Month: June 2020

The Coronavirus pandemic is spreading despite the various efforts taken by the Government and the health department. More and more individuals are getting infected even as the lockdown curbs are easing in many parts of the country. If you read the newspapers or watch the news, you would know that the numbers have crossed 3.5 million and they are rising everyday!!

The infection is resulting in hospitalisation and, in certain cases, even death. In case of hospitalisation in a Government hospital, the charges are minimal or even nil. But if you seek hospitalisation in a private hospital, be prepared to face huge costs. Private hospitalisation is expensive and the costs are considerably high making it difficult for an average man to bear. This is where you can call on your health insurance plans. The plans cover the hospitalisation expenses incurred due to COVID infection thereby helping you financially. Moreover, in case of death of an individual, life insurance plans provide the much needed financial assistance to the deceased’s family. 

Because insurance can play an important role in tackling the financial implication of this pandemic, the Insurance Regulatory and Development Authority of India (IRDAI) has issued various guidelines for health insurance companies. These guidelines have been issued in the interests of policyholders so that their health insurance plans can come to their rescue in case of COVID related claims. Here’s what the guidelines say –

For health insurance claims which cover hospitalisation expenses –

• If the health insurance policy covers hospitalisation, insurance companies should settle COVID-related claims of hospitalisation quickly
• The medical costs incurred by policyholders during hospitalisation due to the virus and also during the quarantine period should be settled as per the terms and conditions of the policy. Moreover, the settlement should be in compliance with the regulatory framework. In case of home quarantine however, claims would not be admissible.
• If a claim is being rejected or repudiated, the claim should be thoroughly reviewed by the claim review committee of the insurance company before such rejection or repudiation

Health insurance companies are also encouraged to offer COVID specific health insurance policies which would cover the treatment costs of the virus effectively.

The guidelines were issued by the IRDAI on 4th March 2020 under the provisions of Section 14(2)(e) of the IRDA Act, 1999 and they came into force immediately.

Though there were no specific guidelines for life insurance companies, they were urged by IRDAI to handle their death claims in an expeditious manner so that the family of the policyholders can get claim settlements as quickly as possible. 

These guidelines are proving beneficial for policyholders who are facing the threat of COVID infection. They are being able to make claims in their policies easily. You should also know these guidelines so that you know what to expect from your health insurance plans and how to handle your claims in case of an emergency.

Health insurance claim settlements can prove to be a challenge if the health insurance company contests the claims and rejects or repudiates it. After all, with the policy promising assistance in a medical contingency, claim rejection can be a nightmare!! In such cases, policyholders face huge medical costs and might suffer a financial strain. To safeguard your and other policyholders’ interests, the Insurance Regulatory and Development Authority of India (IRDAI) has, therefore, issued fresh guidelines with regards to health insurance claim settlements. These guidelines are aimed to standardize health insurance terms and conditions and to simplify them for the common man. Let’s find out what IRDAI guidelines state –

IRDAI guidelines on health insurance claim settlements 

According to the latest guidelines issued by the IRDAI, health insurance companies will not be allowed to challenge claims in a policy where premiums for eight continuous years have been paid. Thus, in simpler terms, if you have a health insurance policy which has been continuing non-stop for the last 8 years or above and you have paid regular premiums under the policy, your claims would be settled easily. The insurance company would not be able to challenge claims on such policies given the tenure for which the policy has been in existence. 

