Last Updated on October 1, 2023 at 8:16 pm
Arogya Sanjeevani Policy, the standard health insurance policy announced by IRDAI can make buying health insurance easier and increase its reach. Here is a look at the features, benefits, pros and cons in the form of a FAQ.
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Buying health insurance can often turn out to be a mind-numbing experience. There are a large number of insurance companies offering many similar products with a myriad of terms and conditions. Adding to the agony are terms like “Co-payment”, “Deductible”, “Waiting Period” etc. which are easier said than understood by a layman. In such a scenario, the need for a simple, non-cumbersome basic health insurance product was always felt.
Now, the Insurance Regulatory and Development Authority of India (IRDAI-the health insurance regulator) has announced a standardized product with all basic features to be offered by all health insurance companies.
FAQ about Arogya Sanjeevani Standard Health Insurance Policy Benefits
What is Arogya Sanjeevani Policy? This is a standard health insurance product with common features to be offered by all health insurers from 1st April 2020 onwards. This product will be named ‘Arogya Sanjeevani Policy’, followed by the name of the insurer.
A common name will make it easier for the target customers to differentiate the policy from the various other schemes offered by insurance companies.
What are the options available? The policy can be bought as an individual plan as well as a family floater plan. A family includes the spouse, mother, father, mother-in-law, father-in-law, and dependent children aged 3 months to 25 years. A child above 18 years of age and financially independent will not be eligible for policy coverage.
What are the sum insured limits? Minimum sum insured is Rs 1 lakh and the maximum sum insured is 5 lakhs. Update: IRDAI has now removed the max limit.
What is the minimum and maximum entry age? Minimum entry age is 18 years and the maximum entry age is 65 years.
Can the policy be renewed lifelong? Yes.
Does the policy offer cashless benefits? Yes.
Are premium variable from place to place? No, it will be the same pan India.
What is the frequency of premium payment? The premiums can be paid annually, half-yearly, quarterly or monthly. A 30-day grace period is allowed for the yearly premium payment and a 15-day grace period for other modes.
Will the policy pay 100% of all expenses? Is there a co-payment? Co-payment is fixed at 5% on all claims. This means the insured will have to pay 5% of the medical-expenses and Arogya Sanjeevani Policy will pay the rest.
Other features: Mandatory cover includes expenditure incurred on treatment of cataract will be covered up to 25 per cent of the sum insured or Rs 40,000 whichever is lower, per eye. Also included is dental treatment and plastic surgery that has been necessitated due to disease or injury, all daycare treatments and expenses on road ambulance subject to a maximum of Rs 2,000 per hospitalization.
Is there a waiting period? There will two types of waiting periods in the policy depending upon the type of disease: 24 months and 48 months. This means that for certain diseases, the insured will be covered only when the waiting period specified for the disease is over.
Is it possible to shift to other insurers or other products (portability/migration)?
Yes, both are possible. Policyholders can migrate to different health insurance products of the same company or can port their Arogya Sanjeevani Policy to another company
Migration option: There is a migration option- the right accorded to health insurance policyholders (including all members under family cover and members of group health insurance policy) to transfer the credit gained for pre-existing conditions and time-bound exclusions, with the same insurer. Thus, an existing policyholder of an insurance company can utilize the credit gained while switching to Arogya Sanjeevani. You can also migrate to other products from the same company.
Portability option: Yes, both are possible. Policyholders can migrate to different health insurance products of the same company or can port their Arogya Sanjeevani Policy to another company
Does Arogya Sanjeevani Policy have sub-limits? Yes. Hospitalization expenses like room, boarding, and nursing expenses are covered up to 2 per cent of the sum insured subject to a maximum of up to Rs 5,000 per day. ICU/ICCU expenses are also covered up to 5 per cent of the sum insured subject to a maximum of up to Rs 10,000 per day.
What are the pre-hospitalization and post-hospitalization benefits? This policy covers 30 days of pre-hospitalization expenses and 60 days of post-hospitalization expenses
Will it cover AYUSH (Ayurvedic, Yoga, and Naturopathy, Unani, Siddha, Homeopathy) treatments? Yes.
What are the no-claim benefits? A 5% ‘No Claim Bonus’ (NCB) for each claim-free year up to 50 per cent of the sum insured provided the policy is renewed without break.
Other features:
- You can also purchase multiple Arogya Sanjeevani Policies.
- If you cancel the policy within 30 days, you will get back 75 per cent of the premiums paid. Cancellation within 31 to 90 days will result in a refund of 50 per cent of the premiums, within 3 to 6 months will get you 25 per cent of the premiums. Beyond that, no premium will be returned.
Pros:
- The product is simple and standardized with common policy wordings across insurance companies.
- The premiums will likely be low due to heavy competition as all insurance companies will have to offer this product.
- Allowing premium payment in instalments will make the policy easier on the pockets of the lower-middle-income segment which is outside the net of Ayushman Bharat.
- The policyholder will be allowed a period of at least 15 days from the date of receipt of the policy to review the terms and conditions of the policy and to cancel the policy if not acceptable.
- There is no limit on the Arogya Sanjeevani policies you can purchase.
- Features like portability will ensure that insurance companies provide good service.
- The policy includes most of the features which may be required by a common policyholder. Thus, it is likely to see wide acceptance.
- Most of the exclusions such as treatments related to weight loss, change of gender, plastic surgery, injuries due to hazardous adventure sports etc. are pretty basic without any major basic exclusion.
Cons:
- There is a waiting period of 30 days from the date of issue of the policy.
- Maternity benefit isn’t covered.
- With the burgeoning population of senior citizens, the maximum entry age of 65 could have been higher. However, life long renewal takes away some of the problems.
- The maximum sum insured of Rs 5 lakh may not be enough for policyholders of expensive Tier-1 cities.
- Co-payment of 5% could have been avoided to make the policy more attractive to the lower-earning class.
Final Word
IRDAI has done a great service to the common citizens by offering a standardized and simple insurance product. However, the pricing of the product is left to the insurance companies and it remains to be seen whether the policy will truly be affordable.
It is also critical that IRDAI, as well as the insurance companies, market the product widely so that a large number of people get to benefit from the offering. Some of the issues like non-availability of maternity benefit and waiting periods as long as 48 months for certain diseases also need to be re-looked at by the IRDAI.
On the whole, Arogya Sanjeevani is a good product on paper which was badly needed in a country like ours. A five lakh cover is too small for those who can afford to pay more. If insurers offer a 10 lakh cover in this plan then it can be considered in better light.
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