Guidelines on Standard Vector Borne Disease Health Policy

1 Ref: IRDAI/HLT/REG/CIR/25/02/2021 03rd February, 2021 Guidelines on Standard Vector Borne Disease Health Policy Sy no 115/1, Financial District, Nanakramguda, Hyderabad 500 032 www.irda.gov.in Sl.No Item Page No. 1. Guidelines on Standard Vector Borne Disease Health Policy 2-7 2. Annexure-1: Policy Terms and Conditions of the Standard Product 8-27 3. Annexure-2: Format for Customer Information Sheet 28-30 4. Annexure-3: Form for filing the Standard Product 31-40 2 To All General and Health Insurers (except ECGC&AIC) Guidelines on Standard Vector Borne Disease Health Policy A. Preamble: 1. In order to make available Vector Borne Disease specific health insurance product addressing the needs of insuring public for getting health insurance coverage to specified Vector Borne Diseases, the Authority encourages all general and health insurers to offer Standard Vector Borne Disease Health Policy (Hereafter referred as standard product). 2. Towards this, the following Guidelines on Standard Product are proposed to be issued under the provisions of Regulation 11 (e) of IRDAI (Health Insurance) Regulations, 2016. 3. All general and health insurers are encouraged to offer the Standard Product by duly complying with these guidelines. 4. The Standard Product shall have coverage as specified in these Guidelines which shall be uniform across all General and Health Insurers. 5. The Standard Product shall offer the health insurance coverage as specified in these guidelines in respect of all the specified vector borne disease (s). 6. The insurer may determine the price keeping in view the cover proposed to be offered subject to complying with the norms specified in the IRDAI (Health Insurance) Regulations, 2016 and Guidelines notified there under. 7. The Coverage of Standard Product shall be offered on fixed benefit basis as specified in these guidelines. 8. The total amount payable in respect of the coverages offered shall not exceed 100% of the Sum Insured during a policy period. 9. The Standard Product shall offer policy tenure of one year (12 Months). 10. The Standard Product shall comply with all the provisions of Insurance Regulatory and Development Authority of India (IRDAI) (Health Insurance) 3 Regulations, 2016, all other applicable Regulations and other applicable Guidelines as amended from time to time. 11. Insurers are allowed to offer Standard Product as group product by duly complying with the norms specified hereunder. a. Insurers are allowed to use the standard product name for the group policy after adding the word “group”, provided all terms and conditions as applicable to the Standard Product remain the same except premium rate and specification on operation of group policy. b. The insurers shall determine the price keeping in view the cover proposed to be offered subject to complying with the norms specified in the IRDAI (Health Insurance) Regulations, 2016 and Guidelines notified there under. c. The product shall be filed on Use and File basis by duly complying with the norms specified in Chapter IV of the Consolidated Guidelines on product filing in health insurance business” (Ref: IRDAI/HLT/REG/CIR/194/07/2020 dated 22nd July, 2020) as modified from time to time. d. This group product shall comply with the all other applicable norms stipulated under “Guidelines on Product filing in Health Insurance business” (IRDAI/HLT/REG/CIR/194/07/2020 dated 22nd July, 2020). B. Construct of Standard Vector Borne Disease Health Policy: The Standard Product shall offer the following: Coverage: 12. Hospitalization Benefit: Lump sum benefit equal to 100% of the Sum Insured (excluding the amount paid under diagnosis cover referred at s.no 13, if any) shall be payable on positive diagnosis of any of the following vector borne disease (s) requiring hospitalization for a minimum continuous period of 72 hours. i. Dengue fever ii. Malaria iii. Filaria (Lymphatic Filariasis) iv. Kala-azar 4 v. Chikungunya vi. Japanese Encephalitis vii. Zika Virus 13. Diagnosis Cover: 2% of the sum insured shall be payable on positive diagnosis (through laboratory examination and confirmed by the medical practitioner) of every covered vector borne disease on the first diagnosis during the Cover Period, subject to policy terms and conditions. The Policyholder is entitled for payments under “diagnosis cover” payment for each disease only once in the policy year. 14. No deductibles are permitted in this product. C. Other Norms applicable: Sl.No Particulars Norms Applicable 1. Plan Variants No plan variants are allowed. 2. Distributions Channels Standard Product is allowed to be distributed across all distribution channels including Micro Insurance Agents, Point of sale persons and Common Public Service Centres. Distribution of Standard Product shall be governed by the regulations of concerned distribution channels. In addition to the number of products allowed to be marketed as per IRDAI circular ref: IRDAI/ INT/ CIR/ PSP/ 019/01/2020 dated 13thJanuary, 2020 "Standard Vector Borne Disease Health Policy" is also allowed to be marketed by Point of Sale. 3. Definition of family Family consists of the proposer and any one or more of the family members as mentioned below: (i) legally wedded spouse. (ii) Parents and Parents-in-law. (iii) dependent Children (i.e. natural or legally adopted) between the day 1 of age to 25 years. If the child above 18 years of age is financially independent, he or she shall be ineligible for coverage. 5 4. Category of Cover The Standard Product shall be offered both on individual and floater sum insured basis. 5. Minimum and Maximum Sum Insured The minimum sum insured under Standard Product shall be Rs 10,000/- (Ten Thousand only) Maximum limit shall be Rs 2,00,000/-(2Lakh) (in the multiples of ten thousands) 6. Policy Period Standard Product shall be offered with a policy tenure of one year (12 Months). 7. Mode of premium payment Single premium 8. Entry age Minimum entry age shall be 18 years for principal insured and maximum age at entry shall not be less than 65 years for all the insured members including principal insured. Dependent Child / children may be covered from Day 1 of age to 25 years subject to the definition of ‘Family’. 9. Benefit Structure The benefit pay out shall be explicitly disclosed in the format of application (Form – IRDAI-UNF-SVHP) along with other relevant documents. On payment of 100% of sum insured the policy shall be terminated. In case where a policy is issued to a family with individual sum insured for each member, policy will continue for the rest of the members. 10. Underwriting The insurer shall specify the non-medical limit and relevant details explicitly in the format specified. 12. Renewal, Portability and Migration i. Renewal - The Standard Product shall be subject to Renewal ii. Migration and Portability-The insurers are encouraged to offer migration and portability to comprehensive health insurance products as per their underwriting policy. Where migration/portability is allowed, the accrued gains of waiting period served in the existing “Standard Product” (Individual/Group) shall be protected in respect of coverage for the covered Vector Borne Diseases, in the migrated/ported policy. 6 13 Free look period The Standard Product shall have free look period complying with Regulation 14 of HIR 2016. 14. Pricing The premium under this product shall be pan India basis and no geographic location / zone based pricing is allowed. 15. Premium Loading and Discounts The Standard Product shall comply with Regulation 25 of HIR 2016 in respect of loadings on Renewals.