IRDAI had directed all general and health insurers and may soon allow life insurance companies to offer standard health policy.
The standard policy will be called as Arogya Sanjeevani Policy followed by the name of the insurance company.
Here is FAQ on newly introduced Arogya Sanjeevani Policy:
Can the policy be taken for the entire family?
Yes. Arogya Sanjeevani Policy offers both plans - individual and family floater. The IRDAI definition of family includes legally wedded spouse, parents, parents in law and dependent children up to 25 years of age.
How long will the coverage be available under the policy?
Just like any other policy, Arogya Sanjeevani Policy is valid for a year subject to lifelong renewability.
What are the sum insured options available in this product?
The minimum sum insured is Rs.1 lakh and maximum limit is Rs. 5 lakh. The policyholder may choose any sum insured within these limits in the multiples of Rs.50,000.
Does the policy come with sublimits?
Yes, 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.
What will happen in case room rent / ICU rent exceeds the sublimit?
Sub limit is the maximum amount that insurers can pay you for an expense such as room rent. Simply put, if such expenses exceed the sublimit, you will have to pay the excess on your own. For instance, if your room rent is Rs.6000, you will have to Rs.1000 from your pocket.
What about copayment?
IRDAI allowed insurers to 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.
Whether day care treatments are covered?
All the day care treatments are covered. Day care treatment means medical treatment and surgical procedure which are undertaken under general or local anesthesia in a hospital or day care centre in less than 24 hours because of technological advancement.
Remember that the policy does not cover OPD treatment.
Will the policyholder be eligible for no claim benefits?
Yes. Sum insured will be increased by 5% if a policyholder does not file any claim in a policy year. The sum insured can be increased to an extent of 50% of the original sum insured. However, if a policyholder makes a claim, the sum insured will be reduced to its original value.
What are the modes of premium payment allowed in the policy?
A policyholder can pay premium on yearly, half-yearly, quarterly and monthly basis.
However, the grace period changes with the mode of premium payment opted. For instance, for yearly payment, a fixed period of 30 days is allowed as grace period. For all other modes of payment, the policy offers 15 days grace period.
