What is Not Covered in Arogya Sanjeevani Health Insurance Policy?


What is Not Covered in Arogya Sanjeevani Health Insurance Policy?

Arogya Sanjeevani Health Insurance Policy has recently introduced by the IRDAI to ensure basic health coverage to all. It is a standard health insurance policy covering hospitalization expenses and treatment costs up to the sum insured. However, to avoid the misuse of this policy, false or trivial claims, the IRDAI has led several exclusions as well. Let's understand more about it in detail:

>>Click Here to Read Benefits of Arogya Sanjeevani Policy

What are exclusions in Arogya Sanjeevani Health Insurance?

Exclusions are the medical procedures, treatments, diseases, and medical conditions not covered in this health insurance plan. It means any claim related to exclusions is not admissible under the Arogya Sanjeevani Health Insurance coverage, and your claim gets rejected. However, it narrows the scope of health insurance coverage. But, it is required because some risks are uninsurable that can affect several customers in one go, for example, war and natural calamity. Moreover, some treatments and hospital expenses are reasonable that do not require to settle under a health insurance claim.

Now, let's see what is not covered in the Arogya Sanjeevani Policy.

Investigation & Evaluation 

  • Expenses related to any admission primarily for diagnostic and evaluation purposes.
  • Any diagnostic expenses which are not related or not incidental to the current diagnosis and treatment.
  • Rest cure, rehabilitation, and respite care
  • Expenses related to any admission primarily for enforced bed rest and not for receiving treatment.

Obesity/Weight Control

Expenses related to surgical treatment of obesity that does not fulfill the below conditions:

  • Surgery advise by the Doctor
  • Surgery or procedure supported by clinical protocols
  • The insured should be 18 years of age
  • Body Mass Index (BMI):
  • Greater than or equal to 40
  • Greater than or equal to 35 and related cardiomyopathy, coronary heart disease, sleep apnea, and uncontrolled type2 diabetes

Change of Gender Treatments

  • Expenses related to any gender change treatments, including surgical management, or changes in body characteristics.

Cosmetic or Plastic Surgery

  • Expenses related to cosmetic or plastic surgery or any other treatments to change appearance excluded. Until it is a reconstruction in case of accident, burns, cancer, or any medically necessary treatment, advised by Medical Practitioner.

Hazardous or Adventure Sports

  • Expenses related to any treatment required due to the participation in hazardous or adventure sports such as para-jumping, rock climbing, mountaineering, motor racing, etc.

Other Expenses

  • Expenses related to domiciliary hospitalization, OPD treatment, nuclear, chemical, biological attack, war, maternity expenses for complicated deliveries and c section, and sterility and infertility treatments excluded from the coverage.

>>Also Read Quick FAQ's About Arogya Sanjeevani Health Insurance Policy


Therefore, to avoid misconceptions about the coverage and get a hassle-free claim, you should be aware of your health insurance policy's exclusions. Arogya Sanjeevani Health Insurance Policy offered by Care Health Insurance has minimal exclusions and gives you maximum coverage at an affordable premium. So, opt for it and secure yours and your family's health now without getting overburden financially. 

Disclaimer: Plan features, benefits, coverage, and underwriting of claims are subject to policy terms and conditions. Please refer to the brochure, sales prospectus, and policy documents carefully.

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