The arrival of the pandemic took the world by storm. When COVID-19 appeared in full-force in March 2020, in India — healthcare institutions, diagnostic laboratories, and health insurance companies scrambled to fill the gaps that our existing healthcare infrastructure held.
To put it simply, these institutions hadn’t been witness to such large-scale impact as a result of lack of health-related options, yet. And we, as consumers, suddenly understood the criticality and importance of having a policy in place that accounts for such instances.
As the steadily rising cases shook the foundation of our systems and still continues to do so today, individuals across the country have been forced to rethink their insurance coverage for both — health and life. The devastating second wave in March 2021 only further underlined the importance of protection, like never before.
The newest variant Omicron, which has recently hit our shores, is once again a grim reminder highlighting the need for adequate health and life insurance policies available, and access to avenues for credible information about them.
Some of the questions we’d received on COVID-19 and health insurance are listed with responses below.
What are my options to cover myself and my family for COVID-19?
- All existing standard health insurance policies as per the IRDAI, cover hospitalization expenses related to COVID-19.
- Health insurance provided by your employer is typically customized based on conversations between your employer and the insurance provider.
Make sure you go over the policy documents to understand exactly what the terms and conditions entail.
What do I need to look out for when it comes to my employer health insurance policy?
- It shouldn’t have a waiting period for coverage of existing diseases.
- It shouldn’t be prone to any sudden or major deductions.
- It should cover PPE kits (up to a limit).
- It should cover treatment at home, for those unable to get out (specific to the terms of the contract).
- Identify if there is a sub-limit on Room Rent, which could lead to considerable savings.
- Double check that hospital disinfection charges — biomedical waste, sanitization, and fumigation are not payable.
What is personal health insurance as opposed to employer health insurance?
This is the health insurance you buy personally, for yourself. If you have your own policy as such, it should cover COVID-19 related hospitalization expenses.
Other conditions you should be aware of:
- A 15 - 30 day waiting period for claims related to sickness (including COVID-19).
- A 3 - 4 year waiting period for pre-existing diseases.
- It will be prone to heavy deductions.
- It will have a sub-limit or eligibility cap on Room Rent.
- It may not cover the cost of PPE kits separately.
- It may not cover treatment at home.
- It will not cover hospital disinfection charges.
Could you cite examples of policies in place?
IRDAI designed two short-term (maximum term of 9.5 months) health insurance plans to address the needs of COVID-19 specific hospitalization.
1. Corona Kavach
Corona Kavach is a short-term health insurance policy that reimburses actual hospitalization expenses (if you're admitted for more than 24 hours).
The benefits of this policy are:
- It does not have a Room Rent limit.
- It covers PPE kits, masks, and other charges separately.
- It covers hospitalization, even in the case of pre-existing diseases.
- Every insurer is supposed to offer this policy without any exceptions.
However, you cannot claim within the first 15 days of the policy.
2. Corona Rakshak:
Corona Rakshak is a short-term supplementary policy that pays you a fixed cash benefit of up to Rs. 2.50 lakhs per person, in the occurrence of the following events:
- You have been diagnosed as COVID-19 positive.
- You have been hospitalized for more than 72 hours.
The fixed cash component from Corona Rakshak can be used however you want. It helps you pull through large deductions in the claim amount and can function as a source of replacement income.
Any other health insurance related pointers to remember?
1. Mild COVID-19 treatment, hospitalization, and medication might not be covered in your health-insurance policy, unless deemed ‘medically necessary’.
2. You need to be admitted for 'active treatment'. Which means, symptom observation does not count.
3. Home quarantine will not be covered either, unless there is a shortage of hospital beds or it is a critical case.
The author, Dipika Jaikishan, is co-founder and COO at Basis. The views expressed are personal
(Edited by : Anshul)
First Published: IST