The need to have health insurance was always there; it’s only now that many people have started to realize its importance. But a common problem people face is picking the best health insurance plan out of the many that are ideal for their specific health requirements. And if you aren’t aware of the commonly used insurance terminologies, the entire process of buying health insurance can be a little more challenging.
Hence, keeping all these things in mind, IRDAI asked all insurance companies to offer a standard health insurance plan that offers standard coverage and is pretty straightforward in terms of its inclusions, exclusion, terms, and conditions, so anyone can purchase it without facing any difficulty. The standard policy, also known as the Arogya Sanjeevani policy is an indemnity-based health insurance policy that provides coverage starting from Rs.50,000 to a maximum of Rs. 10 lakh.
To help you decide whether the Arogya Sanjeevani policy is right for you or not, we’ve listed down five important things you should know about this policy before making any buying decision.
1. List of Things Covered in the Policy
A crucial thing to be aware of before purchasing any health insurance policy is its coverage. If you’re wondering what you and other secured family members will get with the Arogya Sanjeevani policy, take a quick look at the following:
People insured under this policy will be entitled to receive hospitalization expenses from the insurer. It includes pre-hospitalization and post-hospitalization expenses that took place 30 days prior and 60 days after the hospitalization, respectively. Some examples of these expenses include diagnostic charges, medicine costs, hospital stay expenses, operation costs, doctor charges, etc.
If you avail of the ambulance services during the course of treatment, you can claim the expenses from the insurer. However, be mindful that there is a maximum cap of Rs. 2,000 applied to it.
People secured under the Arogya Sanjeevani policy can claim expenses related to their cataract surgery. They are eligible to claim 25% of the total sum insured or Rs. 40,000 towards the surgery costs- whichever is lower.
Serious illnesses require expensive and special medical treatment, which includes the stay in the ICU/ICCU. If you or any of the covered individuals get admitted to ICU or ICCU facility, you can claim expenses amounting to Rs. 10, 000 per day or 5% of the total sum insured.
Those who prefer alternative treatments, like Homoeopathy, Ayurveda, Unani, and/or Siddha, can get their expenses claimed, provided they get their treatment done from certified hospitals.
Plastic Surgery & Dental Treatments
If the nature of your injury or disease requires plastic surgery or dental treatments, then the associated costs can be claimed from the insurer.
New Age Treatments
With the advancement in technology, medical practitioners are now able to treat diseases more efficiently. If you’ve secured yourself under the Arogya Sanjeevani policy, you can claim expenses for treatments like Immunotherapy, Stem Cell therapy, Balloon Sinuplasty, Oral Chemotherapy, Deep Brain Stimulation, Bronchial Thermoplasty, etc. But be mindful that you can claim up to a maximum of 50% of your sum insured towards new-age treatment expenses.
Before taking the policy, you can visit the insurer’s website and check the details regarding what other things are covered under the policy, along with the associated terms and conditions for each. It will remove any assumptions related to the inclusions, and you won’t encounter a negative experience during claim settlement at a future date.
2. Entry Age for the Policy
The entry age for the Arogya policy is 18 years, and the maximum age capped for entry is 65 years. While anyone within this age limit can get themselves covered under the Arogya Sanjeevani policy, you have to be mindful of specific rules if you plan to add your children to the coverage.
Though you can include children between the age of three months and 25 years in the policy, the same cannot be done if the children are above 18 years and financially independent. If your children were financially dependent on you at the time of taking the policy, which is no longer the case, they would not be covered from the next policy renewal period.
3. Low Co-payment
For those who aren’t well aware of this insurance terminology, co-payment refers to the fixed percentage the insurer asks the insured to pay while filing for a claim. The insurance company never pays the full claim amount, though a significant portion is paid by them. Some policies have a co-payment clause as high as 15%-20%, while others come with a reasonably low co-payment clause. Luckily, the Arogya Sanjeevani policy comes with a minimum co-payment of 5%, which is considered pretty reasonable and low in the insurance industry. As this policy has a lower co-payment percentage, you won’t have to pay higher out-of-pocket expenses during medical emergencies.
4. Cumulative Bonus
The policy period of the Arogya Sanjeevani plan is one year, but it is subject to lifelong renewal. So if you continue the policy for an extended period and don’t file for a claim for a few consecutive years, you will be eligible to receive the benefits of a cumulative bonus. Your sum insured, except the cumulative bonus, can be increased by 5% with regards to the claim-free year, subject to a maximum of 50% of the total sum insured. But to avail of this benefit, make sure you don’t skip any policy renewal payment.
5. Things Not Covered Under the Policy
To take an informed policy purchase decision, it is crucial to be aware of what the policy does not cover. Now that you’re already aware of what is included in the Arogya Sanjeevani policy, let’s take a look at what’s not included. Any treatment related to sterility, fertility, gender change, obesity or weight control surgeries, domiciliary care or OPD expenses, substance abuse, etc., are not covered under the policy.
If the claim is a result of an attempt to commit a criminal act or from a treatment that was considered not medically necessary by doctors, it will not be honoured by the insurance companies. If you’re into adventure sports or activities, be mindful of the fact that any injury arising from it will not make its treatment costs eligible for a claim. These are general exclusions that a person should be aware of before taking the Arogya Sanjeevani policy. However, it is best to check the complete list of exclusions by visiting the insurer’s website you’ve decided to purchase the policy from.
Ready to Futureproof Your Health?
Now that you’re aware of what’s included and excluded in the Arogya Sanjeevani policy, you can make an informed purchase decision. This policy is generally available in two plans, i.e individual and family floater plans, so go ahead with the plan that best covers your need. Arogya Sanjeevani plan also comes at an affordable premium, so most people can get it. If you’re ready to secure your health and your family members’ health, getting an Arogya Sanjeevani plan is the best way to do it.