Take the example of the line of treatment that a hospital follows. According to most insurers, they will only pay for treatments that the government has authorized for covid-19. This means that it’s difficult to ascertain if an insurer will pay for a treatment that may be based on newer research internationally, unless the Indian government approves it.
So if a patient receives plasma therapy, insurers can choose not to pay for the procedure if it’s not part of the protocol the government has prescribed. Some weeks ago, the government had announced that plasma therapy is not an approved treatment, and is still under trial.
“The treatment authorized by the government for covid-19 shall be admissible as per policy terms and conditions. However, any kind of experimental or unproven treatment is outside of scope of this product," said Sanjay Datta, chief of underwriting, claims and reinsurance, ICICI Lombard General Insurance Co. Ltd.
While it is important to seek clarification on the coverage of the policy, here are some other things that may differ among insurers and you should know about before buying.
Only a few insurance companies are selling the product online as of now. Most insurers have a form on their website, which you will need to fill up. The insurer will contact you on receiving the form with your details.
Some of the largest private insurers don’t even mention the Corona Kavach product on their websites. However, all government companies and most of the medium and small insurers have details of the product on their websites.
At present, only three-four insurers are selling the Corona Kavach through online aggregators. “Some insurers have already started selling on the platform. Others are in the process of integration," said Amit Chhabra, business head, health, Policybazaar.com, an insurance distributor.
Age: Some seniors may not be eligible to buy this policy. The maximum age of entry for Corona Kavach is 65 years.
Pre-existing diseases: For pre-existing diseases (PED), there is no standard approach. “The underwriting guidelines and processes differ from one insurer to the other. The proposal is evaluated on the basis of the medical history of the individual and the medical records, to carefully arrive at a decision," said Datta.
HDFC ERGO General Insurance Co. issues a policy irrespective of co-morbidities or pre-existing disease (PED), according to Ravi Vishwanath, company’s president, accident and health.
Future Generali India Insurance Co. Ltd may opt for loading in case the customer declares any adverse health conditions. “Depending on the nature of co-morbidities, the company will decide the loading or change in underwriting," said Shreeraj Deshpande, chief operating officer of Future Generali India Insurance.
Amount of cover
Should you buy Corona Kavach if you already have a health insurance? There is no straightforward answer to this but here are some checks you can run.
One, ask yourself if you have adequate cover. According to Bhabatosh Mishra, director underwriting, products and claims, Max Bupa Health Insurance Co. Ltd, “Considering medical inflation, an individual should have a cover of at least ₹10 lakh."
Two, find out the scope of coverage for covid-19 in your regular health insurance. Ask the insurer if consumables are covered in case of hospitalization due to the virus.
Many insurers do not cover personal protective equipment (PPE) in their regular policies. Corona Kavach covers this. “It’s a disease-specific cover. It can pay for things that a regular insurance plan would not," said Gurdeep Singh Batra, head, retail underwriting, Bajaj Allianz General Insurance.
If a patient is treated at home for covid-19, Corona Kavach will pay for it, as per the protocol for home treatment, but a regular policy may not. “In case of a regular indemnity health insurance, the person needs to be hospitalized for a claim," said Mishra.
In the current situation, an individual with existing health insurance has three choices—ask the insurer to increase the sum insured of the existing policy, or buy a top-up, or buy a Corona Kavach. Make sure that you have adequate cover first. Buying a top-up is usually cheaper than asking the insurer to increase the sum insured.
You can also buy Corona Kavach in addition to a base policy as its scope is wider, and the premiums are not high. “But do remember two important things when buying a Corona Kavach or a top-up. You can’t claim cashless on two policies unless both policies are from the same company and the average claim size for covid-19 hospitalization is around ₹1.5 lakh," said Mishra.
In case a policyholder is hospitalized for the virus, he should first file a claim on the Corona Kavach as it would have better coverage for the disease. If the bill is higher than the sum insured of one policy, the individual can use the regular policy for the excess amount.
When you are filing a claim, pre-existing diseases won’t have any bearing on it. “For a covid-19 product, the detection of the virus would be the trigger for admitting a claim. Other co-morbidities are not considered for admissibility of a claim," said Deshpande.
At least five insurers we spoke with said complications due to co-morbidity will be covered.
Sometimes, the government may take time to include certain medicines, or there can be questions on the efficiency of some drugs. The payment for such drugs, which can be expensive, will depend on the protocol that exists at the time of treatment as anything else would be “an experiment".
“We may ask the hospital to explain the line of treatment adopted and the reason and rationale for its use," said Mishra.
For treatment at home under Corona Kavach, it’s best to get a package from the insurer’s network hospital. “If the home care treatment package is from a network hospital, it would be pre-approved. If it’s from a non-network healthcare provider, it is best that the policyholder takes pre-approval from the insurer. It will help to avoid any issues later when filing a reimbursement claim," said Batra.
Before you buy any covid-19-specific cover, do get your queries addressed by the insurers.