The other points highlighted in the guidelines are as follows –

• Any health insurance policy which does not comply with this new guideline would be modified from 1st April 2021 as and when they are up for renewal. This means that on renewals after 1st April 2021, all health insurance policies would have to comply with the new guidelines.
• The eight years specified in the guideline would be called the moratorium period. During this moratorium period, health insurance companies can judge whether the claims that you make are genuine or not. However, when this trial period is over, health claims cannot be challenged and the contestability clause would be revoked.
• The moratorium period would apply to the sum insured originally chosen by the policyholder. If, however, the sum insured is increased, an additional moratorium period would be applicable to the enhanced amount. For instance, if you buy a health plan of INR 5 lakhs on 1st June 2020, the moratorium period would end on 1st June 2028. However, if the sum insured is enhanced to INR 8 lakhs on 1st June 2022, a moratorium on INR 5 lakhs would end on 1st June 2028 but a moratorium on INR 3 lakhs would end on 1st June 2030.
• Claims would be allowed to be contested only in cases of frauds which the company would have to prove and in the case when a medical cost is specifically excluded from coverage in the policy contract. In the case of frauds, misrepresentation or non-disclosure of material facts, the policy would be considered null and void and the premiums paid by the policyholder would be forfeited by the insurance company
• Any sub-limits or co-payments applicable under the health insurance policy would continue to apply
• The new guideline would apply only to indemnity oriented health insurance plans which cover the actual cost of hospitalisation
• Health insurance companies would have to settle or reject their claims within 30 days of receiving all claim-related documents. If there is any delay in claim settlement, the insurance company would be liable to pay interest on such delay. The interest payable would be calculated @ bank rate + 2%.
• Even in the case of portability, the moratorium period would be applicable on the ported policies from the date the policy was first bought. For instance, if you buy a policy on 1st June 2020, the moratorium period would end on 1st June 2028 irrespective of the number of times you port the policy to another insurance company.

Impact of the guidelines

IRDAI has issued these guidelines to simplify the claim process of health insurance plans and to protect policyholders from the fear of claim rejections in their existing health insurance plans. With these guidelines, the claim related terms and conditions of health insurance policies would be simplified for the common man and you can expect quick and easy settlement of your health insurance claims.

So, in a nutshell, this move by the insurance regulator would ease your claim settlement process. You would not have to lose your sleep on health insurance claims once eight years have passed. Your claims would be settled easily and quickly.

The IRDAI is the insurance regulator which makes necessary changes and regulations in the interest of policyholders. This guideline is also aimed in the best interest of policyholders and would definitely give you an advantage in your health insurance claims.

The recent Coronavirus pandemic has gripped the world in its clutches and there seems to be no relief in sight. The infection is spreading across the world and more and more people are getting infected and being hospitalized for treatment. In case of hospitalization, considerable costs are incurred and many of you might find such costs unaffordable. This is where you seek out a health insurance policy to cover the hospitalization costs incurred on COVID. But do you know whether the health insurance policy would cover the relevant expenses incurred on COVID?

Insurance is a technical concept and you need to know the terms and conditions of your policy to know the coverage that you can expect from your policy. In recent times, given the spread of COVID, health insurance companies have launched COVID insurance plans. These plans are disease-specific policies that help in covering the medical costs and other financial obligations suffered due to Coronavirus. Moreover, the Insurance Regulatory and Development Authority of India (IRDAI) has ensured that your regular health insurance policies would also cover the medical costs of the COVID pandemic. So, COVID insurance has become a reality but there are various questions attached to it. Existing policyholders as well as individuals considering investing in a COVID insurance policy have some queries with regards to the Coronavirus insurance coverage that they can expect. So, let’s answer some common questions about COVID health insurance and simplify the coverage for you –

Commonly asked questions about COVID insurance in India

1. Is the COVID-19 claim payable under my health insurance policy?

   Thanks to the guidelines issued by the IRDAI, all health insurance policies cover hospitalization costs incurred due to Coronavirus. So, if you have an existing health insurance plan and you are hospitalized after being tested positive for the virus, the associated costs of such hospitalization would be covered under your health insurance policy. Moreover, if you are under quarantine and you undergo medical treatments, the costs of such treatments would also be covered under the plan.

2. What is the waiting period for a COVID-19 insurance claim?

   If you have an existing health insurance policy, there would be no waiting period for COVID-19 claims. However, if you buy a new indemnity health insurance plan or a new COVID insurance policy, there might be an initial waiting period of 30 days to 90 days, depending on the policy’s terms and conditions, during which COVID-19 claims would not be admissible. In some plans, the waiting period can be only for 15 days after which COVID-related claims are fully covered. If you are tested positive for the virus and are hospitalized during this initial waiting period, the claim would not be paid. 

3. Can the hospital quarantine expenses due to COVID-19 be claimed?

   The guideline for coverage of quarantine expenses was also issued by the IRDAI. According to such guidelines, if you are quarantined for COVID and you undergo medical expenses at a registered medical facility such expenses would be reimbursed by the health insurance policy. The point to note here is that the expenses which would be covered should be medical in nature and should relate to the treatments taken during such quarantine. Any other ancillary expenses which are not related to medical treatments would not be covered.

