As per the guidelines issued, all the insurers shall have to comply with the following regarding the standard product, Aarogya Sanjeevani Policy, details uniformly.

• No add-ons or optional cover allowed with the standard product and shall be offered on indemnity basis with a policy tenure of one year.

• Insurer may determine the price keeping the covers proposed to be offered as per the norms specified in the IRDAI (health Insurance) Regulations, 2016 (HIR) and Guidelines notified there under.

• While constructing the product, it will cover the following:

• Hospital expenses

  • Boarding expenses of up to 2% of the sum insured subject to a maximum of Rs 5000/-

  • Diagnostic, imaging, operational and surgical and other expenses.

  • Intensive care unit (ICU)/ intensive cardiac care Unit (ICCU) expenses of up to 5% of sum insured subject to maximum of Rs 10,000/per day.

  • Cataract treatment expenses, subject to sublimit

  • Dental treatment and plastic surgery expenses necessitated due to disease or injury

  • All day care treatments

  • Expenses incurred on road ambulance subject to a maximum of Rs 2000 per hospitalisation

• Ayush Treatment

  Expenses incurred on hospitalisation under Ayush as per the guidelines defined in IRDAI (health insurance) under the regulations, 2016 system of medicine shall be covered without any sub-limits. Ayush treatment refers to hospitalisation treatments given under Ayurveda, Yoga, and Naturopathy, Unani, Siddha, and Homeopathy systems.

• Pre-hospitalisation

  The medical expenses incurred for a period of 30 days prior to the date of hospitalisation shall be admissible.

• Post-hospitalisation

  The medical expenses incurred for a period of 60 days from the date of discharge from the hospital shall be admissible.

• Cumulative Bonus

  The original Sum insured, shall be increased by 5% with respect to each claim free policy year, provided the policy is renewed without a break subject to maximum of 50% of the sum insured.

  If a claim is made in any particular year, the cumulative bonus accrued may be reduced at the same rate which it has accrued.

• This Product can be availed on a family floater basis and not combined with critical illness cover or benefit-based covers. No plan variants are allowed and offered as a standard standalone product on indemnity basis.

• The minimum and maximum sum insured will be Rs 1 lakh and Rs 5 lakh, respectively. The product which will have no exit age, has minimum and maximum entry age of 18 years and 65 years, respectively, and three months to 25 years for children under family floater policies.

• The standard product may be offered as a micro insurance product subject to Sum insured limits specified in IRDAI in (Micro Insurance), Regulations 2015, and other circulars/guidelines issued in this regard by the Authority from time to time.

• The nomenclature must be Aarogya Sanjeevani Policy succeeded by name of the insurance company (Aarogya Sanjeevani Policy, )

• The proposal form used for the product shall be subject to the norms specified under the guidelines on product Filing in Health Insurance

• Insurers shall mandatorily issue customer information sheet as per the format specified

Image 1: Snapshot of Customer information sheet

(Source: IRDAI Guidelines on Standard Individual Health Insurance Product)

The main reason why this has been introduced is to eliminate the challenge which the public faces in terms of product selection and:

• To address basic health needs of insuring public

• To have a standard product with common policy wordings across the industry

• To facilitate seamless portability among insurers

Remember, financial and health security are the basic tenets for an individual; the purpose of insurance is indemnification of risk from an untoward event. However as far as wealth management is concerned, it is best to keep insurance and investment needs separate.

[Read: Why Endowment Plans are Useless: A Case Study]

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