The government of India has been taken different regulatory initiatives in Homoeopathy and AYUSH system of medicine.
So, the Insurance Regulatory also included.
In this article we try to discuss about the Health insurance which covers best in AYUSH treatments in details….
The Insurance Regulatory and Development Authority of India (IRDAI) mandating that Ayush (ayurveda, yoga and naturopathy, unani, siddha and homeopathy) treatments to be covered by health insurance products.
It told all insurers to mandatorily offer, from 1 April 2020, Arogya Sanjeevani, a standard health insurance product that will cover Ayush treatments up to the sum insured.
Some health insurance policies covered Ayush treatments earlier too, but with a sub-limit on the sum insured.
IRDAI first asked insurers to provide alternative treatment coverage in 2013, but the uptake of these treatments has picked up in recent years. “In the last three years, we have seen a huge increase in the demand for alternative treatments and medicines,” said Adarsh Agarwal, appointed actuary at Digit General Insurance Ltd.
The Ayush system is based on natural ingredients, but it can also include drug therapies to cure specific diseases. We tell you how Ayush benefits work under a health insurance policy, the key inclusions and exclusions, and what to keep in mind when taking a cover for Ayush treatments.
What do you get?
Arogya Sanjeevani as well as some other health insurance policies cover Ayush treatment. “If your policy has in-patient benefits for Ayush, then any treatment, which is an alternate procedure, is also covered under that plan. So, if you get admitted to, let’s say, an ayurveda hospital that may also be covered in the exact same way that normal treatments are covered,” said Amit Chhabra, business head, health, Policybazaar.com, an online marketplace for insurance.
Coverage: Arogya Sanjeevani covers Ayush treatments up to the sum insured, which has to be a minimum of Rs.50,000; there’s no upper limit.
“This is the first step towards recognition of Ayush treatment. In Arogya Sanjeevani, the product features are uniform across the industry and the companies are mandated that they should cover Ayush,” said Dr S. Prakash, managing director, Star Health and Allied Insurance Co. Ltd. Further, pre-hospitalization (30 days prior to admission) and post-hospitalization expenses (60 days from discharge) are also included in this plan.
Other health insurance policies usually cover Ayush treatment up to a maximum limit of Rs.50,000. “Different policies have different limits. Some policies cover it till the sum insured. In some cases, there are caps on coverage. For example, Ayush coverage may be around 10% of the sum insured,” said Chhabra.
Cost: Overall, such treatments for certain ailments are said to be a lot more cost-effective than modern medicine. “There are some neurological, psychosomatic and chronic dermatological diseases where Ayush has been able to address issues at a lesser cost, particularity in semi-urban and rural areas,” said Prakash, who has a master’s in surgery.
Where can you get it? According to recent guidelines, IRDAI classifies Ayush hospital as a healthcare facility wherein medical or surgical treatment procedures are carried out by Ayush medical practitioners having at least five in-patient beds and a qualified medical practitioner in charge. Citing National Health Portal data, Agarwal said that there are around 98 Ayush hospitals till July 2020 that have been set up in the country.
Further, hospitals in Ayush sectors do not necessarily need the National Accreditation Board for Hospitals and Healthcare (NABH) certification to be able to tie up with health insurers.
Deatails of Arogya Sanjeevani Policy –
Arogya Sanjeevani Policy
Arogya Sanjeevani Policy is a standard health insurance policy introduced by the IRDAI on 1st April, 2020 offered by top health insurance companies in India. Under this policy, insured person can avail policy coverage ranging from Rs 1 lakh to Rs 5 lakhs.
Arogya Sanjeevani Health Insurance comes as an Individual Plan & Family Floater Plan which also covers the hospitalisation expenses due to Coronavirus (COVID-19).
What is Arogya Sanjeevani Policy?
Arogya Sanjeevani Policy, a basic health insurance policy which provides coverage medical / hospitalization expenses up to Rs. 5 lakhs. The Insurance Regulatory and Development Authority of India (IRDAI) has mandated all health insurers to come up with the basic & standard health insurance policy for both individuals & families.
Arogya Sanjeevani Health Policy are universal for all general & health insurance companies in India comes with the several benefits. It covers pre & post hospitalisation expenses which includes bed charges, nursing charges, ICU & doctor consultation charges and many more. Arogya Sanjeevani Health Insurance protects you & your family from the financial burden in case of any medical emergencies.
There are two types of plans comes under the Arogya Sanjeevani Insurance Policy:
- Individual Plan: Under this plan only 1 policyholder as the beneficiary.
- Family Floater Plan: In this plan entire family members can avail the benefits of Arogya Sanjeevani Policy. The policyholder can include dependents, such as spouse, children, parents & parents-in-law in a single policy.
