Are you covered? Health insurance and the growing threat of outbreaks

With diseases like Mpox, dengue, and Covid-19 becoming household names, it’s clear that health crises are on the rise. As these outbreaks increase, so do medical bills. But here’s the big question: does your health insurance cover you during these times?

The Reality of Rising Outbreaks

Jeremy Farrar, Director of the Wellcome Trust, a global health organization, warns, "We’re entering an era of epidemics and pandemics. They’re going to be more complex and more frequent." This makes it more important than ever to understand what your health insurance covers.

Does Your Policy Cover Outbreaks Like Mpox?

The good news is that most health insurance policies in India cover hospitalization for diseases like Mpox, which the WHO has declared a global health emergency. Bhaskar Nerurkar, from Bajaj Allianz General Insurance, says, "Indemnity-based health insurance policies are designed to cover a wide range of illnesses, including new and emerging infectious diseases."

While there might not be specific plans just for these diseases, they are generally covered under broader hospitalization policies. However, as Nerurkar wisely advises, "It’s smart to review your policy details and talk to your insurer to ensure you’re fully covered for any emerging infectious diseases."

What Will Your Insurance Cover?

Mahesh Yelapur from Go Digit General Insurance explains that health insurance usually covers hospitalization expenses, daycare procedures, ambulance charges, and more. However, out-of-pocket costs like OPD treatment or certain co-payments might still pop up.

For example, if your plan has a co-payment clause, you’ll need to pay a portion of the medical bill. Also, while cashless claims at network hospitals eliminate upfront payments, non-network hospitals might require you to pay first and get reimbursed later.

How to Make Sure You’re Covered

To ensure you’re covered during an outbreak, follow these steps:

Keep Your Policy Active: Make sure your health insurance is always up-to-date, especially since most policies include coverage for infectious diseases requiring hospital treatment.

Review Your Coverage: Regularly check and update the sum insured to match your needs. With healthcare costs rising, it’s important to choose a sufficient sum insured.

Consider Extra Coverage: Adding riders for consumables (like gloves, masks, etc.) can help reduce out-of-pocket expenses.

Choose a Comprehensive Plan: Pick a health insurance plan that covers modern treatments, as these might be necessary during an outbreak.

Choosing the Right Plan

When selecting a health insurance plan, consider these tips:

Opt for a high sum insured—especially in metro cities, where medical costs are higher.

Buy early to avoid waiting periods.

Look for add-ons like OPD coverage and no room rent capping.

Consider your lifestyle choices—healthy habits can lead to lower premiums.

How Insurers Are Adapting

Insurers are stepping up their game. They’re improving their policies and claims processes, making it easier for you to get the coverage you need. The Insurance Regulatory and Development Authority of India (Irdai) recently required all cashless claims to be processed within three hours of a discharge request. This is a big win for policyholders.

So, as we navigate this new era of frequent outbreaks, make sure your health insurance is ready to keep up. Review your policy, talk to your insurer, and take steps to ensure you’re covered—because your health and peace of mind are worth it.