Summary
As the number of positive COVID-19 cases in India is rising every day, one of the critical questions that people have is whether their health insurance will cover the treatment cost for Coronavirus. Read on to know more about it.
The whole world is battling the COVID-19 pandemic. As we hear in the news, the number of cases and the death toll is rising across the globe. While the government and the people are taking the necessary precautionary steps to avoid falling prey to the disease, there is a lot of confusion among the health insurance policyholders whether the condition will be covered under the existing policy.
So, if you are wondering does my health insurance policy cover COVID-19, here are a few essential things you must know.
Most health insurance policies cover all kinds of respiratory diseases, which means they include Coronavirus too. But the only condition is that the affected person should not have the diseases at the time of purchasing the policy. The government of India has directed all the insurance companies in India to cover the COVID-19 under their existing plans. Thus, your current policy will cover all expenses, including, hospitalisation charges, pre-hospitalisation and post-hospitalisation care, ambulance charges, in-patient treatment, etc.
Is COVID-19 testing covered under the health insurance policy?
No, generally, the insurance companies do not cover the diagnostic tests under their policy. But, if you test positive for Coronavirus and you get hospitalised, then the diagnostic tests will be covered under the pre-hospitalisation expense. Also, if your policy has an OPD (outpatient department) coverage, then depending on the policy terms, the diagnostic cost may also be covered under your policy.
Are there any specific conditions under which the health insurance policy will not cover COVID-19?
Yes, the insurance company may have a specific limitation on the COVID-19 coverage. Although the conditions may vary from insurer to insurer, generally, the insurer may not offer coverage under the following circumstances:
- If you have been suffering from any respiratory infection for four weeks before the date of filing for a claim
- If you or any of your family members have recently travel history to foreign countries, especially the countries that are worst affected by the virus, including China, USA, Italy, Spain, etc
- If you have any pre-existing medical conditions like cold or cold-related symptoms and were going for a planned treatment
- If you contract the disease during the waiting period
What is the process for filing a claim for patients who are tested positive?
For patients who are tested COVID-19 positive can either apply for a cashless claim or reimbursement depending on the policy terms.
If your policy has cashless claim facility, you can avail the treatment from any of the hospitals that are part of the insurer’s network. But, make sure that you inform the insurer about the treatment beforehand. Post the treatment you can submit the cashless claim settlement form, along with the necessary documents and the insurer will directly the bill with the hospital.
For reimbursement claim, you can avail the treatment from any hospital of your choice after informing the insurance company and settle the full bill with the hospital. Post-discharge, you must submit the reimbursement claim form and the necessary invoices and receipts to support the claim. Upon verification of the expenses, the insurer will reimburse the amount based on the terms and conditions of the policy.
Thus, it is quite clear that you can get coverage against COVID-19 under your existing health insurance policy.
