Eight things you must know about insurance policies covering COVID-19 treatment

COVERING THE COSTS OF COVID TREATMENT

Representational image by Gerd Altmann from Pixabay

Does your health insurance cover testing and treatment for the novel coronavirus disease? Should you be worried about the heavy charges billed by private hospitals? Will you be reimbursed 100% by your insurer? Here is what you need to know about the health insurance policies that cover COVID-19. 

Should you take a new insurance policy for covering COVID?


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It may not be necessary. In view of the pandemic situation, most insurance companies have modified their existing policy to include COVID treatment without charging an additional premium. Some of the companies who have done this are LIC, Oriental Insurance, New India Assurance, Aditya Birla and HDFC Ergo. 

LIC covers death claims arising due to COVID and these are treated on par with other causes of death.

Features of ICICI Lombard’s COVID-19 Protection Cover

– The package covers the first diagnosis of COVID-19
– It includes value added services like health assistance benefit and chat/virtual consultation.
– There is an add-on coverage which includes tele consultation and ambulance assistance
– The company will pay the entire sum insured, as per the policy, as a lump sum amount to the patient, irrespective of hospitalisation. There is no reimbursement against OPD or hospitalisation bills.
– Individuals up to the age of 75 can opt for the policy
– The exceptions include any travel history after December 31, 2019, to any affected area overseas, history of quarantine or diagnosis with COVID-19 prior to the risk inception or within the waiting period of 14 days and any claim within first 14 days after policy inception
Features of Star Novel Coronavirus insurance policy

– Insurance cover will depend on the sum insured.
– Senior citizens up to 74 years** can avail the Novel Coronavirus insurance policy.
– The company is not liable to pay for any illness, sickness or disease other than COVID-19, or any claim with respect to COVID-19 contracted or manifested, or the onset of diseases, prior to the commencement date of the policy or during the waiting period.
– There are two options in terms of the sum insured (for the individual) — Rs 21000 and Rs 42000, with premiums of Rs 299 and Rs 598 (+GST in each case) respectively
– The company can be contacted at 1800 425 2255 / 1800 1024477 or support@starhealth.in for more details.

(** As specified in inputs from Star Health Managing Director Dr S Prakash)

Will your health insurance cover 100% cost of COVID treatment?

No. According to the guidelines set by the Insurance Regulatory and Development Authority of India (IRDAI), the costs of admissible medical expenses during the course of treatment (including the treatment during the quarantine period) shall be settled according to the terms and conditions of the particular policy contract that you have, and the existing regulatory framework.

IRDAI also indicates that if the bill exceeds the policy amount, the excess amount should be borne by the patient.

What part of COVID treatment is insured?

A majority of the schemes cover pre- and post-hospitalisation charges, ambulance and hospital quarantine (certified by a doctor) up to a specified time period as mentioned in one’s policy. 

However, diagnostic charges with no hospitalisation, consumables and home quarantining for asymptomatic COVID-positive patients are not covered by existing health insurance schemes, if not followed by hospitalisation.

In case of pregnant women contracting COVID-19, many policies do not cover pre-natal and post-natal medical expenses, unless the patient is hospitalised.

However, as mentioned above, ICICI Lombard’s special COVID-19 protection cover pays the entire sum insured (a lumpsum amount), irrespective of hospitalisation.

If a dependent gets affected by COVID, will the existing policy cover the dependent too? What are the limitations? 

Yes, the policy will bear the charges of treatment for dependents if they are included in the insurance cover. The same general limitations are applicable: No reimbursement for diagnostic charges, if not found positive and hospitalised.

Can you take health insurance now? Is there a waiting period? 

Yes, you can take health insurance now. However, you would not be insured if you fall ill during the waiting period, which ranges from 15 to 30 days, depending on the insurance company.

Does Ayushman Bharat cover COVID-19?

Yes. The central government offers five packages under Ayushman Bharat which will cover COVID testing and treatment: acute febrile illness, pyrexia of unknown origin, pneumonia, severe pneumonia, respiratory failure due to any cause (pneumonia, asthma, COPD, ARDS, foreign body, poisoning, head injury, etc.,) and type 1 or 2 respiratory failure.

Besides these packages, a press release stated that other packages can be invoked by hospitals as per the clinical condition of the patient. Additional cost required for isolation and treatment will be decided by the state government.

Who is eligible for Ayushman Bharat?

According to Ayushman Bharat website, the eligibility is categorised based on the beneficiary's place of residence - rural or urban.

Urban eligibility extends to:

► Security guard, rag pickers, electricians, mechanics, domestic help, gardeners, sweepers, sanitation workers, tailors and handicraft workers
► Hawkers, cobblers and other street-side service providers
► Masons, plumbers, porters, painters, welders and construction workers, drivers, conductors, rickshaw and car pullers and similar transport workers
► Peons in small establishments, assistants, shopkeepers, delivery boys and waiters

How can one apply for the health insurance scheme?
1. Visit https://mera.pmjay.gov.in/search/login
2. Enter your mobile number
3. Enter the captcha code
4. Click on the ‘Generate OTP’ tab
5. Select the state you’re residing in and search by name, HDD number, mobile number, or ration card number

You may also call Ayushman Bharat's helpline 14555 or 1800 111 565 to check if you are eligible.

Is there any special package for health workers?

Yes. The Ministry of Health and Family Welfare (MoHFW) has introduced Pradhan Mantri Garib Kalyan Package for health workers fighting COVID. 

A few salient features of the package are:

  • The accident insurance scheme covers loss of life due to COVID or accidental death on account of COVID-related duty. 
  • The scheme is for public healthcare providers including community health workers, who may have to be in direct contact and care of COVID cases and who may be at risk because of this.
  • It also covers private hospital staff and retired staff, volunteers, urban local bodies, contracted/daily wage workers, ad-hoc/outsourced staff requisitioned by states/central hospitals/autonomous hospitals of central/states/UTs, AIIMS and INIs/hospital of central ministries.
  • The duration of the policy is for a period of 90 days starting from March 30, 2020. 
  • Individual enrolment is not required.
  • The entire amount of premium for this scheme is borne by the MoHFW. Under this scheme, Rs 50 lakh will be paid to the claimant. The benefit/claim under this policy is in addition to the amount payable under any other policies. 

Are there any group policies that organisations?

Existing insurance policies cover COVID benefits, hence current policyholders (individual or group) can continue with the same policy. For availing new group health insurance policy now, insurance providers should be contacted.

For informal workers, Edelweiss-Gallagher, a composite insurance broker, is offering a Pandemic Group Insurance product for the informal sector and frontline workers across industries in India.

According to a press release from the Company, the policy will provide insurance cover to food delivery agents, informal sector workers in factories as well as frontline workers of hospitals, healthcare providers, pharmaceutical manufacturers and others.

Edelweiss offers customised policies to provide coverage from Rs 50,000 to Rs 50 lakh towards hospitalisation cover at private and public hospitals. Enquiries for the package can be made here.


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About Bhavani Prabhakar 4 Articles
Bhavani Prabhakar is Staff Reporter at Citizen Matters Chennai. She tweets at @_bhavaniprabha