IRDAI issues guidelines on Standard benefit based health policy

Jun 29, 2020 | by Avantis RegTech Legal Research Team

Industry Specific Compliance

The Insurance Regulatory and Development Authority of India (IRDAI) on June 26, 2020 issues guidelines on Covid-19 Standard benefit based health policy. 

The detailed guidelines are as follow:

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

• 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.

• The COVID Standard benefit based health policy shall comply with all the provisions of IRDAI (Health Insurance) Regulations, 2016 and all other applicable Regulations.

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

• 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.

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

• 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 or guidelines issued in this regard by the Authority from time to time.

• Insurers offering COVID Standard benefit based health policy shall provide a certificate of insurance to the policyholder indicating the availability of health insurance coverage. The certificate should have a reference to access detailed terms and conditions of the policy contract. 

• Insurers should 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.

• 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.

These guidelines are valid till March 31, 2021.

[Circular No.- IRDAI/HLT/REG/CIR/164/06/2020]


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