Is there a room rent limit?

Yes. Room rent is covered up to 2% of the sum insured, subject to a maximum of ₹5,000 per day. ICU charges are covered up to 5% of the sum insured, up to ₹10,000 per day. If you take a costlier room, room rent and associated medical expenses are reduced in the same proportion.

How does the cumulative bonus work?

After each policy year, the sum insured grows by 5% of the base sum insured, up to a maximum of 50%, if you renew without a break. In the latest prospectus it is added irrespective of claims.

Is maternity covered?

No. Childbirth, caesarean section, miscarriage (unless caused by an accident), medical termination of pregnancy and infertility treatment are excluded. Ectopic pregnancy is not excluded.

Who can buy this policy and who can be covered?

The proposer must be between 18 and 65 years, although an older proposer can buy it for the family without covering themselves. You can cover your spouse, parents, parents-in-law and dependent children from 3 months to 25 years.

HDFC ERGO Arogya Sanjeevani Policy: Features, Co-pay & Review

Overview of Arogya Sanjeevani Policy

Arogya Sanjeevani Policy is HDFC ERGO's version of the standard health insurance product that IRDAI designed so that the basic terms are the same across insurers. It is an indemnity plan that covers hospitalisation and day-care treatment, with a fixed 5% co-payment on every admissible claim. Sum insured ranges from ₹50,000 to ₹10 lakh in multiples of ₹50,000, and the policy can be taken on an individual or family floater basis for one year at a time. It covers room rent up to 2% of the sum insured (maximum ₹5,000 per day), ICU charges up to 5% (maximum ₹10,000 per day), pre-hospitalisation for 30 days and post-hospitalisation for 60 days. A cumulative bonus of 5% of the sum insured is added every policy year, up to 50%.

A standardised policy design mandated by IRDAI — same core structure across all insurers, so you can compare HDFC ERGO's version directly against other companies' Arogya Sanjeevani plans.

Expert review

Arogya Sanjeevani is a basic, standardised cover, and it is easiest to judge by what it limits. Every claim carries a 5% co-payment. Room rent is capped at 2% of the sum insured and at ₹5,000 per day, and ICU at 5% and ₹10,000 per day. If you take a costlier room, the payable amount for room rent and associated medical expenses is reduced in proportion. Cataract has its own cap of 25% of the sum insured or ₹40,000 per eye, whichever is lower. On the positive side, the plan covers all day-care treatments, AYUSH in-patient treatment, dental treatment and plastic surgery needed because of disease or injury, and 12 modern treatments such as robotic surgery, oral chemotherapy and immunotherapy up to 50% of the sum insured. The cumulative bonus of 5% a year up to 50% is added irrespective of claims in the latest prospectus, and renewal premiums are not loaded because of claims. It suits buyers who want a simple, rule-based cover or a portable base policy. Buyers who want no co-payment, no room rent limit, maternity cover or outpatient cover should compare it with other plans. Waiting periods are 30 days for illness, 24 months for 20 listed conditions and 36 months for pre-existing diseases.

Pros

Standardised IRDAI-designed policy with common wording across insurers, which makes comparison and portability easier.
Cumulative bonus of 5% of the sum insured every policy year, up to 50%.
Covers 12 modern treatments up to 50% of the sum insured, such as robotic surgery, oral chemotherapy and immunotherapy.
All day-care treatments, AYUSH, cataract, and dental and plastic surgery needed because of disease or injury are covered.
Family floater premium table gives a 55% discount on every member except the eldest.

Insurer Profile

HDFC ERGO Health Insurance

Key Insights

Founded

2002

HDFC ERGO Health Insurance was established 24 years ago and has built strong credibility over time, backed by its long-standing presence in the market.

Claims Experience

97.9% CSR, calculated as a 3-year average

HDFC ERGO Health Insurance settles 97.9% of all claims it receives, demonstrating strong credibility.

Network Hospitals

12,000–14,000

HDFC ERGO Health Insurance has a network of 12,000–14,000 hospitals, ensuring wide accessibility and convenience for policyholders.

Features of Arogya Sanjeevani Policy

Cumulative bonus (+5% every year, up to 50%)

After each policy year, the sum insured increases by 5% of the base sum insured, up to a maximum of 50%, as long as the policy is renewed without a break.

Added irrespective of claims as per the latest prospectus. Available only if renewed within the grace period.

Standard IRDAI-designed policy

The policy follows a standard design with common wording across insurers, to make comparison and portability between insurers easier.

Hospitalisation expenses

Covers room rent, boarding and nursing, ICU or ICCU, surgeon, anaesthetist and specialist fees, operation theatre, medicines, blood, oxygen, surgical appliances and diagnostics during an admissible hospitalisation.

Room rent up to 2% of sum insured (max ₹5,000 per day). ICU up to 5% (max ₹10,000 per day). Stay of at least 24 hours is needed, except for day-care treatment.

All day-care treatments

Treatments that need less than 24 hours in hospital because of medical advancement are covered.

Pre and post hospitalisation: 30 and 60 days

Medical expenses incurred 30 days before admission and 60 days after discharge are covered, when related to an admissible hospitalisation.

12 modern treatments (up to 50% of sum insured)

Covers uterine artery embolization and HIFU, balloon sinuplasty, deep brain stimulation, oral chemotherapy, monoclonal antibody immunotherapy, intravitreal injections, robotic surgeries, stereotactic radio surgeries, bronchial thermoplasty, laser prostate vaporisation, intra-operative neuro monitoring and stem cell therapy for bone marrow transplant.

