Arogya Sanjeevani Policy – A uniform health insurance plan (REVIEW)

In a transformative stride towards enhancing accessibility and simplicity in the realm of health insurance, the Insurance Regulatory and Development Authority of India (IRDA) has unveiled the Arogya Sanjeevani Policy. This pioneering initiative signifies a paradigm shift in the way health insurance is structured, offering a standardized set of features tailored to address the fundamental healthcare needs of the common man. Our comprehensive review aims to unravel the intricacies of this novel policy, providing an in-depth exploration of its coverage, features, eligibility criteria, and an insightful analysis of the potential advantages and drawbacks it may bring to the forefront.

Standardization for Universal Coverage

The Arogya Sanjeevani Policy is positioned as a beacon of uniformity, seeking to streamline the often complex landscape of health insurance by ensuring a consistent set of features across all participating insurers. In an environment where the diversity and intricacy of existing health insurance plans can pose a challenge for individuals to make informed choices, this policy emerges as a refreshing solution. As we delve into this comprehensive review, our primary objective is to shed light on how the Arogya Sanjeevani Policy addresses the diverse healthcare needs of the populace and whether its standardized features can truly serve as a panacea for the complexities inherent in the current health insurance market.

Arogya Sanjeevani Policy

Exploring the Nuances

Our journey into the Arogya Sanjeevani Policy will encompass a detailed examination of its coverage spectrum, ranging from eligibility criteria to the nuanced features that define its structure. We will scrutinize the policy’s potential advantages, offering insights into how it aligns with the requirements of the common man and simplifies the decision-making process. Additionally, we will critically evaluate any drawbacks or limitations that might warrant consideration by prospective policyholders. Through this exploration, our goal is to provide a comprehensive understanding of the Arogya Sanjeevani Policy, empowering individuals with the knowledge needed to navigate the evolving landscape of health insurance in India.

Understanding Arogya Sanjeevani Policy

Arogya Sanjeevani Policy has been meticulously crafted as a standard health insurance offering, characterized by uniform features tailor-made to cater to the diverse healthcare needs of the common man. Commencing its implementation on April 1, 2020, this policy is mandated for provision by all health insurance companies in India, with the caveat that premium rates may exhibit variations across different insurers.

Key Features

  • Versatile Coverage: The policy extends its coverage to individuals aged 18 to 65, offering both individual and family floater options.
  • Inclusive Family Coverage: Family coverage includes the principal policyholder, spouse, parents, parents-in-law, and dependent children aged between 3 months and 25 years.
  • Customizable Sum Assured: The policy allows for a minimum sum assured of Rs 1 Lac and a maximum of Rs 5 Lacs, available in multiples of 50,000.
  • Flexible Premium Payments: Premiums can be paid on a monthly, quarterly, half-yearly, or yearly basis, with a one-year policy renewable annually.
  • Cashless Benefits: The policy offers the convenience of cashless benefits, streamlining the healthcare experience for policyholders.
  • Lifetime Renewability: Notably, the Arogya Sanjeevani Policy ensures lifetime renewability, providing long-term coverage.
  • Structured Waiting Period: The waiting period is 30 days, during which no claims will be entertained, ensuring a structured commencement of coverage.
  • Fixed Copayment: A fixed 5% copay is applicable to all age groups, sharing the financial responsibility between insurers and policyholders.
  • Portability Options: The policy provides portability options, allowing policyholders to seamlessly switch to other health insurance providers without compromising coverage.

Inclusions and Exclusions

Delving into the coverage specifics, the Arogya Sanjeevani Policy encompasses a comprehensive package with key features such as:

  • Pre-Hospitalization Coverage: A coverage window of 30 days for pre-hospitalization expenses.
  • Post-Hospitalization Coverage: Post-hospitalization expenses are covered for a duration of 60 days, ensuring a holistic approach to healthcare coverage.
  • Ayush Treatment: The policy extends its scope to Ayush treatment, encapsulating Ayurvedic, Yoga, Naturopathy, Unani, Siddha, and Homeopathy practices.

However, it is imperative to acknowledge the specified exclusions within the policy framework:
Maternity Treatment Expenses: Maternity treatment expenses are expressly excluded from coverage.

  • Weight Loss Treatments: Procedures related to weight loss are not covered.
    Gender Change Procedures: Expenses related to gender change procedures are excluded.
  • Plastic Surgery: Cosmetic or plastic surgery expenses are not covered.
  • Hazardous Adventure Sports: Injuries resulting from hazardous adventure sports are excluded.
    War-Related Incidents: Incidents related to war are expressly excluded from coverage.

This meticulous detailing of inclusions and exclusions serves as a comprehensive guide for prospective policyholders, allowing them to make informed decisions aligned with their specific healthcare needs.

