Big Story | Do you have the right health insurance to fight Covid-19?

When finances are strained due to job losses and paycuts, it is dangerous to leave medical exigencies to be covered out of pocket.

Did you know that the treatment for Covid-19 in private hospitals costs ₹3-5 lakh (over 10-14 days)? If a ventilator is used, costs shoot up further. Protective gear used by doctors and nurses are also charged to the patient.

It is therefore important that you have a comprehensive health insurance policy with sufficient sum insured (SI), if you do not already have one.

All leading health insurance companies, including ICICI Lombard, HDFC ERGO, Star Health and Allied Insurance, and TATA AIG, that BusinessLine spoke to, are thankfully not abandoning their customers infected with Covid-19, and are settling claims.

Numbers with EPOCH Insurance Brokers show that in the past few weeks of private hospitals being allowed to treat coronavirus cases, 130 claims, amounting to ₹3 crore, have been registered with the leading health insurers. These numbers are rising by the day.

If you already have a standard health insurance plan, you can set your worries aside. If you have paid the premium and the policy is in force, you can claim benefits on the policy immediately, if you get hospitalised.

But if you buy a health insurance policy afresh now, note that any claim can be made only after the first month. All regular health insurance policies have an initial waiting period of 30 days. This is to avoid people with ‘known risks’ taking advantage of insurance cover.

There are a few specialised Covid-19 plans in the market now. But beware, these, too, come with a waiting period.

Covid plans vs regular health policies

A few insurers have launched specialised health plans to cover treatment of coronavirus. This includes Digit Insurance, Star Health and Allied Insurance, ICICI Lombard, Future Generali and Reliance General Insurance. However, note that while the plans of ICICI Lombard, Future Generali and Reliance General are group medical covers, Digit’s and Star Health’s policies are individual plans.

The three group covers are benefit policies that pay the entire SI in one go on diagnosis of the illness (Covid-19, in this case). Though generally group health policies usually provide coverage from day one, these plans have a waiting period of 14-15 days.

The policies of Digit and Star Health are indemnity plans where the claim paid is only up to the hospital bill and the SI is the upper limit of what one can claim.

Digit Insurance has stopped fresh subscription to its plan as the product was under the IRDAI’s (Insurance Regulatory and Development Authority of India) sandbox regulation, which mandates no new subscriptions once the plan collects ₹50 lakh in premiums.

Star Health’s plan (Star Novel Coronavirus) continues to be open for subscription, but offers very limited coverage — the maximum SI offered is ₹42,000. The waiting period to claim this policy is 16 days. Also, only those who have been tested positive can make a claim. Those who have been quarantined cannot do so.

Digit’s Covid product, too, had many ifs and buts — the insured or their immediate family members should not have travelled to countries including China, Japan, Singapore and Italy since December 1, 2019. Further, those suffering from cough, cold/nasal block and fever for six weeks were not issued the policy.

Health insurance companies, however, cover a wide range of illnesses in their standard policies itself, and this now includes Covid-19, provided it is not pre-existing at the time of issue of the policy.

Medical expenses during quarantine also get covered as most insurers pay for pre-hospitalisation expenses.

The SIs starts from ₹1.5 lakh and can go up to ₹25 lakh or even ₹1 crore (Aditya Birla’s Diamond with Super NCB offers cover for up to ₹2 crore).

Also, most insurers, including HDFC ERGO, Royal Sundaram and Max Bupa Health, cover domiciliary treatment up to SI — which means, medical expenses at home post-Covid-19 will also be paid for.

Post-hospitalisation expenses are covered up to 60/90 days by most insurers.

In Royal Sundaram Lifeline Supreme and HDFC Health Suraksha Gold, post-hospitalisation expenses are covered for up to 90 days.

ICU charges for Covid-19 patients go up to ₹15,000/day, or higher, in super speciality hospitals as these are isolated units and are high-maintenance.

Many of the standard health insurance policies today have no sub-limits on ICU charges. These include Royal Sundaram’s Lifeline Supreme, HDFC Health Suraksha Goldm, MAX Bupa’s Health Companion and Aditya Birla Health’s Diamond with Super NCB.

Claim process

The process for Covid-19-related claims is same as the usual claims. Customer care desks of most insurers operate 24/7. You can reach out to the call centres through toll-free numbers or intimate the claim through the website or the mobile app of the insurer.

In case of reimbursement because of treatment in a non-network hospital, keep safe all your original documents including test reports and originals of bills. You can later send this by courier to the insurer.

Some of the insurers now accept digital documents, too, so you can send scanned copies of the bills and filled-in claim forms.

The IRDAI has instructed that claims with respect to Covid-19 have to be processed expeditiously by adopting simplified procedures.

Frequently Asked Questions

No.

All regular health insurance plans cover cost of hospitalisation (inclusive of room rent, ICU charges, diagnostic tests, doctor/surgeon fees and medicines) and pre-/post-hospitalisation expenses for 60-90 days. The cost of OPD treatment is also covered by most health policies plans.

Most insurers cover quarantine if associated with treatment; for instance, HDFC ERGO covers it. Social isolation without any treatment is not covered.

