The COVID-19 pandemic has been an eye-opener for several reasons, but at the same time, it also made us realize the importance of having health insurance in Covid-19 Corona. Health insurance gives us much needed mental and financial security when we encounter a medical crisis.
Insurance Regulatory and Development Authority of India (IRDAI) has announced the launch of the Corona Kavach Policy and made it mandatory for all health insurance companies in India to offer this policy to its customers. All existing health insurance policies will provide coronavirus insurance cover. If you have purchased a health insurance policy before testing positive for COVID-19, any medical expenses incurred on the treatment will be covered under it and will include the basic hospitalization charges such as in-patient hospitalization, diagnostic test charges, ICU charges, etc.
Insurance Regulatory and Development Authority of India (IRDAI) has announced the launch of the Corona Kavach Policy and made it mandatory for all health insurance companies in India to offer this policy to its customers. All existing health insurance policies will provide coronavirus insurance cover. If you have purchased a health insurance policy before testing positive for COVID-19, any medical expenses incurred on the treatment will be covered under it and will include the basic hospitalization charges such as in-patient hospitalization, diagnostic test charges, ICU charges, etc.
Many people had health insurance plans before the pandemic's breakout, and many took post spread of the disease. But most of them are unaware of the procedure and requirements to file a COVID claim. It is important to be well informed about COVID-19 related claim settlement procedures. Here are the few things you must know about the COVID-19 claim settlement.
Things to Remember while COVID-19 Claim Settlement
1) TestCOVID-19 only at government authorized labsThere are government-designated labs and private labs approved by the Indian Council of Medical Research (ICMR) to conduct COVID-19 tests in India. While filing for the claim, submit the test report obtained from a government authorized laboratory along with a proper prescription from a qualified physician recommending the test to avoid any inconvenience later. The private labs will test only when prescribed by a qualified physician per the ICMR guidelines.
2) Specify the nature of the treatment Before getting any treatment, it is important to inquire about the insurer whether they cover such costs. Some private hospitals have launched home care packages for COVID-19 treatment. If your medical practitioner recommends this mode of treatment, ask the insurer first before taking the treatment to avoid any confusion during reimbursement.
3) Don’t forget to submit pre and post hospitalization expenses Generally, every health insurance policy covered against pre and post hospitalization expenses, ambulance charges, and treatment expenses for coronavirus treatment. Ensure to submit all consultation papers and bills before hospitalization and follow up treatment after discharge.
6 Conditions under which Insurance Claim might get rejected
There may be the situation, under which, the COVID-19 insurance claim may be rejected. Although, Insurance Regulatory and Development Authority of India (IRDAI) has announced that every existing health insurance policies will be covered for the treatment of Covid-19 Corona Virus. If the insurance policy mentions that it does not cover pandemics or some of the situations, then the claim for COVID-19 treatment will be rejected.
The coverage and claim rules are different from policy to policy. However, we have mentioned here some common situations where policy may not cover the claim for Covid-19 treatment.
1) Hospitalization Duration When the insurance holder is not hospitalized for a minimum of 24 hours, the policy may not cover the claim.
2) Travel history If the policyholder and his/her family members have a recent travel history to the worst coronavirus affected cities/countries (as mentioned in the policy), the company might not entertain the claim.
3) Pre-existing symptoms/disease If the policyholders have been suffering from respiratory issues, cough, flu, breathlessness, and planning to go for a treatment, only to find that the symptoms have transformed into coronavirus disease, the health insurance company might reject the claim. If the insured is already a patient of any respiratory disease for more than one month, then the health insurance policy might not get approved.
4) Expense coverage There are also chances when a policy bought before the pandemic may cover the disease but may not cover the cost of consumables (mask, gloves, face shields, shoe covers, sanitizers, and disinfectants) use during treatment.
5) Waiting period Every policy has a waiting period of some days, mostly for the first 30 days. This means if a policyholder has a disease before purchasing a plan, a claim for treating the disease can only be made after completion of the mentioned waiting period. In such a case, the claim might be rejected.
6) Inaccurate information Any miss-interpretation of any fact can also lead to rejection of claims.
How to claim Health insurance for COVID-19 corona?
There is not much difference in the claim settlement procedure between COVID-19 health insurance and general health insurance. There are two ways to claim health insurance for Covid-19 Corona.
1) Cashless claim Almost every health insurance providers now a day provides the cashless treatment. In this claim facility, the insured is not required to make any payment for the treatment at a network hospital. The insurance company direct settle all the bills with the hospital. Before claiming the bills, one must check if the policy is eligible for the cashless claim.
2) Reimbursement Claim
When a policyholder gets treatment from at non-network hospitals of insurance provider, he cannot claim the cashless facility but can go for a reimbursement claim. In which, the insured will be required to all the bills at the time of discharge. After that, he needs to fill up the reimbursement form, submit the required documents, test reports, bills, and prescriptions within a given limit. The insurance company will verify the claim and reimburse the amount of claim in the bank account.
Health Insurance Plans for Covid-19 Corona
A) HDFC Ergo Corona Kavach Policy
Insurance Regulatory and Development Authority of India (IRDAI) has announced the launch of the Corona Kavach Policy and Corona Rakshak Policy and made it mandatory for all health insurance companies in India to offer this policy to its customers. It is a standard health insurance plan designed to cover medical expenses arising due to Coronavirus Pandemic. This policy aims at covering hospitalization, pre-post hospitalization, home care treatment expenses, and AYUSH treatment in case anyone is tested positive of Covid-19 infection. An HDFC Ergo health insurance policy covers hospitalization expenses to Corona Virus (COVID-19) subject to all terms and conditions of the policy.
