Is COVID-19 covered by your current health insurance plan?

With the COVID-19 pandemic taking a toll of more than 28,000 lives in India, people have started seriously asking the question; does my health policy cover me for Coronavirus? The Coronavirus pandemic has put the world in crisis – health, humanitarian, economic and more. It has made us realize how uncertain and difficult, any disease can be and that even the healthiest of people are vulnerable to illnesses. 

It is therefore important to be financially prepared to meet healthcare expenses. One of the few saviours in these trying times is health insurance. But does your health policy actually cover you for COVID affliction? Many policyholders have been wondering whether or not COVID-19 is covered by regular health insurance plans, or do they need to buy dedicated Coronavirus insurance plans?  

Let’s explore the world of health insurance and COVID-19 and learn how you can ensure you and your family are protected with a suitable health insurance plan.

COVID-19 health insurance – IRDAI guidelines

To understand the effects of COVID-19 on health insurance in India, let’s take a look at the clauses and guidelines set by the Insurance Regulatory and Development Authority of India (IRDAI).

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

According to experts, these short-term Coronavirus health insurance policies are good for those who do not have any health insurance; while for others, a COVID-19 plan could be a good top-up to their existing health plan. Remember, the WHO had declared Coronavirus as an international pandemic and existing health insurance policies, by definition, do not cover pandemics as the impact is not specific to a person.

• IRDAI has instructed insurers to provide health insurance plans that include hospitalization coverage to expedite COVID-19 related cases.
• The cost of medical expenses including that during quarantine period should be settled as per the policy terms.
•  The IRDAI has asked insurance companies to design specific products to meet the needs of Coronavirus related medical care.
• The IRDAI has advised insurers to thoroughly review claims made for COVID-19 related medical treatments to avoid rejections. What do these guidelines mean for health insurance policyholders?

Health insurance and coronavirus – all you need to know

Most health insurance plans that cover hospitalization costs would cover Coronavirus related medical expenses. However, some policies may have clauses that do not allow coverage for pandemics and this is included in most policies. The lesson – it’s time to review your existing health insurance policies and ask some important questions to your insurance agents. 

Is the sum insured enough?

Just having a comprehensive health insurance plan that covers hospitalization may not be enough. Assess if your sum insured would be enough to cover Coronavirus related medical treatments. Considering the average cost of treatment for Coronavirus can range from Rs 1 lakh to 2 lakh to even go all the way up to Rs 6 lakh to 7 lakh, a policy with a low sum insured may not be sufficient.

Is there a sub-limit clause in your policy?

Even though the sum insured of an insurance policy may seem to be enough, do not ignore the sub-limit clause. Sub-limit clauses usually put a cap on expenses such as room rent, which is a major expense in the case of Coronavirus related hospitalization. 

Among other limits, insurance plans usually have caps on day care treatments, diagnostic tests as well as pre and post hospitalization expenses. It is important to assess your existing health policy to understand if there are sub-limits and the amount involved in such sub-limits. If the sub-limit clause could impact the quality of your treatment, it might be wise to buy COVID-19 top-up insurance.

Co-payment clause can be burdensome

Health insurance policies that have co-payment terms may require the insured to pay a certain predefined amount or a percentage of the sum insured towards medical expenses. It is important to check the co-payment clause in your existing health insurance policy. 

Do you need to buy a top-up?

Top-up health insurance plans offer additional coverage to a policyholder beyond the deductible limit. A deductible is a base amount, which is to be paid by the insurance holder. Any expense beyond the deductible would be paid by the insurer, which is called top-up. In the case of top-up, the deductible applies to every claim made during the policy period. 

If the existing sum assured for your health insurance seems inadequate, it is advisable to go for a top-up to supplement your existing policy.

COVID-19 Standard Health Plan 

The Insurance Regulation and Development Authority of India (IRDAI) has directed insurers to design a new product – COVID-19 standard health plan, which would be largely standardized across all health insurance companies. It could have the following 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

The COVID-19 Standard Health Plan would benefit those who do not have any health insurance policy. Even those having health insurance coverage can explore taking this policy as it gives dedicated coverage to COVID-19 afflictions. 
 

To sum it up

Keeping in mind all the above factors, you may decide if your existing health insurance plan will be enough to support you and your family members in the case of coronavirus related hospitalization. Going by the high costs of hospitalization and increasing cases, it is best to be prepared.