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What Is Standard Health Insurance? Benefits For Whole Family

Team AckoOct 1, 2024

A new, standard health insurance policy has mandated 29 health and general insurers by the Insurance Regulatory and Development Authority of India (IRDAI) to offer health insurance coverage to take care of the basic needs of policyholders. All health and general insurance companies in India will offer the standard plan with a cover between Rs.1 lakh and Rs. 5 lakh. In an effort to provide standardized health insurance plans for families, the newly launched standard health insurance, known as the Arogya Sanjeevani Policy, can be availed by individuals as well.

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Standard Health Insurance Policy in Detail:

The standard health insurance policy, offers basic coverage of hospitalization with a sum assured amount between Rs.1 lakh and Rs.5 lakh. The policy can be purchased from any of the health and general insurance companies which is offered from 1 April 2020. This policy is targeted at affordability and enhanced coverage. For example, insurance companies will offer the Standard Health Insurance Policy as “Arogya Sanjeevani Policy, Acko General Insurance Ltd.”

The standard health insurance plan will have basic mandatory coverages as specified by the guidelines issued by the IRDAI and will be the same across all insurance companies. It will be a standalone product and cannot be combined with other defined benefit-based insurance coverages such as critical illness, etc.

Features and Benefits of Standard Health Insurance Policy – Arogya Sanjeevani:

As per the standard health insurance coverage initiated by the Indian government, also known as Arogya Sanjeevani Policy, policyholders receive basic indemnity health insurance benefits. Below are the features and benefits of the basic health insurance policy:

Premium Payment Frequency:

The standard health insurance policy premium can be paid in full annually or can be paid in monthly, half-yearly or quarterly instalments.

Sum Assured:

The minimum sum insured under the standard health insurance policy is Rs.1 lakh while the maximum of Rs.5 lakh. The sum insured between this amount will be in multiples of 50,000. In the case of the floater health insurance policy, the sum insured will be for the entire family and in the case of individual standard health plan, the sum insured is applicable to each individual family member.

Policy Period:

The term or the period of the standard health insurance plan is for 1 year, extendable or renewable every year.

Low Co-Payment Option:

Under this policy, you can opt for a lower co-payment of 5% of the claim amount. This means you will have to pay a maximum of 5% of the claim amount while settling the final hospital bill.

Free Look Period:

A period of 30 days from the date of receipt of the Standard Health Insurance Policy is offered to review the terms and conditions of the coverage before it can be cancelled.

Cumulative Bonus:

For every claim-free year, the Standard Health Insurance Policy offers a cumulative bonus of 5% on the sum insured amount.

Renewability:

The policy is designed to offer lifetime renewability to policyholders.

Individual and Family Floater Availability:

The policy comes with two types of health insurance coverages which include individual as well as family floater policies.

Sub-Limits:

Under this health insurance policy, there is a sub-limit or cap in the amount for room rent and doctor’s fee. Up to 2% or a maximum of Rs.5,000 per day is the cap for room rent, boarding, nursing expenses. Charges for ICU and ICCU are capped at 5% of the sum insured subject to a maximum of Rs.10,000 per day. For cataract operation, the sub-limit is up to 25% of the sum insured or Rs.40,000, whichever is lower.

AYUSH Treatment:

This policy also covers alternative medicine treatment such as the AYUSH which include Ayurveda, Homeopathy, Unani and Siddha treatments.

Waiting Period:

Under this policy, there is a specific waiting period for certain diseases, this includes:

24 Months: Illnesses such as sinus, ENT disorders, cataract, non-infective arthritis, gastric ulcer, rheumatism, spinal diseases except in accidental cases, age-related eye illnesses, tympanoplasty, gout, mastoidectomy, tonsillectomy and cysts.

48 Months: Age-related Osteoarthritis and Osteoporosis, and treatment for joint replacement except due to accidents.

Pre and Post Hospitalization:

Under the Arogya Sanjeevani standard health insurance policy, treatment costs incurred 30 days prior to the date of hospitalization and 60 days from the date of discharge from the hospital are covered.

