Arogya Sanjeevani Explained: India's Standard Health Policy

Quick Answer: Arogya Sanjeevani is the standard health insurance policy mandated by IRDAI: every general and standalone health insurer must offer it, and its core benefits, limits and exclusions are the same whichever insurer you buy it from. Sum insured runs from ₹50,000 to ₹5 lakh, it covers hospitalisation, day-care procedures and AYUSH treatment, and it carries a mandatory 5% co-payment on every claim. Only the premium and the service differ between insurers. Some insurers market higher-limit variants under similar names — check the insurer's page for the exact options it offers.

Most health policies are hard to compare because every insurer writes its own wording. Arogya Sanjeevani fixes that problem by design. IRDAI launched it as a Standard Health Insurance Product on 1 April 2020, and the core product is identical across insurers: the same hospitalisation cover, the same sub-limits, the same waiting periods and the same exclusions. That makes comparison simple in one specific way. If two insurers quote different premiums for Arogya Sanjeevani, you are broadly comparing price and service — claim settlement speed, hospital network and customer support — rather than two different benefit structures. The policy schedule of the insurer you choose still governs your individual contract, so read it before paying.

The policy is an indemnity policy: it reimburses hospitalisation expenses up to the sum insured, rather than paying a fixed lump sum. Its core cover includes: - In-patient hospitalisation: room rent, boarding, nursing, surgeon and doctor fees, medicines, ICU charges and operation theatre costs - Pre-hospitalisation expenses for 30 days before admission and post-hospitalisation expenses for 60 days after discharge - Day-care procedures that do not need 24-hour admission - AYUSH treatment (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy) up to the sum insured - Modern treatments such as robotic surgery and similar specified procedures, up to 50% of the sum insured - Cataract treatment up to 25% of the sum insured or ₹40,000 per eye, whichever is lower - Road ambulance up to ₹2,000 per hospitalisation under the standard wording It is available as an individual policy or a family floater, where one sum insured is shared by the family. Entry age is 18 to 65 years for adults, with dependent children covered from 3 months to 25 years, and renewal is lifelong as long as premiums are paid on time.

Arogya Sanjeevani is deliberately a basic, budget policy, and its sub-limits are where buyers get surprised. Know them before you buy: - Room rent is capped at 2% of the sum insured per day, up to ₹5,000; ICU charges are capped at 5% per day, up to ₹10,000. On a ₹5 lakh policy, that means ₹5,000 a day for a room and ₹10,000 a day for ICU — a single room in a metro private hospital can cost more, and the difference comes from your pocket. - Every claim carries a mandatory 5% co-payment: on an admissible claim of ₹2 lakh, you pay ₹10,000 and the insurer pays ₹1,90,000. - There is a 30-day initial waiting period for illnesses other than accidents, and pre-existing diseases carry a waiting period of 48 months under the standard policy wording. Confirm the exact period in your insurer's policy schedule, as IRDAI has since capped waiting periods for newer health policies generally. Specified diseases and procedures also carry waiting periods set out in the policy schedule. - There are no riders or add-ons on the standard product. If you want maternity cover, a higher room-rent limit or OPD benefits, this is not the policy for them — you would need a separate or different plan. These limits are the trade-off for the price. Arogya Sanjeevani premiums are generally lower than comprehensive plans because the cover is narrower and tightly defined.

It suits first-time buyers on a tight budget, young families who want a basic safety net rather than no cover at all, and anyone who wants a simple policy they can actually understand. It also works as a base policy that can sit alongside an employer's group cover: if the employer cover is thin, a ₹5 lakh Arogya Sanjeevani policy adds a standard layer of protection. It suits less well if you live in a metro city and use private hospitals, where a ₹5 lakh sum insured can be exhausted by one major admission, or if you need cover for pre-existing conditions quickly — the waiting period still applies. In that case, compare a comprehensive plan with a higher sum insured and no room-rent cap.

Because the benefits are standard, comparing Arogya Sanjeevani quotes is one of the few genuinely like-for-like exercises in Indian health insurance. Check these four things: - Premium for the same sum insured, age and family combination — not a cheaper premium for a lower sum insured - The insurer's claim settlement record and cashless hospital network in your city, since service is the main real difference - Whether the quote is for an individual policy or a family floater, and how the sum insured is shared - The waiting periods stated in that insurer's policy schedule, especially for any pre-existing condition

Educational content only — not financial advice. Consult a SEBI-registered investment adviser for personal guidance; investments are subject to market risk.