Written by Amit Chhabra
Soon after the onset of the COVID-19 pandemic, the Insurance Regulatory and Development Authority of India directed all general and specialised health insurers to cover COVID-19 under standard health insurance policies.
The regulator even advised insurers to be extremely cautious while rejecting a claim related to COVID-19 and give proper reason to the customer for rejecting a claim. However, in the last few months, several issues related to claim settlement have emerged from the customer’s end despite strict clarification by the regulatory body.
Some common issues included were would a hospital cover a customer under health insurance for quarantine due to suspected coronavirus infection? Also, will the insurer approve the claim if a customer chooses to get hospitalised after testing positive for COVID-19 just to make sure that the condition does not deteriorate? And, if a customer chooses to take home treatment for COVID-19 instead of getting hospitalised, would the expenses for home treatment be covered under a standard health insurance policy?
These are some of the very common queries that people are facing before filing a claim for the novel coronavirus.
Filing claim for COVID-19
In order to enjoy a seamless claim experience, you need to follow the right claim process. Though the procedure to file a claim for COVID-19 is the same as any other claim, still you need to be extra cautious.
You first need to decide whether you want to make a cashless claim by taking treatment at a network hospital of your insurer or take treatment at a hospital of your choice and later file for reimbursement of the expenses made.
Under cashless treatment, you do not need to pay the hospital bill and rather the bill will be settled with the hospital directly by the insurer. Under the reimbursement process, while taking treatment of your choice, you need to settle the entire hospital bill on your own. The expenses made by you will be later reimbursed to you by the insurer which are subject to approval.
Under both the claim processes, i.e. cashless and reimbursement, it is important for you to first inform the insurer about your hospitalisation and file a claim request. For the convenience of the customers, all the insurers have been directed by the regulatory body that any claim related to COVID-19 must be processed within 2 hours of filing a request.
On the advice of the IRDAI, to process covid related claims in the minimum time possible, many insurers have even set-up a dedicated claims team that will only look after claims related to coronavirus. This team remains in direct touch with the customer and processes their claim request in the minimum time possible.
For availing the treatment of COVID-19, the hospital will first test you for coronavirus infection by doing a PCR test. As per state government guidelines, the private labs throughout the nation have been asked to cap the test prices and a test will only be permitted to be conducted at a NABL-accredited laboratory.
Your insurer will cover you for COVID-19 test expenses in case you are admitted in the hospital for taking treatment for the infection. In all cases, charges incurred 30 days prior and post hospitalisation fall within the ambit of pre and post hospitalisation expenses and are covered under the health insurance policy.
Though, while making a claim it is very important to know what all is covered and what all is not covered under your health insurance plan. Several insurers have issued a set of inclusions and exclusions for the treatment of COVID-19. It is very important for you to know these inclusions and exclusions so that there is no confusion while filing a claim request.
Hospitals for COVID-19 treatment
As per Delhi government orders, the list of hospitals that have been declared as dedicated hospitals for COVID-19 treatment include Lok Nayak Hospital and GB Pant Hospital, Rajiv Gandhi Super Speciality Hospital, Guru Tegh Bahadur Hospital, Deen Dayal Upadhyay Hospital and Dr Baba Saheb Ambedkar Hospital. Apart from these government hospitals, three big private hospitals have also set up dedicated facilities for Covid patients which include Sir Ganga Ram Kolmet Hospital, Apollo Hospital and Max Hospital.
In Mumbai, prominent hospitals providing treatment for COVID-19 include Bombay, Bhatia, Jaslok, Breach Candy, Saifee, Wockhardt and Global.
In Gurugram, the hospitals providing treatment for COVID-19 include Metro Hospital, Narayana Hospital, Signature Hospital, W- Pratiksha Hosptial, Columbia Asia Hospital and Park Hospital.
The author is the Head- Health Insurance at Policybazaar.com. Views expressed are that of the author.
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