The Arogya Sanjeevani Standard Health Plan

When IRDAI introduced Arogya Sanjeevani in 2020, it was a landmark move: for the first time, every general and stand-alone health insurer in India was required to offer an identical baseline health insurance product. No more comparing apples with mangoes — Arogya Sanjeevani gave buyers a single reference point from which to evaluate the rest of the market.

What Is Arogya Sanjeevani?

Arogya Sanjeevani Policy is a standard individual and family floater health insurance plan mandated by IRDAI. The policy wordings, exclusions, and covered conditions are identical across all insurers; the only variable is the premium. This makes it exceptionally easy to compare: lower premium for the same terms equals better value (all else, including network hospitals, being comparable).

Coverage and Sum Insured

• Sum insured: from ₹1 lakh to ₹5 lakh, in multiples of ₹50,000.
• Entry age: 18 to 65 years for adults; children from 3 months to 25 years can be covered as dependants.
• The plan covers hospitalisation expenses, day-care procedures (treatments not requiring 24-hour admission), pre- and post-hospitalisation expenses (30 days and 60 days respectively), Ayush treatments, and modern treatments such as robotic surgery and stem cell therapy up to specified sub-limits.

Key Sub-Limits to Understand

Arogya Sanjeevani has a 5% co-payment on every claim — meaning you bear 5% of every admitted claim amount, and the insurer covers the remaining 95%. This is standardised across all insurers offering this product. Additionally:

• Room rent: capped at 2% of sum insured per day, with a maximum of ₹5,000 per day. Exceeding this limit leads to proportionate deductions on other expenses too.
• ICU charges: capped at 5% of sum insured per day, maximum ₹10,000 per day.
• Cataract treatment: up to 25% of sum insured or ₹40,000 per eye, whichever is lower.

Pre-Existing Disease Waiting Period

All pre-existing conditions are covered after a 48-month waiting period — a standard four years. Specific conditions (such as joint replacement, hernia, cataracts) have a 24-month waiting period for all insurers. The uniformity of waiting periods across all Arogya Sanjeevani policies is one of the plan''s key transparency features.

Who Is It Suited For?

• First-time health insurance buyers who want to start with a known, regulated product before exploring comprehensive plans.
• Individuals in smaller towns where awareness of complex products is limited and simplicity matters.
• Senior-citizen buyers (up to 65 years at entry) who face difficulty purchasing standard comprehensive plans due to age or health conditions.

Limitations

The ₹5 lakh ceiling and the 5% co-payment mean Arogya Sanjeevani is not the right choice for urban families with higher healthcare cost exposure. A serious illness or surgery in a metro hospital can easily exceed ₹5 lakh. For such buyers, a comprehensive plan with a higher sum insured and no co-payment is worth the additional premium.

Conclusion

Arogya Sanjeevani is a valuable standard to measure the market against — if an insurer''s comprehensive plan is only marginally more expensive than Arogya Sanjeevani for significantly better coverage, the upgrade is clearly worthwhile. Use the standard plan as your baseline, then compare upwards. At TruePolicy, you can compare Arogya Sanjeevani premiums across insurers and stack them against enhanced plans to find the sweet spot for your family''s budget and health profile.