Guidelines on Claim Handling of Reported Coronavirus Insurance Cases

With the onset of Covid-19 across the globe claiming more than 4500 deaths, thousands of people have become vigilant to protect themselves from the deadly disease. In India, the Insurance Regulatory and Development Authority of India (IRDAI) has set out a directive asking all the insurance providers to design an insurance plan to cover the cost of treatment of the Covid-19. Coronavirus has affected people all across the globe therefore this advice from IRDAI to introduce new insurance plans specifically for Covid-19 is a relief for thousands of people in India. In addition, the IRDAI, India’s apex Insurance regulatory body, has issued guidelines on the claim handling process for cases reported under coronavirus. The guideline issued on 04th March 2020 has put forward clarity for all insurance providers in India regarding the handling of claims.

The circular issued by Mr DVS Ramesh, General Manager, IRDAI states the following guidelines must be observed by all insurance providers handling health insurance claims related to coronavirus:

1. The regulatory body states that these guidelines are laid down to alleviate the hardships that might be caused to the policyholders.
2. For all health insurance plans that provide cover for hospitalization expenses, insurance providers must ensure that all COVID-19 cases to be expeditiously handled
3. All the costs related to admissible medical expenses incurred during the course of treatment including the cost of treatment provided during the quarantine period of the policyholder shall be settled by the insurer. The claim settlement in such cases shall be as per the applicable terms and conditions of the insurance policy contract and as per the extent of the regulatory framework.
4. All the insurance claims registered and reported for coronavirus Covid-19 shall be strictly reviewed by a claims committee before being rejected for claims settlement
5. IRDAI has further asked all the insurance providers in India to design insurance plans that will cover the treatment cost of the coronavirus disease. The guideline encourages insurance providers to provide a need-based health insurance plan to cover specific diseases including vector-borne diseases i.e. diseases caused due to transmission of infection to humans by blood-feeding anthropods such as mosquitoes, ticks, and fleas. (example of vector-borne diseases is Dengue, Malaria, West Nile Virus, etc). In the same manner, IRDAI advises all insurers in India to design and introduce an insurance product that will meet the cost of coronavirus treatment.
6. Lastly, IRDAI, clearly states that this directive has been issued for the interest of the people and the guideline is issued as per the provisions of Section 14(2)(e) of the IRDA Act, 1999. Further, the IRDAI states that these guidelines shall come in to force with an immediate effect.

Final Words

IRDAI is the apex regulatory body that has the authority to ensure that the interest of the insurance investor is protected. The authority has laid down these guidelines to promote insurers to design specific health insurance plans that will cover the hospitalization and treatment cost of coronavirus affected policyholders.