NiveshKarBefikar With Vaidyanathan Covid-19 and Insurance Innovations For Consumers

In the last few months, ever since the Covid-19 outbreak has happened, we all have been forced to rethink our regular daily lives, be it education, entertainment, or any kind of savings. The way things were done at the start of this year and the way they are being done now have changed completely. With restrictions on travel, closure of offices, and recommendations to stay at home, almost everyone has started switching to digital tools for any kind of engagement in our daily lives.

Insurers have come up with a lot of innovations so that consumers can get the maximum benefit of the insurance products amidst this ongoing pandemic. These innovations include video-based KYC, e- KYC for buying new insurance policies. Issuing policy to digital signatures, one time password making digital payments, the introduction of telemedical, etc. In continuation of its consumer awareness initiatives, Policybazaar organized a webinar on Covid-19 and insurance innovations for consumers, under its Nivesh Kar Befikar series. The webinar was hosted by Apeksha Mishra, Communications Manager, Policybazaar who spoke to Vaidyanathan Ramani, Head, Products and Innovations, Policybazaar. Here are the edited excerpts from the Q&A session:

Q. There is no Covid-19 specific health policy for a person whose age is 65+ but the Insurance and Regulatory and Development Authority of India (IRDAI) has directed that all health policies that include hospitalization would include Covid-19 related situations. Is there any top-up policy for us who are above 65 years of age? I am 69 years old.
—From Gautam Ghosh
There are policies available for people who are above 65 years old. The market is probably not as expansive as one would find, but there are a fair amount of options available. You should be able to find a lot of these on the Policybazaar platform as well. It is indeed true that normal health insurance policies will also cover Covid related hospitalizations. At the start of this pandemic, the regulator gave clear instructions that insurers will honour Covid claims as well as long as the policy-based conditions are tuned to support any kind of hospitalization.

Now, most of the policies in the Indian market are indemnity policies. They are bound to support any kind of hospitalizations of at least 24 hours and specified daycare treatments etc. But as long as any Covid related complications lead to hospitalization of at least 24 hours, these basic health insurance policies are equally valid and they would be honouring the outcome as per the normal terms and conditions. I would definitely recommend that if you're looking to expand and have a coverage that you feel is inadequate at this age, you should look for top-up and super top-up policies as they are far more efficient in terms of premiums as well as coverage incrementally.

Q. How to claim my policy in the pandemic situation?
From B Deva
The process of filing a claim for Covid-19 is as simple and similar to what you would have for a claim for any other illness. If you are holding a new kind of indemnity cover, be it a normal health plan or a Covid-19 specific plan, all of these are dependent on the hospitalization. And once you've had the hospitalization event, insurers have extended cashless capability in network hospitals. At the point of administering one of these hospitals, you must be able to trigger them by giving them details about your policies or your beneficiary ids Should that not be possible, reimbursements are also allowed. Post hospitalization, you have to give details to the insurer about the whole hospitalization and the discharge summaries and all the documentation. These would be processed within these specified timelines by IRDAI, and the money would be reimbursed as per the terms and conditions of the policy.

Q.What are the items not included in the claim for Covid-19 affected patients like I had a PPE kit, which was not included. How much is the ICU charge which can be claimed?
—From Sampat Mala
If you have a normal health insurance policy that covers all diseases, including Covid-19 have certain terms and conditions. By default, a lot of these policies have been drawn up to pay for most in an event of hospitalization but certain things like disposables, gloves, etc., are excluded. These are built for prudence in the policy and have been based on past experiences. Now, specifically, because you asked about PPE kits, they would be constituted under this classification of disposables. However, if you have a normal policy, then they get excluded. I have seen cases of most of the insurers in the market are far more sympathetic to the customer need and consequently accepting and adopting to pay some of this. You should check with your specific insurer in this case. Covid-19 specific policies in the market consequent to the pandemic setting are more open and explicit about coverage to PPE kits.

For the second part of the question, ICU charges depend on the policy. There are different kinds of policies in the market that have either fixed payments with regard to the kind of room that you select to have the hospitalization and have different clauses about ICU charges. Many policies in the market don’t have a separate distinction between ICU and non ICU charges and continue to pay. For example, if you have a single private room coverage allowed in your policy, then they normally do not differentiate between ICU and non ICU charges. There are some policies which have specific limits. Let's say for a room. Some policies have a limit of about Rs 3000 per day for a normal room and doubling it up to Rs 6000 per day for an ICU.

Q.I already have health insurance. Will it cover me for Covid-19 and what is the ideal sum insured one should have not to face any problem during treatment?
—From Deva
Your normal health policy covers you for Covid-19 treatment as long as there is a hospitalization. People who are getting hospitalized for Covid-19 are paying anywhere between Rs 1 lac to even as high as Rs 25 lacs in some cases due to comorbidities. If you are a fairly healthy person who has no existing comorbidities, a fair amount of coverage would be enough. I would recommend a minimum sum assured of Rs 5 lacs. If you live in a metro city where hospital charges are high, I would recommend a minimum of Rs 10 lacs. If you have comorbidities, then you should look for much larger coverages. Rs 1 crore plans are the best bet which is available today at a fairly affordable cost.

