With the proposed standardization of health insurance, insurers both from the general and health care space will no longer be able to offer additional or optional products and customers thus will get a similar cover for the similar offerings and the IRDAI has pegged the minimum sum insured value to be Rs. 50,000 and the maximum is placed at Rs. 10 lakh.
So, in accordance with the IRDAI, a standard health insurance cover will come with only the following mandatory covers:
1. Hospitalization Expenses - The expense include room, boarding, nursing expenses.
Fees of the medical practitioner, anaesthetist, consulant, specialist, whether being paid directly to the surgeon or doctor or to the hospital
Cost for medicines, druges, diagnostics, anaesthesia, oxygen, blood and such similar expenses.
Expenses in relation to hospitalization are permitted only for a minimum period of 24 hours. But when the case as specified in the policy contract, does not requires hospitalization, then also the reimbursements are made.
Expenses towards ICU or internsive cardiac care unit
Expenses on the treatment of cataract subject to sub-limits as decided basis the sum insured chosen.
Dental treatment or plastic surgery required as a result of some injury
2. Pre-Hospitalization medical expenses: For the purpose, only expenses incurred just 30 days prior to the hospitalization date shall be considered.
In case of post-hospitalisation expenses, expenses incurred for period of not less than 60 days from the date of discharge from the hospital shall be admissible.
3. AYUSH Treatment: Expenses incurred on treatment under Unani, Sidha, Homeopathy, ayurveda etc will also be covered subject to standard sub-limits depending on the sum insured.
4. Health check-ups and consultation services: As per the policy, the insured is allowed a free consultation of at least once in any of the insurer's group of network or empanelled hospitals.
5. Disease Management: As part of this programme other than the follow-up, other suitable professional medical services will be offered to the claimant. This is towards bettering insured's health profile.
6. Wellness incentives: To promote further well-being such that insured live a longer, healthier and productive life, the following features shall be made available as part of with the provisions of Regulation 19 of IRDAI (Health Insurance) Regulations, 2016 and the applicable guidelines notified thereunder.
Fitness regime : Based on the fitness practices being followed, insured will be allotted parametric indices and reward mechanism announced will serve as the motivational factor for the insured to continue with the fitness regime.
Outpatient consultations or treatments: Also, the outpatient or consulation shall be made available periodically or as per the triggers based on the health condition of the insured.
7. No deductibles allowed under the base cover
8. Cumulative Bonus(CB): Sum insured that excludes cumulative bonus shall be increased by 5% for every claim free policy year but the pre-condition remains that the policy should have remained in force continuously subject to maximum of 50% of the sum insured (excluding CB accrued) under the current policy period.