In its latest notification, IRDAI has asked all the non-life and standalone health insurance companies to offer a standard health insurance policy. However, the policy will have regressive features like copayment and sub limits.
While copayment is the percentage amount, which the client will have to shell from his own pocket as medical expenses, sub limit is the maximum amount that insurers can pay you for an expense such as room rent.
Currently, many standalone health insurers and private general insurers offer policies with no co-payment clause and sublimits.
IRDAI said that insurers could levy a fixed co-pay of 5% in the standard policy. For e.g., if the hospitalisation expense has been Rs. 1 lakh and co-payment is 5%, then the insurance provider will pay Rs.95,000 while the policyholder will have to bear the remaining expense of Rs. 5,000.
The regulator has also set sub-limits for room/doctors fee. Maximum of Rs.5000 per day or 2% of sum insured will be given to policyholders for room rent, boarding and nursing expense. Similarly, if a patient is in ICU, the maximum amount that an insurer can pay will be Rs.10000 per day or 5% of sum insured, whichever is lower. Similarly, for treatment of certain diseases like cataract, policyholders will get 25% of sum insured or Rs.40,000, whichever is lower.
On premium pricing, the insurance regulator said that the premium should not be hiked based on geographical location of policyholders.
IRDAI has asked all general and health insurers to offer this product from April 1, 2020. The standard policy will be called as Arogya Sanjeevani Policy followed by the name of insurance company.
