COVID Insurance: Are Home Hospitalisation, Tests & CTs Covered?

Video Editor: Purnendu Pritam

Is COVID-19 hospitalisation covered by all types of health insurance? What are the hospital expenses that are covered? Are there any restrictions on buying health insurance policies at the moment? The Quint spoke to Amit Chhabra, Business Head - Health and Travel Insurance, Policybazaar.com to understand the different aspects of health insurance coverage, as India battles a second wave of the COVID-19 pandemic. Here are some excerpts:

What are the hospital expenses that are covered?

The largest expense is the hospitalisation expense. It would include everything from medication to doctor fees to room charges to oxygen charges to food and all of that. This is covered under every health insurance policy. The only catch is there must be at least a 24-hour hospitalisation, which is normal in COVID-19, because COVID-19 hospitalisation lasts for ten days or more.

Are blood tests and CT scans covered?

There are pre- and post-hospitalisation expenses. Like before going to a hospital, you would have done a COVID-19 RT-PCR test. You might have done some initial medication at home or might have done some blood tests or an HRTC scan. All of this, in case you are hospitalised, is also covered. The limit varies by insurance. Some insurance cover for 30 days before and up to 60 days after hospitalisation.

Reports say that policy-holders are only getting 50 percent of COVID-19 hospital expenses. What is not covered?

Let's say a customer wants to be paid for OPD. But, if OPD is not a part of the policy benefit... Or, let's say a customer is eligible for a room of Rs 5,000 per night, whereas the room that the customer has gone to is probably Rs 15,000 per night. In this case, the insurance will only pay what is eligible, which is Rs 5,000, they won't pay for more. These are typically the reason why customers may think that the amount being paid by the insurer is less. But actually, that's exactly the benefit or the terms and conditions of the policy that's there.

Are PPE kits covered?

Specific to COVID-19, a very large item is consumable item (sic). By consumable we refer to things which are used-up during the treatment. Like, for example PPE kits, gloves, injections, so on and so forth and this amount becomes fairly large in reference to COVID-19, because PPE kits do cost a lot and a lot of PPE kits do get used in the treatment. In a lot of policies, and I would caveat this, consumable items are covered. But check it with your policy advisor.

Is Home ICU covered under health insurance?

This is also called domiciliary treatment. This kicks in when hospitalisation is required, but no bed is available, which is a very real-world scenario right now. Almost in every city we are seeing that no beds are available. In all of these scenarios, domiciliary treatment kicks in. It needs at least three days of treatment at home and it has to be a formal treatment. There has to be a line of treatment with somebody monitoring it, creating a file. But, again, it is treated like hospitalisation. So, all the expenses of treatment at home like the cost of a doctor or nurse visiting from time to time, the cost of equipment, the cost of oxygen medicines, all of that gets covered exactly how hospitalisation gets covered.

What about medical expenses incurred during home isolation?

Hospitalisation must be required in this case, that's the only pre-requisite a doctor or qualified medical practitioner should have endorsed that a hospitalisation is needed. There's a reason why I am saying this. A lot of people get treated in home isolation where a hospitalisation is not needed but you isolate at home and get basic medication. That is not covered because it is isolation at home, it never required hospitalisation.

What if I purchased Remdesivir for double the amount?

What insurers will pay for is the actual cost of the medicine. Let's say Remdesivir is available... it's selling in lakhs also, as we hear, but the actual dose which I understand is about Rs 3,500. So that is what insurance companies will pay. They will not pay Rs 50,000 if somebody has taken that amount. And the other point is that a bill will be required, just to prove that it’s taken.

Are there any restrictions on buying health insurance at the moment?

The only clause that's there is called a cooling-off period. Which basically means that there has to be a certain gap between you getting COVID and you getting an insurance. So, what a lot of insurers say is they are not sure of the long-term side-effects of COVID-19 on your body, hence they want you to have spent some time after being COVID-negative, before you become eligible to buy a policy. And this varies, this varies from zero days for some insurers and it goes as high as six months also, in some cases.