{"id":614,"date":"2020-11-19T12:28:31","date_gmt":"2020-11-19T06:58:31","guid":{"rendered":"https:\/\/www.plancover.com\/insurance\/?p=614"},"modified":"2021-07-28T17:02:55","modified_gmt":"2021-07-28T11:32:55","slug":"oriental-guidelines-covid-claims","status":"publish","type":"post","link":"https:\/\/www.plancover.com\/insurance\/oriental-guidelines-covid-claims\/","title":{"rendered":"Oriental Insurance Corona Claim Process: All You Should Know"},"content":{"rendered":"

Guidelines on various components related to Covid19 Claims<\/span>
\n(By \u2013 The Oriental Insurance Company Limited, Dated \u2013 21.07.2020)<\/span><\/p>\n

Here is a consolidated advisory on various issues \/ components related to Covid \u2013 19 treatment. This is important as MoHFW \/ State Health Bodies \/ IRDAI \/ GI Counsil has modified their directives on various aspects pertaining to Covid \u2013 19 treatment based on the dynamics of the situation.<\/span><\/p>\n

1. Covid \u2013 19 Test<\/span><\/strong><\/p>\n

A. For Covid Positive Patients<\/span><\/strong><\/p>\n

    \n
  1. Admissibility \u2013 Yes<\/span><\/li>\n
  2. Cost \u2013 As per State Negotiated Rates or ICMR Guidelines, whichever is lesser.<\/span><\/li>\n
  3. Frequency \u2013 As per Extant Clinical Management & Discharge Guidelines of MoHFW (Ministry of Health & Family Welfare).<\/span><\/li>\n<\/ol>\n

    B. For Non-Covid Patients<\/span><\/strong><\/p>\n

      \n
    1. Admissibility \u2013 A Covid Test prescribed by a Medical Practitioner to be considered as a Pre-Hospitalisation or Hospitalisation expense as per the terms and conditions of the existing policy contract.<\/span><\/li>\n
    2. Cost \u2013 As per the State Negotiated Rates or ICMR Guidelines, whichever is lesser.<\/span><\/li>\n
    3. Frequency \u2013 1 Test per insured per policy period for all ailments including chronic \/ repetitive \/ day care treatments like dialysis and chemotherapy.<\/span><\/li>\n<\/ol>\n

      2. Personal Protective Equipment (PPE) Kit<\/span><\/strong><\/p>\n

      A. For Covid Positive Patients<\/span><\/strong><\/p>\n

        \n
      1. Number of PPE Kits<\/span>
        \nAs per MoHFW guidelines, PPE Kit consists of \u2013 Goggles, Face Shield, Masks, Gloves, Coverall \/ Gowns (with or without Aprons), Head Cover and Shoe Cover.<\/span><\/li>\n<\/ol>\n

        The following number of PPE is admissible as per the guideline \u2013<\/span><\/p>\n\n\n\n\n\n\n
        Sr. No.<\/strong><\/span><\/td>\nOccupancy<\/strong><\/span><\/td>\nNo. of PPE<\/strong><\/span><\/td>\n<\/tr>\n
        1<\/span><\/td>\nIsolation Ward<\/span><\/td>\n1 PPE per day<\/span><\/td>\n<\/tr>\n
        2<\/span><\/td>\nSingle Room<\/span><\/td>\n2 or 3 PPE per day<\/span><\/td>\n<\/tr>\n
        3<\/span><\/td>\nICU \/ ICCU\/ Ventilator<\/span><\/td>\n4 or 5 PPE per day<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

        \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 2<\/span>. Cost of PPE<\/span>
        \n\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Rs 812 to Rs 1087 or Net Procurement Cost + Up to 10%, whichever is lesser.<\/span><\/p>\n

        B. For Non-Covid Positive Patients<\/span><\/strong><\/p>\n

          \n
        • Expense of 1 PPE Kit per hospitalisation is admissible only if there is a hospitalisation claim admissible under the policy.<\/span><\/li>\n<\/ul>\n

          Condition:<\/strong> Policy terms and conditions will be paramount while reimbursing expenses for PPE Kits.<\/span><\/p>\n

          3. Billing of hospitalisation expenses for treatment of Covid \u2013 19<\/span><\/strong><\/p>\n

            \n
          • Government Prescribed Package Rates<\/span>
            \nOr<\/span><\/li>\n
          • As per agreed schedule of charges (where Government rates are not applicable) whichever is lesser<\/span><\/li>\n<\/ul>\n

