COVID-19: Do health policies cover tests done at private labs?

Twelve private laboratories, including Metropolis, SRL Labs, Suburban Diagnostics and Thyrocare have been allowed to conduct Coronavirus Disease (COVID-19) diagnostic tests. So, getting tested will be relatively easier.

These tests are likely to come at a cost, though the Indian Council of Medical Research (ICMR) has appealed to private diagnostic centres to offer the service free of charge. The central government has capped the charges at Rs 4,500.

Insurers will cover tests

The comforting piece of information for policyholders is that even regular, indemnity-based health policies (where the actual hospitalisation cost incurred is paid for) will cover COVID-19 tests as part of pre-hospitalisation expenses, subject to certain conditions. “However, it is not prudent to undergo tests only because the access is easier. Ensure that you get tested only if you – or someone with whom you’ve come in contact with recently – have travelled abroad in the last 14 days or you have developed COVID-19-like symptoms that worsened over two to three days,” says Dr S Prakash,  Managing Director, Star Health and Allied Insurance. You do not need to buy a special Covid-19 health insurance policy to cover the cost of hospitalisation; your existing health insurance is good enough.

Typically, your insurance company will reimburse you the Covid-19 test’s cost only if it leads to hospitalisation for being tested positive. Here, diagnostic tests get covered if they has taken place up to 30 days prior to hospitalisation, which is likely to be the case with COVID tests, given that the incubation period is between 2-14 days. “A regular health insurance policy covers individuals for coronavirus-related hospitalisation, and it will also cover the cost for diagnostic tests under pre- and post-hospitalisation for those who are tested positive,” says Ravi Vishwanath, President, Accident and Health, HDFC ERGO General Insurance. That’s how indemnity-based health insurance policies work – a minimum of a 24-hour hospitalisation is necessary for the claim to be payable.

Put simply, COVID-19 claims will be treated at par with routine health claims. So far, the central and state governments were taking care of COVID tests and subsequent hospitalisation. With private hospitals too  being roped in to treat COVID-19 cases from March 26, your individual health policies would cover the costs of treating the ailment. “We have already received around eight claims across the country. Most of them were admitted to a government facility, while one case is undergoing treatment at a private hospital,” says Dr S Prakash.

A cover for home quarantine?

However, the COVID-19 treatment has created a special situation – quarantine at a government-approved facility that is not a hospital or even isolation in your own home. “Even if the policyholder is quarantined at a government-approved facility after testing positive, the expenses, including pre- and post-hospitalisation, will be paid for as it will be considered equivalent to hospitalisation,” says Amit Chhabra, Business Head, Health, Policybazaar.com.

Home quarantine is a bit tricky, though. Under a regular policy, pre-hospitalisation expenses don’t get covered if you have to follow home quarantine as home quarantine is not technically hospitalisation. In this case, check if your policy covers outpatient department (OPD) expenses. If it does, then your policy will cover your COVID-19 test expenses, even if you get home-quarantined.

This apart, many insurers including Digit, Star Health, ICICI Lombard and Edelweiss General Insurance have launched COVID-specific health covers – either individual or group products. Typically, these policies hand out a pre-defined amount once the policyholder tests positive for COVID-19.

Know the exclusions

You must go through the list of exclusions – expenses that the insurer will not bear. For one, cost of diagnostic tests will not be paid for if the policyholder tests negative and, therefore, is neither hospitalised nor quarantined. This is the case with any diagnostic test that is not linked to subsequent hospitalisation. “The only thing that the insured has to keep in mind, is to ensure that the claim towards main hospitalisation expenses, should be admissible and approved,” says Shanai Ghosh, Executive Director and CEO, Edelweiss General Insurance.

Watch out for the waiting period. “A regular health insurance policy does not cover any infectious diseases for the first 30 days from the inception of the policy,” says Vishwanath. But Edelweiss has waived off this clause for COVID-related ailments.

If you have purchased a COVID-specific policy, too, you need to keep an eye on the fine print. “Symptomatic (where COVID-19 is not confirmed) treatment will not be admissible. Similarly, if the report is negative, the expenses will not be eligible for a claim. Expenses incurred for any ailment other than COVID-19 will also not be payable,” says Sudha Reddy, head, health and travel, Digit Insurance.

How to file a claim?

Just like any other regular health insurance claim, make sure you keep all your hospitalisation and test bills handy. You can opt for the cashless facility if the hospital features in your insurer’s . Else, submit your documents within seven to 15 days, depending on your insurer’s deadline.

Given the high risk of commuting during COVID-19 pandemic, some insurers are offering simpler procedures. “Claim intimation can be done over email. Self-attest all bills; scan and email them – no courier or physical copy would be needed. If at all required, we will arrange for a pickup,” says Reddy.

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