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Coronavirus health insurance: Does my policy cover COVID-19; how to register a claim and other questions answered

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With the increasing number of cases, inquiries about health insurance policies for the viral infection have also picked up.

Coronavirus health insurance: Does my policy cover COVID-19; how to register a claim and other questions answered
Coronavirus cases in India have crossed 4,400-mark including more than 3,981 active cases and as many as 114 deaths. With the increasing number of cases, inquiries about health insurance policies for the virus have picked up. Nonetheless, there is quite a bit of confusion among policyholders as to whether or not they are covered for treatment for COVID-19, how can one make a claim for a confirmed case, what is the coverage policy for quarantine etc.
Here are some important answers related to health insurance coverage for coronavirus.
Does my existing health insurance policy cover coronavirus?
Health insurance policies cover all kinds of respiratory diseases, which means they cover coronavirus, provided the affected person does not have COVID-19 at the time of the purchasing the policy.
"Coverage will be available in all products that offer hospitalisation cover. Hence, all covers such as in-patient treatment, pre-hospitalisation, post-hospitalisation and ambulance cover that a particular health policy offers will be available for coronavirus as well," explains Mayank Bathwal, CEO, Aditya Birla Health Insurance.
Will testing for COVID-19 also be covered by my policy?
No. Diagnostic expenses are generally not covered by health policies. However, if the patient is tested positive and hospitalised, diagnostic expenses will be covered under pre-hospitalisation extension. Accoring to experts, in case, the policy covers OPD (outpatient department) expenses, then the cost of diagnostics can be covered depending on the policy terms.
Is there any circumstance under which my policy will not cover COVID-19?
Yes, there are certain limitations imposed on the coronavirus infection as well. According to PolicyBazaar, if you already have been suffering from a respiratory infection in the past four weeks, then your mediclaim under a basic health insurance policy or a coronavirus specific insurance policy might not get settled.
Also, you may not be able to register a claim under the following conditions:
  • If you and your family members have recent travel history to the worst affected countries
  • If you have been hospitalized for lesser than 24 hours
  • If you have pre-existing cold-like symptoms and were going for planned treatment
  • If the insured contracts the disease during policy waiting period
  • How can I  claim insurance for confirmed coronavirus?
    You can choose to go with cashless claim facility or reimbursement facility depending upon the policy terms.
    "For cashless claim, you can choose to get admitted in a network hospital and take the necessary treatment by informing the third party administrator (TPA) within the hospital," explains Amit Chhabra, Head of Health Insurance at PolicyBazaar. In cashless claims, a patient does not have to pay any incurred expense for the treatment of an illness.
    "While in reimbursement process, you can take treatment at any choice of hospital after informing the insurer and pay the incurred bills. All these bills are later reimbursed to the policyholder up to the sum insured after proper verification from the insurer," Chhabra adds.
    In any form of insurance, there are terms and conditions, exclusions, or waiting periods as per which claims are settled or rejected.
    Are there specific policies for coronavirus too? If yes, what is the sum insured?
    Yes, many insurance companies have come up with insurance products that cover individuals specifically for coronavirus.
    GoDigit, built under Digit Health Care Plus is an insurance product that covers individuals on the detection of coronavirus, wherein 100 percent sum is insured in the form of a lump sum. If quarantine is advised, the policyholder is paid 50 percent of the sum insured in the form of a lump sum. You can choose from multiple sums insured options starting from Rs 25,000 up to Rs 2 lakh.
    Star Novel Coronavirus Insurance Policy, launched by 'Star Health and Allied Insurance' covers all those who test positive for COVID-19. It provides a lump-sum payment to any individual insured between age 18 to 65. The policy doesn't have any international travel history-related exclusions. It is available under two sum insured options of Rs 21,000 and Rs 42,000 at premiums of Rs 459 plus GST and Rs 918 plus GST, respectively.
    'COVID-19 Protection Cover’ of ICICI Lombard also pays 100 percent of the sum insured to the policyholder in case they are declared coronavirus positive, irrespective of hospitalisation expenses.
    Airtel Payments Bank recently said that it has partnered with Bharti AXA General Insurance to offer health insurance plans to provide cover and give financial protection against COVID-19.
    Under the tie-up, the companies are offering two health insurance plans -- Bharti AXA Group Health Assure which offers lump sum benefit of Rs 25,000 and Group Hospital Cash which provides daily benefit starting Rs 500 per day -- to provide protection against COVID-19.
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