Corona health insurance plans: Features, inclusions, exclusions – Explained

By: |
Updated: Jul 10, 2020 5:29 PM

The Covid Standard Health Policy need to be compulsorily offered by all general and health insurance companies from July 10, 2020.

 Corona health insurance plan, Corona Kavach Policy, Features, maximum coverage, tenure, terms and conditionsThe hospitalization expenses incurred by the insured person for the treatment of COVID will be paid by the insurer on Positive diagnosis of COVID.

Health Insurance Plans for Covid-19: Exclusive health insurance plans for Covid-19 hospitalization treatment are going to be there in the market from today. Called Corona Kavach Policy, according to IRDAI, the COVID Standard Health Policy need to be compulsorily offered by all general and health insurance companies from July 10, 2020. What makes Corona Kavach Policy a simple product to buy is that every insurer needs to carry common policy wordings. The features and the premium will be more or less similar across the insurers. So, now if anyone wants to buy a health cover to guard against Covid-19 related hospital expenses, one can buy it from any insurer. However, there are a few differentiations and conditions to be met, read on to find out.

COVID Positive

The Hospitalization expenses incurred by the insured person for the treatment of COVID will be paid by the insurer on Positive diagnosis of Covid only when the testing has been done in government authorized diagnostic centre.

Basic plus Optional cover

The Covid Standard Health Policy shall have One Basic mandatory cover and One Optional Cover. The premium payable towards this Optional Cover shall be specified separately so as to enable policyholders to choose and pay based on the need.

Benefits

The Base Cover of Covid Standard Health Policy shall be offered on Indemnity basis whereas Optional Cover shall be made available on Benefit Basis. In an indemnity cover, the claim is paid as per the hospital bills while in a Benefit cover, the entire sum insured is paid to the policyholder. “As per the data available with General Insurance Council, the average claim size ranges between Rs 1.5 to 2 lakh, in case of hospitalization,” informs Shanai Ghosh, Executive Director and CEO, Edelweiss General insurance.

Tenure of policy

The Covid Standard Health Policy shall offer a policy tenure of 3 ½ months, 6 ½ months, and 9 ½ months including waiting period. The features of lifetime renewability, migration and portability are not applicable in the policy. “Given the current trajectory of the pandemic, high risk of community transmissions and the initial waiting period in a policy, one needs to be cautious. Therefore, it is advisable to consider a policy with a longer tenure,” suggests Shanai.

Features

There are no plan variants thus buying it is simple without much of comparison between different plans. Covid Standard Health Policy shall be offered on a family floater basis also. To keep it much simpler, there is no Deductible in the policy.

Minimum, maximum limits

The minimum sum insured under Covid Standard Health Policy is Rs 50,000 and the maximum is Rs 5 lakh. Anyone between 18 and 65 years can buy the cover and also cover dependent children between day 1 of age to 25 years.

As far as choosing the sum insured or the cover amount is concerned, Shanai says, “The treatment for COID includes patient isolation, use of personal protective equipment, prolonged hospitalization, diagnosis and treatment of pre-existing or developing co-morbidities etc. Considering the complexity of the disease and the treatment, it is advisable that you choose an adequate Sum insured, bearing the following factors in mind:

  • Your Age
  • Type / Choice of Hospital
  • Locality  (Metro/Non-Metro /Town)
  • Your Dependents
  • Your Current Health Condition (Co-Morbidity)

I. Base cover – What is covered

When you buy the Covid Standard Health Policy, the base coverage or the sum insured will apply only when there is a minimum period of 24 hours of hospitalization. The hospital expense up to the sum insured will be paid as claim by the insurer irrespective of the days of stay in the hospital.

This section shall cover the following:
a)    Room, Boarding, Nursing Expenses as provided by the Hospital or Nursing Home.

b)    Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialist Fees including consultation through telemedicine whether paid directly to the treating doctor or surgeon or to the hospital.

c)    Anesthesia, blood, oxygen, operation theatre charges, surgical appliances, ventilator charges, medicines and drugs, costs towards diagnostics, diagnostic imaging modalities, PPE Kit, gloves, mask and such other similar expenses

d)    Intensive Care Unit (ICU) / Intensive Cardiac Care Unit (ICCU) expenses.

e)    Expenses incurred on road Ambulance subject to a maximum of Rs.2000 per hospitalization.

After discharge from hospital

The Covid Standard Health Policy also provides coverage to home care treatment expenses. Insurer will cover the costs of treatment of COVID incurred by the Insured person on availing treatment at home maximum up to 14 days per incident provided that:

a)    The Medical practitioner advices the Insured person to undergo treatment at home.

b)    There is a continuous active line of treatment with monitoring of the health status by a medical practitioner for each day through the duration of the home care treatment.

c)    Daily monitoring chart including records of treatment administered duly signed by the treating doctor is maintained.

d)    Insured shall be permitted to avail the services as prescribed by the medical practitioner. Cashless or reimbursement facility are offered under homecare expenses subject to claim settlement policy disclosed in the website of the Insurer.

e)    In case the insured intends to avail the services of non-network provider, claim shall be subject to reimbursement, a prior approval from the Insurer needs to be taken before availing such services.

AYUSH Treatment

The Medical expenses incurred on hospitalization under AYUSH systems of medicine for the treatment of Covid on Positive diagnosis of Covid in a government authorized diagnostic centre will also be covered up to the Sum Insured without any sub-limits.

Pre and Post Hospitalization

Pre-Hospitalization medical expenses including the costs of diagnostics incurred for a period of 15 days prior to the date of hospitalization/home care treatment and Post-Hospitalization medical expenses incurred for a period of 30 days from the date of discharge from the hospital or completion of home care treatment, following an admissible claim under this policy will be covered.

And, most importantly, the Covid Standard Health Policy will also include the cost of treatment for any co-morbid condition including pre-existing comorbid condition along with the treatment for Covid.

II. Optional cover – What is covered

At times, there could be some out-of-pocket hospital expenses which could even be incurred by family members during hospital visits. The Covid Standard Health Policy gives one the option to add ‘Hospital Daily Cash’ cover. Under it, the insurer will pay 0.5 per cent of sum insured per day for every 24 hours of continuous hospitalization for treatment of Covid following an admissible hospitalization claim under this policy. The benefit shall be payable maximum up to 15 days during a policy period.

Having regular individual health insurance is equally essential as they are more comprehensive in nature. However, to supplement them, buying an exclusive COVID cover is also a better approach.

Do you know What is ? FE Knowledge Desk explains each of these and more in detail at Financial Express Explained. Also get Live BSE/NSE Stock Prices, latest NAV of Mutual Funds, Best equity funds, Top Gainers, Top Losers on Financial Express. Don’t forget to try our free Income Tax Calculator tool.

Financial Express is now on Telegram. Click here to join our channel and stay updated with the latest Biz news and updates.

Next Stories
1Health insurance misconceptions among millennials – Get clarity now
2International Youth Day 2020: Health insurance sees major takers in Millennials, post COVID-19
3Now buy term insurance plan using OTP – Check IRDAI’s new rule