Fixed-benefit plan helps cover costs that standard health policy doesn’t2 min read . Updated: 10 Sep 2020, 10:53 PM IST
Fixed-benefit plans pay a specified amount on meeting the agreed trigger
I am 39 years old and have a family floater health insurance policy that covers me and my wife. Given the recent covid-19 crisis, I am thinking of buying a health insurance plan specific for this disease. I want to know what coverage should I expect and the terms and conditions associated with the coverage.
—Name withheld on request
There are two kinds of plans that are currently being offered by insurance companies for covid-19. These can be classified into indemnity and fixed-benefit plans. Indemnity plans reimburse expenses incurred within the policy limits. Fixed-benefit plans pay a specified amount on meeting the agreed trigger. The standard health insurance plan is an indemnity plan. If you buy an indemnity-based covid-19 plan, then you can claim expenses in either your existing policy or in the new plan, but not both. However, if you exhaust the sum assured in one plan, then you can claim the balance from the other plan. In the fixed-benefit plan, you will get a lump sum, irrespective of the actual expenses incurred. You could still make a claim under your family floater health insurance plan.
In indemnity plans, you should check the initial waiting period, coverage for co-morbidity conditions and stay-at-home care. A large proportion of covid-19 cases are now treated at home, with doctors and nurses visiting the patient. Most health insurance plans do not cover such at-home care for covid-19. So, through the covid-19-specific plan and you could fill this gap.
Recently, the Insurance Regulatory and Development Authority of India (Irdai) had asked insurers to offer short-term covid-19 indemnity plans (Corona Kavach). These would be available for tenures of 3.5 month, 6.5 months and 9.5 months. Such plans would have a waiting period of 15 days, and cover at home care. The coverage will be standard across all insurers. You could evaluate such plans as well.
In the fixed-benefit plan, you should check for the waiting period, and the condition of claim trigger. For a few plans, just a positive lab report is sufficient. Other plans may require hospitalization. Fixed-benefit plans work better for you, as you already have a health insurance plan. The payout from the fixed-benefit plan will help you cover for expenses not admissible under standard health insurance.
All plans require that the test should be done by a government-approved laboratory. These also exclude coverage if you had any recent foreign travel history. Some plans exclude coverage if you were cohabiting with a covid-19 patient.
Abhishek Bondia is principal officer and managing director, SecureNow.in. Queries and views at firstname.lastname@example.org