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Does a Health Insurance Plan Cover COVID-19 Treatment?

By Vikas Chandra Das
21 July 2022, 11:46 AM

Today, the world is fighting against the coronavirus pandemic. While the situation all over the world is tough, you should remember that panic is not the key to the problem, prevention is. As the number of positive cases of coronavirus has been surging across the world, having the right health insurance cover with the right amount of coverage for this deadly virus becomes all the more important. 

Currently in India, active coronavirus cases stood at 3.28 crore (as of 1 September 2021) which is a matter of great concern for our vastly populated country. The treatment cost of this novel- coronavirus infection is very expensive and therefore you need to find out whether your regular health insurance plan covers COVID-19 treatment or not. 

Does a Health Insurance Plan Cover COVID-19 Treatment? 

Yes, health insurance plans cover COVID-19 treatment expenses. If you are hospitalised for a period minimum of 24 hours for COVID-19 treatment, the medical expenses will be covered in your standard health insurance plan. However, there are certain limitations on this coverage which are discussed as follows- 

  • Diagnostic expenses are not covered in a standard health insurance plan unless there is a linked hospitalisation for the treatment. The diagnostic expenses are covered only when the patient is symptomatic and requires hospitalisation or tests positive for COVID-19 and is later admitted to a hospital. Otherwise, regular health insurance plans do not cover diagnostic costs.
  • An indemnity health plan does not provide coverage for the cost of consumables used in the treatment of COVID-19. The cost of consumables is around 25%-30% of the total treatment cost of the disease. Consumables refer to single-use items such as PPE kits, sanitizers, goggles, disinfectants, etc. which are used for COVID treatments. These are considered as non-medical items and are not payable under most health insurance plans. Thus, you would have to bear the cost of consumables from your own pockets.
  • Quarantine or observation, that would not require hospitalisation of the patient, will not be covered under a regular health insurance plan.

So, the existing regular health insurance plans cover the cost of hospitalisation due to COVID-19. However, the costs of consumables, which constitute a primary portion of your medical bill, are excluded leading to considerable out of pocket expenses. If you want to avoid such out of pocket expenses and want to cover the consumables cost, you can buy coronavirus specific health insurance plans which are designed specially to meet the current insurance needs of the people. Let’s explore these plans: 

Coronavirus Health Insurance Plans

The Insurance Regulatory and Development Authority of India (IRDAI) directed health insurance companies to design and launch COVID-19 specific health plans to meet the demand for coverage of COVID-19 treatment expenses. As such, 2 COVID specific health plans were launched. These are short-term health insurance plans which cover medical expenses incurred due to coronavirus treatments provided the insured test positive for COVID-19. 

1. Corona Kavach Insurance Policy

Corona Kavach insurance policy is a short-term indemnity oriented health plan which offers coverage against the medical cost incurred on hospitalisation due to COVID-19. 

Features of Corona Kavach Insurance Policy

Corona Kavach is introduced to fulfil the current insurance needs of individuals and hence it covers the cost of consumables, diagnostic expenses, quarantine expenses, etc. Let’s know its features: 

  • Individuals between 18 years to 65 years of age can buy Corona Kavach Insurance policy as an individual or family floater health insurance plan. In a family floater plan, the entry age for dependent children is 1 day to 25 days.
  • It has a waiting period of 15 days only after which the coverage is available. Also, the coverage under the plan is offered only for hospitalisation of the insured due to COVID-19.
  • Under the family floater variant of Corona Kavach, the policyholder, his/her spouse, dependent parents, dependent children and parents-in-law can be covered.
  • The sum insured under the plan starts from INR 50,000 and goes up to INR 5 lakhs (in multiples of INR 50,000).
  • There are three policy tenures offered in the plan to choose from- 105 days (3.5 months), 185 days (6.5 months) and 285 days (9.5 months).
  • The benefit of portability and lifelong renewal is not available. You will have to pay a single premium to buy the plan.
  • A premium discount of 5% is offered to healthcare workers if they buy the plan.
  • The plan offers an optional add-on hospital cover which can be bought at an additional premium. This hospital cover pays 0.5% of the sum insured in the plan for each day of hospitalisation up to a maximum of 15 days.

Coverage under Corona Kavach Health Insurance Plan

Being a COVID-oriented health insurance plan, it is designed with wide coverage benefits. These include the following: 

  • Room rent, ICU and ICCU room rent.
  • Expenses of boarding and nursing expenses.
  • Fees are payable to surgeons, consultants, doctors, medical practitioners and anaesthetists.
  • Pre-hospitalisation expenses for 15 days and post-hospitalisation expenses for 30 days.
  • Cost of oxygen, anaesthesia, blood, surgical appliances, diagnostic, ventilator, PPE kits, gloves, masks, medicines and other consumables are also covered including the cost of AYUSH treatments for COVID-19.
  • Ambulance cost up to INR 2,000
  • Treatment taken at home for upto 14 days after being COVID positive which would have otherwise required hospitalisation. All the costs of diagnostics, medicines, oximeters, consumables would be covered. However, home treatment will be covered only after you obtain approval from the insurance provider.

2. Corona Rakshak Health Insurance Plan

Corona Rakshak health insurance plan is a fixed benefit insurance plan. This plan pays a lump sum benefit if the insured tests positive for coronavirus. 

Features of Corona Rakshak Health Insurance Plan

Features of Corona Rakshak Health plan are discussed as follows: 

  • Corona Rakshak is available on an individual basis only. The family floater variant of this plan is not available.
  • Individuals of age 18 years to 65 years can be covered under this health insurance plan.
  • The minimum sum insured under the plan is INR 50,000 and the maximum sum insured is INR 2.5 lakhs (only in multiples of INR 50,000).
  • There are three policy tenures to choose from- 105 days (3.5 months), 185 days (6.5 months) and 285 days (9.5 months).
  • The plan offers a premium discount that can be availed if two or more members of the same family are covered under the same health plan on an individual sum insured basis.

Coverage under Corona Rakshak Health Insurance plan

Corona Rakshak plan covers COVID-19 infection. The lump-sum benefit is paid if the insured is COVID positive and gets hospitalised for at least 72 hours. 

Conclusion

If you have a regular health insurance plan, you need not worry about hospitalisation expenses. It provides coverage for COVID-19 treatments. But there are certain limitations to such coverage which has been mentioned earlier. You can, therefore, buy the above-mentioned COVID specific health plans for your immediate coverage needs. These plans would provide financial assistance in case of COVID infection and help you face the medical costs incurred.

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