CORONA KAVACH POLICY
Policy period: March 21 to December 19, 2021
EMPLOYEE INSURANCE BENEFITS GUIDE
Intuit Confidential and Proprietary 2
Corona Kavach Policy
Policy Details
Enrolment Procedure
Claims Procedure
Exclusions
Contacts & Links
Overview
Corona Kavach Policy
The Corona Kavach policy covers medical expenses incurred by the insured or family members due to treatment of COVID-19. This policy is applicable to the treatments taken within India only.
Note:
❑ Payable only if there is 24 hours of hospitalization
❑ Home care treatment expenses are covered in case a medical practitioneradvises the insured person to undergo treatment at home
❑ Typical expenses covered are room/boarding as provided by the hospital ornursing home, nursing, oxygen, medicines and drugs, positive COVID-19investigation charges (done in authorized center)
Policy Details
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Corona Kavach Policy
Policy Details
Claims Procedure
Exclusions
Contacts & Links
Enrolment Procedure
Policy details
Corona Kavach Policy
Policy Details
Policy Holder Intuit India
Policy Period March 21, 2021 to December 19, 2021
Insurer National Insurance Company Limited
Third Party Administrator (TPA) Medi Assist India TPA Pvt. Ltd.
Sum Insured INR 300,000 per member
Eligible Members Self + spouse + 3 dependent children (maximum age limit: 25 years)+ 2 parents (maximum age limit: 80 years)
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Corona Kavach Policy
Policy Details
Claims Procedure
Exclusions
Contacts & Links
Enrolment Procedure
Hospitalization Benefit
Corona Kavach Policy
Hospitalization Benefit
Waiting Periods 15 days
24 Hours of Hospitalization Mandatory to get the claim paid
Treatment Payable Only if• Hospitalized and treatment taken in hospital with active line treatment• Home care treatment advised by duly qualified medical practitioners covered maximum of 14
days
Pre- & Post-Hospitalization Expenses Covered (up to 15 days & 30 days respectively)
Pre-existing Diseases Not covered
Treatment Type Allopathy & AYUSH
Room Rent Normal/ICU Actuals
Pulse Oximeter, Oxygen Cylinder and Nebulizer
Payable under home care treatment expenses only if prescribed and provided by hospital as part of the treatment kit
PPE Kits/Gloves/Mask Covered, only in case of hospitalization/home care
Comorbidities Covered during COVID treatment
Ambulance Charges Covered up to INR 2,000 per hospitalization
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Corona Kavach Policy
Policy Details
Claims Procedure
Exclusions
Contacts & Links
Enrolment Procedure
Home Care Treatment
Corona Kavach Policy
Home Care Treatment
Home care treatment means treatment availed by the insured person at home for a positive COVID-19 diagnosis in a government-authorized diagnostic centre, which in normal course would require care and treatment at a hospital but is actually taken at home for a maximum of 14 days per incident provided that:
A. The medical practitioner advises the insured person to undergo treatment at home.B. There is a continuous active line of treatment with monitoring of the health status by a medical practitioner for each day through
the duration of the home care treatment.C. A daily monitoring chart, including record of treatment administered duly signed by the treating doctor, is maintained.D. Insured shall be permitted to avail the services as prescribed by the medical practitioner. Cashless or reimbursement facility shall be
offered under home care expenses subject to claim settlement policy disclosed in the insurer website.(https://nationalinsurance.nic.co.in/en/health-insurance/corona-kavach-policy-national)
E. In case the insured intends to avail the services of non-network provider claim shall be subject to reimbursement, a prior approvalfrom the insurer needs to be taken before availing such services.
