“Arogya Sanjeevani” is a standard health insurance policy introduced by the Insurance Regulatory and Development Authority of India (IRDAI) in April 2020. It aims to make health insurance more accessible and affordable for individuals and families.
Standard Coverage Features of Arogya Sanjeevani (as per the general guidelines set by IRDAI):
1. Hospitalization Expenses: Covers in-patient hospitalization expenses, including room charges, boarding, nursing expenses, ICU charges, surgeon’s/doctor’s fees, anesthesia, blood, oxygen, operation theater charges, etc.
2. Pre and Post Hospitalization: Covers medical expenses incurred immediately before and after hospitalization for a specific period, usually 30 days before hospitalization and 60 days after discharge.
3. Day Care Treatments: Covers specified medical procedures that require less than 24 hours of hospitalization due to advanced medical technology.
4. Ambulance Charges: Reimburses the cost of ambulance services during an emergency up to a certain limit, as mentioned in the policy.
5. AYUSH Treatment: Covers treatment taken under Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy systems up to the sum insured.
6. Cataract Surgery: Provides coverage for cataract treatment, subject to a specific limit.
Waiting Periods under Arogya Sanjeevani:
1. Initial Waiting Period: There is a waiting period of 30 days from the policy start date. During this period, no claims will be accepted, except for accidental injuries.
2. Pre-existing Conditions: There is a waiting period for pre-existing illnesses before they become eligible for coverage. This waiting period is usually 2 to 4 years, depending on the policy terms.
It’s essential to review the policy document of the specific insurance provider to understand the exact waiting periods and other terms and conditions associated with Arogya Sanjeevani health insurance. Different insurance companies might slightly vary in their offerings while still adhering to the standard guidelines set by IRDAI for this policy.
Renewability and Age Limit
Renewability and age limits are important aspects of health insurance policies, including Arogya Sanjeevani. Here’s what you need to know about them:
Arogya Sanjeevani policies are generally offered with lifelong renewability. This means that once you purchase the policy, you can renew it continuously for the rest of your life, as long as you pay the premium within the due date. This feature ensures that you have continued coverage and access to medical protection even in your old age when healthcare needs may be higher.
2. Age Limit:
The age limit for purchasing Arogya Sanjeevani health insurance may vary among insurance providers. However, as of my last update in September 2021, the minimum entry age is usually 18 years, and the maximum entry age is generally around 65 years. This means that individuals between the ages of 18 and 65 are eligible to apply for Arogya Sanjeevani coverage.
Once you purchase the policy within the eligible entry age, you can renew it every year, regardless of age. As long as you keep renewing the policy regularly, the coverage will remain in force without any age-based restrictions.
It’s essential to remember that the premium for health insurance policies tends to increase with age, as the risk of health issues and medical expenses typically rises as we grow older. Therefore, purchasing health insurance at a younger age can often be more cost-effective.
Keep in mind that specific terms and conditions, including renewability and age limits, may vary among insurance companies. It’s crucial to carefully review the policy document and clarify any doubts with the insurance provider before making a purchase to ensure that you understand the coverage and any limitations associated with Arogya Sanjeevani health insurance.
Cashless Facility and Network Hospitals under Arogya Sanjeevani:
1. Cashless Facility: Arogya Sanjeevani policies generally offer a cashless facility at network hospitals. When you need medical treatment at a network hospital, you can avail cashless services. Under this facility, the insured doesn’t have to pay for covered medical expenses out of pocket, subject to policy terms and conditions. The insurance company settles the bills directly with the hospital, up to the sum insured.
2. Network Hospitals: Insurance companies have tie-ups with a network of hospitals where the cashless facility is available. These network hospitals are empaneled with the insurer, and you can receive treatment without making upfront payments. A list of network hospitals is typically provided by the insurance company or can be found on their website. It’s essential to choose a network hospital for cashless treatment to avail of this benefit.
Co-payment and Deductibles under Arogya Sanjeevani:
1. Co-payment: Some Arogya Sanjeevani policies may have a co-payment clause. Co-payment means that the policyholder agrees to bear a certain percentage of the claim amount, while the insurance company covers the remaining portion. For example, if the policy has a 10% co-payment clause, and a claim of ₹10,000 is made, the insured will need to pay ₹1,000 (10% of the claim amount), and the insurance company will pay the remaining ₹9,000.
