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From April next year, general and standalone health insurance companies will offer a standard personal accident cover. The standard product will have a basic mandatory cover, the minimum sum insured will be Rs 2.5 lakh and the maximum will be Rs 1 crore. The pricing will be decided by the insurance companies depending on the cover.

In April, non-life and standalone health insurance companies launched a standard health insurance policy known as Arogya Sanjeevani and the regulator has also initiated a standard term insurance plan.

Product Features
The draft guidelines issued by Insurance Regulatory and Development Authority of India (Irdai) has said that the sum insured will increase by 5% for each claim-free policy year, provided the policy is renewed without a break subject to a maximum of 50% of the sum insured. If a claim is made in any particular year, the cumulative bonus accrued will be reduced at the same rate at which it has accrued. The minimum entry age will be 18 years and the maximum age will be at least 70 for the persons covered.

The death benefit will be equal to 100% of the sum insured and will be paid on death of the insured person due to an injury sustained in an accident during the policy period. For permanent total disablement, benefit will be 100% of the sum insured.

The permanent total disablement would be total and irrecoverable loss of both eyes or physical separation or loss of use of both hands or feet or physical separation or loss of one hand and one foot or loss of sight of one eye and physical separation or loss of use of hand or foot. In case of permanent partial disablement, benefit paid will be up to 50% of the sum insured based on the nature of loss.

The premium can be paid on a yearly, half-yearly, quarterly or monthly basis. The policy will be distributed across all channels including micro insurance agents, point of sale persons and common public service centres. The insurer will specify the non-medical limit and relevant details in the format specified.

Optional Covers
Insurers can offer optional covers along with the standard product. If the insured person sustains an injury in an accident during the policy period which completely incapacitates him from engaging in any employment or occupation which he was capable of performing at the time of the accident, then the compensation will be 1% of the base sum insured per week, till the time the insured person is able to return to work.

However, the compensation payable will not be more than 100 weeks in respect of any one injury calculated from the date of commencement of disablement and will not exceed the sum insured. During the course of payment under this benefit, the insurance company can call for a certification from an independent medical practitioner with regard to the continuity of temporary total disability. The decision of an independent medical practitioner would be binding on both the parties.

Hospitalisation expenses due to an accident will be indemnified up to the limit of 10% of base sum insured. The expenses will cover surgeon, anaesthetist, medical practitioner, consultants, specialist fees whether paid directly to the treating doctor / surgeon or to the hospital. It will also cover anaesthesia, blood, oxygen, operation theatre charges, surgical appliances, medicines and drugs, costs towards diagnostics, diagnostic imaging modalities, and other similar expenses.

In case of death or permanent total disability of the insured person, an one-time educational grant of 10% of the base sum insured will be paid for a maximum of two dependent children of the insured, provided that the dependent child is pursuing an educational course as a full-time student in an educational institution and is not more than 25 years of age. Intimation about an accident that will give rise to a claim under this policy will have to be given to the insurer within 30 days.

Standard Policy
Policy will offer minimum sum insured of Rs 2.5 lakh and maximum of Rs 1 crore
Sum insured will increase by 5% for each claim-free policy year, provided the policy is renewed without a break subject to a maximum of 50% of the sum insured
Death benefit will be equal to 100% of sum insured
Hospitalisation expenses due to an accident will be indemnified up to the limit of 10% of base sum insured
The COVID-19 pandemic is currently on top of everyone’s mind. Until now, the global pandemic has infected millions of people across the globe and increasing in numbers every hour. In India, the total number of cases reported has crossed 20 per cent of the global tally. These difficult times pose a great challenge to the public health-care system and the government, with both trying beyond their capacity and fiscal limitations to address this unique situation. During these times, insurers are being flooded with queries from anxious customers trying to know the coverage offered, the waiting period, if any, the cost implications, and the claim process.

Here are some of the common health insurance questions related to COVID-19, faced by most customers:

Is it essential to opt for a COVID health policy?
Given that there is still no clarity on the shape of recovery or recurrence for the pandemic and the vaccine is still many months away, to avoid getting your lifetime or retirement savings completely diluted due to a Covid hospitalization, it is absolutely critical that the first and foremost financial security and investment that you should do is to buy Health insurance or increase your insurance coverage right away.

Is Quarantine covered in the Policy?
The COVID-19 treatment has led to the creation of a special situation consisting of quarantine at a government-approved facility that is not a hospital or even isolation in your own home. Even if the policyholder is isolated at a government-approved facility on being tested positive, the expenses, including pre and post-hospitalization, will be compensated, as it will be considered equivalent to hospitalization, as per the terms and conditions of the Health Insurance Product. Quarantine only for isolation without any treatment, is not covered.

What is the average waiting period of a COVID policy?
Every health insurance policy comes with a clause of the waiting period of 30 days for regular hospitalization and 2 to 4 years for pre-existing diseases. Considering the Covid related difficulties being faced by the general public and as per the regulator’s guidelines, a few insurers have reduced the initial waiting period from 30 to 15 days for the policyholders for COVID-19 related inpatient hospitalization claims. Any COVID-19 specific policies that provide coverage from day one?

