IRDAI spells out draft norms of standard mediclaim policy

A uniform health insurance product, to be called a standard Mediclaim Policy offering basic cover, will be available for all soon.

According to the draft guidelines issued by the Insurance Regulatory and Development Authority of India (IRDAI), the product will have the basic mandatory covers and no additional or add-on covers will be allowed.

The minimum basic sum insured under the standard product shall be Rs 50,000, with a maximum limit of Rs 10 lakh. The product would have lifelong renewability option for those in the age group of 18 and 65. Dependents and children will be covered up to 25 years.

“The insurer may determine the price, keeping in view the covers proposed to be offered, subject to compliance with the norms specified in health regulations 2016 and guidelines notified there under,’’ IRDAI said.

The proposed product will cover hospitalisation expenses, including intensive care unit, treatment of cataract, dental treatment necessitated by injury, plastic surgery due to disease or injury, and domiciliary hospitalisation.

The minimum 24-hour hospitalisation norm will not apply when the treatment does not require hospitalisation.

Expenses incurred on treatment under Ayurveda, Unani, Siddha and Homeopathy will also be covered, subject to fixed and standard sub-limits based on sum insured.

Pre-hospitalisation costs for a period of not less than 30 days prior to the date of hospitalisation and post-hospitalisation medical expenses incurred for a period of not less than 60 days from the date of discharge, will also be covered.

In order to promote and maintain a wellness regime, incentives will be incorporated for regular health check-ups, disease management and fitness activities, besides cumulative bonus for regular renewal.

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