Table of Contents
Arogya Sanjeevani Policy
In April 2020, in the midst of a global pandemic, IRDAI did something quietly significant: it mandated that every health insurance company in India must offer a standardised, basic health insurance product with identical core features across all insurers. This product is called Arogya Sanjeevani. It was designed to end the confusion of comparing hundreds of different health plans with different features, different exclusions, and different terminology. One standard product. One set of rules. Different prices from different insurers — and you pick the cheapest from the most reputable. Here is everything about it.
The Philosophy Behind Arogya Sanjeevani
Before Arogya Sanjeevani, comparing health insurance plans in India required expertise. Every plan had different room rent limits, different exclusion lists worded differently, different day care procedure lists, different sub-limits. A consumer without insurance expertise could not meaningfully compare Plans A, B, and C because each was structured differently. The comparison was apples to oranges.
IRDAI’s insight was that the market needed a benchmark standard product — one that every insurer must offer, with identical coverage, so that price and insurer service quality become the only differentiators. Arogya Sanjeevani is that product. All 30-plus health insurers in India offer it, and since the coverage is standardised by regulation, the only meaningful difference between them is premium and claim settlement quality.
Coverage Details — What Every Arogya Sanjeevani Policy Includes
The sum insured under Arogya Sanjeevani ranges from ₹1 lakh to ₹10 lakh, available in multiples of ₹50,000. You can buy ₹1 lakh, ₹1.5 lakh, ₹2 lakh, and so on up to ₹10 lakh. The minimum entry age is 18 years. Children can be covered from 3 months as part of a family floater. The maximum entry age is 65 years. The policy is available both as individual and family floater. In a family floater, covered members are the policyholder, spouse, dependent children between 3 months and 25 years, and dependent parents.
Hospitalisation coverage includes inpatient treatment — room, boarding, nursing, surgeon and anaesthetist fees, medicines, blood, oxygen, operating theatre charges, and all hospital-incurred charges related to the illness or injury. Pre-hospitalisation expenses are covered for 30 days before admission and post-hospitalisation for 60 days after discharge. Day care procedures — medical and surgical procedures that are completed within less than 24 hours due to technological advancement — are covered. The policy specifies that AYUSH treatment (Ayurveda, Yoga, Naturopathy, Unani, Siddha, Homeopathy) at recognised AYUSH hospitals is covered.
Ambulance charges are covered up to ₹2,000 per hospitalisation for transportation to the hospital. Cataract surgery is covered but with a sub-limit of 25% of sum insured or ₹40,000 — whichever is lower — per eye per policy year.
The Mandatory Co-Payment and What It Means
Every Arogya Sanjeevani policy has a mandatory 5% co-payment on every claim. This means for every ₹1 lakh in medical bills, you pay ₹5,000 and the insurer pays ₹95,000. This co-pay percentage is fixed by IRDAI across all insurers — no insurer can offer Arogya Sanjeevani without this 5% co-pay. While 5% is not large, for a ₹5 lakh hospitalisation bill, your co-pay would be ₹25,000 — a meaningful amount. Budget for this in your emergency planning.
Room Rent Structure
The room rent under Arogya Sanjeevani is capped at 2% of sum insured per day. For a ₹5 lakh plan, this means a maximum room rent of ₹10,000 per day. For a ₹3 lakh plan, the room rent cap is ₹6,000 per day. ICU charges are capped at 5% of sum insured per day — ₹15,000 per day for a ₹3 lakh plan, ₹25,000 per day for a ₹5 lakh plan.
As discussed in other contexts, room rent caps create proportionate deductions when the actual room cost exceeds the cap. Choosing a plan with a sum insured high enough that the room rent cap exceeds the typical room rate in your preferred hospital is important. For a hospital charging ₹8,000 per day for a standard private room, a ₹5 lakh Arogya Sanjeevani (cap of ₹10,000/day) is comfortably within range. A ₹3 lakh Arogya Sanjeevani (cap of ₹6,000/day) would result in proportionate deductions for ₹8,000 rooms.
Waiting Periods in Arogya Sanjeevani
The initial waiting period for all non-accidental illnesses is 30 days from policy inception. Accidental injuries are covered from Day 1. The pre-existing disease waiting period is 48 months (4 years) — this is the one aspect where Arogya Sanjeevani is at the conservative end of the market. Some commercial comprehensive plans offer 2-year or even 1-year PED waiting periods, but Arogya Sanjeevani by regulation has 4 years. Specific diseases listed in Schedule I of the policy (conditions like hernia, cataract, joint replacement, etc.) have a waiting period of 24 months.
Who Benefits Most From Arogya Sanjeevani
First-time health insurance buyers who are overwhelmed by the complexity of the market and simply want a straightforward, government-regulated product are the primary beneficiaries. The standardisation eliminates comparison confusion — buy the cheapest Arogya Sanjeevani from a reputable insurer and you have solid basic coverage.
People in rural or semi-urban areas who interact with agents rather than online platforms benefit from knowing that any insurer’s Arogya Sanjeevani is the same product. They cannot be sold a version with hidden inferior features — the coverage is defined by regulation.
Very price-sensitive buyers who need any coverage at the lowest possible premium can use Arogya Sanjeevani as a cost-effective entry point. A family floater for a family of four with ₹5 lakh sum insured can cost ₹8,000 to ₹15,000 per year depending on the insurer — significantly less than comprehensive commercial plans of equivalent coverage.
Building on Arogya Sanjeevani — The Super Top-Up Strategy
Because Arogya Sanjeevani’s maximum sum insured is ₹10 lakh, it may be insufficient for serious illness in metro hospitals. The strategic solution is to buy a ₹5 lakh or ₹10 lakh Arogya Sanjeevani as the base and add a Super Top-Up plan with a deductible equal to the Arogya Sanjeevani sum insured. The Super Top-Up activates for expenses beyond the base coverage, providing high total coverage at moderate combined premium.
Frequently Asked Questions
Is Arogya Sanjeevani available for people above 65? No. The maximum entry age for Arogya Sanjeevani is 65 years. People above 65 must look at senior citizen specific plans. However, if a policy was purchased before the insured turned 65, it can continue to renew beyond 65 as long as the insured remains a member and premiums are paid.
Can I have both Arogya Sanjeevani and a commercial health plan? Yes, you can hold multiple health insurance policies simultaneously. In the event of a claim, you can claim from one policy first and use the other for expenses not covered or amounts exceeding the first policy’s limit. Both policies need to be intimated at the time of hospitalisation. The coordination of benefits (which policy pays first and for what) is governed by IRDAI guidelines.
Does Arogya Sanjeevani cover COVID-19 treatment? Yes. COVID-19 treatment is covered as a medical illness under Arogya Sanjeevani since COVID-19 is not specifically excluded. Hospitalisation for COVID treatment, related investigations, and medicines during the hospital stay are covered in the same way as any other inpatient treatment.
My Profile