Covid-19 Cases Rise Again: What Your Health Insurance May Not Cover

• Covid-19 hospitalisation is generally covered under comprehensive health insurance

• Masks, sanitisers, supplements, and routine home expenses may be excluded

• Cashless treatment depends on network hospitals and insurer approval

• Policyholders should review sum insured, home-care benefits, and claim rules

A fresh rise in Covid-19 cases in parts of India has again turned attention to the cost of treatment. The present increase is reported to be localised, with hospitals not facing the kind of pressure seen during the earlier waves. Even so, policyholders may want to check how their health cover would respond if an infection leads to hospitalisation or treatment at home.

Under most comprehensive health insurance policies, Covid-19 is treated like other illnesses. A claim may cover medically necessary hospitalisation, intensive care, oxygen support, medicines, tests conducted during admission and doctors’ charges, subject to the sum insured and other policy conditions.

Coverage, however, does not mean that every expense connected with the infection will be paid.

What May Be Left Out Of The Claim

Many patients with mild symptoms recover at home. This is also where the gap between medical spending and insurance coverage may become visible, according to a recent report by NDTV.

Arun Ramamurthy, co-founder, Staywell.Health, told NDTV that the extent of payment depends on the policy wording. Expenses on masks, sanitisers, pulse oximeters, nutritional supplements and certain medicines bought for home use may not be reimbursed.

Teleconsultation fees, home nursing, and treatment provided without hospital admission may also fall outside the cover unless the policy includes outpatient, home-care, or domiciliary treatment benefits. Even where such benefits are available, insurers may apply limits, medical-necessity conditions or documentation requirements.

Routine preventive spending is generally different from treatment expenses. Policyholders should not assume that the cost of protective equipment or items bought for personal use will form part of a hospitalisation claim.

Cashless Treatment Depends On The Hospital

A cashless claim is normally available when treatment is taken at a hospital in the insurer’s network, and the request is approved. At a non-network hospital, the patient may have to pay first and later file a reimbursement claim.

The insurer may ask for prescriptions, test reports, hospital bills, pharmacy invoices and the discharge summary. Missing documents or expenses that are not supported by a doctor’s prescription can delay settlement or lead to deductions.

Waiting periods, exclusions and room-rent restrictions also continue to apply. A claim may be reduced or rejected when the treatment falls within an applicable waiting period or violates a policy condition.

Check Whether Your Cover Is Enough

A policy bought several years ago may not be sufficient for a prolonged hospital stay today. Policyholders should review the sum insured, room eligibility, co-payment and deductible instead of looking only at whether Covid-19 is covered.

Those relying entirely on an employer’s group policy should also check its limit and benefits. The cover may end with the job or may not be enough for all family members. An individual policy or a super top-up can provide an additional layer of protection.

The key is to read the policy before a medical emergency. Knowing the network hospitals, claim procedure, and home-treatment rules can help avoid surprises when treatment is required.

FAQs

1. Does a regular health insurance policy cover Covid-19 treatment?

Most comprehensive policies cover medically necessary hospitalisation, ICU care, oxygen, medicines and tests, subject to the policy terms and sum insured.

2. Are home-treatment expenses for Covid-19 covered?

Only if the policy includes home-care, domiciliary or outpatient benefits. Masks, sanitisers, pulse oximeters and supplements may not be reimbursed.

3. Can policyholders get cashless treatment for Covid-19?

Cashless treatment is generally available at network hospitals after insurer approval. At a non-network hospital, the patient may need to seek reimbursement later.