Coverage under Corona Kavach Health Insurance Policy- Hospitalization Expenses: bed-charges, nursing charges, blood tests, PPE kits, oxygen, ICU, and Doctor Consultation fees
- Pre-hospitalization Cover: Before hospitalization medical charges such as doctor consultations, check-ups and diagnosis15 days before hospitalization
- Post-hospitalisation Cover: Coverage for medical expenses incurred until 30 days after discharge from the hospital
- Home care treatment expenses: undergoing treatment for Coronavirus at home, medical expenses related to health monitoring, medicine costs up to 14 days.
- AYUSH Treatment (Non-Allopathic): All other types of treatment such as Ayurveda, Unani, Sidha, and Homeopathy treatment.
- Road Ambulance Cover: Transfer from home to hospital or hospital to home in an ambulance is also covered by paying Rs. 2000 per hospitalization.
- Diagnostic expenses
- Rehabilitation & Cure
- Dietary supplements
- Unproven Treatments
- Biological War
- Daycare treatments
- Vaccination
- Diagnosis outside India
- Unauthorized testing
COVID-19 is uncharted territory for all policyholders as well as insurance providers. Hence, the rules for filing a claim are not the same as regular plans. There are different ways of claiming COVID-19 Corona insurance. You can either go for cashless claims or the reimbursement process. With both processes, one can file for their coronavirus insurance claim.
HDFC Ergo Online Cashless claims To go for a cashless claim, you can simply call the respective insurance customer care and register a claim by keying in your customer ID and details of the hospital.
The Insurance Regulatory and Development Authority of India (IRDAI) stated that insurance providers have to assess and decide on the authorization in case of cashless claims made by hospitals within two hours of the receipt of the claim request. Once registered, the insurance provider contacts the hospital and sends the required documents to the office, where the insurance authorities scrutinize the bills and other relevant papers before processing the amount. If the bill amount is more than the coverage amount, then the patient is required to pay the hospital directly.
HDFC Ergo Reimbursement claims If you can pay the hospital bills upfront, then you can seek reimbursement claims where it is mandatory to fill in the claims form, and attach a list of documents like bills, discharge summaries, acknowledgment number, etc. Both online and offline claim process is valid.
Upload your documents online on the insurance provider’s website, where they are scrutinized by the authorities, before processing the amount. An insurance clearance form is adequate for instructing your insurance provider to deposit the amount in a bank account.
B) ICICI Lombard General Insurance Co. Ltd
While the Insurance Regulatory and Development Authority of India (IRDAI) has proposed a benefit-based policy for the treatment of Covid-19, ICICI Lombard General Insurance Co. Ltd is adding Covid-19 new benefits and features to their existing health insurance plans at no extra cost. If a person is first diagnosed with COVID-19 during the policy period, the entire Sum Insured as specified in the Policy Certificate against this cover will be paid. ICICI Lombard has reduced the waiting period to cover COVID-19 from 30 days to 15 days.
Why ICICI Lombard General Insurance for Covid-19 Treatment?
- Highest Priority for Coronavirus Cases
- Fixing an appointment with Medical Practitioners
- Whole Hospitalisation Covered
- Easy Claiming
- Emergency Ambulance Expenses
- Free Tele-consultation
- Providing information on ailments and possible lines of treatment
- Arrangement for the Second Opinion
ICICI Lombard Cashless Claim-
To file a cashless claim, inform the insurer about admission, get admitted at a network hospital, show ID card at the hospital desk, fill in the pre-authorization form, and submit it. Once your application is approved, you can proceed with the cashless treatment and all bills will be directly settled by ICICI Lombard.
ICICI Lombard Reimbursement Claim-
To get a reimbursement claim, call the insurer, get treatment at any hospital, collect all original documents from the hospital and send them to ICICI Lombard. Within 15 days of receipt of all the relevant documents, ICICI Lombard will settle the claim amount.
C) Star Health Novel Corona Virus Insurance Policy
If during the period of Insurance, the insured person shall contract and is diagnosed with COVID19 Coronavirus requiring Hospitalization, then Company will pay the sum insured opted under the plans of Star Health Novel Corona Virus Insurance Policy. The policy provides the lump-sum benefit of Rs.21,000/- and Rs.42,000/- (as per plans) for the person contracted and is diagnosed with Novel Coronavirus (COVID-19) requiring Hospitalization.
Insurance under this policy shall cease upon payment of lump-sum. Sum Insured Options are Rs.21,000/- and Rs.42,000/- on an Individual basis. The Waiting Period is just 16 days from the date of commencement of insurance.
Star Health Advantages:
- Faster and hassle-free claim settlement
- The cashless facility at in-network hospitals.
- No Third Party Administrator, direct in-house claims settlement.
Star Health Cashless Claim-
To reduce the financial burden on an insured individual at the time of hospitalization, Star Health provides cashless hospitalization service to the policyholders. Under Cashless Hospitalization, all the bills of expenses will be settled directly by Star Health Insurance.
