One of the many reasons why people do not buy a health insurance policy is complex structure of it. On top of it, there are 100s of health plans and their variants. The people who suffer the most are the ones looking for a basic coverage at the most affordable price. To help such people, IRDA has come up with a product called Arogya Sanjeevani health insurance policy, which all insurance companies are mandated to offer. We tell you important features of this policy and whether you should buy it:
Standard basic coverage
Just like any other standard plan, this policy covers illnesses that require more than 24 hours of hospitalisation. Besides, it also covers expenses 30 days prior to hospitalisation and 60 days after being discharged from the hospital. The minimum cover under this policy is Rs 1 lakh while the maximum Rs 5 lakh. There is a provision of 5 per cent co-payment for all eligible claims made under this policy.
The insurer will pay for medical expenses incurred for treatment of cataract, subject to a limit of 25 per cent of sum insured but maximum up to Rs 40,000 for each eye in one policy year. The policy will also cover medical expenses incurred for inpatient care treatment under ayurveda, yoga and naturopathy, unani, siddha and homeopathy systems of medicines during each policy year up to the limit of sum insured as specified in the policy schedule in any AYUSH Hospital.
Capping of charges
Room rent, boarding and nursing expenses are capped up to 2 per cent of the sum insured and maximum Rs 5,000 per day. Intensive Care Unit (ICU) / Intensive Cardiac Care Unit (ICCU) expenses are capped up to 5 per cent of the sum insured and maximum Rs 10,000 per day. The maximum ambulance covered under this policy is Rs 2,000 per hospitalisation. Many other procedures such as balloon sinuplasty, deep brain stimulation, oral chemotherapy, intra vitreal injections, robotic surgeries and so on are covered either as inpatient or as part of day care treatment in a hospital up to 50 per cent of original sum insured.
Cooling and waiting period
Except accident no other ailments will be covered in first 30 days of the policy. For any pre-existing diseases the insured person will have to wait for 48 months to get coverage under the policy. It means if you get hospitalised due to diseases that you had declared while taking the policy, it will not be covered under the policy during the waiting period.
Simple to understand
The toughest part for a layman wanting to buy a health insurance policy is to understand its coverage, inclusions, exclusions, cooling period and waiting period for pre-existing diseases. The policy wording is often so long and complicated that many people find it near impossible to check out if there is something they are missing on. With IRDA defining the Arogya Sanjeevani as the best basic cover, customers may rest assured that they have a comprehensive cover against most of the common diseases.
Easy to compare
When every insurer is offering the same standard policy, it becomes easier to compare the advantage in terms of premium and claims settlement. You can easily pick an insurer with a good claims settlement track record and lower premium. If you want to go with better service quality and greater accessibility in terms of network hospitals, you can pick the insurer of your choice and see how much extra you need to shell out for the purpose.
Although portability has been allowed in health insurance, it is a tedious process because there is a lot of difference in terms of coverage of existing policy and the new policy where one wishes to migrate. Arogya Sanjeevani being a standard plan remains same with every insurers. This will ensure seamless portability in case you wish to change your health insurance provider.
Bonus for claim-free year
For each claim-free year, you get a bonus of 5 per cent on your sum insured that gets added to the sum assured for next year. All such bonuses put together cannot cross 50 per cent of the original sum assured of the policy. For example, if you have taken a health plan of Rs 5 lakh sum assured, for each claim-free year, your sum assured will get increased by Rs 25,000. However, the total sum assured will not cross Rs 7.5 lakh. In case of a claim in a year, your cumulative bonus will reduce by 5 per cent.
No claim rejection after 8 years
After completion of eight continuous years under this policy, no look back will be available for insurers. The period of eight years has been defined by IRDA as a moratorium period. The moratorium will be applicable for the sum insured of the first policy and subsequently completion of eight continuous years would be applicable from the date of enhancement of sums insured
only on the enhanced limits. Once this period is over, no claim under this policy can be contested by the health insurance company except for proven fraud and permanent exclusions specified in the policy contract. The policies will, however, be subjected to all limits, sub limits and co-payments as per the policy.
Should you go for it?
If you are looking for a basic health insurance plan which offers standard coverage at affordable cost, this is a good plan to go for as it offers good value for money. However, you have to be aware about the limitation of this plan. This plan has maximum sum assured of Rs 5 lakh which many people may find insufficient. In that case, you should go for other plans for desired sum assured. In terms of coverage of disease and capping of charges, this plan has limited offering and people who want greater coverage can go for other plans being offered by health insurers. There are many specific diseases and critical illnesses which this plan does not cover. So, if you wish to have a broader coverage, you may go for a suitable plan being offered by health insurance companies.