Arogya Sanjeevani Health Insurance Policy Details at a Glance
|Health Insurance Companies||Care Health Insurance (Formerly known as Religare Health Insurance)||Max Bupa Health Insurance||Raheja QBE Health Insurance|
|Policy Name||Care Health Arogya Sanjeevani Health Insurance||Arogya Sanjeevani Max Bupa Health Insurance||Arogya Sanjeevani Raheja QBE Health Insurance|
|Coverage||Individual/Family Floater||Individual/Family Floater||Individual/Family Floater|
|Sum Insured (in Rs.)||5 Lakhs||1-5 Lakhs||1-5 Lakhs|
|Premium||6,013 annually||Min. – 3,148 annually
Max. – 4,722 annually
|Min. – 2,579 annually
Max. – 3,764 annually
|Eligibility Criteria||Adults: 18- 65 years
Children: 3 months- 25 years
|Adults: 18- 65 years
Children: 3 months- 25 years
|Adults: 18- 65 years
Children: 3 months- 25 years
|Features||Lifetime renewability, cashless treatment, free look period, and tax saving benefits||Cashless hospitalization, lifetime policy renewal, tax saving benefits, and free look period||Tax saving benefits, lifetime renewability, cashless treatment, and free look period,|
|Inclusions (up to a specified limit & as per the policy wordings)||Cataract Treatment up to Rs 40000 or 25% of SI, Ayush Treatment, Hospitalization Expenses, ICU up to Rs 10,000 per day or 5% of the SI, Room rent up to 2% of SI or Rs 5000 per day, Ambulance Charges, -Modern Treatments, etc.||In-patient care, ambulance cover, room rent, ICU charges, Ayush treatment, day care treatments, modern treatments such as oral chemotherapy, stem cell therapy, and the likewise.||In-patient care, Ayush treatment, plastic surgery/dental treatment if required as a part of the treatment, day care expenses, road ambulance cover, cataract surgery, modern treatments, etc.|
|Pre- hospitalization Expenses||30 days||30 days||30 days|
|Post-hospitalization Expenses||60 days||60 days||60 days|
|Co-pay||5% on all the claims||5% on all the claims||5% on all the claims|
|Pre-existing Diseases Waiting Period||48 months||48 months||48 months|
|Specific Diseases Waiting Period||24/48 months||24/48 months||24/48 months|
Inclusions of Arogya Sanjeevani Policy
An Arogya Sanjeevani Health Insurance Policy comes with the following inclusions:
- Pre & Post Hospitalization Expenses – This policy will cover all the pre and post hospitalization expenses in case of any medical emergency due to an illness or accidental injury. It also offers coverage for medical & hospitalisation expenses occurs due to Coronavirus (COVID-19).
- COVID-19 Cover – It also offers corona insurance protection and pays for any expenses incurred on hospitalization due to contracting COVID-19 or coronavirus disease.
- AYUSH Benefit – It includes hospitalization expenses incurred on obtaining alternative treatments, such as Ayurveda, homeopathy, Siddha, etc, at an approved hospital.
- ICU/ ICCU Charges – The policy pays up to 5% charges of the treatment taken in the ICU (Intensive Care Unit) or ICCU (Intensive Coronary Care Unit) of the total sum insured up to a maximum Rs. 10,000 per day.
- Room Rent – It covers the room rent of the hospital up to a maximum of Rs. 5,000 per day.
- Ambulance Services – It covers the cost of ambulance services up to a maximum cap of Rs. 2,000 per hospitalization.
- Daycare Treatment – It covers the expenses arising out of any daycare treatment procedures.
- Plastic Surgery and Dental Treatment – The cost of any dental or plastic surgery treatment taken as a result of an illness or injury is also covered.
- Cataract Surgery – It also covers the cost of cataract surgery for each eye up to a maximum of Rs. 40,000 or 25% of the total sum insured amount, whichever is less.
- New Age/ Modern Treatment – This policy also covers the cost of modern/ new age treatment up to a maximum of 50% of the total sum insured amount.
