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10 Things to Know About the Standard Health Insurance Policy An Insurer has to Offer

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January 4, 2020

The Insurance Regulatory and Development Authority of India (IRDAI), on January 2, issued a circular mandating health and general insurance companies to offer a standardised product that will take care of the basic requirements of policyholders.

According to IRDAI, the policy will be named as Arogya Sanjeevani Policy, succeeded by the name of the insurance company. The regulator said, no other name is allowed in any of the documents. Insurers will have to start offering the policy from April 1, 2020.

“It is a welcome move to increase penetration in the lower-middle-income segment as this will come with a facility of paying a premium in instalments. Thus, making it an attractive avenue for people as it will not only be easy on their pocket but will also give them enhanced coverage. Moreover, since all the insurers have been directed to have the same coverage and exclusions, it will be simpler for the customer to understand,” said Gurdeep Singh Batra, Head – Retail Underwriting, Bajaj Allianz General Insurance.

According to IRDAI’s guidelines, issued on January 2, these are the key features of the Arogya Sanjeevani Policy.

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  • Health insurance policy to take care of basic health needs of insuring public
  • To have a standard product with common policy wordings across the industry
  • To facilitate seamless portability among insurers

The health insurance plan will have the basic mandatory covers as specified under the guidelines which will be uniform across the health insurance sector. The following health insurance plan will be offered on indemnity basis, as a standalone product. It will not be combined with defined benefit-based insurance covers such as critical illness covers and so on.

Here are 10 things you should know about the health insurance plan, as per IRDAI:

1. Minimum and maximum sum insured: The minimum sum insured under the health insurance plan will be Rs 1 lakh and the maximum sum insured limit should be Rs 5 lakh (in multiples of 50,000). In the case of individual health policy, the sum insured will apply to each individual family member and in the case of the floater health insurance plan, the sum insured will apply to the entire family.

2. Eligibility: Minimum entry age is 18 years and the maximum age at entry is 65. However, there is no exit age. The policy is subject to lifelong renewability. Biresh Giri, Appointed Actuary, Head of Product Development & CRO, Acko General Insurance said that a proposer with higher age can obtain a policy for the family without covering one’s self.” The policy can be availed for self and the following family members:

1. Legally wedded spouse
2. Parents and parents-in-laws
3. Dependent children (i.e., natural or legally adopted) between the age of 3 months and 25 years. If the child is above 18 years of age and is financially independent, he or she will not be eligible for coverage in the subsequent renewals.

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Source: The Economic Times

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