Decoding the Corona Rakshak and the Corona Kavach Policy

The current pandemic situation of Covid 19 has created a need for a specific insurance products to cover the cost of treatment and has given birth to two products – Corona Rakshak Policy (Benefit based) and the other Corona Kavach Policy (Indemnity based). The following article has been decoded in detail about both of the policies -  

CORONA HEALTH RAKSHAK POLICY:

Corona Rakshak Policy is a Standard benefit only health insurance policy that provides a lump sum amount in case you are diagnosed and hospitalized due to COVID infection. 

Snapshot of the Policy

• Product Type: Individual
• Category Cover: Benefit based
• Sum Insured: Rs 50,000/- (Fifty Thousand) to 2,50,000/- (Two and half Lakh) (in the multiples of fifty thousand)
• Policy Period: Three and half months (3 1⁄2 months) i.e. 105 days, Six and half months (6 1⁄2 months) i.e. 195 days, Nine and half months (9 1⁄2 months) i.e. 285 days
• Eligibility: Policy can be availed by persons between the age of 18 years and 65 years. Proposers with higher age can obtain the policy for adult members of the family, without covering self.
• Coverage: COVID Cover

Lump-sum benefit equal to 100% of the Sum Insured shall be payable on a positive diagnosis of COVID, requiring hospitalization for a minimum continuous period of 72 hours. The positive diagnosis of COVID shall be from a government authorized diagnostic center.

• Waiting Period: The Insurer shall not be liable for any claim arising for COVID within 15 days from the first policy commencement date.
• Tax Benefits: Premium paid by any mode other than cash and demand draft is eligible for tax relief as provided under Section 80-D of the Income Tax Act.
• Claims: All claims under the policy shall be payable in Indian currency only. On payment of 100% of sum insured the policy will be terminated.
• Pre-Insurance Medical Examination: No pre-insurance medical examination test is required, irrespective of the sum insured and age of the insured.

- Underwriting loading of the premium will be applicable to the particular Insured’s premium in case of adverse health conditions declared on the proposal form.

• Exclusions: 

- Expenses related to any admission primarily for diagnostics and evaluation purposes. 

- Any diagnosis which is not related and not incidental to COVID. 

- Testing done at a Diagnostic center which is not authorized by the Government. 

- Any claim with respect to COVID manifested prior to the commencement date of this policy or during the waiting period. 

- Cover under this Policy shall cease if the Insured Person travels to any country placed under travel restriction by the Government of India.

• Documents for claim

- Duly filled and signed Claim Form in original 

- Copy of Insured Person’s passport, if available (All pages) 

- Photocopy of Photo Identity proof of the patient (if the insured person does not own a passport) 

- Photocopy of Medical practitioner’s prescription advising admission 

- Photocopy of Discharge summary including the complete medical history of the patient along with other details. 

- Photocopy of Investigation reports including Insured Person’s Test Reports from Authorized diagnostic centre for COVID. 

- NEFT Details (to enable direct credit of claim amount in the bank account) and canceled cheque 

- KYC (Identity proof with Address) of the proposer, where claim liability is above Rs 1 Lakh as per AML Guidelines

- Legal heir/succession certificate, wherever applicable

- Any other relevant document required by Company/TPA for assessment of the claim. 

Also Read: Impact of Coronavirus on Economy and Finance

CORONA KAVACH POLICY:

Corona Kavach Policy is an affordable health insurance policy that safeguards your entire family against hospitalization expenses due to COVID-19.It’s a need-based short term indemnity health cover for COVID-19 pandemic.

Snapshot of the Policy

• Product Type: Individual / Floater
• Category of Cover: The Base Cover is on indemnity basis and Optional Cover is on Benefit Basis.
• Sum Insured: Rs 50,000/- (Fifty Thousand) to 5,00,000/- (Five Lakh) (in the multiples of fifty thousand)

-On Individual basis – SI shall apply to each individual family member

-On Floater basis – SI shall apply to the entire family

• Policy Period: Three and Half Months (3 1⁄2 months), Six and Half Months (6 1⁄2 months), Nine and Half Months (9 1⁄2 months) including waiting period.
• Eligibility: Policy can be availed by persons between the age of 18 years up to 65 years as Proposer. Proposer with higher age can obtain policy for family, without covering self.

