Arogya Sanjeevani Policy is the insurer's version of the IRDAI-mandated standard health insurance product — enhanced with a higher ₹10 lakh sum insured (vs. the standard ₹5L), enhanced room rent and ICU limits, 10% online discount, and instalment payment facility. Transparent, affordable, lifelong renewable. The right starting point for first-time health insurance buyers.
the insurer Health Insurance· IRDAI Standard Product· Mandated Since April 2020· ASP Enhanced Version
Arogya Sanjeevani is India's IRDAI-mandated standard health insurance product — every general and standalone health insurer must offer it. the insurer's version, the ASP, goes beyond the IRDAI standard with a higher ₹10 lakh sum insured, enhanced room rent and ICU limits, an online discount, and instalment payment options. It's the most transparent health insurance product in India — terms are identical across insurers, making it easy to understand and compare.
"All General and Standalone Health insurers are mandated to offer Standard Individual Health Insurance Product 'Arogya Sanjeevani Policy'." Standardised terms, waiting periods, and exclusions across all 30 insurers. Only variables: premium and claim service. The most transparent health product in India.
IRDAI Mandated"Sum Insured up to 10 Lakhs." The IRDAI standard caps at ₹5L. the insurer's ASP goes twice as high — ₹10L sum insured in multiples of ₹50,000 from ₹1L to ₹10L. This is the insurer's most significant differentiator from the standard ASP product.
₹1L–₹10L· the insurer Only"Annual Increase in SI by 5% for each claim free year up to maximum 50% of SI opted." Every claim-free year grows your effective sum insured by 5% — at zero additional premium. After 10 claim-free years: ₹5L policy becomes ₹7.5L effective cover. No cost.
5% / Year· Max 50%"If the new policy is issued through online portal or renewed through online portal then policyholders can avail 10% discount."/the insurer confirmed. Buying direct online through the insurer's portal (without intermediary) gets a 10% discount on premium. Significant saving, especially for higher SI options.
10% Online· Direct Only"Premium for the Policy may be paid in installments of Monthly, Quarterly, Half Yearly as well as Yearly." — the insurer/IRDAI standard. Monthly, quarterly, or half-yearly premium payment makes ASP accessible to budget-conscious buyers. Grace period: 30 days (annual), 15 days (other modes).
Monthly· Quarterly"Policy is subject to lifelong renewability." No upper age limit on renewal. Once enrolled, you can renew for life — even with chronic conditions diagnosed later. This is an IRDAI mandate across all Arogya Sanjeevani offerings.
Lifelong· No Age Limitthe insurer ASP vs IRDAI Standard· What Makes the insurer's Version Better
All Arogya Sanjeevani policies share the same IRDAI-mandated base terms. the insurer's ASP goes further in three specific dimensions: a higher sum insured cap, enhanced room rent and ICU limits, and a 10% online discount. Here's exactly what the insurer offers beyond the standard.
IRDAI Standard· the insurer ASP· Entry Age· Family Definition· Medical Check-Up
Eligibility criteria confirmed from IRDAI official FAQs and the insurer's product page. The ASP follows IRDAI standard eligibility for age and family composition, with the insurer's specific requirement for pre-acceptance medical check-up for first-time buyers aged 55 and above.
"Minimum entry age is 18 years and maximum age at entry is 65 years." Adults between 18 and 65 years can purchase the policy as proposer (primary insured). No upper age limit for renewal — lifelong.
18–65 Years"Dependent Child/children will be covered from the age of 3 months to 25 years." Children above 18 who are financially independent become ineligible at the next renewal. Children between 3 months and 25 years (financially dependent) are covered.
3 Months–25 Years"Family consists of proposer and any one or more of: legally wedded spouse; parents and parents-in-law; dependent children (3 months–25 years)." Important: under family floater, either parents OR parents-in-law can be covered — not both sets simultaneously.
Spouse· Children· Parents"For Proposers aged 55 years and above (including dependents) and availing the policy for the first time." Pre-acceptance medical required for first-time buyers aged 55+. Relaxed to 60 years if: ≥3 members covered and at least one member under 35. the insurer reimburses 50% of check-up costs if proposal is accepted.
≥55 Years· First-Time Buyers"No requirement for medical check-ups until the age of 45 years." For first-time buyers below 55 (or 60 with family relaxation), no pre-acceptance medical check-up is required. This makes ASP easy to purchase online without clinic visits for most buyers.
Below 55 — No Check-Up"Portability (migration) allowed from/to similar products as per IRDAI guidelines." You can port from any other insurer's Arogya Sanjeevani policy to the insurer's ASP at renewal. Waiting period credit for time already served is mandatory under IRDAI portability rules.