Up to 50% of the sum insured, either as in-patient or day-care treatment, wherever medically indicated.

Cataract treatment

Cataract treatment is covered up to 25% of the sum insured or ₹40,000, whichever is lower, per eye in one policy year.

A 24-month waiting period applies to cataract.

AYUSH treatment

In-patient treatment under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy is covered up to the sum insured, in an AYUSH hospital.

Dental treatment and plastic surgery

Dental treatment and plastic surgery are covered when they are needed because of disease or injury.

Road ambulance

Road ambulance charges are covered per hospitalisation.

Up to ₹2,000 per hospitalisation.

Individual or family floater

Cover yourself, your spouse, parents, parents-in-law and dependent children. On an individual basis, each member has their own sum insured. On a floater basis, one sum insured is shared by the whole family.

A 10% family discount applies on individual policies with 2 or more members. On floater policies, the premium table gives a 55% discount on every member except the eldest.

No claim-based loading on renewal

Renewal cannot be denied because you made a claim in an earlier year, and your renewal premium is not loaded based on your claims experience.

60-month moratorium

After 60 continuous months of cover, the insurer cannot contest your policy or claims on grounds of non-disclosure or misrepresentation, except for established fraud.

Cashless or reimbursement claims

Get cashless treatment at network hospitals after pre-authorisation, or pay and claim reimbursement with documents submitted within 30 days of discharge.

Premium discounts and instalments

Family discount 10%, online purchase discount 5%, HDFC and group employee discount 10%, loyalty discount of ₹250, and rural discount of 15%. Premium can be paid yearly, half-yearly, quarterly or monthly.

These discounts together are capped at 20%.

Exclusions in Arogya Sanjeevani Policy

Conditions or treatments that the policy clearly says it will not cover.

Pre-existing diseases until 36 months of continuous cover are completed.
Listed conditions and surgeries during the first 24 months (and 48 months for joint replacement and age-related osteoarthritis and osteoporosis), unless caused by an accident.
Illness within the first 30 days of the first policy (accidents are covered). This does not apply if you have had more than 12 months of continuous cover.
Hospital admission primarily for diagnosis and evaluation.
Rest cure, rehabilitation, respite and custodial care.
Obesity or weight-control surgery that does not meet the clinical conditions in the policy.
Change-of-gender treatments.
Cosmetic or plastic surgery, unless needed after an accident, burns or cancer, or certified as medically necessary.
Treatment arising from professional participation in hazardous or adventure sports.
Breach of law: treatment arising from committing or attempting a criminal offence.
Treatment at hospitals or providers excluded by HDFC ERGO.
Treatment for alcoholism, drug or substance abuse or any addictive condition.
Treatment at health hydros, nature cure clinics, spas or similar establishments.
Dietary supplements and substances available without prescription.
Correction of eyesight for refractive error below 7.5 dioptres.
Unproven or experimental treatments.
Sterility and infertility, including sterilisation, IVF, surrogacy and reversal of sterilisation.
Maternity: childbirth and caesarean section, miscarriage (unless caused by an accident) and medical termination of pregnancy. Ectopic pregnancy is not excluded.
War, invasion, civil war and rebellion, and nuclear, chemical or biological attack.
Domiciliary hospitalisation and OPD treatment.
Treatment taken outside India.
Existing diseases disclosed by the insured and listed in the policy schedule, for the specified ICD codes.

Disclaimer: For illustration purposes only - exact terms are in the policy wording.

Specific illness

A 24-month waiting period applies to the 20 conditions and procedures below, unless the claim arises from an accident. Joint replacement and age-related osteoarthritis and osteoporosis have a longer 48-month wait. If a listed condition is also a pre-existing disease, the longer waiting period applies.

Benign ENT disorders
Tonsillectomy
Adenoidectomy
Mastoidectomy
Tympanoplasty
Hysterectomy
All internal and external benign tumours, cysts and polyps, including benign breast lumps
Benign prostate hypertrophy
Cataract and age-related eye ailments
Gastric or duodenal ulcer
Gout and rheumatism
Hernia of all types
Hydrocele
Non-infective arthritis
Piles, fissures and fistula in anus
Pilonidal sinus, sinusitis and related disorders
Prolapsed intervertebral disc and spinal diseases, unless arising from an accident
Calculi in the urinary system, gall bladder and bile duct, excluding malignancy
Varicose veins and varicose ulcers
Internal congenital anomalies
Joint replacement, unless arising from an accident (48-month wait)
Age-related osteoarthritis and osteoporosis (48-month wait)

Frequently asked questions

What is the Arogya Sanjeevani Policy?

It is a standard health insurance product designed by IRDAI, with common terms across insurers. HDFC ERGO's version is an indemnity plan covering hospitalisation and day-care treatment, with a fixed 5% co-payment on every claim and a 1-year policy term.

How does the 5% co-payment work?

Every admissible claim is paid after deducting 5%, which you bear. For example, on an admissible claim of ₹1,00,000 the insurer pays ₹95,000. The co-payment does not reduce your sum insured.

What sum insured options are available?

According to the prospectus, sum insured starts at ₹50,000 and goes up to ₹10 lakh in multiples of ₹50,000.

Arogya Sanjeevani Policy