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With an alarming increase in the COVID-19 cases in India, people are more concerned about whether the health insurance policy they purchase covers them adequately or not. Moreover, the demand for the health insurance policy for parents and families has also surged. Most of the medical insurance policies offered by the insurance company cover in-patient treatment for Coronavirus. While buying health insurance online, including coverage for COVID-19 treatment it is important to keep in mind the four Cs i.e. benefits covered, co-pay, coverage, and consumable cover.
Let’s take a look at these aspects in more detail.
Most of the people getting in contact with covid-19 do not have any significant symptoms that require inpatient treatment. In some cases, a covid-19 basic medication or diagnostic test is required on an OPD (outpatient) basis. These expenses are only covered if the policy offers coverage for OPD expenses. While purchasing the policy make sure you check whether your health insurance plan provides OPD coverage or not, so that in times of need these expenses can be covered.
In severe cases, if the patient needs to be admitted then the expenses will be covered under most of the health insurance policy. However, some of the insurance companies have created an exclusion for the pandemic diseases. Make sure you read the fine print of the policy thoroughly to ensure that the policy you purchase does not have any such exclusion.
As per the reports, the hospitalization for treatment in the case of COVID-19 is more likely to happen for the vulnerable population, which includes senior citizens and individuals with pre-existing illnesses like diabetes, hypertension, and respiratory tract diseases. If you suffer from any of these illnesses before buying the policy, then for these conditions the policy might have a waiting period for covering pre-existing diseases.
While zeroing in on a policy, do check with the insurance company on how they treat a claim for Coronavirus and where a section of treatment will be for diseases that have a waiting period. Even though the treatment for these conditions is standardized by the IRDAI, the standardized protocol is expected to be entirely in effect by the end of the year. As of now, the claims are likely to be treated as per the documents issued by the policy.
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The insurance companies have reported around 200 claims for the COVID-19 and most of the patients are still hospitalised, thus, it is early to analyse the cost of the treatment for Covid-19. On basis of a quick analysis of claims filed in the six major cities and an assessment of the cost of treatment based on reported complication, time period of stay, etc., the average claim amount of Covid-19 is expected to be approximately Rs 5 lakh or more. Also, there is a high probability that more than one person may get affected by the virus due to a highly transmittable nature. Thus, it is important that you have adequate coverage of more than Rs 10 lakh to ensure that you have a proper financial backup in case of any medical emergency.
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In many health insurance policies for family, the policyholder is required to bear a share of expenses from his/her pocket, known as co-payment. This is a simple measure of cost control build in by the health insurance companies. When the medical expenses are small then co-pay can be a reasonable amount to pay from your pocket. However, if the treatment cost is higher, then it can be a burden on your pocket.
For instance, if your health insurance policy has a 10% co-pay and the claim amount is Rs 50,000 then you will need to bear the cost of Rs 5,000 and the remaining Rs 45,000 will be paid by the insurer. However, if the claim amount is Rs 10,00,000 then you will need to pay Rs 1,00,000 under the co-pay facility. Thus, it is significant to check whether your policy has any co-pay clause and the quantum of the same.
In cases of coronavirus, a huge part of the cost of treatment is one of the room rent, specifically if the treatment of the insured person is done in a private hospital. In many private hospitals, specialized isolation facility has been created, which are charged higher than the regular rooms. Most of the health insurance policies have a room rent limit. The room rent coverage is offered either as a specific percentage of the sum insured or by specifying a category of room. If the room rent surpasses the limit set by the insurer, there can be an equal deduction of the claim amount. Thus, to choose the right health insurance plan clear your queries regarding sub-limits of room rent that the policy may have.
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These are the items that can be used only for one-time, mainly due to reasons of infection prevention and sterility. Consumables are classified as masks, gloves, cotton, sanitizers, etc. and most of the health insurance policies do not cover consumables. Coronavirus is a highly infectious and communicable disease due to which the healthcare workers are required to use whole body PPE (Personal Protection Equipment) extensively, to prevent the spread of the virus from patients who are being treated. This is one of the major reasons for the increase in demand for the numbers of consumables like gloves, masks, PPE kits, etc. resulting in the surge of the hospital bills. Therefore, it will be wise for you to check whether the policy covers consumables or not. As there are only a few health insurance plans available in the market that cover consumables, thus make an informed choice after reading the fine lines of the policy.
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In the best of times, the healthcare system is quite challenging to navigate. The task to choose the right medical insurance plan is a bit more tedious during a pandemic. Therefore, by keeping all these aspects in mind make sure you choose an appropriate plan to ensure that you have adequate coverage in case of any unforeseen health emergency.