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Do Existing Health Insurance Policies in India cover Coronavirus (Covid-19)?

The Insurance Regulatory and Development Authority of India (IRDAI) has issued guidelines and directions that all existing health insurance policies of existing insurance companies will need to cover Coronavirus diseases or COVID-19 mandatorily. This means that if you have an existing health insurance policy and have crossed the mandatory policy waiting period, any medical expenses incurred relating to the treatment of Coronavirus will be covered under the policy. IRDAI has further directed all insurance companies to expedite coronavirus related claim settlement in the case of hospitalization.
It is important to mention here that if you’re purchasing a new India health insurance for Covid-19 policy, then the Coronavirus related treatment will not be covered for the mandatory waiting period, which is typically 30 days. Post this it will be covered. Also, if the customer is unfortunately infected with the Coronavirus while applying for the policy, the same will be treated as a pre-existing disease/condition and remain excluded from the coverage.

Under the Covid-19 health insurance coverage will be part of hospitalization expenses which include in-patient hospitalization treatment, ICU charges and diagnostic and other test charges.

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Covid-19 Indian health insurance review

  • Coverage
  • Limitations
  • Claims
  • Testing

What health insurance policy should I buy to ensure coverage for Coronavirus (Covid-19)?

All health insurance policies are designed to cover in patient hospitalization expenses of the insured individual for all ailments (except excluded ailments), that they have been diagnosed with. Many insurance companies have started providing health insurance plans for treatment of the Coronavirus for the proposer as well as his/her family. Hence it is advisable for the individual to go for a Covid-19 comprehensive health insurance plan that covers both in-patient and out-patient expenses incurred for all treatments including that of Coronavirus (Covid-19). Subject to crossing the mandatory waiting period of 30 days, the health insurance plan will pay all expenses, upto the policy limit, from the day of diagnosis of the disease. As in the case of almost all health insurance plans, the mediclaim coronavirus health insurance coverage should include but not be limited to:
  • In-patient hospitalization expenses that also include
    • ICU Room rent
    • Doctors/Surgeons fees
  • Pre and Post Hospitalization expenses
  • Restoration of Sum Insured Benefit
  • Day Care procedures
  • Ambulance expenses
  • Daily Hospital Cash
  • Organ donor expenses
  • YUSH Treatment
  • Maternity benefit with New born baby cover
Apart from the coverage there are a couple of important aspects that an individual must keep in mind with respect to buying a Coronavirus India Health insurance policy:
  • Cashless Hospitalisation - Insured should ensure treatment at a Network Hospital of the insurance company to ensure Cashless Hospitalisation. If the treatment is at a non network hospital, the insured will need to settle the bills and then seek reimbursement from the insurance company.
  • Coverage/Sum Insured - Coronavirus is not just a respiratory illness, but impacts all important organs in the body, and hence its treatment can get very expensive and more so patients with existing medical conditions. There have been costs reported from ₹1.5 lacs and going upto ₹8lacs, and while the medical fraternity is trying to being some standardisation into the treatment costs for Coronavirus, it is advisable to opt for a relatively higher sum insured amount to ensure satisfactory coverage. One is recommended to have atleast a ₹10 lacs cover.
  • Waiting Period : While investing in a health insurance plan overall and especially for for the coronavirus, one must be aware that all health insurance plans come with a minimum waiting period of the first 30 days, post which if the Coronavirus is diagnosed, treatment costs are covered.

What are the Limitations of the Health Insurance Plans relating to the Coronavirus?

It is also important for all insureds to be aware of what are excluded and the possible limitations under the Health insurance plans they are likely to invest in for themselves and their families. Some of the key exclusions:
  • Filing a claim for reimbursement of expenses along with A Medical Report of Novel Coronavirus (nCoV) (COVID-19) confirming that the test results are negative.
  • Filing a claim if the medical report /quarantine due to the coronavirus is not issued by a Government Authorised Centre (private/public owned).
  • Expenses incurred during home quarantine.
  • Insured not hospitalised for 24 hours continuously – there may be some relaxation on this given the nature of the pandemic.
  • The individual has a travel history to any foreign countries after December 31, 2019.
  • The claim is filed for an insured who is located beyond the geographical boundaries of India.
  • Hospitalization without doctor’s recommendation.
  • Any claim for Novel Coronavirus (COVID-19) contracted before the commencement date of the policy or during the waiting period – will be treated as a pre existing condition.

