Arogya Sanjeevani Health Insurance: Features, Coverage, Pros & Cons

What is Arogya Sanjeevani Health Insurance? Arogya Sanjeevani Health Insurance is a standardized health policy launched in April 2020 to provide simple and affordable medical coverage. It offers uniform benefits across all insurers. This makes it easy to compare policies based on price and service. This plan is suitable for first-time buyers, families seeking basic protection, and individuals on a budget, or those struggling to get insured elsewhere due to pre-existing conditions.

For most Indians today, getting quality healthcare while keeping expenses under control has become a top priority. Recognizing this need, the Insurance Regulatory and Development Authority of India (IRDAI) introduced the Arogya Sanjeevani Health Insurance policy as a mandatory standard health insurance product to simplify and standardize health coverage across insurers.

This guide delves into everything you need to know about Arogya Sanjeevani Health Insurance, from its key features, eligibility, coverage details, and who can consider this policy.

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What is Arogya Sanjeevani Health Insurance?

Arogya Sanjeevani Health Insurance is a standardized indemnity-based health insurance product launched by IRDAI in April, 2020. The primary goal of this policy is to provide uniform, affordable, and simple health coverage options to individuals and families all over India. 

All general and standalone health insurance companies are mandated to offer this product with identical core features, benefits, and terms, though premiums may vary depending on the company and region. This ensures that customers can easily compare policies based on premium, service quality, and insurer reputation, without worrying about complex variations in terms and conditions. Currently, the policy is available through 30 insurers in India.

Eligibility Criteria for Purchasing Arogya Sanjeevani Policy

The policy is designed for a broad spectrum of individuals and families, with straightforward eligibility requirements:

• Entry Age: Adults between 18 to 65 years can purchase the policy.
• Children Eligibility: Dependent children from as young as 3 months up to 25 years are eligible for coverage under the family floater option.
• Residency: The policy is available to Indian residents across all states and union territories.
• No Medical Tests: Typically, no mandatory health check-up or pre-acceptance medical testing is required unless insurers specify based on age or sum insured.
• Renewability: Lifelong
• Coverage Type: Individual / Family Floater

What is Covered Under Arogya Sanjeevani Health Insurance?

1. Sum Insured Options: The minimum sum insured available is ₹50,000, while the maximum can go up to ₹10,00,000, depending on the insurer. The policyholder can choose the sum insured in multiples as specified by the insurer.
2. In-Patient Hospitalization: Covers hospital room rent and related expenses up to 2% of the sum insured per day, with a cap of ₹5,000 per day.
3. ICU/ICCU Expenses: Expenses incurred for Intensive Care Unit or Intensive Cardiac Care Unit are covered up to 5% of the sum insured per day, subject to a maximum of ₹10,000 per day.
4. Co-Payment: A 5% co-pay is applicable on all claims, meaning the insured person needs to bear 5% of the admissible claim amount, and the rest will be paid by the insurer.
5. Pre and Post Hospitalization: Medical expenses are covered for 30 days prior to hospitalization and for 60 days after discharge.
6. Day Care Procedures: Treatments or surgeries that do not require 24-hour hospitalization are fully covered.
7. AYUSH Treatments: Expenses for alternative treatments such as Ayurveda, Yoga, Unani, Siddha, and Homeopathy are included.
8. Modern Treatments: Advanced medical procedures such as robotic surgeries and stem cell therapy are covered up to 50% of the sum insured.
9. Road Ambulance Charges: Reimbursement up to ₹2,000 per hospitalization is provided for ambulance services.
10. Cataract Surgery: Covered up to 25% of the sum insured or ₹40,000 per eye, whichever is lower.
11. Cumulative Bonus: For every claim-free year, the insured gets a bonus of 5% of the sum insured, which can accumulate up to 50%. If a claim is made, the bonus reduces in the same proportion.
12. Waiting Periods:

• 30 days initial waiting period, except for accidents (which are covered from day one).2 years for specific listed illnesses.3 years for pre-existing conditions before coverage begins.

Pros of the Arogya Sanjeevani Health Insurance Plan

• One Nation, One Policy: The biggest advantage is its uniformity. No matter which insurer you choose, the benefits remain the same. This removes confusion and ensures that customers across India get equal protection.
• Regulator-Backed Trust: Since the plan is designed and mandated by the IRDAI (Insurance Regulatory and Development Authority of India), there are no hidden gimmicks, misleading riders, or complex terms. The plan is straightforward and transparent.
• Cashless Hospitalization: Treatment at network hospitals without upfront payment; you only bear non-medical and consumable costs.
• Family Coverage in One Plan: Policyholders can include their spouse, dependent children, and even parents under a single plan (subject to insurer’s terms). This makes it easier and often more affordable to manage the family’s health insurance needs in one go.
• Affordable Premiums: The premium rates are capped within a regulated range, making it affordable for low- and middle-income families to get health protection without straining their finances.

To help you compare costs, here’s a quick look at the premiums for HDFC Ergo Optima Secure (a retail health plan) versus HDFC Arogya Sanjeevani.

The figures below show annual premiums for a ₹10 lakh sum insured, based on different family profiles in pincode 110001 (Tier I city).

