Health insurance cover of Rs 25 lakh advised for a family of 4 in Tier 1 cities: Sanjiv Bajaj

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From getting the infection to testing negative, policyholders have a lot of queries around the claim settlement. Even new buyers are looking for answers around the right amount of coverage and a lot more. In an interview with Money9, Sanjiv Bajaj, Joint Chairman and MD, Bajaj Capital talks about how new and existing policyholders can keep the process of claim settlement smooth in case of a hospitalization. Here are some excerpts.

How soon can someone who has tested negative after getting infected with Covid-19, buy a health insurance policy?

Sanjiv: After recovering from Covid infection and having tested negative, buying health insurance may not be as easy as before. Most insurance companies are resorting to a cooling-off period which may be from a few days to up to three months, before issuing a new policy to the individual.

The cooling-off period allows a reasonable time for the buyers to assess whether they have developed any post-Covid complications and make those declarations as part of their medical history at the time of purchase of health insurance policy. This also ensures that Covid-19 infection is not treated as a pre-existing condition.

How crucial is it to buy health cover for someone who hasn’t contracted Covid-19?

Sanjiv: Those who have not yet purchased a health insurance policy should immediately get a policy for themselves and even all family members. Those who are getting infected with Covid are finding it difficult to buy a policy immediately as they may have to wait till the cooling-off period ends. Even those who have a policy need to evaluate their coverage amount. Adequate coverage helps one to avoid dipping into existing savings during hospitalization.

In the current scenario, how much coverage should a family of 4, including two kids, have?

Sanjiv: Cost of hospitalization owing to coronavirus is running into lakhs depending on city and type of hospital for the 10-14 days of treatment. What has also been witnessed is that in the second wave, if one family member gets infected, many other members also get infected. How the pandemic will shape up during the third wave is something not known to even doctors and medical science. Buying adequate coverage of around Rs 25 lakh could be of help at the time of hospitalization especially for those living in tier I cities.

For Covid-19 treatment at home, will the insurance company pay the claim?

Not all health insurance policies provide for claims if the treatment is carried at home. However, given the current situation when the availability of hospital beds is a concern, it’s better to get a written communication from the insurer. You may send the doctor’s prescription, your health card or policy number, etc., and get approval after intimating the insurer. It is essential to get in writing on the specific cost-heads that the insurer will cover in case of home treatment of the policyholder.

If a policyholder gets admitted to a hospital due to Covid-19, will there be a cashless claim or will the bills be reimbursed?

Yes, in case the hospital is on the approved list of empanelled service providers, the hospitalization will be cashless. Health insurance companies have to now communicate their cashless approvals to the hospitals within 60 minutes of receipt of authorization request along with all necessary requirements from the hospital. In the case of a non-network hospitalization, you will have to send all the hospital papers including bills, discharge report, etc. to the insurer for reimbursement of the bill amount.