The Insurance Regulatory and Development Authority of India (Irdai), on Thursday, mandated all general and health insurance companies to offer a standard health insurance product with a maximum sum insured of ₹5 lakh. In a circular, the regulator said the product shall be named 'Arogya Sanjeevani Policy' followed by the insurer’s name. Insurers will have to offer this product starting April 1, 2020.
“The Health Insurance market already has a number of individual health insurance products. But each product has unique features and the insuring public may find it a challenge to choose an appropriate product," said Biresh Giri, appointed actuary - head of product development and chief risk officer, Acko General Insurance. “Irdai has decided to mandate all general and health insurers to offer a standard individual health insurance product with an objective to take care of basic health needs of insuring public, have a standard product with common policy wording across the industry, and facilitate seamless portability among insurers."
The standard health product will be offered on indemnity basis only and will have basic mandatory covers such as hospitalization expenses including anesthesia, consultants, cost of medicines and drugs, oxygen, surgeons, room, boarding and so on. Note that the cover on expenses for room, boarding and nursing is capped up to 2% of the sum insured subject to a maximum of ₹5,000 a day. Expenses for the Intensive Care Unit (ICU) and Intensive Cardiac Care Unit (ICCU) facility will be covered too but only up to 5% of the sum insured subject to maximum of ₹10,000 a day. However, insurers are not allowed to offer add-ons or optional covers with this product. The tenure of the policy is fixed for a period of one year and will be offered in the form of a family floater plan as well.
The policy will also cover dental treatment and plastic surgery necessitated due to disease or injury, all day care treatments and expenses incurred on road ambulance but with a cap up to ₹2,000 a day. Expenses incurred on hospitalization under AYUSH system of medicine will also be covered without any sub-limits. Irdai said pre-hospitalization (from 30 days prior to the date of admission) and post-hospitalisation expenses (60 days from the date of discharge) will be covered too.
Irdai has said that insurers can launch this standard product without prior approval of the regulator but will have to ensure that it complies with the necessary conditions.