New-Age/ Modern Treatments Covered Under Arogya Sanjeevani Policy
The Arogya Sanjeevani Insurance Policy covers the following modern or new-age treatments:
- Balloon Sinuplasty
- Bronchial Thermoplasty
- Intraoperative Neuromonitoring (IONM)
- Intravitreal Injections
- Oral Chemotherapy
- Robotic Surgeries
- Stem Cell Therapy (Bone marrow transplant through Hematopoietic stem cells for hematological conditions)
- Stereotactic Radio Surgeries
- Uterine Artery Embolization and High Intensity Focussed Ultrasound (HIFU)
- Vaporisation of the Prostate (Green Laser/ Holmium Laser treatment)
Features of Arogya Sanjeevani Policy
There are several features that differentiate an Arogya Sanjeevani Policy from other health insurance plans available in India. Take a look at some of the most attractive features of Arogya Sanjeevani Policy below:
- More economical than other health plans
- Universal coverage, terms & conditions across all health insurance companies in India
- Sum insured ranging from Rs. 1 lakh to Rs. 5 lakhs
- Available in Individual as well as Family Floater basis
- Covers hospitalization expenses related to COVID-19 (Coronavirus)
Benefits of Arogya Sanjeevani Policy
Arogya Sanjeevani Policy has been launched with an aim to simplify health insurance in India by offering a basic & standard medical insurance with the exact same coverage by all best health insurance companies. It strives to provide basic indemnity insurance benefits to the policyholder across all income groups in India. To understand this policy better, take a look through the list of benefits that a policyholder can avail under the Arogya Sanjeevani Plan:
- No More Confusion – It eliminates the scope of any confusion that may arise in the minds of a policyholder as the same level of coverage and the terms & conditions is offered by all insurance companies in India.
- Lower Co-payment Option – It offers a lower co-payment option of only 5% of the total claim amount, which means the applicant will have to pay the only 5% of the total claim amount at the time of settlement.
- Cumulative Bonus – Just like other medical insurance policies, the Arogya Sanjeevani Health Plan also rewards a cumulative bonus of 5% on the total sum insured amount for every claim-free year.
- Boon for First-Time Buyers – This is the perfect stepping & an ideal choice for a first-time health insurance buyer as he will be able to get a wide range of coverage at minimum cost without the hassles of understanding the pros and cons of different kinds of health plans.
- Lifetime Renewability – It comes with lifetime renewability that allows policyholders to renew their policies for as long as they live.
Eligibility Criteria for Arogya Sanjeevani Policy
Arogya Sanjeevani Health Insurance Policy can be availed by any person between the age of 18 years to 65 years. Under the Arogya Sanheevani Family Floater Plan, you can purchase this policy for dependent children between 3 months & 25 years.
If your children age is above 18 years then he / she can’t be covered under the family floater health scheme. You need to buy Arogya Sanjeevani Individual Health Plan for the same.
Under the Family Floater Arogya Sanjeevani Health Policy, a policyholder can include his / her parents & parents-in-law. This policy comes with lifelong renewability.
Arogya Sanjeevani Policy Renewal
The Arogya Sanjeevani Policy comes with lifetime renewals. This means that a policyholder can renew his Arogya Sanjeevani Health Insurance Policy for as long as he is alive. However, he should make sure to renew his policy before its date of expiry. If the policy is not cancelled even after the grace period of 30 days, it will be get terminated.
The Arogya Sanjeevani Policy can be renewed online by entering the required details and paying the health insurance premium.
Arogya Sanjeevani Cancellation and Refunds Policy
All policyholders of the Arogya Sanjeevani Policy offer a 15-day free-look period. This means the policyholder can cancel his / her policy within the first 15 days without paying any cancellation charges. The paid premium will be refunded to the policyholder minus any expenses incurred by the insurance company, provided no claims were made during this period.
Please note that the free-look period is not applicable at the time insurance renewals.
However, if the 15-day free-look period gets over, the policyholder can still cancel his Arogya Sanjeevani Health Insurance Policy. He will be required to give a 15-days written notice to the insurance provider for cancelling the policy. The premium for the remaining policy period will be refunded to the policyholder as per the rates given below:
|Refund of Arogya Sanjeevani Policy Premium|
|Time of Cancellation||Percentage of Premium Refund|
|Up to 30 days||75%|
|31 days to 90 days||50%|
|3 months to 6 months||25%|
|6 to 12 months||0%|
Exclusions of Arogya Sanjeevani Policy
The Arogya Sanjeevani Health Plan does not include the following treatments or situations:
- Diagnostic or Investigative Tests – It will not cover the expenses incurred on getting any diagnostic or investigative tests done.
- Bed Rest or Rehabilitation Expenses – It will not cover any expenses incurred due to enforced bed rest in the absence of treatment. It will also not cover any expenses arising out of rehabilitation needs.
- Weight Control/ Obesity Treatment – Any expenses arising out of the treatment taken for obesity or weight management will not be covered.
- Gender-change Treatment – It will not cover the cost of taking any treatment for changing the gender.
- Cosmetic or Plastic Surgery – Any expenses incurred on cosmetic or plastic surgery which is not required as a result of an accident, cancer, burn injury or medically necessary treatment will not be covered.
- Maternity Expenses – It will not cover the cost of any treatment related to pregnancy and child birth.
