United India Insurance Company Limited provides health insurance cover on an Individual or Family Floater basis. And we know that insurance companies including United India have come with a separate policy for individuals to deal with the ongoing COVID-19 pandemic. With the United India Corona Kavach Policy the sum insured will be separate for each person as provided under the Individual Sum Insured basis, while under the Family Floater basis, the Sum Insured limit will be shared by the whole family as specified in the policy schedule. There are various Sum Insured options in United India Corona Kavach Policy – INR 50,000, INR 1 Lakh, INR 1.5 Lakh, INR 2 Lakh, INR 2.5 Lakh, INR 3 Lakh, INR 3.5 Lakh, INR 4 Lakh, INR 4.5 Lakh, and INR 5 Lakh.
The policy period is 3 ½ months, 6 ½ months, and 9 ½ months including the waiting periods that are 105 days, 195 days, and 285 days, respectively. The company’s total liability for a family cannot exceed the Sum Insured in a policy period. Let’s read this post and know more about the United India Corona Kavach Policy benefits.
United India Corona Kavach Policy Cover
The policy is known to provide the following coverages to the insured person. Check them out!
- COVID Hospitalisation Expenses
- COVID Home Care Treatment Expenses
- AYUSH In-Patient Treatment for COVID
- Pre-hospitalization Expenses
- Post Hospitalisation Expenses
- Hospital Daily Cash (optional benefit)
Now let’s find out when these listed covers will be payable to you under the United India Insurance Corona Kavach Policy.
COVID Hospitalization Cover
The company will pay for the medical expenses incurred for the treatment of Covid in hospitals if you are diagnosed positive in a government authorized diagnostic center. This includes the expenses incurred on treatment of any comorbidity along with the treatment for Covid up to the policy Sum Insured, for the following:
- Room Rent, Boarding, Nursing Expenses
- ICU or ICCU expenses also known as Intensive Care Unit and Intensive Cardiac Care Unit
- Surgeon, Anaesthetists, Medical Practitioner, Consultants and Specialist Fees (Paid directly to the treating DoctorSurgeon or the hospital)
- Anaesthesia, blood, oxygen, operation theatre fee
- Surgical appliances, ventilator fee
- Medicines and drugs
- Costs towards diagnostics, including diagnostic imaging modalities, PPE Kit, gloves, masks, and other expenses.
- Road Ambulance fee, subject to a maximum of INR 2,000 per hospitalization, if the services are offered by a Hospital or by an Ambulance service provider (Providing relation to Covid Hospitalization).
Note: Expenses of hospitalization are admissible only if it is for a minimum of 24 consecutive hours.
Home Care Treatment Expenses
At home Covid treatment for the positive diagnosed insured person, which requires care and treatment at a hospital but is taken at home for up to 14 days per incident provided that:
- Your Medical Practitioner advises undergoing treatment at home
- There is a continuous active line of treatment with monitoring of the health status for each day at the home care treatment by a medical practitioner
- Daily monitoring chart with records of treatments duly signed by the treating doctor
- You are permitted to avail of the services as prescribed by your Medical Practitioner
- In case you intend to get the services of a non-network provider, the claim shall be subject to reimbursement and prior approval will be required from the Insurer before availing such services.
In this benefit, the following will be covered if prescribed by the treating Medical Practitioner and if it is related to the treatment of COVID-19.
- Diagnostic tests performed at home/diagnostics center
- Medicines prescribed in writing by the doctor
- A consultation fee of the medical practitioner/doctor
- Nursing fee related to the home medical staff
- Medical procedures are limited to parenteral administration of medicines
- Cost of a Pulse oximeter, Oxygen cylinder, and Nebulizer as per the requirement of treatment
The company pays for the medical expenses if they are incurred as an in-patient for Covid on positive diagnosis in a government authorized diagnostic center, which includes treatment of any comorbidity along with the treatment for Covid under Ayurveda, Yoga, and Naturopathy, Unani, Siddha, and Homeopathy systems of medicines in the policy period. And the upper limit for this is specified in the Policy Schedule. The covered expenses under this benefit will be the same as specified under Covid Hospitalisation Expenses.
The company pays Pre-Hospitalisation or home care medical expenses for a fixed period of 15 days before the date of admissible hospitalization or home care treatment.
The payment of medical expenses post Hospitalisation or home care treatment will be done by your insurer for a fixed period of 30 days from the date of discharge from the hospital.
