Step By Step Guide to File A Claim for Coronavirus

When we read about Coronavirus hospitalization expenses in the media, it sometimes scares us. There are questions about what is covered, and what is not, in case of hospitalization, and whether the claims procedure is the same or different from other hospitalization cases.

Here are certain things specific to Coronavirus to keep in mind if you need to file a claim.

If a person has undergone a test in a private NABL-accredited laboratory and eventually needs hospitalization, then such a test if performed within 30 days before hospitalization is admissible for a claim. The pre/post-hospitalization expense clause is applicable for Corona like any other illness. If the same person didn’t require hospitalization or tested negative, this expense will not qualify for a claim.

Secondly, a major portion of Covid-19 hospital treatment expense is due to speciality gear that is required for regular care. These consumables form a substantial part of the bill and in non-Covid cases would either not be admissible or admissible with sub-limits for claim purposes. However, exceptions are being made by insurance providers under IRDAI guidelines hence insured people need not worry about this part of their claim.

Another question that people going for Covid specific plans, like Corona Kavach, have is whether there is a specific claim procedure for these specific types of plans. The answer is, the claim procedure is the same for all kinds of Mediclaim.

With that being said, as with any other illness, patients can avail Cashless Hospitalization in a network hospital, or reimburse costs if the treatment is in a non-network hospital. Patients requiring Domiciliary hospitalization and AYUSH in-patient care need to get in touch with insurance companies to clearly understand the extent of coverage before proceeding with such treatment and filing claims.

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Cashless Claim Process for Coronavirus Treatment

In case of cashless hospitalization, the claim will be directly settled by the insurance company.

• Patient obtains pre-hospitalization approval from Third Party Administrator (TPA)/Insurance provider before 24 – 48 hours for hospitalization.
• Avails treatment once authorized.
• Duly completes the discharge process and makes any payments not covered under cashless hospitalization.
• Claim is settled by the TPA/Insurance provider directly with the hospital.

Reimbursement Claim Process for Coronavirus Treatment

Usually, the policyholder would require, the following documents for processing a reimbursement claim for hospitalization in a non-network hospital

1. Identity proof 
2. Doctor’s prescription
3. Medical bills with proof of payment
4. Break-up of charges like:

• Room rent
• ICU charges
• Ventilator charges
• Oxygen
• PPE Kit, Gloves, other protective gear
• Other charges

5. Care notes updated daily by nurse/doctor
6. KYC for claims exceeding Rs. 1 lakh
7. Bank account details
8. Any other documents mentioned in the claim reimbursement process

Due to the social distancing requirements in case of Covid-19, insurance companies might require soft copies to be scanned and emailed or submitted by other electronic means for claim processing. They might require retaining physical copies for later submission, once the situation improves.

Insurance companies are creating Covid-19 specific claim settlement teams to ensure necessary care is taken to provide a hassle-free and safe experience to the insured. Policy holders can obtain additional information by getting in touch with their insurance provider.

At home treatments might qualify for Domiciliary hospitalization if approved by doctor and AYUSH in-patient treatment costs may also be admissible as a claim. You are advised to discuss in detail with the insurance company to check claim eligibility for such treatments and file claims accordingly.

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Read more: Covid-19 Health Insurance

Conclusion

In addition to the toll on health taken by the Coronavirus, financial strain due to hospitalization is a major setback to many families. Fortunately, your Mediclaim or Corona specific coverage can help you find the cost of treatment. So, check out your plan, discuss with your insurance provider and file a claim if it is valid.

Disclaimer: This article is issued in general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.