- Which policy to buy?
- What should be the sum assured amount?
- What are the riders or add-ons to avail of?
- How to evaluate terms related to co-payment, deductibles etc.?
The aim of 'Arogya Sanjeevani' is to ensure a standard health policy exists across companies to take care of basic health needs of the people. There is one policy common across companies so that people understand it and can port it from one insurer to another easily.
While a standard product will surely simplify health insurance for you, do keep in mind that it has to be evaluated carefully before buying it. It may not be the best product in the market. We give you the features and details of the new standard plan -
- Provide a minimum sum assured of ₹ 1,00,000 and a maximum of ₹ 5,00,000.
- It is available for people in the age group – 18-65 years.
- It can be taken as an individual policy or as a family floater policy.
- It will be offered for a term of one year with the option for renewal and a grace period of 30 days.
- Premium payment can be made on a yearly, half-yearly, quarterly or monthly basis
- It offers cashless insurance.
- It covers AYUSH (Ayurvedic, Yoga, and Naturopathy, Unani, Siddha, Homeopathy) treatments.
- There is no claim bonus (NCB). The sum assured will be increased by 5% per year for each claim-free policy year provided it is renewed regularly. The NCB is restricted to 50% of the sum assured amount.
- It will be portable.
- The company will decide the premium amount but pricing based on geography is not allowed.
- It covers boarding expenses, dental and plastic surgery due to disease and injury and ICU/ICCU expenses subject to certain conditions.
- A co-payment of 5% is applicable irrespective of age and claim conditions.
- There is a 1-year waiting period for certain conditions/treatments like benign ENT disorders, tonsillectomy, hysterectomy, tumours, cataract and related ailments, varicose veins, and congenital anomalies, etc.
- There is a 2- year waiting period for joint replacement, osteoarthritis, and osteoporosis that are age-related
- Maternity expenses cannot be claimed
- Cataract expenses are limited to 25% of policy amount or ₹ 40,000 whichever is lower.
- Evaluation, rest, rehabilitation, change of gender related treatment, cosmetic surgery, treatment for conditions due to participation in adventure sports are not covered.
A common health policy across companies is a positive step. It makes things simpler as policy terms and wordings will be standardized across all insurers. It is a good basic health insurance policy to have for you and your family. Most of the features and exclusions are as per standard health insurance products. On the other hand, it does not cover senior citizens who require health insurance more than others though life-long renewal is possible. The sum assured amount might not be enough in many cases. Maternity expenses are not covered and there is a waiting period of 30 days after issue of policy to avail of the benefits. We have to see how companies set the premium. It will allow a larger number of people to access health insurance but we will know better when companies roll out their products in April 2020.