Policy can be availed for Self and the following family members –

1. Legally wedded spouse
2. Parents and Parents in law
3. Dependent children (i.e Natural or legally adopted) between the day 1 of age to 25 years. If the child above 18 years of age is financially independent, he or she shall be ineligible.

• Hospitalization Expenses: Medical Expenses of Hospitalization for Covid for a minimum period of 24 consecutive hours only shall be admissible.

- Room Rent, Boarding, Nursing Expenses as provided by the Hospital / Nursing Home. Intensive Care Unit (ICU) /Intensive Cardiac Care Unit (ICCU) expenses. 

- Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialist Fees whether paid directly to the treating doctor/surgeon or to the hospital 

- Anesthesia, blood, oxygen, operation theatre charges, surgical appliances, ventilator charges, medicines and drugs, costs towards diagnostics, diagnostic imaging modalities, PPE Kit, gloves, mask, and such similar other expenses.

- Road Ambulance subject to a maximum of Rs.2000/- per hospitalization for the Ambulance services offered by a Hospital or by an Ambulance service provider, provided that the Ambulance is availed only in relation to Covid Hospitalization for which the insurer has accepted a claim under section This also includes the cost of the transportation of the Insured Person from a Hospital to the another Hospital as prescribed by a Medical Practitioner. 

• Pre Hospitalisation: For 15 days prior to the date of hospitalization/home care treatment
• Post Hospitalisation: For 30 days from the date of discharge from the hospital/completion of home care treatment
• Sub Limits: 

-Hospital Daily Cash: 0.5% of Sum Insured per day subject to a maximum of 15 days in a policy period for every insured member

-Home care treatment: Maximum up to 14 days per incident

• AYUSH: Medical Expenses incurred for Inpatient Care treatment for Covid under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems of medicines shall be covered upto sum insured during the Policy period as specified in the policy schedule. Medical expenses incurred for inpatient care treatment for Covid on Positive diagnosis of COVID at any AYUSH Hospital.
• Home Care Treatment expenses: this benefit, the following shall be covered if prescribed by the treating medical practitioner and is related to the 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

• Hospital Daily Cash: Insurer shall pay the Insured Person 0.5% of sum insured per day for each 24 hours of continuous hospitalization for which the Company has accepted a claim under Covid Hospitalization Cover. The benefit shall be payable maximum up to 15 days during a policy period in respect of every insured person.
• Pre Medical Insurance Examination: 

-No pre-insurance medical examination test is required, irrespective of the sum insured and age of the insured.

-Underwriting loading on the standard premium rates will be applicable based on health status of the proposed Insured person. It will take into consideration the adverse health conditions declared on the proposal form.

• Exclusions:

- Any claim in relation to Covid where it has been diagnosed prior to Policy Start Date.

- Admission primarily for investigation & evaluation

- Day Care treatment and OPD treatment

- Expenses related to any unproven treatment, services and supplies for or in connection with any treatment.

- Inoculation/Vaccination

- Diagnosis /Treatment outside the geographical limits of India Testing done at a Diagnostic centre which is not authorized by the Government shall not be recognized under this Policy Expenses related to any unproven treatment, services and supplies for or in connection with any treatment.

• Claim Procedure

Claims under this policy can be made cashless or reimbursement basis. The procedure is as follows – 

Procedure for Cashless claims: 

(i)Treatment may be taken in a network provider and is subject to pre-authorization by the Company or its authorized TPA. 

(ii) Cashless request form available with the network provider and TPA shall be completed and sent to the Company/TPA for authorization.

(iii) The Company/ TPA upon getting a cashless request form and related medical information from the insured person/ network provider will issue a pre-authorization letter to the hospital after verification. 

(iv) At the time of discharge, the insured person has to verify and sign the discharge papers, pay for non-medical and inadmissible expenses. 

(v) The Company / TPA reserves the right to deny pre-authorization in case the insured person is unable to provide the relevant medical details. 

(vi) In case of denial of cashless access, the insured person may obtain the treatment as per treating doctor’s advice and submit the claim documents to the Company / TPA for reimbursement. 

