Home >> What's New
Visitors count:11331
 What's New
Zoom OutDefaultZoom In
Print Print Document  Pdf Download PDF      
To All Insurers
Ref. No:IRDAI/HLT/REG/CIR/164/06/2020 Date:26-06-2020
Guidelines on COVID Standard benefit based health policy

To

All Insurers,

Guidelines on COVID Standard benefit based health policy

 A.  Preamble:

1.    In view of the global pandemic COVID-19, to help the public to protect themselves all insurers (life, general and health insurers) are encouraged to offer an individual COVID specific Standard benefit based health policy with the following objective:

 

·         To have a COVID specific benefit based product addressing health insurance needs of insuring public related to COVID.

 

2.    The COVID Standard benefit based health policy shall have the basic cover as specified in these Guidelines which shall be uniform across all Insurers.

 

3.    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.

 

4.    The COVID- Standard benefit-based health policy shall offer a policy tenure of three and half months (3 ½ months), six and half months (6 ½ months) and nine and half months (9 ½ months) i.e, 105 days, 195 days and 285 days respectively.

 

5.    The COVID Standard benefit based health policy shall comply with all the provisions of IRDAI (Health Insurance) Regulations, 2016, all other applicable Regulations, Guidelines on Standardization in Health Insurance (Ref: IRDA/HLT/REG/CIR/146/07/2016) dated 29th July, 2016, Guidelines on Product Filing in Health Insurance Business (Ref: IRDA/HLT/REG/CIR/150/07/2016) dated 29th July, 2016 and other applicable Guidelines as amended from time to time.

 

6.    All Insurers (General, Health and Life) transacting Health Insurance business may endeavor offering this product preferably by 10th July,2020.

 

 

B. Construct of COVID Standard benefit based health policy: The COVID Standard benefit based health policy shall offer the following:

Covid Cover:

 

Lump sum benefit equal to 100% of the Sum Insured shall be payable on positive diagnosis of COVID, requiring hospitalization for a minimum continuous period of 72 hours. The positive diagnosis of COVID shall be from a government authorized diagnostic centre.

 

 

 

C. Other Norms applicable:

 

Sl.No

Particulars

Norms Applicable

1.

Plan Variants

No plan variants are allowed.

 

2.

 

Distributions Channels

COVID Standard benefit based health policy may be distributed across all distribution channels including Micro Insurance Agents, Point of sale persons and Common Public Service Centres.

Distribution of COVID Standard benefit based health policy shall be governed by the regulations of concerned distribution channels.

3.

Individual Basis

 COVID Standard benefit based health policy shall be offered on individual basis only.

4.

Category of Cover

The cover shall be made available on benefit basis

5.

 

Minimum and Maximum Sum Insured

The minimum sum insured under COVID Standard benefit based health policy shall be Rs. 50,000/- (Fifty Thousand only)

Maximum limit shall be Rs.2,50,000(Two lakhs and Fifty Thousand only) (in the multiples of fifty thousand)

5.

Policy Period

COVID Standard benefit based health policy  shall be offered with a policy term of three and half months (3 ½ months), six and half months (6 ½ months) and nine and half months (9 ½ months) i.e, 105 days, 195 days and 285 days respectively.

6.

Modes of premium payment

Single premium payment mode shall only be allowed.

 

7.

Entry age

Minimum entry age shall be 18 years and maximum age at entry shall not be less than 65 years for the persons covered complying to Regulation 12(i) of HIR 2016.

8.

Benefit Structure

The benefit pay out should be explicitly disclosed in the format of application (Form – IRDAI-UNF-SCHP) along with other relevant documents.

On payment of 100% of sum insured the policy shall be terminated.

9.

Underwriting

The insurer shall specify the non-medical limit and relevant details explicitly in the format specified.

10.

Renewal, migration and portability

 

Lifelong renewability, migration and portability stipulated under Regulation 13 and 17 of IRDAI (Health Insurance) Regulations, 2016 respectively are not applicable to this product.

 

11.

Pricing

The premium under this product shall be pan India basis and no geographic location / zone based pricing is allowed.

 

D: Construct of  Terms and Conditions  for COVID Standard benefit based health policy 

7.    The Policy Terms and Conditions of the COVID Standard benefit based health policy shall be in the format specified in Annexure – 1. Insurer may suitably modify the definitions and other clauses of the policy contract prospectively based on the Regulations or Guidelines that may be issued by the Authority from time to time.

 

E: Other Norms:

 

8.    The nomenclature of the product shall be Corona Rakshak Policy, succeeded by name of insurance company, (Corona Rakshak Policy, ).  No other name is allowed in any of the documents.

 

9.    The Proposal Form used for the product shall be subject to the norms specified under the Guidelines on Product Filing in Health Insurance.

 

10. Insurers shall issue Customer Information Sheet as per the format specified in Annexure-2

 

11. The COVID Standard benefit based health policy may be offered as MICRO Insurance Product subject to Sum Insured limits specified in IRDAI (Micro Insurance) Regulations, 2015, and other circulars / guidelines issued in this regard by the Authority from time to time.

 

12. The COVID Standard benefit based health policy may be launched under use and file without prior approval of the Authority subject to complying with the following conditions.

a.    The product shall be approved by the Product Management Committee (as may be applicable).

b.    Insurers shall obtain UIN from the Authority for the COVID Standard benefit based health policy by filing the relevant particulars in Form – IRDAI-UNF-SCHP (as specified in Annexure – 3 of these Guidelines) along with a certificate from Chief Compliance Officer that the product filed is in compliance with the norms specified under these guidelines.

c.    On review of the application, the Authority may call for such further information as may be required and may issue suitable directions which shall be retrospectively effected in respect of all contracts issued under this product.

 

13. In terms of the provisions of Regulation 4(iii) of IRDAI (Issuance of e-Insurance Policies) Regulations, 2016 providing policy document in physical form is mandatory when policies are issued in electronic form directly to the policyholders. Since features of COVID Standard benefit based health policy are common across the industry and as the terms and conditions of the policy are already specified by the Authority, with the objective of reducing the oprearating costs and to pass on this benefit of reduced operational cost to the policyholders by way of affordable premiums, insurers are allowed to issue the policy contract of COVID Standard benefit based health policy in electronic / digital format. The digital form of the policy contract may be forwaded through email or a link shall be provided in the certificate of insurance.However, where policyholder specifically seeks the physical form of the policy contract, the same shall be provided by the insurer.

 

14. Insurers offering COVID Standard benefit based health policy shall provide a certificate of insurance to the policyholder indicating the availability of health insuarnce coverage.The certificate shall have a reference to access detailed terms and conditions of the policy contract. Insurers shall also clearly mention policy period (Policy Start Date to Policy End Date), effective policy period (from end of waiting period to end of policy period), waiting period (policy start date to end of policy period) in the Certificate of Insurance.

 

15. In terms of Clause 5 of Guidelines on short term health insurance policies Ref: IRDAI/HLT/REG/CIR/156/05/2020 dated 23rd June, 2020, the guidelines will remain valid till 31st March, 2021 for issue of short term policies in respect of standard COVID product as specified in these guidelines.

 

16. This has approval of the Competent Authority.

 

 

(DVS Ramesh)

General Manager

Insurance Regulatory and Development Authority of India. All Right Reserved.