You should know why to be Insured
Faqs of Corona Kavach
Why Buy Corona Kavach if you already have a Mediclaim Policy ?
Need for separate umbrella to protect from COVID !
• Standard Mediclaim Policy has many exclusions which are permanent in nature and are never covered.
• There are various deductibles, non-admissible items and non-payable items which are not covered.
•The tenure is longer and so is the premium.
•Hospitalization costs in COVID is more because of necessity of isolation, safety and precautionary measures, repeated lab tests, ventilator costs etc. hence need for extra coverage.
•In standard Mediclaim Policies there are cappings on Room Rent , Consultation , Medical equipments which reduce the final amount payable to the insured.
•Home Care/Domiciliary treatment is usually not covered/ has restricted coverage in Standard Mediclaim.
•Immediate enhancement of SI of existing Mediclaim Policy may incur higher premiums or pre policy check up and may not be the requirement in the long run.
Who can be covered ?
•Self & Spouse (less than 65 years)
•Parents and Parents-in-law (less than 65 years)
•Dependent children ( less than 25 years, 18 years if independent) with parent/s covered.
Who can buy the policy?
•18 to 65 years covering self with or without family.
•Above 65 years of age but excluding self covering only family.
How much to cover and for how long ?
•Sum Insured: Rs.50,000/- to Rs.5,00,000/- in multiples of 50,000 as per insured’s need and convenience
•If opted for Individual Basis, different SI may be selected for different Insured Person (proposer being highest).
•If floater SI is opted then single SI shall apply cumulatively to all Insured Persons.
•Policy duration available are as follows –
a) 3 ½ months (105 days)
b) 6 ½ months (195 days)
c) 9 ½ months (285 days)
What am I covered for ?
•Treatment of COVID positive patient in a Hospital/Nursing Home (on positive report of a Govt. authorized lab)
•Room /ICU Rent and Nursing Expenses
•Doctor’s consultation fees
•Anesthesia, blood, oxygen, operation theatre charges, surgical appliances, ventilator charges, medicines and drugs, costs towards diagnostics, diagnostic imaging modalities, PPE Kit, gloves, mask.
•Road Ambulance (maximum of Rs.2000/- per hospitalization)
What are the additional benefits ?
• COVID Home Care
• COVID + Co-morbidity
• AYUSH treatment in designated hospitals
• Pre (15 days) and Post Hospitalization (30 days) expenses
• Hospital Cash Benefit (if opted)
• Tax Rebate
What are the additional benefits ?
Zero deductible policy - PPE Kits, consumables, non-admissible items are all payable.
Telemedicine / E-consultations.
5% discount for Health Workers.
10% discount if policy is purchased online (and without intermediary).
What is Hospital Daily Cash - Add-on Optional Cover
• Optional Cover – On Payment of additional Premium
• 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 Hospitalization Cover.
• The benefit shall be payable maximum up to 15 days during a policy period in respect of every insured person.
• However this benefit is not over and above the Sum Insured Chosen by client & the total payout for both Inbuilt cover and add on cover together should not exceed 100% of Sum Insured.
How to avail Home Care Treatment ?
- When doctor advices to undergo treatment at home.
There is a continuous active line of treatment with monitoring of the health status by a doctor everyday.
Daily monitoring chart including records of treatment administered duly signed by the treating doctor is maintained.
Cashless facility can be availed if treatment administered by empanelled Hospitals of the Company/TPA
What is covered under COVID Home Care?
- Diagnostic tests undergone at home or at diagnostics centre.
Medicines prescribed in writing
Consultation and nursing charges related to medical staff
Cost of Pulse oximeter, Oxygen cylinder and nebulizer
What are the timelines for claim notification?
•Within 24 hours from the date of emergency hospitalization / cashless Home Care Treatment.
•At least 48 hours prior to admission in Hospital in case of a planned Hospitalization.
What are the timelines for claim submission?
•Hospitalization and Pre-Hospitalization – 30 days from DOD
•Post Hospitalization – 15 days from completion of post hospitalization treatment
•Home Care Treatment- 30 days from completion of home care treatment
Procedure to be followed in case of Cashless Claim.
Contact TPA Desk at network Hospital where Cashless request form is available which has to be completed and sent to the TPA for authorization.
The TPA upon getting cashless request form and related medical information from the insured / network provider will issue pre-authorization letter to the hospital.
At the time of discharge, the insured person has to verify and sign the discharge papers.
The TPA may deny pre-authorization in case the insured person is unable to provide the relevant sufficient details to the TPA
In case of denial of cashless access, the insured person may obtain the treatment and submit the claim documents to the Company / TPA for reimbursement
What are the Documents to be submitted in case of Reimbursement?
•Duly filled and signed Claim Form
•Copy of Insured Person’s passport, if available
•Photo ID of the patient (if insured person does not own a passport)
•Medical practitioner’s prescription advising admission
•Original bills with itemized break-up
•Investigation reports & Payment receipts
•Sticker/Invoice of the devices, wherever applicable.
•NEFT Details and cancelled cheque
•KYC of the proposer, where claim liability is above Rs 1 Lakh
•Legal heir/succession certificate if needed
•Any other relevant document required by Company/TPA
•A certificate from medical practitioner advising treatment at home or consent from the insured person on availing home care benefit (additional document for COVID Home Care)
•Daily monitoring chart including records of treatment administered duly signed by the treating doctor is maintained (additional document for COVID Home Care)
How to Buy?
Where to Buy Policy?
Click on Buy now Tab and fill the required data
You will be contacted for Payment and You are Done.
What Documents are required?
•Completed proposal form
•Photograph (1) for each insured person
•Details of existing policies (if any)
•Proof of identity
•Proof of residence
•Copy of IT Certificate/ IT Return, if applicable
•Pan Details/ Form 60/61