With an adverse effect of COVID-19 cases in India, people are more concerned about whether the medical insurance plan they purchase provides them with adequate coverage or not. Moreover, with the surge of COVID-19 cases in India, more and more people are keen to purchase a health insurance policy for parents and families. Nowadays, most of the health insurance policies offered by different insurers provide coverage for inpatient treatment. While purchasing COVID-19 health insurance, it is important to consider the four different aspects: co-pay, benefits covered, coverage and consumable cover. Let’s discuss these aspects in more detail.
Inpatient treatment is not required for most of the people who get infected with COVID-19 but do not have any significant symptoms. In some cases, a basic medication or COVID-19 diagnostic test is required on an outpatient (OPD) basis. These expenses are only covered in case the plan offers coverage for OPD expenses. While purchasing a policy, make sure to check that OPD treatment or inpatient treatment is covered under the policy or not.
In most cases, if the patient is admitted to a hospital, the health insurance policy covers all the expenses. However, certain exclusions are created by the health insurance providers for pandemic diseases. Make sure to go through the fine prints of the policy meticulously to ensure that there is no such exclusion in the policy.
Moreover, the hospitalization treatment for COVID-19 is more likely to happen for the vulnerable population, which includes senior citizens and individuals with pre-existing illnesses such as respiratory tract diseases, diabetes, hypertension, etc. The policy will have a waiting period for pre-existing illnesses, in case the policy buyer suffers from any of these diseases before purchasing the plan.
While buying a policy, do check with the insurance company on how they work on claims for COVID-19 and the section of treatment will be for diseases that have a waiting period. Even though the treatment for these conditions is standardized by the IRDA, the standardized protocol is expected to be entirely in effect by the end of the year. As of now, the claims are likely to be treated as per the documents issued by the policy.
Co-Pay and Room Rent Limit
Many health insurance policies for families offer the option of co-payment. This means that the insurance holder will have to bear a share of the treatment cost from his/her pocket. This is a simple measure built by insurance companies to control the cost. In case of lower medical expenses, the co-payment can be a reasonable amount to pay out of pocket. However, if the treatment expense is high then it can burn a hole in the pocket.
For example, if a health insurance policy has a co-pay of 10% and the claim amount is Rs. 50,000 then the policyholder will have to pay Rs.5000 and the rest Rs. 45,000 will be covered by the insurer. However, if the claim amount is Rs..20,00,000 then the policyholder will have to bear a share of Rs. 2,00,000 under the copay option. Thus, is it imperative to check whether the policy has any co-pay clause or not?
In the case of COVID-19, a large amount of treatment cost is from the room rent, specifically if the treatment of the insured person is done in a private hospital. Many private hospitals have created specialized isolation facilities which charge higher than the regular rooms. The health insurance policies have a limit on room rent. The room rent coverage is offered either by specifying a category of room or as a specific percentage of the sum insured. If the room rent surpasses the limit set by the insurer, there can be an equal deduction of the claim amount. Thus to choose the right health insurance plan by clearing the queries regarding sub-limits of room rent that the policy may have.
The insurance companies have reported around 200 claims for the Covid-19 and most of the patients are still admitted thus, it is early to analyze the cost of the treatment for Covid-19. Based on a quick analysis of claims filed in the six major cities and an assessment of the cost of treatment based on reported complications, time period of stay, etc., the average claim amount of Covid-19 is expected to be approximate Rs.5 lakhs or more. Also, there is a high probability that more than one person may get affected by the virus due to its highly transmittable nature. Thus a person must have adequate coverage of more than Rs.10 lakh to ensure that they have a proper financial backup in case of a medical emergency.
Consumables are items that can be used only one-time, mainly due to infection prevention and sterility. Consumables are categorized as sanitizers, masks, gloves, cotton, etc. In most health insurance plans, the consumables are not covered. Coronavirus is a communicable disease and highly infectious due to which the workers of the healthcare sector need to use whole body PPE (Personal Protection Equipment) to stop the spread of the COVID-19 virus from patients who are being treated. As the demand for consumables is very high this increases hospital bills. Thus, make sure to check whether the policy covers consumables or not.
In case of emergency, the healthcare system can be very challenging to navigate. The task of choosing the most appropriate plan can be a bit more difficult during a pandemic. Thus, by keeping the above-mentioned aspects in mind make sure to choose the most benefits plan that provides the right coverage in case of any medical emergency.