What is Standard Health Insurance? Benefits for the Whole Family.by Selena Pinto General
Health insurance is a necessity for everyone,
especially when we are facing a pandemic. However, with so many insurance
companies offering various types of health plans, buying one can be an
expensive and confusing exercise.
Thus, to make buying health insurance easier and more accessible, the Insurance Regulatory and Development Authority of India (IRDAI) has mandated that all health and general insurance companies introduce a Standard Health Insurance Plan offering a basic health cover between ₹ 1 Lakh and ₹ 5 Lakh.
This standard health plan is available as Aarogya Sanjeevani Policy, succeeded by the name of the insurance company. For example- ‘Aarogya Sanjeevani Policy, Bharti AXA GI’ and it takes care of basic healthcare needs of an individual and families. This is also an initiative for insuring the non-insured, lower-income group citizens of the country.
This standard health insurance plan has a
mandatory coverage as specified under IRDAI guidelines and is offered as a
standalone product, i.e., it cannot be combined with other benefit-based
insurance coverages such as critical illness cover etc. The cover is the same
across all insurance companies and only the premium varies, depending on your
chosen insurance provider.
Listed below are the features of Standard Health
Insurance Plan :
Sum Insured : Arogya Sanjeevani Policy insures
for a minimum assured sum ₹ 1 Lakh and
maximum assured sum of ₹ 5 Lakh, in
multiples of ₹ 50,000. The cover cannot
be increased beyond ₹ 5 Lakh
Individual and Family Floater Plan: If you
choose an individual standard plan, the sum assured is applicable to only the
individual whereas in a family floater plan, the sum assured is applicable to
the entire family. It is a good plan for people looking for health insurance
Policy Term : The policy term is for 1 year, to be renewed every year and
is subject to lifetime renewability.
Eligibility: Anyone between age 18-65 can
purchase policy and the cover extends to spouse, parents and children aged 3
Mode of premium Payment : The premium can be
paid in full or in instalments either annually, half-yearly, quarterly or
Free Look Period : A 15 day free look period is
offered after purchase of policy to review terms and conditions of coverage
Waiting Period – There is a waiting period for
certain diseases as follows :
- 24 Months - For diseases such as
ENT disorders, Tonsillectomy, Hysterectomy, Tympanoplasty, Mastoidectomy. All
benign tumours, cysts and polyps, breast lumps and prostate problems. Cataract,
eye-related ailments, gastric ulcers, hernias, gout and Rheumatism, non-infective
Arthritis, Piles, Spinal diseases except in case of accident etc.
- 48 Months- Age related
Osteoarthritis & Osteoporosis and Joint Replacement treatment, unless
arising from an accident.
Pre and Post Hospitalization Care : Treatment
costs incurred 30 days prior to date of hospitalization and 60 days post
hospitalization from date of discharge are covered under the standard health
Mandatory Co-Payment : You have to pay 5% of
the claim amount, regardless of age and the insurer will pay the rest.
Cumulative Bonus : For every claim-free year,
there is a cumulative bonus of 5% on your assured sum and is subject to a
maximum of 50% of sum insured if the policy is renewed regularly. If you make a
claim, the cumulative bonus reduces at 5% per claim.
Sub-Limits : In a standard health insurance policy,
there is a cap on room rent amount and doctor’s fee at 2% or a maximum of ₹ 5000 per day for boarding & nursing.
Intensive Care Unit (ICU) and Intensive Cardiac Care Unit (ICCU) charges are
capped at 5% of assured sum, subject to
₹ 10,000 per day. Expenses on Cataract treatment are capped at 25% of
assured sum or ₹ 40,000, whichever is
lower. Ambulance costs are capped at ₹
2,000 per hospitalization.
AYUSH Treatments : A unique feature of the
standard health insurance plan is that it also covers expenses incurred for
alternative treatments under Ayurveda, Yoga, Naturopathy, Unani and Siddha.
Cost of homeopathic medicines are also reimbursed under AYUSH.
Standard Health Insurance plans take care of many emergency medical expenses and even cover COVID-19 or coronavirus related treatments. It is a good option to insure ageing parents who might need certain services such as cataract surgery or arthritis treatment.
Created on Jun 30th 2020 01:59. Viewed 270 times.