Diseases like Dengue, Malaria, Filaria, Kala-azar, Chikungunya, Japanese Encephalitis, and Zika Virus will be covered under this standard health plan
The insurance regulator has proposed that a standard health product for vector-borne diseases be offered by general insurers and standalone health insurers.
Vector-borne diseases, including malaria and dengue among others, are covered by individual insurers. These diseases are transmitted to humans by blood-sucking insects like mosquitos. There is no standard policy available for these diseases in the market right now.
The Insurance Regulatory and Development Authority of India (IRDAI) said in an exposure draft that this standard product will be offered on indemnity basis. This means that the policyholder will be reimbursed for the medical expenses once he/she has completed the treatment. The payment is made on the basis of the medical bills and doctor consultation records submitted.
IRDAI said diseases like Dengue, Malaria, Filaria, Kala-azar, Chikungunya, Japanese Encephalitis, and Zika Virus will be covered under this standard health plan. A policyholder can opt for one, all, or a combination of diseases. This will be a one-year product.
The minimum sum insured is Rs 10,000 and the maximum has been fixed at Rs 2 lakh.
The regulator said the product will cover room, boarding, nursing expenses as provided by the hospital/nursing home up to 2 percent of the sum insured (excluding bonus) for the sum insured above Rs 20,000. If the sum insured is below Rs 20,000, a fixed amount of Rs 500 per day will be paid.
Within the hospitalisation cover, doctor fees (including telemedicine), anesthesia, blood, oxygen, operation theatre charges, surgical appliances, ventilator charges, medicines, and drugs will be covered. Also, costs towards diagnostics, diagnostic imaging modalities, PPE Kit, gloves, mask will be part of the standard insurance.
This policy will also cover Intensive Care Unit (ICU) / Intensive Cardiac Care Unit (ICCU) expenses up to 5 percent of sum insured for the sum insured (excluding bonus) above Rs 20,000. If it is below Rs 20,000, the expense will be capped at Rs 1,000 per day.
Pre-hospitalisation expenses of up to 15 days and post hospitalisation up to 30 days will be paid.
The standard product will also have a cumulative basis (CB). Here, the sum insured (excluding CB) will be increased by 5 percent for every claim-free year. This is provided that is renewed without a break subject to maximum of 50 percent of the sum insured.
If a claim is made in any particular year, the cumulative bonus accrued could be reduced at the same rate at which it has accrued.Stakeholders have to submit their suggestions to IRDAI by November 27 post which the draft will be finalised into regulations.