Does My Corporate or Group Health Insurance Policy Cover Coronavirus?

With an increasing number of coronavirus cases, inquiries related to health insurance policies that are covering the virus infection has also risen. Apart from this, there is a lot of confusion among many health insurance policyholders whether their policy covers the treatment of COVID-19 or not. How will they be able to make claim when they are tested positive for coronavirus and what is covered in their policy when they are home quarantined, etc.

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Here in this article, we are going to answer some important questions related to health insurance plans and coronavirus:

Is the Treatment of Coronavirus Covered in My Health Insurance?

Health insurance plans cover all types of respiratory illnesses that means they provide coverage for coronavirus provided that the person affected should not have COVID-19 while he/she is purchasing the policy.

As per the guidelines of IRDAI all the health and general insurance providers should have to offer cover for coronavirus in the existing policy of a policyholder. Along with this, IRDAI has also issued a notice in which it has directed health insurance companies to include medical cover for coronavirus treatment, irrespective of the policy owned by a consumer.

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Does the Testing of COVID – 19 Also Covered in My Health Insurance Policy?

No, the expenses of diagnostic tests are not covered in most of the health insurance plans. However, when a patient is tested positive for coronavirus and is hospitalized, then the diagnostic expenses are covered under the pre-hospitalization expenses. As per the experts, in case, a health insurance policy provides coverage for OPD, then the diagnostic cost can be covered in int according to the terms of the policy.

Are There Any Circumstances Under Which My Health Insurance Will Not Provide Coverage for COVID – 19?

Yes, some limitations are imposed on the infection of coronavirus also. As per some experts, if you are already suffering from some respiratory infection in the last four weeks, then your medical insurance policy under a basic health insurance plan or a policy specific for coronavirus may not get settled. In addition to this, you may not be able to register an insurance claim under the below-mentioned conditions:

  • If your family members or you have recently traveled to any of the worst affected countries.
  • If you have pre-existing symptoms of cold and you are going for planned treatment.
  • If you are hospitalized for less than 24 hours.
  • If you contracted the disease during the waiting period of the policy.

What Are the Steps to Claim Insurance In Confirmed Case of COVID – 19?

You can choose to opt for the facility of reimbursement or cashless claim settlement according to the terms of your policy.

For a cashless claim settlement, you can opt to get yourself admitted to a network hospital and get the required treatment by giving the information to the Third-Party Administrator (TPA). Every insurer has a TPA desk in its network hospital. In the case of a cashless claim settlement, you do not have to pay for your incurred treatment expenses.

On the other hand, in case of reimbursement, you are free to take the treatment in a hospital of your choice after informing your health insurance provider and pay the bills. You can get all these bills reimbursed later as per the sum insured of your policy. The insurer passes these bills after properly verifying your case.

In any type of insurance, there are conditions and terms, waiting periods, and exclusions according to the claims that are rejected or settled.

Are There Any Specific Health Insurance Policies for Coronavirus as Well?

The Insurance Regulatory and Development Authority of India has issued guidelines specifically for health insurance plans for COVID – 19. The plan under which is referred to as Corona Kavach. Health insurance providers have to offer healthcare plans for individuals and families. Earlier, IRDAI has advised all the insurers to accept the claims concerning the expenses of COVID – 19. This means that your existing medical insurance policy will provide coverage for the expenses related to coronavirus.

Even though the IRDAI has stated that all the health insurance policies in India have to offer coverage for coronavirus, however, one should look at the Corona Kavach policy and get to know what the policy is, and then opt for it so that he/she feels secure in this time of uncertainties. 

Elements of Corona Kavach Plan

Like any other health insurance plan for an individual, a policy for coronavirus as well as a specific policy for individuals. According to Corona Kavach for individuals provides insurance coverage pre and post hospitalization, hospitalization, co-morbidities treatment, home isolation treatment. The treatment provides coverage for homeopathy treatment, Siddha, Ayurveda, and Unani treatment are as well covered in this plan and the coverage up to the sum insured is provided. Another best part of Corona Kavach is the availability of home care treatment, wherein any treatment that one avails after testing positive for coronavirus is as well covered. In such cases, the patient is advised to take home treatment, which is monitored by the healthcare providers. This daily monitoring includes the details of the treatment and it has to be signed by the doctors under whom the patient is being treated.

The Corona Kavach plan is available for both individuals and families for up to Rs.5 Lakhs for the tenure of 3.5 months, 6.5 months, and 9.5 months. The Corona Kavach policy for the family is available for two adults and four children.

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Summing It Up!

Having a group health insurance policy for self and family helps you to protect yourself and your family from various unexpected medical emergencies and so does a coronavirus plan. However, thinking before finalizing a health policy with the required add-ons is needed.

Now with the help of this article, you can understand the coverage that is provided in health insurance plans for coronavirus related treatment. If you have not taken the right health insurance policy, then it is the right time to purchase one.


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Written By: PolicyBazaar - Updated: 26 August 2021

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