If You're Buying A Health Plan, You Must Buy This One

Bydhrishtri parikh

This article discusses the increasingly popular Arogya Sanjeevani health plan, and what it entails. If you have not purchased it yet, read on for information.

What is the Arogya Sanjeevani Policy?

It is a universal health insurance plan that is offered by all health insurance providers in India. You need not go to any specific health provider to buy this plan – it is mandatorily the same across all service providers in terms of its benefits, riders, sub-limit clauses and other features.

At its core, it is a health care plan that covers both hospitalisation and day care procedures, and has a maximum sum assured of Rs 10 lakh. It is an excellent health insurance plan to buy if you have never purchased insurance for yourself or your loved ones before, or if you are sceptical about investing too much money on premiums for a few years.

Another reason why this plan is increasingly popular, apart from its simplicity, is that it offers a valuable add-on coverage in case you want to enhance the sum assured but cannot get it on your primary health plan.

I have a health insurance plan. Why do I need this one?

If you have a primary plan with a coverage of Rs 5 lakh, it is obviously insufficient for your needs in this day of high inflation and increasing needs. Thus, when you buy the Arogya Sanjeevani policy cover, you get a total sum assured of Rs 15 lakh because the latter has a sum assured of up to Rs 10 lakh.

This policy is like a top up plan to your primary health plan. However, it cannot be used like a super top plan, which allows for multiple coverage in a year over the deductible on the primary plan.

What are some of the things I should know about the Arogya Sanjeevani health insurance?

The following are some important facts to take on board before you buy the Arogya Sanjeevani policy:

* It can be taken for individuals or for families

* You must be at least 18 years of age when you buy it, and not older than 65 years of age at the time of purchase.

* In the case of family policies, the coverage is extended to major dependent children without a source of income up to the age of 25 years. However, if your child is 18 years of age and has an income, they cannot be covered under the plan. Aged parents and spouse can be covered

* This policy offers hospitalisation coverage for 30 days before the date of admission to hospital, and 60 days from discharge. As mentioned above, the maximum sum assured in the plan is Rs 10 lakh.

* As far as treatments are concerned, the policy covers all major and minor surgeries as admissible in the plan, and including day care treatments. You can claim the coverage for surgical or medical procedures performed under anaesthesia (local or general) in a hospital and which lasts less than 24 hours due to technology and which in the absence of that technology, would have resulted in hospitalisation over 24 hours. The doctor must certify this before you file the claim. Do note that OPD (Out Patient Department) consultation and treatment is not included in the coverage.

* The most important component of this policy are its sub-limit clauses. Do note them as under:

  • For the room rent, the sub-limit is 2% of the total sum assured or maximum of Rs 5,000 per day. If admitted to ICU, the sub-limit is 5% of the sum assured or maximum Rs 10,000 per day.
  • The policy pays a maximum of Rs 2,000 for ambulance charges.
  • Treatment costs for less complex surgical procedures as notified by the policy document, are covered up to 25% of the sum assured or maximum of Rs 40,000. The limits for complicated surgeries is 50% of the sum assured.
  • The co-payment limit of 5% on the claim amount is admissible under the policy.

 * The sum assured is increased by 5% for every No-Claim year, as long as the plan is renewed on or before due date every year without a break. The bonus is subject to 50% of the sum assured.