IRDAI Releases the Final Guidelines for COVID-19 Health Policies – Part 2

You know that the Insurance Regulatory and Development Authority of India (IRDAI) has published the guidelines for indemnity and benefit-based health policies to cover COVID-19. The previous part of this article has covered the segments, such as features of the policies, who should buy them, and the limitation of the policies. In this part, we are going to elaborate on each of the plans.

‘Corona Kavach’ Indemnity Policy

The indemnity policy shall be called ‘Corona Kavach Policy’ following the insurer’s name. The plan comes with a cap on the sum insured at Rs.5 lakh, and the minimum sum insured will be Rs.50,000. You can choose a cover in the multiples of Rs.50,000. The policy covers the cost of treatment for any co-morbid conditions, even the pre-existing ones, along with the treatment cost for COVID-19.

Insurance companies are free to offer an optional cover whose premium will be explicitly mentioned. The base cover of the policy is to be provided on an indemnity basis, whereas the optional cover will be offered on a benefits basis.

When a policyholder tests positive for COVID-19 as diagnosed by a government-approved diagnostic centre, the policy will pay for the hospitalisation expenses for the treatment. The plan is supposed to cover the costs, such as room, boarding, and nursing. The fees charged for surgeons, consultants, anaesthetists, and specialists, including the consultation through telemedicine, will be covered by the policy.

Other expenses related to oxygen cylinders, operation theatre, surgery, drugs and medicines, PPE kits, and gloves will be covered only if the policyholder is hospitalised for a minimum of 24 hours. Also, the expenses of the intensive care unit, as well as the intensive cardiac care unit, will be covered. 

The policy not only covers the hospitalisation expense but also the costs of at-home treatment if medical practitioners prescribe home treatment. Such medication is covered if there is a continuous active line of treatment, which requires regular monitoring of health condition by a medical practitioner. The coverage for at-home treatment is provided only for a maximum of 14 days per incident. In this case, the treating doctor has to maintain daily monitoring charts, including records of treatment, and sign them.

Also Read: IRDAI Releases the Final Guidelines for COVID-19 Health Policies – Part 1

The policy provides cashless services to policyholders when the treatment is sought at a panel hospital. In the case of a non-panel hospital, the cash paid for the medical bills shall be reimbursed. Any diagnostic tests performed at home or diagnostic centres, prescribed medicines, cost of the pulse oximeter, and nebuliser are all covered under the home care benefit label.

The policy is designed such that it covers Ayush treatment, pre-hospitalisation expenses incurred in the 15 days before hospitalisation, and posy-hospitalisation expenses for 30 days after discharge from the hospital. The policy has an optional daily hospital cash cover where the insurance company pays up to 0.5% of the sum insured once every 24 hours of the hospitalisation. The regular hospital cash will be payable for up to 15 days.

The policy will be available based on a family floater as well. Meanwhile, IRDAI has let the insurance companies decide on the premiums. 

‘Corona Rakshak’ Fixed-Benefit Policy

The other type of COVID-19 policy is supposed to be called ‘Corona Rakshak Policy’ following the insurance company’s name. The minimum sum insured for the plan will be Rs.50,000 and can be chosen in the multiples of Rs.50,000 up to Rs.2.5 lakh. 

The policy pays up to 100% of the sum insured in a lump sum if the policyholder tests positive for COVID-19 infection and has to be hospitalised for a minimum of 72 hours. Upon paying 100% of the sum insured as a lump sum, the policy will be terminated. The plan is for individuals only and does not include family floater. 

An individual can purchase only one such policy. The regulator has delegated the right to choose the premiums for this policy to the insurance companies.

These insurance policies seem to provide a great advantage, especially for those who are uninsured. The number of positive cases has shot up recently, and everyone is on the verge of contracting the illness irrespective of having a travel history. Though you have to wait until 10 July for the insurers to launch their policies, there might be a lot of people waiting to purchase the policies desperately. This too, shall pass!

For any clarifications/feedback on the topic, please contact the writer at apoorva.n@cleartax.in