New Delhi. The Insurance Regulatory and Development Authority (IRDAI) informed all insurance companies that, from April 1, all general and health insurance companies will have to introduce a standard health insurance product – Arogya Sanjivani Policy – relating to hospitalization, pre and post treatment and AYUSH treatment. Will include basic expenses. Both non-life insurers and standalone health insurers will offer this policy.
The Times of India has said in a report that the move has been taken by the insurance regulator in view of differences in individual health insurance products. All insurance companies will charge a uniform rate for this standard health plan. The standard policy will have the benefits of cumulative bonuses and insurers will not be allowed to impose deductibles. However, customers will be subject to a certain whack of 5% of the claim amount throughout all ages, which will be clearly mentioned in the application, which is mentioned.
The regulator has asked all insurance companies to offer this cover only on compensation basis. This means that they can only pay for actual expenses (either through cashless or reimbursement). No add-ons such as serious illness or benefit-based cover can be covered. Insurers will have a final decision on the premium price. However, rates must be the same across India and insurers may not have geography or zone-specific pricing.
“We already have such a standard cover and there are not much challenges from these guidelines in this direction,” the publication quoted Sanjay Dutt, head of underwriting and claims, ICICI Lombard General Insurance. While general pricing is mandatory across the country, insurers have the freedom to fix policy prices. We can expect some discounts from the geography-based pricing clause not ography.
A wellness can buy a sanjivani policy either on an individual basis or on a family floater basis. The minimum and maximum sum assured will be Rs 1 lakh and Rs 5 lakh respectively. The product, which has no exit age, will allow a minimum and maximum entry age of 18 and 65 years for children and from three months to 25 years respectively under the family’s floater policies. The standard product will 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 glaucoma and age-related eye diseases, ulcers, hemorrhoids, sinuses, benign ENT disorders, tonsillitis, adenoidactomy, mastoidactomy, timepoplasty, hysterectomy and all internal and external tumors will be subject to a waiting period of 24 months. Treatment for joint replacement, unless resulting from accident and age-related osteoarthritis, will be a waiting period of 48 months.