Hospital Daily Cash
This is an Optional Policy benefit available to insured persons as per the terms of the Policy. The insurer will pay 0.5% of the Sum Insured per day for every 24 hours of continuous hospitalization. This benefit will be payable for a maximum of up to 15 days during a Policy Period in respect of every Insured Person. The total amount payable in respect of Covers shall not exceed 100% of the Sum Insured during a Policy Period.
Eligibility for United India Corona Kavach Policy
If you are wondering whether you are eligible for the United India Corona Kavach Policy benefits or not, take a look at the policy eligibility criteria:-
- A person should be aged between 18 and 65 years
- This policy can be taken for yourself and your family consisting of Self, Spouse, Dependent Children, Parents, and Parents-in-Law, either on an Individual Sum Insured or Family Floater basis.
- Dependent children should be natural or legally adopted and should be a maximum of 25 years, provided either or both parents are covered concurrently.
- If a child is above 18 years and financially independent, he or she will be eligible for coverage under the same policy. However, a separate policy can be taken for children on the expiry of the current policy.
- Mid-term inclusion of family members is allowed under the policy at pro-rata premium only in the case of a newly married spouse or newborn baby.
The company is not liable to make any payment under United India Corona Kavach Policy in connection with or in respect of following expenses till the expiry of its waiting period as mentioned in the policy schedule. Expenses related to the treatment of Covid has a waiting period of 15 days from the policy commencement date.
Expenses That will be Excluded from the United India Corona Kavach Policy
The company is not liable to make any payment under the policy, in respect of the following expenses:
- Expenses of any admission which is primarily for diagnostics and evaluation purposes. that are not related to or not incidental to your current diagnosis and treatment.
- Expenses of any admission which is primarily for enforced bed rest and not for treatment. It includes Custodial care at home/nursing facility and any services for people who are terminally ill and unable to address physical, social, emotional, and spiritual needs.
- Dietary supplements and substances purchased without a prescription, including Vitamins, minerals, and organic substances (unless prescribed by a medical practitioner or part of hospitalization/Home Care claim)
- Expenses of any unproven treatment, services, and supplies in connection to any treatment. However, treatment authorized by the Government for COVID will be covered.
- Any claim about Covid where it is diagnosed before the starting date of the policy
- Any Daycare treatment and OPD treatment
- Diagnosis or Treatment outside India
- COVID testing done at a diagnostic center, which is not authorized by the Indian Government
Note:- United India Corona Kavach Policy will cease to exist if you travel to any country placed under travel restrictions by the Government of India.
United India Corona Kavach Policy Claim Procedures
A notice with full particulars of the insured must be sent to the company or TPA within 24 hours from the date of emergency hospitalization or cashless home care treatment. The intimation should be made at least 48 hours before admission to the hospital in a planned hospitalization. United India provides you two different types of options to claim this policy when any of the covered situations arise. So if you want to know how to claim United India Corona Kavach Policy, check out the below procedures:-
Cashless Claim Facility
- Treatment must be taken in a network hospital. This is subject to pre-authorization by the company or its authorized TPA.
- The cashless request form is available at the network provider and it must be completed and sent to the company/TPA for authorization.
- When the company/TPA gets the cashless request form and checks the related medical information, the pre-authorization letter will be sent to the hospital after verification.
- At the time of discharge, you need to verify and sign the discharge papers and pay for the rest of the non-medical and inadmissible expenses, which aren’t covered in this policy.
- The company/TPA reserves the right to deny a pre-authorization in case the insured is unable to provide the relevant medical details.
- In the case of denial, you may obtain treatment as per the treating doctor’s advice and submit the claim documents to the Company/TPA and seek reimbursement.
For reimbursement, the Insured Person should submit the necessary documents to TPA or company.
COVID Hospitalisation Cover
- Duly filled and signed claim form
- Copy of the insured passport all pages (if available)
- Photo Identity proof (if Insured does not have a passport)
- Medical practitioner’s prescription advising admission to the insured
- Original bills with a break-up of expenses
- Payment receipts, discharge summary including your complete medical history with other details
- Investigation reports such as test reports from the authorized diagnostic center for COVID
- OT notes or Surgeon’s certificate (wherever applicable)
- Sticker or Invoice of the implants (wherever applicable)
- NEFT details (for direct credit of the claim amount in your bank account)
- A canceled cheque
- KYC (Identity proof with current address, if claim liability is above INR 1 lakh as per AML Guidelines)
- Legal heir/succession certificate (wherever applicable)
- Any other relevant document (Required by the Company/TPA) to assess the claim
Home Care Treatment
- Duly filled and signed claim form
- Copy of the insured person’s passport all pages (if available)
- Photo Identity proof (if the insured person does not have a passport)
- Medical Practitioner’s prescription advising the insured hospitalization
- Certificate from your attending medical practitioner advising treatment at home
- Or the consent from the insured person availing the home care benefit of United India Corona Kavach Policy.
