Royal Sundaram Corona Kavach health insurance

Eligibility for Royal Sundaram Corona Kavach health insurance

• Adults: Persons between the age of 18 to 65 years can be the insured member under the policy
• Children: Children upto the age of 25 years

Self, spouse, Parents, Parents-in-law and Dependent Children are the family members that can be covered

Benefits for Royal Sundaram Corona Kavach health insurance

Product Type	Available on Individual and Family Floater Basis
Coverage Basis	Base Cover on Indemnity Basis- Covid19 Hospitalization cover Optional Cover on Benefit Basis- Hospital Daily Cash
Sum Insured	₹50,000/- (Fifty Thousand) to ₹5,00,000/- (Five Lacs) (in the multiples of fifty thousand)
Eligibility of Insured	Adults: Persons between the age of 18 to 65 years can be the insured member under the policy. Children: Children upto the age of 25 years Self, spouse, Parents, Parents-in-law and Dependent Children are the family members that can be covered
Waiting Period	15 days
Policy Period Options	Three and Half Months (3 ½ months) Six and Half Months(6 ½ months) Nine and Half Months (9 ½ months) These policy duration is including waiting period of 15 days.
Premium payment	Single Premium
Hospitalization Expenses	Medical Expenses of Hospitalization related to Covid 19 (upto to the Sum Insured chosen) on diagnosis shall be payable under this plan
Pre Hospitalization Expenses	15 days
Post Hospitalization Expenses	30 days
Sub-limits	Home care treatment: Maximum upto 14 days per incident. Ambulance Charges: Rs.2000/- per hospitalization. Optional Cover of Hospital Daily Cash: 0.5% of Sum Insured per day subject to maximum of 15 days in a policy period for every insured member.
Renewability	Lifetime Renewal
Home Care Treatment Expenses	Cost of treatment incurred by the Insured person on availing treatment at home for Covid on positive diagnosis up to 14 days per incident, which in the normal course would require care and treatment at a hospital but is actually taken while confined at home.
Hospital	For the purpose of this policy any set-up designated by the government as hospital for the treatment of Covid shall also be also considered as hospital.
Premium	Standardised across India for all geographies

Claims Procedure for Royal Sundaram Corona Kavach's health insurance

	Cashless Claims Process	Reimbursement Claims Process
Step 1	Approach a Network Hospital of the respective insurance company, who will verify your details and send it ahead to the insurer for authorization	In case of hospitalization notify the insurer of your admission in network or non network hospital. After getting admitted and at the time of discharge, settle bills directly to the hospital.
Step 2	Based on the information received from the hospital, the claim will be approved based on admissibility, within 24 hours. The insurer may seek clarifications from the hospital in case of certain queries, post which an authorization letter is sent to the hospital within 7 days.	On discharge, please ensure to collect all relevant documents, invoices, medical reports and discharge certificate from the Hospital in originals.
Step 3	Once your authorization is in place, insured can get admitted, get treated and be discharged. Insurer will coordinate with the hospital and clear all the necessary medical bills and costs.	Send these documents and the completely filled and signed claim form to the insurer along with your valid ID proof and age proof. The claim form is available on the company website and in your policy document kit as well.
Step 4		Post approval the reimbursement will be made subject to admissibility,

Documents needed for processing a claim

For Hospitalization claims (Cashless & Reimbursement):

• Duly filled and signed Claim Form
• Copy of photo Identity proof
• Medical practitioner's prescription advising admission
• Original bills with itemized break-up
• Payment receipts
• Discharge summary including complete medical history of the patient along with other details
• Investigation reports including your test reports from Authorized diagnostic centre for COVID
• OT notes or Surgeon's certificate giving details of the operation performed, wherever applicable
• Sticker/Invoice of the Implants, wherever applicable
• NEFT Details (to enable direct credit of claim amount into bank account) and cancelled cheque.

For Home Treatment claims:

• Duly filled and signed Claim Form
• Copy of photo Identity proof
• Medical practitioner's prescription advising admission + a certificate from medical practitioner advising treatment at home or your consent on availing home care benefit
• Discharge Certificate from the medical practitioner specifying date of start and completion of home care treatment
• Daily monitoring chart (including records of treatment administered duly signed by the treating doctor)

Exclusions under the Royal Sundaram Corona Kavach health insurance

The insurance company shall not be liable to make any payment under the policy, in respect of any expenses incurred inrespect of:

• Any claim in relation to Covid where it has been diagnosed prior to Policy Start Date.
• Any expenses incurred on Day Care treatment and OPD treatment
• Investigation & Evaluation - Expenses related to any admission primarily for diagnostics and evaluation purposes. Any diagnostic expenseswhich are not related or not incidental to the current diagnosis and treatment
• Rest Cure, rehabilitation and respite care - Expenses related to any admission primarily for enforced bed rest and not for receiving treatment. This alsoincludes:
  • Custodial care either at home or in a nursing facility for personal care such as help with activities of daily livingsuch as bathing, dressing, moving around either by skilled nurses or assistant or non-skilled persons
  • Any services for people who are terminally ill to address physical, social, emotional and spiritual needs.
• Dietary supplements and substances that can be purchased without prescription, including but not limited toVitamins, minerals and organic substances u n less prescribed by a medical practitioner as part of hospitalizationclaim or Home care treatment.
• Unproven Treatments - Expenses related to any unproven treatment, services and supplies for or in connection with any treatment.Unproven treatments are treatments, procedures or supplies that lack significant medical documentation tosupport their effectiveness. However, treatment authorized by the government for the treatment of COVID shallbe covered.
• Diagnosis /Treatment outside the geographical limits of India
• Testing done at a Diagnostic centre which is not authorized by the Government shall not be recognized underthis Policy
• All covers under this Policy shall cease if the Insured Person travels to any country placed under travel restrictionby the Government of India