F. In this benefit, the following shall be covered if prescribed by the treating medical practitioner and is related to treatment of COVID-19:a) Diagnostic tests undergone at home or diagnostics centerb) Medicines prescribed in writingc) Consultation charges of the medical practitionerd) Nursing charges related to medical staffe) Medical procedures limited to parenteral administration of medicinesf) Cost of pulse oximeter, oxygen cylinder and nebulizer
Enrollment Procedure
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Corona Kavach Policy
Policy Details
Claims Procedure
Exclusions
Contacts & Links
Enrolment Procedure
Corona Kavach Policy Enrolment page sample for enrolment:
Corona Kavach Policy
Dependents covered under base policy (Group Medical
Insurance policy)
Click on Add button to add additional dependents who are not covered under Base Policy
Claims Procedure
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Corona Kavach Policy
Policy Details
Claims Procedure
Exclusions
Contacts & Links
Enrolment Procedure
Planned Hospitalization
Corona Kavach Policy
Medi Assist issues letter of credit(for cashless) with approval forpartial / full amount as per eligibilityand coverage to the hospital
Medi Assist sends final approval to hospital, which allows the employee to get discharged by paying all non-medical/non-payable expenses
Start
Follow reimbursement process Claims processing by TPA and insurer, release of payments to the hospital
Cashless HospitalizationEmployee approaches network hospital with Corona Kavach e-card (along with valid photo ID) well in advance
Hospital contacts Medi Assist and sends pre-authorization request with approximate cost of the treatment for approval
At time of discharge, hospital sends final bill and discharge summary to Medi Assist for final approval
Medi Assist issues letter of credit (for cashless) with approval for partial/full amount as per eligibility and coverage to the hospital
Hospital sends complete set of claims documents for processing to Medi Assist
No
No
Yes
Yes
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Corona Kavach Policy
Policy Details
Claims Procedure
Exclusions
Contacts & Links
Enrolment Procedure
Emergency Hospitalization
Corona Kavach Policy
Member gets admitted to the hospital in case of emergency by showing Corona Kavache-card (along with valid photo ID)and treatment starts
Member/hospital applies for pre-authorization to Medi Assist within 24 hours
Member gets treated and discharged after paying all non-medical/non-payable expenses
Medi Assist verifies admissibility of the claim to be registered and issues pre-authorization
Pre-authorization given by Medi
Assist
Hospital sends complete set of claims documents for processing to Medi Assist
Claims processing by TPA and insurer
Release of payments to the hospital
Follow reimbursement process
Yes
No
Cashless Hospitalization
Start
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Corona Kavach Policy
Policy Details
Claims Procedure
Exclusions
Contacts & Links
Enrolment Procedure
Hospitalization Reimbursement
Corona Kavach Policy
Start
Claim Documents
Employee submits all the documents to Medi Assist within 30 days from discharge from the hospital along with copy of cancelled cheque
Medi Assist checks for the eligibility and admissibility of the claim as per policy terms
Is claim payable?
Medi Assist reassesses the complete claim documents for admissibility as per policy terms
Employee submits the shortfall documents to Medi Assist
Medi Assist asks for the additional/missing documents
On rejection of the claim, Medi Assist provides the reason for rejection
Medi Assist processes the claim and sends the reimbursement via EFT to employee account
Are documents
intact?Yes
No
No
Yes
Yes
No
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Corona Kavach Policy
Policy Details
Claims Procedure
Exclusions
Contacts & Links
Enrolment Procedure
Claim Documents for Hospitalization Related Reimbursement Claims
Corona Kavach Policy
Documents GMC Claim
Cancelled cheque
Original claim form fully filled out and duly signed by you
Original main hospital bill with bill number and break-up (with detailed break-up of various expenses like room rent/OT charges/nursing charges, etc.)
Original discharge summary (gives the summary of diagnosis and treatment in hospital)
Original death summary (only in case of death of patient during hospital stay)
Original hospital payment receipt with receipt number
Hospital registration number (registration number and number of beds on hospital letterhead with signature)
Doctor’s registration number (on doctor’s letterhead with signature)
Original pharmacy and investigation bills
Original prescriptions
Investigation reports in original/attested from hospital (reports for all tests done along with images)
* This is an indicative List. If any additional documents are required, Medi Assist will revert to you.
Exclusions
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Corona Kavach Policy
Policy Details
Claims Procedure
Exclusions
Contacts & Links
Enrolment Procedure
Exclusions
Corona Kavach Policy
• Claim arising out of detection of COVID-19 within first 15 days of/prior to policy inception
• Investigation and evaluation
• Rest cure, rehabilitation and respite care
• Dietary supplements and substances
• Unproven treatments
• Treatment other than COVID-19
• Any expenses incurred on day care treatment and OPD treatment
• Diagnosis/treatment outside the geographical limits of India
• Testing done at a diagnostic center which is not authorized by the government shall not be recognized under this policy
• All covers under this policy shall cease if the insured person travels to any country placed under travelrestriction by the government of India
Note: This is an indicative list. Please get in touch with Medi Assist for more exclusions.
Contacts & Links
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Corona Kavach Policy
Policy Details
Claims Procedure
Exclusions
Contacts & Links
Enrolment Procedure
Contact Information
Corona Kavach Policy
Particulars Contact Mail ID
Dedicated Helpline Toll-Free Number 080-46855372 [email protected]
SPOC Mr. Suman Manjunath Contact: +91 99725 78987
First-Level Escalation
Mr. Y Amit Kumar Contact: +91 95138 68677 [email protected]
Final-Level EscalationMr. Kannan Gopalan
Contact: +91 77609 64280 [email protected]
Dedicated Helpline
Second-Level Escalation
Mr. Prakash KContact: +91 99725 78987 [email protected]
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Corona Kavach Policy
Policy Details
Claims Procedure
Exclusions
Contacts & Links
Enrolment Procedure
Links
Corona Kavach Policy
Medi Assist Health Care website : https://medibuddy.sso.intuit.com/
All India Hospital Network: https://network.medibuddy.in/national-insurance-network-hospital.html
Pre-authorization form for cashless claim
Claims form for reimbursement claim
https://www.medibuddy.in/assets/claimForms/cashless-claim-form.pdf
https://www.medibuddy.in/assets/claimForms/reimbursement-claim-form.pdf
THANKS & STAY HEALTHY
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