IRDA mandate for group health insurance policy

IRDA mandate for group health insurance policy

The COVID-19 outbreak is on the top of everyone’s mind right now, and why not? Until now, the global pandemic has infected close to 3 million people across the globe, of which more than 2 lakh people have already lost their lives with numbers increasing every hour. In India, the total number of cases reported due to the novel coronavirus infection has crossed the 27,500 mark while the death toll has crossed the 850 mark. These trying times pose a great challenge to the public health-care systems and the government with both trying beyond their limits to address this unprecedented situation.

During times like these, unwanted chaos is created amongst the people who are not sure if their health insurance policy will provide them with adequate coverage against the deadly virus. Several insurers have reported of being flooded with customer queries with anxious customers trying to know the extent of coverage being offered for COVID-19 infection, the waiting period, if any, the pricing impact and the claim process.

Here are some of your common health insurance queries related to COVID-19 being addressed.

Does a Regular Health Insurance Policy Provide Coverage Against Coronavirus Infection?

Yes, on the directions of Insurance Regulatory and Development Authority of India (IRDAI), all specialised health and general health insurance companies have been asked to cover claims related to COVID-19 under regular health insurance plans. Anyone, who has an active health insurance policy can file a claim for coronavirus infection.

What is the Extent of Coverage Offered for Coronavirus Infection?

Under a regular health insurance plan, the coverage for coronavirus infection is completely similar to that of any other ailment. To avail treatment through your medical insurance, you need to be hospitalised for at least 24 hours. During your hospitalisation, all your expenses will be covered for treatment of the ailment. Apart from this, pre and post hospitalisation expenses will also be covered which includes test for COVID-19, regular blood tests, x-ray and ambulance expenses. You must remember that pre and post hospitalisation expenses are only covered up to before 30 days of hospitalisation and after 30 days of hospitalisation.

If You Don’t Have a Health Insurance Policy, can you Buy One Now to Cover COVID-19?

You can definitely buy a health insurance policy to cover yourself against not only COVID-19 but all other ailments as well. However, before buying a policy you must be aware of two very important aspects. First, any insurer will not issue you a policy if you are already suffering from the COVID-19 infection. You must make sure that before buying a policy, you are not suffering from any such ailment. Second, after buying the policy, you need to serve the waiting period, i.E. Of 30 days before filing a claim for coronavirus infection. Every health insurance policy comes with a clause of the waiting period of 30 days for regular hospitalisation and 2 – 4 years for pre-exiting diseases. However, claims related to accident are covered form day one of buying the policy.

Are There Any COVID-19 Specific Health Plans that Provide Coverage from Day One?

On the advisory of IRDAI, several insurers have come up with fixed-benefit plans that provide coverage for only COVID-19. These plans are disease-specific plans that offer a lump-sum amount on diagnosis of coronavirus infection. Such plans are an excellent way to compensate for loss of income during the treatment of the illness as the policyholder is paid the entire sum insured as a lump sum in case of testing positive for coronavirus and 50 per cent lump sum if the person is advised quarantine at a medical centre. Though these plans also come with a waiting period of 10 – 15 days, depending upon plan to plan. Some prominent insurers offering such plans include ICICI Lombard, Star Health Insurance and Future Generali.

However, one must only buy these plans as a rider along with the regular indemnity-based health plans that provide comprehensive coverage against all illnesses and ailments up to the total sum insured.

What is the Average Cost of Treatment of Coronavirus Infection?

The total cost of treatment of coronavirus infection depends on various factors such as choice of hospital, severity of the infection and age of the patient. For an average adult between the age group of 30 and 45 years taking treatment at a normal private hospital, the cost of treatment comes around Rs 5 to Rs 6 lakh. However, if the patient is over 50 years of age and the infection is quite severe (as the chances are quite high amongst people above 50), the cost of treatment may go up to Rs 10 to Rs 12 lakh as the person may require ventilator support and extreme care in Intensive Care Unit where the daily charges are quite high.