Although the Govt has taken a positive step to introduce a standard policy for battling Coronavirus, hospitalisation and other medical costs, it should also make it easier for the claims to be settled
T he outbreak of the Novel Coronavirus in the city of Wuhan in China towards the end of last year became a major health emergency and a global pandemic. Over the last 10 months or so, different parts of the world have been the epicentres of this contagion. Governments around the world have reacted to this unprecedented situation by taking extreme measures like closing international borders and air space, imposing restrictions on domestic travel, prohibiting huge gatherings like sporting or religious events, shutting down entertainment hubs and educational institutes. The toll of the virus on both personal and economic aspects has been tremendous with the huge loss of human lives and slowdown of economies around the world impacting several industries and the financial markets. Governments have responded by providing a slew of measures to aid the ailing industry by providing liquidity and slashing interest rates, among others.
The insurance industry is one such industry that had to react quickly to this situation to develop new products in the face of the growing spread of the Coronavirus and the socio-economic uncertainties it brought in its wake. Lack of education and awareness have been the main reasons for India being largely under-insured, particularly in the area of health insurance, with only 18 per cent of the urban and 14 per cent of the rural population availing protective schemes. The Insurance Regulatory and Development Authority (IRDA) recently made the availability of the standard health policy, Corona Kavach, mandatory. Though it can’t replace the normal mediclaim policy, and all standard indemnity policies are covering Coronavirus in India, if people don’t have a health insurance, or if they are not adequately covered by their health insurance, it would make a lot of sense to buy this special policy. Especially given the fact that India now has nearly 37,69,523 confirmed cases of Covid-19, the third-highest in the world after the US and Brazil. There are no drugs as yet to fully cure patients and work on the vaccines for the virus is still in the trial stages.
While most people with mild symptoms recover with the medicines prescribed by doctors, in extreme cases, infected people require hospitalisation and ventilator support. That is where the bills go up exponentially and this is where a person who does not have health insurance or whose cover is not adequate will be most vulnerable as the out of pocket expense will be huge. The features of Corona Kavach are very standard and cover both individuals and families, and it is available in one basic mandatory cover offered on indemnity basis and one optional cover available on benefit basis. Corona Kavach is a single premium plan where the sum insured is in the multiples of Rs 50,000 where the maximum sum insured is Rs 5 lakh, minimum being Rs 50,000. Not only is the Corona Kavach a standardised policy, which is uniform across all the insurers, it is also very comprehensive, covering homecare and Ayurvedic, Unani, Siddha and Homeopathic treatment, PPE and treatment of co-morbidities when hospitalised, including any ventilator and ICU charges, ambulance cost upto Rs 2,000, pre and post-hospitalisation care upto a certain number of days and daily cash allowance of 0.5 per cent of the sum insured for a certain number of days. Some insurers do not have a cap on the room rent as long as the room availed is a single private one.
Then there is the Corona Rakshak which is an optional benefit-based cover that can be issued by life insurance companies also in addition to health and general insurance firms. The maximum sum insured is Rs 2.5 lakh, which is offered as lumpsum and can be used at will, especially during home quarantine, on treatment, medicines and for nursing charges. The tenure of the policy and waiting period remains the same as that of Corona Kavach. The requirement for claim in the Corona Kavach policy is a positive diagnosis of Coronavirus from a Government-authorised centre and hospitalisation for 24 hours. For Corona Rakshak, other things being same, the hospitalisation requirement is for 72 hours. One is also unsure of the amount of additional cover required if an health insurance policy is a part of the portfolio. An individual should have a health insurance cover of Rs 8-10 lakh, so depending on this, an additional coverage of Corona Kavach can be taken, to top up your existing health policy. But remember to choose a top-up Corona Kavach policy from the same company as your basic health policy to claim cashless benefits for both. In most of the cases, co-morbidities will also be covered during the claims. The premium may vary from as low as Rs 127 per month to as high as Rs 14,927, based on the sum insured, availing family cover, age of the insured and so on. The IRDA has given a go-ahead to 29 general and health insurance companies, both State-owned and private, to market the Corona Kavach policy. Some of the prominent State-owned insurers marketing this policy are SBI General Insurance, National Insurance, New India Assurance, Oriental Insurance and United India Insurance. Other renowned private players include Acko General Insurance, ICICI Lombard General Insurance, HDFC ERGO General Insurance and Star Health and Allied Insurance among others. So how do you choose the insurance company? There are some factors, among others, that can help you make a wise decision.
Affordability: Choose an insurance company that can provide these policies at an affordable premium.
Choose family coverage: It is also important to cover your entire family and, therefore, choose an insurance company that offers coverage to family.
Network: A health emergency can strike you, anytime and anywhere. Therefore, choose an insurance company that has a wide network of hospitals around the world.
Healthy claim settlement ratio: Choose an insurer who has a high claim settlement ratio, which means it settles more claims than others when compared to the total claims received.
Although the Corona Kavach is very comprehensive, there are still circumstances which are not covered. First, if the diagnosis is negative or not from a Government-approved centre. Second, if hospitalisation is not required and the patient undergoes only day care procedures. Third, if medicines are bought without proper prescription; fourth, if the treatment is availed outside India and fifth any vaccination, inoculation expenses used for prevention of the condition are not covered in the policy. So we have to be careful about different situations under which our claims may not be processed. One of the reasons a claim may not be approved is the choice of the line of treatment. It is a grey area as only treatments, which are approved by the Indian Government, are recognised by the health insurers. For example, the recently-tried plasma therapy is not officially recognised by the Government. The insurance companies are claiming that they have eased their norms to make it easier for their customers to settle claims, like accepting email submissions and in some cases, on meeting certain conditions, without policy documents. The LIC settled more than 561 Covid-19 death claims amounting to nearly Rs 27 crore till the last week of July. Although this data looks impressive, there are a number of cases where the kin of Corona warriors like doctors and nurses, who died of Coronavirus, are battling to claim the insurance money. Red tapism is making their lives hell and the families of the deceased health workers are struggling to prove that they contracted the deadly infection in the line of duty to claim the Rs 50 lakh insurance provided by the Government.
In some cases, insurance claims were not approved of doctors and nurses who laid down their lives in taking care of patients as they were not Central Government employees. Although the Government has provided an insurance scheme for frontline workers like sanitation workers, ASHA workers, ward boys, paramedics, doctors, nurses and specialists, it fails to cover their treatment and is limited to their death. Even after months into this pandemic, several claims are rejected due to the confusion about the eligibility and other requirements buried within the fine print of policy guidelines of the insurance companies.
Although, the Government has taken a positive step to introduce a standard policy for battling Coronavirus, hospitalisation and other medical costs associated with it, it should also make it easier for the claims to be settled. Though the insurance money can never replace our loved ones, the bereaved family members can at least hope to pick up the remaining threads of their lives with it.
(The writer is Associate Professor, Amity University, Noida)