Even though the lockdown is gradually being lifted in India, the case count has been rising across the country. Keeping this in view, the Insurance Regulatory and Development Authority of India (IRDAI) has come up with a standard individual Covid-19 product.

In view of the global pandemic Covid-19, the Authority has decided to mandate all general and health insurers to offer a standard individual COVID-19 health insurance product that will be a COVID-19 specific product addressing basic health insurance needs of the public related to Covid-19. The policy should also have a standard product with common policy wordings across the industry.

IRDAI’s COVID cover is a draft product for now, and the regulator has asked both the general and health insurance companies to ensure that this product is compulsorily offered on or before June 15. While comparing with the existing health insurance policies in the market covering the Covid-19 treatment, the fresh IRDAI guidelines and caps are limited to COVID-specific products that will be issued over the next 10 days.

The Financial Express reviewed a copy of Irdai’s draft guidelines. According to the draft guidelines, the insurer has also included the treatment of Covid-19 patients in makeshift hospitals, while the existing health insurance policies do not cover that. As add on covers, only 2 add-ons are allowed to be offered along with the standard Covid-19 product: Quarantine Cover, and Hospital Daily Cash cover. The premium payable towards these 2 add-ons needs to be specified separately so as to enable policyholders to pick, choose, and pay based on the need.

Features of the IRDAI’s COVID cover

  • This cover comes with a minimum sum insured of Rs 50,000, and a maximum sum insured of Rs 5 lakh. The ICU charges have been capped at Rs 10,000 per day, room charges have been capped at Rs 5,000 per day, and quarantine charges at Rs 3,000 per day.
  • The tenure of the policy is set at one year. It will be available on a family floater basis for individuals with a minimum entry age of 18 years and a maximum of 65 years. The policy will be subject to lifelong renewability.
  • The hospitalization cost covers room, nursing expenses, boarding expenses which is up to 2 per cent of the sum insured, capped at Rs 5,000 per day. It also includes surgeon, consultants, specialist fees, anesthetist, medical practitioner, paid directly to the treating doctor, surgeon, or hospital. Other similar expenses include operation theatre charges, surgical appliances, anesthesia, blood, oxygen, medicines and drugs, costs towards diagnostics, and diagnostic imaging modalities.
  • According to the guidelines, the policy will cover ICU expenses up to 5 per cent of the sum insured, which is capped at Rs 10,000 per day. Expenses incurred on road ambulance is set at Rs 2,000 per hospitalization. The policy will also cover all daycare treatment.
  • The draft guidelines said that the Covid-19 product must be uniform across the market, and should have the basic mandatory covers included.
  • The policy is also supposed to cover expenses incurred on hospitalization under AYUSH medicine will be covered without any sub-limits under the policy.
  • Pre-hospitalization medical expenses incurred will also be admissible for a period of 30 days prior to the date of hospitalization. It will also cover the costs of diagnostics towards COVID–19. Post-hospitalisation medical expenses following an admissible claim, incurred for a period of 60 days from the date of discharge, will also be included.
  • If an individual is quarantined due to diagnosis or suspected infection, under the add-on cover, the insurer will pay 1 per cent of the sum insured per day, up to Rs 3,000 per day. The insurer will pay 0.5 per cent of the sum insured per day as daily hospital cash, for every 24 hours of hospitalization on a positive diagnosis of Covid-19.
  • The base covers of standard Covid-19 products will be offered on an indemnity basis. The add-ons, however, will be made available on the basis of the benefits.
  • For the standard, COVID–19 product premium can be made on a monthly, quarterly, half-yearly, and yearly basis, according to the regulator