The Insurance Regulatory and Development Authority of India (IRDAI) has set in motion the process of formulating guidelines for a Standard Health Product that it wants all general and health insurance companies to offer.
The Standard Mediclaim Policy, followed by the name of the insurer concerned, as the product would be called, will have a minimum basic sum insured of ₹50,000 and a maximum limit of ₹10 lakh. It will be for those above 18 years of age with the maximum age at entry of 65 years. With health products differing significantly in terms of their benefits, it is essential that potential customers need to have access to a basic health insurance cover. This would enable them to choose the coverage based on the need, IRDAI said, inviting suggestions from stakeholders on the draft guidelines.
Such a policy, it said, was necessary as at times the prospective customers may have no option but to choose a health product which has embedded certain other covers whether or not such covers are needed. Dependent child/children aged upto 25 years are to be covered under the policy.
On the benefit structure, the regulator mooted a ‘Base Cover’ comprising various, mandatory components under hospitalisation expenses. These include ICU/ICCU expenses; cost incurred on treatment of cataract subject to certain limits; dental treatment, necessitated due to an injury; and plastic surgery, necessitated due to disease or injury. IRDAI wanted the companies to devise a pricing mechanism that incentivised early entry of prospective policyholders, continued renewals and favourable claim experience.
Expenses incurred on treatment under Ayurveda, Unani, Siddha and Homeopathy (AYUSH) systems of medicines would be covered as well as those on pre and post hospitalisation medical expenses subject to certain conditions, the proposed guideline said. Wellness incentives are to be offered as part of the proposed policy.
