Your health insurance policy might not cover coronavirus in these situations

Although most health insurance policies in India provide coverage for coronavirus infection, you may not be able to get an application for processing in the following scenarios.

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

  • If you are not hospitalized for at least 24 hours

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

Shreeraj Deshpande, COO, Future Generali India Insurance said, “Anyone who is hospitalized as a result of coronavirus and is undergoing treatment will be covered like any other illness. Subsequent complaints will be handled according to normal standards, provided the person has been hospitalized. for at least 24 hours.”

  • If the disease is declared epidemic/pandemic

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

Subramanyam Brahmajoysula, Head of Underwriting and Reinsurance, SBI General Insurance, said: “If the coronavirus is declared as a pandemic by the WHO or the Government of India or both, claims may not be payable as these claims are excluded from many health insurance policies.

However, Pankaj Verma, Head – Underwriting Market Operation, SBI General Insurance, said: “Our standard health policy is able to take care of the coronavirus coverage. “He adds:” In terms of claims, we understand that Covid-19 is a disease of epidemic proportions and will have a profound impact on people’s lives, we try to provide all the help. SBI General does not reject any claim without minimum compliance with prescribed regulatory requirements.”

So instead of panicking, ask your health insurer if their policy covers coronavirus disease. Amit Chhabra, head of insurance,, said. “Not all, but most health insurance policies cover these epidemics / pandemics However, this depends mainly on the police Few policies have. epidemic/pandemic non-coverage clauses. You must read the policy document and contact your health insurer immediately.”

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

  • If you are going for planned treatment

In the past four weeks, if you have suffered from a respiratory illness, your claims under a regular indemnity-type health insurance policy or specific coronavirus insurance policy may not be settled. For example, if you have suffered from severe cough, respiratory illnesses, shortness of breath, flu in the past few days and are planning to undergo treatment, your policy may not cover even if it causes symptoms of illness/ coronavirus infection.

Chhabra said the symptoms of the coronavirus are quite similar to those of the common flu as they affect the upper respiratory tract. “However, if you already have a coronavirus disease/infection and are considering purchasing a health insurance policy and wish to settle claims, your claims will likely not be paid under the new regular health insurance or of the coronavirus insurance policy,” he mentioned.

Therefore, any treatment originally planned (planned before the purchase policy) under a newly purchased health insurance / coronavirus insurance policy is not covered.

Sanjiv Bajaj, Vice Chairman and Managing Director of Bajaj Capital, said, “If there is an emergency outbreak in the country, in any way, the disease will be covered by a policy of health insurance, however, if it is a planned treatment, it will not be covered.”

  • If you contract the disease during the policy waiting period

The insured will not be sued for the treatment of a disease within the waiting period policy of a health insurance policy if the treatment of the disease is excluded within the waiting period. Generally, most policies exclude several types of treatment within the policy’s waiting period.

A waiting period is a pre-set period of time from the date of purchase of the policy. Coverage for many illnesses does not begin until after this waiting period ends in most health insurance policies.

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

Mayank Bathwal, CEO, said Aditya Birla Medicare, “The general expectation to cover respiratory diseases is 30 days, unless you have a preexisting condition for the same. »

  • You or a family member have recently traveled to the affected countries

In the case of the health insurance policy, Bathwal said: “If you are traveling from a country affected by coronavirus and diagnosed positive, you will be covered by a regular indemnity health insurance policy as long as you are put in quarantine in India.”

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

Vivek Chaturvedi, Online Marketing and Direct Sales Manager, Digit Insurance, referring to the special coronavirus insurance policy, said: “Your claim will not be settled even if you contract the disease/infection from a family member who has traveled to these places/countries.”


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