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IRDAI's fresh guidelines: Now Ayush treatment, home care under COVID-19 health policy

Considering a rapid rise in coronavirus cases in India, the IRDA has mandated insurers to offer individual COVID-19 health policies to people; all insurers must provide one basic mandatory cover, says the insurance regulator

twitter-logoBusinessToday.In | June 27, 2020 | Updated 16:42 IST
IRDAI's fresh guidelines: Now Ayush treatment, home care under COVID-19 health policy
General and health insurers must ensure that the product (health care cover) is compulsorily offered on or before 10th July, 2020.

The Insurance Regulatory and Development Authority (IRDAI), under its latest guidelines for standard COVID-19 health policy, has included home care and Ayush treatment under the standard health policy. Considering a rapid rise in coronavirus cases in India, the IRDA has mandated all general and health insurers to offer individual COVID-19 health policies to people.

Under Section 34 (1) (a) of Insurance Act, 1938, the IRDA has said that all general and health insurers must provide one basic mandatory cover. "One Optional Cover specified in these Guidelines shall be offered along with the COVID Standard Health Policy within the sum insured," the IRDAI said.

Insurers can determine the price keeping in view the covers proposed to be offered. The base cover of COVID Standard Health Policy should be offered on the indemnity basis, whereas optional cover shall be made available on a benefit basis.

The COVID Standard Health Policy shall offer a policy tenure of three and half months; six and half months; and nine and half months, including waiting period.

Also read: No rejection of claim if your health insurance plan is 8 years old

As per the IRDAI guidelines, the base cover under COVID standard health policy shall offer the following:

COVID Hospitalisation Expenses: The hospitalisation expense incurred by the insured person for the treatment of COVID on positive diagnosis in a government authorised diagnostic centre can be covered under the policy. The scheme should cover room, boarding, nursing expenses provided by the hospital or nursing

home. It should also include surgeon, anaesthetist, medical practitioner, consultants, specialist fees (including consultation through telemedicine). 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 other similar expenses also included in the base cover. Intensive Care Unit or Intensive Cardiac Care Unit expenses and expenses incurred on road ambulance up to Rs 2,000 per hospitalisation can also be covered under the base cover.

Home Care Treatment Expenses: The insurer will cover the costs of treatment of COVID incurred by the insured person on availing treatment at home maximum up to 14 days, provided the person is advised to get treatment at home by doctors. Other conditions are constant monitoring of the health status by doctors

every day; daily monitoring chart including records of treatment is maintained; and cashless or reimbursement facility is offered under homecare expenses. In case the insured person intends to avail the services of a non-network provider, the claim shall be subject to reimbursement, prior approval from the insurer needs to be taken before availing such services, the guidelines suggest.

Also read: New-look Health Plans

AYUSH Treatment: The medical expenses incurred on hospitalisation under AYUSH systems of medicine for the treatment in a government authorised diagnostic centre shall be covered up to the sum insured without any sub-limits.

Pre-hospitalisation: Pre-hospitalisation medical expenses incurred for a period of 15 days prior to the date of hospitalisation or home care treatment following an admissible claim under this policy shall be covered. Pre-hospitalisation expenses shall also cover the costs of diagnostics towards Covid-19.

Post-hospitalisation: Post-hospitalisation medical expenses incurred for a period of 30 days from the date of discharge from the hospital/completion of home care treatment, following an admissible claim under this policy shall be covered.

No deductibles are permitted in this product: The policy shall include the cost of treatment for any comorbid condition including pre-existing comorbid condition (s) along with the treatment for COVID.

Also read: Coronavirus crisis: IRDAI allows insurers to offer short-term health policies for COVID-19

Optional cover: The company will pay 0.5 per cent of the sum insured per day for every 24 hours of continuous hospitalisation for treatment of Covid-19 following an admissible hospitalisation claim under this policy.

The benefit shall be payable maximum up to 15 days during a policy period in respect of every insured person.

Other guidelines: The COVID Standard Health Policy shall be offered on a family floater basis also. The minimum sum insured under COVID Standard Health Policy shall be Rs 50,000 and maximum limit shall be Rs 5,00,000.

Minimum entry age will be 18 years for principal insured and maximum age at entry shall not be less than 65 years for all the insured members including principal insured. As per the IRDAI, the nomenclature of the product shall be Corona Kavach Policy, succeeded by name of insurance company, (Corona Kavach Policy). No other name is allowed in any of the documents. General and health insurers must ensure that the product (health care cover) is compulsorily offered on or before 10th July, 2020.

Also read: Coronavirus loan moratorium - how to pause, continue or get refund for EMIs

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