            4. Expenses for treatment of Covid \u2013 19 in makeshift \/ temporary \/ extended hospitals (permitted by the State \/ Central Government)<\/span><\/strong><\/p>\n

              \n
            • Hospitalisation claims for the treatment cost to be settled<\/span><\/li>\n
            • Cashless facility to be made available for such claims<\/span><\/li>\n
            • Such facilities to provide all necessary medical services, PPE Kits and required equipment like Oximeter, Thermometer, Oxygen Cylinder etc. <\/span><\/li>\n
            • Resuscitation services to be made available in case of rapid deterioration in the clinical condition of the patient.<\/span><\/li>\n<\/ul>\n

              5. Expenses for Homecare treatment of Covid positive patients<\/span><\/strong><\/p>\n

              A. Standard Retail \/ Group \/ Bancassurance Health Insurance policies<\/strong><\/span><\/p>\n

              Such standard indemnity-based policies will cover expenses incurred on Homecare Treatment only when such expenses qualify for reimbursement as defined under the clause of Domiciliary Hospitalisation specified by IRDAI.<\/span><\/p>\n

              B. Corona Kavach Policy<\/span><\/strong><\/p>\n

              Homecare treatment is covered under Corona Kavach Policy which is defined as:<\/span><\/p>\n

              Treatment availed by the insured person at home on positive diagnosis of Covid \u2013 19 by a Government Authorised Diagnostic Centre, which in normal course would require care and treatment at a hospital but is actually taken at home \u2013 maximum up to 14 days per incident provided that <\/span><\/p>\n

                \n
              • It is advised by a Medical Practitioner to undergo treatment at home.<\/span><\/li>\n
              • There is continuous active line of treatment with a daily monitoring of health status by the Medical Practitioner \/ Doctor through the duration of the home care treatment<\/span><\/li>\n
              • Daily monitoring chart including records of treatment administered duly signed by the treating doctor is maintained.<\/span><\/li>\n
              • All services to be availed as per prescribed by the treating doctor.<\/span><\/li>\n
              • In case of services from a non network provider, claim would be subject to reimbursement. A prior approval from the insurer to be taken before availing such services.<\/span><\/li>\n<\/ul>\n

                In this benefit, the following treatments \/ services are covered if prescribed by the Medical Practitioner and is related to treatment of Coronavirus Infection:<\/span><\/p>\n

                  \n
                • Diagnostics tests undergone at home or diagnostic centre<\/span><\/li>\n
                • Medicines prescribed in writing<\/span><\/li>\n
                • Consultation charges of the Medical Practitioner<\/span><\/li>\n
                • Nursing charges related to medical staff<\/span><\/li>\n
                • Medical procedures limited to parenteral administration of medicines<\/span><\/li>\n
                • Cost of Pulse Oximeter, Oxygen Cylinder and Nebuliser<\/span><\/li>\n<\/ul>\n

                  6. Quarantine and isolation expenses<\/strong> – Not Payable<\/span><\/p>\n

                  Need More Answers?<\/span><\/strong><\/p>\n

                  Have some questions regarding Corona Kavach Policy Oriental Insurance<\/strong>?
                  \n
                  \nNeed more information on Oriental health insurance for COVID 19<\/strong>?
                  \n
                  \nWondering is PPE kit covered in insurance<\/strong>? Or, what’s the Oriental health insurance claim process<\/strong> look like?
                  \n
                  \nOr do you have other questions like how to claim car insurance Oriental<\/strong>?
                  \n
                  \nConnect with an insurance broker today and get all your questions answered. PlanCover is one of India’s topmost insurance marketplaces with a large team of licensed insurance brokers. Our team is committed to help individuals and business owners make informed decisions on buying insurance policies.
                  \n
                  \nSince inception, we have helped thousands of individuals and businesses buy the best insurance plan. Our services extend end-to-end, assuring to support you at every step on the way, taking care of all your insurance needs and requirements.
                  \n
                  \nWhether you want to buy Oriental health insurance<\/strong>, or have any query on Oriental insurance corona Kavach<\/strong> or some other policies, connect with us today and let’s talk.<\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/p>\n

                  Oriental Guidelines – Covid Claims<\/span><\/strong><\/p>\n[pdf-embedder url=”https:\/\/www.plancover.com\/insurance\/wp-content\/uploads\/2020\/11\/Oriental-GUIDELINES-ON-COVID19.pdf” title=”Oriental GUIDELINES ON COVID19″]\n