After the insurance regulator made it mandatory for all general and health insurance companies to offer Arogya Sanjeevani—a standard individual health insurance policy—it has now allowed them to offer the policy as a group product also. As the policy covers Covid-19, this standard group policy will be useful to various private and public establishments for covering the medical needs of their employees.
Arogya Sanjeevani as group cover
All the terms and conditions of the standard policy are retained except for the premium which is to be fixed by the insurers. The policy can protect a large number of employees engaged in manufacturing, services, SMEs, MSMEs, logistics sector, and migrant workers, catering to their medical needs.
Insurers are allowed to set their minimum and maximum sum limits under this group policy, subject to the board approved underwriting policy. The mandate of offering sum insured in multiples of Rs 50,000 is not necessary for the group product.
Arogya Sanjeevani covers the hospitalization treatment costs of COVID–19. The policy will provide a basic health cover of minimum Rs 50,000 and maximum above `5 lakh subject to the underwriting policy of the insurer. The policy will cover hospitalization expenses such as room, boarding, and nursing at 2% of the sum insured, maximum up to Rs 5,000 each day.
Even pre-hospitalization medical expenses for 30 days before the date of hospitalization will be admissible. Also, post-hospitalization medical expenses incurred for 60 days from the date of discharge from the hospital will be admissible.
Corona Kavach Policy as group cover
Irdai has also allowed insurers to offer Corona Kavach Policy as a group health insurance product apart from the individual one. The policy will be for a minimum term of three months to a maximum of 9.5 months. All the terms and conditions as applicable to the standard individual policy will remain the same in the group policy except the premium rate. The insurers will determine the price keeping in view the cover proposed to be offered to the company.
While life insurers will offer only benefit-based short-term health insurance policies, general and standalone health insurers can offer both indemnity-based and benefit-based short term health insurance policies. The waiting period for the short-term health insurance policies will not be more than 15 days against 30 days in regular health insurance plans.
Buy an individual cover
While many employees may be covered under a group health insurance scheme, it is better to buy an individual health policy at an early age. Group policy will not be valid if the individual resigns from the organization or retires. If an individual exits his group plan and buys an individual policy, then the waiting period will start afresh. In such a case, he and his family will be at risk as he is still under his new policy’s waiting period.
If you rely on your group insurance policy till retirement and plan to buy a cover after retirement, it will not only be very expensive but insurers may reject your case on medical grounds. Also, all group insurance policies have limitations in terms of coverage amount which may be out of sync with rising healthcare costs. It is always better to buy an individual health insurance policy with adequate coverage as per your needs.
(With inputs from FinancialExpress)