All you need to know about insurance claims for COVID-19

The COVID-19 pandemic is running amok across the length and breadth of the country. The economic impact due to the pandemic has been huge and the actual damage could be known only in a few months from now. As of now, hospitalization arising out of the coronavirus infection is putting a strain on the finances of individuals who are getting treated. 

Having health insurance can save a lot of money and will avoid the need for dipping into existing savings to meet hospital costs. There are several queries around health insurance coverage related to COVID-19 and hospitalization. Here are some basic pointers to help you sail through the maze of health cover plans and their claim settlements.

Existing policyholder

If you have a regular health insurance plan – an individual policy or a Family Floater – the cost of hospitalization due to COVID-19 is met by the insurer up to the sum insured. However, if you have to undergo home care treatment, you need to check with the insurer if expenses incurred will be reimbursed by the insurer. Coronavirus treatment requires special procedures and processes, the cost of which may not be covered under the basic policy.

Also, going by recent experience, if one member in a family falls ill, the probability of other members also falling sick appears high. In such a case, more than one member in the same family gets hospitalized. Therefore, it may be better to opt for individual health covers rather than family floater plans, as the sum insured may get exhausted soon in the latter.

Not all health insurance policies provide for claims if the treatment is taken at home. However, given the current situation, when the availability of hospital beds is a concern, it's better to get a written communication from the insurer. You may send the doctor's prescription, your health card or policy number etc., and get approval after intimating the insurer. 

It is essential to get in writing on the specific cost-heads that the insurer will cover in case of home treatment of the policyholder. Given the need and importance of home treatment, many insurers are launching new health insurance plans providing home care as an in-built feature.

New policyholder

However, if you wish to buy a health insurance plan now and use it to cover hospitalization expenses arising out of COVID-19 anytime in the future, you may still do so. However, remember, there will be a waiting period of 30 days before any hospitalization (other than any arising out of accidents) including that of COVID-19 gets covered.

Enhancing Coverage

Now, if you as an existing health insurance policyholder, wish to enhance the coverage, you may do so. However, any enhancement in coverage is allowed only at the time of renewal of the policy. One may still opt to go for a top-Up or a super top-up for enhancing the coverage amount.
Given the 14-days stay in the hospital necessitates payment of a few lakhs of rupees, it is essential to keep a high coverage amount. Depending on the city of residence and the type of hospitals in your area and also your own affordability, keeping a sum insured of about Rs. 25 lakh is being suggested by industry experts. You may also buy a new health insurance policy as holding multiple health covers is allowed.

Corona Kavach plans

There are exclusive health insurance plans to take care of hospitalization costs owing to COVID-19, such as the Corona Kavach that covers home care costs as well. Anyone between 18 and 65 years of age can buy Corona Kavach health insurance plans. These are basically short-term plans available for 3.5 months, 6.5 months and 9.5 months tenures and come with a waiting period of 15 days.

The Home Care treatment expenses will be covered up to 14 days for the Corona Kavach policyholder, subject to the condition that any such treatment is prescribed by a medical practitioner. Cost of Pulse oximeter, Oxygen cylinder, Nebulizer, medicines prescribed in writing, consultation charges, and the nursing charges related to medical staff get covered, but they have to be prescribed by the medical practitioner.

Claims settlement

As far as claims settlement is concerned, the regulator has directed insurers to streamline the entire process. In case the hospital is on the approved list of empanelled service providers, the hospitalization will be cashless. The IRDAI has asked health insurance companies to communicate their cashless approvals to hospitals within 60 minutes of receipt of authorization request, along with all necessary requirements from the hospital. In case of non-network hospitalization, you will have to send all the hospital papers including bills, discharge reports, etc. to the insurer for reimbursement of the bill amount.

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