Does your health insurance cover black and white fungus treatment?

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The coronavirus infection has led to hospitalization of several individuals and the treatment cost is running into lakhs of rupees for a 10-14 days stay in the hospital. Those holding a health insurance policy are getting the hospital bills paid by the insurance companies on either a cashless or on reimbursement basis depending on the empanelment of the hospital with the insurer.

The treatment of Covid-19 is covered under the health insurance policies but many patients also suffered from mucormycosis during or after the treatment. The insurance companies have acknowledged the fact that even the treatment of mucormycosis is a part of the coverage of health insurance policies and is covered for claims.

Mucormycosis is a serious but rare fungal infection and most people get mucormycosis by coming in contact with the fungal spores in the environment. Mucormycosis is being commonly referred to as Black fungus and in some cases as white, yellow and even green fungus.

Points you need to note

In a health insurance policy, there are certain permanent exclusions and some ailments have a waiting period before they are recovered by the insurer. The pre-existing diseases are covered by insurers typically after 48 months. There is no such waiting period or exclusion defined in the policy documents of health insurance policies for the treatment of Black fungus. This means they are fully covered by the insurer as any other ailment.

Further, black and fungus have been enlisted as a pandemic by the government. Therefore, just like Covid-19, all these are already covered under all health Insurance policies by all insurers.

Claim process

However, the claims, for these could be settled as per instructions and guidelines received from time to time by ICMR, AIIMS and Health Ministry. Some insurance companies may cover treatment towards black fungus for conservative management only but any surgical intervention due to the fungus may fall in the two years waiting period. This can be a tricky situation and we hope insurers don’t take that view.

Further, there are exclusive health insurance plans to take care of hospitalization costs owing to covid-19 such as Corona Kavach plans that cover home care costs as well. This may be a good option for any family which has a cover of less than Rs 20 lakh for a family.

If you wish to buy a new health insurance plan now and use it to cover hospitalisation expenses arising out of Covid-19 or black fungus anytime in the future, you may do so. However, remember, there will be a waiting period of 30 days before any hospitalization ( other than arising out of accidents) due to any ailment including that of Covid-19 or Black Fungus gets covered. It is better not to leave things to chances and buy adequate coverage for self and family members at the earliest.  Also do only buy health insurance from a good retail insurance broker as these are complicated plans and have complex conditions which only a specialist can understand and help navigate for you. They will also help you in case any claim gets stuck. Bajaj Capital, despite the pandemic, has been able to get most of the claims of their clients settled but it has required a special team to work around the clock to help policy holders at the time of this need.

Review your existing cover

If you already have an existing health insurance policy, please understand that a sum assured of less than Rs 25 to 50 Lakhs for a family is insufficient. People still think a Rs 3 or 5 lakh cover is adequate but it is not. The best part is increasing your cover from Rs 5 lakhs to Rs 25 lakhs or so should not cost you more than 25% extra premium. Please immediately go for an enhancement and also get your insurance cover reviewed as a lot of people have old outdated policies and at the same cost they can have a better plan. As a part of our contribution to the society during the pandemic we have launched capital.bajajcapital.com initiative where we are offered free health insurance policy reviews for policy holders and have done thousands of reviews till now.

However, any enhancement in coverage is allowed only at the time of renewal of the policy. One may still opt to go for top-up or Super top-up for enhancing the coverage amount. You may even port from one insurer to another as the portability of a health insurance policy is allowed without having to lose the accrued benefits in the policy.

(The writer is Joint Chairman & MD, Bajaj Capital. His Twitter handle is @bajajsanjiv. Views expressed are personal)