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Does your existing health insurance policy cover Omicron?

Team AckoAug 5, 2022

The Delta variant of COVID-19 wreaked havoc resulting in the hospitlisation of several people across the globe and in India. While the infection rate declined over the next couple of months, a new and highly infectious variant, ‘Omicron’, found its way into the community infecting many, causing the third wave of the infection.

Does Your Existing Health Insurance Policy Cover Omicron?

Be it individual or a family floater, all existing health insurance policies cover the treatment of the Delta variant. But does it cover the Omicron variant of COVID-19? In this article, you’ll learn about the health insurance coverage for the Omicron variant and how you can benefit from the health insurance plan covering the new Coronavirus variant.

Omicron cases in India and the world

As of January 2022, more than 2.38 lakhs new COVID-19 cases were reported in India. And the Omicron variant had infected more than 8,800 people in India. On the other hand, the world has witnessed more than 5.5 lakh cases of the Omicron variant during the same time period.

Apart from South Africa, Omicron has spread across other countries such as the United States of America, Canada, Australia, the United Kingdom, France, Japan, Italy, Germany, Spain, Denmark, etc.

Health insurance coverage for Omicron COVID variant

Omicron is a variant of the Coronavirus. The IRDAI has stated that all health insurance policies issued by general insurers that cover the treatment of COVID-19 also cover the treatment of the Omicron variant.

The industry regulator also directed insurers to provide seamless cashless facilities and effective services to all hospitalised policyholders to treat Omicron infections.

Benefits of health insurance for Omicron COVID variant

Here are the primary benefits of health insurance for Omicron.

  • Hospitalisation costs: It covers the insured against hospitalisation expenses arising from the treatment of the infections of the Omicron COVID variant.

  • Home treatment costs: It covers the cost of treating the Omicron infection as long as a doctor prescribes it.

  • Consumables costs: The plan covers expenses of consumable items such as PPE kits, gloves, masks, oxygen, etc., used to treat the infection.

  • Cashless facility: It offers cashless hospitalisation at a vast network of hospitals.

  • Add-on covers: You can include some essential add-ons to increase the regular health insurance plan's coverage.

Is Omicron covered under the existing health insurance plan?

Yes, all indemnity-based health insurance plans cover the treatment of the infections of the Omicron variant of COVID-19. The IRDAI has made it mandatory for insurers to cover the treatment of diseases of all variants of COVID-19. Hence, Omicron is covered under your existing health insurance policy subject to the terms and conditions of the policy.

If you have purchased a health insurance plan before being infected with the Omicron, your insurer compensates for the hospitalisation expenses required to treat the infections. However, your policy will not cover the treatment expenses if you have tested positive for COVID-19 just before purchasing a health insurance plan.

Also, under your existing health insurance plan, there is no waiting period for treating the Omicron variant of COVID-19. It is prudent to read the terms and conditions of the policy document to know what is covered and not covered under the plan.

Inclusions of health insurance for Omicron treatment

Here are some of the most common coverage details of the health insurance plan for Omicron treatment.

Exclusions of health insurance for Omicron treatment

Here are some of the most common exclusions under the health insurance plan for Omicron treatment.

  • Quarantine costs at non-authorised centres

  • Home quarantine expenses

  • Omicron positive test conducted a non-authorised centres

  • Hospitalisation without the advice of a doctor

  • Travelling to restricted countries

  • Unproven treatment costs

  • Dietary supplements to boost immunity against the Omicron infections

How to raise a claim against health insurance for Omicron

There are two primary methods of raising claims against your health insurance to treat Omicron infections.

  1. Cashless claim

    Under this type of claim, you don’t have to pay the hospitalisation expenses for treatment if you get admitted to a network hospital. The insurer settles the bill directly with the hospital. You may have to bear the required deductibles as per the terms and conditions of the policy.

  2. Reimbursement claim

    If you have availed of treatment for the infections of the Omicron variant at a non-network hospital, you can pay the bill from your pocket upfront and raise a reimbursement claim. You must submit the required bills, payment receipts and supporting documents for the insurer to verify and settle the claim according to the terms and conditions of the policy.

In a nutshell

Be it the health insurance coverage for treating the infections of the Delta or the Omicron variant of COVID-19 or for other medical treatment, you should purchase a health insurance policy today to secure yourself and your family against unforeseen hospitalisation.

Buy a wide-ranging health insurance plan so that you are financially protected against unexpected hospitalisation, especially if it's for treating the infections such as the life-threatening Omicron variant.

Frequently asked questions

Here are some common questions about the Omicron variant's health insurance.

Are there any waiting periods applicable to health insurance for the Omicron variant of COVID-19?

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Typically, most insurers offer a new health insurance plan with an initial waiting period of 15 to 30 days before you can raise a claim. It is better to check the terms and conditions of the policy before you decide on the correct type of health insurance plan.

Should I buy a COVID-19 specific health insurance plan to stay covered against the Omicron variant?

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You can buy the COVID-19 specific health insurance plans such as the Corona Rakshak or Corona Kavach (Aarogya Sanjeevani) policies. However, as per the IRDAI guidelines, these policies are available until 31 March 2022. If you are looking for broad coverage for Omicron and beyond, it is better to opt for a regular health insurance plan.

Should I pass a medical test to be eligible for a health insurance plan for the Omicron variant of the COVID-19?

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Most insurers do not ask for a medical test before issuing health insurance that covers Omicron. However, it depends on the insurer, and you may be asked to pass a medical examination if you have any pre-existing disease.

Are there any tax benefits under the health insurance policy for Omicron?

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Yes, you can avail tax benefits for the premium paid for a health insurance plan that covers Omicron treatment under Section 80D of the Income Tax Act, 1961.

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Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on industry experience and several secondary sources on the internet; and is subject to changes. Please go through the applicable policy wordings for updated ACKO-centric content and before making any insurance-related decisions.

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