Does Your Existing Health Insurance Cover You for COVID-19?

Novel Coronavirus, or COVID-19 as it is called in short, is an unprecedented global biological threat that has gripped the whole world. Soon after originating in China, the infection spread worldwide and today, all the leading nations are grappling with the spread of the infection. Given the increasing incidence of the disease, the World Health Organisation (WHO) declared it a pandemic. Even in India, Coronavirus is slowly wreaking havoc as the numbers, though restricted, are rising with each passing day. More and more cases are coming to light every day and amidst this health panic, many of you must be wondering whether your health insurance policy would cover the infection or not. What do you think? Would your existing health plan cover the medical bills if you or your family member is struck with the infection?

One of the many medical insurance benefits includes coverage for hospitalization costs if you are admitted to a hospital for an illness or injury. So, by their nature, health plans would extend coverage if you are hospitalized for a suspected or confirmed case of Coronavirus infection. Even the Insurance Regulatory and Development Authority of India (IRDAI) has issued guidelines for insurance companies to cover claims arising out of COVID-19 infection. Thus, insurance companies are providing coverage against COVID-19 to their policyholders who are covered under an existing health insurance plan. However, there are some terms and conditions associated with such coverage. You need to know these terms and conditions to know whether your COVID-19 claims would be honored by your insurance company or not. So, here are some pitfalls to look out for –

• OPD expenses might not get covered

Coverage for OPD expenses is available only is selected health insurance plans. Most plans cover hospitalization costs which incur if you are hospitalized for 24 hours or more. Thus, if you incur medical expenses on an outpatient basis, wherein 24-hour hospitalization has not occurred, your claim might not be paid by the insurance company even though your health plan covers COVID-19. Thus, you should check whether your policy has OPD coverage benefit or not avail coverage against the expenses incurred on an outpatient basis.

• The pandemic situation might be an exclusion

Some health insurance plans specifically exclude illnesses which occur due to a pandemic or epidemic like situation. Since WHO has already declared COVID-19 as a pandemic, you might not get coverage for your hospitalization if your plan has a pandemic exclusion. 

• Suffering the infection within the waiting period of the policy

When you buy a new health insurance plan, there is a waiting period of 30 days to 60 days within which illnesses are not covered. So, if you have recently bought a new health insurance plan and you suffer from the infection during the initial waiting period of 30-60 days, you might not get coverage for hospitalization.

• If it is a pre-existing condition

This condition is also applicable if you are buying a new health insurance plan. Pre-existing diseases are not covered within the first 2-4 years which is called the pre-existing waiting period. So, if you are suffering from COVID-19 symptoms and you invest in a health plan for coverage, the infection would be treated as a pre-existing condition and you might not get covered for the medical costs that you incur.

If you have an existing health insurance policy, chances are that your policy would cover the medical costs you face due to COVID-19. However, if you buy health insurance online and then suffer from the infection within the first few days, the coverage might not be available. So, it is always better to find out from your insurance company whether you can avail coverage against COVID-19 and the associated terms and conditions of the coverage.