Insurance firms have come up with a standard health insurance plan — Arogya Sanjeevani — that caters to all quality healthcare needs of an individual and family. For first-time buyers of health insurance, the plan is a boon since the product is the same, regardless of the insurance company offering it.
The current health insurance products available in the market are different and quite complex, and it is difficult for the common man to understand various inclusions and exclusions of the plans. This is a major reason why many people face numerous difficulties while filing a claim and often, their claims get rejected.
The introduction of Arogya Sanjeevani is a revolutionary move as it will give access to quality and world-class healthcare services to everyone at highly affordable prices. The whole standardisation process helps in making the buying process much simpler.
What is covered
Arogya Sanjeevani is a standard health policy that comes with the same coverages and exclusions across all insurers. The plan is an indemnity-based health insurance policy that has to be renewed every year to ensure the benefit of the policy continues.
You may buy the policy as an individual plan to just cover yourself or invest in a family floater plan to cover self along with spouse, parents/parents-in-law and dependent kids. The plan is available for a minimum sum insured of ₹1 lakh up to a maximum of ₹5 lakh.
Further, various expenses covered under the plan include hospitalisation (minimum 24 hours), pre- and post-hospitalisation expenses such as X-rays, blood tests and ambulance charges (subject to a maximum of ₹2,000 per hospitalisation).
You may also avail treatment under day care procedures, AYUSH Coverage, Cataract (subject to a limit of 25% of the sum insured or ₹40,000, whichever is lower), dental treatments and plastic surgery (provided it is necessitated due to disease or injury).
Within the Arogya Sanjeevani plan, you may also undergo procedures as an in-patient or as part of the day treatment up to 50% of the sum insured.
These procedures include robotic surgeries, uterine artery embolisation, high intensity focused ultrasound, oral chemotherapy and stem cell therapy.With respect to cumulative bonus, your total sum insured (excluding the bonus) will rise by 5% for each claim-free policy year.
To file a claim under the policy, the minimum waiting period is 30 days while the disease-specific waiting period is 24-48 months, depending on the diseases.
A grace period of 30 days is allowed on payment of premium if you choose to make yearly payment and a grace period of 15-days is permitted for all other payment modes.
Portability is also available after completion of 12 months of the policy. The policy also offers cashless facility, provided hospitalisation is at a network hospital.
Know the exclusions
The plan does not cover expenses incurred for maternity treatment, weight loss, unproven treatments, sterility and infertility, change of gender, hazardous adventure sports and conditions caused by breach of law or due to war and refractive error.
The plan does not provide coverage for out-patient department (OPD) expenses. It implements a sub-limit on room rent limited to 2% of the sum insured or up to a maximum of ₹5,000 per day whichever is lesser and ICU expenses are limited to 5% of sum insured or a maximum of ₹10,000 per day.
There are no deductibles allowed in the plan. There is a mandatory co-payment clause under which the policyholder has to pay 5% of the claim.
(The author is health business head, Policybazaar.com)
