Planning to claim for Covid Insurance? Here’s how you can do it

You may opt for reimbursement if you can pay the hospital bills upfront. People who undergo treatment at non-network hospitals for coronavirus infections must intimate the insurer within 48 hours of hospitalisation.

The Covid-19 second wave has severely impacted the country. The need for Covid insurance is rising as the infection rapidly spreads among the rural population. As more people avail of Covid insurance, the focus is shifting towards hassle-free claim settlement.

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Hospitalisation due to the coronavirus infection can severely strain your finances. The coronavirus insurance plan can save you a lot of money, avoiding the need to dip into emergency funds. Moreover, coronavirus infection may affect many family members, necessitating the entire family’s coverage with Covid insurance.

The regular health insurance plan covers hospitalisation costs due to Covid-19 up to the sum assured. However, you must check if home care treatment is covered under the regular health insurance plan. You may avail of cashless treatment at the network hospitals listed by the insurer. Otherwise, you will have to pay the hospital bills upfront and then claim reimbursements. People who don’t have health insurance may opt for Covid-specific insurance plans that cover the treatment costs of Covid-19.

How to avail cashless hospitalisation through Covid insurance?

It would help if you informed the insurer of the hospitalisation due to the coronavirus infection within 24 hours. Display your health card at the help desk of the network hospital for the verification of your details.

Fill up and sign the pre-authorisation form submitted to the TPA (Third party administrator) of the insurer. After verifying the pre-authorisation request, the TPA sends an approval letter to the network hospital that directly settles your medical bills.

How to claim the reimbursement of medical bills for Covid treatment?

You may opt for reimbursement if you can pay the hospital bills upfront. People who undergo treatment at non-network hospitals for coronavirus infections must intimate the insurer within 48 hours of hospitalisation.

  • After the Covid-19 treatment, you must collect your hospital bills and the invoices from the hospital.
  • Also, collect the exit file, which contains details of your treatment, discharge summary and the doctor’s prescription.
  • You must submit the duly filled reimbursement claim form and the original copy of your medical documents along with a cancelled cheque to the insurer. It helps to upload your documents online on the insurer’s website to avoid travelling during the pandemic.
  • The insurer verifies the documents, and on approval, you receive the claim amount.

Many Covid-19 patients are opting for home treatment rather than at the hospital. You have several Covid-specific plans covering the cost of home treatment. However, you must contact the insurer at the earliest, ideally as soon as you are diagnosed with the coronavirus infection, for a hassle-free claim settlement. Here’s how you can claim expenses for treatment of coronavirus infection under home isolation.

  • You need a Covid-19 positive test report (Only RTPCR test) having the SRF (Specimen Referral Form) ID from the ICMR-approved testing laboratory. Moreover, the doctor’s prescription is vital for home treatment.
  • You may check all the inclusions and exclusions under the policy before submitting the claim.
  • You can make a reimbursement claim by submitting the bills showing the doctor’s consultation charges, costs of diagnostic tests and renting of medical equipment such as oxygen cylinders under active medical supervision. However, the insurer will not reimburse the oxygen cylinder costs, but only the oxygen usage and refilling expenses.
  • The health insurer covers home treatment only for mild coronavirus cases. Moreover, food expenses and costs of unproven treatment are not covered under the policy.

Many regular health insurance plans have a clause on ‘domiciliary hospitalisation’. The purpose of this clause is to offer sophisticated medical treatment at home if the patient cannot find a hospital bed. The home ICU setup that includes doctor visits and nursing charges may be covered under the health insurance plan up to the sum assured.

You must have the mandatory documentation in place while claiming for home treatment under regular health insurance. Moreover, insurers may approve only GST-registered firms that provide detailed invoices for home treatment. You must check the sub-limits clause under the policy where some insurers cover home treatment only up to three days or cover expenses up to a fixed percentage of the sum assured.

You must pay close attention to the inclusions and exclusions in the health insurance plan for a hassle-free claim settlement. Keep all the original bills handy as insurers reimburse expenses only against these bills. Moreover, the home treatment for Covid-19 may be covered only under the reimbursement process where you pay the hospital bills upfront, and the insurer reimburses the hospitalisation expenses after the submission of the bills.

by, Archit Gupta, Founder and CEO – ClearTax

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