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Health Insurance 10078 views January 28, 2020
Table of Contents
|Sum Insured||1 Lakh-5Lakh|
|Premium||As per insurer's discretion|
|Tenure||One year with life time renewal|
|Co-Pay||5% of sum insured|
|Room Expenses||Capped at 2% of sum insured|
|Modern treatments||50% of the sum insured|
|Cumulative bonus||5% for each claim free year|
|Sub limits||25% for cataract treatment|
The IRDAI (Insurance Regulatory and Development Authority of India) has made it mandatory for the health and general insurance providers in India to offer a Standard Health Insurance Product. The name of this standard health insurance product would be “Arogya Sanjeevani Policy- Name of the Insurance provider”. Today, general health insurance policies are highly complicated and are quite different from each other. A common man would be in great confusion to decide which health insurance policy would be a perfect one for him. So, this initiative has been taken by the IRDAI to ensure that common people can select their health insurance policies easily without any confusion.
The Arogya Sanjeevani policy helps to provide cover for the basic health needs of the policyholders from 1st April 2020 onwards. In India, mostly all the health insurance policies are valid up to the age of 60 years and might rise to the age of 80 years. However, the Arogya Sanjeevani policy has no age limit and claims can be made throughout the lifetime. Moreover, the Arogya Sanjeevani policy has common wordings of the policy throughout all the industries which reduces the chances of common people getting confused and it has a unique feature of seamless portability.
The minimum entry age for the Arogya Sanjeevani policy is 18 years whereas the maximum entry age is 65 years of age. The Arogya Sanjeevani policy can be purchased for yourself and your family in the form of a floater plan. The floater plan for the family will include the below-mentioned family members.
The major features and benefits which are provided in this policy can be listed below.
The minimum sum assured for the Arogya Sanjeevani Health Insurance Policy is Rs. 1 lakhs and the maximum sum assured is Rs. 5 lakhs i.e. in the multiple of Rs. 50,000. For individuals, the sum assured will be applicable for one member whereas in a floater plan the sum assured would be applicable for the entire family.
The Arogya Sanjeevani policy provides the benefit of cashless hospitalization to the policyholders.
Premium Payment Frequency
The premium for the Arogya Sanjeevani Health Insurance Policy can be paid on a monthly, quarterly, half-yearly and yearly basis. There would be uniform premium pricing for this standard health insurance policy and the premium for the policy would be determined on the PAN India basis and no pricing based on geographic locations would be allowed.
The Arogya Sanjeevani Health Insurance Policy can be renewed throughout the lifetime. There is no particular age for exit from the policy.
The Arogya Sanjeevani Health Plan would be offered for a policy period of one year after which it needs to be renewed.
Pre-Hospitalization and Post-Hospitalization Expenses
This standard health insurance policy provides coverage for pre-hospitalization expenses for 30 days before actual hospitalization. Also, it offers coverage for expenses incurred in post-hospitalization for 60 days from the discharge date.
The plan also provides coverage for the ambulance expenses incurred up to a limit of Rs. 2000 per hospitalization.
Under the Arogya Sanjeevani Health Insurance, the expenses incurred for alternate treatment methods i.e. AYUSH which comprises of Ayurveda, Yoga, Unani, Sidha and Homeopathy systems are also provided with coverage.
There are certain sub-limits applicable to the coverage provided such as
ICU or ICCU expenses are covered up to an amount of 5% of the sum assured or it is limited up to Rs. 10,000 in a day.
In case of expenses related to hospitalization such as room, nursing, boarding, etc. coverage is provided up to 2% of the sum assured or up to a maximum amount of Rs. 5,000 per day.
The sub-limit provided for cataract surgery is equivalent to the actual expenses i.e. 25% of the sum assured or Rs. 4 lakhs whichever is less.
There are two types of waiting periods associated with this Standard health insurance policy.
Diseases such as Cataract and age-related eye illnesses, tympanoplasty, benign ENT disorders, Non-infective arthritis, pilonidal sinus, Gastric ulcer, Gout, Rheumatism, Tonsillectomy, Mastoidectomy, cysts, hydrocele, piles, polyps, spinal diseases except those which are arising from accident, and many more have a waiting period of 24 months.
Diseases like joint replacement treatment unless those arising from an accident, Osteoporosis and age-related Osteoarthritis have a waiting period of 48 months.
A co-pay of 5% on all the claims made is applicable for all the policyholders irrespective of their ages.
In the case of a claim-free policy year, the sum assured is increased by 5% provided the Arogya Sanjeevani Health Insurance is renewed every year continuously for 5 years subject to a maximum of 50% of the sum assured.
The Arogya Sanjeevani Health Insurance can be ported from one insurance provider to another based on the convenience of the policyholder.
The policyholders would be allowed at least 15 days within which they can review the policy document, analyze the terms and conditions of the policy and cancel the policy if it is unacceptable.
When the policy premium is to be paid yearly, a grace period of 30 days is allowed within which the policyholder has to pay his premium which is due. For the other premium payment modes i.e. monthly, quarterly and half-yearly a grace period of 15 days is allowed.
The major exclusion of this health insurance policy is maternity expense coverage. Along with it, there are some other treatments which are not covered under the Arogya Sanjeevani policy such as treatments associated with weight loss, plastic surgery, change of gender, any injury or treatment related to participation in adventurous sports, treatment of injuries due to war or breach of the law, etc.
The major beneficial features of the policy are that its premium would be based on geographic locations and it would help in providing basic health coverage that every common man in India requires. However, there are some loopholes visible such as the co-pay of 5%, the sub-limits on some specific expenses and the restricted sum assured of Rs. 5 lakhs. These features can be the cause of inconvenience among many policyholders. So, it is necessary to do proper research and also keep in mind other health insurance plans which have higher sum assured and no co-pay.
Hence, the Arogya Sanjeevani policy is an excellent initiative for bringing awareness among common people for health insurance. This policy would give the common Indian people a chance to purchase health insurance policy as it is affordable and ensures comprehensive health coverage. We can wait for a few months and then find out the exact benefits and lacuna related to the product once it is launched in April 2020.
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