Port In/Out· IRDAI NormsIRDAI Standard Coverage· the insurer ASP· Full Inpatient + AYUSH + Modern
Coverage confirmed from IRDAI official FAQs and the insurer's product page. All coverage items below are IRDAI-mandated and uniformly available across all Arogya Sanjeevani offerings. the insurer's enhanced sum insured (₹10L) means the sub-limit percentages translate to larger absolute amounts.
Room rent, nursing, ICU/ICCU charges, surgeon/anaesthetist/consultant fees, anaesthesia, blood, oxygen, OT charges, surgical appliances, medicines, drugs, diagnostic tests, diagnostic imaging. All medically necessary inpatient treatment expenses covered.
Full Inpatient· No Sub-Limit"Pre-Hospitalisation medical expenses incurred for a period of 30 days prior to the date of hospitalisation are covered." Doctor consultations, diagnostic tests, and medicines prescribed as part of the condition requiring hospitalisation: covered for 30 days before admission.
30 Days Prior"Post Hospitalisation medical expenses incurred for a period of 60 days from the date of discharge from the hospital are covered." Follow-up consultations, medicines, and diagnostic tests related to the hospitalisation: covered for 60 days after discharge.
60 Days After Discharge"All the day care treatments are covered in Arogya Sanjeevani Policy." Medical procedures under general/local anaesthesia requiring less than 24 hours hospitalisation (due to technological advancement) are covered. Includes cataract surgery, chemotherapy, dialysis, and more.
All Day Care Procedures"Expense incurred on ambulance services is available subject to a maximum of Rs.2000/- per hospitalization." Road ambulance for emergency transport to hospital: covered up to ₹2,000 per hospitalisation event.
₹2,000 Per Hospitalisation"Expenses incurred on hospitalisation under AYUSH systems of medicine will be covered." Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homeopathy treatments: covered when administered in a government hospital or NABH-accredited institution.
AYUSH· Govt/NABH OnlyModern medical procedures covered up to 50% of sum insured: Robotic surgeries, Uterine Artery Embolisation, HIFU, oral chemotherapy, Bronchial Thermoplasty, Intra Vitreal injections, stem cell therapy. Confirmed from Care Insurance /.
50% of Sum Insured"Coverage is available for treatment of Cataract. Expenses incurred on treatment of cataract are covered up to 25% of Sum insured or Rs.40,000/- whichever is lower." Sub-limit applies per eye per policy year. At ₹10L SI: 25% = ₹2.5L vs ₹40,000 cap — ₹40,000 applies.
25% of SI or ₹40K· Lower"Expenses incurred on Dental treatment necessitated due to disease or injury is covered." Dental treatment arising from accident requiring hospitalisation or due to disease: covered. Routine dental checkups, cleanings, and cosmetic dental work are excluded.
Accident/Disease Only"Expenses incurred on Plastic surgery necessitated due to disease or injury, are covered." Reconstructive plastic surgery following accidents, burns, or disease: covered. Cosmetic plastic surgery for aesthetic purposes is excluded.
Medical Necessity OnlyIRDAI· All Sub-Limits Identical Across All Arogya Sanjeevani Policies
"What are the sub limits in Arogya Sanjeevani Policy?" Sub-limits are IRDAI-standardised and identical across all insurers. At the insurer's ₹10L sum insured, the percentage-based sub-limits translate to larger absolute amounts than at ₹5L SI.
| Benefit | Sub-Limit | At ₹5L SI | At ₹10L SI (the insurer) |
|---|---|---|---|
| Room Rent per Day | 2% of SI / max ₹5,000 | ₹5,000/day | ₹5,000/day (cap) |
| ICU / ICCU per Day | 5% of SI / max ₹10,000 | ₹10,000/day | ₹10,000/day (cap) |
| Cataract Surgery | 25% of SI or ₹40,000 (lower) | ₹40,000 | ₹40,000 |
| Modern Treatments | 50% of Sum Insured | ₹2,50,000 | ₹5,00,000 |
| Ambulance | ₹2,000 per hospitalisation | ₹2,000 | ₹2,000 |
| Co-Payment (all claims) | 5% mandatory | 5% of claim | 5% of claim |
5%/Year· Up to 50% Max· No Premium Increase
"Sum insured (excluding CB) will be increased by 5% in respect of each claim free policy year, provided the policy is renewed without a break subject to maximum of 50% of the sum insured. If a claim is made in any particular year, the cumulative bonus accrued will be reduced at the same rate at which it has accrued."