Q.If I buy a health insurance policy, there will be a waiting period of 30 days to cover against Covid-19. Why?
—From Sandeep Kaushik
The waiting period of 30 days wasn’t actually drawn up to cover Covid-19. This is the base waiting period that was drawn up in the policies that existed in the market. Whenever a health insurance policy is being issued in the market, if you look across the world, many, many parts of the world actually go to a fairly strong underwriting process where the customer's current health condition is fairly examined before the policy is issued. In the Indian market, thanks to friendly insurers and the regulator enabling this, the processes have been customer friendly.

In order to buy a health insurance policy, we don't need to do anything beyond simply declaring our current health conditions, and the policy is immediately issued. Now, as a balance against this process, the initial rating period was introduced a fairly long time ago and has continued to be an established process to give the balance so that people don’t lead to situations where they purchase health insurance immediately to make a claim. Many insurers have also taken permission from the regulator to bring down the waiting period for Covid-19 coverage.

Q.I live in Surat. Is Rs 5 lacs sum insured health insurance sufficient or not?
—From Bhavik Prajapati
If you have the option to pick coverage today, please go for Rs 1 crore cover. They are fairly affordable and more than enough for Covid-19. If you don’t have any comorbidities, Rs 5 lacs coverage along with no claim bonus earned should be enough.

Q.I am 69 years old. Will there be any top-up or super top-up available for me?
—From Gautam Ghosh
There are few policies available but come with underwriting conditions given the age. So those will unfortunately be the way for this segment. However, a fairly good number of customers are able to cross underwriting limits and able to buy these policies.

Q.If I am buying health insurance for my senior citizen parents, is the waiting period still 15 days for Covid-19 and cancer?
—From Anuj
Yes. If you're buying a Covid-19 specific policy that has been issued today, then they come with blanket coverage for all kinds of customers. If you're looking at a normal health plan that covers Covid-19 they have an initial waiting period of 30 days. There is a specific waiting period of up to two years for named conditions. You would find these in the policy. These are for conditions like kidney stones, appendix, etc. They are fairly standardized, thanks to the regulator's involvement. So you can look at that list. For any pre-existing condition, there is 4 years waiting period.

Q.I have a family health cover for Rs 10 lacs. I have one kid and we are two adults. Is it sufficient to cover Covid-19 and other illnesses?
—From Raghu
If you can go for higher coverage, I would recommend you buy a Rs 1 crore health insurance plan which is available at a very affordable rate. However, if you don’t have the option, Rs 10 lacs is the bare minimum limit. If you can expand coverage, I would recommend you to do so. Covid-19 is an infectious disease and you have three members in your family. There are higher chances of all members getting infected which means hospitalization for all of you. I would definitely recommend increasing this by 1.25 to 2X limit.

Q.I am a diabetic patient. Will I be eligible to get a Covid-19 specific policy?
—From Atul Malani
Yes, the Covid-19 specific plans rolled out with the regulator support cover all kinds of customers. Your pre-existing condition is not a deterrent and all customers up to the age of 65 years are eligible to buy these policies.

Q.What about the current crisis? Does it worry you? What gives you the most hope?
—From Suresh Saini
We are continuously surrounded by uncertainty. Covid-19 has just brought it closer to our faith and shown that uncertainty will hit us when we expect it the least. Insurance is a way to protect ourselves against these risks. These are not going to go away. Today is Covid-19, tomorrow, it is going to be one of the diseases and disabilities in various forms and manifests that will come to us.

Q.Do regular comprehensive plans cover global treatment?
—From Abhijeet Dutta
Most policies are not built for global coverages. However, there are plans in the market that also offer global coverage. These are typically opened up at higher denominations and higher sum assured. They cover global coverage across three phases. There are plans that offer unplanned global coverage, let’s say if you're on a visit and you require global coverage at that point in time. There is a second set of plans that give you the ability to go outside India for named illnesses. There is the third kind of plans that offer a blanket global coverage wherein for any kind of illness at any point in time, you can go anywhere and they will cover your illness.

Q.How can one claim for Covid expenses? Do health insurance policies cover post Covid treatment as well?
Yes, all normal health insurance policies are built to handle hospitalization, and any pre and post expenses up to a certain number of days. They can be a range anywhere from 30 to as high as 180 days, pre and post. The requirement would be Covid-19 situation which led to hospitalization. All these policies are somewhere linked to a hospitalization event and consequently will pay for those. So that is the limitation requirement that we have.

Q.Which health policies are available for two adults of 60 years of age. One is diabetic for 10 years and the other has hypertension for five years.
—From Anant
There are a plethora of options for both. If you are not severely diabetic and are able to manage your lifestyle to keep vitals under check, then most of the health insurance policies in the market are available. Some of these would require a bit of underwriting whereas many would take some declarations and you will be able to then get these policies. All of these options are available on a platform like Policybazaar. If you have a slightly higher diabetic, either having to take tablets on a daily basis or should be far more severely diabetic, including intake of insulin then specific diabetic plans are available.

There are multiple insurers in the market like Star, Care, Max offers such plans. They offer diabetics specific plans that are full coverages for your specific needs because you may be someone under heavy usage of insulin and blood sugar levels keep fluctuating. They would not just cover diabetes but also give support for maintaining your health. A similar outcome for hypertension too. If it's mild hypertension, many of these policies can accommodate you with simple underwriting and should be the best option. For severe cases of hypertension, there are specific plans, and these plans not just offer coverage but provide support to bring that hypertension level into a more controllable level over a period of time.
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