'Opt for a minimum cover of Rs 10 lakh to Rs 15 lakh, especially in urban and metro areas.'
With rising COVID-19 cases in India, policyholders must assess whether their health insurance policies offer adequate coverage and possess the features required to deal with this threat.
Gaps uncovered
The limitations of many retail health policies were exposed during the earlier waves.
"These included sub-limits on room rent, and exclusion of non-payable items like PPE (personal protective equipment) kits," says Bhaskar Nerurkar, head - health administration team, Bajaj Allianz General Insurance.
The rigid definition of hospitalisation was another impediment.
"Domiciliary treatment was not commonly covered at the time," says Siddharth Singhal, head of health insurance, Policybazaar.
Is sum insured adequate?
The pandemic underlined the importance of adequate coverage.
"Opt for a minimum cover of Rs 10 lakh to Rs 15 lakh, especially in urban and metro areas. For a family of three, a floater cover of Rs 20 lakh to Rs 25 lakh is advisable," says Nerurkar.
Must-have features
Domiciliary or home treatment is critical. It allows patients with mild symptoms to receive care at home when hospitalisation is not possible or necessary.
"The insured can claim expenses such as nursing charges, medicines, diagnostics, and equipment used at home, provided the treatment is under the advice of a medical practitioner," says Nerurkar.
Tele-consultation is another indispensable feature.
"It provides safe and convenient access to medical advice without visiting hospitals," says Singhal.
The restoration of sum insured feature is also essential so that the insured or their family members can receive treatment within the policy year even after the sum insured has got exhausted.
A room rent waiver rider is also useful.
Many COVID-19 cases required ICU admission or isolation rooms, whose cost exceeded the standard room rent limits.
Without this rider, claims are subject to proportionate deduction.
"In most cases, policies with a higher sum insured or those with additional premium options do not impose a limit on room rent," says Niharika Singh, executive director of marketing, IFFCO Tokio General Insurance.
Coverage for consumables like PPE kits, gloves, masks and sanitisers is a must-have.
Its absence pushed costs significantly during earlier waves.
"Even where such coverage is available, the extent and list of consumables included can differ across insurers," says Dinesh Mosamkar, senior vice president of consumer underwriting, TATA AIG General Insurance.
The policy should also offer OPD benefits for doctor consultations, diagnostics, medicines, and follow-ups.
It should also come with a strong hospital network.
Enhance protection with super top-up
A super top-up plan can supplement the base policy.
"In case of prolonged treatment, high ICU costs, or multiple hospitalisations, as seen during previous COVID-19 waves, the sum insured in the base policy can quickly get exhausted.
"A super top-up can kick in once medical expenses in a year exceed a predefined deductible limit," says Nerurkar.
Exclusions to watch out for
Older policies typically have more exclusions.
"Common exclusions may include OPD expenses, treatments received in certain establishments, home care treatments," says Mosamkar.
One should also be cognisant of waiting periods.
"There is usually a waiting period before coverage begins -- typically 30 days from the start date of the policy.
"Waiting periods also exist for pre-existing conditions, which can vary from one policy to another," says Singh.
She recommends buying early and maintaining continuous coverage so that waiting periods are crossed.
Mosamkar warns that some policies may exclude experimental or unproven medicines or therapies from coverage.
He urges policyholders to examine documents closely for add-ons that may be required to cover exclusions.
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Feature Presentation: Ashish Narsale/Rediff
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