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Health Insurance: Do you have health cover for Covid treatment?

10-May-2021

Given the severity of the Covid-19 pandemic, it is of utmost priority to buy a health insurance cover, renew and review the existing policy, take a top-up cover and keep in mind the fine print of the policy regarding waiting period, exclusions and rejection of claims. A health insurance policy, including short-term Covid specific covers—Corona Kavach and Corona Rakshak—will not only ensure financial protection in case of a medical emergency due to Covid but will also give peace of mind to the policyholder and his dependents.

Health covers: Various options
While it is ideal to have a comprehensive health insurance cover, one can opt for standard health insurance policy or a short-term Covid specific cover. The standard health insurance Arogya Sanjeevani is offered by all general and standalone health insurance companies. The minimum entry age is 18 years and the maximum is 65 years and the policy can be renewed for life. In this policy, the maximum coverage is up to Rs 5 lakh and it has a sub-limit on the room rent. It covers hospitalisation costs for Covid treatment.

Corona Kavach Policy, an indemnity-based plan, covers hospitalisation, pre-post hospitalisation, home care treatment expenses and Ayush treatment for Covid patients. All hospitalisation expenses such as personal protection equipment (PPE) kits, oxygen, ventilators, and consultation fees will be covered. It also covers home care expenses. Pre and post hospitalisation expenses—15 days before hospitalisation and up to 30 days after discharge— are also covered. One can buy it for a period of 3.5 months, 6.5 months or 9.5 months and can renew it. The sum insured is Rs 50,000-Rs 5 lakh. A policyholder can opt for cashless claim at a network hospital or reimbursement claims at a non-network hospital.

Corona Rakshak Health Insurance Plan, a benefit-based plan, offers a lump sum payout if you require hospitalisation for Covid. The lump sum payout can be used to meet the medical needs. The sum insured is Rs 50,000-Rs 2.5 lakh. The period of the coverage will be for 3.5 months, 6.6 months and 9.5 months.

Experts say the lump sum received under Corona Rakshak can be used to pay for consumables such as PPE kits which are usually not covered in a standard health insurance plan. While Corona Rakshak Policy offers individual coverage, Corona Kavach Policy has a family floater plan. Given the increasing medical costs, go for a comprehensive health insurance cover, review the sum assured based on family’s medical needs and buy a top-up cover.

In any regular health insurance policy, look for any clause of sub-limits or co-payments as many insurers impose certain restrictions to keep the premium low. For instance, if there is a sub-limit of 1% of the sum insured on room rent in case of hospitalisation, then for a sum insured of Rs 10 lakh, you can claim a maximum of Rs 10,000 towards room rent. Also look at plans with no such sub-limits.

Waiting periods & claim rejection
In a regular health insurance policy, Covid hospitalisation is covered after 30 days of the initial waiting period. For short-term Covid specific covers, waiting period is 15 days. So, no Covid claims made within the waiting period will be cleared.

While Covid is not covered under day care treatment, you can claim money if hospitalised. One can even go for claims if quarantined and treated at home, provided it is payable under the policy’s terms and conditions. As hospitalisation is not required for mild Covid, insurers can reject the claim if hospitalisation was not done according to the ICMR/AIIMS clinical norms. Take consent from the insurance company through the third-party administrator for Covid-related hospitalisation in case of moderate to severe disease.

While insurers have to communicate cashless approvals within 60 minutes of receipt of authorisation request along with other details from the hospital, for reimbursement claims one must ensure that the claims form include discharge summaries, test reports, bills, prescriptions, etc., for faster claims payment.

Source : Financial Express

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