Arogya Sanjeevani Policy 2026: Worth Buying? (Premiums)
Arogya Sanjeevani is IRDAI's standard ₹5L plan, but the mandatory 5% co-pay catches buyers out. See premiums across insurers and whether it is right for you.
What is Arogya Sanjeevani Health Insurance Policy?
Arogya Sanjeevani is an IRDAI-mandated standardized health insurance product that every general and health insurer in India is required to offer. It features identical coverage terms, waiting periods, and exclusions across all insurers - the only variables are premium (within IRDAI's pricing band) and claim service quality. The policy covers Sum Insured options from ₹1 lakh to ₹5 lakhs.
Every premium on this page is the full amount you pay. Individual health insurance has attracted nil GST since 22 September 2025, so there is nothing to add on top.
Key features include: a room rent cap of 2% of the sum insured (maximum ₹5,000 a day), a mandatory 5% co-pay on all claims (non-negotiable), 36-month waiting period for pre-existing diseases (aligned with IRDAI's May 2024 cap, reduced from the earlier 48-month standard), and 2-year waiting period for specific illnesses. For an individual aged 35, annual premiums range from ₹6,500–₹8,500 for ₹5 lakh cover depending on the insurer. While it's an excellent entry-level policy with transparent terms, the ₹5 lakh maximum sum insured is often insufficient for metro families - most financial advisors recommend using Arogya Sanjeevani as a base and adding a super top-up for comprehensive coverage.
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Quick checklist
- Goal: evaluate Arogya Sanjeevani (IRDAI-standardized plan) on coverage limits, waiting periods, and claim mechanics.
- Avoid: assuming standardized plan is always cheapest; compare actual out-of-pocket costs with non-standardized plans.
- Prefer: Arogya Sanjeevani if premium affordability is priority; use as base with top-up for higher claims.
- Claims-first: Arogya Sanjeevani claim rules are transparent; verify limits and exclusions match your hospitalization tier.
What is Arogya Sanjeevani?
Arogya Sanjeevani is a standardized health insurance policy mandated by IRDAI in 2020. Every general and health insurer in India must offer it with identical features.
Why IRDAI created it
- Simplify health insurance comparison
- Ensure minimum quality standards
- Make basic health cover accessible
- Reduce mis-selling
What's standardized
- Policy terms and conditions
- Waiting periods
- Coverage inclusions/exclusions
- Sum insured options
- Co-pay percentage
What can vary
- Premium (within IRDAI's pricing band)
- Claim settlement service
- Network hospital list
- Add-on riders (limited)
Arogya Sanjeevani: Key features table
| Feature | Arogya Sanjeevani | Typical comprehensive plan |
|---|---|---|
| Sum insured options | ₹1 lakh to ₹5 lakh as standard; insurers may offer higher since IRDAI relaxed the cap in 2021 | ₹3 lakh to ₹2 crore+ |
| Room rent limit | No limit (any room) | Varies (some have limits) |
| Co-pay | 5% mandatory | Usually 0% (or optional) |
| ICU charges limit | No limit | Varies |
| Pre-existing disease waiting | Up to 36 months (IRDAI cap) | Up to 36 months (IRDAI cap) |
| Specific illness waiting | 2 years | up to 3 years |
| Initial waiting period | 30 days | 30 days |
| AYUSH treatment | Covered | Usually covered |
| Maternity | Not covered | Available in some plans |
| Cataract | ₹40,000 per eye (limit) | Varies (₹25K-₹1 lakh) |
| Pre-policy medical check | No (below 55 years) | Varies by age |
| Entry age | 18-65 years | Varies (up to 80 in some) |
| Lifetime renewability | Yes | Usually yes |
Premium comparison across insurers (2026)
Since features are identical, compare on premium and claim service.
