Page 41 - Insurance Times March 2019

Grace Period Standard product shall comply with Free Look The Standard Product shall have free
for premium Clause 15 of Chapter I of Guidelines on Period look period complying with Regulation
payment Standardization in Health Insurance and 14 of HIR 2016
further such product shall comply with Premium The Standard Product shall comply with
Regulation 2(i)(e) of HIR 2016 at the Loading and Regulation 25 of HIR 2016 in respect of
time of renewal of the policy. Discounts loadings on Renewals.
For Yearly payment of mode, a fixed Other All the sections of File and Use
period of 30 days is to be allowed as Sections of application, as per Form-IRDAI-FnU-HIP
Grace Period and for all other modes of F&U shall apply mutatis mutandis to
payment a fixed period of 15 days be application Standard Product.
allowed as grace period. Portability The Standard Product shall comply with
Basic Sum The minimum basic sum insured under Portability provisions, as envisaged in
Insured standard product shall be Rs 50,000. Schedule I of HIR 2016
Maximum limit shall be Rs 10 lacs.
E: Proposed construct of Terms and Condi-
Policy Period Standard product shall comply with
Regulation 3(c) of HIR 2016 in respect tions for Standard Product:
of policy term offered 19. The Policy Terms and Conditions of the Standard Prod-
uct shall be divided into the following parts.
Modes of All the modes (Yly, Hly, Qly, Mly) shall
premium be allowed for the standard product i. Policy Schedule – Part-I: Policy Schedule shall be
payment Part – I. Policy Schedule shall specify the eligible
limits of sum insured as chosen by the policyholder
Entry age Minimum entry age shall be 18 years for various base covers offered
for principal insured and maximum age
at entry shall be 65, complying to ii. Definitions - Part-II: Definitions shall be in Part – II.
Regulation 12(i) of HIR 2016, along with All definitions, wherever applicable, shall comply with
lifelong renewability. There shall be no the standard definitions notified by the Authority.
maximum exit age. iii. Benefit Design - Part-III: Benefit Design shall be in
Policy is subject to lifelong renewability. Part – III. Benefit design shall consist of the ben-
efits offered and contingencies under which the
Dependent Child / children shall be
policyholder is entitled for various benefits cov-
covered from the age of 0 days to 25 years.
ered under the policy. Benefit Design of the policy
Benefit The mandatory covers as specified in shall be presented with clarity and be specific.
Structure Para A above shall be offered invariably.
These covers are to be referred as iv. Exclusions - Part-IV: Exclusions shall be subject to
the Guidelines specified by IRDAI from time to time.
“Base Covers”. The benefit pay out
under each cover should be explicitly v. Other Terms and Conditions - Part-V: All other
disclosed in File and Use application applicable terms and conditions of the standard
(Form – IRDAI-FnU-HIP)along with other product shall be incorporated in this part.
relevant documents.
F: Other Norms:
Co-payment 5% of Co-pay shall be part of the
20. The nomenclature of the product shall be Standard
product feature and it shall be explicitly Mediclaim Policy, succeeded by name of insurance
disclosed in File & Use application company, (Standard Mediclaim Policy, ). No other
(Form – IRDAI-FnU-HIP). name is allowed in any of the documents.
Underwriting The insurer shall specify the non-medical 21. The Proposal Form used for the product shall be sub-
limit and relevant details explicitly in File ject to the norms specified under the Guidelines on
and Use Application form in respect of Product Filing in Health Insurance.
Standard Health Product.
22. The Standard Product may be offered as MICRO Insur-
Renewal The Standard product shall specify the ance Product subject to Sum Insured limits specified
terms and conditions for Renewal duly in IRDAI(Micro Insurance) Regulations, 2015 and other
complying with Regulation 13 of HIR, circulars / guidelines issued in this regard by the Au-
2016
thority from time to time.
The Insurance Times, March 2019 41