In a bid to to enable customers to choose an appropriate health insurance coverage of their choice, the insurance regulator IRDAI has asked all general and health insurers to offer the standard individual health insurance product (other than personal accident and travel covers) with eight mndatory features and has issued specific guidelines for the purpose on Tuesday…
This standard product should have the basic mandatory covers as specified in the proposed norms which has to be uniform across the market. No additional add-ons or optional covers allowed to be proposed to offer along with the standard product, said IRDAI..
The IRDAI has issued the Draft Guidelines on designing the standard product on Tuesday and asked all the stakeholders to offer their suggestions, on the proposed Guidelines by 6th March.
Also in order to incentivise early entry into health insurance by the young prospective policyholders of health insurance market, IRDAI has asked all general insurers / health Insurers to offer them Standard Product and devise a pricing mechanism in such a way to incentivise the early entry of prospective policyholders, continued renewals and favourable claim experience.
Prasun Sikdar, managing director & CEO, Cigna TTK Health Insurance Company, said, “The IRDAI’s proposed move for standardisation of health product will give consumers greater certainty about the services covered and to find one that meets individual needs. This will also encourage more Indians to purchase health insurance as the new simplified products will be easy to understand and offer an instant solution to the buyer.''
The healthcare costs are immensely high and on a continuous rise, but India is one of the least insured countries, with a low health insurance penetration rate. One of the reason for poor penetration is that most consumers find it difficult to understand what services different health insurance products cover, and do not, cover, he said.
Standard Health Product shall offer only the following mandatory covers-.
The Hospitalization expenses shall cover the following;
a)Room, Boarding, Nursing Expenses all inclusive as provided by the Hospital / Nursing Home
b)Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialist Fees whether paid directly to the treating doctor / surgeon or to the hospital
c)Anaesthesia, blood, oxygen, operation theatre charges, surgical appliances, medicines and drugs, costs towards diagnostics, diagnostic imaging modalities, and such other similar expenses.Hospitalisation expenses on for a minimum period of 24 hours only are admissible. However, this time limit will of 24 hours shall not apply when the treatment does not require hospitalization as specified in the terms and conditions of policy contract, where the treatment is taken in the hospital and the Insured is discharged on the same day.
d)Intensive Care Unit (ICU) / Intensive Cardiac Care Unit (ICCU) expenses
e)Expenses incurred on treatment of Cataract subject to sub limits, if any, based on sum insured
f) Dental treatment, necessitated due to an injury
g)Plastic surgery, necessitated due to disease or injury
AYUSH Treatment: Expenses incurred on treatment under Ayurveda, Unani, Sidha and Homeopathy systems of medicines shall be covered subject to fixed and standard sub-limits based on Sum Insured.
Pre-Hospitalization medical expenses incurred for a period not less than 30 days prior to the date of hospitalization shall be admissible. Post Hospitalization medical expenses incurred for a period of not less than 60 days from the date of discharge from the hospital towards Consultant fees, Diagnostic charges, Medicines and Drugs wherever required and recommended by the Hospital / Medical Practitioner, where the treatment was taken, following an admissible claim shall be included.
In order to promote and maintain wellness regime, it is considered essential that a wellness and preventive program that incentivises the targeted market segment to start living healthier shall also be incorporated. Accordingly, to enable the individuals to lead longer, healthier and more productive lives, the following wellness features shall be made available to all the insured persons.
Health Check-ups and Consultation services:
Under this cover, the insured person shall be made available an access to the health consultations across the network providers or other empanelled hospitals of the insurer, for getting periodic consultation of at least once in a policy year.
Under this cover, every insured person should be provided an access to the professional medical services for bettering the health profile. As part of post-hospitalization services follow up care shall be made available, as part of Disease Management. Insurers may also provide other suitable services under this programme.
Under this cover, insurers has to provide parametric indices based on fitness regime being followed by insured person, during the policy tenure and reward mechanism shall be designed so as to incentivize the policyholders to continue with the fitness regime.
Outpatient consultations or treatments
Under this programme, insured person has to be be provided services of outpatient consultations or treatments periodically or based on the pre-determined triggers contingent upon the health of the insured.
Explaining the objective of the proposed norms in Standard Health Insurance product, IRDAI said as health products differ significantly with each other in terms of benefits offered, it is considered essential that the potential customers seeking health insurance should have an access to the basic health insurance covers so as to enable them to choose the coverage based on the need. At times the prospective customers may have no option, but to choose a product which has embedded certain other covers whether or not such covers are needed, .