Claims Processing / Settlement for Coronavirus

Step by Step Process for Coronavirus Health Insurance Reimbursement Claims
  1. Contact the Insurance Company’s Toll Free Number to report/register the mediclaim insurance for Coronavirus providing basic information regarding the illness.
  2. Insured can get admitted to the hospital of their preference, but preferably to a network hospital of the insurance company (All insurance companies inform the insured at the time of availing the policy, the list of network hospitals – this list keeps getting updated from time to time).
  3. Post receipt of treatment for Coronavirus, insured should then settle the hospital bills and retain the original bills/invoices/receipts for submission to the insurance company along with the claim form.
  4. On receipt of the complete set of claim documents, the insurance company will adjudicate the claims and make the payment to the proposer for the admissible amount, along with a settlement workings.
  5. Documents to be Submitted for a Reimbursement Claim
    • a.Duly Filled Claims Form.
    • b. Original Discharge Summary document.
    • c. Original Hospital Bill with detailed Cost Break-up + Original Paid Receipts.
    • d. All Coronavirus related reports + Doctor’s Consultation Reports.
    • e. All Investigation, Lab and Test reports from an authorised/approved medical.
    • f. Photo Identity of Patient along with Health Card.
    • g. KYC documents
Step by Step Process for Health Cashless Claims
  1. Contact the Insurance Company’s Toll Free Number to report/register the claim for Coronavirus providing basic information regarding the illness.
  2. Insured must get admitted to a network hospital of the insurance company to be entitled for cashless treatment.
  3. The hospital will send the insurer the necessary preauthorization request form which contains details of Coronavirus diagnosis and treatment, medical history, proposed treatment approach and estimated cost. Based on the eligibility, the authorization letter is shared by the insurance company with the hospital.
  4. Post discharge of the insured, the hospital will send the original claim documents supported by the bills to the insurer. The claim will be assessed and payment will be made to the hospital accordingly.

Novel Coronavirus (Covid-19)

The Novel Coronavirus (Covid-19) has impacted thousands of people worldwide, at last count around 22 lacs with 1.54 lacs unfortunately dead. For those impacted, the stress goes beyond physical and mental health, involves high medical costs, maybe a loss of job/salary and associated financial stress. It is important for people to understand that even if they have a regular health insurance plan from any insurer paying for medical costs either through a cashless facility or reimbursement, all illnesses including Covid-19 are covered.

Many India health insurance providers are working on designing a best Covid-19 comprehensive health plan that specifically treats the coronavirus disease. This product needs to be designed by taking into consideration the expenses incurred during the treatment. It also has to take the duration of the quarantine period, treatment, and post-hospitalization costs incurred by the patients.

The existing health plans cover the pre and post-hospitalization charges. However, considering the pandemic and its impact, the new plan will be designed with respect to the treatment needed for this critical illness. Under the memorandum issued by the IRDAI, the features of the new plan should include:
  • The insurance providers will either have to design a comprehensive policy to comprehend the current COVID-19 situation in the country or cover the expenses of the treatment under its existing health policies.
  • The entire treatment cost of the infected person will be reimbursed.
  • Insurance providers need to review the claims carefully before reimbursement.
The testing of the disease, quarantine treatment, and hospitalization charges will be reimbursed under the health insurance plan if one is tested positive for the virus.

FAQ’s on Coronovirus and Health Insurance

Yes. All existing health policies cover Coronavirus as per the directive from IRDAI. If one wants to buy a new health insurance plan, they can do so and the policy will cover Coronavirus treatment after the mandatory waiting period, provided the insured didn’t have the illness while purchasing the plan.

Yes, one can cancel the same within the free look period, which normally is for 15 days. After that it will be cancelled and premium refunded, subject to no claim and on a prorata basis.

Yes. Existing health insurance policies will cover treatment expenses for Coronavirus treatment as per the directive from IRDAI, subject to completion of the mandatory waiting period.

Expenses relating to in hospital treatment, ambulance expenses, diagnostic tests, medical evacuation benefits if you’re unable to receive treatment at your current location, quarantine related expenses, if recommended by the attending doctor.

