Long COVID Among Beneficiaries of a State-Sponsored Health Insurance Scheme in West Bengal, India: Clinical Burden, Financial Protection Gaps, and Policy Opportunities for Structured Rehabilitation Coverage

Background Long COVID, also termed post-COVID-19 condition or post-acute sequelae of SARS-CoV-2 infection (PASC), has emerged as a significant public health challenge globally. Persistent symptoms such as fatigue, dyspnea, cognitive dysfunction, anxiety, depression, and reduced functional capacity continue to affect a substantial proportion of individuals months or years after acute infection. Although India’s public health insurance programs have expanded financial protection against hospitalization costs, the extent to which chronic post-COVID conditions are accommodated within existing reimbursement frameworks remains unclear. Objective To examine the implications of Long COVID for beneficiaries of West Bengal’s state-sponsored health insurance scheme and to explore policy mechanisms for integrating diagnostic, rehabilitation, and long-term management services into publicly funded health coverage. Methods This narrative policy review synthesizes evidence from Indian Long COVID studies, public health insurance literature, rehabilitation research, and state health policy documents. Particular emphasis is placed on the mismatch between the chronic outpatient nature of Long COVID and hospitalization-oriented reimbursement structures. Results Long COVID generates substantial healthcare utilization, productivity losses, and out-of-pocket expenditures. Existing insurance frameworks primarily support inpatient and procedure-based services, leaving diagnostic assessments, rehabilitation interventions, mental health services, and multidisciplinary follow-up inadequately covered. Policy opportunities exist for introducing bundled Long COVID packages and integrating rehabilitation services within existing reimbursement mechanisms. Conclusion Recognizing Long COVID as a chronic health condition requiring structured multidisciplinary management may improve patient outcomes, reduce avoidable hospitalizations, and strengthen financial protection. Health insurance reforms focused on rehabilitation and continuity of care represent an important public health investment.