Your health insurance policy might not cover coronavirus in these situations

While most health insurance policies in India are providing cover for the coronavirus infection, you may not be able to get a claim for its treatment in the following scenarios.

Your claim will also be limited by the maximum sum insured by your health insurance policy.

• If you are not hospitalised for at least 24 hours

Health insurance claim due to coronavirus will be payable only if you are hospitalised for at least 24 hours. However, if you are not hospitalised, then your policy may not cover the claim as most of the indemnity type health insurance policies (mediclaim) in India do not cover outpatient treatment.

Shreeraj Deshpande, COO, Future Generali India Insurance said, "Any person who is hospitalised as a result of coronavirus and takes treatment will be covered as any other illness. The subsequent claims will be processed as per regular norms, provided the individual has been hospitalised for at least 24 hours."

• If the disease is declared as epidemic/pandemic

Your insurer might not settle a claim under your health insurance policy if the disease is declared as an epidemic or pandemic by the World Health Organization (WHO).

Subramanyam Brahmajoysula, Head - Underwriting and Reinsurance, SBI General Insurance said, "If coronavirus is declared as a pandemic by the WHO or Indian government, or both, then claims might not be payable as such claims are excluded under many health insurance policies."

However, Pankaj Verma, Head - Market Underwriting Operation, SBI General Insurance, said, "Our standard health policy is capable to take care of coronavirus coverage." He adds, "On the claims front, we comprehend that Covid-19 is a disease of epidemic proportions and will have deeper impact on people's lives, we are trying to provide all the help. SBI General is not rejecting any claim without minimum compliance of regulatory requirements as prescribed."

Hence, instead of panicking, one should ask one's health insurer whether their policy covers the coronavirus disease. Amit Chhabra, Head- Health Insurance, Policybazaar.com said, "Not all, but most of the health insurance policies cover such epidemics/pandemics. However, it majorly depends upon the policy. Very few policies have clauses of not covering epidemics/pandemics. You must read the policy document and contact your health insurer immediately."

If you have purchased a new health insurance policy, then claim for treatment for this disease may not be covered under the following scenarios:

• If you are going for a planned treatment

Over the past four weeks, if you have been suffering from any respiratory-related disease, then your claims under a regular indemnity type health insurance policy or a specific coronavirus insurance policy might not get settled. For instance, if you have been suffering from severe cough, respiratory diseases, breathlessness, flu over the past few days and you plan to take treatment for it, your policy might not cover even if it results in symptoms for coronavirus disease/infection.

Chhabra said that the symptoms of coronavirus are quite similar to the common flu as it affects the upper respiratory body. "However, if you already have coronavirus disease/infection and you are thinking of buying a health insurance policy and want to get the claims settled then probably your claims will not get paid under the newly bought regular health insurance or coronavirus insurance policy," he said.

Hence, any previously planned treatment (planned before purchasing policy) under a newly purchased health insurance/coronavirus insurance policy is not covered.

Sanjiv Bajaj, Vice Chairman and MD, Bajaj Capital said, "If it's an emergency outbreak in the country, any which ways the disease shall be covered under a health insurance policy, however, if it is a planned treatment, it shall not be covered."

• If you contract the disease within the policy waiting period

The insured will not get claim filed for treatment of a disease within the policy waiting period of a health insurance policy if the disease treatment is excluded within the waiting period. Typically, most policies exclude several kinds of treatment in the waiting period of the policy.

A waiting period is a pre-fixed time period starting from the date of purchase of the policy. Coverage of many diseases starts only after this waiting period is over in most health insurance policies.

The special coronavirus insurance policy launched by insurer, Digit, also has a waiting period of 15 days. This means that if you are diagnosed with the coronavirus disease/infection within this waiting period, your policy will not cover it. In such a case, the claims will not get settled for this disease by the insurer.

Mayank Bathwal, CEO, Aditya Birla Health Insurance said, "The general waiting for covering respiratory diseases is 30 days unless you had a pre-existing condition for the same."

• You or family member recently travelled to affected countries

In the case of health insurance policy, Bathwal said, "If you are travelling from a coronavirus affected country and diagnosed positive, you will be covered under regular indemnity health insurance policy as long as you are being quarantined in India."

However, the special coronavirus insurance policy does not cover people who have travelled to coronavirus affected countries such as China, Hong Kong, Macau, Taiwan, Italy, Kuwait, Japan, Singapore, South Korea, Thailand, etc.

Vivek Chaturvedi, Head - Marketing and Direct Sales Online, Digit Insurance, referring to the special coronavirus insurance policy, said, "Your claim will not get settled even if you contract the disease/infection from a family member who has travelled to these places/countries."