Insurance watchdog Insurance Regulatory and Development Authority of India (IRDAI) has revised its draft standard product COVID-19 health insurance policy structure and may now come in two variants.
The IRDAI has reverted to the original proposal of a base indemnity-based health policy plus a benefit-based optional add-on. Insurers will also offer an independent benefit-based product, with sums insured ranging from Rs 50,000-Rs 3 lakh, if the policyholder has to be hospitalised for at least three days, or 72 hours, after testing positive for COVID-19.
Besides, the new set of policies will now be available by July 15, instead of June 30 as proposed earlier.
This is the third such draft. The first one, which was an indemnity product, was withdrawn, to be replaced by a benefit-based policy.
Now, insurers can offer both, provided the drafts are finalised in their current forms.
An indemnity policy reimburses the amount actually incurred on hospitalisation to the extent of the sum insured, while a benefit product hands out a pre-agreed sum upon the diagnosis of the disease, either as a lump-sum or on a daily basis. Premiums will be determined by the insurers.
As per the latest proposal, the indemnity plan’s base sum-insured will range from Rs 50,000 to Rs 5 lakh, offered over tenures of three months, six months and one year to individuals aged between 18 and 65.
In the family floater plan, dependent children up to the age of 25 will be covered, apart from parents and parents-in-law.
The cover will kick in after an initial waiting period of 15 days.
In the last three months, several insurers have often excluded the cost of personal protection equipment (PPE), masks and other consumables from the claim payout, leaving policyholders in a lurch.
In this backdrop, the insurance regulator has specified that the policy will have to cover diagnostic costs, PPE kits, gloves, masks as part of hospitalisation expenses.
The base indemnity policy will pay for the actual cost of hospitalisation to the extent of the sum insured chosen.
Though it is a COVID-19-focussed product, any co-morbidities – for instance, diabetes or hypertension – that need treatment during the period of stay, will be covered.
Significantly, it will now also take care of home care bills, provided a medical practitioner has recommended this line of treatment. Diagnostic tests, medicines prescribed in writing, consultation and nursing charges as also the cost of the oximeter, oxygen cylinder and nebuliser will be covered.
The benefit-based optional cover will hand out a pre-agreed sum – 0.5 per cent of the sum insured per day of hospitalisation, for up to 15 days.