Health Insurer.