Detailed Analysis of Arogya Sanjeevani Policy

Sum Assured and Premium Structure

  • The Arogya Sanjeevani Policy ensures a comprehensive coverage spectrum with a minimum sum assured of Rs 1 Lac and a maximum cap of Rs 5 Lacs.
  • The flexibility in premium payments is a noteworthy aspect, allowing policyholders to choose from various frequencies such as monthly, quarterly, half-yearly, or yearly intervals.
  • Despite the standardized features, insurers retain the freedom to set premium rates, offering a degree of customization to cater to diverse financial preferences.

Waiting Periods and Co-payment Clause

  • The policy introduces a waiting period of 30 days, during which no claims will be payable. This provision ensures a grace period for policyholders to familiarize themselves with the coverage.
  • Notably, there are two distinct waiting periods – 24 months and 48 months – for specific illnesses, providing a nuanced approach to coverage for different medical conditions.
  • A 5% co-payment applies across all age groups, introducing a shared financial responsibility between the insurer and the policyholder.

Sub Limits and Added Benefits

  • The imposition of sub-limits on hospitalization expenses, including room, boarding, nursing, and ICU/ICCU charges, aims to streamline the reimbursement process.
  • The policy incorporates coverage for ambulance charges, with a defined maximum limit set at Rs. 2000 per hospitalization. This feature enhances the overall financial support for emergency medical services.

No Claim Bonus (NCB) and Absence of Riders

  • A noteworthy feature of the Arogya Sanjeevani Policy is the No Claim Bonus (NCB) system, where policyholders enjoy a 5% bonus for each claim-free year. This accumulates up to an impressive 50% of the sum assured.
  • It is essential to note that the policy, while robust in its core features, does not provide additional riders. This simplicity ensures a straightforward understanding of the policy’s benefits without the complexity of optional add-ons.

Policy Cancellation and Refund Options

  • The policy accommodates cancellations with varying refund options, creating a flexible approach for policyholders.
  • Refunds are structured based on the cancellation period:
    • If canceled within the initial 30 days, a substantial 75% of the premiums are refundable.
    • Cancellations between 31 to 90 days yield a 50% refund.
    • For cancellations between 3 to 6 months, a 25% refund is applicable.
    • After the initial 6 months, there is no refund available.

Geographical Uniformity in Premiums

  • One of the standout features of the Arogya Sanjeevani Policy is the geographical uniformity in premium rates. Regardless of the policyholder’s location within India, the premiums remain consistent.
  • This uniformity eliminates any potential disparities in premiums based on city or zone-specific factors, providing an equitable pricing structure for all policyholders across the country.

In essence, the Arogya Sanjeevani Policy not only offers a standardized health insurance solution but also incorporates nuanced features and flexible options, contributing to a comprehensive and adaptable coverage framework for the policyholders.

Evaluation of Arogya Sanjeevani Policy

Positive Aspects

Comprehensive Coverage

  • The policy seamlessly incorporates all essential features, addressing the diverse needs of any investor.
  • Standardized features alleviate confusion when comparing premiums across different insurers.

Competitive Premiums

  • The policy’s straightforward design, combined with a substantial market demand, is anticipated to result in highly competitive premium rates.

No-Brainer Policy

  • Tailored for individuals in search of a straightforward health insurance policy without convoluted features.

Multiple Policy Options

  • Investors enjoy the flexibility of acquiring multiple Arogya Sanjeevani Policies from various insurers, providing diversified coverage options.

Advantages in Detail

Comprehensive Coverage

  • The Arogya Sanjeevani Policy stands out for its inclusive coverage, ensuring that it caters to the fundamental requirements of every investor. This encompasses a wide array of features that address various health insurance needs, making it a comprehensive solution for individuals seeking a robust insurance plan.

Standardized Features

  • One of the key strengths of this policy lies in its standardized features. By adopting a uniform set of attributes, the Arogya Sanjeevani Policy minimizes confusion that often arises when comparing premiums offered by different insurers. This standardization not only enhances transparency but also simplifies the decision-making process for potential policyholders.

Competitive Premiums

  • The inherent simplicity of the Arogya Sanjeevani Policy, coupled with its widespread market demand, is poised to have a positive impact on premium rates. The competitive nature of the health insurance landscape is expected to drive insurers to offer cost-effective premiums, making it an attractive choice for a broad spectrum of individuals.

No-Brainer Policy

  • Designed as a “no-brainer” policy, this health insurance plan is tailored for those who seek a straightforward and uncomplicated coverage solution. With a focus on essential features and the elimination of complex elements, the Arogya Sanjeevani Policy caters to the needs of individuals who prioritize simplicity and ease of understanding in their insurance plans.