Procedure for reimbursement of claims:

For reimbursement of claims the insured person may submit the necessary documents to TPA (if applicable)/Company within the prescribed time limit as specified hereunder. 

1. Reimbursement of hospitalization and pre-hospitalization expenses - Within thirty days of the date of discharge from hospital

2. Reimbursement of post-hospitalization expenses - Within fifteen days from completion of post-hospitalization treatment 

3. Reimbursement of Home Care expenses - Within thirty days from completion of home care treatment.

• Claim Payment

- Insurer shall make payment in Indian Rupees and In India only

- The total amount payable in respect of Base and Optional covers are limited to 100% of the Sum Insured during a policy period.

• Documentation for claim: The claim is to be supported with the following documents and submitted within the prescribed time limit.
• Covid Hospitalization Cover:

i. Duly filled and signed Claim Form

ii. Photo Copy of Insured Person’s passport, if available (All pages)

iii. Photo Copy of Photo Identity proof of the patient (if insured person does not own a passport)

iv. Medical practitioner’s prescription advising admission

v. Original bills with itemized break-up

vi. Original Payment receipts

vii. Original Discharge summary including complete medical history of the patient along with other details.

viii. Original Investigation reports including Insured Person’s test reports from Authorized diagnostic centre for COVID

ix. OT notes or Surgeon’s certificate giving details of the operation performed, wherever applicable

x. Sticker/Invoice of the Implants, wherever applicable.

xi. NEFT Details (to enable direct credit of claim amount in bank account) and cancelled cheque

xii. KYC (Identity proof with Address) of the proposer, where claim liability is above Rs 1 Lakh as per AML Guidelines

xiii. Legal heir/succession certificate, wherever applicable

xiv.Any other relevant document required by Company/TPA for assessment of the claim.

• Home Care treatment expenses 

i. Duly filled and signed Claim Form in original

ii. Copy of Insured Person’s passport, if available (All pages)

iii. Photo Identity proof of the patient (if insured person does not own a passport)

iv. Medical practitioners’ prescription advising hospitalization in original

v. A certificate from a medical practitioner advising treatment at home or consent from the insured person on availing home care benefit.

vi. Original Discharge Certificate from medical practitioner specifying date of start and completion of home care treatment.

vii. Original Daily monitoring chart including records of treatment administered duly signed by the treating doctor is maintained.

Cost wise: 

Premium rates for Corona Kavach Health Insurance Plan are very low and affordable due to its shorter tenure. The coverage and features are standard across all insurance companies but the premiums vary from insurer to insurer. Following is a sample premium rate chart for a person aged 35 yrs and sum insured Rs.5 lacs with different tenures –

Premium rates for Corona Rakshak Health Insurance Plan

Similar to Corona Kavach, Corona Rakshak also has a standard coverage across all insurers but the premium rates vary. The premiums of different insurance companies are given below considering a sum insured of INR 2.5 lakhs and an age of 35 years 

Difference between Corona Rakshak and Corona Kavach Policy:

Though both Corona Kavach insurance and Corona Rakshak plan are standard health plans offered solely for covering the medical costs incurred due to Coronavirus infection, both these plans are different. Here is a table showing the comparative difference between the two –

Both these policies are suitable for your short term coverage needs against COVID infection. If you already have an existing indemnity health plan, remember that the plan would not cover the cost of consumables in case of COVID hospitalization. Since the cost of consumables would be high, you can buy Corona Kavach insurance which covers all possible costs incurred if you are hospitalized due to COVID. In fact, the COVID Kavach insurance plan also covers home treatment expenses thereby allowing you coverage for home quarantine too. While your normal health plan might not provide coverage for home treatments, the Corona Kavach insurance policy would and it would cover all possible costs incurred in treating you. The premiums are also quite low making the plan all the more feasible.

When it comes to the Corona Rakshak health insurance plan, it gives you a lump sum benefit on hospitalization for 72 hours or more. This benefit would help you meet the non-medical financial costs which you might suffer if you are tested positive for COVID. The plan, therefore, acts as a supplemental coverage which you can opt for if you have an existing indemnity policy. The lump-sum benefit paid under the plan can be used to pay for the cost of consumables which are excluded from the claim of your normal health plan.

More Information:

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