What Is The Difference Between Sum Insured And Sum Assured?

by SMCIB on Monday, 27 May 2024

What Is The Difference Between Sum Insured And Sum Assured?

Viral infectious diseases are a significant concern globally, given their ability to spread rapidly and cause widespread health issues. Dengue fever stands out as one such viral illness that is transmitted through mosquito bites. Its varying severity, from mild symptoms to potentially life-threatening complications, has raised concerns about the financial impact of hospitalisation and medical treatment. The costs associated with dengue fever can be daunting, often requiring extended hospital stays and specialised care.

In such challenging times, health insurance emerges as a potential saviour, providing financial protection and peace of mind during medical emergencies. However, the critical question remains: does health insurance cover dengue fever? Let's get the answer to this question and much more in this article.

First, What Is Dengue?

As mentioned earlier, dengue is a viral illness spread by mosquitoes. It is often found in warm, tropical areas. This infection arises from one of four dengue viruses, collectively termed 'serotypes', which exhibit close genetic relationships. The symptoms of dengue fever can vary widely, from mild to severe, sometimes needing hospitalisation or medical intervention.

Dengue fever can be identified through various symptoms that usually appear within 4 to 7 days after being bitten by an infected mosquito. However, sometimes, the incubation period might stretch up to 14 days. Here's a list of common symptoms that may suggest you or someone you know is experiencing dengue fever -

  • Severe headache
  • Sudden high fever
  • Nausea
  • Eye pain
  • Joint pain or muscle pain
  • Body rash
  • Constant vomiting
  • Weak pulse
  • Fatigue
  • Disorientation
  • Bleed of mouth, nose or gums

Dengue fever can be quite severe for humans, as the dengue virus significantly lowers the blood platelet count among infected individuals. This can sometimes necessitate hospitalisation, which may result in a substantial financial burden.

So, Is Dengue Covered In Health Insurance?

Yes, nearly all standard health insurance policies cover dengue unless it's specifically excluded. Some insurance companies even offer plans tailored specifically for diseases like dengue. These plans aim to ease the financial burden if you're diagnosed while also protecting your no-claims bonus. Whether dengue is in its early stages or more advanced stages, these plans offer comprehensive coverage.

Dengue insurance is specifically tailored to support individuals in managing expenses incurred upon diagnosis and treatment of the disease. Here’s what it covers -

  • Inpatient Hospitalisation
    In case of inpatient care, it encompasses hospitalisation expenses for periods exceeding 24 hours, as well as any medical expenses before and after your hospital stay.
  • Outpatient Hospitalisation
    Outpatient benefits cover various aspects of dengue treatment, such as visiting a general doctor, undergoing necessary diagnostic tests if you test positive for dengue, acquiring prescribed medications, and receiving home nursing care from an empanelled medical professional. The cost of these services can vary between Rs 49 to Rs 682, depending on factors like the insurance provider, the chosen sum insured, and specific terms. The sum insured for these plans ranges from Rs 10,000 to Rs 1 lakh.

Now, let’s look at a few insurance companies who provide coverage for dengue fever-

Bajaj Allianz: M-Care Health Insurance Policy

The Bajaj Allianz M-Care health insurance policy, safeguards you from the potential financial burden caused by vector-borne diseases. This policy is designed to support you if you are diagnosed with any of the below conditions, ensuring financial security during challenging times -

  • Dengue Fever
  • Malaria
  • Kala Azar
  • Filariasis(Payable only once in a lifetime)
  • Chikungunya
  • Zika Virus
  • Japanese Encephalitis

Moreover, it offers a floater cover that includes coverage for your spouse, dependent children, and dependent parents.

While the policy offers extensive coverage, it's essential to be aware of its limitations. The following are excluded from coverage -

  • Any treatment beyond those specified for vector-borne diseases as outlined in the coverage section.
  • Admission to the hospital for less than 24 hours.
  • Diagnosis and treatment outside India. However, this exclusion does not apply to the countries listed below -
    • New Zealand  
    • Japan
    • Singapore       
    • Dubai
    • Canada
    • Switzerland    
    • Malaysia
    • USA   
    • Hong Kong    
    • Countries of the European Union

Additionally, there are several conditions that govern the policy's coverage and renewal process. If you receive a diagnosis within the initial 15 days of commencing your insurance policy, coverage for that condition will not apply. You also need to be aware that pre-existing diseases (PEDs) are subject to a waiting period of 60 days.

And, if you renew your M-Care Health Insurance Policy within 60 days of your last paid claim, a 60-day cooling-off period will be enforced for the same ailment upon renewal. But worry not, there won't be any waiting period for other listed vector-borne diseases. Lastly, suppose you renew your M-Care Health Insurance Policy 60 days after the date of admission of the previously paid claim; there will be a new 15-day waiting period for all listed vector-borne diseases under the policy.

Future Generali: Future Vector Care Group

The plan is tailored for groups as defined under IRDAI Group guidelines. The product is provided on a personalised sum insured basis, ensuring the coverage aligns with the individual needs. Furthermore, regardless of age or sum insured, no medical tests are required for policy issuance, simplifying the enrollment process.

