Mpox first case confirmed in India: How can standard health insurance provide financial immunity?

The Indian government confirmed the first case of Mpox on Monday, raising alarms over the transmission of the virus in the country. The development coincides with the prevalence of other infectious and vector-borne diseases like malaria, dengue, chikungunya, etc, raising concerns about rising medical costs.

The World Health Organisation (WHO) declared the clade 1 variant of Mpox, a viral illness caused by the monkeypox virus, a public health emergency of international concern in August 2024. However, the Union Health Ministry confirmed that the Mpox patient in India was infected with the clade 2 variant, which is not part of the current public health emergency. As the risk of Mpox outbreak persists, let's understand how health insurance plans provide financial immunity against such diseases.

Is a standard health insurance plan enough for Mpox?

According to health experts, most basic health insurance plans cover Monkeypox medical expenses as it is classified as an infectious disease.“Since Monkeypox is classified as an infectious disease, the costs associated with hospitalisation, diagnostic tests, and treatment are typically included under the standard provisions of comprehensive health insurance policies. However, it's always advisable to review your specific policy details or consult with your insurer to confirm the extent of coverage,” said Rakesh Jain, CEO of Reliance General Insurance.

Soaring hospitalisation costs for viral infections

From doctor consultations to medical tests, a common treatment for viral infections has become expensive, especially in metro cities. The cost of treatment increases significantly if there is a hospitalisation.

“The cost of treatment for severe viral infections can exceed ₹10- ₹15 lakh, especially in private hospitals in major cities,” said Siddharth Singhal, Head of Health Insurance, Policybazaar. He also recommended that individuals residing in metro cities opt for health insurance with a sum insured of ₹1 crore.

“Individuals may encounter additional expenses that they may need to pay out-of- their pockets. These include co-payments, deductibles, sub-limits etc. To address these potential costs, we recommend reviewing your policy terms & conditions thoroughly and exploring additional riders or add-ons in case you want to avoid these,” said Ajay Shah, Head – Distribution, Care Health Insurance.

Should you buy a specific infectious disease cover?

Specific infectious disease covers or vector-borne disease riders can enhance the benefits of a standard health insurance policy by providing additional benefits. A common infectious disease like dengue or malaria may also lead to longer hospitalisations.

“Policyholders may face the additional challenge of losing their jobs due to prolonged illness. To help mitigate this financial burden, riders or add-on covers can be highly beneficial. These optional benefits can be attached to an existing health insurance policy. For example, a hospital cash rider offers a daily cash allowance during hospitalisation, helping to cover unexpected expenses,” noted Rakesh Jain.

However, due to their low popularity, the market offers fewer options for specific infectious disease covers or riders. “In the past, companies had tried specialised insurance products to treat diseases caused by mosquitoes (malaria/dengue), but they could not attract good numbers of customers due to lack of interest for a policy which is needed for few weeks in a year,” said S K Sethi, co-chair, BFSI Committee at PHDCCI.

Comprehensive coverage and telemedicine services

Experts also urge people to opt for a comprehensive health insurance policy that covers pre- and post-hospitalisation fees, as well as other costs such as out-of-hospital care charges, ambulance charges, ICU rates, etc.

Underlining the need for adequate sum insured cover, Parthanil Ghosh, Director & Chief Business Officer, HDFC ERGO General Insurance, advices insurance buyers to check the “insurance company's claim payout ratio” for better reliability and efficient claim processing. He also advocates opting for a policy that offers telemedicine services.

“Various insurers are also using telemedicine, another facet of Medtech, to ensure healthcare accessibility, which becomes crucial in case of quarantine or when visiting a doctor physically is not feasible,” Parthanil Ghosh added.

How are insurers adapting to the frequent disease outbreaks?

Several insurance companies are upgrading their risk-assessment approach and policies to provide better facilities to customers during outbreaks. “Now, insurers are also adapting to the rising frequency of global disease outbreaks by leveraging data-driven underwriting for better risk assessment and integrating telemedicine and digital health services. Additionally, insurers are partnering with healthcare providers and aligning with international health guidelines to ensure better access to care during outbreaks,” noted Siddharth Singhal.