Eligibility:

Below table offers the eligibility criteria under the Standard Health Insurance plan:

Criteria	Eligibility
Minimum Age	Adult -18 Years, Children - 3 Months
Maximum Age	Adult - 65 Years, Children - 25 Years
Renewability	Lifetime

Minimum and Maximum Sum Insured:

The standard health insurance policy, offers to cover both individuals as well as family floater plans. You can purchase a cover of minimum Rs.1 lakh while Rs. 5 lakh is the maximum amount. The sum insured between Rs.1 lakh and Rs.5 lakh will be in multiples of 50,000.

Also, read: Family Health Insurance

Standard Health Insurance Product Availability:

With several types of health insurance policies available in the market, the IRDAI has mandated all insurance companies to offer a standard health insurance plan. This health insurance product is named Arogya Sanjeevani. However, with different health and insurance companies offering the product, the IRDAI has said that the insurer’s name will follow Arogya Sanjeevani nomenclature. The basic health insurance plan is available from 1 April 2020.

Standard Health Insurance Premium Rates:

The new standard health insurance plan is available across health and general insurance companies operating in India. Each insurer’s premium of the standard health insurance policy will differ slightly. The premium for the coverage is not fixed hence you need to contact the insurer for further information. Read more details about Arogya Sanjeevani Policy Rates.

Where Can I Get Standard Health Insurance?

The IRDAI has mandated all health and general insurance companies to offer the Standard Health Insurance Plan. You can also get “Arogya Sanjeevani Standard Health Insurance” from Acko.

Frequently Asked Questions:

Here are some of the frequently asked questions about the standard health insurance policy (Arogya Sanjeevani):

What is the name of the mandatory Standard individual health insurance policy launched by the IRDAI?

The standard health insurance policy is called Arogya Sanjeevani and has authorized 29 health and general insurance companies to offer the policy. It is mandated that the policy should be named Arogya Sanjeevani followed by the insurance provider’s name.

What is the term of the Standard Health Insurance policy?

The standard health insurance plan is offered with a policy term of 1 year.

Is Coronavirus (COVID-19) covered under the Standard Health Insurance policy (Arogya Sanjeevani)?

Yes, the treatment for the coronavirus infection is covered under this scheme.

Who is eligible to buy the Standard Health Insurance plan?

The policy is available to anyone who is of a minimum of 18 years and a maximum of 65 years.

What is the room rent cap under the Standard Health Insurance plan?

The standard health insurance policy (Arogya Sanjeevani) caps the room rent at 2% or a maximum of Rs.5,000 per day.

Which medical costs are covered under the Standard Health Insurance policy (Arogya Sanjeevani)?

Medical expenses incurred during hospitalization as well as prior and post-hospitalisation are covered under this insurance policy.

Can I increase the sum insured in the Standard Health Insurance policy?

Under this plan, the sum insured is limited between Rs.1 lakh and Rs.5 lakh. The sum insured amount cannot be increased beyond Rs.5 lakh.

Do I have to bear the copayment under the Standard Health Insurance plan (Arogya Sanjeevani)?

As per the IRDAI guidelines, all insurance companies offering the Arogya Sanjeevani otherwise known as standard health insurance requires a copayment of 5% of the claim amount.

Is there a free look period before I can buy the Standard Health Insurance plan?

Yes, there is a free look period of 15 days from the date of the receipt of the insurance policy. This does not apply during renewing the plan.

How do I buy the Standard Health Insurance plan?

Acko is one of the health and general insurance companies approved by the IRDAI to offer the standard health insurance product (Arogya Sanjeevani). Visit Acko to avail the policy.

Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on industry experience and several secondary sources on the internet; and is subject to changes. Please go through the applicable policy wordings for updated ACKO-centric content and before making any insurance-related decisions.