If you go to the hospitalfor a Covid-19 confirmatory test, it will be covered as part of the hospitalisation and pre-/post-hospitalisation claim by most insurers including HDFC ERGO and TATA AIG. Even if the test result is negative, the expenses will be covered.

Yes. In regular health plans, exclusions include self-inflicted injury, sexually transmitted diseases and injury from nuclear explosion/war, treatment related to obesity or weight control, and cosmetic surgery. Unlike Covid-19 special plans, regular health insurance policies do not pose restrictions for claim based on an individual’s travel history. You can get treated and claim the policy irrespective of how you contracted the virus.

Do note here that insurers that do not cover domiciliary treatment under their health policies will not cover costs incurred in home quarantine.

The regulator allows consumables including gloves and kits used for surgeries to be excluded from cover. But some insurers may cover them subject to caps under the policy.

Regulation has it that the insurers should continue to cover the policy till the insured continues to pay premium. So, lifelong renewal is guaranteed.

Yes. The maximum entry age is 65 years in most health policies, and once taken, the policy can be renewed lifelong.

Yes, provided you have a family floater health insurance plan.

Yes. If you get treated in any of the network hospitals of the insurance company, cashless settlement will be allowed. If the treatment is outside the network hospitals, you will have to spend from your pocket and file for reimbursement.

If your health insurance policy covers outpatient treatment, expenses on a Covid-19 vaccine will also be covered.

5 things to know about health insurance plans

It has been observed that demand for life and health insurance typically goes up during epidemics, like it did during SARS and MERS. Indian health insurers have also been witnessing increased sales over the recent months. If you are going to buy a health policy now, do not fall for tall claims made by agents. Read the fine print in the policy brochure carefully. The free look-up period is 15 days – this is the time within which you can return the policy if you do not agree to any condition. Below are five points to note before buying a health insurance cover:

1 Do not fall for ‘no medical tests’ promotion

Because of the lockdown, most insurers are waiving the mandatory health tests and are advertising the same. However, note that health insurance firms now use tele-underwriting where an appointed doctor asks the policy seeker basic medical questions to know the state of his/her health. Santosh Agarwal, Chief Business Officer, Life insurance, Policybazaar.com, says: “During the call, questions are asked on medical history of the individual and if they were hospitalised in the last 12 months; also if they have any medical conditions like high/low BP, diabetes, etc.” Do not make false disclosure or hide the truth about your health condition, smoking/drinking habits or your travel history. This may result in claim rejection later.

2 You can’t start claiming immediately

Diseases contracted in the initial 30 days of a policy will not be paid for. This is called the initial waiting period and is standard across policies. This will hold good for all conditions including Covid-19. However, note that this is applicable only on new policies and not on policies that are renewed.

When you browse online for health insurance plans, do not go for the cheapest bet. An insurer which offers a lower premium than the industry average will surely have hidden conditions and may cap payments on expenses including room rent and ICU charges, making you pay for expenses from your pocket. So it is always suggested that you go for a comprehensive health cover without sub-limits or co-pay requirements. Also, for a little extra premium, you can also get sum-insured restoration benefit these days. In policies with this benefit, if you exhaust the SI and the no-claim bonus, the base SI will be restored (with some conditions). A few suggestions on comprehensive plans are: Royal Sundaram’s Lifeline Supreme, Max Bupa’s Health Companion and HDFC ERGO’s My Health Suraksha. Note that Arogya Sanjeevani, a standard health insurance plan launched by insurers on the instruction of IRDAI, covers Covid-19, but has sub-limits and co-pay.

While the premium of this plan is relatively cheap, do not buy it unless you are left with no other option.

4 No rejection after eight years

As per a recent regulation, a health insurance claim can’t be rejected if it has been renewed continuously for eight years, except in case of fraud. This rule comes into force on October 1, 2020. That said, there is a strong grievance-redressal network through the Insurance Ombudsman and the IRDAI that can come into help if a genuine claim is rejected.

5 New regulation to take effect on October 1

In September 2019, the insurance market watchdog announced a set of new guidelines for health insurance policies. Insurers have to withdraw their old plans and bring new policies adhering to these guidelines from October 1.

As per the new guidelines, many lifestyle disorders and those relating to genetic problems that were earlier excluded, now have to be covered by insurers. This includes treatment of mental illness, stress or psychological disorders; puberty- and menopause-related disorders; genetic disorders, internal congenital diseases; speech disorders; injury or illness associated with hazardous activity; and also age-related illnesses such as knee-cap replacements.

Insurers also cannot exclude diseases contracted after taking a policy. So, say, if a person is diagnosed with a chronic kidney disease after a few months of issuance of a policy and the condition was not under permanent exclusion at the time of issuing the policy, the insurance company has to cover it. To ensure that health insurance policyholders get the benefit of modern treatment methodologies, the regulator has also listed some procedures that all insurers should cover.

These include balloon sinuplasty, deep brain stimulation, oral chemotherapy, immunotherapy, intravitreal injections, robotic surgeries and stem-cell therapy. The IRDAI, however, gives freedom to insurers to impose sub-limits on these treatments.

Premiums, as a result, may go up. For those of you who are buying a policy now, the premium from the next renewal may be higher.

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