- Discharge Certificate from your attending Medical Practitioner specifying the date of start and completion of home care treatment
- Daily monitoring chart with records of treatment duly signed by your treating doctor
Note: The company will accept bills, invoices, medical treatment-related documents only in the Insured’s name for whom the claim is submitted. If a claim lodged under the policy and the original documents are submitted to any other insurer, the company may accept the copy of the documents and claim settlement advice, duly certified by the other insurer is subject to satisfaction of the company. Delay in claim notification or submission is condoned on merit where the delay is proved to be for reasons beyond the control of the insured.
Below is the prescribed time limit to submit the above-mentioned documents:
- For hospitalization and pre-hospitalization expenses within 30-days of the date of discharge from the hospital.
- For post-hospitalization expenses within 15-days from the completion of post-hospitalization treatment.
- For Home Care expenses within 30-days from completion of home care treatment
Claim Settlement by United India Insurance Company Ltd. (Provision for Penal Interest in United India Corona Kavach Policy)
The company settles or rejects a claim, as the case may be, within 30 days, which starts from the date of receiving the last necessary document. If there is a delay in the payment of a claim, the company will be liable to pay interest starting from the date of receipt of the last necessary document to the date of the payment of your claim at 2% above the bank rate. However, if a claim warrants an investigation in the opinion of the company, it shall initiate and complete such investigation at the earliest, not later than 30 days from the date of receiving the last necessary document (in any case). In such a situation, the company settles or rejects the claim within 45 days from the date of receipt of the last necessary document. If the claim delays beyond the stipulated 45 days, the company will pay an interest of 2% above the bank rate from the date of receipt of the last necessary document to the date of claim payment.
Note: “Bank rate” means the rate fixed by the Reserve Bank of India (RBl) at the beginning of the financial year in which the claim is due.
TPA Services on United India Corona Kavach Policy
Servicing of policy claims includes claim admissions and assessments by pre-authorization of cashless treatment, processing of claims other than cashless claims, or both as per the policy underlying terms and conditions. Here, the services offered by a TPA may not include:
- Claim settlement and rejection;
- Any services related to any Insured Person or any other person unless the service is due to the policy terms and conditions as agreed with the company.
United India Corona Kavach Policy Terms & Conditions
- Submit the duly completed and signed proposal form by giving details of all the Insured persons to the nearest office of the United India Insurance Company Ltd. Alternatively, this policy can be purchased online by visiting the company’s official website.
- The premium under this United India product will be paid on a pan-India basis
- All premium rates in this policy are in INR and the premium rate on the company website are exclusive of Goods & Service Tax (GST) and Cess (if any).
- The full premium for the policy must be paid before the commencement of risk
- Single-Premium can be paid online
- Your PAN details must be submitted. In case the PAN is not available, Form 60 or Form 61 must be submitted.
- Health Care Worker will get a discount of 5% on premium
- And a discount factor of 10% will be applicable for policies where the address of the proposer is in a rural area in India.
- A discount factor of 10% for policies purchased directly online through the UIIC website.
- The company can cancel the policy anytime on the grounds of misrepresentation, non-disclosure of material facts, fraud by the insured person, by giving the insured written notice of 7 days. And there would be no refund of premium on cancellation on grounds of misrepresentation, non-disclosure of material facts, or fraud.
- In case the Insured Person dies, the cover shall continue for the remaining Insured Persons till the end of the Policy Period. All relevant particulars in respect of such insured persons (including his/her relationship with the Insured Person) must be submitted to the company along with an application form. Provided no claim is made, and termination takes place on account of the death of the insured person, a pro-rata refund of a premium of the deceased Insured Person for the balance period of the policy will be effective.
- You need to make a nomination for payment of claims under the policy in the event of your death. Any change of nomination must be communicated to the company in writing and such changes are effective only when an endorsement of the policy is made. In the event of the death of the policyholder, the company will pay the nominee and in case there is no subsisting nominee, to the legal heirs or legal representatives of the policyholder whose discharge is treated as the full and final discharge of policy liabilities.
- Tax rebate is available under the provisions of Income Tax Rules under Section 80D
- Lifelong renewability, Migration, and Portability stipulated under the regulation 13 and 17 of IRDAI Regulations, 2016 respectively, do NOT apply to the United India Corona Kavach Policy.