Corona Kavach Policy-National

CORONA KAVACH POLICY-NATIONAL

Policy Details:

In view of the global pandemic COVID-19 a standard CORONA KAVACH POLICY - NATIONAL is introduced:
To have a COVID specific product addressing basic health insurance needs of insuring public related to COVID-19.
To have a standard product with common policy wordings across the industry.

Pre Policy Check Up

No pre policy health check-up is required in this policy.

Highlights :

1. Sum Insured range Rs.50,000/- to Rs.5, 00,000/-
2. Entry Age18 to 65 years
3. Who can be covered - Policy can be issued covering self (proposer), legally wedded spouse, parents and parents-in-law, dependent children (i.e., naturally or legally adopted) between the age day 1 to 25 years. If the child above 18 years of age is financially independent, he or she shall be ineligible for coverage.
4. Policy period is three and half months (3 and the half months or 105 days), six and half months (6 and the half months or 195 days), nine and half months (9 and the half months or 285 days).
5. Lines of treatment covered Allopathy, AYUSH (Up to 100% of SI)
6. Ambulance Charges covered up to sublimit mentioned.
7. Pre and Post Hospitalization up to 15 days and 30 days respectively.
8. Basic hospitalization coverage for all claims pertaining to COVID-19.
9. Cashless Facility available at Network Hospitals Only through TPA.
10. This is a Short Term Policy, with no renewal. However, fresh Policy may be bought where waiting period will apply

Covered :

Why buy CORONA KAVACH POLICY NATIONAL:

1. Home care treatment expenses are covered.

2. All COVID claims with or without pre-existing co-morbid conditions are covered.

3. No sub limits for room rent, doctor's fees, medicines, diagnostics and other related charges.

4. PPE Kit, gloves, mask, cost of Pulse oximeter, Oxygen cylinder, nebulizer and such similar other expenses are covered.

5. No pre policy health check-up is required.

6. Pre/Post hospitalization for 15 & 30 days respectively.

7. AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Sidha and Homeopathy) Treatment up to SI available.

8. Hospital daily cash of 0.5% of SI is available as an optional add on cover.

9. Discounts 5% discount for Health care workers; 10% discount for online policy where no intermediary is involved.

10. Tax benefits available as per Section 80D of Income Tax Act.

Exclusions :

1. Waiting period for expenses related to the treatment of Covid within 15 days from the first policy commencement date shall be excluded.

2. Investigation & Evaluation

3. Rest Cure, rehabilitation and respite care

4. Dietary supplements and substances

5. Unproven Treatments

6. Any claim in relation to Covid where it has been diagnosed prior to Policy start date

7. Any expenses incurred on Day Care treatment and OPD treatment

8. Diagnosis /Treatment outside the geographical limits of India

9. Testing done at a Diagnostic Centre which is not authorized by the Government shall not be recognized under this Policy

10. All covers under this Policy shall cease if the Insured Person travels to any country placed under Travel restriction by the Government of India

Claims Procedure

Procedure for Cashless claims:

1. Treatment may be taken in a network provider and is subject to pre authorization by the Company or its authorized TPA.

2. Cashless request form available with the network provider and TPA shall be completed and sent to the Company/TPA for authorization.

3. The Company/TPA upon getting cashless request form and related medical information from the insured person/ network provider will issue pre-authorization letter to the hospital after verification.

4. At the time of discharge, the insured person has to verify and sign the discharge papers, pay for non-medical and inadmissible expenses.

5. The Company / TPA reserves the right to deny pre-authorization in case the insured person is unable to provide the relevant medical details.

6. In case of denial of cashless access, the insured person may obtain the treatment as per treating doctor's advice and submit the claim documents to the Company/TPA for reimbursement.

Procedure for reimbursement of claims:

For reimbursement of claims the insured person may submit the necessary documents to TPA/Company within the prescribed time limit as specified hereunder.



Notification of Claim:

Notice with full particulars shall be sent to the Company/TPA as under:
1. Within 24 hours from the date of emergency hospitalization/cashless home care treatment.

2. At least 48 hours prior to admission in Hospital in case of a planned Hospitalization.

Claim Documents for Hospitalization Expenses/AYUSH Hospitalization/Pre-Post Hospitalization Expenses:

1. Claim Form A/B/C/D as applicable duly filled and signed by insured

2. Copy of Insured Person's passport, if available (All pages)

3. Copy of Insured Member Photo ID / Photo ID Proof, if Passport is not available.

4. Medical practitioner's prescription advising admission.

5. Hospital bills and all payment receipts (Original) for all consolidated amounts, the detailed breakup of the billed amount is required from the hospital.

6. Advance payment made if any should be supported by a receipt.

7. Discharge Summary / Discharge card (Original, Photocopy for pre/post hospitalization claim) including complete medical history of the patient along with other details.

8. Investigation reports (original) including Insured Person's test reports from Authorized diagnostic Centre for COVlD.

9. OT notes or Surgeon's certificate giving details of the operation performed, wherever applicable.

10. Sticker/Invoice of the Implants, wherever applicable.

11. For medicines purchased from outside the original bill should be accompanied by prescriptions from the doctor.

12. Cancelled Cheque (with pre-printed name) / Copy of passbook of the proposer for electronic fund transfer type.

13. KYC (Identity proof with Address) of the proposer, where claim liability is above Rs 1 Lakh as per AML Guidelines

14. Legal heir/succession certificate, wherever applicable.

15. Any other relevant document required by Company/TPA for assessment of the claim

Additional claim Documents to be submitted for claim under Home Care Treatment Section:

1. A certificate from medical practitioner advising treatment at home or consent from the insured person on availing home care benefit.

2. Discharge Certificate from medical practitioner specifying date of start and completion of home care treatment.

3. Daily monitoring chart including records of treatment administered duly signed by the treating doctor.

4. In case Home Care Treatment is undergone in a non-network hospital, prior approval letter from insured. (copy to be attached).