4. Can expenses due to quarantine because of COVID – 19 at home be claimed?

   If you are quarantined at your own home for COVID-19, expenses incurred on medical assistance would not be admissible in a normal indemnity-oriented health insurance plan. The health insurance plan covers hospitalization-related expenses and since home quarantine does not involve hospitalization, no coverage is allowed under the policy. However, if you buy a COVID insurance scheme that specifically covers Coronavirus, you get a lump sum benefit if you are tested positive for the virus. This lump sum benefit is payable whether you are hospitalized or you are quarantined at home.

5. Is cashless treatment possible for COVID-19 in a government hospital?

   Cashless treatments under health insurance plans are allowed if you get treated in a hospital that is tied up with the insurance company. So, if the Government hospital is a networked hospital, you can avail cashless treatments for COVID-19. However, if the hospital is not tied-up with your insurance provider, claims would be settled on a reimbursement basis. You would have to bear your medical costs initially and after discharge from the hospital, the medical bills should be submitted to the health insurance company for reimbursement of the costs incurred.

6. What is the approximate cost of treatment of COVID-19 infection?

   The cost of treating COVID-19 is not standardized. It depends on the hospital’s pricing policies, age of the patient, co-morbidities, severity of the infection, etc. In the initial stages, if you can get treated in the general ward, the expenses are lower. However, for severe complications, an ICU and a ventilator are a must which adds to the cost. Basically, considering the doctor’s fee, consumables, room rent, cost of medical tests, and treatment costs, the average daily cost of hospitalization in a private hospital can range between INR 20,000 to INR 25,000. If ICU and ventilator are added to this equation, the cost shoots up to INR 50,000 to even a lakh. So, a 10-day stay in the hospital easily amounts to lakhs and you need sufficient health insurance coverage at your disposal to meet such considerable costs. 

7. Are specialized COVID insurance plans and normal health plans differ from one another?

   Given the rising threat of the Coronavirus pandemic, many health insurance companies have launched COVID-specific health insurance policies to cover the disease. These health insurance plans are different from the normal health insurance plans which are available in the market. Discussed below are the differences between the two –

   COVID insurance policy	Normal health insurance policy
   This is a fixed benefit health insurance plan which pays a lump sum benefit if you test positive for Coronavirus	This is an indemnity oriented health insurance plan which covers the cost of hospitalisation and medical treatments only when you are hospitalised for Coronavirus infection
   The total sum insured is paid in lump sum as claim	The claim amount depends on the actual medical costs incurred on COVID treatment
   Any financial liability can be met with the benefit received from the COVID insurance scheme	The claim payable under the policy is only for the medical costs incurred on COVID treatment
   The policy does not cover any other medical contingency which you might suffer	A normal health insurance policy offers a wide scope of coverage and covers other illnesses and injuries besides COVID which requires hospitalisation

Thus, both COVID insurance plans and normal health insurance plans are different from one another and should not be considered the same.

Best health insurance plans for COVID

Given the requirement of insurance coverage for meeting the costs of COVID treatments, health insurance plans with COVID coverage have become essential. Here are some of the best plans which provide Coronavirus insurance coverage under their scope of coverage –

COVID specific health plans

These plans are specially designed to cover Coronavirus and pay a claim if you test positive for the virus and undergo treatments. These plans are fixed benefit plans which pay the sum insured in a lump sum on diagnosis of COVID. Some of the best COVID insurance plans are as follows –

1. Star Novel Coronavirus Insurance Policy 

   A fixed benefit plan offered by Star Health, the policy has a waiting period of 16 days. No pre-entrance health check-ups are needed to buy the plan and two coverage levels are allowed – INR 21,000 and INR 42,000. You can add family members to the coverage but the sum insured would be allowed on an individual basis only. The lump-sum benefit is paid if you test positive for COVID and are hospitalized for treatments.

