Be wary of unproven treatments for COVID-19 which may not get insurance cover

If you or your family member takes any unverified treatment or supplies as a Coronavirus (COVID-19) cure, the expenses would not be covered.

As per draft guidelines circulated among insurers by Insurance Regulatory and Development Authority of India (IRDAI), a standard exclusion in the proposed COVID-19 health cover will be expenses related to any unproven treatment, services and supplies for or in connection with any treatment.

Moneycontrol has reviewed a copy of the draft guidelines sent to general insurers and standalone health insurers.

Here, unproven treatments are treatments, procedures or supplies that lack significant medical documentation to support their effectiveness. However, treatment authorised by the government for the treatment of COVID-19 will be covered.

Under the standard COVID-19 covers, there will be option between fixed benefit (lumpsum amount plan) and indemnity (reimbursement) covers.

The draft norms said that the base cover of COVID-19 standard health policy will be offered on indemnity basis whereas optional cover will be on benefit basis. There will be a policy tenure of three months, six months, and one year.

Under the optional cover, the insurer has to pay 0.5 percent of sum insured per day for each 24 hours of continuous hospitalisation (upto 15 days) for COVID-19 treatment following a claim. Entry age limit is 18-65 years.

Insurers have been asked to ensure that the cover is available on or before July 15. Here, AYUSH hospitals with at least five in-patient beds will also be covered if treatment is availed here.

In the hospital, room rent charges as well ICU expenses, diagnostics, PPE kit expenses, doctor fees and road ambulance (with Rs 2,000 limit) per person will be allowed. Due to no standard definition of COVID-19 medical expenses right now, hospitals have been overcharging customers.

Also Read: Hospitals feel the pinch of infection control measures

Under the basic plan, the policy will include the cost of treatment for any comorbid condition along with COVID-19 treatment. Pre-hospitalisation expenses like diagnostics will be covered for 15 days prior to being admitted to the hospital. Post hospitalisation medical expenses will be covered for 30 days after being discharged.

When it comes to the benefit-based health plan for COVID-19, the lump sum benefit/sum assured will be payable as soon as an individual is diagnosed Coronavirus positive.

Here, there is an add-on cover that can be bought. Under this add-on, if the insured is quarantined due to suspected infection of COVID-19 then 50 percent of the base sum insured will be paid.

The waiting period has been kept standard at 15 days and only tests done at government-authorised laboratories and testing centres/hospitals will be eligible for claims. Home quarantine is not covered under the add-on cover.

Also read: Will it get tougher to buy health insurance post COVID-19?

The policy term will be one year and it would be offered with a sum insured option between Rs 50,000-Rs 5 lakh. Typically, the average premium for a Rs 5 lakh individual medical cover for a 30-year-old is between Rs 4,000-7,000. It is anticipated that the premium for the standard COVID-19 plan for individuals will be around Rs 2,500-2,600 for the Rs 5 lakh cover.

The head of underwriting at a mid-sized health insurer told Moneycontrol that there have been cases where COVID-19 affected have been found availing unrecognised treatments involving herbal remedies and religious rituals.

“While we have no say in the treatment that an individual chooses to avail of, it is clear that the standard COVID-19 cover will not pay for it,” he added.

Till now, regular health insurance products were covering expenses for COVID-19 hospitalisation. However, the policy terms did not offer any basic terms on the items that would be covered.

Follow our full coverage of the coronavirus pandemic here.