Individual (age 35, ₹5 lakh sum insured)
| Insurer | Annual premium (approx.) | Claim settlement quality |
|---|---|---|
| Star Health | ₹7,500-8,500 | Excellent network, fast cashless |
| Care Health | ₹7,000-8,000 | Good service, competitive |
| HDFC Ergo | ₹7,500-8,500 | Strong metro network |
| ICICI Lombard | ₹7,200-8,200 | Good urban presence |
| Niva Bupa | ₹7,800-8,800 | Good claims experience |
| Bajaj General | ₹7,000-7,800 | Decent, improving |
| New India Assurance | ₹6,500-7,500 | PSU, wide network |
| United India | ₹6,500-7,500 | PSU, basic service |
Family floater (2 adults 35 + 2 children, ₹5 lakh sum insured)
| Insurer | Annual premium (approx.) |
|---|---|
| Star Health | ₹15,000-17,000 |
| Care Health | ₹14,000-16,000 |
| HDFC Ergo | ₹15,000-17,000 |
| ICICI Lombard | ₹14,500-16,500 |
| Niva Bupa | ₹15,500-17,500 |
| New India Assurance | ₹13,000-15,000 |
City-specific premium variations
| City | Premium adjustment |
|---|---|
| Mumbai (Zone A) | Base premium |
| Delhi (Zone A) | Base premium |
| Bangalore (Zone A) | Base premium |
| Chennai (Zone A) | Base to -5% |
| Tier-2 cities (Zone B/C) | -10% to -15% |
The 5% co-pay: What it means in practice
Claim calculation example
Scenario: Surgery costing ₹3,00,000 eligible claim
| Component | Amount |
|---|---|
| Total eligible claim | ₹3,00,000 |
| Co-pay (5%) | ₹15,000 |
| Insurer pays | ₹2,85,000 |
| You pay | ₹15,000 + non-payables |
Why 5% co-pay exists
- Controls unnecessary claims
- Keeps premium low
- Standard across all Arogya Sanjeevani policies
- Cannot be removed (unlike other plans)
Co-pay impact by claim size
| Claim amount | 5% co-pay you pay |
|---|---|
| ₹50,000 | ₹2,500 |
| ₹1,00,000 | ₹5,000 |
| ₹2,00,000 | ₹10,000 |
| ₹3,00,000 | ₹15,000 |
| ₹5,00,000 | ₹25,000 |
Related: Understanding co-pay in health insurance • How much cover do I need
Who should buy Arogya Sanjeevani?
Good fit for:
- First-time buyers wanting simple, affordable cover
- Budget-conscious individuals okay with 5% co-pay
- People who want no room rent hassle (no limits)
- Those with existing corporate cover wanting basic backup
- Students/young professionals starting insurance journey
Not ideal for:
- Families wanting higher coverage (max ₹5 lakh only)
- Those who want zero co-pay (5% is mandatory)
- People needing maternity cover (not included)
- Those seeking comprehensive benefits (basic plan)
- Families with seniors (better options available)
Arogya Sanjeevani vs regular comprehensive plans
Scenario comparison: Family in Mumbai
| Parameter | Arogya Sanjeevani (₹5L) | Care Supreme (₹10L) |
|---|---|---|
| Premium | ₹15,000/year | ₹25,000/year |
| Sum insured | ₹5 lakh | ₹10 lakh |
| Co-pay | 5% mandatory | 0% |
| Room rent limit | None | None |
| PED waiting | Up to 3 years | Up to 3 years |
| Maternity | Not covered | Available as rider |
| Restoration | Basic | Unlimited |
| Consumables | Limited | Better coverage |
| 5-year total cost | ₹75,000 | ₹1,25,000 |
Verdict
Arogya Sanjeevani saves ₹50,000 over 5 years but gives half the coverage and mandatory co-pay. For families who can afford it, a comprehensive plan is usually better value.
How to choose an insurer for Arogya Sanjeevani
Since features are identical, focus on:
1. Claim settlement ratio
Higher is better. Check IRDAI annual reports.
2. Network hospitals in YOUR city
| City | Recommended insurers |
|---|---|
| Mumbai | Star Health, HDFC Ergo, Care Health |
| Delhi | Star Health, ICICI Lombard, Care Health |
| Bangalore | Star Health, Niva Bupa, HDFC Ergo |
| Chennai | Star Health, Care Health, New India |
| Tier-2 cities | Star Health, New India (PSU wider reach) |
3. Cashless claim process
In-house claim teams (Star, Care) often faster than TPA-dependent insurers.
4. Premium (within IRDAI band)
PSU insurers (New India, United India) often 10-15% cheaper but may have slower processes.
