mint reviewed the new draft guidelines for the two policies. Among other changes, the provision to cover the cost of PPE kits and no sub-limit on room rent stands out. Read on to find out which products are reviewed and whether they will benefit you.
The minimum entry age for both policies will be 18 and the maximum 65. Dependent children will be covered from the age of 3 months to 25 years. The term of the policy could be three months, six months or a year.
Compensation policy: The revised product will have basic coverage with a cap on the sum insured up to ??5 lakh. The minimum insured amount will be ??50,000. You can opt for coverage in multiples of ??50,000, up to ??5 lakh. Insurers are authorized to offer optional coverage, the premium of which will be specifically mentioned.
Basic coverage will be offered on an indemnity basis while optional coverage will be available on a benefit basis. The policy will cover the hospital costs incurred by the policyholder for the treatment of covid-19 upon a positive diagnosis of the infection at a diagnostic center approved by the government. It will cover the cost of room, board and nursing care. Surgeons, anesthetists, consultants, specialist fees, including telemedicine consultation, will be covered.
Other costs such as oxygen, operating room fees, surgical devices, drugs and medications, PPE kits and gloves, among others, will be eligible if they are hospitalized for at least 24 hours. The expenses of intensive care units and intensive cardiac care units will also be covered. Unlike the previous version, the revised policy has no sub-limits on room rent, which would work in favor of the policyholder.
The policy will also cover the cost of home treatment provided the doctor advises home treatment and there is a continuous active treatment line, which requires medical monitoring of the condition for the duration of the treatment. home treatment.
Policyholders can benefit from cashless services, which must be arranged by the insurer through network providers. If the services are provided by a non-network operator, the refund option must be provided. Diagnostic tests carried out at home or in diagnostic centers, prescribed drugs, consultation and nursing costs, as well as the cost of the oximeter, oxygen cylinder and nebulizer will be covered by the service. home care.
Ayush treatment, pre-hospitalization costs incurred 15 days before the date of hospitalization and post-hospitalization costs incurred 30 days after will be covered.
The policy comes with optional daily hospital cash coverage in which the insurer will pay up to 0.5% of the sum insured for every 24 hours of hospitalization. The benefit will be payable for up to 15 days during an insurance period.
The regulator has left it to the discretion of the insurance company to decide on premiums and the policy will also be available on a floating family basis.
This product will pay a lump sum compensation equal to 100% of the sum insured if the insured tests positive for covid-19 and requires hospitalization for a minimum of 72 hours. The product should cover one individual only. The previously offered add-on for quarantine coverage has now been removed. The minimum insured amount is ??50,000 and the maximum limit is ??3 lakh. A person will only be allowed to purchase one of these policies. “It should be made clear in the proposal form that the policyholder is not entitled to benefits under multiple policies of this standard product,” the draft guidelines said. The policy will be accompanied by a waiting period of 15 days during which no claim will be accepted.
Will the products benefit you?
After several rounds of revisions, the regulator has finally addressed the high cost of PPE that could burn a hole in your pocket, as PPE kits and other consumables are not covered by most insurance companies. “PPE kits have become an important part of the hospital bill. Deductions for such expenses have become a major source of conflict for policyholders. Covering PPE, gloves, masks and other similar expenses clears the ambiguity and provides comprehensive treatment to policyholders for covid-19, ”said Abhishek Bondia, MD and senior director of Securenow.in. “In fact, the regulator should encourage insurers to offer supplements to cover PPE in existing health policies.”
Insurers we spoke to said the regulator’s intention behind launching two separate products is to meet the needs of the uninsured population and help them understand how health insurance works at an affordable cost.
“With this product, the uninformed and uninsured population can experience health insurance, then they may prefer to buy a regular health insurance policy. It’s a good place to start, ”said Dr. S. Prakash, MD, Star Health and Allied Insurance Co Ltd.
The premium for these policies is expected to be lower than the standard Arogya Sanjeevani policy that all insurers currently offer. “The ceiling of the sum insured for the defined benefit contract ( ??3lakh) was decided taking into account the average cost of covid-19 treatment in the country. This product is primarily intended for low and middle income groups who may not be able to afford a lot of money for health insurance, ”added Dr Prakash.
While insurers will want to inquire about co-morbid conditions when selling a policy, Dr Prakash said premiums will always need to be reasonable. According to the guidelines, admission due to Covid-19, regardless of co-morbid conditions, must be covered by the policy.
If you already have regular health insurance with adequate coverage, purchasing a covid-specific policy would be of little use. In addition, the provision of home care, which accompanies the indemnity policy should not be a reason for you to purchase the policy as some insurers such as ICICI Lombard General Insurance Company have started to add this feature in their insurance policies. regular health and others should do the same.
Bondia said home treatment can be relatively inexpensive and the total sum insured is unlikely to be used up. The benefit-based policy also requires a 72-hour hospital stay, which doesn’t help much. That said, the fact that the compensation policy specifically covers the cost of PPE is a plus. “I would always recommend buying a regular health insurance policy, which would cover any type of hospitalization and not just limit you to covid-19,” Bondia said. Insurance companies have sent in their comments and the regulator is expected to issue final guidelines soon. . Watch this place!
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