To

AllGeneral and Health Insurers (except ECGC & AIC)   

Guidelineson Covid Standard Health Policy

A. Preamble:

1.   In view of the global pandemic Covid 19, theAuthority has decided to mandate all general and health insurers to offer IndividualCovid Standard Health Policy with the following objectives:

·        To have a Covid specific product addressing basichealth insurance needs of insuring public related to Covid.

·        To have a standard product with common policywordings across the industry

2.   Towards this, the following Guidelines on CovidStandard Health Policy are issued under the provisions of Section 34 (1) (a) ofInsurance Act, 1938.

3.   All general and health insurers shall offer theCovid Standard Health Policy by duly complying with the following guidelines.

4.   The Covid Standard Health Policy shall have OneBasic mandatory cover as specified in these Guidelines which shall be uniformacross all General and Health Insurers.

5.   One Optional Cover specified in theseGuidelines, shall be offered along with the Covid Standard Health Policy withinthe sum insured. The total amount payable in respect of Covers B (I) (11) (12)(13) (14) (15) and B(II) (18) shall not exceed 100% of the Sum Insured during apolicy period. The premium payable towards this Optional Cover shall bespecified separately so as to enable policyholders to choose and pay based onthe need.

6.   The insurer may determine the price keeping inview the covers proposed to be offered subject to complying with the normsspecified in the IRDAI (Health Insurance) Regulations, 2016 and Guidelinesnotified there under.

7.   The Base Cover of Covid Standard Health Policy shallbe offered on Indemnity basis whereas Optional Cover shall be made available onBenefit Basis.

8.   The Covid Standard Health Policy shall offer a policytenure of three and half months (3 ½ months), six and half months (6 ½ months),and nine and half months (9 ½ months) including waiting period.

9.    Every General and Standalone Health Insurer, who has been issued aCertificate of Registration to transact General and/or Health InsuranceBusiness, shall mandatorily offer this product. However,if any insurer is currently not offering health insurance products at all, theabove stipulation will not apply to those.

10.The Covid Standard Health Policy shall complywith all the provisions of Insurance Regulatory and Development Authority ofIndia (IRDAI) (Health Insurance) Regulations, 2016, all other applicableRegulations, Guidelines on Standardization in Health Insurance (Ref:IRDA/HLT/REG/CIR/146/07/2016) dated 29th July, 2016, Guidelines on ProductFiling in Health Insurance Business (Ref: IRDA/HLT/REG/CIR/150/07/2016) dated29th July, 2016, Guidelines on Standardization of Exclusions in HealthInsurance Contracts (Ref: IRDAI/HLT/REG/CIR/177/09/2019) dated 27thSeptember,2019 and other applicable Guidelines as amended from time to time.

B.Construct of Covid Standard Health Policy: The CovidStandard Health Policy shall offer the following:

I.Base cover:

11. COVID Hospitalization Expenses: The Hospitalization expensesincurred by the insured person for the treatment of Covid on Positive diagnosisof Covid in a government authorized diagnostic centre. This section shall coverthe following:

a)   Room, Boarding, Nursing Expenses as provided bythe Hospital / Nursing Home.

b)   Surgeon, Anesthetist, Medical Practitioner,Consultants, Specialist Fees (including consultation through telemedicine as perTelemedicine Practice Guideline of 25^th March 2020) whether paiddirectly to the treating doctor / surgeon or to the hospital.

c)   Anesthesia, blood, oxygen, operation theatrecharges, surgical appliances, ventilator charges, medicines and drugs, coststowards diagnostics, diagnostic imaging modalities, PPE Kit, gloves, mask andsuch other similar expenses

(Expenses on Hospitalization for a minimumperiod of 24 hours are admissible.)

d)    Intensive Care Unit (ICU) / Intensive Cardiac Care Unit (ICCU)expenses.

e)    Expensesincurred on road Ambulance subject to a maximum of Rs.2000/- per hospitalization.

12. Home Care Treatment Expenses: Insurer shall cover the costsof treatment of COVID incurred by the Insured person on availing treatment athome maximum up to 14 days per incident provided that:

a)   The Medical practitioner advicesthe Insured person to undergo treatment at home.

b)   There is a continuous active lineof treatment with monitoring of the health status by a medical practitioner foreach day through the duration of the home care treatment.

c)    Daily monitoring chart including records of treatment administeredduly signed by the treating doctor is maintained.

d)    Insured shall be permitted to avail the services as prescribed bythe medical practitioner. Cashless or reimbursement facility are offered underhomecare expenses subject to claim settlement policy disclosed in the websiteof the Insurer.

e)    In case the insured intends to avail the services of non-networkprovider, claim shall be subject to reimbursement, a prior approval from theInsurer needs to be taken before availing such services. Insurer shall respondto approval request within 2 hrs of receiving the last necessary requirement.

