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A Comprehensive Discussion on the Upper Coverage Limit in Aarogya Sanjeevani Health Insurance Policy

By Juhi Walia
03 October 2022, 11:15 AM

Previously, the Aarogya Sanjeevani health insurance policy was offered by all the insurance providers in the country as a mandatory option among indemnity-based health insurance plans, with a sum limit ranging between INR 50,000 and INR 10 lakh. 

The Insurance Regulatory and Development Authority of India (IRDAI) instructed all general and health insurance companies to offer this policy to policyholders. In July 2020, the insurance regulatory body allowed all insurance providers to customise and create their options for the sum insured according to their personal needs, removing the upper limit from the plan. 

Aarogya Sanjeevani health plan first entered the market on April 1, 2020, during the surge of the worldwide pandemic outbreak of Covid-19. The primary target behind the introduction of this plan was to reduce the extreme confusion among the policyholders regarding the innumerable health plans available in the market by different health insurance companies

Although all the insurance companies are allowed to mandatorily offer this product, without changing the name of the plan. No company is permitted to allow the addition of any rider or deductible or variant to this plan. However, there is a provision of a cumulative bonus in health insurance in the form of a 5% enhancement in the cover for each claim-free year, rising to 50%. 

 Major Highlights of the Plan

  • The plan is available under the same name and can be easily bought from any insurance company.
  • This is a standard product and possesses similar policy wordings and conditions throughout.
  • The total sum insured limit is INR 50,000 to INR 10 lakhs (calculated in multiples of INR 50000).
  • The policyholder is supposed to receive a benefit of an increase of 5% in the cover for every claim-free year, rising to 50%.
  • Zero riders, deductibles, or variants can be added to the plan.
  • The minimum and maximum entry age limit is 18 years and 65 years respectively.
  • Offers lifelong renewability.
  • Offers an option of co-payment of 5% for every age group.
  • Irrespective of the plan type, it covers Covid 19

New Age Treatments Covered Under the Plan

  • Balloon sinuplasty
  • Intraoperative neuromonitoring
  • Bronchial thermoplasty
  • Intravitreal injections
  • Stereotactic neuromonitoring
  • Immunotherapy
  • Deep brain stimulation
  • Green laser treatment
  • Bronchial thermoplasty
  • Stem cell research and therapy
  • Holmium laser treatment
  • Uterine artery embolisation
  • Oral chemotherapy
  • High focused ultrasound


  • Non-medical expenses
  • Venereal ailments/AIDS/STDs
  • Pre-and-post hospitalisation bills unrelated to any medical claim, hospital bills
  • Maternity/fertility/STD-related expenses
  • Hospitalisation caused due to alcohol/ drug/narcotics/ abuse
  • OPD expenses
  • Domiciliary care and hospitalisation
  • Intentional plastic and cosmetic surgery
  • Bariatric surgery and other weight management treatment costs
  • Lifestyle ailments
  • War-like situations
  • Costs of dietary supplements


  • Customised Option for Total Sum Insured: Depending on your budget and financial status, you can choose the limit of the total sum insured ranging between INR 50,000 to INR 10 lakhs.
  • Wide Coverage Limit: The plan offers a wide coverage during hospitalisation including, boarding, room rent, nursing, consultation fee, etc. The chosen insurance company may cap the daily limit in case of hospitalisation amounting to 2% of the total sum insured or up to INR 5,000.
  • Co-payment: Irrespective of all ages, there is a co-payment facility of 5%.
  • Pre-and-Post-hospitalisation: The plan covers all the expenses covered 30 days before hospitalisation and 60 days after discharge.
  • Dental Treatment: The sum insured covers the dental expenses caused due to any ailment or injury.
  • Day Care Treatment: Any treatment which requires less than 24 hours of hospitalisation are covered under this plan.
  • Ambulance Cover: On-road ambulance cost of up to INR 2000 per hospitalisation.
  • Non-allopathic Treatment: Any expenses incurred due to hospitalisation during alternative therapy including, homoeopathy, AYUSH, Unani, and, Siddha.
  • Cataract Treatment: The insurance company will bear the cost of up to 25% of the total sum insured or INR 40,000 for each eye during cataract surgery.
  • Plastic Surgery: If the policyholder requires undergoing plastic surgery due to any accident or ailment, the insurance provider will bear the cost.
  • Payment Mode: Under this plan, you can choose the desired frequency with which you would wish to make the payment for health insurance premium-monthly, quarterly, half-yearly, or annually. 
  • Pre-policy Health Diagnosis: No diagnosis is required before the purchase of the plan if the policyholder’s age is below 50 years.
  • Cumulative Bonus: For each claim-free year, the policyholder receives a benefit of a 5% enhancement in the cover, rising to 50%.
  • Discounts: When family members are added to the plan, you become eligible for discounts on presses. You are eligible to add your parents, spouse, in-laws, children who are either biological or legally adopted, aged between 3 months and 25 years, and financially dependent. 

Basic Features

  • Free Look Period: The free look period is 15 days from the purchase date. In case it doesn’t fit your requirements, you can apply for a refund. If you have made no health insurance claims, a refund will be initiated after deducting the cost of stamp duty, proportionate risk premium, and pre-acceptance medical screening.
  • Tax Benefits: The premium paid under this plan is eligible for tax redemption under Section 80D of the IT Act. 
  • Grace Period: The plan offers a grace period of 15 days for renewing the plan after expiry. No policy benefit can be availed of during this grace period. 
  • Policy Cancellation: The plan may get cancelled under certain circumstances, the plan is not renewed within the grace period; any fraudulent action; or the death of the policyholder.

Waiting Period

The waiting period for the Aarogya Sanjeevani plan can be classified into three categories:

  • Waiting Period of 30 Days: Any treatment undergone within the initial 30 days of purchasing the plan is not covered, except for accidental circumstances. 
  • Waiting Period of 2 Years: For tonsillectomy, benign ENT disorders, adenoidectomy, tympanoplasty, mastoidectomy, any internal and external benign tumours, cysts, benign breast lumps, sinus, sinusitis, hernia, hydrocele, fissures, fistula, gout, rheumatism, spinal disorders and prolapse, etc. 
  • Waiting Period of 4 Years: Joint replacement except for any accidents; age-related osteoarthritis and osteoporosis

Read more - Waiting Period In Health Insurance


The above discussion sheds light on the details of the Aarogya Sanjeevani Health Insurance Policy. This comprehensive plan is available to all, depending on the circumstances. You can easily buy this health plan and avail yourself of its benefits. 

Read more -


1. Is it viable to invest in the Aarogya Sanjeevani scheme?

It is a wise approach to invest in this scheme, especially for first-time health insurance investors and residents of Tier II cities. 

2. Am I allowed to enhance the total sum insured under this scheme?

During health insurance renewal, you are eligible to alter the total sum insured.

3. May I add any preferable riders to the Aarogya plan?

No, adding riders is strictly not permitted under the terms of this particular scheme. 

4. Is the co-payment option available for a policy buyer of 60 years?

 Yes, a 5% co-payment facility is available to all the policyholders irrespective of age.

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