IRDAI Issues Guidelines for Corona Kavach Policy to Insurers: July 10, 2020

• A Coronavirus specific product that covers basic health insurance needs related to COVID treatment
• A standard medical insurance product with common policy wordings across the health insurance industry
• A policy with no deductibles

Guidelines:

• The base product shall be offered on Indemnity Basis and the optional cover should be on the Benefit basis
• The Standard COVID-19 Insurance policy prices need to be determined keeping in mind the IRDAI health regulations 2016
• The policy term under the COVID specific product shall be – 3.5 months, 6.5 months, and 9.5 months including the waiting period
• This is a mandatory product for all the General and Health Insurers
• 5% discount in premium to be provided to health care workers.

Features and Benefits of Standard COVID-19 Health Insurance Plans

Basic Coverage under COVID Standard Health Insurance Policy

1. Hospitalization Expenses (minimum 24 hours of admission)

The policy shall pay for the hospitalization expenses incurred by the policyholder for COVID treatment in a government authorized diagnostic centre. It includes the following medical expenses

• Nursing expenses, hospital room rent, and boarding charges
• Cost of blood, Anaesthesia, oxygen, surgical appliances, operation theatre, ventilator charges, drugs, medicine, diagnostic tests, PPE Kit, mask, gloves, and the likewise
• It shall also cover the fees charged by the Doctor, Surgeon, Anesthetist, Consultants, Specialist Fees (including telemedicine consultations as per Telemedicine Practice Guideline of March 25, 2020)
• Intensive Cardiac Care Unit (ICCU) and Intensive Care Unit (ICU) expenses
• Road Ambulance charges up to Rs 2000 per hospitalization

2. Home Care Treatment Expenses

The insurance provider shall cover the cost of COVID treatment at home up to 14 days provided:

• The insured person has been advised to take treatment at home
• Monitoring of health is required during home treatment
• Daily monitoring chart to be maintained and is signed by the doctor
• Cashless and reimbursement facility as per the claim settlement policy followed by the insurer
• Reimbursement claim requests to be approved within 2-hours by the insurer

3. Pre and Post Hospitalization

The policy shall cover pre-hospitalization expenses incurred 15days before the date of hospitalization/home treatment including the cost of diagnosis as per the admissible claim. It shall also cover 30 days of post-hospitalization expenses.

4. Ayush Treatment

Ayush hospitalization expenses (as per the IRDAI Health Insurance Regulations, 2016) systems of medicine for the treatment of COVID on Positive diagnosis of COVID in a government authorized diagnostic centre shall be covered up to the Sum Insured without any sub-limits.

5. Optional Cover

The insurer shall pay 0.5% of the sum insured amount on daily basis for hospitalization required for 24 hours for treatment of COVID up to a maximum of 15 days during the policy term.