Arogya Sanjeevani

What is Arogya Sanjeevani?

Arogya Sanjeevani is the standard individual indemnity health insurance policy that IRDAI asked all general and standalone health insurers to offer from 1 April 2020. Every insurer sells it under the same name, "Arogya Sanjeevani Policy" followed by the insurer's name, with the same cover, exclusions and limits. Only the premium and the insurer's service differ, which makes it the simplest health policy to compare.

It was designed as a basic, affordable hospitalisation cover for first-time buyers and for people who find comprehensive plans hard to understand.

How Arogya Sanjeevani works

IRDAI's FAQ on the product says all general and standalone health insurers must offer it, except an insurer that does not sell indemnity health products at all. The main features, as described by IRDAI:

Sum insured. The original guidelines of January 2020 set the sum insured at ₹1 lakh to ₹5 lakh. In March 2021, IRDAI widened the range to ₹50,000 to ₹10 lakh from 1 May 2021. IRDAI's 2024 health master circular later replaced many older product circulars, including the 2021 modification, so the bands each insurer now offers can differ. The Customer Information Sheet of the specific insurer shows what is available.

Waiting periods and moratorium. Policy wordings carry an initial 30-day waiting period for illness (accidents are covered from day one), specific waiting periods of 24 or 36 months for listed conditions, and a pre-existing disease waiting period of 36 months, which is also the maximum allowed under the IRDAI (Insurance Products) Regulations, 2024. The 60-month moratorium applies.

Exclusions. Domiciliary hospitalisation and OPD treatment are excluded, along with the usual standard exclusions.

Tax. Since 22 September 2025, premiums for individual health policies, including family floaters, are exempt from GST, which removed the 18% tax that was earlier added to the Arogya Sanjeevani premium.

As of October 2026, IRDAI's FAQ page still describes the product as mandatory and insurers continue to sell it, though some details in older IRDAI material, such as the sum insured band, have been overtaken by later changes. Check the insurer's current policy wording.

What Arogya Sanjeevani means for distribution

• An entry product for new markets. Uniform terms and a low ticket size make it suited to first-time buyers, Tier 2 and Tier 3 customers, bank and Common Service Centre counters, and assisted digital journeys. The sales conversation is short because there is less to explain.
• The two clauses that cause complaints. The 5% co-payment and the room rent limit with proportionate deduction are where customers feel short-changed at claim time. An adviser should work through one example. On a ₹2 lakh policy the room rent limit is ₹4,000 a day (2% of the sum insured). If the patient takes a ₹6,000 room, the insurer pays rent at ₹4,000 and also scales down the charges linked to the room category to two-thirds, and then deducts the 5% co-payment from the admissible amount. Showing this at sale protects the relationship.
• Comparison is on service. Since the cover is the same, the real differences are premium, network hospitals in the customer's area, claim settlement experience and the insurer's grievance record. Distributors who show these, instead of only the cheapest premium, give better advice.
• An upgrade path. A customer who starts with Arogya Sanjeevani can later move to a richer product of the same insurer through migration, or to another insurer through portability, keeping waiting period credits.
• Commission. Commission is paid under each insurer's board-approved policy within the expenses of management limits, as for any product. Because premiums are low, distributors earn more by building renewals than from the first sale, which makes persistency the measure to watch.