News 398 views March 13, 2020

Health Insurance Policies – Situations that Won’t Cover Covid-19 Treatment Cost

Coronavirus is making headlines across the globe. The deadly virus has taken the global death toll to 4638 people. The COVID-19, that had its first outbreak in Wuhan China, has taken the world by storm and it is still casting a shadow of fear across the globe, including India. India has registered 45 confirmed cases of Covid-19 causing panic across the country. While the Ministry of Health, Government, and all health advisory boards are floating ‘prevention’ messages, there are certain health insurance providers who are offering cover for the coronavirus treatment. However, the insurance companies are transparent about the situations under which policyholders shall not receive the claim. Additionally, the claim amount shall be the maximum amount of sum insured offered under your health insurance policy. The following are various situations under which health insurance provider shall not provide cover coronavirus treatment.

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  1. Hospitalization for at least 24 hours: In a case, where the policyholder is not hospitalized for at least 24 hours, the health insurance providers shall not cover the health insurance claim for coronavirus. Instead, the health insurance claim shall be processed as per regular norms. Hospitalization for at least 24 hours is required to cover the health insurance claim for coronavirus. If the policyholder is not hospitalized, the health insurance claim may not be covered as it will be considered as an outpatient treatment, as the majority of Mediclaim policies do not cover this cost.
  2. Declaration of the disease as epidemic or pandemic: In case, the World Health Organisation or Indian Government, or both, declare coronavirus as epidemic or pandemic, then health insurance claims will not be covered by a health insurance provider as few of the health insurance providers have clauses of not covering an epidemic or pandemic. Therefore, it is recommended to check the terms and conditions related to insurance cover claim under an epidemic or pandemic circumstances. Coronavirus can turn to become an epidemic if specific precautions are not taken therefore asking one’s health insurance provider or reading the policy document will give a clear idea about the insurance providers stand in cases related to epidemic or pandemic.
  3. Planned treatment for on-going symptoms: if a policyholder has been suffering from respiratory tract diseases or infections having symptoms like flu, cough, breathlessness, then a health insurance claim might not be settled. For example, if a policyholder is taking planned medication for respiratory tract disease or infection which might result in showing symptoms of Covid-19 then the health insurance policy might not cover the risk. Hence, any on-going treatment related to the respiratory tract shall not be covered under a newly purchased health insurance plan offering cover for coronavirus treatment.
  4. Contraction of disease during the waiting period: under most of the health insurance policies, the coverage against the disease start after the waiting period is over. Even for a coronavirus insurance policy, the insurance provider has included a waiting period of 15 days. Thus, if any policyholder is diagnosed with COVID-19 disease or infection during the waiting period, then under this situation the policy shall not provide coverage.
  5. A recent trip to affected countries: if the policyholder or any of their family member have recently visited or travelle-d from a Covid-19 affected country such as China, Italy, Singapore, Hong Kong, etc. and have been diagnosed positive, under such circumstances, no health insurance claim shall be settled by the health insurance provider.

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