All about Corona Kavach and Corona Rakshak Policy

The Covid second wave has been proving frightful for everyone. At this time not only the number of Covid-19 patients has been spiraling, but the number death from this disease is also frightening. Facing this, people are once again revisiting the need of health insurance. We are telling you here whether your existing health insurance policy suffices or should you take a separate policy like Corona Kavach and Corona Rakshak.

Subhas Tiwari

Many have suffered severe financial distress while meeting the Covid-19 treatment. It is often reported that hospitals for Covid treatment have made a bill of Rs 8 to 10 lakh. Quite possible, your existing corporate policy or family floater policy falling short of paying for this treatment. This has opened us to policies like Corona Kavach or Corona Rakshak.

IRDAI directed instructions

The Insurance Regulatory and Development Authority of India (IRDAI) had directed in April last year that Covid-19 treatment would also be covered under all health insurance products. Meaning that if you have a health insurance policy, then the insurance company cannot refuse the claim for Covid treatment. Generally, such a policy covers cost of any other hospitalization treatment for more than 24 hours. The same applies to Covid treatment. But if you have taken a policy which has special schemes to cover diseases like Cancer, heart disease, critical illness, then it often does not cover Covid-19 treatment.

The IRDAI had last year asked all insurance companies operating in the country to bring a standard Covid-19 health insurance policy which such companies followed by bringing Covid specific covers. The good thing is that in such policies, the grace period is only 15 days. It implies you will get a cover when you take an insurance policy today and after 15 days you get infected with Covid. These policies are of two types – Corona Kavach and Corona Rakshak.

Corona Kavach Insurance Policy

This is a standard health insurance plan designed to cover the costs caused by Covid. This policy frees you from thinking about medical bills and treatment expenses.

Sum Insured and Duration

The Corona Kavach policy will have a basic mandatory policy. Apart from this, there is an optional cover, which can be added. To buy this policy, the minimum age of an adult should be 18 years and maximum age is 65 years. Whereas the minimum age for a child should be one day and maximum age should be 25 years. The Sum Insured for Corona Kavach policy is minimum Rs. 50, 000 and maximum is Rs 5 lakh. Tenure of insurance can be at least 3.5 months, 6.5 months and 9.5 months.

What does the Corona Kavach Policy cover?

Hospitalisation expenses: This includes bed charge, nursing charge, blood test, PPE kit, oxygen, ICU and doctor’s consulting fees.

Pre-Admission Expenses: Before hospitalization, the expenses of doctor consultation, check-up and diagnosis are included. On such expenses, cover is provided up to 15 days before hospitalisation.

Expenses after discharge: It provides coverage on medical expenses up to 30 days after discharge from the hospital.

Home care expenses: In case of home treatment too health monitoring and medicines are covered for up to 14 days.

Ayush: Under this policy, expenses on Ayurveda and related treatment are also covered

Road ambulance cover: Transfer from home to hospital and ambulance from hospital to home is also covered. In this, you get up to Rs. 2,000 per recruitment.

Hospital daily cash cover: In this policy, you have the option to add the hospital daily cash cover. Under this, the insurance company gives 0.5 per cent of the amount of insurance per day. It lasts for 15 days.

Tax benefit: You can avail tax benefit on premiums paid under health sections of this policy, as per Section 80D of Income Tax Act, 1961 and amendments made thereafter.

What it does not cover? 

1. Waiting Period – Exclusions: The company shall not be liable to make any payment under the policy in connection with or in respect to following expenses till the expiry of waiting period mentioned below:
2. First Fifteen Days Waiting Period– Covid treatment expenses of the first 15 days from the policy commencement date shall be excluded.
3. Exclusions- The company shall not be liable to make any payment under the policy, in respect of any expenses incurred in connection with or in respect of:
4. Investigation & Evaluation- Expenses related to any admission primarily for diagnostics and evaluation purposes. Any diagnostic expenses which are not related or not incidental to the current diagnosis and treatment.
5. Rest cure, rehabilitation and respite care- Expenses related to any admission primarily for enforced bed rest and not for receiving treatment.
6. Dietary supplements and substances that can be purchased without prescription, including but not limited to vitamins, minerals and organic substances unless prescribed by a medical practitioner as part of hospitalisation claim or home care treatment.
7. Unproven treatments- Expenses related to any unproven treatment, services and supplies for or in connection with any treatment. Unproven treatments are treatments, procedures or supplies that lack significant medical documentation to support their effectiveness. However, treatment authorised by the government for the treatment of Covid shall be covered.
8. Any claim in relation to Covid where it has been diagnosed prior to Policy Start Date.
9. Any expenses incurred on Day Care treatment and OPD treatment.
10. Diagnosis /treatment outside the geographical limits of India.
11. Testing done at a diagnostic center which is not authorised by the government shall not be recognised under this policy.
12. All covers under this policy shall cease if the insured person travels to any country placed under travel restriction by the Government of India.

