Health Insurance: A standard plan for vector-borne diseases

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November 23, 2020 12:15 AM

The maximum sum assured under this indemnity-based standard health insurance policy will be 2 lakh

Two optional covers—hospital cash benefit and diagnosis cover—can be offered along with the standard product.Two optional covers—hospital cash benefit and diagnosis cover—can be offered along with the standard product.

General insurance companies will soon launch a standard health insurance policy for vector-borne diseases such as dengue, malaria, filaria, chikungunya, etc.

The minimum sum assured will be Rs 10,000 and maximum will be Rs 2 lakh. The policy will have a fixed term of one year with a waiting period of 15 days and can be renewed. The standard product will be offered both on individual and on floater sum insured basis.

In a standard health insurance policy, the features and coverage are uniform across all insurance companies. However, pricing depends on the company’s actuarial calculations. In fact, in April, non-life and standalone health insurance companies launched a standard health insurance policy, Arogya Sanjeevani.

The policy provides a basic health cover of Rs 1 lakh-Rs 5 lakh and there are no deductibles.

Coverage under standard policy
The hospitalisation expenses incurred for the treatment of specified vector-borne diseases will be covered. It will cover room expenses related to boarding and nursing up to 2% of the sum insured (excluding the cumulative bonus) for the sum insured above Rs 20,000 and a fixed amount of Rs 500 a day for sum insured up to Rs 20,000. No deductibles are permitted under this standard health insurance policy for vector-borne diseases.

The medical expenses related to surgeon, anesthetist, medical practitioner, consultants, specialist fees will be covered. Other expenses such as anesthesia, blood, oxygen, operation theatre charges, surgical appliances, ventilator charges, medicines and drugs, costs towards diagnostics, diagnostic imaging modalities, PPE Kit, gloves, mask and such other similar expenses will be covered.

Expenses covered for intensive care unit or intensive cardiac care unit will be up to 5% of the sum insured for the sum insured above Rs 20,000 and a fixed sum of Rs 1,000 a day for the sum insured up to Rs 20,000. Expenses for ambulance will be covered up to Rs 2,000 per hospitalisation.

Medical expenses on hospitalisation under AYUSH system of medicine for the treatment of specified vector-borne diseases will be covered up to the sum insured without any sub-limits. Pre-hospitalisation medical expenses incurred for a period of 15 days prior to the date of hospitalisation and post-hospitalisation medical expenses incurred for a period of 30 days from the date of discharge from the hospital following an admissible claim under this policy will also be covered.

The cumulative bonus will be increased by 5% in respect of each claim free policy year, provided the policy is renewed without a break subject to a maximum of 50% of the sum insured. If a claim is made in any particular year, the cumulative bonus accrued will be reduced at the same rate at which it has accrued.

Other norms
Two optional covers—hospital cash benefit and diagnosis cover—can be offered along with the standard product. For hospital cash benefit, 0.5% of the sum insured will be paid for each completed 24 hours of hospitalisation due to positive diagnosis of covered vector borne diseases.

Also, for diagnosis cover a fixed 2% of the sum insured will be paid on positive diagnosis of covered vector borne diseases, which is diagnosed during the cover period, subject to policy terms and conditions and provided that the insured is not hospitalised for the same illness within 15 days from diagnosis.

Insurers will price for every covered disease separately and the regulator has advised the insurers to offer discount as per underwriting policy for opting for various disease combinations. The base cover of the standard product will be offered on indemnity basis and optional covers will be offered on benefit basis.

While a standard health insurance policy for vector-borne diseases will increase the coverage of health insurance in the country, those who have a comprehensive health insurance plan are covered for vector-borne diseases. So, it is always better to go for a health insurance policy with higher sum insured and a standard health plan for vector-borne diseases can be a supplementary cover.

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