The Future Vector Care Group policy offers extensive coverage for various vector-borne diseases, including -

  • Dengue Fever
  • Malaria
  • Kala Azar
  • Filariasis(Payable only once in a lifetime)
  • Japanese Encephalitis
  • Chikungunya
  • Zika Virus

While the policy provides comprehensive coverage, certain exclusions apply. Let’s look at them below -

  • Non-vector-borne diseases are not covered under this policy.
  • Outpatient treatment is not included in the coverage.
  • Any condition for which you received a diagnosis or medical advice/treatment during the waiting period will not be covered
  • Experimental or unproven medical treatments are not covered.
  • Non-allopathic medication is not included in the coverage.
  • Treatment outside India is not covered under the policy.

Some health insurance policies like SBI HealthEdge offer an add-on to provide such protection. Let's take a look -

SBI HealthEdge: Vector-Borne Fixed Benefit Add-On

In SBI HealthEdge's vector-borne fixed benefit, you’ll receive a lump sum payout of either Rs. 50,000 or Rs. 1 Lakh for essential hospitalisation needs. This benefit is triggered when hospitalisation is deemed medically necessary for any of the following diseases -

  • Dengue
  • Filaria  (Lymphatic Filariasis)
  • Malaria
  • Kala-azar
  • Japanese Encephalitis
  • Chikungunya
  • Zika Virus

Benefits Of Health Insurance Coverage For Vector-Borne Diseases

Here are are the advantages of possessing health insurance covering vector-borne illnesses in India -

  • Anticipate the Unforeseen
    Health insurance serves to ensure financial readiness in the face of illness or disease. Although many of us tend to be optimistic about our health, it's wise to think ahead and safeguard yourself with health insurance. This coverage can provide crucial support if you ever face unexpected health challenges down the road.
  • Get High-Quality Healthcare
    Healthcare costs can be quite daunting, but when you're unwell, your health is the last thing you want to compromise on. That's where health insurance comes in handy - it takes away the financial strain, allowing you to access quality healthcare worry-free.
  • Financial Stability
    When your health is compromised, the last thing you need is financial stress weighing you down. That's where health insurance steps in to provide financial security if you or a family member is affected by a vector-borne disease or any other illness for that matter.
  • Enjoy Policy Benefits Even If You Don't Utilise The Coverage
    Did you know that you can reap health insurance benefits even if you haven't made any claims? Yes, you can enjoy perks such as cumulative bonuses for each claim-free year and annual tax savings, regardless of whether you've utilised the coverage.

In the ever-evolving landscape of health insurance, staying informed about regulatory guidelines is essential for making informed decisions.

Guidelines By IRDAI For Vector-Borne Disease Policy

The Insurance Regulatory and Development Authority of India (IRDAI) has laid out specific guidelines for policies covering vector-borne diseases, providing a framework for insurance companies. Let’s look at them below -

  • Hospitalisation Benefit
    If you're diagnosed with any of the listed vector-borne diseases and require hospitalisation for at least 72 hours, you'll receive a lump sum benefit equal to 100% of the sum insured. The listed illnesses are -
    • Dengue fever
    • Malaria
    • Filaria (Lymphatic Filariasis)
    • Kala-azar
    • Chikungunya
    • Japanese Encephalitis
    • Zika Virus
  • Diagnosis Cover
    You'll receive a payment of 2% of the sum insured upon the first diagnosis of each covered vector-borne disease during the policy period, confirmed by laboratory examination and a medical practitioner. This "diagnosis cover" payment is applicable once per disease per policy year, according to the policy’s terms and conditions.
  • Deductibles
    This product does not allow for deductibles.
  • Plan Variants
    No plan variants are permitted.
  • Category Of Cover
    The standard product will be available for both individual and floater sum insured options.
  • Minimum And Maximum Sum Insured
    • The minimum sum insured for the standard product is Rs 10,000 (Ten Thousand only).
    • The maximum limit for the standard product is Rs 2,00,000 (2 Lakh) (in multiples of ten thousand).
  • Policy period
    The standard product comes with a policy term of one year, equivalent to 12 months.
  • Modes Of Premium Payment
    Under the plan, you need to pay the premium in one single go as a lump sum.
  • Entry Age
    The minimal entry age for the principal insured is 18 years, while the maximum entry age for all insured members, including the principal insured, is 65 years or above.

    Dependent children can be covered from day one of birth to 25 years of age, as per the definition of 'Family'.

    These guidelines outline key aspects of the product as per IRDAI regulations. For complete details, please refer to the complete guidelines.

Summing Up!

As dengue becomes more prevalent, having strong health insurance coverage is crucial. It's essential for dealing with the complexities of diagnosing, treating, and financially preparing for this disease. By understanding dengue's complexities and embracing comprehensive health insurance solutions, you can empower yourself and your family to confront health challenges with resilience and confidence.

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