IRDAI asks health, general insurers to bring standard accident cover from April

New Delhi: Insurance regulator Irdai has asked general and health insurance providers to provide standard personal accident cover products to their customers.

The Insurance Regulatory and Development Authority of India (IRDAI) said the insurance market has a wide variety of personal accident insurance products.

Each product has unique features and the insuring public may find it a challenge to choose an appropriate product, Irdai said in its guidelines issued to the insurers for the standard accident cover.

“Therefore, with the objective of having a standard product with common coverage and policy wordings across the industry, the authority has decided to mandate all general and health insurers to offer the standard personal accident insurance product,” it said.

The product, IRDAI said, should be named as Saral Suraksha Bima, succeeded by the name of the insurance company, and no other name is allowed in any of the documents, said the regulator.

General and health insurers shall offer this product from April 1, 2021, onwards, it added.

Irdai said the product should have a minimum sum assured of Rs 2.5 lakh and the maximum sum assured can be Rs 1 crore. Sum insured offered shall be in multiples of Rs 50,000.

However, beyond the range specified by Irdai, insurers are allowed to offer on their own and can use the same name for the product.

Directing the insurers that the standard product should have the basic mandatory covers under the guidelines, Irdai said the insurers can offer optional covers along with the standard product.

“The insurer may determine the price keeping in view the covers proposed to be offered subject to complying with the norms specified in the Irdai (Health Insurance) Regulations, 2016, (HIR, 2016) and guidelines… The policy tenure of the standard product shall be for a period of one year,” said the regulator.

Among the base covers, insurers will have to provide a death benefit up to 100% of the sum insured to the policyholder if the death occurs due to injury in an accident during the policy period, and that the person dies within 12 months from the date of accident.

On permanent total disablement, the insurer will get benefit equal to 100 per cent of the sum insured and that the disablement occurs within 12 months from accident.

It will include total and irrecoverable loss of sight of both eyes; physical separation or loss of use of both hands or feet; physical separation or loss of use of one hand and one foot and few others.

Likewise, for permanent partial disablement, the policyholders will get 1-50% of the sum assured depending upon the types of losses.

On the hopitalisation expenses, Irdai said it should cover room, boarding, nursing expenses, surgeon, anaesthetist, medical practitioner, consultants and specialist fees.

It should also cover blood, oxygen and operation theatre charges and costs related to surgical appliances, medicines, diagnostics and diagnostic imaging modalities.

It will also cover intensive care unit (ICU)/ intensive cardiac care unit (ICCU) expenses, cost of prosthetic and other devices or equipment, as well as expenses incurred on hospitalisation, under the AYUSH (as defined in IRDAI (Health Insurance) Regulations, 2016, systems of medicine.

Dental treatment, plastic surgery, all-the-day care treatments and expenses on road ambulance subject to maximum cap of Rs 2,000 per hospitalisation can be covered under optional covers.

The minimum entry age for the cover is fixed at 18 years and a maximum age of 70 years.

Insurers are allowed to use the name of standard product for the group policy by adding the word ‘group’, said the regulator.