Hyderabad:
The insurance regulator IRDAI has clarified that the newly designed standard health insurance product ‘Arogya Sanjeevani’, where the cover size ranges from Rs 1 to Rs 5 lakh with premium between Rs 1,000 to Rs 5,000,offered by the 29 general and health insurers,will cover the hospitalisation treatment costs of COVID – 19.
Besides newly launched ‘Arogya Sanjeevani’ IRDAI has already clarified to the public, that the existing indemnity based health insurance products, that cover the treatment costs of hospitalization offered by all general and health insurance companies,also cover the costs of hospitalization treatment on account of COVID -19.
All insurers have been advised by the IRDAI on 30th March to expedite settlement of COVID 19 related claims. They have also been advised to display FAQs on COVID 19 claims in their respective websites, said IRDAI, said TR Alamelu, member(non-life), IRDAI on Wednesday.
The IRDAI, which had asked the domestic general and health insurers to launch such standard health insurance product , has already issued clearance to the 29 companies to market the new health insurance product.
This standard product should have the basic mandatory covers as specified in the proposed norms which has to be uniform across the market. No additional add-ons or optional covers allowed to be proposed to offer along with the standard product, said IRDAI..
Also in order to incentivise early entry into health insurance by the young prospective policyholders of health insurance market, IRDAI has asked all general insurers / health Insurers to offer them Standard Product and devise a pricing mechanism in such a way to incentivise the early entry of prospective policyholders, continued renewals and favourable claim experience.
The hospitalisation expenses in ‘Arogya Sanjeevani’ will cover the following;
a)Room, Boarding, Nursing Expenses all inclusive as provided by the Hospital / Nursing Home
b)Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialist Fees whether paid directly to the treating doctor / surgeon or to the hospital
c)Anaesthesia, blood, oxygen, operation theatre charges, surgical appliances, medicines and drugs, costs towards diagnostics, diagnostic imaging modalities, and such other similar expenses.Hospitalisation expenses on for a minimum period of 24 hours only are admissible.
However, this time limit will of 24 hours will not apply when the treatment does not require hospitalization as specified in the terms and conditions of policy contract, where the treatment is taken in the hospital and the Insured is discharged on the same day.
d)Intensive Care Unit (ICU) / Intensive Cardiac Care Unit (ICCU) expenses
e)Expenses incurred on treatment of Cataract subject to sub limits, if any, based on sum insured
f) Dental treatment, necessitated due to an injury
g)Plastic surgery, necessitated due to disease or injury
h)Domiciliary Hospitalization
AYUSH Treatment:
Expenses incurred on treatment under Ayurveda, Unani, Sidha and Homeopathy systems of medicines shall be covered subject to fixed and standard sub-limits based on Sum Insured.
Pre-Hospitalization medical expenses incurred for a period not less than 30 days prior to the date of hospitalization shall be admissible. Post Hospitalization medical expenses incurred for a period of not less than 60 days from the date of discharge from the hospital towards Consultant fees, Diagnostic charges, Medicines and Drugs wherever required and recommended by the Hospital / Medical Practitioner, where the treatment was taken, following an admissible claim shall be included.