Guide for a health insurance claim for the coronavirus disease

Since the onset of the COVID-19 pandemic, many people have been unsure how to file a health insurance claim, even if they have an adequate policy that

Since the onset of the COVID-19 pandemic, many people have been unsure how to file a health insurance claim, even if they have an adequate policy that cover the coronavirus treatment. Today, we will discuss how to raise a claim for COVID-19. But, before we get into the claim procedure, let’s look at some of the important IRDAI guidelines for filing a COVID-19 claim.

IRDAI guidelines for COVID-19 related claims

  • The health insurance providers must try to expedite the settlement of medical expenses related to coronavirus-induced hospitalisation. Such claims should be given top priority to avoid any inconvenience to policyholders.
  • The policy’s covered expenses and the treatment received during the quarantine period must be reimbursed as per the policy’s terms and conditions.
  • Before rejecting a claim, the claim assessment committee must verify its authenticity and cross-check it with the relevant hospital.
  • Special medical plans such as the Corona Kavach and Corona Rakshak policies are designed to cover the cost of treating the coronavirus infection. The policy features and coverage are as per the IRDAI guidelines and regulations.
  • The IRDAI has issued these directions under section 14 (2) (e) of the Insurance Regulatory Development Authority Act, 1999. The regulatory body seeks the implementation of these instructions with immediate effect.

Now that you have learnt about the IRDAI guidelines, it’s time to understand how to make a claim for medical expenditures related to COVID-19.

Cashless claim procedure for COVID-19

The term “cashless health insurance claim” refers to the situation in which you are not required to pay any money out of pocket for the covered expenses. The health insurance provider will directly settle your medical bills with the insurer. If you are wondering how to raise a cashless claim for COVID-19, check the steps below:

Step 1:

Search for the nearest network hospital from the list available on the insurer’s website.

Step 2:

On your visit to the empanelled hospital, show your health card at the COVID-19 help desk.

Step 3:

The hospital administration department will cross verify the details with your mediclaim insurance provider

Step 4:

You will also need to submit the duly filled and signed pre-authorisation form to the insurance provider’s third-party administrator (TPA).

Step 5

Once the TPA approves your pre-authorisation application, an approval mail will be sent to the empanelled hospital.

Step 6

Following the mail, the insurer will process the COVID-19 related cashless claim, and the medical bills will be settled directly with the network hospital.

However, don’t get too worked up if your cashless claim request is denied. You may apply for a reimbursement claim post your treatment/discharge. Remember to keep track of any pharma bills, hospitalisation bills and ambulance charges in a file.

Reimbursement claim procedure for COVID-19

The term “reimbursement health insurance claim” refers to the situation in which you must bear the upfront expenses. Once your treatment is completed, the insurer will reimburse the amount to your account. If you are wondering how to raise a reimbursement claim for COVID-19, check the steps outlined below:

Step 1:

Once you have received the treatment and are discharged from the hospital, make a file of pharma bills, ambulance bills, consultation charge receipt and others. In addition, you must sign the discharge form and obtain the doctor’s prescription along with the discharge report. All of these records are proof of your treatment.

Step 2:

Next, thoroughly fill out the reimbursement claim form. Submit the claim application and all the relevant original documents supporting your COVID-19 treatment to the insurer. 

Step 3:

Following receipt of your application, the insurer will cross-check the information with the hospital where you had treatment.

Step 4:

The insurer will release the payment to your account after the successful verification within 7 to 10 days.

However, if the verification is not satisfactory, the insurer will reject your claim. The reason for the claim denial will be stated in the rejection letter that you will receive shortly.

To conclude

The process of filing a claim for COVID-19-related treatment is quite similar to that of filing a regular health insurance claim. If you are unsure of the procedure, follow the steps mentioned above or get in touch with your insurance provider.