Arogya Sanjeevani: What's covered
Inpatient hospitalization
- Room, boarding, nursing
- Surgeon, anesthetist, consultant fees
- ICU charges
- Medicines, consumables
- Diagnostic tests
- Pre-hospitalization (30 days)
- Post-hospitalization (60 days)
Day care procedures
- Dialysis, chemotherapy, cataract, etc.
- 140+ listed procedures
Other benefits
- AYUSH treatment (Ayurveda, Yoga, Unani, etc.)
- Ambulance (₹2,000 per hospitalization)
- Organ donor expenses
Arogya Sanjeevani: What's NOT covered
Exclusions
- Maternity and childbirth
- Outpatient treatment (OPD)
- Dental (unless from accident)
- Cosmetic/plastic surgery
- Obesity treatment
- Self-inflicted injuries
- War, nuclear events
- Adventure sports injuries
- Waiting period conditions (until served)
FAQs - Arogya Sanjeevani Coverage, Co-pay & Purchase
Is Arogya Sanjeevani a government scheme?
No. It's a standard policy mandated by IRDAI (regulator) but sold by private and public insurers. It's not free or subsidized.
Why is 5% co-pay mandatory in Arogya Sanjeevani?
IRDAI designed it with mandatory co-pay to keep premiums affordable and discourage unnecessary claims. It cannot be removed.
Can I increase sum insured beyond ₹5 lakh?
No. Arogya Sanjeevani maximum is ₹5 lakh. For higher cover, buy a comprehensive plan or add a super top-up.
Is Arogya Sanjeevani good for families?
It's basic but functional. For ₹5 lakh shared cover with 5% co-pay, it works for small families. Larger families or those wanting better features should consider comprehensive plans.
Can I port from Arogya Sanjeevani to a regular plan?
Yes. You can port to a different plan at renewal. Waiting periods served are credited.
Does Arogya Sanjeevani cover pre-existing diseases?
Yes, after the PED waiting period (up to 36 months per IRDAI's May 2024 cap; older Arogya Sanjeevani policies may still have a 48-month wait). Disclose all conditions at policy purchase.
Which insurer has the best Arogya Sanjeevani claim service?
Star Health and Care Health generally have better claim processes. But check network hospitals in your specific city.
Can I add riders to Arogya Sanjeevani?
Limited riders may be available depending on the insurer. No maternity or OPD riders possible.
Is there any age limit for Arogya Sanjeevani?
Entry age: 18-65 years (some insurers may vary slightly). Lifetime renewal available.
How does no-claim bonus work in Arogya Sanjeevani?
5% increase in sum insured per claim-free year, up to 50% maximum. Reduces by 5% after claim year.
Can I buy Arogya Sanjeevani online?
Yes. Available on insurer websites and aggregators. Compare premiums before buying.
Is Arogya Sanjeevani better than corporate insurance?
Different purposes. Corporate insurance may have higher cover but isn't in your control. Arogya Sanjeevani is your personal backup-but consider comprehensive plans for full protection.
Disclaimer: This is educational content, not individual insurance advice. Arogya Sanjeevani terms are standardized by IRDAI, but premiums vary by insurer. Always confirm current pricing and network hospitals before purchasing.
Source: Claim and complaint ratios are a weighted average of the last three financial years, latest available as of March 2026, from IRDAI's published data.
Related Guides
- Pillar: Health insurance guide
- Siblings: Best plans 2026 • Co-pay explained
- Cross-cluster: Cashless claim checklist
Our editorial principles
- Salaried advisors, not commission-linked: we focus on clarity and suitability, not product hype.
- No spam: we don't sell your data; we keep advice simple and actionable.
- Claims-first: policy features are evaluated by how they behave during claims.
- Education-first: this content is for informational purpose only.
Book a call for advice on the best policy for you and your family
A salaried, IRDAI-certified NYVO advisor will look at your cover, flag the gaps that matter, and tell you plainly what to fix. No commission, no pressure.
16+ years in financial services. Former investment banker at Bank of America, Kotak Investment Banking, and SBICaps, and ex-CFO of slice. Founder of NYVO and Principal Officer - IRDAI Certified.