2. Corona Rakshak

   Another fixed benefit policy, is standardized coverage for the COVID pandemic which has been mandated by the IRDAI (Insurance Regulatory and Development Authority of India) to provide policyholders with customized coverage for COVID. The policy pays a lump sum benefit if you are hospitalized for 72 hours or more due to COVID. The sum insured available ranges between INR 50,000 to INR 2.5 lakhs. If you are aged between 18 and 65 years, you can buy the policy. The coverage tenure is 3.5 months, 6.5 months, and 9.5 months.

3. Corona Kavach 

   Corona Kavach is also a standardized COVID insurance policy that was introduced along with Corona Rakshak as per the mandate issued by the IRDAI. The policy is an indemnity-oriented health insurance plan which covers hospitalizations due to COVID. If you suffer from COVID and are hospitalized for 24 hours or more, the policy would cover the medical costs incurred. Corona Rakshak covers all types of medical costs incurred on hospitalization without any deduction for consumables, deductibles, or co-payment. The sum insured ranges from INR 50,000 to INR 5 lakhs and the coverage tenures available are 3.5 months, 6.5 months, and 9.5 months.

Comprehensive health insurance plans – 

While the above-mentioned plans cover only COVID, the comprehensive health insurance plans are those which cover other medical contingencies too and have a wider scope of coverage. Some of the leading health insurance plans which cover the hospitalization and treatment costs of Coronavirus are as follows –

1. HDFC ERGO Health Optima Restore

   A comprehensive health insurance policy, Optima Restore allows coverage up to INR 50 lakhs. The policy has restore benefit which restores the full sum insured during the policy year after a claim has been made. This allows you to avail of double coverage under the plan. Moreover, the multiplier benefit increases the coverage by 50% after each claim-free year without any additional premium. You can also get premium discounts if you take a specified number of steps within a policy year and stay healthy.

2. Religare Care

   A comprehensive health insurance policy offered by Religare, Care allows coverage up to INR 6 crores. The plan has a range of inbuilt coverage benefits and also allows a variety of optional add-ons which can be chosen to enhance your coverage. Free health check-ups are allowed every year and you can also enjoy international coverage under the Care Anywhere benefit available with the plan.

3. Star Comprehensive Insurance Policy 

   A popular family floater plan, the policy has no limit on the room rent in case of inpatient hospitalization. You can get coverage for air ambulance, domiciliary treatments, and a second medical opinion through the policy. Maternity expenses are also covered and you also get coverage for bariatric surgery which is a unique coverage feature of the plan. The policy has a wellness program too which motivates healthy living and allows premium discounts on maintaining a healthy lifestyle.

4. Manipal Cigna ProHealth Insurance 

   The ProHealth range of insurance plans offered by Manipal Cigna comes in different variants with staggering sum insured levels. You can, therefore, choose a variant as per your coverage requirement. The policy has the benefits of sum insured restoration, international coverage, maternity coverage, and annual health check-ups. You can opt for high sum insured levels too as the plan allows coverage up to INR 1 crore.

5. Max Bupa Health Premia:

   Health Premia is a newly launched health insurance plan offered by Max Bupa which boasts of some of the best coverage benefits. You can get coverage up to INR 3 crores under the policy and there are three variants of Silver, Gold, and Platinum. Sum insured restoration, international coverage, travel insurance coverage, health check-ups, etc. are some of the notable coverage benefits of the plan.

Here’s a quick look at these plans –

Name of the plan	Sum insured	Pre-existing waiting period	Salient features
HDFC ERGO Health Optima Restore	INR 3 lakhs – INR 50 lakhs	36 months	· Free e-opinion for critical illness · 100% restoration of the sum insured · Multiplier benefit doubles the sum insured within two claim-free years
Religare Care	INR 4 lakhs – INR 6 crores	48 months	· Range of add-ons to customize the plan · Free annual health check-ups · 100% sum insured restoration
Star Comprehensive Insurance Policy	INR 5 lakhs – INR 25 lakhs	48 months	· Air ambulance cover · OPD cover for medical consultations · Bariatric surgery is covered · Automatic restoration of sum insured
Manipal Cigna ProHealth Insurance	INR 2.5 lakhs – INR 1 crore	24-48 months depending on the plan variant selected	· Worldwide coverage in case of an emergency · OPD coverage through health maintenance benefit · Expert opinion in a critical illness
Max Bupa Health Premia	INR 5 lakhs to INR 3 crores	24 months	· Coverage for advanced new age treatments · International coverage available · Inbuilt coverage for travel insurance