₹5L base SI grows to ₹7.5L effective SI after 10 claim-free years — at no additional premium. For ₹10L SI: grows to ₹15L effective cover. "If Mr. A has bought a health insurance plan with sum insured Rs. One Lakh and he did not register any claim in the first policy year; at the time of renewal he will get a cumulative bonus of 5%."
the insurer ASP· 30 Days· 48 Months PED· 2 and 4 Year Specific Diseases
the insurer's ASP has four waiting period types — IRDAI standard, and the insurer. Note: the insurer's ASP retains the 48-month PED waiting period. The IRDAI reduced this to 36 months in May 2024, but the insurer's current policy wording (December 2024) maintains 48 months — verify at purchase.
the insurer/IRDAI· Standard Arogya Sanjeevani Exclusions
Exclusions product page and the insurer. These are the IRDAI-standardised exclusions applicable to all Arogya Sanjeevani policies.
"Our policy does not cover accidents encountered while participating in adventure sports." Injuries from bungee jumping, skydiving, rock climbing, motorsports, and similar adventure activities are excluded from ASP.
"Refractive error surgery due to refractive error less than 7.5 dioptres." LASIK and similar refractive error surgeries for mild vision correction (<7.5D) are excluded. Cataract surgery is separately covered with a sub-limit.
"Dental treatment (unless arising out of accident and requiring hospitalisation)." Routine dental — cleanings, fillings, root canals, orthodontics — is excluded. Only dental treatment necessitated by accident or disease requiring hospitalisation is covered.
Cosmetic surgery, aesthetic procedures, beauty treatments, and elective plastic surgery for appearance enhancement. Only plastic surgery necessitated by accident, disease, or injury is covered. Pure cosmetic procedures: excluded.
Treatment for conditions arising from or related to alcohol, drug, or substance abuse/dependency. Intoxication-related hospitalisations: excluded. Standard IRDAI health insurance universal exclusion.
Pregnancy, childbirth, maternity expenses, and related complications are not covered under the standard Arogya Sanjeevani product. IRDAI did not include maternity in the ASP mandated coverage. Separate maternity cover requires a different policy.
Day-to-day outpatient consultations, OPD medicines, diagnostic tests not leading to hospitalisation, and pharmacy costs without admission: excluded. ASP is an inpatient-focused policy. OPD coverage requires a separate OPD rider.
All pre-existing diseases during the 48-month waiting period. Specific diseases during 24/48-month waiting periods. Conditions arising in the first 30 days (non-accident). These are time-bound exclusions that lapse after the respective waiting periods are served.
the insurer· Cashless + Reimbursement· TPA-Based
"For Cashless Facility – available only for policies serviced by a Third Party Administrator (TPA). Check if the hospital falls under the networked hospitals (Preferred provider network/other network hospitals), as cashless is available only for empanelled network hospitals of the Company/TPA." the insurer Toll-Free: 022 4302 0000.
"For Cashless Facility – available only for policies serviced by a Third Party Administrator (TPA)." Check your ASP policy schedule for your TPA's name and helpline number. Verify that your hospital is in the TPA's network — cashless is only at network hospitals.
"For planned hospitalisation, intimation is to be sent to the TPA/Company in advance (72 hours prior) with details of Name and address of the hospital and condition requiring hospitalisation." For emergencies: intimate within 24 hours of admission. Provide: policy number, patient details, hospital name, diagnosis.
At a network hospital: show your ASP policy card/schedule at the hospital's insurance desk. The hospital submits a pre-authorisation request to the TPA. TPA approves, and your admission is cashless (you pay only the mandatory 5% co-pay and any non-covered charges). ASP's 5% co-pay is paid by you at discharge.
If treated at a non-network hospital or without cashless pre-authorisation: pay the bills yourself and collect all original documents. Submit within 15 days of discharge: original bills, payment receipts, discharge summary, doctor's prescriptions, diagnostic reports, and the completed the insurer claim form. KYC documents if claim is above ₹1 lakh.
the insurer/TPA reviews the claim. The 5% co-pay is deducted from the admissible claim amount. Sub-limits (room rent, ICU, cataract, modern treatments) are applied. Settlement by direct payment to hospital (cashless) or bank transfer to insured (reimbursement). Call 022 4302 0000 for claim status.
Arogya Sanjeevani Policy· Frequently Asked Questions
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By submitting you agree to our Privacy Policy and Terms & Conditions. Arogya Sanjeevani Policy (ASP)· the insurer· IRDAI Standard Product· SI ₹1L–₹10L· 5% co-pay mandatory· Lifelong renewable· PED 48-month wait per the insurer policy wording· Premium + terms subject to the insurer's rate chart and policy wording (Dec 2024). Probitas Insurance Brokers Pvt. Ltd.· IRDAI Lic. No. 528.