Since health policies cover hospitalisation, out-of-pocket expenses on vaccinations typically do not make the cut, except under certain circumstances
The world is waiting with bated breath for a vaccine that will finally end the scourge of the novel Corona Virus Disease (COVID-19) that has wreaked havoc on lives and economies globally.
It certainly seems to be on its way – sooner than originally expected – but will entail substantial cost, with estimates pegging the cost of Oxford and Moderna vaccine candidates between Rs 1,000-4,500 . Through a tie-up with global vaccine alliance GAVI and Bill and Melinda Gates Foundation, Serum Institute, Pune is likely to offer anti-COVID-19 vaccines at $3 per dose by 2021.
While vaccines remain critical to the prevention of the pandemic, you will have to foot the bills, unless the central and state governments step in with an alternative funding plan.
Are vaccination expenses covered under regular health insurance policies?
Frequently Asked Questions
A vaccine works by mimicking a natural infection. A vaccine not only induces immune response to protect people from any future COVID-19 infection, but also helps quickly build herd immunity to put an end to the pandemic. Herd immunity occurs when a sufficient percentage of a population becomes immune to a disease, making the spread of disease from person to person unlikely. The good news is that SARS-CoV-2 virus has been fairly stable, which increases the viability of a vaccine.
There are broadly four types of vaccine — one, a vaccine based on the whole virus (this could be either inactivated, or an attenuated [weakened] virus vaccine); two, a non-replicating viral vector vaccine that uses a benign virus as vector that carries the antigen of SARS-CoV; three, nucleic-acid vaccines that have genetic material like DNA and RNA of antigens like spike protein given to a person, helping human cells decode genetic material and produce the vaccine; and four, protein subunit vaccine wherein the recombinant proteins of SARS-COV-2 along with an adjuvant (booster) is given as a vaccine.
Vaccine development is a long, complex process. Unlike drugs that are given to people with a diseased, vaccines are given to healthy people and also vulnerable sections such as children, pregnant women and the elderly. So rigorous tests are compulsory. History says that the fastest time it took to develop a vaccine is five years, but it usually takes double or sometimes triple that time.
A regular health insurance cover reimburses your hospitalisation expenses up to your sum insured, as also pre-admission and post-discharge bills. Therefore, vaccines will usually not make the cut under such regular policies, except for post-animal-bite vaccinations or antidotes. New-born babies’ vaccinations, too, will be covered under policies that pay for pregnancy expenses.
What kind of policies pay for vaccination expenses?
Some policies that cover outpatient department expenses (OPD) will pay for the vaccination expenses too. “We cover vaccinations under our premium variant, where there is an OPD element of Rs 10,000. This includes routine vaccinations such as Hepatitis B or Influenza. As and when vaccines for COVID-19 are developed, those expenses will be paid for too,” says Nikhil Apte, Chief Product Officer, Health Insurance, Royal Sundaram General Insurance.
In future, as more insurers launch OPD products, it is likely that vaccinations will be paid for as part of preventive healthcare costs. For now, the number of such products – and coverage for vaccines under these – remain limited. “You need to check if your policy specifically covers vaccinations. Generally, these are not covered as they do not qualify as treatment procedures, but are preventive in nature. And regular health covers are not meant for preventive care,” says Abhishek Bondia, Co-Founder, SecureNow.in. In fact, vaccines are specifically excluded – not eligible for claim – under some policies.
This apart, products with maternity benefits will also take care of the new-born’s vaccinations. These include BCG, Measles, Hepatitis B, Chicken Pox and so on. However, a policy that pays for pregnancy expenses will also come with higher premiums, besides a waiting period of up to four years for this particular cover.
However, maternity and OPD benefit covers are costlier than regular covers. For example, a 35-year-old buying a regular Rs 5-lakh cover will have to pay an annual premium Rs 6,827 under ICICI Lombard’s iHealth Plus policy. If you were to add the outpatient department, wellness and preventive care and maternity benefit add-on to this base cover, you will have to shell out Rs 9,925 a year.
Is there any standard list of vaccines that maternity benefit policies will pay for?Insurance companies will reimburse the new-born’s expenses in line with government of India’s National Immunisation Schedule, up to 90 days from the date of delivery. Once you include the baby in the cover, vaccine expenses will be paid for till the child turns five, depending on the policy terms and conditions.