The second wave of COVID-19 is becoming more ferocious day by day. Ministries of different states are taking strict steps like night curfew, partial lockdown to break the chain spread. Like its first wave in 2020, it is not only going to impact our health worse but also finances, if not taken care of at times.
Now being a good financial planner of your finances, you might have prepared yourself for COVID-19, by including a cover for it in your health insurance policy. In this way, you might feel financially protected but you need to know that your financial protection is limited to an extent.
This is because all health insurance policies come with exclusions – that is, expenses that they will not pay for. For example, in all health insurance policies, treatment of pre-existing diseases before the waiting period is over is not covered.
Some similar cases have been witnessed in the case of the COVID-19 claim. Disputes between hospitals and insurers on overcharging have only added to policyholders’ financial burden. In fact, as per industry reports, the policyholders across the country have been receiving only around 50-55 percent of their actual claimed amount for COVID-19 hospitalization.
The prime reason stated by the insurer is that there are kinds of expenses in COVID-19 treatment that the insurer doesn’t promise to pay. Well, let us know the story behind the scene.
COVID-19 Expenses That The Health Policies Don’t Include!!
You might not be aware of this fact but in COVID-19 treatment the policy cover allows for PPE kits but only to a specified limit, PPE kits used excess from that limit are not included in the cover. Well, this is less shocking than the fact that initially the cost of PPE kits used was not included in the claim. Later, insurers relented and started covering a part of these costs, which had also reduced over a period of time.
The General Insurance Council indicative rate structure specifies the cap on PPE to Rs 1,200-2,000 a day. “Multiple PPE kits are not covered in a day. Most insurance companies pay for one PPE kit per day or up to Rs 1,500-2,000 per day for a PPE Kit,” says Dr. Sudha Reddy, Head, Health and Travel, Digit Insurance.
Some Other Expenses Not Included In The Cover-
Nowadays hospitals keep good attention to maintaining good hygiene and thus levies kind of expense to the patient’s bill. As per the insurer, these expenses such as housekeeping, air conditioning, daily charts, and infection control charges are to be subsumed into the room charges by the hospitals and should not be billed separately.
This is because there are some insurers that do not pay for these costs if they are charged separately.
There are some items that are completely excluded from the cover by the insurer, these items are nebulizer kits, steam inhalers, attendant charges, and private nurses.
Do All Insurance Policies Have This Kind Of Exclusions?
Well, yes these kinds of exclusions are found in almost all health insurance policies. Basically, the exclusions are the costs of certain expenses in your medical treatment, that are not paid by the insurer and this is made clear by the insurer before issuing the health insurance policy to any individual. Basically, the exclusions are those expenses that must be covered from your pocket.
The insurance regulator IRDAI has standardized a whole host of exclusions – a list that all health insurers have to follow. Despite this, the COVID-19 crisis saw policyholders having to fork out a substantial amount from their own pockets, as hospitals and insurers locked horns over ‘unreasonable’ and ‘excessive’ charges levied by the former.
So basically, while taking cover for COVID-19, do ensure what are the cost covered in the claim!!
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