Saturday, 9 November 2019

Will Standard Individual Benefit Based Coronavirus Health Insurance policy help you? - The Economic Times

Will Standard Individual Benefit Based Coronavirus Health Insurance policy help you?

The Insurance Regulatory and Development Authority of India (IRDAI) has directed all general and health insurance companies to mandatorily offer a standard individual Benefit Based Covid-19 health insurance product on or before June 30, 2020.
This will be a standard individual benefit-based insurance policy for individuals and families which will provide coverage of up to Rs 5 lakh for hospitalisation expenses related to Covid-19.
The policy will be named as Covid-19 Standard Individual benefit-based Health Policy succeeded by the name of the insurance company.
These are the five key features of the standard coronavirus policy:
  • The health insurance policy will take care of basic Covid-19 related health needs of the insuring public;
  • It will be a standard product with common policy wordings across the industry;
  • It will facilitate seamless portability among insurers;
  • Senior citizen up to the age of 65 years can avail this policy;
  • The policy will be issued for one year and can be renewed every year.
So, should you buy a Standard Individual Benefit Based Coronavirus Health Insurance policy? Read on to find out more about this health cover.

Here are 8 important things you should know about the Standard Individual Coronavirus Health Insurance policy, as per IRDAI:
Sum insured The minimum sum insured will be Rs 50,000 and the maximum will be Rs 5 lakh. The amount will also have to be in multiples of Rs 50,000.
Eligibility The policy can be availed by persons between the age of 18 years and 65 years, as proposer. Proposer of higher age can find a policy for family, without covering self.
Family Floater The policy will also be offered on family floater basis. Only dependent children shall be covered from the age of three months to 25 years.
Category of Cover The base mask and the add-on cover shall be made available on support basis
Modes of premium payment All the modes (Yearly, Half-yearly, Quarterly, Monthly) will be allowed for the standard product. ECS (Auto-debit facility) is also allowed in all respect of the modes.
Grace period For yearly payment of mode, a fixed period of 30 days is to be allowed as grace period and for all other modes of payment, a fixed period of 15 days be allowed as a grace period.
Freelook period The insured will be allowed at least 15 days from the date of receipt of the policy to review the terms and conditions of the policy and to cancel the policy if not acceptable.
Waiting period/ Pre-existing disease The policy comes with a waiting period of 15 days. Only Pre Existing Diseases declared in the proposal form and accepted for coverage by the company shall be covered after a waiting period of 48 months.

One add-on is available with the policy
Both the base cover of the Standard Individual Benefit Based Covid-19 policy and the add-on screen will be made available on a defined benefit basis. Here is how add-on will work:

Quarantine Cover: If the insured person is quarantined due to suspected infection of Covid-19 then 50% of base sum insured shall be payable. The total amount payable in respect of the base screen and add-on cover mentioned above, shall not exceed 100% of the Sum Insured during a policy period. Where the policyholder is diagnosed with COVID - 19 after settlement of benefits on account of quarantine screen, the policyholder is entitled for balance amount of benefit. Therefore, the quarantine cover is merely partial acceleration of the base cover benefit and not an increase in the sum insured.
Insurers will have to separately specify the premium payable towards the add-on so that policyholders can pick, choose and pay based on their needs.

How the benefit based Covid-19 policy will work
As per the IRDAI guidelines, the insurance company will pay lump sum benefit equal to 100 per cent of the sum insured on positive diagnosis for Novel Coronavirus (nCoV) (COVID19), resulting in hospitalisation specified in the policy schedule. The diagnosis has to be confirmed by authorized centers as declared by the Ministry of Health and Family Welfare, Government of India.

For instance, you buy this Covid-19 health policy with a maximum sum insured of Rs 5 lakh, then on hospitalization, you will get a lump sum payout of Rs 5 lakh. However, in case your hospital bill goes higher than the sum insured, then in that case, you will have to bear the additional cost from your pocket.

The premium difference
Being a standard product, insurers will be allowed to brand the product following their underwriting understanding. What this means is that the policy premium will vary across all insurers.

Naval Goel, CEO & Founder of said that the premium will be decided by the insurer based on their expectations of claim ratios, etc. which are based on certain assumptions. "The actuarial team of each insurer may make different assumptions and therefore the premium rates of different insurance company may be different. Also, the quality of services offered by all insurers is not the same. This is another reason for the difference in pricing," Goel added.

Will the serve based Covid-19 policy help you?
This benefit based Covid-19 screen can be useful for someone who does not have a health insurance policy and is looking for one to protect himself/herself amid the coronavirus pandemic. However, if you already have a sufficient regular or comprehensive health insurance policy then you may not need this wrong benefit policy as you are likely to be already covered for covid-19 treatment under your existing regular or comprehensive health insurance policies.

Chandan D S Dang, Executive Director,, a Delhi-based insurance broker said, "A coronavirus benefit-based insurance policy with maximum sum insured of Rs 5 lakh can be useful as high-cost protection if you don't have a outlandish health insurance policy, or your health insurance coverage is low - say its Rs 1 lakh or lower. However, even in such a situation, it may be better to buy a regular health insurance policy with top-up health cover trusty that will cover treatment both for coronavirus and other illnesses."
Besides, Amit Chhabra, Head-Health Insurance, said that the pricing of the benefit based Covid-19 policy will also play an important role in understanding whether the policy is really expedient buying. Apart from this, unlike Arogya Sanjeevani policy which is applicable for all illnesses, this new health insurance product applies to Covid-19 only. "Therefore, if you can afford it, you must go for a outlandish health insurance plan rather than buying a disease-specific plan as a regular health insurance policy will provide you adequate coverage against all possible illnesses including pandemics like COVID-19," said Chhabra.

What will happen to the existing coronavirus policies offered by insurers?
Chhabra said that the other ongoing coronavirus policies offered by insurers will disconclude to co-exist with the wrong individual coronavirus policy offered by insurers after June 30. "This will be a separate health insurance policy. Just as Arogya Sanjeevani policy and other retail health insurance plans exist, similarly, this and other Covid-19 plans will also co-exist. Therefore, make sure you read the policy document, terms and conditions before opting for it," Chhabra said.
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