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Does Standard Health Insurance Cover Covid-19 Treatment?

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

As we know, COVID-19 has struck the world and many people are seriously ill due to it. Sadly, it is a highly infectious disease and lakhs of people are getting infected each day. No one knows who will get infected next. So you want to ensure whether a standard health plan covers Covid-19 treatment or not. 

The answer to your question, YES! 

Is a COVID-19 cover included in your standard health insurance plan?  Thankfully, the answer is YES. 

Let’s find out more in the article below.

Is COVID- 19 Covered? 

In the month of March 2020, when the ailment was just starting to spread in India, the IRDA instructed all the health insurance companies to cover the COVID-19 related ailments in the standard health insurance plans. 

Since viral infections and complications related to those are covered under a comprehensive health plan, the IRDA said no insurer should refuse a COVID-19 related claim. The IRDA also instructed the health insurance companies to launch new disease-specific health plans that were specifically designed for Coronavirus treatments. Many health insurance companies have now launched such plans too.

Points to Remember When Using the COVID-19 Cover

What is Covered?

As per the instructions of the IRDAI, health insurance companies are settling all coronavirus related cases with an immediate effect. However, the coverage that you get depends totally on the terms and conditions of the plan that you have opted for. It is highly recommended that you go through the policy documents or get in touch with a customer care executive to find out coverage. You may be covered for:

1. In-patient Expenses
Your health insurance policy covers the following expenses up to your sum insured:

  • Room charges, Boarding and nursing
  • Consultation Charges
  • Diagnostic procedures
  • ICU charges
  • Consultation fees
  • Consumable (PPE Kits) only If covered under your plan

2. Alternative Treatments
Depending on your health plan, alternate treatments are also covered. When you get admitted to a recognised hospital, insurance policy the following are covered:

  • Ayurvedic
  • Unani
  • Siddha
  • Homoeopathy

3. Pre and Post-hospitalisation Expenses
The medical expenses that are incurred before and after the hospitalisation will be covered up to a specific number of days. 

4. Quarantine
A doctor-prescribed quarantine in a hospital would be covered as per the terms and conditions of the policy that you have. The expenses that you had to incur because of self-isolation/ self-quarantine at home, however, would not be covered.

What is not Covered?

In the case of the following situations, the treatment would not be covered:

  • Claim made during the initial 15 days of policy inception would not be accepted
  • Medicines purchased without prescription would not be accepted
  • If the diagnosis was done before the policy inception, the claim would not be accepted
  • In case of travel to ‘prohibited countries’ during the past few months, treatment would not be covered
  • If testing is done at an unauthorised centre, the claim would not be entertained

How to Claim Under the COVID-19 Cover?

The claim settlement procedure under a health insurance policy, even from different insurance companies generally has a few common basics. However, when a claim is being made for COVID-19, it is recommended that you check the same from your insurance company. Most companies are prioritising the COVID-19 claims and are giving Covid patients proactive claim settlement. Though the guidelines issued by the different companies may be different, the common ones are:

  • Companies have issued new helpline numbers to intimate Covid-19 diagnosis.
  • The test for COVID-19 should be conducted strictly as per the government laid instructions and at a laboratory that is government-designated.
  • Depending on the hospitals that you take treatment in, your health insurance claim would be settled. Most insurance companies have tie-ups with hospitals and when you seek hospitalisation in a network hospital you can avail the facility of Cashless Hospitals. Else, you can go for Reimbursement.
    • Cashless Claims - Once the pre-authorisation is received, your cashless treatment would begin. You would have to submit the Claim Form, along with the other required documents, if asked. Your health insurance company/ its TPA would settle the bills directly with the hospital up to your sum insured limit.
    • Reimbursement Claim - In case you could not receive treatment in a network hospital, inform your insurance company at the earliest. Once your treatment is done, and you get a discharge, you can submit all the claim related documents with the company. Post verification, the medical expenses incurred by you would be reimbursed, up to your sum insured limit. Make sure you file your claim within 15 days of the treatment taken.
    • Documents Required:
      • Claim Form-Filled and Signed
      • Lab Report with Sign and Stamp of Authority
      • Certificate from Medical Officer confirming the diagnosis
      • Declaration Certificate of “No Travel” by the insured
      • All Treatment-related papers
      • KYC and NEFT details

Things to Keep In Mind When Making a Claim

Here are some tips to help you find the correct way out to file a claim for Coronavirus treatment hospitalisation under standard health insurance :

  1. Read the policy wordings - While a vast majority of the health insurance plans are now offering a COVID-19 cover, there may be a fine print on your health insurance policy that would hold you back from paying the claim. Read your policy wording very carefully to fully understand whether or not you can make a claim. For example, some health plans do not pay the claim for an infectious disease within the first 30 days of buying the plan, so under such a policy, you can't make a claim for the COVID-19 related issues. Read the policy carefully before you make the claim.
  2. Opt for a corona cover - If you are prone to get COVID-19 (frontline worker, living in a congested neighbourhood, etc), consider getting a corona cover that most of the health insurance companies are now offering. These plans offer a more well-rounded and comprehensive coverage against this specific illness. The plans also have little to no waiting periods, which further prove to be effective. But before you buy such a plan, check if the coverage is already available under your standard health plan as there is little use in buying extra health insurance.
  3. Look for group coverage - If you do not have a health insurance cover currently, or for some reason, your policy is not covering the COVID-19 ailments, do not lose heart. You can still make a claim under your group health insurance plan. If you are employed, in all probability, you have an employer-provided group health plan. Most group health plans cover corona ailments, so ensure you get the claim from the policy as you rightfully deserve it.
  4. Keep your plan active - And last but not least, never allow your health insurance plan to lapse. As you can see, the times are very uncertain and no one can predict who will get infected next. Even while taking all the precautions, many people are getting COVID-19. The only way to truly stay protected is by having a good health insurance plan that will allow you to get treated at the best facility and recover faster. If you allow your plan to lapse, you won't get this benefit and then the road to recovery can get a lot more difficult. Stay away from all such issues and pay your health insurance premium on time to enjoy an uninterrupted health cover.

After following these steps, you may find it easier to make a health insurance claim after you receive treatment for ailments caused by the COVID-19 virus.

A Standard Health Insurance Plan does Cover Covid-19 Treatment, Better to Stay Covered

Health insurance is a very crucial requirement of life, and we understand this even better at such times of global medical emergencies. When you buy a health insurance plan, you expect your insurer to cover you for all medical expenses, especially those incurred when you spend a few days in a hospital. 

If you have a standard health plan, then you don’t have to worry. But, if you do not have a health plan, get one at the earliest. If you think you are at greater risk, make use of the handy Corona cover health plans. Also, use your standard health covers and group health covers as and when needed. Make your decisions wisely and keep yourself and your loved ones protected at this dangerous and fragile time.

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