When you take admission to a hospital for COVID treatment they add the cost of consumable items like sanitation kits, PPE kits, and ventilators to the bill. But a basic health insurance plan that covers basic COVID hospitalization expenses will not cover most of these charges.
*All savings are provided by the insurer as per the IRDAI approved insurance plan. Standard T&C Apply
*Tax benefit is subject to changes in tax laws. Standard T&C Apply
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2021 is witnessing the second wave of COVID-19 and it has hit the entire nation hard and is severer than the COVID wave in 2020. Apart from taking a toll on people’s health, it can also put a dent in savings and ruin all the financial planning.
If you have health insurance cover, financial protection is provided only up to an extent. This is because all health insurance plans come with a set of exclusions for which the medical expenses are not covered. For instance, all medical insurance plans have a waiting period of 2-4 years before the expenses incurred on pre-existing diseases are covered. Similarly, hernia and cataract surgeries are usually not compensated in the first policy year.
During coronavirus hospitalization, disputes between hospitals and insurance companies on overcharging further added to the financial burden. As per industry estimates, policyholders only get 50-55% of their actual COVID-19 hospitalization expense. In such a situation a coronavirus health insurance policy is what you need. We will discuss different health plans like Corona Rakshak and Corona Kavach policy policies later on this page.
PPE kits are a major expense of COVID-19 treatment because they are consumable items, their cost is not covered. Insurance companies later changed their minds and started covering these expenses as well up to a certain limit. Since PPE kits add to a significant portion of the total hospital bill and usage of excess kits above the specified limit is not allowed.
The capping on PPE kits as per the General Insurance Council is kept at Rs 1,200-2,000 a day. The cost of multiple PPE kits is not covered. Most of the insurers pay for one PPE kit per day up to a maximum of Rs 1,500-2,000 on daily basis for PPE Kits.
The increased cost of sanitization by the hospitals has added up to the overall hospital bills. Insurance companies, in some cases object to bills that are charged separately. The cost of air conditioning, housekeeping, daily charts, and infection control charges are a part of the room rent bills. If they are billed separately then they might not be covered. And if sanitization expenses are charged separately then they are also not covered.
Some other expenses that your basic medical insurance policy won’t cover are nebulizers, oxygen cylinders, and private attendant/nurses charges.
These are the expenses that are paid by the insurer:
However, if you have purchased specific coronavirus health insurance plans like Corona kavach policy, Corona Rakshak policy then the insurer will cover all these costs up to the limit specified. However, you can also consider buying coronavirus health insurance plans from health insurance companies other than corona kavach and corona Rakshak. All the insurers are offering pilot products to cover the cost of COVID-related hospitalization expenses.
You can buy all these coronavirus health plans online from Policybazaar from the comfort of your home.
While settling cashless health claims, health insurers directly make the payment to network hospitals up to the sum insured or the limit as specified in the policy wordings. But during COVID-19 treatment, policyholders have faced huge deductions that were not covered by the insurer under the cashless claims also. In January, the IRDAI stepped in to advise the insurance companies to enter into agreements for COVID-19 cashless claims with hospitals, using COVID-19 cashless claims and state government as references.
As per agreed tariff rates, the insurer settles the cashless claims. After the intervention of the Insurance Regulator, though the situation seems to have improved for policyholders, not all the insurance providers agree to COVID-19 cashless payments due to differences over fair pricing.
After GI Council guidelines to reduce excessive rates due to coronavirus pandemic, a lot of hospitals are not in agreement with the proposed tariffs. Therefore, the insurers are now doing fresh negotiations for claims settlement as per the policy wordings.
For claim reimbursement, you need to submit your hospitalization bills to the Health Insurance Company that will make the payment after ascertaining all the documents submitted by you.
Medical claims where the hospitals have billed as per the local body or state rates are settled according to the bills submitted. If the hospitals submit open bills or non-GI Council bills the same gets settled as per mediclaim policy terms and conditions.
Though, medical policies have a clause of reasonable and customary charges. And the reimbursement is provided as per the policy terms and conditions adhering to capping imposed by the GI Council or government, leading to a partial payment of claim amount.
During such tough times, health insurers are trying their best to meet the rising demand for adequate health cover. If you have a health insurance policy do read its clauses for COVID cover, if it’s not sufficient buy to buy coronavirus health insurance online from Policybazaar at reasonable premiums.
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