Oriental Corona Kavach Policy
Oriental Corona Kavach policy is a standard coronavirus health insurance product that offers coverage on an indemnity basis. The coverage provided under this policy is for both adults and children on a family floater basis. It is also available on the individual sum insured basis. The coverage amount goes up to Rs 5 Lakh for COVID-19 hospitalization expenses, home care treatments, and Ayush treatment.
Features and Benefits of Oriental Corona Kavach Policy
Oriental Corona Kavach Policy comes with the following features and coverage benefits:
- The sum insured under this Corona Kavach policy starts from Rs 50,000 and goes up to a maximum of Rs 5 Lakh
- The base health insurance cover is on indemnity basis and the optional cover is on benefit basis
- There are three policy term options- 3 ½ months, 6 ½ , and 9 ½ months
- Adults starting from 18 years of age and people as old as 65 years can buy this policy
- Children starting from day 1 can be covered and up to a maximum age of 25 years if either of the parents is insured under this policy
- 5% discount on premium is offered to doctors and nurses on purchase of this policy
- The policyholder can also claim for 15 days of pre-hospitalization expenses and 30 days of post-hospitalization expenses
Oriental Corona Kavach Policy Coverage
The coverage benefits under this policy for coronavirus treatment are given in detail below:
Hospitalization Expenses for COVID-19
Oriental Corona Kavach pays the policyholder where COVID-19 hospitalization is required for at least 24 hours and coverage benefits are given below:
- The cost of hospital room rent, boarding expenses, and nursing charges can be claimed
- The treatment cost including doctor and surgeon fees, anaesthetist, and specialists’ fees is taken care of
- Intensive Cardiac Care Unit (ICCU) or Intensive Care Unit (ICU) are paid by the Insurance Company
- Other treatment costs including the operation theatre charges, anaesthesia, diagnostics tests, blood, oxygen, drugs, surgical appliances, medicines, and ventilator charges are paid for
- For COVID positive patient, the policy also pays for ambulance expenses up to Rs 2000
- The cost of consumable items such as masks, PPE kits, oximeter, and gloves are covered as well
AYUSH Treatment Cover
The Company shall cover inpatient care treatment on being diagnosed COVID-19 Positive by a government registered Diagnostic Centre including the treatment expenses for comorbidities and COVID treatment under Yoga, Ayurveda, Unani, Homeopathy, Siddha and Naturopathy systems of medicines during the policy term up to the sum insured limited in an eligible AYUSH Hospital. It will cover the expenses that were covered under COVID hospitalization expenses.
Home Care COVID-19 Treatment Cover
The policy also compensates for home treatment expenses for COVID-19 positive insured person up to a maximum of 14 days provided that:
- Home treatment is advised by the treating doctor
- Active treatment with constant health monitoring on daily basis by the treating doctor during the course of homecare treatment
- Maintaining a daily monitoring chart with treatment records as duly signed by the treating doctor
- Cashless or reimbursement facility shall be offered as per the policy terms and conditions
- Treatment taken in a non-network provider is eligible for reimbursement post approval from the insurer to avail the treatment
It covers the following coronavirus related home treatment expenses:
- Cost of Diagnostic tests
- Cost of the prescribed medicines
- Doctor’s Consultation fee
- Cost of Oxygen cylinder, Pulse Oximeter, and Nebulizer
- Nursing charges
- Medical techniques restricted to parenteral administration of medicines
Pre and Post Hospitalization Cover
Pre-hospitalization expenses are paid for a period of 15 days and post-hospitalization expenses are paid for a maximum of 30 days after hospital discharge
Daily Hospital Cash Add-on Benefit
Oriental Corona Kavach health insurance policy provides the option to avail Daily Hospital cash benefits. The policy covers 0.5% of the Sum Insured amount as daily hospital cash benefit. It is only valid where hospitalization is required for 24 hours and for a maximum of 15 days for every insured member during a policy term.
Exclusions under Oriental Insurance Corona Kavach Policy
Oriental Corona Kavach health insurance policy shall not cover claims arising due to the following expenses:
- OPD expenses
- The cost incurred on medical evaluation and investigation
- COVID treatment expenses before the policy inception
- Day Care procedures
- Admission required for rehabilitation, rest cure, and respite care
- Any kind of unproven treatment is not eligible for a claim
- Medical treatment expenses within 15 days of policy purchase are not admissible for claims
Oriental Corona Kavach Policy Claim Procedures
It is quite simple to file a claim for Oriental Corona Kavach policy and the procedure for both cashless and reimbursement claims along with the required documents are given below:
- For reimbursement of pre-hospitalization expenses, the documents need to be submitted within 30 days of getting discharged
- For reimbursement of COVID home treatment expenses the documents need to be submitted within 30 days of getting discharged
- Whereas for post-hospitalization expenses the documents need to be submitted within 15 days of the hospital discharge date
Claim Settlement Process for Reimbursement
- It is your duty to inform The TPA department within seven days of hospitalization
- Submit all the details including the name of the insured person ad policyholder, policy number, nature of illness or injury, name and address of the hospital or nursing home along with the doctor’s name
- Send the claim documents with the hospital bills and invoices within the 30 days of discharge from the hospital.
- Provide all the information and documents as mentioned by the TPA department or the insurance company for a seamless claim process
- The documents can be sent to the registered office of Oriental insurance or sent over the email. It is the discretion of the insurer at that time.
Claim Process for Cashless Treatment/Hospitalization
In case of an emergency or planned hospitalization, the process is as follows -
- For cashless payment, the claim form needs to be approved by the network hospital.
- The insurer will verify all the information, documents and determine your eligibility for the claim.
- If the information is found to be satisfactory then the pre-authorization letter will be sent to the registered hospital. This letter will include the amount that will be paid by the insurer.
- In case all the necessary documents and the pre-authorization letter are not submitted, and the treatment is started, then you need to contact the TPA department for reimbursement of the claims.
- The documents must be sent to the registered office of Oriental insurance or sent over email, as suggested by the insurer.
Oriental Corona Kavach Policy Claim Documents
All the documents, medical bills, reports, and cash memos should be provided to the TPA/company within 15 days of discharge from the hospital. The list of documents is as follows -
- Original medical bills, discharge certificate, and receipts
- Copy of passport or Photo ID proof in case you do not have a passport
- All the documents related to the treatment including the consultation, test, and medical reports
- Patient’s medical history as per hospital records
- Cash-memo from the hospital or chemists along with the prescription letters
- Original receipts of pathological/ radiology tests with supporting letter from the Medical Practitioner or surgeon that it is required as part of the treatment
- Original bills, receipts, and diagnosis report from attending anesthetists, specialists and consultants.
- KYC details if the claim amount is more than Rs 1 Lakh
- Original certificate from the surgeon confirming the diagnosis and nature of operation done.
- Successors certificate, if required
- Death or disability certificate ( if any)
- Discharge summary
- Any other document demanded by the insurer and TPA
- Once the documentation is complete, the insurer or the TPA department will share the policy claim status with you.
Documents need to be submitted for Home Treatment Claims
- Filled and Signed Policy Claim Form
- Copy of passport or Photo ID proof in case you do not have a passport
- Doctor’s prescription advising COVID-19 treatment at home
- Medical reports along with daily monitoring charts by the doctor
- Discharge Certificate from the treating doctor with the date of start of the treatment and its completion