By Priyanka Sambhav
Coronavirus has brought our lives to a standstill . The Indian consumer is postponing all their purchases but amid the falling purchase environment the buying graph of Insurance is seeing a rise. COVID-19 outbreak has made us understand that health insurance is an essential expense. That is why a standard Health Insurance policy with no-frill is much needed and Arogya Sanjeevni Policy is promising to be just that.
The Insurance Regulatory and Development Authority of India (IRDAI) launched the Arogya Sanjeevani Policy on 1st April 2020. It is a move towards simplifying health insurance. IRDAI made it mandatory for all the health insurance and general insurance companies to offer a basic standard health policy to buyers.
The complexities of various health insurance policies available in the market, obscure terms and conditions, and high premium rates were some of the major problems stopping Indians from purchasing them. As per the Economic Survey 2019, only 4.2 crore people out of the 130 crore population owned retail health policies in India. Common and simple policy wording across the industry and thus ease of portability – are the two important factors which makes Arogya Sanjeevani a simple go-to policy.
Everything to know about Arogya Sanjeevani Policy
Sum Insured
This standard health policy by IRDAI makes the buying of health policies easier. It covers the medical and hospital expense of up to any amount starting from Rs 50,000. Earlier the maximum limit was capped at Rs. 5 Lakhs but now insurers are allowed to offer a minimum sum insured of less than Rs.1 lakh and the maximum sum insured greater than Rs.5 lakh subject to the underwriting policy of the Insurers. However, the sum insured options must only be offered in the multiples of Rs. 50,000.
Types of Plan
One can avail either of the two plans available through the Arogya Sanjeevani Health Insurance Policy:
a. Individual Plan: This plan can be accessed for benefits only by a single individual.
b. Family Floater Plan: Multiple family members of the policyholder are registered as the beneficiaries of the health insurance plan.
Eligibility
Age criteria is 18-65 year old. This policy has lifelong renewability. Following family members can be a part of the Family Floater plan
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Spouse
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Parents and Parent- In-laws
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Dependent children aged 3 to 25years
Expenses Covered
This all-in-one health plan covers all the diseases including the novel coronavirus SarsCov2, cataract treatment, dental treatment, plastic surgery, and specified pre-existing diseases. The following policy coverages and benefits can be availed:
– Pre Hospitalisation & Post Hospitalisation
The policy covers the cost of treatment required for the preparation of hospitalisation. Depending on the terms of your insurance policy, one can receive this benefit for 30 days before hospitalisation and post hospitalisation too.
– In-patient Hospitalisation
Depending on the terms set by various insurers, the sum can be availed for hospitalisation expenses like room rent/boarding and nursing. Intensive Care Unit (ICU) / Intensive Cardiac Care Unit (ICCU) charges are also covered along with the surgeon’s fee, doctor’s fee, anaesthesia, blood, oxygen, operation theatre charges.
– In-patient AYUSH Treatment
Alternative treatments like Ayurveda, Unani, Siddha and Homeopathy (AYUSH) undergone in a government hospital or any institute recognised by the government and or accredited by Quality Council of India/National Accreditation Board are also covered under the policy. The rates and benefits depend upon the insurer’s terms.
– Day Care Procedures & Emergency Ambulance Costs
Medical bills for one-day of hospitalisation can also be availed. Certain insurers also provide on-road ambulance charges.
Co-pay
Co-pay is that part of the bill which the policy holder has to pay.The majority part of the claim is paid by the insurer but companies always puts away a small portion which has to be paid by the policy holder. Usually, this is one point where insurance buyer was getting a raw deal and Arogya Sanjeevni tries to even it out by fixing co-pay at 5 percent for all the claims.
Free look period
There is the usual 15 day freelook with the policy which means within the 15 days of receipt of policy you have 15 days to review the policy and cancel it if you feel that terms and conditions are not meeting your expectation.
Waiting period Rules
There is a 24 month waiting period for disease like benign ENT disorder,tonsillectomy, varicose vein, spinal issues, arthritis and few more. Do check the specific guidelines as there could be a 48 month waiting period for specific illness like joint replacement unless it is required due to an accident or even age related osteoporosis comes under a longer waiting period.
What is not covered?
Depending on insurer regulations, several things like admission primarily for diagnostic and evaluation expenses, diagnostic expenses that don’t relate to the treatment one is undergoing will not be covered. Similarly costs incurred for nursing at home, OPD expenses, costs incurred by non-allopathic treatment, unproven treatment, treatment of pregnancy and childbirth related complications, cosmetic, aesthetic and obesity related treatment will not be paid.Expenses arising out of war, civil war, nuclear attack, chemical or biological attack or breach of law, and costs incurred for treatments out of India will not be covered.
