In light of the ongoing coronavirus pandemic, the Insurance Regulatory and Development Authority of India (IRDAI) formulated a new standard health insurance policy - Arogya Sanjeevani, which offers coverage between Rs 1 lakh and Rs 5 Lakhs. The policy, available since April this year, is aimed to cover Covid-19 related treatment costs among other medical emergencies. The plans available under the Arogya Sanjeevani caters to individuals as well as families under the Individual Plan and Family Floater Plan.
Following is the list of expenses that are covered in the Arogya Sanjeevani policy.
1. Hospitalization: Under the policy, the insurance company covers the treatment cost for hospitalization. Expenses such as nursing room rent, hospital stay, bed charges are covered by the policy, however, your insurer may put a cap of 2% of the sum insured up to Rs 5,000 per day on hospitalization .Your insurer may pay 5% of the sum insured up to Rs. 10,000 per day, if the policyholder is admitted in a critical care unit like ICU or ICCU.Fees charged by the medical practitioners are also covered under the Arogya Sanjeevani Policy. Besides, other charges such as oxygen, operation theatre charges, surgical appliances among others are also covered under the policy.
2. Post Hospitalization: Certain ailments require patients to continue treatment under even after being discharged from the hospital. Arogya Sanjeevani Policy covers costs like expenses under Post Hospitalization, usually for 60 days after discharge.
3. Room rent: The Arogya Sanjeevani Policy pays 2% of the sum insured up to Rs 5,000 per day. In case of intensive Care Unit (ICU), the room rent paid will be 5% of the sum insured up to Rs 10,000 per day.
4. Ambulance Charges: The cost of transporting a patient with the help of an on-road Ambulance is borne by the insurance company. The company pays up to Rs 2,000 per hospitalization.
5. Cataract Treatment Stem Cell Therapy: The cost of cataract treatment is covered up to 25% of the sum insured or Rs 40,000 (whichever is lower) by the insurance company for each eye. Stem Cell Therapy has a cap of 50 per cent of the sum insured during the policy period. Besides a new-age treatment that is mentioned in the policy will be covered under out-patient treatment and will have a cap of 50% of the sum insured.
If the policyholder has had any condition, ailment or injury prior to the inception of their first policy until 48 months from the date of inception is not covered by the Arogya Sanjeevani policy. Other than that, expenses for cosmetic or plastic surgery, treatment necessitated due to participation in hazardous or adventure sports cosmetic or plastic surgery are not covered.
Treatment outside India is also excluded from the policy coverage. The policy document will have other exclusions in detail.
The features and benefits under the Arogya Sanjeevani insurance are similar irrespective of the insurance company. The policy coverage ranges from Rs 1,00,000 to a maximum of Rs 5,00,000 and comes with a tenure of 1 year but the policy has a feature of lifetime renewability.
List of New-age or Modern Treatments covered under the Arogya Sanjeevani Health Scheme:
1) AYUSH Treatment: AYUSH is an abbreviation of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy 2) Cataract Treatment 3) Uterine Artery Embolization and HIFU (High intensity focused ultrasound)4) Balloon Sinuplasty 5) Deep Brain Stimulation 6) Oral Chemotherapy 7) Immunotherapy 8) The Vaporization of The Prostate 9) IONM – (Intra Operative Neuro Monitoring)10) Stem Cell Therapy 11) Intravitreal Injections 12) Robotic Surgeries 13) Bronchial Thermoplasty 14) Stereotactic Radio Surgeries
A person between the age of 18 to 65 years is eligible to purchase the Arogya Sanjeevani Health insurance policy. Depending upon the family size one can also purchase policy for dependent children between 3 months and 25 years.
Independent children over the age of 18 years, however, cannot be covered in family policy. An individual policy for this purpose is required.
It must be noted that this health insurance policy has lifelong renewability with an exception of people above the age of 65 cannot who cannot purchase a fresh policy. Existing policies can be renewed if the policyholder crosses 65 years.
Arogya Sanjeevani Policy can be renewed after the expiry date within the grace period as mentioned in the policy. A policyholder can change the amount of sum insured while renewing this Arogya insurance.
For instance, if a dependent child covered under the policy attains the age of 18 years and is financially independent, he/she will be removed from the policy at the time of renewal.
Besides, the policyholders get a 5% Cumulative Bonus in case the previous policy year was claim-free.
Arogya Sanjeevani Policy is a Standard Health Insurance Product (SHIP) and has been started as a key policy measure to provide relief from the medical charges owing to the Covid-19 infection. Currently, over 50,000 cases are reported every day in India. While news of a vaccine is yet to surface, it can be safely sayid that the Covid-19 pandemic is one of the biggest health crises faced by the world in decades. A great option to consider is Health Insurance available on Finserv MARKETS that provides swift claim settlements within 60 minutes and cashless facilities in more than 6500 hospitals.
Yes, the Arogya Sanjeevani health insurance policy covers the hospitalization treatment costs of COVID-19.
No, maternity expenses are not covered.
Arogya Sanjeevani Health Insurance Policy is available with a policy tenure of 1 year. But it can be renewed. Although a fresh policy cannot be purchased post the age of 65.
Arogya Sanjeevani Health Insurance Policy is available in two plan types, namely Individual Plan and Family Floater Plan.
Yes, Non-Resident Indians (NRIs) can also buy Arogya Sanjeevani Policy. However, the premium for the plan has to be paid in Indian currency and via an Indian Bank Account.
Pre-existing conditions/diseases declared and/or accepted at the time of application come with a waiting period of 48 months from the date of policy inception.
No, medical treatments taken outside India are not covered under Arogya Sanjeevani Policy.