In this benefit, the followingshall be covered if prescribed by the treating medical

practitioner and is related totreatment of COVID, 

a.    Diagnostic testsundergone at home or at diagnostics centre 

b.    Medicinesprescribed in writing 

c.    Consultationcharges of the medical practitioner

d.    Nursingcharges related to medical staff

e.    Medicalprocedures limited to parenteral administration of medicines 

f. Cost of Pulse oximeter, Oxygen cylinder and Nebulizer

 Subject to other terms, conditions and exclusions of the policy,expenses payable during the Policy period shall not in aggregate exceed themaximum Sum Insured as specified in the Policy Schedule against this Benefit.

13. AYUSH Treatment: The Medicalexpenses incurred on hospitalization under AYUSH (as defined in IRDAI (Health Insurance) Regulations, 2016)systems of medicine for the treatment of Covid on Positive diagnosis of Covidin a government authorized diagnostic centre shall be covered up to the SumInsured without any sub-limits.

14. Pre-Hospitalization medicalexpenses incurred for a period of 15days prior to the date of hospitalization/homecare treatment following an admissible claim under this policy shall be covered.Pre hospitalization expenses shall also cover the costs of diagnostics towards Covid.

15. Post-Hospitalization medicalexpenses incurred for a period of 30days from the date of discharge from thehospital/completion of home care treatment, following an admissible claim underthis policy shall be covered.

16. No deductibles are permitted in this product.

17. The Policy shall include the cost of treatment for any comorbidcondition including pre-existing comorbid condition (s)along with the treatmentfor Covid.

II.Optional cover:

18. Hospital Daily Cash: The Companywill pay 0.5% of sum insured per day for each 24 hours of continuous hospitalizationfor treatment of Covid following an admissible hospitalization claim under thispolicy.

The benefit shall be payable maximumup to 15 days during a policy period in respect of everyinsured person.

C. Other Norms applicable:

D: Construct of Terms and Conditions for Covid Standard HealthPolicy:

19. The Policy Terms and Conditions of the Covid Standard HealthPolicy shall be in the format specified in Annexure – 1. Insurer may suitablymodify the definitions and other clauses of the policy contract prospectivelybased on the Regulations or Guidelines that may be issued by the Authority fromtime to time.

E: Other Norms:

20. The nomenclature of the product shall be Corona Kavach Policy,succeeded by name of insurance company, (Corona Kavach Policy, <name ofinsurer>). No other name is allowed in any of the documents.

21. The Proposal Form used for the product shall be subject to thenorms specified under the Guidelines on Product Filing in Health Insurance.

22. Insurers shall mandatorily issue Customer Information Sheet as perthe format specified in Annexure-2.

23. The Covid Standard Health Policy may be offered as MICRO InsuranceProduct subject to Sum Insured limits specified in IRDAI (Micro Insurance)Regulations, 2015, and other circulars / guidelines issued in this regard bythe Authority from time to time.

24. The Covid Standard Health Policy shall be launched without priorapproval of the Authority subject to complying with the following conditions.

a.    The product shall be approved by the Product Management Committee.

b.    Insurers shall obtain UIN for the Covid Standard Health Policy byfiling the relevant particulars in Form – IRDAI-UNF-SCHP (as specified inAnnexure – 3 of these Guidelines) along with a certificate from ChiefCompliance Officer that the product filed is in compliance with the normsspecified under these guidelines.

c.    On review of the application, the Authority may call for suchfurther information as may be required and may issue suitable directions whichshall be retrospectively effected in respect of all contracts issued under thisproduct.

25. General and Health Insurers shall ensure that this product iscompulsorily offered on or before 10th July, 2020.

26.In terms of the provisions of Regulation4(iii) of IRDAI (Issuance of e-Insurance Policies) Regulations, 2016 providingpolicy document in physical form is mandatory when policies are issued inelectronic form directly to the policyholders. Since features of CoronaKavach Policy shall be common across theindustry and as the terms and conditions of the policy are specified by theAuthority, with the objective of reducing the operating costsand to pass on this benefit of reduced operational cost to the policyholders byway of affordable premiums, insurers are allowed to issuethe policy contract of Corona Kavach Policy in electronic/ digital format. The digital form of the policy contract may beforwaded through email or a link shall be provided in the certificate ofinsurance.However, where policyholder specifically seeks the physical form ofthe policy contract, the same shall be provided by the insurer.

27.Every insurer offering Corona Kavach Policy shall provide a certificate of insurance to the policyholder indicating theavailability of health insuarnce coverage.The certificate shall have a reference to access detailed terms and conditions of the policycontract. Insurers shall also clearly mention policy period (Policy Start Dateto Policy End Date), effective policy period (from end of waiting period to endof policy period), waiting period (policy start date to end of policy period)in the Certificate of Insurance.

28. In terms ofClause 5 of Guidelines on short term health insurance policies Ref:IRDAI/HLT/REG/CIR/156/05/2020 dated 23rd June, 2020, the policies issuedunder these guidelines will remain valid till 31st March, 2021.

29. This has the approval of Competent Authority.

(DVS Ramesh)

General Manager