As per the advisory of IRDAI, several insurers are offering COVID-specific fixed-benefit plans such as Corona Rakshak/Kavach. These are disease-specific plans that provide a lump-sum amount on a positive diagnosis and hospitalization due to COVID-19 infection. However, it is advisable to purchase these plans along with the regular indemnity-based health plans that offer comprehensive coverage against all ailments up to the total sum insured.

What is the extent of coverage offered?
The coverage for COVID-19 infection is similar to that of any other ailment. To avail of treatment through your medical insurance, hospitalization for at least 24 hours is required. All your expenses will be covered for treatment, during your hospitalization. Besides this, pre and post hospitalization expenses will also be covered that include the test for COVID-19, regular blood tests, x-ray, and ambulance expenses. It is necessary to keep in mind, that pre and post-hospitalization expenses cover only up to 30 days before and after hospitalization.

What is Home Treatment Benefit?
Considering the safety and wellbeing of customers and the shortage of beds at the hospital, a few insurers are offering a Home Treatment facility to policyholders as per the ICMR Guidelines. This Home treatment facility would be provided on a cashless basis through Network Providers and Empanelled Service Providers.

Life is uncertain, any unfortunate accidents can happen to anyone at any time. Due to the competitive lifestyle today, we are leading a life full of stress. Hence, as a result more and more people are now getting prone to health related diseases these days. Moreover, there is also a sharp rise in the number of accidents happening every day due to poor condition of roads.

In order to keep yourself and your family safe, it is highly significant to purchase a health insurance plan. With the help of a health insurance plan you can save yourself from the financial crisis that could arise due to any mishap or accident. Also, you can buy a personal accident cover alongside a health insurance plan to get extensive coverage. Both the plans are designed to meet the medical expenses that can arise due to injury/illness/disability or any other health condition.

Health Insurance Plan V/s Accident Insurance
A lot of health insurance plans now offer coverage for various health conditions, but only a few selected insurers offer accident cover. Most of the insurers have a separate insurance product providing accidental cover, which is commonly referred to as personal accident insurance. These insurance plans are designed to offer coverage against complete disability and death caused by an accident. Many such insurance policies also offer optional covers such as accident hospitalisation expenditure, daily allowance for hospital, and much more. Therefore, to simplify health insurance policies are not enough, you require an additional accident insurance cover to protect yourself against accidental injuries.

Accident Cover as Add-On
Many insurance companies also provide accident cover as an add-on alongside good health insurance plans. In case, you do not wish to purchase any separate accident insurance plan, you can consider buying accident cover as an add-on with your health insurance plan.

Other than accident cover, many insurance plans offer various add-on covers such as critical illness cover, top up cover etc.

Advantages of Purchasing Personal Accident Insurance Plan

Highlighted below are some of advantages of buying a personal accident insurance plan:
1. Provides Cover for Personal Disability and Accidental Death
Many severe accidents can cause either a disability or even death of the person. The situation can turn out to be worse, if the individual is the sole bread earner of the family. Therefore, you should consider buying a personal accident cover as it provides much-needed financial assistance to your family in the vent of disability or accidental death.

2. Cover for Hospitalisation Expenditure
A lot of insurance companies provide optional hospitalisation cover. In case, an individual gets admitted to a hospital post-accident, through this cover the insurer would cover the person against hospitalisation expenses as well.

A life Insurance works as an income replacement tool besides enabling the family to continue with their existing financial savings plans. The coverage should depend on the individual’s family’s lifestyle, long-term financial responsibilities such as a child’s education, healthcare commitments to retired parents, as well as any financial liabilities such as home or vehicular loans. Life insurers have been innovating plans, offerings to meet increasing and varied customer needs.

Critical Illness Benefit:
Lifestyle related ailments such as hypertension, diabetes, cancer and heart conditions are on the rise. According to the National Health Authority of India, 64.2% of total health expenditure by households are out-of-pocket expenditures. Keeping these issues in perspective, insurers have introduced plans with the critical illness feature built-in. A policyholder can get buy these riders while purchasing the plan. Upon being diagnosed, the claim is paid out to the policyholder.

Whole Life Option
The whole life option provides the extra cushion to people who are otherwise worried that they might outlive their policy term. With this option, people can insure themselves until they turn 99. Purchasing a plan is not enough and policyholders should make it a point to inform their dependents about the policy and how best to use the proceeds of the life cover. Life insurance should act as the necessary foundation to build a sound financial plan. If planned well, it can provide long-term assurance to beneficiaries, and offer critical care benefits to the policyholder. Starting early and making an informed decision can provide essential healthcare and financial benefits for the policyholders’ future, making them resilient to uncertainty.
Please mark all your queries / responses to
Information provided on this newsletter has been independently obtained from sources believed to be reliable. However, such information may include inaccuracies, errors or omissions. and its affiliates, information providers or content providers, shall have no liability to you or third parties for the accuracy, completeness, timeliness or correct sequencing of information available on this newsletter, or for any decision made or action taken by you in reliance upon such information, or for the delay or interruption of such information. , its affiliates, information providers and content providers shall have no liability for investment decisions or other actions taken or made by you based on the information provided on this newsletter.