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Exclusive | Covid vaccine reluctance: Adverse reactions covered under health insurance

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If you’re hesitant about taking a COVID-19 vaccine fearing an adverse reaction and huge hospital bills that will not be covered, you may want to reconsider that position. Your health insurance policy will certainly cover any hospitalisation due to a reaction to the vaccine.

General insurance industry sources told Moneycontrol that they will be covering any vaccine-related hospitalisation, in line with regular policy terms.

“Adverse reactions to new vaccines are expected. If a policyholder experiences any discomfort after taking the COVID-19 vaccine and needs to be hospitalised for treatment, it will be covered under health insurance. We have clarified this to the regulator,” said the claims head of a non-life insurer, speaking on condition of anonymity as IRDAI may issue a circular clarifying the matter.

The insurers have clarified this to regulator IRDAI recently through their industry body, General Insurance Council, which has all the general insurance companies as members.

However, as reported by Moneycontrol earlier, vaccination costs are excluded.

And, as with all health insurance products, a policyholder will have to hospitalised for a minimum of 24 hours for treatment to avail the claim.

Several healthcare workers had approached non-life insurers seeking clarification on policy coverage for vaccine reactions and allied hospitalisation.

1.58 million vaccinated, 1,238 adverse events recorded

So far, 1.58 million people have been vaccinated against COVID-19 in India. A total of 1,238 adverse events have been recorded so far. This is 0.08% of the total vaccinations according to the health ministry. In those reporting adverse reactions, 11 have been hospitalised.

There have been six deaths reported so far of healthcare workers who received the vaccine. The government has stated that these deaths are not linked to the vaccine.  India began its vaccination drive on January 16 and will inoculate frontline workers first.

Union health minister Harsh Vardhan, through a social media message, said that the public should not pay heed to rumours. “Stay informed, stay safe & when your time comes, get vaccinated,” he said. This was amidst reports of vaccine hesitancy among healthcare workers due to safety concerns related to Bharat Biotech’s Covaxin.

Moneycontrol has reported that Bharat Biotech's Phase-1 interim data, published by the company in the peer-reviewed British medical journal Lancet, found Covaxin was well tolerated and produced an immune response.

Some countries have agreed to indemnify the vaccine makers for claims as part of their purchase pacts. This means that the government will extend protection from potential lawsuits and related financial claims associated with vaccine-related adverse events if they are to participate in pandemic responses. India has not agreed to this so far.

This means that individuals taking the vaccine would have to fight lengthy legal battles to get financial claims for extreme adverse reactions. Those with health insurance would get claims passed as part of the regular settlement process in case they are hospitalised.

Insurers said that since there were several queries filed about adverse reaction-related hospitalisation being excluded, they have clarified this to the regulator.

“It is incorrect to say that we will not cover claims. Hospitalisation will not be excluded for all policyholders if their health policy covers this,” added the underwriting head at a state-run insurer.

The process to file a claim will be similar to the regular health insurance claims process. If a policyholder needs to be hospitalised in case of treatment for a vaccine-related adverse reaction, he/she has to inform the insurer.

Depending on the health insurance policy, an insured person can avail of either cashless cover or reimbursement for the hospitalisation. The final claim amount will be paid based on the policy size and sub-limits for room rent and doctor’s fees, among other charges.

However, as reported by Moneycontrol earlier, it is only hospitalisation claims that will be paid. Vaccination costs or treatment/medication for minor fever, body ache by local doctors after taking the vaccine will not be borne by the insurer since this does not involve hospitalisation.