Insurance companies are gearing up for claims from people admitted with swine flu to private hospitals, but are clear that the cost of Tamiflu will not be covered.

The government, while allowing private hospitals to treat swine flu cases, had made it clear that Tamiflu will be provided free, though the hospitals can charge them for facilities like tests, beds and doctors’ fees.

“Since we are providing free Tamiflu to select private hospitals with isolation wards, I expect them to provide it free. Other charges will be decided by the hospitals,” said Sharvaree Gokhale, Additional Chief Secretary, Health.

Most insurance companies, in both public and private sectors, say they will cover swine flu. “Swine flu is not mentioned in the excluded diseases’ list and hence is covered under health insurance. But a hospitalised patient may not make any claim if he has not been tested positive for swine flu,” said S L Mohan, Secretary General, General Insurance Council.

“It is not an excluded disease and hence is covered. But testing charges will not be covered,” said B S Bagga, Senior Divisional Manager, New India Assurance. Those who hold a normal health insurance policy will automatically be covered for all epidemic diseases, the only condition being that 30 days must have elapsed after the purchase of the policy, under standard exclusion rules.

Although many experts say any global epidemic or pandemic (which swine flu is) is excluded from an insurance cover, domestic insurance companies say they will cover the disease. “Globally, epidemics are not covered, but our company will ensure all policyholders admitted to hospitals and who test positive for swine flu will be covered under hospitalisation reimbursement plans like Bajaj Allianz Health Guard, Mediclaim or Group Health Insurance Scheme. Any illness that requires hospitalisation is covered,” said Dr Shreeraj Deshpande, Head, Health Insurance, Bajaj Allianz General Insurance. So far, Bajaj Allianz has got one international medical insurance claim that the company says they have settled.

... contd.