COVID 19 Treatments Cost in India – How COVID Health Insurance Plans Come to the Rescue

The Coronavirus pandemic has left the country in a crisis of sorts; be it humanitarian, health, financial, or medical. The cost of Coronavirus treatment is a cause of concern for all; patients with health insurance, patients without health insurance, and the insurers too. Being a pandemic, there is a lot of uncertainty whether a normal health cover will reimburse the treatment costs of COVID-19 or not.

With no standardization, insurers are worried that hospitals would overcharge, the brunt of which would have to be borne by insurance companies. Patients without insurance have to bear huge hospitalization expenses from their personal funds. Those who have health insurance may be in a better position compared to the uninsured, but worry that they may not have sufficient sum insured to cover the huge expenses.

Let’s take a peek at the average costs for the treatment of Coronavirus in India.

The average costs of Coronavirus treatment are high

The high costs of Coronavirus treatment across the country have been a cause for concern for everyone, and that has not been properly planned and managed as has been done in many other countries. The issue has been discussed in news reports as well as forums and groups.

A report by Hindustan Times shares a breakdown of the costs: The average daily cost of treatment for Coronavirus is Rs 20,000 to Rs 25, 000. The treatment for Coronavirus usually requires at least 10 day to two weeks. The total treatment cost can add up to Rs 2 lakh to Rs 3 lakh. The swab test costs Rs 4,500 while the kit itself costs Rs 3000 each. To make things worse, many unscrupulous medical practitioners and pharmacies are also fleecing customers in these uncertain times.

If suspected to have contracted the virus, even before testing positive, the patient has to travel only in an ambulance, which could cost upwards of Rs 1000 depending on the distance to be travelled. Add to this the cost of having separate rooms with in-built toilets and ventilators for severe cases. The average total cost for a 10-day treatment could easily add up to Rs 6 to 7 lakh. The irony is that all these costs are being incurred although there is no medicine or vaccination for Coronavirus and most of the treatments are experimental.

See more by visiting this infographic on health insurance in India.

Why are Coronavirus treatment costs rising?

A report by the Economic Times reveals that the costs of Coronavirus treatment have been increasing exponentially. The reason: the cost of consumables used to treat Coronavirus has increased. Also, consumables used in the treatment for the virus cannot be reused and have to be disposed; which adds to the cost. Surgical accessories such as PPE kits, slippers and gowns etc used by doctors and nurses, too have to be discarded with every single use, the cost of which adds up to the patient’s bill.

How does the basic health insurance plan come to rescue for Coronavirus treatment?

The confusion arises because normal health covers do not include covers for epidemics and pandemics. Many are unaware that a basic comprehensive health insurance plan covers Coronavirus treatment, including hospitalization. The IRDAI has laid out a set of rules and guidelines especially for Coronavirus treatment. Let’s understand these:

• IRDAI has allowed insurance companies to offer short-term health insurance policies of up to 3 months to 12 months to cover Coronavirus. These can be individual or family floater plans.

• Insurers have been advised to expedite Coronavirus related claims.

• The cost of treatment during the quarantine period also has to be covered by the insurer, depending on the clauses in the fine print of the policy.

• The IRDAI has shared guidelines for insurers to introduce a COVID-19 Standard Health Plan. This product is not mandatory for insurance companies and so each company can decide whether or not it wants to offer health insurance plans.

How does COVID-19 Standard Health Plan help?

There are two types of Coronavirus health insurance plans:

• Corona Kavach is a standard health plan that offers policies of sum insured between Rs 50,000 and Rs 5 lakh.
• Corona Rakshak offers policies of sum insured between Rs 2.5 lakh and Rs 5 lakh.

The COVID-19 Standard Health Plan would be more beneficial to those who do not have any health insurance policy. These are its key features:

• Sum insured: Rs 50,000 to Rs 5 lakh (in multiples of 50,000)
• Age eligibility: Between 18 years and 65 years
• Pre and post hospitalization: 15 days pre hospitalization and 30 days post hospitalization
• Premium payment: monthly, quarterly, half-yearly and annually
• Waiting period: 15 days
• Home care expenses: covers COVID-19 treatment taken at home
• A lump sum insured would be paid upon the diagnosis of Coronavirus requiring hospitalization of at least 3 days
• The positive diagnosis of the policyholder has to be from a government authorised diagnosis centre only.
• The plans cover: hospitalization expenses, pre-hospitalization expenses, day-care procedure expenses, ambulance costs, ICU room rent, post hospitalization expenses, recovery benefit, among other standard covers.
• The Coronavirus policies offer the add-on facility of maternity benefit with newborn baby cover.    

Let’s understand the lump sum payment clause of the Coronavirus plans with an example. If a person buys a COVID-19 policy for Rs 3 lakh, tests positive and is hospitalized for 10 days, incurring a total bill of Rs 6 lakh, the insurance company is liable to pay a lump sum of only Rs 3 lakh, which is the sum insured. The remaining Rs 3 lakh have to be borne by the policyholders out of their personal funds.

The COVID-19 Standard Health Plan will help those who do not have any comprehensive health insurance plan. Such people could buy this policy to ensure financial coverage during the Coronavirus times. However, experts suggest that people should have a high sum insured so as to have sufficient coverage to meet the high costs of treatment.

You need to be aware on what is covered and excluded. This infographic on surgeries covered will help.

Best practices for utilizing health insurance for Coronavirus

• Like any other health insurance plan, it is important to carefully go through each and every clause mentioned in the policy.
• Details such as claim process, inclusions, exclusions, sub-limits, deductibles, among other important details should not be missed.
• The exclusions of the Coronavirus plans should be scanned carefully. Normal exclusions include pre-existing diseases, non recognized quarantine facilities and hospitalization without doctor’s recommendation.

Coronavirus health insurance claim process

Cashless claim

In the cashless claim feature, the policyholder does not have to pay any amount to the hospital; the insurer directly pays to the hospital on behalf of the policyholder. So if policyholders receive Coronavirus treatment at any of the network hospitals mentioned in the policy, they do not have to pay cash. This relieves money-related stress to a great extent, given the high costs of hospitalization related to Coronavirus treatment.

Reimbursement claim

The reimbursement claim process typically comes into the picture when policyholders receive treatments at non-network hospitals. In this case, policyholders have to pay the hospital bills, and then apply for claim to the insurance company with all the relevant documents and bills. The insurance company then verifies the bills and documents and pays the claim amount by way of bank transfer.

To sum it up

The Coronavirus pandemic has increased awareness about the importance of health insurance. The health insurance industry in India too has responded proactively to the needs and requirements of customers by providing Special COVID-19 policies. The IRDAI has consistently made amendments in rules and regulations to make the life of both the insured and the insurer easier. This has not only led the uninsured to buy insurance policies during this period, but it has encouraged the insured or underinsured policyholders to buy add-ons and increase coverage with sufficient sum insured to help them meet medical uncertainties.