So, take your pick from the above-mentioned health insurance plans to protect yourself from the financial implication of Coronavirus infection. If you have an existing health insurance policy, your policy would cover your hospitalization and treatment expenses which incur due to Coronavirus. However, you should ensure that the coverage level of your plan is sufficient. COVID-related hospitalization can amount to lakhs and a sufficient sum insured is needed to meet the medical costs sufficiently. If your coverage is low, enhance your coverage through another health plan or through a top-up plan. You can also buy a specific COVID insurance scheme to get a lump sum benefit in case of COVID infection. 

Assess your needs and then make an informed choice. Also know the coverage benefits of your health insurance policy so that you have clarity about raising a claim for Coronavirus.

A health insurance policy has become a necessary requirement in today’s times when medical costs have become too expensive to afford. The middle-class man finds himself in a financial crisis if a medical emergency strikes himself or his family members. Meeting the expensive medical costs puts a dent in his finances and a health insurance policy is needed to avoid this dent. 

Given the need for health insurance, people are increasingly becoming aware of the importance of having health insurance coverage and are investing in a comprehensive policy to cover their medical emergencies. However, insurance is a technical concept and each health insurance company promises to offer something better in its health insurance plan compared to its competitors. This confuses a layman in choosing a comprehensive yet affordable health insurance plan for himself and his family. Keeping this dilemma in view, the Insurance Regulatory and Development Authority of India (IRDAI) proposed a standard health insurance plan to be offered by all insurance companies. Therefore, in accordance with IRDAI’s proposal, the Arogya Sanjeevani health insurance policy was launched and currently, almost all insurance companies are offering the policy to individuals. Let’s understand what this policy is all about and its features –

What is the Arogya Sanjeevani policy?

The Arogya Sanjeevani health insurance plan is a standardized health insurance plan which offers uniform coverage benefits and has the same features across all insurance companies. The policy is an indemnity oriented health insurance plan which covers the medical costs incurred when you are hospitalised. Though all insurance companies offer the same uniform features and coverage benefits under the Arogya Sanjeevani policy, the premium of the policy is not the same across insurers. The premium is determined by the insurance company according to its pricing policies.

Salient features of Arogya Sanjeevani

The Arogya Sanjeevani plan is the first-ever standardized health insurance plan which is being offered in the Indian health insurance market. Here are some of the salient features of the policy which you should know about –

• The Arogya Sanjivani policy is issued for a tenure of one year after which you can renew it for continued coverage 
• The policy is offered both as an individual plan and a family floater plan
• There is a no claim bonus offered by the policy if you don’t make a claim in a policy year. The bonus is a 5% increase in the sum insured without any additional premium. This bonus is cumulative in nature and it continues increasing the sum insured for each subsequent claim-free year up to a maximum of 50% of the original sum insured.
• There is a waiting period of 4 years for pre-existing illnesses, joint replacement surgeries and age-related osteoporosis and osteoarthritis. For other specified illnesses, the waiting period is 2 years.
• The premium of the policy varies across insurers. It depends on your age, medical history, number of members covered and the sum insured chosen 
• No pre-entrance health check-ups are needed until 45 years of age

Eligibility criteria for Arogya Sanjivani

To be able to buy an Arogya Sanjeevani policy, the following eligibility criteria should be fulfilled –

Age criteria	Adults aged between 18 and 65 years can buy the plan Dependent children aged between 3 months and 25 years can be covered under the family floater variant Independent children aged 18 years and above cannot be covered under the family floater plan
Members covered	Individual plan – self  Family floater plan – self, spouse, dependent children, dependent parents, dependent parents-in-law
Sum insured	INR 1 lakh to INR 5 lakhs
Renewability	Lifelong renewability is allowed
Co-payment	5% of each and every claim amount

Coverage benefits of Arogya Sanjeevani plan

The Arogya Sanjeevani policy covers basic medical costs and also the costs incurred on new-age treatments in keeping with the development in medical science. The coverage benefits of the policy are as follows –

1. Pre and post hospitalisation expenses

   Expenses incurred before being hospitalised are called pre-hospitalisation expenses. Such expenses are covered for 30 days before hospitalisation. Similarly, post hospitalisation expenses are those which are incurred on recovery after you are discharged from the hospital. Such expenses are covered for up to 60 days after discharge. 

