Page 40 - Insurance Times March 2019

of 24 hours only are admissible. However, this time post-hospitalization services follow up care shall be
limit will of 24 hours shall not apply when the made available, as part of Disease Management.
treatment does not require hospitalization as Insurers may also provide other suitable services
specified in the terms and conditions of policy under this programme.
contract, where the treatment is taken in the Hos- iii. Fitness Activities:
pital and the Insured is discharged on the same Under this cover, insurers shall provide paramet-
day.) ric indices based on fitness regime being followed
d) Intensive Care Unit (ICU) / Intensive Cardiac Care by insured person, during the policy tenure and re-
Unit (ICCU) expenses ward mechanism shall be designed so as to
e) Expenses incurred on treatment of Cataract sub- incentivize the policyholders to continue with the
ject to sub limits, if any, based on sum insured fitness regime.
iv. Outpatient consultations or treatments
f) Dental treatment, necessitated due to an injury
Under this programme, insured person shall be pro-
g) Plastic surgery, necessitated due to disease or injury
vided services of outpatient consultations or treat-
h) Domiciliary Hospitalization ments periodically or based on the pre-determined
12. AYUSH Treatment: Expenses incurred on treatment triggers contingent upon the health of the insured.
under Ayurveda, Unani, Sidha and Homeopathy sys- 16. Cumulative Bonus(CB): Sum insured (excluding CB)
tems of medicines shall be covered subject to fixed and shall be increased by 5% in respect of each claim free
standard sub-limits based on Sum Insured. policy period (where no claims are reported), provided
the policy is continuously renewed without a break
13. Pre-Hospitalization medical expenses incurred for a
period not less than 30 days prior to the date of hos- subject to maximum of 50% of the sum insured (ex-
pitalization shall be admissible. cluding CB accrued) under the current policy period.
17. No deductible features are permitted under the base
14. Post Hospitalization medical expenses incurred for a
period of not less than 60 days from the date of dis- cover.
charge from the hospital towards Consultant fees, Di- 18. A standard Co-Pay as specified under Section – D shall
agnostic charges, Medicines and Drugs wherever re- be offered.
quired and recommended by the Hospital / Medical
Practitioner, where the treatment was taken, following C. Add-ons or Optional Covers : Add-ons or Op-
an admissible claim shall be included. tional Covers are not allowed to be attached to the
15. Wellness Incentives: In order to promote and maintain base cover.
wellness regime, it is considered essential that a
wellness and preventive program that incentivises the D. Other Norms applicable:
targeted market segment to start living healthier shall Plan Variants The standard covers shall be mandatorily
also be incorporated. Accordingly, to enable the indi- covered under the standard product. No
viduals to lead longer, healthier and more productive plan variants are allowed.
lives, the following wellness features shall be made Distributions Standard product may be distributed
available to all the insured persons by duly complying Channels across all distribution channels including
with the provisions of Regulation 19 of IRDAI (Health
Micro Insurance Agents, POS and CSC.
Insurance) Regulations, 2016 and the applicable guide- The commission and remuneration pay
lines notified thereunder. able shall be in accordance to the appli
i. Health Check-ups and Consultation services: cable regulatory framework governing
Under this cover, the insured person shall be made the respective insurance agents or insur
available an access to the health consultations
ance intermediaries.
across the network providers or other empanelled
hospitals of the insurer, for getting periodic con- Family Floater Standard product shall be offered on
family floater basis also.
sultation of at least once in a policy year.
Category of Standard product shall be offered on
ii. Disease Management
Under this cover, every insured person shall be Cover indemnity basis, as a standalone
It shall not be combined with Critical
product.
provided an access to the professional medical ser-
vices for bettering the health profile. As part of Illness Covers or Benefit Based covers.

40 The Insurance Times, March 2019