This post has been written by Anushree Tadge, a third year law student from ILS Law College, Pune.

India has over 74, 000 Covid-19 positive cases till date and majority of the these people are opting for government hospitals, along with a smaller section going for private healthcare. Insurance is also playing it’s small role in these times. Although, there is quite a some confusion amongst some policyholders if  whether or not they are covered by their insurance companies for treatment if one suffers from COVID-19, how to make a claim ? is there a coverage policy if one stays in quarantine etc. Now mostly all health insurance policies cover respiratory diseases, so it is implied that they would cover coronavirus, although the it will not be allowed if a person has COVID-19 at the time while purchasing any policy. According to the General Insurance Council, if the infection results in hospitalisation and related expenses and the same is covered by one’s medical policy then the same principle shall be followed. According to Mayank Bathwal, CEO of Aditya Birla Health Insurance  “Coverage for COVID 19 patients shall be available in all kinds of products that provide for hospitalisation cover. So it is implied that such covers will give for in-patient treatment, expenses that are incurred both pre and post-hospitalisation along with ambulance coverage. Please understand that pre hospitalisation will cover testing expenses also, provided the patient is tested positive and gets hospitalised.

Further, The World Health Organization (WHO) has declared the current coronavirus outbreak as a ‘pandemic’ on 12 March 2020. According to the General Insurance Council, the existing policies that are covering for hospitalisation will continue to cover the COVID 19 related expenses of hospitalisation. Although for newly purchased policies there is a waiting period of 30 days and if a person gets infected by coronavirus during this waiting period then the expenses shall not be covered.

Subramanyam Brahmajoysula, from, SBI General Insurance gave a statement that, in case coronavirus is declared as a pandemic by the World Health Organisation or the Indian government, then claims might not be satisfied as many health insurance policies negate such claims. So it is best advised to go through your policy’s terms and conditions clauses so as to confirm if the cover will be provided in case you get infected.

COVID-19 Specific Plans and Aarogya Sanjeevani

The Insurance Regulatory and Development Authority of India in January 2020 made it compulsory for all health insurance companies to offer a different standard product called the Arogya Sanjeevani policy to curb the Corona virus outbreak starting from 1st April 2020. Almost 29 insurers are offering this with a maximum sum upto ₹5 lakh.

Government has allowed treatment of positive tested individuals in private hospitals too and  also put a cap on how much can private labs charge for the test of COVID 19, but still there is no prescribed limit on how far can private hospitals charge for treatment. In this aforementioned Sanjeevani policy, room rent is allowed upto 2% or the most upto Rs. 5000/day along with ICU capping upto 5% or most upto Rs. 10,000/ day.mBut the room rent cap and other co-pay clauses which are not detailed in the Arogya Sanjeevani policy may push the insured to force out a part of the claim from your own pocket.

In the wake of coronavirus disease, insurance companies have planned to come out with Corona Specific plans in order to support the infected. These include Star Novel Coronavirus (nCoV) (COVID-19) Insurance ICICI Lombard’s Novel Coronavirus Policy and Policy, Digit Healthcare. All these plans are designed in such a way that they will provide a whole ‘lump sum’ amount to the insured person so as to deal with the incurred expenses during the course of hospitalization. All these plans are easily affordable at a premium which is generally in reach of a common individual. Such policies come out as the most handy solution right now for all those people who do not own any health insurance plan and looking for security against COVID-19. 

However, the sum assured by these insurance policies are limited and since these are designed to be ‘COVID-19 specific’ and they would not be able to cover if you if you are diagnosed with any other disease. Also, these policies have a few glitches that you need to be aware of in case you’re planning to buy them- 

  1. During the tenure of the policy, the insured cannot be in contact with any person who is or has been infected with the disease. So, if your family member gets infected and even returns back from the hospital after the treatment, you will have to isolate yourself in order to avail the benefits of policy.
  2.  The insured or their related family members must not have returned from the countries- China, Singapore, Taiwan, Thailand, Japan, Malaysia, Hong Kong, Italy etc. after 1st December 2019. Vivek Chaturvedi, from Digit Insurance, referring to the new coronavirus specific insurance policy, stated that, “Your claim will not be satisfied by repayment even if you get infected with the disease by a family member who has a travel history to the listed countries.” 
  3. Insured suffering from problems such as cough (with sputum or dry), cold, breathlessness or fever for last six weeks starting from investing sums in the policy shall not be liable to claim. 

CRITIQUE

There are numerous limitations imposed on the claims that are related to corona virus infection as well. For example, Policy Bazaar states in case a person is already suffering from a respiratory infection in the past four weeks from infection, then a Mediclaim under a basic health insurance policy might not get settled. 

A few situations where the claims might not get settled are-

  • If you or your family members have any recent travel history to the worst affected countries.
  • If  the hospitalization has not been for 24 hours.
  • If there are pre-existing cold-like symptoms to the insured.
  • If the policy waiting period is on and the insured contracts the disease during that period.

So just being a policy holder is not enough for the people infected by COVID-19. People should be pro-active in these times and understand all these terms and conditions.

CONCLUSION

After reading all the current situation of the Corona outbreak in India, even the readers must have understood that a satisfactory health insurance plan has become the need of the hour. It has become a big necessity and while people are stressing out and in a lot of panic due to this deadly virus, health insurance acts as financial supporter and keeps the mental health relaxed while allowing them to fight back the infection more strongly. Those who were never aware of or even thought of investing in health insurance schemes should now actively plan for it. One must compare the designs of all available plans and choose the satisfactory policies as per the desired requirement. At the end, taking good care of one’s health and maintaining social distancing before everything else is of primary importance. Stay Safe!

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