How To Be Ready For Filing A COVID-19 Claim in India

The COVID-19 pandemic brought about many changes. Many such changes were seen in health insurance in India. One such change was the introduction of Corona insurances such as Corona Rakshak policy. The Insurance Regulatory and Development Authority of India directed all general and specialised health insurance companies to cover COVID-19 under health insurance policies.

IRDAI also advised insurance companies to be cautious before rejecting a claim of COVID-19. The regulator has advised insurers to give a valid reason to customers before rejecting their claims of health insurance in India. In the past few months, several claim settlement-related issues have emerged for customers despite strict guidelines by IRDAI.

Common issues relating to COVID-19 claim in the insurance

Some common queries that people are facing before filing a claim for novel coronavirus are:

1. Whether or not a hospital would cover customers under health insurance for quarantine because of suspected coronavirus infection.
2. Whether or not an insurer approves a claim in case a customer chooses hospitalisation after testing positive for COVID-19 to make sure that his/her condition does not deteriorate.
3. In case a customer chooses home treatment for COVID-19 and not hospitalisation, whether or not the home treatment expenses be covered under a standard health insurance policy

How to file a COVID-19 claim

If you want to have a seamless claim experience, you must follow the right claim process for your health insurance in India. The procedure for filing a COVID-19 claim, whether or not for Corona insurances like Corona Kavach and Corona Rakshak policy, is the same as any other claim. But still, you need to be cautious regarding the same.

1. First of all, decide what fits you better. If a cashless claim would suit you better where you take treatment at your insurer’s network hospital. Or you want to take treatment for Coronavirus Disease at a hospital of your choice and file for the reimbursement of the expenses made later.
2. If you opt for cashless treatment, you are not to pay any hospital bills. Instead, your bills with the hospital will be settled directly by your insurance company. In case you go for the reimbursement process, you can take treatment of your choice. But at first, you need to settle the entire hospital bill on your own. The expenses that you make during your hospitalisation are reimbursed to you later by your insurance company. The costs are subject to the approval of your insurer.
3. For both the claim processes — cashless and reimbursement, it is essential that you first inform your insurance company about hospitalisation before filing a claim request.
4. For your convenience, all the insurance companies have been directed by IRDAI that any COVID-19 related claim must be processed in under two hours of filing a request.
5. Per the advice from the IRDAI, to process COVID related claims in the minimum time possible, many insurance companies have formed dedicated claims teams. The teams only look after claims that are related to coronavirus. The units are in direct touch with the customers and try to process customer claim request as soon as they can.

How do they conduct the COVID test

Not anyone can avail the treatment for COVID-19. The hospital first does a PCR test on you to test you for coronavirus infection. As per the state governments’ guidelines, private labs throughout the nation have already been asked to put a cap to the test prices. Conducting a test has only been permitted at a NABL-accredited laboratory.

How insurance companies cover you for COVID

Your insurance company will cover you for expenses made towards COVID-19 when you are admitted to a hospital for treatment against the infection. For all the cases, charges incurred 30 days before and after hospitalisation are covered under the pre and post hospitalisation. The expenses are completely covered under your health insurance policy.

The bottom line

Nevertheless, before making a claim, it is crucial to know what is covered and not under your health insurance plans. Several insurance companies have issued inclusions and exclusions for the COVID-19 treatment. So, you can refer to these inclusions and exclusions before filing a claim request to avoid any confusion at a later stage.