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Covid-19 vaccine: Your existing health policy is unlikely to cover costs, adverse reactions

Currently, all Covid-related hospitalisation is covered by traditional health insurance policies. Additionally, there are special health insurance covers only for Covid. But contrary to popular perception, existing health insurance policies are unlikely to cover the cost of vaccination and adverse reactions, if any. Only policies designed purely for the Covid-19 vaccination process — there is none at the moment — will cover the costs

December 02, 2020 / 01:13 PM IST
Source: Reuters

Source: Reuters

Bidisha Ray, 35, from Kolkata, gave birth to a child in October and is hoping to get the Covid-19 vaccine in the first tranche when it is launched. Ray wants her nursing baby to be safe from the virus but is also worried about any adverse reaction that she and her infant may suffer.

At the other end of the country, in Mumbai, Pradeep Sharma, 46, who tested positive for Covid, is also planning to take the vaccine. Sharma got his Rs 2.8 lakh medical claim reimbursed by his private insurer but is worried about how to pay for any adverse reactions to the vaccine as also the cost of vaccination.

The coronavirus vaccines being developed by various companies are in phase three trials. But amidst this there are fears over who will bear the cost of vaccinating the general public and possible adverse reactions to the vaccines.

No cover

Contrary to popular perception, existing health insurance policies are unlikely to cover the cost of vaccination and adverse reactions, if any. Insurance sources told Moneycontrol that only policies designed purely for the Covid-19 vaccination process would help bear the costs.

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“Considering the individuals in high-risk groups with comorbidities such as hypertension and diabetes, as also senior citizens and children, the vaccination cost burden on insurers is very high. Separate covers will have to be developed only for Covid-19 vaccinations and any adverse reactions to them,” said a senior health insurance official.

The vaccine itself could cost between Rs 1,000-2,000 per dose. However, it is the possibility of an adverse reaction and the financial costs to treat these side-effects that has many worried.

What is the situation now?

Currently, all Covid-related hospitalisation is covered by traditional health insurance policies. Additionally, there are special health insurance covers only for Covid-19 with 3.5 months, 6.5 months and 9.5 months coverage.

Even under Covid-19 hospitalisation claims, there have been multiple instances of insurers paying claims only partially. Moneycontrol had reported on how there is a constant tussle between hospitals and insurers over what is payable under Covid-19 hospitalisation for insured patients.

Follow the latest updates on Covid-19 vaccines here

There are also standard rates fixed across States. However, the common complaint is that hospitals do not follow these rate charts.

Insurers are of the view that adverse reactions pertaining to Covid-19 treatment are not completely covered even now.

“We have cases where hospital bills of patients had seen additional costs of Rs 1 lakh-2.5 lakh due to a drug either causing side effects or not working. In these cases, too, the entire amount is not paid since policy terms and conditions also give insurers the flexibility to exclude such exigencies. The same process will be followed if vaccine insurance is mandated,” said the head of claims at a mid-size private non-life insurer.

As for volunteers of vaccine trials, the company conducting the trials offers them insurance. However, in case there is an adverse reaction reported by a volunteer that is not related to the vaccine trials, then the company is not responsible for these medical expenses of the participant.

A 40-year-old man who took part in the ‘Covishield’ vaccine trial in India alleged serious side effects, including a virtual neurological breakdown and impairment of cognitive functions and sought Rs 5 crore compensation in a legal notice to Serum Institute and others, besides seeking a halt to the trial.

The legal notice was sent to Pune-based Serum Institute of India (SII), which has collaborated with Oxford University and Astra Zeneca, a pharmaceutical company, for trials of the vaccine.

However, SII has refuted his claims and said that the side effects were not related to the vaccine.

What will happen once a vaccine is launched?

It is likely that high-risk individuals, including senior citizens, children and pregnant women, will be given the Covid-19 vaccine in the first stage.

Insurance sources said that only if there is a mandatory coverage requirement will there be covers to pay for vaccination costs.

“Mandatory covers for Covid-19 vaccines and allied expenses will be launched if required. However, considering that there is no past data for possible claims, these covers could be 15-20 percent more expensive than regular medical policies,” said the underwriting head at a public sector insurer.

In the past, even the Polio vaccine, which is orally administered, has led to adverse reactions in a few children. A 2019 scientific paper said that the oral polio vaccine has caused paralysis among some children.

For Covid-19 vaccination as well, insurers are seeking either a pool structure, wherein premiums can be collected and pooled for large-scale adverse risks, or have standard covers with risk-based pricing.

“If there is a grave adverse reaction, the insurers will study these on a case-to-case basis and decide on claims disbursements. Since this is a new vaccine, existing covers won’t be adequate,” said the head of underwriting at a standalone health insurer.

While the initial expectation was that the entire country would get the Covid-19 vaccine, the PM Narendra Modi-led government has said that this will not be the case.

The government on December 1 said it never spoke about vaccinating the entire country.

“I just want to make this clear that the government has never spoken about vaccinating the entire country. It's important that we discuss such scientific issues, based on factual information only,” Health Secretary Rajesh Bhushan said while responding to a question on when a vaccine can be provided to everyone in the country.

 
M Saraswathy
first published: Dec 2, 2020 01:13 pm

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