Coronavirus Health Insurance

The outbreak of Coronavirus has been in the news for months now. More than 19 million people around the world have tested positive of this disease that has claimed over 1 million lives so far (as on 14^th April 2020). With more than 10,000 people in India testing positive with the disease (as on 14^th April 2020), it has become a matter of great concern for our vastly populated nation. There have been outbreaks of many deadly viruses in the past, such as Zika, Ebola, MERS, Nipah, etc, But the novel Coronavirus disease (COVID-19) has brought the whole world to a standstill with several countries under lockdown, including India.

Though it has not spread in India as widely as most developed nations, such as China, Italy and the USA, it is important to be prepared for any unfavourable circumstance in advance. But if you have a health insurance policy, the question is if the novel Coronavirus disease falls under the ambit of medical insurance coverage in India or not?

What is Coronavirus?

Coronavirus is a group of virus that attacks the immunity of a human being causing diseases ranging from the common cold to Severe Acute Respiratory Syndrome or SARS. In late December 2019, a new strain of coronavirus originated in China, which was unknown to humans before. It came to be known as the novel Coronavirus disease or COVID-19. Ever since the disease has spread across the globe killing over 1 million people (As on 14^th April 2020).  

The coronavirus disease causes infection in the nose, upper throat and sinuses. In severe cases, the virus can lead to major respiratory illnesses such as pneumonia, kidney failure as well as multiple organ failure. Therefore, the 2019-nCoV or the novel coronavirus disease has been fatal largely for people above the age of 60 years and those who had pre-medical conditions.

The symptoms of Coronavirus infection are similar to those of regular flu that includes sore throat, fever, dry cough, runny nose and sometimes a headache. Being a new strain of the coronavirus, there is no vaccination or guaranteed cure available as of now.

What is Coronavirus Health Insurance?

Coronavirus Health Insurance refers to a health insurance policy that covers the medical expenses incurred on the treatment of COVID-19. A health insurance policy is designed to cover hospitalization expenses of the insured person, irrespective of the disease that he has been diagnosed with (unless it is a critical illness that is not covered). Almost all the health insurance plans cover hospitalization expenses incurred on the treatment of viral infections. Since Coronavirus is a viral infection, a comprehensive health insurance policy pays off hospitalization expenses including in-patient and out-patient expenses, incurred on the treatment of COVID-19.

The Coronavirus health insurance cover will be available from the day the insured gets diagnosed with the disease. This is because COVID-19 is a new disease and therefore, does not come under the category of pre-existing illness.

What is Covered by Coronavirus Health Insurance Plan?

The following table shows the list of inclusions under coronavirus health insurance:

What is Not Covered by Coronavirus Health Insurance Plan?

Not all medical expenses are covered under your coronavirus mediclaim insurance policy. Take a look at the list of exclusions under your coronavirus insurance:

• Home Quarantine – This policy does not cover any expenses that you incur while staying in quarantine at your home
• Non-recognized Quarantine Centre – If you quarantine at a non-recognized centre for coronavirus treatment, the medical expenses incurred will not be covered under your policy
• Pre-Existing Diseases – Any medical expenses incurred on the treatment of any pre-existing diseases will not be covered under this policy unless the waiting period gets over
• Pre-Natal & Post-Natal Expenses – This policy will not cover any pre-natal or post-natal expenses incurred by the insured unless it leads to his hospitalization.
• Hospitalization without Doctor’s Recommendation – If you get hospitalized without the recommendation of a qualified doctor (as mentioned on a prescription), then this policy will not cover the hospitalization expenses arising out of it

How to Claim Health Insurance for Coronavirus?

There are two ways of filing a health insurance claim for Coronavirus disease. You can file a cashless claim or a reimbursement claim. Let us read in detail about both types of claims for coronavirus health insurance cover:

• Cashless Claims for Coronavirus

  Most health insurance providers today provide cashless treatment facility. As part of this facility, the insured is not required to make any payment for the treatment taken at one of the network hospitals of the insurer. Instead, the insurance company settles the treatment bills directly with the hospital.

  So if you receive treatment for coronavirus disease at a network hospital of your insurance provider, you will be able to avail cashless treatment facility and would not be required to make any payment for the treatment received.

  Make sure to check if your health insurance for coronavirus offers cashless claim facility. You can find the list of network hospitals of your insurer on the policy wordings or at the official website of your insurance provider.

• Reimbursement Claims for Coronavirus

  Reimbursement claims are meant for policyholders who get hospitalized and receive treatment at a non-network hospital of his insurance provider. If you obtain treatment for COVID-19 at a non-network hospital of your insurer, you will be required to pay all the hospital bills in full at the time of your discharge.

  Once you get discharged, you need to file a reimbursement claim with your insurance provider. To do so, you’ll have to fill up the reimbursement claim form and submit the required documents including the hospital bill payment receipts, investigation & test reports and doctor’s prescription to the insurer within the specified time limit.

  The insurance company will verify your claim and post that the reimbursement amount will be transferred to your bank account.

Is Coronavirus Covered Under Existing Health Insurance Policy?

Coronavirus diseases or COVID-19 may be newly discovered disease. But all existing health insurance policies will provide coronavirus health insurance cover. This means that if you purchased a health insurance policy before testing positive for the coronavirus disease, any medical expenses incurred on its treatment will be covered under it (provided you don’t get diagnosed during the initial waiting period).

Since the coronavirus is not a pre-existing ailment, it will be covered as part of the basic hospitalization expenses under a health insurance plan that includes in-patient hospitalization expenses, ICU charges and diagnostic test charges amongst others.

However, if you don’t already have a health insurance policy and decide to buy one after testing positive for COVID-19, then coronavirus treatment expenses will not be covered under the policy.

Important Facts on Coronavirus Insurance Cover

Before you buy a coronavirus insurance India is offering, you should be aware of a few facts related to the policy. Here are some important facts that you should know before buying a coronavirus health insurance cover:

• Sum Insured: Coronavirus has claimed several lives across the world and thousands of people have been critically ill due to contracting the disease. Since COVID-19 can lead to severe respiratory illness and impacts overall body functioning, its treatment can get very expensive especially for people with underlying diseases. Therefore, it is advisable to opt for a higher sum insured amount for your coronavirus health plan so that you are appropriately covered for any circumstance.
• Coverage: It is important to carefully go through the coverage provided by the COVID-19 health insurance before you choose a plan. Most policies offer coverage for in-hospitalization expenses, post-hospitalization care, ICU charges, OPD charges, ambulance charges, etc.
• Waiting Period: While buying health insurance for coronavirus, it is important to check the in-built waiting periods under the policy. Almost all health insurance plans come with a waiting period of the first 30 days. However, some insurance providers, such as Star Health Insurance, is offering 16 days waiting period only under their coronavirus health insurance policy. During this period, none of the claims filed by you will be covered by under the policy. Thus, make sure to check the initial waiting period that your coronavirus insurance comes with before buying.

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