Profiles (Age)	HDFC Ergo Optima Secure	HDFC Arogya Sanjeevani
25 (Single individual)	₹13,367	₹6,719
30, 30 (Married couple, no children)	₹20,697	₹9,743
35, 30, 5 (Young family with one child)	₹24,499	₹12,086
60, 60 (senior couple)	₹59,113	₹26,885Profiles (Age)	HDFC Ergo Optima Secure	HDFC Arogya Sanjeevani
25 (Single individual)	₹13,367	₹6,719
30, 30 (Married couple, no children)	₹20,697	₹9,743
35, 30, 5 (Young family with one child)	₹24,499	₹12,086
60, 60 (senior couple)	₹59,113	₹26,885

• Portability & Lifetime Renewability: You can switch your Arogya Sanjeevani Policy to another insurer without losing benefits like waiting periods, moratorium, or NCB. The plan also offers lifetime renewals that ensures continuous cover and long-term security, especially in older age.

Cons of the Arogya Sanjeevani Health Insurance Plan

• Room Rent Cap: The policy has a daily room rent limit (2% of the sum insured, capped at ₹5,000). If you choose a room above this limit, a proportionate deduction applies. It means you’ll have to bear part of the hospital bill yourself.
• Disease-Wise Sub-Limits: Certain treatments, like cataract surgery and modern procedures (e.g., robotic surgeries), have fixed caps. If actual expenses exceed these caps, the extra cost must be paid out-of-pocket by the insured.
• Mandatory Co-Pay: A 5% co-payment clause is applicable on all claims, irrespective of the insured person’s age or insurer chosen. This means for every hospital bill, you will always have to pay at least 5% yourself.
• No Domiciliary Treatment Cover: Expenses for treatments taken at home (when hospitalization is advised but not possible) are not covered under this plan. This is a feature that many comprehensive health insurance policies usually provide.
• No Restoration of Sum Insured: With the Arogya Sanjeevani Health Insurance, once your coverage limit is used up in a year, it doesn’t reset. This can be tricky for families with multiple members or for anyone who might need several hospital visits in the same year.
• Limited Sum Insured Range: The policy covers up to ₹10 lakh, but with rising medical costs, this amount may not always be enough for expensive treatments.
• No Add-Ons or Customization: Unlike other health plans, Arogya Sanjeevani Health Insurance Policy cannot be customized with riders such as reduced waiting periods, higher bonuses, restoration, consumables cover, annual health checkups or maternity benefits. The lack of personalization may not suit customers with specific needs.

Who Should Consider the Arogya Sanjeevani Health Insurance?

• You’re finding it difficult to get insured elsewhere: For individuals with multiple pre-existing medical conditions or those who have faced rejection from insurers, Arogya Sanjeevani Health Insurance can serve as a fallback option. Since it is an IRDAI-mandated health plan, every insurer is required to offer it, making it more accessible.
• You want a simple backup plan: If you already have employer-provided health insurance or another retail policy, this plan can act as a secondary health cover. However, do note that restrictions like co-pay and room rent limits may still lead to significant out-of-pocket medical expenses. If budget is a concern, a super top-up health insurance plan may be more cost-effective in the long run.
• You prefer a regulator-defined, no-frills product: This policy is straightforward, uniform across insurers, and easy to understand. It works well for those who don’t want to get caught up in complicated plan variants, riders, or fine print.

Note: In all these situations, be prepared for some out-of-pocket expenses, especially if hospitalization costs exceed the policy’s sub-limits.

Who Should Not Choose Arogya Sanjeevani Policy?

• You are young and healthy: Instead of settling for a restrictive basic health insurance plan, opt for a comprehensive health insurance policy with a higher sum insured, no room rent restrictions, no mandatory co-pay, and no disease-specific limits. This provides much better value in the long term and is usually affordable as well.
• You have pre-existing diseases (PEDs): The Arogya Sanjeevani Policy has a 3-year waiting period for PEDs and no add-ons to shorten it, unlike many retail plans. So, if you need coverage for existing health issues sooner, you might want to explore specialized disease-specific plans or insurers that offer shorter PED waiting periods.
• You’re seeking broad and complete protection: The Arogya Sanjeevani Health Insurance does not include important benefits like OPD expenses, maternity cover, domiciliary care, consumables coverage, annual health check-ups, or restoration of sum insured. If you want all-round protection, you’ll be better off with a more comprehensive retail plan.
• You need flexibility and customization: Arogya Sanjeevani Health Insurance is rigid. It has limited sum insured options (₹50,000 to ₹10 lakh) and no riders or add-ons to tailor coverage. If your health needs evolve over time, this plan won’t offer the flexibility you may require.

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Conclusion

The Arogya Sanjeevani Health Insurance is a simple, regulator-backed health insurance that covers essential hospitalization needs. It’s easy to understand and accessible, making it a good choice for those seeking basic protection.

However, its fixed limits, co-pays, and sub-limits can leave you paying out-of-pocket for bigger medical expenses. In comparison, retail health insurance plans may cost a bit more but offer greater flexibility, fewer restrictions, and stronger long-term coverage.

If possible, go for coverage that grows with your needs. If not, the Arogya Sanjeevani Health Insurance policy is better than being uninsured. Understand its limits and buy it for protection, not just the price.

If you need help deciding which health insurance plan is right for you, feel free to reach out to us. Book a free call with our experts for unbiased guidance tailored to your situation. We’ll help you understand your options and make the right choice.

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