2. Inpatient hospitalisation 

   Inpatient hospitalisation expenses are those expenses which are incurred when you are hospitalised for 24 hours or more. These expenses include room rent, nurse’s fee, doctor’s fee, surgeon’s fee, blood, medicine, oxygen, etc. Such expenses are covered up to the sum insured. However, there is a sub-limit on room rent and ICU room rent. The limit on room rent is 2% of the sum insured subject to a maximum of INR 5,000 per day and for ICU room rent it is 5% of the sum insured subject to a maximum of INR 10,000 per day.

3. Ambulance expenses 

   The charges incurred in hiring an ambulance to take you to the hospital are covered under the policy. The maximum coverage limit is INR 2,000 per instance of hospitalisation.

4. Daycare treatments

   Treatments which do not require 24-hour hospitalisation due to advanced medical techniques are called daycare treatments. Such treatments are covered under the Arogya Sanjeevani plan for up to 50% of the sum insured.

5. AYUSH treatments

   Non-allopathic treatments like Ayurveda, Unani, Homeopathy and Siddha are covered under the policy for up to a specified limit of the sum insured.

6. Dental treatments and plastic surgery

   If due to an illness or injury, you are required to undergo dental treatments or plastic surgery, the cost of such treatments would be covered by the policy. Coverage would be allowed up to the sum insured of the plan.

7. Cataract treatment

   Treatment for cataract would be covered for up to 25% of the sum insured subject to a maximum of INR 40,000 per eye.

8. New age treatments

   To make the Arogya Sanjeevani policy suitable for the modern times, coverage for new-age treatments is extended under the scope of the plan. The coverage for such treatments is restricted to 50% of the sum insured. The treatments which fall under the category of new-age treatments and are covered by the plan include the following –

• Uterine Artery Embolization and High intensity focused ultrasound (HIFU)
• Balloon Sinuplasty 
• Deep Brain Stimulation
• Immunotherapy
• Oral Chemotherapy
• Vaporization of The Prostate
• Intra Operative Neuro Monitoring (IONM)
• Intravitreal Injections
• Stem cell therapy 
• Robotic surgeries
• Stereotactic Radio Surgeries
• Bronchial Thermoplasty

Exclusions under Arogya Sanjeevani

Although the scope of coverage of the Arogya Sanjeevani plan is quite extensive, the policy does have exclusions in which case claims are not paid. Common exclusions under the plan are as follows –

1. Diagnostic costs
2. Medical costs incurred due to activities which breached common law, participation in hazardous activities and due to substance abuse
3. Any type of cosmetic surgery or gender change treatments
4. Weight control treatments
5. Treatments for vision correction
6. Infertility treatments
7. Medical emergencies suffered due to war
8. Rehabilitation expenses
9. Maternity expenses
10. Expenses incurred on dietary supplements
11. Medical treatments taken outside India and the associated medical expenses

Sample premium rates of Arogya Sanjeevani

Though the premium rates of the Arogya Sanjeevani policy vary across insurers, the rates can be compared. Here are the sample rates of leading insurance companies for individual health insurance coverage taken by a 35-year-old man for a sum insured of INR 5 lakhs.

Name of the company 

Benefits of Arogya Sanjeevani

Arogya Sanjeevani health insurance policy offers the following benefits to policyholders and is therefore recommended –

• If you are looking for an affordable yet comprehensive health insurance plan, you can opt for Arogya Sanjeevani and get yourself and your family members covered
• The plan also covers new age modern treatments which might usually not be covered under other basic health insurance plans
• Since the coverage features are standard, you can buy the policy online through any insurance company after comparing the premium rates charged
• The premium paid for the Arogya Sanjeevani policy is eligible for deduction under Section 80D. The maximum deduction which you can claim is INR 25,000 which increases to INR 50,000 if you are a senior citizen.

The Arogya Sanjeevani health insurance plan is a basic and comprehensive health insurance policy which allows you coverage against medical expenses. If you are looking for affordable health insurance coverage which does not compromise on the coverage features, you can choose the policy and get yourself and your family members covered under the plan.