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Things you Need to Know about Coronavirus Health Insurance Policy Coverage

With the recent announcement by IRDAI, most of the health insurance plans in India are covering the treatment cost for the coronavirus infection, which has recently taken a kick in India.  Any person who gets hospitalized to take treatment for coronavirus will be covered just like any other disease or illness. If there is hospitalization for at least 24 hours then all the health insurance claims will be processed by the insurer as per the regular norms.

Tracking Novel Coronavirus Cases in India so far:

  • Jammu & Kashmir- 1 case with travel history to Iran
  • Rajasthan- 17 cases that include 16 Italian tourists and 1 Dubai Return Indian National
  • Maharashtra- 39 cases so far and 1 death
  • UP- 13 cases so far ( 4 have been cured)
  • Karnataka- 1 death and 8 tested positive
  • Telangana- 1 case with a travel history to Bengaluru and Dubai
  • Tamil Nadu- 1 man who returned from Oman
  • Delhi- 7 cases, and 1 death
  • Haryana- 15 confirmed ( 14 foreign nationals and 1 Indian)
  • Ladakh- 2 cases with a travel history to Iran
  • Kerala- 24 cases and increasing

(All the above figures are subjected to changes)

But like other illnesses, certain limitations are imposed on the coronavirus infection as well.
If have already 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. You may not be able to register a claim under the following scenarios:

If you and your family members have recent travel history to the worst affected countries

If you diagnose positive after returning from a coronavirus affected country then your regular indemnity medical insurance policy will cover if you are being quarantined in India. Whereas the specially designed coronavirus insurance policy might not cover people with a travel history to a few affected countries such as Macau, China, Italy, Taiwan, Hong Kong, Japan, Kuwait, Singapore, Thailand, South Korea,  etc.  Also, if the insured catches the virus from an infected family member with a travel history to these countries then also the mediclaim will not get settled.

If hospitalized is lesser than 24 hours

Just like all the health insurance claims an insured person cannot claim the insurer for coronavirus treatment if the hospitalization is lesser than 24 hours. Without hospitalization, the insurer may not accept the claim as the majority of the basic indemnity health insurance policies in India do not cover outpatient treatment expenses unless the insured has taken an add-on cover.

If you have a pre-existing cold-like symptoms going for a planned treatment

If you have been suffering from any respiratory-problems within the last four weeks, then your claims under a regular indemnity type health insurance policy or a specific coronavirus insurance policy might not get settled. Both flu and coronavirus have similar symptoms and if the insured has been suffering from flu, cough, breathlessness, respiratory illness, and has been planning to take its treatment and it further develops into coronavirus disease/infection plans then the insurer is most likely to reject your mediclaim.

If an applicant or insured is suffering from coronavirus infection and plans to file a claim under a normal health insurance policy or a specific health plan for coronavirus then he/she is likely to be rejected the claim request.  Any planned treatment or pre-existing illness before purchasing insurance shall not be covered.

Any health emergency in the country is usually covered, but if it’s a planned treatment, then it shall not be paid off by the insurer.

If Coronavirus is declared as an Epidemic/Pandemic

If World Health Organization (WHO) or the Government declares COVD-19 as epidemic/pandemic then the insurer might not settle health claims arising due to coronavirus infection, as such claims are not covered under many health insurance policies. However, there are some insurers who still cover it, so make sure that you check it with the provider.

If the Insured contracts the Disease during the Policy Waiting Period

Most of the health insurance plans have a waiting period clause, which is a pre-determined duration starting from the policy commencement date. This waiting period applies to some specific diseases as well as pre-existing illnesses and the treatment expenses are covered only after the completion of the waiting period.
So, the usual waiting period for respiratory illnesses is 30 days if it is not a pre-existing condition. For instance, Digital coronavirus health insurance policy only has a waiting period of 15 days and the claims will be paid to the insured if it’s filed after the completion of the waiting period.

With this, you will have a fair understanding before you purchase a new health insurance policy or corona virus-specific policy that the claim for treatment of this disease may not be covered under the above-mentioned scenarios.

In a nutshell

The Noval coronavirus is an illness of epidemic proportions and can have a deeper impact on the life of people.  Therefore, the insurers are offering maximum help as much possible after the IRDAI announcements and are covering coronavirus claims under their standard health policies.

There is no need to panic but equally important to take precautionary measures. And instead of panicking it makes sense to check with your insurance provider if your policy covers the illness or not? As of now most of the insurers are covering COVD-19, but some might not compensate because of its pandemic nature. However, it depends on the type of medical insurance policy. And if you are planning to file a claim make sure that you go through the policy wordings, policy clauses, and immediately get in touch with your health insurer.

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