Health insurance policy helps cover the cost of medical treatment, which can be expensive. It allows individuals to access quality health care, including preventive care and speciality services. Despite these benefits of health insurance policy, the penetration rate of insurance in India is low.
One of the reasons is the complexity of the insurance market. Due to numerous insurance companies offering a wide range of products, it can be overwhelming for buyers to navigate and compare different options. As a result, they are often left confused about the best health insurance policy for them.
To overcome this challenge, the Insurance Regulatory and Development Authority of India (IRDAI) mandated insurers to offer standard health insurance plans under the Arogya Sanjeevani Policy from 1 April 2020. Read on to learn more about the standard health insurance policy in India.
What is the Standard Health Insurance Policy?
Through the Arogya Sanjeevani policy, IRDAI has sought to bring uniformity and facilitate portability in the insurance sector. Under this policy, insurers provide a standardised health insurance product with similar coverage, exclusion, and benefits. They, however, have the discretion to set the premium of their choice.
What are the Features of the Standard Health Insurance Policy?
Offered as a standalone product, it is easy to understand and satisfies all of the customers’ fundamental needs. More details about the standardised health insurance policy in India are listed below.
Sum Assured
Standard health insurance plans offer a minimum sum insured of ₹ 50,000. The amount can be increased in the multiple of ₹ 50,000 up to a maximum of ₹ 10,00,000.
Eligibility
People falling in the age bracket of 18 years to 65 years are eligible to buy this plan. The policy can be taken for self, spouse, parents, and parents-in-law. Dependent children in the age range of 3 months to 25 years are also covered. However, it excludes independent children who are above 18 years.
Policy Period
The policy covers a period of one year and is lifetime renewable. It means that the buyers can renew the policy throughout their life without restrictions like age limits.
Coverage
The standard plans will cover hospitalisation expenses, AYUSH treatment, cataract surgeries, dental care, daycare procedures, road ambulance charges, etc. Moreover, treatment fees incurred 30 days before the date of hospitalisation and 60 days after discharge from the hospital are also covered.
Exclusions
Standard health insurance policies do not cover expenses related to self-inflicted injuries, adventure sports injuries, war-related injuries, sexually transmitted diseases treatment, obesity treatment, and cosmetic surgeries.
Types of Plan
Arogya Sanjeevani has two options- individual health insurance plans and family floater plan. Individual Plans, as the name suggests, cover only one beneficiary. On the other hand, family floater plans cover the entire family under a single sum assured amount and premium payment.
Cumulative Bonus
Buyers will not lose anything even if they do not file a claim during any year. 5% of the insured amount will be added as a bonus for each claim-free year.
Co-payment
Co-payment clause specifies the percentage of the claim amount that the policyholders have to pay from their own pockets. Under Arogya Sanjeevani, there is a minimum co-payment of 5% only.
Premium Payments
The policyholder can pay the premium annually, biannually, quarterly, or monthly. A fixed 30-day grace period is permitted for the yearly mode of payment, and a fixed 15-day grace period for all other modes of payment.
Free Look Period
After receiving the Standard Health Insurance Policy, buyers will have 15 days to evaluate its terms and conditions before they can cancel it.
Conclusion
Standard health insurance plans provide much-needed clarity to policy buyers. It is, however, crucial to remember that the regulator has not fixed the premiums of the standard plan. The premiums thus differ with every insurance company and are listed along with other health insurance policy details on the companies’ websites. Buyers must go through them and select the best health insurance policy, i.e., the one that meets their specific requirements without straining their budget.
