Health insurance: a standard plan for vector-borne diseases

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Two optional coverages – hospital benefit and diagnostic cover – may be offered with the standard product.

General insurance companies will soon be launching a standard health insurance policy for vector-borne diseases such as dengue, malaria, filaria, chikungunya, etc.

The minimum sum insured will be Rs 10,000 and the maximum will be Rs 2 lakh. The policy will have a fixed duration of one year with a waiting period of 15 days and can be renewed. The standard product will be offered both on an individual insurance basis and on a floating insurance basis.

In a standard health insurance policy, the features and coverage are uniform across all insurance companies. However, pricing depends on the company’s actuarial calculations. In fact, in April, the non-life and stand-alone health insurance companies launched a standard health insurance policy, Arogya Sanjeevani.

The policy provides for basic health coverage of Rs 1 lakh-Rs 5 lakh and there is no deductible.

Coverage under standard policy
Hospital costs incurred for the treatment of certain vector-borne diseases will be covered. It will cover room costs related to board and nursing care up to 2% of the sum insured (excluding cumulative bonus) for the sum insured greater than Rs 20,000 and a fixed amount of Rs 500 per day for an insured sum up to Rs 20,000. No deductible is allowed under this standard health insurance policy for vector-borne diseases.

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Medical expenses related to surgeon, anesthesiologist, doctor, consultants, specialist fees will be covered. Other expenses such as anesthesia, blood, oxygen, operating room costs, surgical equipment, ventilation costs, drugs and medications, diagnostic costs, diagnostic imaging modalities , PPE kit, gloves, mask and other similar expenses will be covered.

The costs covered for the intensive care unit or the intensive cardiac care unit will be up to 5% of the sum insured for the sum insured above Rs 20,000 and a fixed sum of Rs 1,000 per day for the sum insured up to Rs 20,000. Ambulance costs will be covered up to Rs 2,000 per hospitalization.

The medical costs of hospitalization under the AYUSH system of medicine for the treatment of certain vector-borne diseases will be covered up to the sum insured without any sub-limit. Pre-hospitalization medical expenses incurred during a period of 15 days before the date of hospitalization and post-hospitalization medical expenses incurred during a period of 30 days from the date of discharge from hospital following a Claim admissible under this policy will also be covered. .

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The cumulative bonus will be increased by 5% for each insurance year without loss, provided that the contract is renewed without interruption subject to a maximum of 50% of the sum insured. If a claim is made in any given year, the cumulative bonus accrued will be reduced at the same rate at which it accrued.

Other standards
Two optional coverages – hospital benefit and diagnostic cover – may be offered with the standard product. For cash hospitalization benefits, 0.5% of the sum insured will be paid for each 24 hours of hospitalization performed following a positive diagnosis of covered vector-borne diseases.

In addition, for diagnosis, a fixed cover of 2% of the sum insured will be paid in the event of a positive diagnosis of covered vector-borne diseases, diagnosed during the period of cover, subject to the general conditions of the policy and provided that the insured is not hospitalized for the same thing. illness within 15 days of diagnosis.

Insurers will set the price for each covered illness separately and the regulator has advised insurers to offer a discount in accordance with underwriting policy to opt for various combinations of illnesses. Basic coverage of the standard product will be offered on an indemnity basis and optional coverages will be offered on a benefit basis.

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While a standard health insurance policy for vector-borne diseases will increase health insurance coverage in the country, those with a comprehensive health insurance plan are covered for vector-borne diseases. So it is always better to go for a health insurance policy with a higher sum insured and a standard health plan for vector-borne diseases can be additional coverage.

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