Corona Rakshak Insurance Policy

Corona Rakshak is a benefit-based policy. A lump sum is paid to the person taking this policy when tested positive. However, for this you need to be admitted in the hospital for at least 72 hours continuously. People get three types of options under this policy. All three are of short duration. The policy has a duration of 3.5 months, 6.5 months and 9.5 months. After this period the policy will have to be renewed.

You will get the benefit only after 15 days

There is a 15-days waiting period in the Corona Rakshak Policy. You will not get the benefit of this policy if you test positive within 15 days of taking the policy.

Up to Rs. 2.5 lakh cover

The Corona Rakshak Policy offers even insured from Rs 50,000 to Rs 2,50,000. If you have taken a sum assured policy of Rs. 2.5 lakh, then you can get treatment up to Rs 2.5 lakh. This policy can be taken by anyone from 18 years to 65 years.

Exclusions: The company shall not be liable to make any payment under the policy, in respect of any expenses incurred in connection with or in respect of:

1. Investigation & Evaluation
2. Expenses related to any admission primarily for diagnostics and evaluation purposes.
3. Any diagnostic expenses which are not related or not incidental to the current diagnosis and treatment
4. Any diagnosis which is not related and not incidental to Covid is not covered in this policy.
5. Testing done at a diagnostic center which is not authorised by the government shall not be recognised under this Policy.
6. Any Covid claim manifested prior to commencement date of this policy or during the waiting period.
7. Cover under this policy shall cease if the insured person travels to any country placed under travel restriction by the Government of India.

Difference between Corona Kavach and Corona Rakshak

Who is offering: Corona Kavach Policy is Covid Standard Health Insurance Policy which is mandatory to be issued by all general and health insurance companies. Life insurance companies cannot offer this. In contrast, any insurance company can offer Corona Rakshak Policy.

Minimum and maximum cover: Corona Kavach policy gets a cover of minimum Rs 50, 000 and maximum of Rs 5 lakh whereas under the Corona Rakshak Policy, minimum Rs 50, 000 and maximum of Rs 2.5 lakh is available.

Hospitalisation: Base coverage or even insurance in the Corona Kavach Policy will be applicable only if you have been hospitalised for at least 24 hours. After this, for any number of days, the insurance company will bear the sum of the sum insured for the hospital. Coverage will be available only after being admitted to the hospital for at least 72 hours under the Corona Rakshak Policy.

Nature of the policy: The Corona Kavach Policy shall have one basic mandatory cover and one optional cover. The premium payable towards this optional cover will have to be paid separately so as to enable policyholders to choose and pay based on the need. The base cover of Corona Kavach Policy will be offered on indemnity basis whereas optional cover shall be made available on benefit basis. In an indemnity cover, the claim is paid as per the hospital bills while in a benefit cover, the entire sum insured is paid to the policyholder.

Type of policy: One can buy Corona Kavach both on an individual basis and on family floater basis but Corona Rakshak is offered on an individual basis only and hence no family floater option is available in it.

Optional benefit: The Corona Kavach Policy gives one the option to add ‘Hospital Daily Cash’ cover. Under it, the insurer will pay 0.5 per cent of the sum insured per day for every 24 hours of continuous hospitalisation for Covid treatment following an admissible hospitalisation claim under this policy. The benefit shall be payable maximum up to 15 days during a policy period. However, there is no such feature in Corona Rakshak policy as it is entirely a benefit-based plan.

Documents to be submitted for Claim

The claim is to be supported with the following documents and submitted within the prescribed time limit.

1. Duly filled and signed claim form.
2. Copy of insured person’s passport, if available (All pages).
3. Photo identity proof of the patient (if insured person does not own a passport).
4. Medical practitioner’s prescription advising admission.
5. Discharge summary including complete medical history of the patient along with other details.
6. Investigation reports including insured person’s test reports from authorized diagnostic centre for Covid.
7. NEFT Details (to enable direct credit of claim amount in bank account) and cancelled cheque.
8. KYC (Identity proof with Address) of the proposer, where claim liability is above Rs 1 Lakh as per AML Guidelines.
9. Legal heir/succession certificate, wherever applicable.
10. Any other relevant document required by company/TPA for assessment of the claim.

Claim settlement guidelines (provision for penal interest)

• The company shall settle or reject a claim, as the case may be, within 30 days from the date of receipt of last necessary document.
• In the case of delay in the payment of a claim, the company shall be liable to pay interest from the date of receipt of last necessary document to the date of payment of claim at a rate of 2 per cent above the bank rate.
• However, where the circumstances of a claim warrant an investigation in the opinion of the company, it shall initiate and complete such investigation at the earliest in any case not later than 30 days from the date of receipt of last necessary document. In such cases, the company shall settle the claim within 45 days from the date of receipt of last necessary document.