Coronavirus health insurance comes with a waiting period of 30 days from the date of inception of the policy.

Most clinics and hospitals in India are conducting coronavirus tests for free or for a subsidised cost. However, hospitalisation charges, including room rent, surgical procedures and medical expenses are to be borne by patients. This is where a health insurance policy comes into play. If you have an existing policy, your hospitalisation expenses will be covered by the insurer.

If you don’t have an existing health insurance policy, you should go ahead and buy one immediately. Any standard health insurance policy will help covering your hospitalisation and medical, testing and quarantine expenses.

All health plans by insurance companies in India offer both cashless and reimbursement claims processing for all treatments including Coronavirus. While cashless claims can be availed for treatment at a network hospital of the insurance company, a reimbursement claim can be made for treatment at any non network hospital, provided the insured settles all the bills with the hospital and then makes a claim with the insurer on submission of all related documents.

One has to follow the normal process like any other sickness/accident related claim. Get in touch with the Assistance Company (TPA) or Insurance company or their Toll free number, and register a claim providing them the policy details and the information relating to the claim. Refer your policy document or health card for the Assistance related toll free information.

Offcourse, one can go ahead buy a coronavirus health insurance online. This link will provide all related information on the existing health insurance plans which offer this coverage. Enter the required insurance related personal and health details and then pay the insurance premium online. Post this, the insurance company will issue you your policy.

corona

Coronavirus (COVID-19)

Also known as SARS-CoV-2, nCov, 2019 Novel Coronavirus, COVID-19 is a new illness that can affect your lungs and airways. It's caused by a virus called coronavirus. There’s no specific treatment for coronavirus (COVID-19). Treatment aims to relieve the symptoms until you recover. It's not known exactly how coronavirus (COVID-19) spreads from person to person, but similar viruses are spread in cough droplets. While the majority of cases result in mild symptoms, some progress to severe pneumonia and multi-organ failure. As of 20 March 2020, the rate of deaths per number of diagnosed cases is 4.1%; however, it ranges from 0.2% to 15% depending on age and other health problems.

The World Health Organization (WHO) declared the 2019–20 coronavirus outbreak a pandemic and a Public Health Emergency of International Concern.

Time from exposure to onset of symptoms is generally between two and 14 days, with an average of five days. The standard method of diagnosis is by reverse transcription polymerase chain reaction (rRT-PCR) from a nasopharyngeal swab. The infection can also be diagnosed from a combination of symptoms, risk factors and a chest CT scan showing features of pneumonia. There is no vaccine or specific antiviral treatment for COVID-19. Management involves treatment of symptoms, supportive care, isolation, and experimental measures.

Common symptoms include fever, cough, and shortness of breath. Muscle pain, sputum production and sore throat are less common. The virus is typically spread from one person to another via respiratory droplets produced during coughing. It may also be spread from touching contaminated surfaces and then touching one's face.

Basic protective measures against the new coronavirus

Stay aware of the latest information on the COVID-19 outbreak, available on the WHO website and through your national and local public health authority, including the Government of India’s notifications from the Health Ministry. Most people who become infected experience mild illness and recover, but it can be more severe for others. Take care of your health and protect others by doing the following:
  • Wash your hands frequently - Regularly and thoroughly clean your hands with an alcohol-based hand rub or wash them with soap and water. Washing your hands with soap and water or using alcohol-based hand rub kills viruses that may be on your hands.
  • Maintain social distancing - Maintain at least 1 metre (3 feet) distance between yourself and anyone who is coughing or sneezing. When someone coughs or sneezes they spray small liquid droplets from their nose or mouth which may contain virus. If you are too close, you can breathe in the droplets, including the COVID-19 virus if the person coughing has the disease.
  • Avoid touching eyes, nose and mouth - Hands touch many surfaces and can pick up viruses. Once contaminated, hands can transfer the virus to your eyes, nose or mouth. From there, the virus can enter your body and can make you sick.
  • Practice respiratory hygiene - Make sure you, and the people around you, follow good respiratory hygiene. This means covering your mouth and nose with your bent elbow or tissue when you cough or sneeze. Then dispose of the used tissue immediately. Droplets spread virus. By following good respiratory hygiene you protect the people around you from viruses such as cold, flu and COVID-19.
  • If you have fever, cough and difficulty breathing, seek medical care early - Stay home if you feel unwell. If you have a fever, cough and difficulty breathing, seek medical attention and call in advance. Follow the directions of your local health authority. National and local authorities will have the most up to date information on the situation in your area. Calling in advance will allow your health care provider to quickly direct you to the right health facility. This will also protect you and help prevent spread of viruses and other infections.
  • Stay informed and follow advice given by your healthcare provider - Stay informed on the latest developments about COVID-19. Follow advice given by your healthcare provider, your national and local public health authority or your employer on how to protect yourself and others from COVID-19. They are best placed to advise on what people in your area should be doing to protect themselves.
  • Protection measures for persons who are in or have recently visited (past 45-60 days) areas where COVID-19 is spreading - Call in advance and tell the Government authorities / hospital provider of any recent travel or contact with travellers from nations with the virus and how one can potentially be a carrier. This will also help to prevent possible spread of COVID-19 in a timely manner.

