Standard health cover for individuals on cards

Mumbai: The insurance regulator wants non-life and health insurance companies to offer a standard mediclaim policy for individuals, covering pre- and post-hospitalisation expenses with a minimum basic cover of Rs 50,000 while the maximum cover can be up to Rs 10 lakh. This mandatory standard product can also be offered on family a floater basis.

As per the draft guidelines released by the Insurance Regulatory and Development Authority of India (IRDAI) on Tuesday, while the terms and conditions would be uniform across insurers, they would be free to decide the pricing. However, the pricing will have to incentivize individuals who buy the product young, continue to renew their policy and have a favourable claim experience, said the IRDAI.

By the draft norms, expenses on hospitalisation are admissible for a minimum period of 24 hours. Pre-hospitalisation medical expenses incurred for a period not less than 30 days prior to the date of hospitalisation would be admissible.

Post-hospitalisation medical expenses incurred for a period of not more than 60 days from the date of discharge from the hospital towards consultant fees, diagnostic charges, medicines and drugs would be paid for. The policy will pay for ICU, ICCU expenses, dental treatment if necessitated due to an injury, plastic surgery, necessitated due to disease or injury, and domiciliary hospitalisation.

The minimum entry age shall be 18 years for the principal insured and the maximum age at entry shall be 65. The policy can be renewed lifelong. No additional add-ons or optional covers are allowed to be offered along with this product. The policy will offer standard exclusions.

A close look at the draft contours of the Standard Mediclaim reveals that it would not be much different from what most insurers currently offer but captures most of the innovations that are being offered across insurers. For instance, the policy would pay for expenses incurred on treatment under Ayurveda, Unani, Sidha and Homeopathy systems of medicines subject to fixed and standard sub-limits. It would also offer health check-ups and consultation services at least once in a policy year.

Similarly, every insured person shall be provided an access to the professional medical services for bettering his health profile. Under this cover, insurers will have to provide parametric indices based on fitness regime being followed by an insured person, during the policy tenure and reward mechanism so as to incentivise the policyholders to continue with the fitness regime.

Says Sanjay Datta, Chief-Underwriting, Claims and Reinsurance at ICICI Lombard General Insurance, “Since the coverage and the conditions will be standardised people will be able to understand how the policy works and will be able to respond to it."

Explaining the rationale for standard mediclaim, the 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 shall 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.”

Comments and suggestion are invited from all the stakeholders till March 6.