If you’ve been on the lookout for an affordable health insurance policy, the Arogya Sanjeevani Health Insurance Plan might just be the answer.
The Insurance Regulatory and Development Authority of India (IRDAI) introduced this type of policy to standardise health insurance coverage across insurers, offering a simple and straightforward solution for you and your family.
But what sets this policy apart from other options? What makes it suitable for people of different financial backgrounds? In this article, let’s explore the key aspects of the Arogya Sanjeevani Policy and compare it to other health insurance plans in the market. Whether you're new to health insurance or looking for an affordable option, this will help you make an informed decision.
The Union government has recently expanded the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) to cover all citizens aged 70 and above, offering ₹5 lakh worth of annual health insurance coverage. Families with senior citizens aged 70 and above already covered by AB PM-JAY will receive an additional top-up cover of up to ₹5 lakh per year, specifically for those elderly members.
Apart from this, senior citizens already enrolled in public health schemes like the Central Government Health Scheme (CGHS), Ex-Servicemen Contributory Health Scheme (ECHS), or Ayushman CAPF can choose between continuing with their current scheme or switching to AB PM-JAY. This move is aligned with the government's effort to ensure accessible healthcare for India's elderly population, particularly those belonging to vulnerable socio-economic groups.
What is Arogya Sanjeevani Health Insurance?
The Arogya Sanjeevani Health Insurance Policy is a standard health insurance plan introduced by the IRDAI to simplify health insurance. It’s a type of health insurance policy that is available across multiple insurance providers and has a uniform set of features and benefits.
This policy offers basic yet adequate coverage at an affordable premium. It covers in-hospitalisation as well as day-care treatments and is available for individuals and families with coverage ranging from ₹50k to ₹10 lakhs.
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What are the Features of Arogya Sanjeevani Health Insurance Policy?
Here are some important points to understand whether a health insurance policy is good or not:
- No co-payment, room rent limits, and disease-wise sub-limits.
- A Low pre-existing disease waiting period (PED WP) and specific illness waiting period (SI WP).
- A good restoration bonus, pre- and post-hospitalisation cover, network hospital list, and no-claim bonus are also added advantages.
- Apart from these features in the policy, you should also consider some metrics that assess the insurer’s performance. These include the Incurred Claim Ratio (ICR) and the Claim Settlement Ratio (CSR).
Based on these criteria, let’s take a look at Aarogya Sanjeevani Health Insurance Plans:
What are the Pros and Cons of Arogya Sanjeevani Health Insurance Plans?
Similar to any other health insurance policy, it is wise to compare the pros and cons of Arogya Sanjeevani plans, too. Here are some advantages and disadvantages of the same:
What are the Advantages of Arogya Sanjeevani Health Insurance Plans?
- Affordable Premiums: Arogya Sanjeevani is designed to be affordable, offering coverage at a lower cost compared to regular health insurance policies.
- Comprehensive Coverage: Despite being a basic plan, it covers most essential medical expenses, including COVID-19 treatments.
- Standardisation: Since all insurers offer the same set of features, it eliminates confusion, making it easier to choose the policy that best suits you.
- No Complex Features: This plan focuses on providing essential coverage without complicating terms and conditions, making it beginner-friendly.
- Family Floater Option: It allows you to cover your entire family under a single policy, providing peace of mind.
What are the Disadvantages of Arogya Sanjeevani Health Insurance Plans?
- Limited Coverage: The sum insured ranges only from ₹50k to ₹10 lakhs, which may not be sufficient for those seeking higher coverage.
- Room Rent Capping: The policy caps room rent at 2% of the sum insured and ICU charges at 5%, which could result in out-of-pocket expenses in some hospitals.
- No Add-Ons: Unlike regular health insurance policies, there are no options for add-ons, limiting customisation.
- Low NCB: Arogya Sanjeevani Policies offer
- Co-payment Clause: There is a 5% co-payment clause applicable to all claims, meaning the insured has to bear 5% of the claim amount out of pocket. Considering that this policy is aimed at the financially weaker section, this may not be beneficial.
- Sub-Limits on Specific Treatments: There are restrictions on certain treatments, such as cataract surgeries, which might not be ideal if you’re seeking comprehensive coverage.
What are the best Health Insurance plans in 2024?
Arogya Sanjeevani is an excellent option if you’re looking for an affordable, no-frills health insurance plan that covers basic healthcare needs. While it has limitations in terms of coverage amount and customisation, it serves as a reliable safety net for millions of Indians, particularly those in the lower-income bracket.
However, for those seeking more comprehensive coverage or flexibility, exploring standard health insurance policies might be a better option. Here are some of the top policies offered by private insurers in India:
| Top Health Insurance Pan | Waiting Periods | Other features | Insurer Metrics |
|---|---|---|---|
| Aditya Birla Activ One Max | PED WP: 3 years (add-ons can reduce it) SI WP: 2 years |
Pre & post hospitalisation cover: 90 & 180 days Restoration: 100% of base SI, unlimited times Loyalty/ RenewalBonus: 100% pa, up to 500% |
Network Hospitals: 11k+ CSR: 95% ICR: 61% |
| HDFC ERGO Optima Secure | PED WP: 3 years SI WP: 2 years |
Pre & post hospitalisation cover: 60 & 180 days Restoration: 100% of base SI, once a year(add-on can make it unlimited) Loyalty/ Renewal Bonus: 50% pa, up to 100% |
Network Hospitals: 13k + CSR: 98% ICR: 85% |
| Care Supreme | PED WP: 4 years (add-ons can reduce it) SI WP: 2 years |
Pre & post hospitalisation cover: 60 & 180 days Restoration: Up to Base SI, unlimited times Loyalty/ Renewal Bonus: 50% pa, up to 100% (add-on can increase it to 100% pa, up to 500%) |
Network Hospitals: 16k+ CSR: 90% ICR: 58% |
What is the difference between a normal Health Insurance Policy and the Arogya Sanjeevani Health Insurance Plan?
While Arogya Sanjeevani provides a basic level of health coverage, a standard health insurance plan offers more flexibility, higher coverage limits, and customisable add-ons. Here are some differences in a nutshell:
| Feature | Arogya Sanjeevani Policy | Standard Health Insurance Policy |
|---|---|---|
| Premium | Lower premiums, standardised across insurers | Varies significantly by insurer and coverage |
| Coverage | Limited coverage | Can offer much higher coverage |
| Room Rent Limit | 2% of sum insured for room, 5% for ICU | Usually, there is no limit in higher-tier plans |
| Customisation | No add-ons | Offers customisation through add-ons |
| Sum Insured | ₹50k to ₹10 lakhs | Can range from ₹1 lakh to ₹1 crore+ |
| Eligibility | Basic eligibility criteria. Common across all insurers. | More comprehensive underwriting for higher coverage |
| Claims Process | Simplified and standardised | Can vary widely between insurers |
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Conclusion
If you're considering health insurance, it's important to weigh your healthcare needs, budget, and the level of coverage required. Whether you opt for Arogya Sanjeevani or a standard health insurance policy, ensuring that you and your family are adequately covered should always be a priority.
