Is your health policy Covid-ready? Key features you must look for

Check if your health insurance covers home care, tele-consultations, PPE kits, room rent waiver and has sufficient sum insured to deal with Covid-related hospitalisation costs

With Covid-19 cases in India crossing the 1,000-mark, policyholders must assess whether their health insurance policies offer adequate coverage and possess the features required to deal with this threat. 

 

Gaps uncovered 

The limitations of many retail health policies were exposed during the first and second waves. “These included sub-limits on room rent, and exclusion of non-payable items like PPE (personal protective equipment) kits,” says Bhaskar Nerurkar, head – health administration team, Bajaj Allianz General Insurance.

 

The rigid definition of hospitalisation was another impediment. “Domiciliary treatment was not commonly covered across plans at the time,” says Siddharth Singhal, head of health insurance, Policybazaar. 

 

Policies have evolved 

The pandemic led to several product upgrades. “Health insurance policies now come with features such as coverage for home isolation, domiciliary treatment, post-Covid-19 complications, and consumables. Tele-consultation has become a standard offering,” says Nerurkar.

 

Singhal adds that many policies now include benefits for OPD care and recharge feature. 

 

Is sum insured adequate? 

The pandemic underlined the importance of adequate coverage. “Opt for a minimum cover of ₹10–₹15 lakh, especially in urban and metro areas. For a family of three, a floater cover of ₹20–₹25 lakh is advisable,” says Nerurkar. 

 

Must-have features 

Domiciliary or home treatment is critical. It allows patients with mild or moderate symptoms to receive care at home when hospitalisation is not possible or necessary. “The insured can claim expenses such as nursing charges, medicines, diagnostics, and equipment used at home, provided the treatment is under the advice of a medical practitioner,” says Nerurkar.

Tele-consultation is another indispensable feature. “It provides safe and  convenient access to medical advice without visiting hospitals,” says Singhal.

 

The restoration of the sum insured feature is also essential so that the insured or their family members can receive treatment within the policy year even after the sum insured has got exhausted.

 

A room rent waiver rider is also useful. Many Covid-19 cases required ICU admission or isolation rooms, whose cost exceeded the standard room rent limits. Without this rider, claims face proportionate deductions.

 

“In most cases, policies with a higher sum insured or those with additional premium options do not impose a limit on room rent,” says Niharika Singh, executive director of marketing, IFFCO Tokio General Insurance.

 

Coverage for consumables like PPE kits, gloves, masks and sanitisers is essential. Its absence pushed costs significantly during earlier waves. 

“Even where such coverage is available, the extent and list of consumables included under the benefit can differ across insurers,” says Dinesh Mosamkar, senior vice-president of consumer underwriting, TATA AIG General Insurance.

 

The policy should also offer OPD benefit for doctor consultations, diagnostics, medicines, and follow-ups. It should also come with a strong hospital network.

 

Enhance protection with super top-up 

A super top-up plan can supplement the base policy. “In case of prolonged treatment, high ICU costs, or multiple hospitalisations, as seen during previous Covid-19 waves, the sum insured in the base policy can quickly get exhausted. A super top-up can kick in once medical expenses in a year exceed a predefined deductible limit,” says Nerurkar. 

 

Exclusions to watch out for 

Older policies typically have more exclusions. “Common exclusions may include OPD expenses, treatments received in certain establishments, home care treatments, etc,” says Mosamkar. He advises reviewing policy documents to identify gaps.

 

One should also be cognisant of waiting periods. “There is usually a waiting period before coverage begins — typically 30 days from the start date of the policy. Waiting periods also exist for pre-existing conditions, which can vary from one policy to another,” says Singh.

 

She recommends buying early and maintaining continuous coverage to avoid lapses.

 

Mosamkar warns that some policies may exclude experimental or unproven medicines or therapies from coverage. He urges policyholders to examine documents closely for add-ons that may be required to cover exclusions.

   

Preparatory measures

 

• Be aware of network hospitals in your area
• Avoid blacklisted hospitals; cashless claims will not be accepted there
• Keep contact details of third-party administrator (TPA) handy
• Understand pre-authorisation and claim procedures in advance
• Have essential documents available like insurance card, ID proof, policy copy, and medical reports