The insurance cover also provides a lump sum amount (10 per cent of the sum insured maximum up to Rs 30,000) to the surviving insured person after his/her discharge from minimum 14 days of hospitalisation. This amount is paid over and above the hospitalisation cover, as per the policy document. Besides, the policy also has various exclusions and certification requirements.
Here is a closer look at the insurance policy.
The policy framework
This is an indemnity type medical insurance policy offered to individuals for reimbursement of hospitalization expenses subject to conditions. The policy is offered only to Bajaj Capital customers and the cover can be bought and renewed like a regular insurance coverage every year. The policy is offered in collaboration with Reliance General Insurance.
A Rs 5 lakh sum insured policy will cost around Rs 4,175 per annum (P.A.) as premium. (exclusive of taxes) for a senior citizen i.e a person aged 60 years and above. However, for a person aged 55 years or less, the policy premium will be around Rs 3,479 P.A. (exclusive of taxes).
Who and what is covered under the policy?
The policy can be bought by any Indian citizen in the age group of 03-65 years. Under the hospitalisation cover, the policy will cover medical expenses incurred on hospitalisation due to a diagnosis of the presence of Covid-19.
As per the policy document, irrespective of the number of claims made under this Covid policy, the maximum claim amount payable during the policy period will be restricted to the sum insured limit.
The policy will cover the medical expenses incurred up to 30 days prior to the date of hospitalisation and up to 60 days post-discharge from the hospital within the hospitalisation sum insured limits.
Sanjiv Bajaj, Vice Chairman & MD, Bajaj Capital said, “The main problem with a coronavirus infection is that if it enters a family, then it is likely to infect multiple family members so even if you have a family floater wherein sum insured ranges from Rs 3 to Rs 5 lakh, the policy sum insured may not suffice as in the case of a coronavirus infection the average treatment cost alone is around Rs 5 lakh per person in a good hospital. Therefore, in the current situation, having an individual policy for coronavirus treatment is a must.”
Add-on insurance available
The 1 to 4 add-ons mentioned below are inbuilt and available with the policy as follows:
1. Convalescence cover: The convalescence cover will provide a lump sum amount (10% of the sum insured maximum up to Rs 30,000) to the surviving insured person after his/her discharge from a minimum 14 days of hospitalisation. This lump sum will be paid post-discharge. As per policy document, “Only one claim per insured person shall be payable under Convalescence Cover. For a claim to be admissible under ‘Convalescence Cover’, a claim should have been made and accepted by the company either under ‘Hospitalization cover’ or ‘Quarantine cover’.
2. Quarantine cover: Medical expenses during quarantine are covered starting from the 4th day of quarantine for a maximum of 15 days during the policy period. Here quarantine means isolation due to suspected infection of Covid-19. Testing/diagnosis/prescription of quarantine to be done by authorized centres as declared by Union Health Ministry of India. Under quarantine cover, the total medical expenses payable per day will be limited to 2 per cent of the sum insured subject to a maximum of Rs 5000 per day. Only one of the hospitalisation cover or quarantine cover will be paid.
3. Daily Cash benefit: A daily cash benefit provides a lump sum amount daily, for every 24 hours of hospitalisation starting from the 2nd consecutive day of hospitalisation excluding quarantine. The amount can be used for meeting additional expenses that are not covered under the policy. As per the policy document, only one claim per insured person will be payable for Daily Cash benefit. For a claim to be admissible under ‘Daily Cash’, a claim should have been made and accepted by the insurer under “Hospitalisation cover” excluding “Quarantine cover”.
4. Ambulance cover: It covers up to Rs 3,500 spent on use of ambulance per hospitalisation of the insured person due to presence of Covid-19.
Ambulance cover, Daily Cash benefit and Convalescence cover are offered over and above the sum insured as per the policy document.
5.Travel Exclusion cover: Waiver of travel restriction exclusion. This is an additional insurance cover which can be availed on payment of extra premium. The additional premium varies as per the age group. By taking this add-on, the insured person will be eligible for a claim under hospitalisation cover i.e the base policy even if he/she has travelled to the travel-restricted countries 45 days immediately preceding the policy period start date.
Limitations of the policy
The policy is applicable only for the treatment of Covid-19 in case of hospitalisation due to a positive diagnosis of Covid-19 disease. The policy does not cover pre-existing disease and comes with an initial waiting period of 15 days.
A pre-existing disease (PED) is a condition, ailment or injury that already exists at the time you buy a health insurance policy and these PEDs are generally excluded from the policy coverage for an initial waiting period. The maximum waiting period on such PEDs is four years in case of general medical insurance policies (those that are not covid 19 specific).
Also take look at the following exclusions which are not covered under the base policy as well as under the add-ons, if any are taken.
Base cover exclusions
- Co-habitation with an existing Covid-19 patient
- Travel to any restricted countries (If add-on is not opted for the same)
- Diagnosis done at Unauthorized testing centers
- Diagnosis/Treatment taken outside India
Add-on cover exclusions
- Quarantine advised by any unauthorized testing center
- Quarantine/Isolation at any unauthorized center
- Cluster containment operations carried out by State or Central Govt
- Domiciliary (home care treatment) or OPD treatment