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IRDAI: 1st Health insurance cover in the name ‘Arogya Sanjeevani’ mandatory for insurance companies

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On January 02, 2020 the Insurance Regulatory and Development Authority of India (IRDAI) has mandated all the health and General Insurance Companies(GICs) to offer 1st of its kind standardised health insurance products (SHIP) in the name “Arogya Sanjeevani” policy with effect from April 1, 2020. All the health products offered by those companies will be succeeded by this name. It is to be noted that no health insurance companies will mention any other name other than the standard name of Arogya Sanjeevani in any of the documents.Insurance limit: Under the Arogya Sanjeevani plan, the minimum sum insured will be Rs. 1 lakh while the maximum sum insured limit will be Rs. 5 lakhs (in multiples of 50,000). The health insurance plan should be offered with a policy term of one year. The details of this insurance plan are as follows:

Arogya Sanjeevani health insurance policy:

i.Key features: 3 key features of the policy have been mandated in the IRDAI’s guidelines. These include providing health insurance policy for basic health needs of the insured public; Having a standard product with common policy wordings; Providing seamless portability among the insurers.

ii.Eligibility: Any person aged between 18-65 (inclusive of 18 & 65 years of age) eligible for the Arogya Sanjeevani policy. The following family members of a person can avail the policy. These include legal spouse, parents and Parents-in-laws and dependent children.

  • Dependent children: Children who are natural or legally adopted between the ages of 3months and 25 years will be eligible. A child above 18 years of age and financially independent will not be eligible for policy coverage.

iii.Mode of premium payment: All modes of premium payment, i.e., annual, half-yearly, quarterly or monthly mode will be available. There will also be uniformity in premium pricing irrespective of geographic locations/zones etc.

iv.Grace period for premium payments: A fixed period of 30 days will be allowed as grace period for premium payments. However, a fixed period of 15 days grace period will be allowed for all other modes of payment.

v.Expenses coverage: Upto 25% of the sum insured or Rs. 40,000 whichever is, low per eye will be covered for cataract treatments. All daycare treatments and expenses incurred on road whereby ambulance cost subject to a maximum of Rs 2,000 per hospitalisation and coverage will be done.

  • AYUSH coverage: The health policy will also cover expenses for hospitalisation under AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy) treatment.
  • Pre & post hospitalisation: Pre-hospitalisation expenses incurred for a period of 30 days and post-hospitalisation expenses for a period of 60 days will also be covered.

vi.15 day free look period: At least a 15 day free look period will be given from the date of receipt of the policy to review the terms and conditions of the policy and also to cancel the policy if not acceptable.

vii.5% Co-pay: Fixed co-pay of 5% on all claims will be applicable and also be eligible across all ages. Click here to know more.

Important insurance terms:

  • Premium: An insurance premium is the amount of money an individual or business pays for an insurance policy.
  • Grace Period: It is the time provided to the customer over and above the exact due date to make payments for the renewal premium without lapsing the insurance policy or reducing any of the policy benefits.
  • Free look period: It is a required period of time in which a new life insurance policy owner can terminate or end his/her policy without penalties or surrender charges.
  • Co-Pay: It refers to an arrangement in which the policyholder will need to pay a portion of the medical expenses on their own and the insurance company will pay the remaining amount.

About Insurance Regulatory & Development Authority of India(IRDAI):
Fact- IRDAI is a 10-member team consisting of 1 chairman, 5 whole time members and 4-part time members.
Founded- 1999.
Headquarters- Hyderabad, Telangana.
Constituted act- Insurance Regulatory and Development Authority Act, 1999
Chairman- Subhash Chandra Khuntia