Arogya Sanjeevani policy, Benefit, Coverage and Limitation

What is Arogya Sanjeevani policy?

IRDAI has issued a standard health insurance policy from 1 st April 2020. This policy is named as Arogya Sanjeevani Policy and this policy is available with all Health Insurance Providers in India.

This is a standard insurance policy and provides basic health insurance cover between Rs 1 to Rs 5 lakhs rupees.

What is the significance of the Arogya Sanjeevani policy?

In India, there are many health insurance companies, and all of them provide different types of health insurance. Customers always get confused when it comes to select the right insurance policy for them. To sort out this IRDAI has issued a standard Health Insurance Plan, in which benefit will remain the same.

So what difference actually have while purchasing this policy from the different insurers?

Well, the actual difference is in service provided by the insurer, premium price, claims and it's buying process.

What’s covered under Arogya Sanjeevani policy?

1) Hospital Expense: Arogya Sanjeevani policy covers all hospital expense occur due to illness or accident. COVID-19 treatment is also covered under this policy.

2) AYUSH: Arogya Sanjeevani policy also covers treatment for AYUSH (Ayurvedic, Yoga, and Naturopathy, Unani, Siddha, Homeopathy).

3) Cumulative Bonus: 5% bonus is rewarded for every claim-free year for you and your family.

4) Room Rent: 2% of the SI maximum up to Rs 5,000 per day.

5) ICU/ICCU: 5% of the SI maximum up to Rs 10,000 per day.

6) Ambulance Services: Ambulance charges with a maximum cap of ₹2,000 per hospitalization are included in the policy.

7) Plastic Surgery and Dental Treatments: Both are cover under situation due to injury and diseases.

8) Cataract Surgery: Cataract Surgery is cover under the Arogya Sanjeevani policy. A policyholder can claim up to 40,000 or 25 % of the total sum insured or whichever is lower.

9) New Age Treatments: Arogya Sanjeevani policy cover modern treatment like Balloon Sinuplasty, Immunotherapy, and Stem Cell Therapy, among many other treatments (the list is given below), can be covered to up to 50% of the total sum insured.

10) Lifelong Renewability: Age of entry is between 18-65 years and this policy comes with life long renewability.

11) Affordable Premium: Premium are lower then other health insurance policy.

12) Individual & Family Floater Available: The Arogya Sanjeevani Policy comes with two plans available: An Individual Health Policy (One policy each for a family member) and a Family Floater Health Insurance (One policy for the entire family). 

List of New-Age Treatments Covered in Arogya Sanjeevani Policy

1) Uterine Artery Embolization and HIFU (High intensity focused ultrasound) : Uterine fibroids are noncancerous (benign) tumors that develop in the uterus (womb) and Uterine artery embolization (UAE) is a procedure to treat fibroids without surgery . HIFU (High intensity focused ultrasound) is used to increase the flow of blood or lymph, or to destroy tissue, such as tumors, through a number of mechanisms.

2) Balloon Sinuplasty: Balloon sinuplasty is a type of endoscopic nasal surgery to treat large nasal sinuses.

3) Deep Brain stimulation: Deep Brain stimulation is technique used in the treatment of movement disorders, including Parkinson's disease, essential tremor, and dystonia.

4) Oral Chemotherapy: Oral chemotherapy is a cancer-fighting drug given by mouth in tablet, capsule, or liquid form.

5) Immunotherapy : Immunotherapy is used in cancer treatment with help on monoclonal antibodies for treatment of cancer.

6) Intra vitreal injections: Intravitreal injections are used to treat certain eye problems.

7) Robotic surgeries: Robotic surgery, or robot-assisted surgery, allows doctors to perform many types of complex procedures with more precision, flexibility, and control than is possible with conventional techniques. Robotic surgery is usually associated with minimally invasive surgery — procedures performed through tiny incisions. It is also sometimes used in certain traditional open surgical procedures.

8) Stereotactic radio surgeries: Stereotactic radiosurgery (SRS) uses many precisely focused radiation beams to treat tumors and other problems in the brain, neck, lungs, liver, spine, and other parts of the body.

9) Bronchial Thermoplasty: Bronchial thermoplasty (BT) is used for treating asthma and is thought to prevent the chronic structural changes that occur in airway smooth muscle (ASM) in individuals with asthma.

10) Vaporisation of the prostrate: This technique is used to treat enlarge prostrate.

11) IONM: Intra Operative Neuro Monitoring is used monitor certain neural structures during surgery.

12) Stem cell therapy: Stem cells may have the potential to be grown to become new tissue for use in transplant and regenerative medicine.

Limitations:

1) In this policy Maximum sum assured is of Rs 5 Lakhs.

2) Limitations on room expenses / ICU expenses / Cataract expenses.

3) No riders are available.

4) A co-payment of 5% of hospital expenses is another limitation.

5) Maternity expenses are not covered.

6) There is no fixed premium. The premium price depends on the insurer.

Arogya Sanjeevani Policy IRDA guidelines can be seen at this link.

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