- OPD Treatment – It will not cover the cost of any OPD or out-patient treatment taken by the policyholder.
- Adventure/ Hazardous Sports – Under this medical insurance does not cover any medical treatment expenses arising due to participation in a hazardous or adventure sports, such as rock climbing, sky diving, para-jumping, deep-sea diving, mountaineering, etc, as a professional.
- Breach of Law – It will not cover any expenses incurred due to breaching the law with a criminal intention.
- Alcohol/ Drug addiction – Any expenses arising out of the treatment for addiction of alcohol or drug or substance abuse will not be covered.
- Dietary Supplements – It will not cover the cost of purchasing any dietary substance or supplements, such as minerals, vitamins, etc., without a prescription.
- Unproven Treatment – This policy will not cover the cost of any unproven treatment taken by the policyholder.
- Infertility and Sterility – It will not cover any expenses arising out of infertility or sterility.
- Domiciliary hospitalization – Any expenses arising out of domiciliary hospitalization will not be covered.
- Nuclear attack or War – This policy will not cover any claims arising out of a nuclear attack or a war/ war-like situation.
- Treatment outside India – It will not cover the expenses incurred on receiving any outside India.
The Arogya Sanjeevani Health Policy comes with the following waiting periods:
- Initial Waiting Period – An initial waiting period of 30 days from the date of policy commencement for all claims except accidental claims.
- Pre-Existing Disease – A waiting period of 4 years for coverage of pre-existing disease or medical condition.
- Specific Illness/ Treatment – A waiting period of 2/ 4 years for coverage of specific treatments such as tonsillectomy, benign prostate hypertrophy, hernia, cataract, internal congenital anomalies, age-related osteoporosis/ osteoarthritis, joint replacement treatment, etc.
The Ayush benefits come with certain limitations currently, both for the insurers as well as the policyholders.
For insurers: Distinguishing the right practitioner is a challenge insurers are facing. “Ayush has its benefits, gives a remedy for some of the medical challenges in allopathy, but the biggest limitation is how to distinguish the right Ayush practitioner,” Prakash said.
The fear of misuse and abuse in terms of alternative treatments has also driven insurers to offer Ayush cover with some limited benefits. “We respect the system and acknowledge the benefits in select areas out of Ayush, but the biggest challenge is to identify the right connect and the right place where an evidence-based treatment is given,” he said.
Lack of clarity and quality control is another issue for insurers. “Ayush treatment is acceptable in certain cases, but overall there is a big question mark on the studies to determine the efficacy and the quality control of its medicines. Unless these issues are addressed, there is a big risk of having such treatments covered under insurance. People will tend to misuse it, as there are no indicators that can be monitored and there is lack of a standard line of treatment,” said Dr Bharat Gadhavi, president of Ahmedabad Hospitals and Nursing Homes Association (AHNA).
For policyholders: Alternative treatments such as homeopathy, unani or ayurveda in most scenarios are out-patient, and health insurance mostly covers in-patient treatment. This means that consultation or evaluation expenses for Ayush treatment may not get covered. “To claim for the expenses, one needs to be hospitalized for at least for 24 hours. Also, any preventive and rejuvenation treatments that are not medically necessary won’t be covered under Ayush benefits,” said Agarwal.
Further, treatment at a health care facility that is not approved and not a hospital is excluded, so choose the practitioner carefully.
While general health insurance offering Ayush benefits caps the claim amount, the Arogya Sanjeevani has a 5% co-pay (fixed out-of-pocket amount paid by the insured) and 2% sub-limit on room rent (the insurer will pay only up to 2% of the sum insured as room rent). The cost of other procedures are usually calculated based on the room rent.
To get the Ayush benefit, you might have to pay extra premium in case of a general health insurance plan.
Further, only a few insurance companies offer cashless treatment, and the majority of the claims are reimbursed later on the basis of bills.
How to Buy Arogya Sanjeevani Policy?
An Arogya Sanjeevani Policy can be purchased online. The IRDAI has permitted insurance companies to issue the Arogya Sanjeevani Policy online or electronically to the policyholders. This further reduces the operating/ serving cost of the insurance company making it more economical for the buyers.
In order to buy Arogya Sanjeevani Health Insurance Policy, the policyholder will need to compare the premium quotes using the Arogya Sanjeevani Policy Premium Calculator. After comparing premium and choosing this plan, the policyholder will have to fill up the proposal form and pay the premium online. The Arogya Sanjeevani Policy will be issued online.
However, it is mandatory for insurance providers to issue the policy document in physical form even if it has been purchased online. Moreover, the IRDAI has also directed all health insurance companies to offer a certificate of insurance to the policyholders specifying the Arogya Sanjeevani Policy details including the terms and conditions.