Not all such tests will be
covered by your health insurance.


Twelve private laboratories, including
Metropolis, SRL Labs, Suburban Diagnostics and Thyrocare have been allowed to
conduct Coronavirus Disease (COVID-19) diagnostic tests. So, getting tested
will be relatively easier.
These tests are likely to come at a cost, though the Indian
Council of Medical Research (ICMR) has appealed to private diagnostic centres
to offer the service free of charge. The central government has capped the
charges at Rs 4,500.
Insurers will cover tests
The comforting piece of information for policyholders is that
even regular, indemnity-based health policies (where the actual hospitalisation
cost incurred is paid for) will cover COVID-19 tests as part of
pre-hospitalisation expenses, subject to certain conditions. “However, it is
not prudent to undergo tests only because the access is easier. Ensure that you
get tested only if you – or someone with whom you’ve come in contact with
recently – have travelled abroad in the last 14 days or you have developed
COVID-19-like symptoms that worsened over two to three days,” says Dr S
Prakash, Managing Director, Star Health and Allied Insurance. You do not
need to buy a special Covid-19 health insurance policy to cover the cost of
hospitalisation; your existing health insurance is good enough.
Typically, your insurance company will reimburse you the
Covid-19 test’s cost only if it leads to hospitalisation for being tested
positive. Here, diagnostic tests get covered if they has taken place up to 30
days prior to hospitalisation, which is likely to be the case with COVID tests,
given that the incubation period is between 2-14 days. “A regular health
insurance policy covers individuals for coronavirus-related hospitalisation,
and it will also cover the cost for diagnostic tests under pre- and
post-hospitalisation for those who are tested positive,” says Ravi Vishwanath,
President, Accident and Health, HDFC ERGO General Insurance. That’s how
indemnity-based health insurance policies work – a minimum of a 24-hour hospitalisation
is necessary for the claim to be payable.
Put simply, COVID-19 claims will be treated at par with routine
health claims. So far, the central and state governments were taking care of
COVID tests and subsequent hospitalisation. With private hospitals too
being roped in to treat COVID-19 cases from March 26, your individual
health policies would cover the costs of treating the ailment. “We have already
received around eight claims across the country. Most of them were admitted to
a government facility, while one case is undergoing treatment at a private
hospital,” says Dr S Prakash.
A cover for home quarantine?
However, the COVID-19 treatment has created a special situation
– quarantine at a government-approved facility that is not a hospital or even
isolation in your own home. “Even if the policyholder is quarantined at a
government-approved facility after testing positive, the expenses, including
pre- and post-hospitalisation, will be paid for as it will be considered
equivalent to hospitalisation,” says Amit Chhabra, Business Head, Health,
Policybazaar.com.
Home quarantine is a bit tricky, though. Under a regular policy,
pre-hospitalisation expenses don’t get covered if you have to follow home quarantine
as home quarantine is not technically hospitalisation. In this case, check if
your policy covers outpatient department (OPD) expenses. If it does, then your
policy will cover your COVID-19 test expenses, even if you get
home-quarantined.
This apart, many insurers including Digit, Star Health, ICICI
Lombard and Edelweiss General Insurance have launched COVID-specific health
covers – either individual or group products. Typically, these policies hand
out a pre-defined amount once the policyholder tests positive for COVID-19.
Know the exclusions
You must go through the list of exclusions – expenses that the insurer will not
bear. For one, cost of diagnostic tests will not be paid for if the
policyholder tests negative and, therefore, is neither hospitalised nor
quarantined. This is the case with any diagnostic test that is not linked to
subsequent hospitalisation. “The only thing that the insured has to keep
in mind, is to ensure that the claim towards main
hospitalisation expenses, should be admissible and approved,” says Shanai
Ghosh, Executive Director and CEO, Edelweiss General Insurance.
Watch out for the waiting period. “A regular health insurance
policy does not cover any infectious diseases for the first 30 days from the
inception of the policy,” says Vishwanath. But Edelweiss has waived off this
clause for COVID-related ailments.
If you have purchased a COVID-specific policy, too, you need to
keep an eye on the fine print. “Symptomatic (where COVID-19 is not confirmed)
treatment will not be admissible. Similarly, if the report is negative, the
expenses will not be eligible for a claim. Expenses incurred for any ailment
other than COVID-19 will also not be payable,” says Sudha Reddy, head, health
and travel, Digit Insurance.
How to file a claim?
Just like any other regular health insurance claim, make sure
you keep all your hospitalisation andmo test bills handy. You can opt for the
cashless facility if the hospital features in your insurer’s . Else, submit
your documents within seven to 15 days, depending on your insurer’s deadline.
Given the high risk of commuting during COVID-19 pandemic, some
insurers are offering simpler procedures. “Claim intimation can be done over
email. Self-attest all bills; scan and email them – no courier or physical copy
would be needed. If at all required, we will arrange for a pickup,” says Reddy.
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