In the time of Covid-19, a key concern of the public has been the expenses that will be incurred if they get infected. Will their health insurance policies cover the expenses and if they are denied, is the government equipped to intervene?
Some health insurance policies are HDFC Ergo Health Insurance, SBI Health Insurance, Religare Health Insurance, Reliance General Health Insurance, etc. But does India have laws to regulate them?
The Parliament passed the Insurance Regulatory and Development Act, 1999 (IRD Act) with the aim “to provide for the establishment of an Authority, to protect the interests of the policy holders, to regulate, promote and ensure orderly growth of the insurance industry, and to establish the Insurance Regulatory and Development Authority (IRDA) as a statutory authority responsible to regulate and promote the insurance industry in India and protect the interests of insurance policy holders”.
The main aim of the health industry is not just to sell insurance policies but also provide timely and efficient claims when their requirement arises. In order to avoid misunderstanding and ambiguity, IRDA has defined guidelines to standardise health insurance through the Insurance Regulatory and Development Authority of India (Health Insurance) Regulations, 2016. In the wake of the Covid-19 outbreak, IRDA took immediate measures through a circular on March 4, 2020, and issued guidelines for health insurers asking them to expedite coronavirus-related claims in case of hospitalisation. The circular stated: “Where hospitalisation is covered in a product, costs of admissible medical expenses during the course of treatment including the treatment during quarantine period are settled per applicable norms.” The regulator emphasised that insurers shall review the claims thoroughly before clearing them. So insurers are now mandated to cover hospitalisation as well as quarantine expenses if the insured tests positive for Covid-19.
IRDA issued instructions to life insurance companies on March 23 with reference to Covid-19 death claims and insurers were directed to settle the claims expeditiously. Any health insurance contracts already issued regarding admissibility of Covid-19 claims should be put up on the website, it said. On March 30, IRDA again issued instructions and strongly encouraged insurance companies to devise insurance products that would provide protection from the risks of Covid-19, and that it would fast-track such applications.
Despite these directions, there was panic among the public regarding the coverage of coronavirus in health insurance policies. These were due to the following reasons:
- pandemics or epidemics are often excluded under many health insurance policies
- health insurance claims are payable after hospitalisation of at least 24 hours and most policies in India don’t cover outpatient treatment if the insured is already under treatment for any respiratory-related disease, claims under a regular indemnity type health insurance policy or a specific coronavirus insurance policy might not get settled
- refusal of a claim in case the insured contracts the disease within the policy waiting period.
Even though insurance companies stated that they would do the needful for their policyholders, the pandemic aspect was expected to change the equation. With over 1,18,000 cases of Covid-19 in 114 countries, WHO declared it a pandemic on March 11. With an increasing number of such cases and the possibility of a rise in deaths, insurance companies may deny claims as the cost of tests and treatments could rise too.
Digit Insurance launched a health policy for coronavirus patients, covering both positive and quarantined cases. Under it, if the insured is tested positive and files a claim, he would be eligible for 100 percent of the sum insured. And in case he is quarantined, which could lead to a loss of income, he would be eligible for 50 percent. The policy imposed certain conditions such as the insured should not be in contact with someone with a suspected history of coronavirus till the policy ends, should not be suffering from any Covid-19 related symptoms for the last six weeks and he or immediate family members should not have travelled to China, Japan, etc., since December 1, 2019.
Future Generali India Insurance Company announced a group insurance policy for coronavirus whereby a lump sum benefit will be given in case the insured is diagnosed with it and is confirmed by a medical practitioner along with a government/WHO-approved lab or quarantined for suspected symptoms. It will cover all, from a day-old infant to a senior citizen up to 75 years of age.
Edelweiss General Insurance will cover hospitalisation for not only those who have a confirmed diagnosis but also those who have been quarantined in facilities identified by the government. For the quarantined, it will also cover the entire period with up to 100 percent of the claim amount being paid.
Star Health and Allied Insurance launched the Star Novel Coronavirus Insurance Policy which will cover all those testing positive and requiring hospitalisation. It will provide a lump sum payment to any insured aged 18 to 65 years who are declared positive by a government accredited test and is hospitalised for coronavirus and has no international travel history.
ICICI Lombard introduced a “Covid-19 Protection Cover” in group insurance mode that covers those in the 18-75 age bracket. The policy is priced at a premium of Rs 149 per employee and provides a sum of Rs 25,000, including value-added benefits such as health assistance, chat/virtual assistance, tele-consultation and ambulance assistance.
Religare’s coronavirus health insurance plan covers hospitalisation and includes in-patient care, ICU charges and quarantine period at a registered facility. The cover will not be provided if the insured is quarantined at home or has undergone quarantine at any non-recognised facility.
Reliance General Health Insurance will cover coronavirus from the day the insured is diagnosed with the infection, irrespective of the type of policy or how dangerous the infection is. It will be covered under the base policy of the insured as Covid-19 is a new disease and does not come under pre-existing diseases. The insured will be provided with all the covers, including in-patient treatment, pre- and post-hospitalisation and other tests and diagnosis.
Aditya Birla Health Insurance under the existing cover of the insured will take care of the cost of admissible medical expenses during the hospitalisation. Treatment during quarantine inside a hospital will be also be settled.
Other than these private insurance companies, the public sector New India Assurance has also introduced a policy of Rs 50 lakh per person for 22.12 lakh healthcare providers who are spearheading the battle against coronavirus. This three-month insurance scheme was part of the Pradhan Mantri Garib Kalyan package announced by the finance minister in March. The policy will provide comprehensive personal accident cover, including accidental loss of life on account of Covid-19. The scheme takes effect from March 30 and will continue till June 2020. Those insured will be both public healthcare providers and private healthcare staff who may have to be in direct care of Covid-19 patients and risk being affected by it.
One wonders how many people will go in for such specific policies when there are certain exclusions in them. Also, those already having a standard health insurance plan, which covers corona, may not need extra policies especially after IRDA directed all insurers to cover these cases.
Nonetheless, IRDA’s constant attempts to bring Covid-19 patients under its umbrella are reassuring.
Lead picture: UNI