Signs & Symptoms

  • Although those infected with the virus may be asymptomatic, many develop flu-like symptoms including fever, cough, and shortness of breath. Emergency symptoms include difficulty breathing, persistent chest pain or pressure, confusion, difficulty waking, and bluish face or lips; immediate medical attention is advised if these symptoms are present.
  • Less commonly, upper respiratory symptoms such as sneezing, runny nose, or sore throat may be seen. Symptoms such as nausea, vomiting, and diarrhoea have been observed in varying percentages among patients in several studies, with percentages varying from 3% to 31% of cases depending on the study.
  • In some, the disease may progress to pneumonia, multi-organ failure, and death.
As is common with infections, there is a delay from when a person is infected with the virus to when they develop symptoms, known as the incubation period. The incubation period for COVID-19 is typically five to six days but may range from two to fourteen days.

Causes

  • The disease is caused by the virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), previously referred to as the 2019 novel coronavirus (2019-nCoV). It is primarily spread between people via respiratory droplets from coughs and sneezes.
  • The virus can remain viable for up to three days on plastic and stainless steel, and for three hours in aerosols . The virus has also been found in faeces, but as of March 2020 it is unknown whether transmission through faeces is possible, and the risk is expected to be low. The WHO is now also maintaining that the virus could be spread in the air, with it staying upto 8 hours in the air from an infected person.
  • The lungs are the organs most affected by COVID-19 because the virus accesses host cells via the enzyme ACE2, which is most abundant in the type II alveolar cells of the lungs. The virus uses a special surface glycoprotein called a "spike" (peplomer) to connect to ACE2 and enter the host cell. The density of ACE2 in each tissue correlates with the severity of the disease in that tissue.
  • The virus is thought to be natural and have an animal origin, through spillover infection. It was first transmitted to humans in Wuhan, China, in November or December 2019, and the primary source of infection became human-to-human transmission by early January 2020. The earliest known infection occurred on 17 November 2019 in Wuhan, China.

Prognosis

  • The severity of COVID-19 varies. The disease may take a mild course with few or no symptoms, resembling other common upper respiratory diseases such as the common cold. Mild cases typically recover within two weeks, while those with severe or critical disease may take three to six weeks to recover. Among those who have died, the time from symptom onset to death has ranged from two to eight weeks.
  • Children of all ages are susceptible to the disease, but are likely to have milder symptoms and a much lower chance of severe disease than adults; in those younger than 50 years, the risk of death is less than 0.5%, while in those older than 70 it is more than 8%. Pregnant women are at particular risk for severe infection.
  • In some patients COVID-19 may affect the lungs causing pneumonia. In those most severely affected, COVID-19 may rapidly progress to acute respiratory distress syndrome (ARDS) causing respiratory failure, septic shock, or multi-organ failure.
  • Complications associated with COVID-19 include sepsis, abnormal clotting, and damage to the heart, kidneys, and liver. Clotting abnormalities, specifically an increase in prothrombin time, have been described in 6% of those admitted to hospital with COVID-19, while abnormal kidney function is seen in 4% of this group.
  • Liver injury as shown by blood markers of liver damage is frequently seen in severe cases.
  • Many of those who die of COVID-19 have pre-existing conditions, including hypertension, diabetes mellitus.

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