What is Arogya Raksha?
Arogya Raksha is a governmentbacked health insurance scheme designed to provide affordable, comprehensive medical coverage to individuals and families across the country. Launched with the objective of reducing the financial burden of healthcare, the policy offers cashless treatment in network hospitals, coverage for preexisting conditions after a waiting period, and a range of preventive health services.
Key Benefits
- Cashless Hospitalisation Avail treatment without paying outofpocket at any empanelled hospital.
- Wide Network Over 10,000 network hospitals and clinics nationwide.
- PreExisting Illnesses Covered after a 12month waiting period.
- Family Cover One policy can cover the whole family (spouse, children, parents).
- No Claim Bonus Policy sum insured increases by 10% for each claimfree year, up to a maximum of 50%.
- Annual Health Checkup Free preventive health checkup once every policy year.
Coverage Details
The policy provides a sum insured ranging from 2lakhs to 10lakhs, customizable as per the applicants needs. Below is a snapshot of the typical coverage:
| Category | Coverage |
|---|---|
| Inpatient Hospitalisation | Room rent, ICU, surgery fees, doctors fees, medicines, diagnostic tests |
| Day Care Procedures | All listed procedures done on an outpatient basis |
| Pre and PostHospitalisation | 15days before and 30days after admission |
| Ambulance Charges | Up to 5000 per trip (maximum 2 trips per admission) |
| Domiciliary Treatment | Medical care provided at home when hospitalisation is not feasible |
| Ayush Treatments | Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homeopathy (subject to network hospital) |
Eligibility & Enrollment
Anyone aged 1865 years can apply for Arogya Raksha. The policy is open to:
- Employees of participating organisations
- Selfemployed professionals
- Members of cooperative societies and agricultural cooperatives
- Individuals living in designated rural and urban pockets
How to Enrol:
1. Visit the official portal or a certified enrolment centre.
2Age 2. Submit proof of identity, address and age (Aadhaar, PAN, or passport).
3. Choose the desired sum insured and pay the premium (available as a onetime or monthly instalment).
4. Receive the policy document and ecard within 48 hours.
Claim Process Simple and Transparent
Claims can be filed either digitally or at the hospitals claim desk. Follow these steps for a smooth experience:
- Cashless Claim: Present your Arogya Raksha ecard and a valid ID at the network hospitals insurance desk. The hospital will verify eligibility and obtain preauthorization.
- Reimbursement Claim: If treatment is received at a nonnetwork hospital, collect all original bills, discharge summary, and doctors prescription.
- Upload the documents through the online portal or submit them at the nearest claim centre.
- The claim will be processed within 710 working days. Approvals are communicated via email/SMS.
Tip: Keep a digital copy of all documents on your phone for quick access.
Frequently Asked Questions
1. Is there a waiting period for preexisting diseases?
Yes. The waiting period is 12 months from the policy start date. After this period, preexisting conditions are covered up to the sum insured, subject to sublimits.
2. Can I increase my sum insured later?
Policyholders may request an increase during the renewal window (30 days before renewal). The premium will be adjusted accordingly.
3. What happens if I miss a premium payment?
The policy enters a grace period of 30 days. If the premium is paid within this period, coverage continues without interruption. After 30 days, the policy lapses and must be reinstated.
4. Does the policy cover maternity expenses?
Yes. Maternity and newborn care are covered after a 24month waiting period, with a maximum limit of 50,000 per pregnancy.
5. Are COVID19 related treatments included?
All COVID19 hospitalisations, tests and related expenses are fully covered under the policy without any waiting period.
