Does your health insurance cover COVID-19 costs?
Growing monetary concerns among people in India, during the time when the country's economy is on the edge of recession, are not groundless, as many employers have imposed cuts in salaries and benefits. With the number of coronavirus cases increasing exponentially in India, frightening narratives of lack of bed availability, exorbitant charges levied by private hospitals to treat COVID-19 patients have emerged.
The need for a health insurance policy to cover medical expenses is of primary importance during this time. According to the Asia Insurance Review, less than 4 per cent of COVID-19 patients in India have health insurance coverage, which is not surprising considering that total insurance coverage in India is very small.
In April 2020, the Insurance Regulatory Authority of India (IRDAI) announced that all health insurance policies that cover the cost of hospitalization care provided by both general and health insurance firms should also cover the cost of hospitalization for COVID-19.
The health insurance plan usually covers all medical costs incurred by the covered person for all diseases, except those critical to the health insurance policy that is not part of the package. However, after the IRDAI circular, for those that have a general health insurance policy (taken up individually or provided by your employer), you will still be eligible to claim benefits for COVID-19 care.
Many health insurance providers have released this information on their respective websites.
What would your health insurance policy cover?
Existing health insurance policies will cover hospitalisation costs, if the person has been hospitalised for more than 24 hours after being diagnosed with COVID-19. Several insurance companies have confirmed that the policy will cover costs incurred for pre-hospital treatment, diagnostics, referral coverage if the insured person tests positive from the licensed medical practitioner, quarantine-related expenses, mainly for isolated patients, and only for licensed centres, are also covered. These could include ICU costs, depending on insurance coverage.
And all costs are agreed on the basis of the terms and conditions of the agreement. It is therefore recommended that you contact your insurer to explain how much of the room to bed charges are protected by your policy.
What is not covered?
If you buy an insurance policy after you have been confirmed positive for the novel coronavirus, you will not be entitled to receive any benefits.
Home quarantine risks are not covered by most policies. Travellers who have to undergo compulsory hospital quarantine prior to being checked would also be unable to take advantage of benefits. However, insurance benefits may only be available to a person in institutional quarantine who is tested positive. In many cases, if a person claims for treatment within the prescribed "waiting period," they will not be able to make use of insurance benefits. The waiting period shall be the first 30-90 days from the date of purchase of a health insurance policy. A person can not claim the benefits of the COVID-19 treatment policy if they are in the review period. The review time varies depending on the insurance policy, with a minimum of 30 days.
Even, if you have a health insurance policy for particular illnesses such as cancer, heart disease, serious illness care, etc., there is no provision for COVID-19 medication. Scan the terms and conditions of the contract to find out what circumstances and events are covered and what they are not.
No health insurance cover?
If you do not have a health insurance policy, experts suggest that you get one as soon as possible, while taking into account the waiting period.
The Ministry of Home Affairs has made it compulsory for all companies to provide health insurance to their employees as and when they resume operations. It also requested all insurance providers to sell comprehensive health insurance plans to people or associations in order to make it easier for employers to comply with the Centre 's directives.
Indeed, IRDAI, too, will soon be mandating all general and health insurance companies to offer a stand-alone 'Standard COVID-19 health insurance policy' that addresses people's insurance needs in relation to COVID-19. This COVID-19 cover is currently a request for a bid, but IRDAI has directed all insurers to provide this person cover by 15 June. IRDAI will soon issue new guidelines for insurance products which explicitly cover COVID-19.
As per the draft guidelines, the features of the COVID-specific insurance policy would have to come with a minimum sum insured of Rs 50,000 and a maximum sum insured of Rs 5 lakh.
The policy covers hospitalisation costs, which includes room, nursing expenses, fees of the surgeon, anaesthetist, consultants and specialists if any. It also covers operation theatre charges, blood, oxygen, medicines, anaesthesia and surgical appliances charges as well. The policy would cover room and nursing charges of up to 2% of the total sum insured and is capped at Rs 5,000 a day. It also covers quarantine charges of up to Rs 3,000 a day and ICU charges at Rs 10,000 per day.
The insurance policy would have a minimum age entry of 18 years and a maximum of 65 years and can be taken for an individual or family. The tenure of the policy would be one year. It also offers two add-ons: Quarantine cover, and hospital daily cash cover, which is a fixed amount of cash for each day of hospitalisation.
According to experts, a COVID-19-specific cover is beneficial for those who may not have a health insurance cover policy, and are looking for a cost-effective cover in the current scenario as they cannot afford a comprehensive health insurance policy.
However, if you are looking for health insurance cover, experts recommend going for a comprehensive policy that covers not just COVID-19.
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