Standardized Health Insurance Products: Arogya Sanjeevani and Corona Kavach

Insurance Law IRDAI
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A Comprehensive Analysis of IRDAI-Mandated Standard Products

Executive Summary

IRDAI has mandated standardized health insurance products to ensure minimum coverage standards and facilitate comparison across insurers. This guide examines Arogya Sanjeevani, Corona Kavach, and other standard products.

Key Statistics (2024-2025)

Metric Value
Arogya Sanjeevani policies 50 lakh+
Average premium (individual) Rs. 8,000-15,000
Minimum sum insured Rs. 1 lakh
Maximum sum insured Rs. 5 lakhs

1. Statutory Framework

IRDAI (Health Insurance) Regulations, 2016

  • Regulation 3: Standard products

IRDAI Circulars

  • Arogya Sanjeevani Policy (April 2020)
  • Corona Kavach (July 2020)
  • Corona Rakshak (July 2020)

2. Arogya Sanjeevani Policy

Key Features

Feature Specification
Sum insured range Rs. 1-5 lakhs
Entry age 18-65 years (individual)
Family coverage Self, spouse, dependent children, parents
Room rent No sub-limits
Co-payment Nil
Pre-policy medical Not required below Rs. 2 lakhs

Coverage Components

Component Coverage
In-patient hospitalization Full sum insured
Day care procedures Listed procedures covered
Pre-hospitalization 30 days
Post-hospitalization 60 days
Road ambulance Rs. 2,000 per hospitalization
AYUSH treatment Full coverage

Waiting Periods

Condition Waiting Period
Initial waiting 30 days
Specified diseases 24 months
Pre-existing diseases 48 months

3. Corona Kavach Policy

Key Features (Historical Reference)

Feature Specification
Coverage COVID-19 hospitalization
Sum insured Rs. 50,000 - Rs. 5 lakhs
Policy term 3.5/6.5/9.5 months
Home treatment Rs. 14,000 limit
AYUSH Covered
No claim bonus 5% per year

4. Comparison with Regular Products

Aspect Arogya Sanjeevani Regular Products
Room rent No sub-limit Often 1-2% of SI
Co-payment Nil Often 10-20%
PED waiting 48 months 12-48 months
Sum insured Max Rs. 5 lakhs Up to Rs. 1 crore+
Premium variation Limited Wide range

5. Compliance Requirements

For Insurers

  • Offer Arogya Sanjeevani mandatorily
  • Use standard policy wording
  • File premium rates with IRDAI
  • No material deviation from standard terms
  • Provide comparison documents

For Intermediaries

  • Explain standard product features
  • Compare with other offerings
  • Document customer choice
  • Disclose limitations of sum insured cap

6. Key Takeaways for Practitioners

  1. Arogya Sanjeevani is mandatory offering for all health insurers
  2. No room rent sub-limits is significant benefit
  3. Rs. 5 lakh cap may be insufficient for major treatments
  4. Consider as base policy with top-up
  5. Standardization enables easy comparison
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