Does your Existing Health Insurance Policy Covers Omicron?

Several months earlier, the Delta version of COVID-19 wreaked havoc, leading to the hospitalisation of countless people all across the world, including India. The third wave of the illness was brought on by a novel and an extremely contagious variation called “Omicron,” which made its way into the community and infected many people, although the rate of infection decreased over the course of the following several months.

What is Omicron?

On 24th November 2021, a new variant of the Coronavirus, also known as SARS-CoV-2, was first discovered in South Africa, called Omicron. It is also known as B.1.1.529, which is even more contagious than its predecessor. This has led to a rapid increase in cases worldwide, particularly in the country where it was first identified.

Several subversions have also emerged since the Omicron version of BA.1, including BA.2, BA.3, BA.4, and BA.5.

Existing Health Insurance and COVID-19 Virus

During the first outbreak of the virus, many health insurance companies offered financial assistance if only you were hospitalised for a whole day, 24 hours. The money could not be claimed otherwise, since outpatient treatment wasn't covered by most insurance plans. 

Insurance companies, especially the private ones, were reluctant to cover the disease and provide coverage even after the Coronavirus was declared as a worldwide pandemic. They stated that, according to government regulations, claims for epidemics and pandemics were excluded. On the other hand, government agencies worked on the contrary. They accepted the claims, understanding the deep impact the virus had on people's lives. 

Omicron Under the Existing Health Insurance Policy

Insurance Regulatory and Development Authority of India, commonly abbreviated as IRDAI, stated that every health insurance policy covering the treatment of Coronavirus issued by different companies must also cover the treatment of its fifth variant, Omicron.

The statutory authority in charge of monitoring the insurance sector in India has mandated that such insurance companies give continuous cashless facilities and efficient services to all policyholders who are hospitalised in order to cure the illness spread by Omicron.

Do Your Existing Health Insurance Covers Omicron?

There are various types of health insurance; one of them is the indemnity health insurance policy that covers the Omicron infection treatment. 

What is an Indemnity Health Insurance Policy?

It refers to insurance policies that reimburse you for any medical costs you incurred as a result of being hospitalised. You may make a claim for the amount that was insured in accordance with the terms and conditions of the policy.

Thus, all the variants of the Coronavirus were covered by health insurers in their policies, as mandated by the IRDAI, which means, while subjected to the terms and conditions, your existing health policy covers Omicron as well.

The below conditions apply:

• If you obtain health insurance coverage prior to getting infected with Omicron, your insurer will cover the costs associated with your hospital treatment.
• If you tested positive for COVID 19 prior to acquiring insurance coverage, your treatment costs would not be covered by that policy.
• There is no waiting duration of time in your existing health policy for the treatment of Omicron. Therefore, it is advisable for you to go through the terms and conditions of the policy. 

Corona Kavach Policy:

It covers a wide range of items, including home care expenses, all Covid-19 claims, tax benefits, PPE expenses, and pre and post hospitalisation for 15 and 30 days. It is advised to go through this policy before choosing your health insurance plan.

COVID 19 (Omicron) Related Inclusions and Exclusions

Inclusions

• Treatment at home
• Admitted at Hospital
• Hospitalisation expenses for before and after
• Cost of road ambulance
• Expenses for daycare
• Ayush treatment (Ayurveda, Yoga and Naturopathy, Unani, Siddha, Homeopathy)
• Expenses for organ donor
• Recovery costs
• Coverage for critical illness

Exclusions

• The cost incurred on quarantining at non-authorised centres
• Expenses for quarantining at home
• Positive test conducted at non-authorised centres for Omicron
• Hospitalisation without any advice from a doctor
• Restricted countries being travelled to
• Costs of unproven treatment
• Dietary supplements cost to boost immunity against Omicron infections

Factors to be Considered While Buying a Health Insurance Policy

Before purchasing health insurance coverage, you should examine a few crucial things. This ensures that you have adequate coverage for your family's health.

• Checking if the “sum guaranteed” in the policy is sufficient to cover the projected medical costs is vital when choosing health insurance.
• You should verify whether the hospitals you would use are included on the list of hospitals where your insurer offers a cashless facility before purchasing a health insurance policy.
• The extent of the policy is determined by the health insurance plan's coverage (inclusions) and the circumstances for which no claim may be made (exclusions). Before obtaining health insurance, you must be entirely clear on both.

Health Insurance Benefits for the Omicron Variant

The following are the key advantages of Omicron health insurance:

• It secures the policyholder against medical costs associated with the treatment of Omicron Covid-19 variant infections.
• The cost of consumables required to treat the condition, such as PPE kits, masks, oxygen, gloves, etc., is covered by the plan.
• It provides cashless hospitalisation at a major network of hospitals.

Thus, while Omicron is covered by existing health insurance policies, it is necessary to go through the terms and conditions of the plan. If you have not yet purchased a policy, you should keep the factors to be considered while buying a plan in mind, ensuring that you get the benefits provided and buy the best health insurance policy omicron coverage for you from Niva Bupa. Many health insurances can be bought online as well as offline, so you can choose the one best suitable for you, as per the ongoing conditions and do not risk your safety.

FAQ

What is the Omicron variant of COVID-19?

Omicron is a highly contagious variant of the Coronavirus first discovered in South Africa in November 2021. It has several subvariants like BA.1, BA.2, and BA.5. Omicron spreads faster than earlier variants, though its symptoms may be milder in many cases.

Does health insurance in India cover Omicron treatment?

Yes, according to IRDAI, all health insurance plans that cover COVID-19 must also cover Omicron. If you already have a valid policy before testing positive, hospitalisation and related expenses due to Omicron are covered under the same policy terms.

What is an indemnity-based health insurance policy?

An indemnity policy reimburses your actual medical expenses incurred during hospitalisation. It allows you to claim costs up to the sum insured, covering treatments like Omicron if the policy was purchased before the infection occurred.

Is there a waiting period for Omicron coverage in health insurance?

No, there is no specific waiting period for Omicron if it’s covered in your existing policy. However, coverage only applies if the policy was active before the infection. Always check the terms to confirm eligibility and timelines.

Does Omicron health insurance include home care treatment?

Yes, most Omicron-inclusive plans cover home care treatment if prescribed by a doctor. This includes medical supervision, medicines, and daily health monitoring costs for COVID-19 recovery from home, depending on policy specifics.

Why should I consider Omicron coverage in my health plan?

Omicron may lead to unexpected hospital stays or treatment costs. Having a health policy with Omicron coverage ensures financial protection, access to quality care, and peace of mind for you and your family during unpredictable times.