Even as India's Covid-19 cases are flaring up to touch 5 lakhs along with a death toll of 15,301 on Friday, the insurance regulator IRDA has finalised the various contours,that will be uniform across all Insurers,of its short term Covid Standard Health Policy.
The guidelines will remain valid till March 31, 2021 for issue of short term policies in respect of standard COVID product
To be mandatorily termed as“Corona Rakshak Policy’’ it has been made mandatory for all the general insurers and exclusive health insurers while life insurers have been encouraged to launch such products (benefit based).
It has to be offered on indemnity basis whereas optional cover will be made available on benefit basis and all insurers (General, Health and Life) transacting health insurance business may endeavor offering this product preferably by 10th July,2020, said IRDAI.on Friday.
The COVID Standard benefit based health policy has to be offered as micro insurance product subject to sum insured limits and no deductibles and variants are permitted in this standrad product.
The benefit based policies, to be launched by a life insurers, will have a minimum sum insured of Rs50,000 and a maximum limit of Rs.2,50,000 (in the multiples of fifty thousand).For the standard covid indemnity policies, to be launched by the domestic general insurers and exclusive health insurers, the maximum sum assured can be Rs 5 Lakh (in the multiples of fifty thousand)
Both COVID Standard benefit based health policy and indemnity based health policies should be offered with a policy term of three and half months (3 ½ months), six and half months (6 ½ months) and nine and half months (9 ½ months) i.e,105 days,195 days and 285 days respectively, clarified IRDA..
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.The premium under this product will be appliocable pan India basis and no geographic location / zone based pricing is allowed.Five per cent discount in premium need to be provided to health care workers.
Minimum entry age has to be 18 years and maximum age at entry should not be less than 65 years for the persons covered.
The other features like lifelong renewability, migration and portability which are normal feayures of non-covid health insurance policies,are not applicable to this product.
Insurers are allowed to issue the policy contract of COVID Standard benefit based health policy in electronic / digital format
The benefit pay out should be explicitly disclosed in the format of application.Lump sum benefit equal to 100 per cent of the sum insured has to be payable on positive diagnosis of COVID, requiring hospitalisation for a minimum continuous period of 72 hours. The positive diagnosis of COVID has to be from a government authorised diagnostic centre.On payment of 100 per cent of sum insured the benefit based policy has to be terminated.The insurer has to specify the non-medical limit and relevant details explicitly in the format specified.
Indemnity based health policies
All general and health insurers have to offer the Covid Standard Health Policy by duly complying with the following guidelines.
– The base cover of Covid Standard Health Policy has to be offered on Indemnity basis whereas optional cover has to be made available on benefit basis,.
– Optional cover has to be offered along with the Covid Standard Health Policy within the sum insured. The premium payable towards this optional cover has to be specified separately so as to enable policyholders to choose and pay based on the need,
-The policy has to include the cost of treatment for any comorbid condition including pre-existing comorbid condition (s)along with the treatment for Covid.
-Covid Standard Health Policy has be offered on family floater basis also.
Covid Hospitalisation Expenses:
The hospitalization expenses incurred by the insured person for the treatment of Covid on positive diagnosis of Covid in a government authorised diagnostic centre. cover the following:
-Room, Boarding, Nursing Expenses as provided by the Hospital / Nursing Home.
-Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialist Fees (including consultation through telemedicine as per Telemedicine Practice Guideline of 25th March 2020) whether paid directly to the treating doctor / surgeon or to the hospital.
-Expenses on hospitalisation for a minimum period of 24 hours are admissible.
Home Care Treatment Expenses:
-Insurer has to 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:-
-The medical practitioner advices the insured person to undergo treatment at home,
-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,
-Daily monitoring chart including records of treatment administered duly signed by the treating doctor is maintained,
-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,.
-In case the insured intends to avail the services of non-network provider,claim will be subject to reimbursement, a prior approval from the Insurer needs to be taken before availing such services. Insurer has to respond to approval request within 2 hrs of receiving the last necessary requirement.
As part of Home Care Treatment Expenses,the following will be covered if prescribed by the treating medical practitioner and is related to treatment of COVID,
-Diagnostic tests undergone at home or at diagnostics centre
-Medicines prescribed in writing
-Consultation charges of the medical practitioner
-Nursing charges related to medical staff
-Medical procedures limited to parenteral administration of medicines
– Cost of Pulse oximeter, Oxygen cylinder and Nebulizer
The medical expenses incurred on hospitalisation under AYUSH (as defined in IRDAI (Health Insurance) Regulations, 2016) systems of medicine for the treatment of Covid on Positive diagnosis of Covid in a government authorised diagnostic centre will be also covered up to the sum insured without any sub-limits.
Pre-Hospitalization medical expenses
Pre-hospitalization medical expenses incurred for a period of 15days prior to the date of hospitalization/home care treatment following an admissible claim under this policy has be covered. Pre hospitalization expenses shall also cover the costs of diagnostics towards Covid.
Also post-hospitalization medical expenses incurred for a period of 30 days from the date of discharge from the hospital/completion of home care treatment, following an admissible claim under this policy shall be covered.
Rashmi Nandargi,head – retail health underwriting, Bajaj Allianz General Insurance said, "These policies will cater to people who currently don't have a holistic health insurance policy and are looking to cover themselves against Covid-19. The policy coverages, terms & conditions are standard across insurers; the USP would be wide network of hospitals for cashless facility. These Covid-19 specific policies will certainly be a good start and an attractive proposition for people to opt for health insurance, and later may encourage them to opt for a comprehensive health insurance cover. At Bajaj Allianz General Insurance, we are working on these products currently and should be prepared to offer them soon to our customers."