Arogya Sanjeevani Policy – Features, Positives & Limitations
Last month IRDA has indicated that all health insurance companies need to come up with a standard health insurance plan that covers basic health insurance needs. Few days back IRDA has issued features of the Standard Health Insurance and named this as Arogya Sanjeevani Policy. While this health insurance plan has several good features, it has few limitations too. What is Arogya Sanjeevani Policy Scheme? What are the features of this standard health insurance plan to be offered by all health insurance companies? What are the limitations in this Arogya Sanjeevani Scheme?
What is Arogya Sanjeevani Policy Scheme?
Couple of months back, IRDA proposed to have standard health insurance policies to be issued by all health insurance companies. Such standard health plan should have basic needs. Last month IRDA has requested to propose a standard health insurance plan name to to the general public. I have even recommended a name, unfortunately, it is not considered.
Here are the key features of the Arogya Sanjeevani Policy as per IRDA.
1) Health insurance policy to take care of basic health needs of insuring public.
2) To have a standard product with common policy wordings across the industry.
3) To facilitate seamless portability among insurers.
Features of Arogya Sanjeeva Policy Standard Health Insurance Plan
This plan needs to be floated by all insurance companies from 1st April, 2020.
This standard health insurance plan would have a minimum sum assured of Rs 1 Lakh.
This health plan would have maximum of Rs 5 Lakhs sum assured.
Any individual in the age group of 18 to 65 years of age can consider this Arogya Sanjeeva Policy.
This health insurance policy is available in individual plans and family floater plans.
Family floater plans can be taken by individuals and add spouse, children (3 months to 18 years), parents, parent in-laws.
The policy is issued for 1 year and can to be renewed after that.
It covers the hospitalization expenses like Room, Boarding, Nursing expenses up to 2% of Sum Assured or the maximum of Rs.5,000 per day.
ICU/ICCU expenses up to 5% of Sum Assured or the maximum of Rs.10,000 per day.
It covers pre-hospitalization expenses of 30 days.
It covers post-hospitalization expenses up to 60 days.
It offers cashless benefits like any other medical insurance plan.
This policy also covers AYUSH (Ayurvedic, Yoga, and Naturopathy, Unani, Siddha, Homeopathy) treatments.
The health insurance premiums can be paid monthly, half yearly, quarterly and yearly.
This policy is renewable for life long.
The Arogya Sanjeevani Scheme would be offered by all insurance companies. If you are not happy with any health insurance company, there is a portability option to shift to another company.
There is a grace period of 30 days for yearly premium and 15 days for all other premiums.
Expenses covered for Dental treatment necessitated due to disease or injury. Expenses paid for plastic surgery necessitated due to disease or injury All daycare treatments and expenses incurred on road whereby ambulance cost subject to a maximum of Rs 2,000 per hospitalization would get covered.
There is no claim bonus (NCB) in this plan where sum assured would be increased by 5% per year for each claim free policy year (based on the renewals without break). However the maximum sum assured increase is restricted to 50%.
There is a waiting period of 24 months for pre-existing diseases. However, for the treatment for joint replacement unless arising from an accident and age-related Osteoarthritis & Osteoporosis, the waiting period is 48 months.
There is co-payment of 5% to be payable by all individuals covered in the plan.
Cataract expenses per eye are limited to 25% of sum assured of Rs 40,000 whichever is lower.
Maternity expenses are not covered.
How Arogya Sanjeevani Scheme would be issued by health insurance companies?
As per IRDA guidelines, all insurance companies would float this standard health insurance plan with this name by adding their company name at the end. e.g. Apollo Munich has to float this health insurance plan with name “Arogya Sanjeevani Policy – Apollo Munich”. Similar way, Star Health would float as Arogya Sanjeevani Policy – Star Health etc., This health insurance plan needs to be made available by them from 1st April, 2020 onwards.
What are premiums in this Standard Health Insurance Plan?
As per IRDA guidelines, Arogya Sanjeevani Policy Premiums would be fixed by health insurance companies directly.
What are the major exclusions in this health insurance policy?
Here are major exclusions.
1) Admission primarily for investigation and evaluation
2) Admission primarily for rest cure, rehabilitation and respite care.
3) Expenses relating to surgical treatment of obesity that do not fulfill certain conditions.
4) Change of gender treatments.
5) Cosmetic and plastic surgery treatment expenses
6) Treatment expenses for necessitated due to participation in hazardous or adventure sports.
Other exclusions can be read in the IRDA guidelines report.
Positives in Arogya Sanjeevani Policy
Here are positives in this plan.
1) It works like any other health insurance policy where hospitalization expenses, pre-hospitalization and post hospitalization expenses are covered.
2) This health policy has all basic needs required by any individual or their family. Hence, one need NOT re-check whether basic things are covered or not.
3) Since these have standard features, if you are not satisfied with any health insurance company, you can do portability to any other insurance company.
4) Pre-existing disease coverage after 24 months is really a positive point. However, in a few instances it would cover only after 48 months of taking the policy.
5) NCB makes this plan in-line with other health insurance plans being offered by insurance companies to attract customers.
Limitations in Arogya Sanjeevani Policy
Here are some major negative points in this plan.
1) Maximum sum assured of Rs 5 Lakhs makes this plan attractive.
2) Limitations on room expenses / ICU expenses / Cataract expenses.
3) No riders available.
4) Co-payment of 5% of hospital expense is another limitation.
5) Maternity expenses are not covered.
6) There is no fixed premium. Though the features are same, IRDA has left out fixing Argoya Sanjeevani Policy premium to insurance companies. They can decide and fix premiums on their own.
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Arogya Sanjeevani Policy – Standard Health Insurance Plan – Features, Positives & Limitations
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