Multiple Policy Options

  • A notable advantage of the Arogya Sanjeevani Policy is the flexibility it offers in terms of multiple policy options. Investors have the freedom to purchase this policy from different insurers, enabling them to diversify their coverage and potentially access unique benefits offered by various providers. This flexibility adds an extra layer of customization to meet individual preferences and requirements.

Concerns and Considerations

Copay and Sub-limits

  • The imposition of a 5% copay, along with sub-limits on room rent, may pose constraints for certain individuals seeking more extensive coverage.

Waiting Periods

  • The mandatory 30-day waiting period and extended waiting periods for specific illnesses may impact the immediate settlement of claims, necessitating careful consideration.

Limited Maximum Sum Assured

  • The policy’s upper limit of Rs 5 Lacs as the maximum sum assured might be insufficient for individuals aiming for higher coverage levels.

Exploration of Alternatives

  • It is prudent to explore alternative health insurance policies that provide higher sum assured options and potentially fewer restrictions. This approach ensures that individuals can tailor their insurance coverage to better suit their specific needs and preferences.

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What distinguishes the Arogya Sanjeevani Policy from other health insurance plans in the market?

The Arogya Sanjeevani Policy is unique in its approach as it introduces a standardized set of features across various insurers. Unlike other health insurance plans that often come with intricate details and differences, this policy offers a consistent framework, making it easier for individuals to comprehend, compare, and make informed decisions about their health coverage.

Who is eligible to purchase the Arogya Sanjeevani Policy, and what are the coverage options available?

This policy is accessible to individuals within the age bracket of 18 to 65 years. It provides the flexibility of choosing between an individual policy or a family floater option. Family coverage includes not only the policyholder but also the spouse, parents, parents-in-law, and dependent children aged between 3 months and 25 years. This versatility allows individuals to tailor the policy to their unique family dynamics and requirements.

What is the waiting period for the Arogya Sanjeevani Policy, and how does it impact immediate claims?

The Arogya Sanjeevani Policy entails a standard waiting period of 30 days, during which no claims will be paid. Additionally, specific illnesses have extended waiting periods of 24 months and 48 months. While this waiting period is a standard protocol, policyholders should be aware that it may impact the immediate settlement of claims for certain medical conditions.

Does the Arogya Sanjeevani Policy have a copayment requirement, and how does this feature operate?

Yes, the policy includes a fixed copayment of 5% applicable to all age groups. This means that in the event of a claim, the policyholder is responsible for contributing 5% of the claim amount, while the insurance company covers the remaining 95%. This copayment feature fosters a shared responsibility model, ensuring individuals actively participate in their healthcare costs.

Can an individual purchase multiple Arogya Sanjeevani Policies from different insurers?

Absolutely. One of the standout advantages of the Arogya Sanjeevani Policy is the flexibility it offers investors. Individuals have the option to purchase multiple policies from different insurers, allowing them to diversify their coverage. This flexibility empowers policyholders to explore various benefits offered by different insurers, enhancing their overall coverage portfolio.


In conclusion, the Arogya Sanjeevani Policy emerges as a commendable stride in the realm of health insurance, ushering in a new era of standardization and accessibility. Its distinctive feature of uniformity across insurers addresses the long-standing complexity and confusion that often accompanies the selection of health insurance plans. This review has dissected the policy, uncovering its comprehensive coverage, competitive premiums, and user-friendly attributes.

The policy’s inclusivity in terms of age eligibility, family coverage options, and flexibility in choosing multiple policies from different insurers adds a layer of customization for individuals and families. The waiting periods, copayment requirements, and maximum sum assured limitations are considerations that potential policyholders must carefully weigh against the backdrop of their unique health and financial circumstances.
While the Arogya Sanjeevani Policy has undeniable merits, such as the No Claim Bonus, Ayush coverage, and portability options, it does present certain limitations, including the 5% copayment and sub-limits on room rent. Moreover, the maximum sum assured of Rs 5 Lacs might fall short for those seeking higher coverage. As the policy gains traction in the market, it is anticipated to foster competition among insurers, potentially leading to more affordable premiums. However, the policyholder’s decision should be driven by a holistic understanding of their health insurance needs, considering factors beyond just cost.

In essence, the Arogya Sanjeevani Policy mirrors the government’s commitment to making quality healthcare accessible to a broader segment of the population. It serves as a foundational health insurance option, akin to a Jan Dhan account, providing a baseline of essential features. However, individuals with more extensive coverage requirements may find it prudent to explore alternative health insurance policies that offer higher sums assured and fewer limitations. Ultimately, the success of the Arogya Sanjeevani Policy lies not just in its standardized features but in its ability to cater to the diverse needs of the healthcare-seeking populace. As the policy evolves and insurance companies fine-tune their offerings, it will be fascinating to observe how this initiative reshapes the landscape of health insurance, making quality healthcare a reality for a more extensive section of society.

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