27th May 2024

Can I Claim My Health Insurance Policy For COVID-19?


With the active coronavirus case in India increasing every day, there is a pressing need for everyone to have a health insurance plan. But the question is if we have a health insurance plan can we claim that for COVID-19 or how can we make a claim if tested positive. Read on to the know the answers.

If a person already has a health insurance policy, he/she can claim the insurance as all health insurances cover claims for respiratory diseases. But you can only claim the insurance in case of hospitalisation. In such a case, even pre-hospitalisation expenses and post hospitalisation expenses like ambulance costs, costs of tests etc. can be covered depending on the terms and conditions of your policy. 

Here are all the situations when you can claim your health insurance for COVID-19

Coverage COVID-19 tests

The cost of COVID-19 tests is also quite high ranging from about Rs. 2000 to Rs. 4500 and to get the expenses of the tests covered, there are few conditions in your existing health insurance policy.

 If you have taken a test for COVID-19, you wouldn’t be able to file a claim unless you are tested positive and hospitalised for the same. In case you are hospitalised, you can claim both pre – hospitalisation and post hospitalisation expenses. Depending upon your policy terms if your health insurance covers OPD (Out-patient Department) charges, then you can claim for the cost incurred for the tests.

What Are the Situations When You Claim Is Not Accepted?

There are certain limitations on which your claim can be rejected, like in case if you have purchased the policy with a pre-existing respiratory problem. In such a case neither your basic health insurance plan nor your coronavirus Mediclaim plans cover the expenses incurred during hospitalisation.

You may not be able to register a claim if you have a travel history or any of your family members have recently visited country that is worst affected.

  • If you are discharged from before 24 hours
  • If you are suffering from a pre-existing disease like cold, flu or any other respiratory issues
  • If you have been tested positive within the waiting period of the policy

What is the process to file a claim if tested positive for Coronavirus?

If you have a cashless claim policy and you are admitted to any of the network hospitals, you would not have to register any claim for the expenses instead the insurance company would settle the costs with the hospitals directly.

In case you aren’t admitted to any of the network hospitals, you would have to settle the expenses initially and then reimburse the bills from the insurance provider. But all these claims are subjected to the inclusions, exclusions mentioned in the policy document.

So, if you are planning to take a Coronavirus specific health insurance policy during this period, you would have to wait for the waiting period to get over before you claim for the expenses. In case you already have a health insurance plan, you can claim for the expenses depending upon the terms and conditions that have been mentioned in the policy.

Make sure if you wish to take a coronavirus specific health insurance plan, you can only claim it for expenses incurred while treating Coronavirus. While in case of basic health insurance plan, you can claim for Coronavirus and other health ailments as mentioned in the plan.