Health Insurance 523 views May 5, 2021

The second wave of COVID has affected more people compared to the first one. Insurance companies offer both dedicated and regular health insurance plans to cover the treatment cost of COVID. So, if an individual has symptoms of COVID and needs hospitalization, he/she can get coverage with such plans. But what are those things that you should know while applying for claim settlement related to COVID? They could be with regards to tests, claim intimation, and other procedures.

If you know about these important points, you will not face trouble while getting your claim settled. So, on this page, we will tell you such points necessary for a successful COVID claim settlement. Keep reading to know more!

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Points to Remember When Going for COVID Claim Settlement

If you or one of your family members has symptoms of COVID-19 that require due treatment, a health insurance plan will cover all the expenses during the treatment. To get the coverage successfully, you should remember the following points.

Get your Test Done Only At Government-authorized Labs

If you are having any symptoms of COVID-19, you should get yourself tested to check the presence of novel coronavirus in your body. Do remember that it should only be done at labs designated by government and private labs approved by the Indian Council of Medical Research (ICMR) to conduct COVID tests in India. When going for claim settlement, you should submit your test report with a positive result to avoid any hassle.

Intimate the Insurance Company

The first important thing is to inform your insurance company as soon as possible about the nature of the treatment you are undertaking. Depending on the intensity of symptoms of COVID-19, the nature of treatments can be different – Home Care, Quarantine or Treatment in Hospitals. Informing your insurance company about the nature of treatment can save you from any hassle at the time of claim settlement. The insurer will settle the claim according to the terms and conditions of your health insurance policy.

Submit Pre-and Post-Hospitalization Expenses

With a health insurance policy, individuals can also get coverage for pre and post-hospitalization expenses, Ambulance charges, OPD Treatment coverage, etc. To get a smooth claim settlement process, ensure that you have submitted all the required documents and pre-authorization form to the hospital before hospitalization. Other than this, you should also submit documents related to follow-up treatment along with a discharge summary and bills.

One of the good things about the COVID-19-related hospitalization is that insurers or Third-party Administrators (TPAs) ask fewer questions during pre-authorization.

Keep Your Discharge Summary Record Handy

To get a successful COVID claim settlement, keep your discharge summary ready with you with which an insurer can know the number of days of hospitalization (including ICU and general room).

Other than this, you should also submit the following documents to have a hassle-free claim settlement for COVID-19 treatment. Have a look!

  1. Positive RT-PCR Report
  2. Doctor’s prescription
  3. PAN Card
  4. Aadhar Card
  5. Insurer’s Medical Health Card
  6. NEFT details for payment (in case of reimbursement)

Once you submit all these documents to the insurance company, it will assess them before approving your claim. Once approved, your claim will be settled within a few working days.

Stay Away These to Avoid COVID-19 Claim Rejection

We are showing below some reasons because of which you can face rejection for your COVID-19 claim. Please check!

  • If your hospitalization isn’t prescribed by a medical practitioner or doctor.
  • In case your treatment doesn’t follow the standard guidelines. Also, there should be an active line of treatment for the symptoms of COVID that can only be carried out in a hospital.
  • If an individual is hospitalized despite having mild symptoms that can be treated at home.
  • The insurer may also reject your claim if you send unnecessary lab reports, treatment bills during outpatient treatment (OPD) without being hospitalized for the treatment
  • To seek domiciliary hospitalization, you should get consent from your insurer beforehand, otherwise, your claim may face rejection.
  • In case you are making a claim during the waiting period specified on your respective health insurance policy
  • If a policyholder hasn’t communicated about the pre-existing disease at the time of purchasing the policy and the insurer finds the same at the time of claim request, he/she will not get any coverage.
  • If a policyholder fails to submit the required documents to the insurer within specific days.

The Bottom line

You should always prefer a cashless claim settlement for smoother and faster COVID-related claims as compared to the reimbursement claim process. To get a cashless claim, you will need to admit to one of the network hospitals of your respective insurance company. However, if you are getting hospitalized at a non-network hospital, you can always file a reimbursement after getting discharged.

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