Arogya Sanjeevani — IRDAI Standard Product
Arogya Sanjeevani is the standard indemnity health product that insurers have offered since 1 April 2020. This lesson explains what 'standard' means, its sum insured range, its room-rent and ICU limits and its 5% co-pay, with the arithmetic shown.
What it is
Health policies differ widely in wording, limits and add-ons, which makes them hard to compare. Arogya Sanjeevani was introduced as a standard product: a simple, basic hospitalisation cover built on a common set of main terms. Insurers have offered it since 1 April 2020.
It is an indemnity policy. That means it pays the admissible expenses of a hospitalisation, up to the sum insured and subject to the policy's limits, and does not pay a fixed lump sum. It is bought from an insurer for a premium, which sets it apart from a government-funded scheme such as PM-JAY, where the beneficiary pays nothing.
The main terms today
In the versions on sale in October 2026 the sum insured runs from ₹50,000 to ₹10 lakh. When the product began the range was ₹1 lakh to ₹5 lakh, and older material still quotes that.
Room rent is covered up to 2% of the sum insured, with a ceiling of ₹5,000 a day. ICU charges have their own limit: 5% of the sum insured, with a ceiling of ₹10,000 a day. Room charges above the limit are not paid by the policy.
Every admissible claim carries a 5% co-pay: the insurer pays 95% and the policyholder bears 5%. The waiting period for pre-existing diseases has to respect the 36-month cap that applies to all health policies since 1 April 2024.
Which document governs
The IRDAI circulars that introduced the product have been superseded by the Master Circular on Health Insurance Business of 29 May 2024. So the figures above are best read as the terms of the standard product as insurers now offer it, and each insurer's current policy wording is the reference for how a limit or the co-pay is applied.
The general protections of the 2024 framework apply to it as to other individual health policies: a 30-day free-look period on policies of one year or more, and renewal that cannot be refused because of past claims. GST on individual health insurance premiums has been nil since 22 September 2025.
Rules at a glance
Illustration: why the daily ceiling matters
Suppose Kavita holds this product with a sum insured of ₹2 lakh, and her cousin Arun holds it with ₹5 lakh (both figures are assumptions for the illustration). For Kavita, 2% of ₹2,00,000 is ₹4,000, which is below the ₹5,000 ceiling, so her room-rent limit is ₹4,000 a day.
For Arun, 2% of ₹5,00,000 is ₹10,000, which is above the ceiling, so his limit is ₹5,000 a day. The percentage decides the limit at lower sums insured; the rupee ceiling decides it at higher ones.
Applying the 5% co-pay (assumed figures)
- Assume a sum insured of ₹3,00,000 and an admissible claim of ₹80,000 after the policy's limits have been applied; assume the co-pay applies to this amount (the insurer's wording shows how limits and co-pay combine).
- Policyholder's co-pay: 5% × ₹80,000 = ₹4,000.
- Insurer's share: ₹80,000 − ₹4,000 = ₹76,000, which is 95% of ₹80,000.
- Check: ₹76,000 is within the ₹3,00,000 sum insured, so it is payable in full.
Result. The insurer pays ₹76,000 and the policyholder bears ₹4,000.
Key points
- Arogya Sanjeevani is a standard indemnity health insurance product, offered since 1 April 2020.
- The sum insured now runs from ₹50,000 to ₹10 lakh; the original range was ₹1 lakh to ₹5 lakh.
- Room rent is covered up to 2% of the sum insured (maximum ₹5,000 a day) and ICU charges up to 5% (maximum ₹10,000 a day).
- A 5% co-pay applies to every admissible claim.
- The introducing circulars are superseded, so the insurer's current policy wording governs.
Common misunderstandings
- The sum insured is not limited to ₹5 lakh any more: that was the original ceiling, and the range now goes up to ₹10 lakh.
- Room rent is not simply 2% of the sum insured: the ₹5,000 a day ceiling also applies, and the lower of the two is the limit.
- The 5% co-pay is not confined to older policyholders or particular illnesses: it applies to every admissible claim.
- Standard does not mean government-funded: it is a commercial policy bought from an insurer for a premium.
Questions people ask
Is it the same as PM-JAY?
No. Arogya Sanjeevani is bought from an insurer for a premium; PM-JAY is a government-funded scheme in which the beneficiary pays no premium.
Does the ICU limit work like the room-rent limit?
It has the same shape with different numbers: 5% of the sum insured, to a maximum of ₹10,000 a day.
Where are the exact terms found now?
In the insurer's current policy wording and Customer Information Sheet, since the original circulars have been superseded by the 2024 Master Circular.
What this lesson relies on
- IRDAI Master Circular on Health Insurance Business (29 May 2024)
- Arogya Sanjeevani standard product terms as published in insurers' current policy wordings
- GST Council decision effective 22 September 2025 (individual health insurance premiums)
This lesson was reviewed independently against these sources on 8 October 2026. Rules change: check the current regulation, scheme document or policy wording before relying on any figure. This is education, not advice.