Soon, all insurers will have to offer a standard health policy: IRDAI

The Insurance Regulatory and Development Authority has mandated all general and health insurance companies to offer a standard health insurance product—Arogya Sanjeevani Policy—covering basic expenses related to hopitalisation, pre and post-admission treatment and AYUSH treatment. Both non-life insurers and standalone health insurers will offer this policy from April 1, 2020.

The move comes after the insurance regulator observed there were too many variations in individual health insurance products, which it said confused the public while choosing health insurance covers.

The standard policy will have benefits of cumulative bonus and insurers will not be permitted to impose deductibles. However, customers will be subject to a fixed co-pay of 5% of claim amount across all ages, which will be explicitly disclosed in the application.

The regulator has asked all insurers to offer this cover on indemnity (protection) basis only. This means that they can only pay for the actual expenses incurred (either cashless or through reimbursement). There cannot be any add-on cover like critical illness or benefit based covers. Insurers will have the final decision on the premium price. However, rates have to be uniform all India and insurers cannot have geography or zone-based pricing.

The Arogya Sanjeevani Policy can be availed as both individual lives and on a family floater basis. The minimum and maximum sum insured will be Rs.1 lakh and Rs.5 lakh respectively. The product which will have no exit age will allow a minimum and maximum entry age will be 18 and 65 years, and 3 months to 25 years for children under family floater policies.

The standard product shall be offered with a policy term of one year, and will allow all modes of premium payment i.e monthly, quarterly, half-yearly and yearly.

Treatment for cataract and age-related eye ailments, ulcers, piles, sinus, benign ENT disorders, tonsilitis, adenoidectomy, mastoidectomy, tympanoplasty, hysterectomy, and all internal and external tumours will be covered subject to a waiting period of 24 months. Treatment for joint replacement, unless arising from accident and age-related osteoarthritis, will have a waiting period of 48 months.

The primary objective will be to offer a health cover addressing basic health needs of the insuring public, which will have a common policy wording across the industry and to facilitate seamless portability among insurers, the IRDAI said.

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