Health insurance policies in India are structured to cover hospitalisation arising from infectious diseases, including newly identified viral outbreaks, provided the policy is active and terms and conditions are met, industry experts said.
The comments come amid renewed concerns over high-severity infections such as Nipah and Mpox, which can require prolonged hospital stays, intensive care, isolation protocols and advanced treatment, significantly increasing medical costs.
“Health insurance plans in India are structured to cover hospitalisation arising from infectious diseases, even if the virus is newly identified, as long as the illness requires medical admission and the policy is in force,” said Kanishka Gadi, Director – BFSI, IT/ITES, EDME Insurance Brokers.
She added that coverage applies subject to policy conditions, including room rent eligibility and waiting periods.
Echoing a similar view, Sachin Joshi, President – Claims Operations and Customer Service, Liberty General Insurance, said high-severity infections such as Nipah or Mpox are clinically considered infectious in origin and are treated under standard health insurance terms.
“Standard health insurance policies in India typically respond comprehensively to such infections with hospitalisation coverage, including pre- and post-hospitalisation expenses, ICU charges and doctor fees,” he said.
Financial impact of ICU and isolation treatment
Industry experts said the cost of treating severe viral infections can run into several lakhs, particularly if ICU admission, ventilator support or specialised antiviral treatment is required.
“With high-severity infections, intensive care, long hospital stays and isolation costs can quickly escalate. Without adequate cover, these expenses may have to be borne out of pocket,” said Sarita Joshi, Head of Health and Life Insurance, Probus.
Sachin Joshi added that opting for a higher sum insured and plans without restrictive room rent sub-limits can offer stronger financial protection against such unpredictable medical events.
Vikram Roy, Head – Health Claims Operations, Digit General Insurance, added that preventive health benefits — such as routine check-ups, screenings, and vaccinations — are becoming core to insurance.
“Early detection and preventive care reduce the risk of severe hospitalisation and protect families from long-term financial disruptions,” he said.
Common limitations policyholders overlook
While standard policies provide coverage, experts cautioned that policyholders often overlook key limitations.
Gadi pointed out that if a policy allows only a fixed room rent per day and the insured chooses a more expensive room, the insurer may reduce the overall claim amount proportionately.
Joshi said most policies include an initial waiting period — commonly 30 days — during which non-accidental claims are not admissible. Pre-existing diseases may carry waiting periods of two to three years, while certain specified ailments may have their own defined waiting clauses.
He also noted that co-payments, deductibles and specific illness exclusions may apply depending on the product chosen.
Sarita Joshi added that sub-limits on ICU charges, caps on specific treatments and lower sum insured amounts in older policies can result in coverage exhaustion during high-cost treatments.
Vikram Roy emphasised that policyholders should also assess pre- and post-hospitalisation coverage, which can include diagnostic tests before admission and recovery expenses after discharge.
“A robust hospital network and fast claims turnaround are equally important. As per regulations, cashless pre-authorisations should be processed within an hour and reimbursements within a day of submission,” he said.
