Your Money: Filing claim for Covid-19 treatment? Know the rules

By Amit Chhabra

Buying an adequate health insurance policy can help you to stay financially secure against unexpected expenses arising due to hospitalisation for Covid-19 or any other ailment. On the directions of Insurance Regulatory and Development Authority of India (Irdai), general and health insurers have started offering standard Corona Kavach -indemnity based health plan, and Corona Rakshak-fixed benefit health insurance policy for covering Covid-19 treatment cost.

If you already have an adequate health insurance plan that covers treatment for Covid-19, then you don’t have to invest in corona-specific health insurance plans. However, a person can consider investing in corona-specific plans for fixed benefits. To provide maximum value to people, a comprehensive health insurance plan that protects against a wide range of illnesses including coronavirus will be more suitable.

Filing claim for Covid-19

On Irdai’s directions, most health and general insurers are covering maximum consumables under health insurance claim which make up to 30-40% of the Covid-19 treatment cost. However, the extent of coverage varies from insurer to insurer.

For treatment of Covid-19, the hospital/clinic will first test you whether you are corona positive or not. Private labs have been asked to cap the test fees and the test will be only be allowed at NABL-accredited private laboratories. However, people who might test positive for Covid-19 need not worry about the test charges as the test charges fall under pre-hospitalisation expenses and all the pre-hospitalisation expenses are covered. In all cases, charges incurred by an individual 30 days prior to his or her admission to any hospital fall within the ambit of pre-hospitalisation expenses and these are covered under health insurance policy.

However, while making a claim for pre-hospitalisation expenses, keep in mind the exclusions that fall under a health insurance policy. In order to make a claim for pre-hospitalisation expenses, the person for whom the bills are submitted should be hospitalised within 30 days of the expenses incurred. If hospitalisation does not occur within 30 days, the claim is not accepted and the policyholder has to himself pay for the expenses incurred. The insurer only pays for relevant expenses such as tests and x-rays that are related to the illness for which hospitalisation is done.

Choosing the right claim process

The procedure to file a claim in case you get hospitalised for treatment of coronavirus infection is the same as any other claim. All that a policyholder needs to do is to make a health insurance claim either through cashless or reimbursement mode. If you test positive for coronavirus, you may choose to take treatment at your choice of hospital and if that hospital falls under your health insurance provider’s network, you can avail cashless hospitalisation facility.

However, if your choice of hospital is not listed with the insurer, you would be required to pay the bills yourself. The bills will be reimbursed once you file a claim with the insurer. In both the claim processes, inform your insurer about your hospitalisation and register a claim request. This can be done at the TPA desk at each hospital.

Irdai has directed insurers to process Covid-19 related claims within two hours of claim request. Also, many insurers have set-up their own claim settlement teams to help customers process claims at the earliest. Processing claims at the insurer’s end helps customers directly interact with the insurers and get claims processed at the earliest.

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