From April, general and standalone health insurers will mandatorily offer a standard personal accident insurance policy which will cover death, permanent and partial disability under the base cover
From April next year, general and standalone health insurance companies will offer a standard personal accident cover. The standard product will have a basic mandatory cover, the minimum sum insured will be Rs 2.5 lakh and the maximum will be Rs 1 crore. The pricing will be decided by the insurance companies depending on the cover.
In April, non-life and standalone health insurance companies launched a standard health insurance policy known as Arogya Sanjeevani and the regulator has also initiated a standard term insurance plan.
The draft guidelines issued by Insurance Regulatory and Development Authority of India (Irdai) has said that the sum insured will increase by 5% for 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. The minimum entry age will be 18 years and the maximum age will be at least 70 for the persons covered.
The death benefit will be equal to 100% of the sum insured and will be paid on death of the insured person due to an injury sustained in an accident during the policy period. For permanent total disablement, benefit will be 100% of the sum insured. The permanent total disablement would be total and irrecoverable loss of both eyes or physical separation or loss of use of both hands or feet or physical separation or loss of one hand and one foot or loss of sight of one eye and physical separation or loss of use of hand or foot. In case of permanent partial disablement, benefit paid will be up to 50% of the sum insured based on the nature of loss.
The premium can be paid on a yearly, half-yearly, quarterly or monthly basis. The policy will be distributed across all channels including micro insurance agents, point of sale persons and common public service centres. The insurer will specify the non-medical limit and relevant details in the format specified.
Insurers can offer optional covers along with the standard product. If the insured person sustains an injury in an accident during the policy period which completely incapacitates him from engaging in any employment or occupation which he was capable of performing at the time of the accident, then the compensation will be 1% of the base sum insured per week, till the time the insured person is able to return to work.
However, the compensation payable will not be more than 100 weeks in respect of any one injury calculated from the date of commencement of disablement and will not exceed the sum insured. During the course of payment under this benefit, the insurance company can call for a certification from an independent medical practitioner with regard to the continuity of temporary total disability. The decision of an independent medical practitioner would be binding on both the parties.
Hospitalisation expenses due to an accident will be indemnified up to the limit of 10% of base sum insured. The expenses will cover surgeon, anaesthetist, medical practitioner, consultants, specialist fees whether paid directly to the treating doctor / surgeon or to the hospital. It will also cover anaesthesia, blood, oxygen, operation theatre charges, surgical appliances, medicines and drugs, costs towards diagnostics, diagnostic imaging modalities, and other similar expenses.
In case of death or permanent total disability of the insured person, an one-time educational grant of 10% of the base sum insured will be paid for a maximum of two dependent children of the insured, provided that the dependent child is pursuing an educational course as a full-time student in an educational institution and is not more than 25 years of age. Intimation about an accident that will give rise to a claim under this policy will have to be given to the insurer within 30 days.
Policy will offer minimum sum insured of Rs 2.5 lakh and maximum of Rs 1 crore
Sum insured will increase by 5% for each claim-free policy year, provided the policy is renewed without a break subject to a maximum of 50% of the sum insured
Death benefit will be equal to 100% of sum insured
Hospitalisation expenses due to an accident will be indemnified up to the limit of 10% of base sum insured