Will your Health Insurance policy cover the cost of COVID 19 Vaccine?

Health Insurance

After almost a year of battling with the Coronavirus pandemic the vaccine for the illness has become a reality. Although the vaccine rollout program is still in its nascent stages, the road ahead is positive. Institutes and companies like Bharat Biotech, Pfizer and Serum Institute of India have already applied for the authorization to sell their vaccines in the market while the vaccine being developed by Zydus would be available by the end of the year 2021. Frontline warriors have already begun getting the vaccine shot and senior citizens have been registered for the same. What about the cost of such vaccination? Would it be covered under your health insurance policy?

If you are looking for a generic answer, the answer is ‘No’. The cost of vaccination forms a part of OPD expenses which are not covered by most health insurance policies, even COVID-specific health insurance plans. However, this is not the universal answer. In some cases the cost of the vaccination can be covered under the health insurance policy. Let’s find out how –

Case 1 – If vaccination is a part of inpatient hospitalization

If you are hospitalized for COVID and you get the vaccination shot as a part of treatment of the illness, the vaccination would be considered to be a part of your inpatient hospitalization treatment. In such cases, all health insurance plans would cover the cost of the vaccine.

Case 2 – If your policy has an OPD cover or you opted for one

Another situation in which the cost of the vaccine would be covered under your health insurance policy would be if you have OPD coverage in your health insurance plan. Though most health insurance plans do not allow coverage for OPD expenses, many policies have an inbuilt OPD coverage benefit. Moreover, many plans offer OPD coverage as an optional additional benefit. So, if your plan has OPD coverage as an inbuilt benefit or you have paid an additional premium to avail OPD coverage under the plan, the cost of vaccination would be covered.

However, under OPD coverage, here are a few points that you should remember –

  • Plans with inbuilt OPD coverage might have higher premiums
  • If you opt for OPD cover as an add-on, the premium would be increased
  • OPD coverage is allowed up to a certain limit. If the cost of the vaccine is higher than the allowed coverage limit, you would incur out-of-pocket expenses

What should you do?

Check the coverage of your health insurance plan. If you are opting for elective vaccination and your plan does not have OPD coverage, you would have to bear the cost of the vaccine. Even if the plan has OPD coverage, check the coverage limit as you might incur additional costs on the vaccine. If, on the other hand, you are hospitalized for COVID and you get vaccinated, your health insurance plan would cover the cost of the vaccine. 

So, the coverage for the cost of the vaccine depends on your health insurance plan and when is the vaccine administered. Even if the cost is not covered in your health insurance policy, it would not be too considerable to be affordable. Getting vaccinated against the pandemic is important, even if you have to pay from your pockets, isn’t it?

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