Dengue Insurance: Coverages and Exclusions

Q: What is covered in dengue health insurance?

1. Hospitalization expenses (includes room rent, ICU charges, transfusion charges, etc.) 2. Diagnostic tests (before or during hospitalization) 3. Doctor’s consultation fee (before, during, and after hospitalization) 4. Cost of medicines bought before, during, and after hospitalization 5. Medical expenses related to dengue fever incurred before and after 15 days of hospitalization.

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A common disease like dengue, if not cured, can be dangerous. Therefore, it is necessary to take proper treatment and cover it by purchasing an insurance policy that covers dengue.

Dengue is covered under normal health insurance plans. However, one can take an additional cover whenever dengue spreads. This covers the expenses of the dengue treatment.

What is covered in dengue health insurance?

Dengue insurance works like normal health insurance but dengue insurance covers only the treatment of dengue. As this is specific to dengue, hence rates are low like Rs 600 for Rs 1 lakh cover. Moreover, treatment of Dengue does not exceed Rs 1 lakh hence one does not need higher cover than Rs 1 lakh. The insurance covers the following expenses:

Hospitalization expenses (includes room rent, ICU charges, transfusion charges, etc.)
Diagnostic tests (before or during hospitalization)
Doctor’s consultation fee (before, during, and after hospitalization)
Cost of medicines bought before, during, and after hospitalization
Medical expenses related to dengue fever incurred before and after 15 days of hospitalization.

What are the exclusions in dengue insurance?

Only 20% of Dengue patients need hospitalization hence many claims are rejected because the insurance company does not see the justification for hospitalization unless there is evidence of weak vitals.

Also Read: What are the most common reasons for Health Claims Rejection: The Series: Part 5

Standard exclusion guidelines also apply in dengue insurance

If the dengue patient is admitted to the hospital within the waiting period of the policy period (usually 15 or 30 days)
If the treatment given is not according to the standard protocol.
If the claim amount includes expenses related to medicines that are not mentioned in the medical prescription.
If treatment is taken outside India.
If the treatment was taken by an unauthorized person
If medical treatment was taken for any disease, other than dengue.

Read the policy document carefully as there can be more exclusions to the dengue insurance policy.

Here’s a similar case where an insured person was diagnosed with dengue and was advised to get admitted to the hospital:

Mr. Prashanth Kandapalli, an insured was suffering from high fever and chills. He was diagnosed with dengue. Later his doctor advised him to get admitted to the hospital. He was hospitalized for 4 days.

He applied for a dengue health insurance claim. However, his dengue claim was rejected. The claim rejection document stated that the claim was rejected as hospitalization was not justified.

He wasn’t aware of what to do and hence lost all his hopes of getting his money back. Then he learned about Insurance Samadhan and approached us with his case. We verified the case and accepted it on May 24, 2022. We guided him on how to approach the insurance company and informed him about the documents to be submitted to the insurance company. On June 26, 2022, his case was resolved and he received the claim money.

Also Read: Can your claim be rejected because of your lifestyle habits?

Insurance Samadhan has resolved 14500+ customer grievances related to insurance. If you want any guidance, then you can contact us. We’ll be happy to help you.