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10 Key Features of 'Standard Individual Health Insurance'

IRDAI (Insurance Regulatory and Development Authority of India) has recently issued guidelines on the 'Standard Individual Health Insurance Product'.

The market is presently flooded with numerous health insurance plans. Each offers unique features. As such, it is not easy for a common person to choose the most appropriate mediclaim policy.

Hence the need for a standard policy — common across all insurance companies — which will take care of an individual's "basic health insurance requirements". This will also simplify the process of policy portability among insurers.

Listed below are the ten salient aspects of the Standard Individual Health Insurance (will be available under the name Arogya Sanjeevani Policy).

One. All insurance companies have to compulsorily offer the Standard Individual Health Insurance Policy w.e.f. April 1, 2020. It would be a basic policy with no add-ons or optional covers such as critical illness etc.

Two. The minimum cover under the Arogya Sanjeevani Policy would be Rs.1 lakh and maximum Rs.5 lakhs. It will be a co-pay policy under which 5% of the claim amount will be borne by the policyholder.

Three. Each insurance company is free to determine the premium it may charge for such a policy. The same can be paid yearly, half-yearly, quarterly or monthly.

Four. The minimum entry age of the principal insured is stipulated as 18 years and maximum of 65 years, and the policy would be renewable lifelong.

Image by Gerd Altmann from Pixabay

Five. The Standard policy will provide cover for basic hospitalisation expenses as under:
   - Room, Boarding and Nursing expenses up to 2% of the Sum Assured (max. of Rs.5000 per day)
   - ICU and ICCU expenses up to 5% of the Sum Assured (max Rs.10,000 per day)
   - Fees paid to all doctors, specialists, anaesthetists, etc.
   - Cost of medicines, diagnostic tests, blood, oxygen, anaesthesia, operation theatre, surgical appliances etc.

(Note: Normally the hospitalisation should be for 24 hours; except where the treatment does not require 24-hr stay at the hospital as specified in the policy.)

Six. Other expenses to be covered under the Arogya Sanjeevani Policy include:
   - Treatment of Cataract (up to 25% of Sum Insured or max Rs.40,000 per eye)
   - All day care treatments
   - Ambulance charges (max. Rs.2000 per hospitalisation)
   - Dental treatment / Plastic surgery only due to disease or injury
   - 30 days pre-hospitalisation / 60 days post-hospitalisation medical expenses
   - Expenses under AYUSH (Ayurvedic, Yoga and Naturopathy, Unani, Siddha, Homeopath) systems of medicines, without any sub-limits. 

Seven. Certain list of diseases will be covered only after 24 months waiting period. Further, joint replacement and age-related osteoarthritis / osteoporosis will be covered only after 48 months waiting period.

Eight. It shall be an indemnity based policy only i.e. the 'expenses actually incurred' will be reimbursed / covered (subject, of course, to the terms and conditions of the policy). This is unlike the Daily Cash Policy, which pays a fixed sum per day of hospitalisation, irrespective of the expenses incurred.

Nine. Arogya Sanjeevani will be a one-year policy, renewable every year. For each claim-free policy year, the Sum Insured will be increased by 5% as Bonus (subject to a maximum of 50% of the Sum Insured).

Ten. The Standard Individual Health Insurance Policy will also be offered on family floater basis to provide cover for (a) legally wedded spouse, (b) parents and parents-in-law and (c) dependent children between the age of 3 months and 25 years.

The combination of a Arogya Sanjeevani Policy and a Super Top-up Plan is, in most cases, likely to provide adequate protection against exorbitant medical bills (except at the hi-end hospitals and/or super deluxe rooms).

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