Covid-19: Four things you should know about your health insurance policy

While the second wave of Covid-19 has hit India hard, hospitals across the country are flooded with patients. During these testing times, health insurance is something many families look forward to, as timely financial support can help them sail through these uncertain times. But many have doubts about the coverage of their health insurance policies. Whether it covers Covid-19 treatment? Can they claim a cashless settlement?  To understand this better, here are a few quick answers related to Covid coverage under your health insurance policy.

Does my health insurance policy cover Covid-19?

There are different types of health insurance policies ranging from basic medical, Covid Kavach, Covid Rashak to other covid-specific policies. All of these policies cover covid-related treatments, and no insurer can deny you the coverage for treatment of Covid-19.

Under covid-specific policies, you are offered wider coverage in terms of home treatment and PPE while in basic mediclaim policies, generally, home treatment is not covered. But it is recommended to have comprehensive coverage as the first layer of coverage, as it includes hospitalisation for all illnesses and not just from coronavirus.

Am I eligible for cashless service?

Following reports of hospitals denying cashless claims, Finance Minister Nirmala Sitharaman on Thursday asked the Insurance Regulatory and Development Authority (IRDAI) to direct companies to prioritise authorisations and settlement of Covid cases. Hence, hospitals and insurers cannot deny you cashless coverage in a network hospital for covid treatment.

What is the cashless treatment? For a claim on a cashless basis, the treatment has to be done in a network hospital. To avail of this facility, you need to get authorisation first, which can be done by filling in the prescribed form at the hospital desk. You might need to pay some advance deposit at the time of hospitalisation and KYC documents along with the policy number needs to be submitted. Here the insurance company directly pays to the insurer and you don’t have to wait for reimbursement. If the insurer denies you cashless service then you can later get the hospital bills reimbursed from your insurer.

Will it include teleconsultations and make-shift hospitals?

Yes, your health insurance policy should cover make-shift as well as teleconsultations. Finance minister Nirmala Sitharaman in a tweet shared on Thursday said that cashless treatment will be available to hospitals at networked or even temporary hospitals. Even teleconsultations will get covered under the same.

Will PPE cost be covered under my health policy?

Last year in July, when the high cost of PPEs became a cause of concern for many, the General Insurance Council (GIC), an umbrella body of non-life insurers, prepared a rate chart for COVID-19 treatment after taking into account rates published by various state governments. The suggested rates were broadly based on the schedule of rates that were suggested by the Niti Aayog panel. Under the new proposed rates, the partner hospitals can charge between Rs 1,200 and Rs 2,000 for PPE depending upon the severity of the sickness. But insurers say PPE kits have once again become a significant cost of hospital bills, which they saw going down a couple of months back. With hospitals charging as high as Rs 10,000 for PPEs it has again become a point of tussle between the two.