2. Deductibles: A deductible is a fixed amount that the insured must pay out of pocket before the insurance coverage kicks in. If the policy has a deductible of ₹5,000 and a claim of ₹15,000 is made, the insured will need to pay ₹5,000, and the insurance company will cover the remaining ₹10,000.
It’s important to note that not all Arogya Sanjeevani policies include co-payment or deductibles. If they are part of the policy, the specific terms and percentages will be mentioned in the policy document. Always review the policy terms and conditions to understand if co-payment or deductibles apply to your chosen Arogya Sanjeevani health insurance plan. These cost-sharing features can impact your out-of-pocket expenses during claims and should be taken into consideration while selecting a health insurance policy.
Premium for Arogya Sanjeevani health insurance
1. Sum Insured: The higher the sum insured you choose, the higher the premium will be. A higher sum insured provides greater coverage but also increases the premium amount.
2. Age of Insured: The age of the insured person(s) is a significant factor in determining the premium. Generally, younger individuals pay lower premiums, while older individuals may have higher premiums due to increased health risks.
3. Family Coverage: If you opt for a family floater plan that covers multiple family members, the premium may be higher than an individual plan due to increased coverage.
4. Co-payment or Deductible: Some Arogya Sanjeevani policies may include co-payment or deductibles, which can affect the premium. Plans with co-payment or deductibles may have lower premiums but require the insured to share a portion of the medical expenses during claims.
5. Policy Tenure: The duration of the policy, whether it’s for one year or longer, can impact the premium amount.
6. Zone of Coverage: Insurance companies sometimes classify regions into zones, and the premium may vary depending on the zone in which the insured resides.
7. Medical History: Your health condition and medical history might be considered by the insurance company when calculating the premium.
8. Additional Riders or Benefits: If you choose to add optional riders or benefits to enhance your coverage, the premium will increase accordingly.
FAQs (Frequently Asked Questions) about Arogya Sanjeevani Health Insurance:
1. What is Arogya Sanjeevani health insurance?
Arogya Sanjeevani is a standard health insurance policy introduced by IRDAI to provide affordable and accessible health coverage to individuals and families.
2. What does Arogya Sanjeevani cover?
Arogya Sanjeevani covers hospitalization expenses, pre and post-hospitalization, day care treatments, ambulance charges, AYUSH treatments, and cataract surgeries, among other benefits.
3. Are there waiting periods in Arogya Sanjeevani?
Yes, there are waiting periods, including an initial waiting period of 30 days and specific waiting periods for pre-existing conditions.
4. Is Arogya Sanjeevani renewable?
Yes, Arogya Sanjeevani policies are typically offered with lifelong renewability.
5. What is the entry age for Arogya Sanjeevani health insurance?
The minimum entry age is usually 18 years, and the maximum entry age is typically around 65 years, but this may vary among insurance companies.
6. Does Arogya Sanjeevani offer a cashless facility?
Yes, Arogya Sanjeevani policies offer a cashless facility at network hospitals where the insured can avail of medical treatment without making upfront payments.
7. What are co-payment and deductibles?
Some Arogya Sanjeevani policies may include co-payment and deductibles. Co-payment requires the insured to bear a percentage of the claim amount, while deductibles require the insured to pay a fixed amount before the insurance coverage starts.
Arogya Sanjeevani health insurance is a standardized policy that aims to provide comprehensive and affordable healthcare coverage to individuals and families. It covers essential medical expenses, including hospitalization, pre and post-hospitalization, and day care treatments. The policy offers lifelong renewability and is available to individuals between the ages of 18 and 65 years. With a wide network of hospitals offering cashless facilities, Arogya Sanjeevani ensures ease of access to quality healthcare services.
Before purchasing Arogya Sanjeevani health insurance or any other insurance policy, it is crucial to carefully review the policy terms and conditions, coverage features, waiting periods, co-payment, deductibles, and other relevant details. Comparing quotes from different insurance providers will help you find the most suitable plan that aligns with your healthcare needs and budget. For personalized advice and assistance, consider consulting with licensed insurance advisors or agents who can guide you through the process of choosing the right health insurance policy for you and your family.
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