■ Introduction
In the wake of the global pandemic outbreak of COVID-19, which is one of the greatest challenges that humanity has faced, General Insurance Company introduces an affordable health insurance policy, Corona Kavach, to take care of your expenses at the time of hospitalization for COVID-19 treatment. Now you don’t ever have to worry about not having enough money for treatment in case things go wrong.
■ What is the Sum Insured options available under the policy?
50,000 / 1 Lac / 1.5 Lac / 2 Lac / 2.5 Lac / 3 Lac / 3.5 Lac / 4 Lac / 4.5 Lac / 5 Lac
■ What is the entry age?
• Proposer /legally wedded Spouse /Parents/ Parents In law: 18 yrs to 65 years
• Dependent Children: Day 1– 25 yrs
■ What is the Policy Period?
3 ½ Month / 6 ½ Month / 9 ½ Month
■ Is this a floater policy / individual policy?
• Policy provides Individual as well as Floater sum insured options.
■ Who can be covered under Corona Kavach Policy?
• Self, legally wedded Spouse, Dependent Children, Parents, Parents In laws can be covered Under Corona Kavach Policy
■ Base Cover
1. Covid Hospitalization Cover
The Company shall indemnify medical expenses incurred for Hospitalization of the Insured Person during the Policy period for the treatment of Covid on Positive diagnosis of Covid in a government authorized diagnostic centre including the expenses incurred on treatment of any comorbidity along with the treatment for Covid up to the Sum Insured specified in the policy schedule, for,
I. Room Rent, Boarding, Nursing Expenses as provided by the Hospital/ Nursing Home.
II. Intensive Care Unit (ICU) I Intensive Cardiac Care Unit (lCCU) expenses.
III. Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialist Fees whether paid directly to the treating doctor, surgeon or to the hospital
IV. Anaesthesia, 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
V. 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 Company 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.
Note:
I. Expenses of Hospitalization for a minimum period of 24 consecutive hours only shall be admissible.
2. Home Care Treatment Expenses:
Home Care Treatment means Treatment availed by the Insured Person at home for Covid on positive diagnosis of Covid in a Government authorized diagnostic Centre, which in normal course would require care and treatment at a hospital but is actually taken at home maximum up to 14 days per incident provided that:
a. The Medical practitioner advices the Insured person to undergo treatment at home.
b. There is a continuous active line of treatment with monitoring of the health status by a medical practitioner for each day through the duration of the home care treatment.
c. Daily monitoring chart including records of treatment administered duly signed by the treating doctor is maintained.
d. Insured shall be permitted to avail the services as prescribed by the medical practitioner. Cashless or reimbursement facility shall be offered under homecare expenses subject to claim settlement policy disclosed in the website.
e. In case the insured intends to avail the services of non-network provider claim shall be subject to reimbursement, a prior approval from the Insurer needs to be taken before availing such services.
ln this benefit, the following shall be covered if prescribed by the treating medical practitioner and is related to treatment of Covid,
a. Diagnostic tests undergone at home or at diagnostics centre
b. Medicines prescribed in writing
c. Consultation charges of the medical practitioner
d. Nursing charges related to medical staff
e. Medical procedures limited to parenteral administration of medicines
f. Cost of Pulse oximeter, Oxygen cylinder and Nebulizer
3. AYUSH Treatment
The Company shall indemnify medical expenses incurred for inpatient care treatment for Covid on Positive diagnosis of COVID test in a government authorized diagnostic centre including the expenses incurred on treatment of any comorbidity along with the treatment for Covid under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems of medicines during the Policy Period up to the limit of sum insured as specified in the policy schedule in any AYUSH Hospital.
Covered expenses shall be as specified under Covid Hospitalization Expenses, Point 1.
4. Pre Hospitalization
The company shall indemnify pre-hospitalization/home care treatment medical expenses incurred, related to an admissible hospitalization/home care treatment, for a fixed period of 15 days prior to the date of admissible hospitalization/home care treatment covered under the policy.
5. Post Hospitalization
The company shall indemnify post hospitalization//home care treatment medical expenses incurred, related to an admissible home care treatment, for a fixed period of 30 days from the date of discharge from the hospital, following an admissible hospitalization covered under the policy.
The expenses that are not covered in this policy are placed under List-I of Annexure-A. The list of expenses that are to be subsumed into room charges, or procedure charges or costs of treatment are placed under List-II, List- Ill and List-IV of Annexure-A respectively.
■ Optional Cover
The cover listed below is Optional Policy benefit and shall be available to Insured Persons in accordance with the terms set out in the Policy, if the listed cover is opted
1. Hospital Daily Cash
The Company 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 Point 1 Hospitalization Cover.
The benefit shall be payable maximum up to 15 days during a policy period in respect of every insured person.
The total amount payable in respect of Base Covers 1 to 5 and Optional Cover 1, shall not exceed 100% of the Sum Insured during a policy period.
■ What are the Sub-limits under the Sum Insured?
• Hospital Daily Cash: 0.5% of Sum Insured Per day subject to maximum of 15 days in a policy period for every insured member
• Home care treatment: Maximum upto 14 days per incident
■ Cancellation
The Company may cancel the Policy at any time on grounds of mis-representation, non-disclosure of material facts, fraud by the Insured Person, by giving 7 days’ written notice. There would be no refund of premium on cancellation on grounds of mis-representation, non-disclosure of material facts or fraud.
■ What are the Waiting Period & exclusions under the policy?
The Company shall not be liable to make any payment under the policy in connection with or in respect of expenses related to the treatment of Covid within 15 days from the policy commencement date.
■ Exclusions
The Company shall not be liable to make any payment under the policy, in respect of any expenses incurred in connection with or in respect of:
i. Investigation & Evaluation (Code- Excl 04)
Expenses related to any admission primarily for diagnostics and evaluation purposes. Any diagnostic expenses which are not related or not incidental to the current diagnosis and treatment
ii. Rest Cure, rehabilitation and respite care (Code- Exc 05)
Expenses related to any admission primarily for enforced bed rest and not for receiving treatment. This also includes:
I. Custodial care either at home or in a nursing facility for personal care such as help with activities of daily living such as bathing, dressing, moving around either by skilled nurses or assistant or non-skilled persons.
II. Any services for people who are terminally ill to address physical, social, emotional and spiritual needs.
iii. Dietary supplements and substances that can be purchased without prescription, including but not limited to Vitamins, minerals and organic substances u n less prescribed by a medical practitioner as part of hospitalization claim or Home care treatment.
iv. Unproven Treatments:
Expenses related to any unproven treatment, services and supplies for or in connection with any treatment. Unproven treatments are treatments, procedures or supplies that lack significant medical documentation to support their effectiveness. However, treatment authorized by the government for the treatment of COVID shall be covered.
v. Any claim in relation to Covid where it has been diagnosed prior to Policy Start Date.
vi. Any expenses incurred on Day Care treatment and OPD treatment
vii. Diagnosis /Treatment outside the geographical limits of India
viii. Testing done at a Diagnostic centre which is not authorized by the Government shall not be recognized under this Policy
ix. All covers under this Policy shall cease if the Insured Person travels to any country placed under travel restriction by the Government of India.
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