Claiming health insurance for coronavirus: A step-by-step guide

Posted on May, 2021

India was starting to recover from the first wave of Coronavirus when the second wave struck with more significant physical and financial consequences. At a time like this, when financial resources can prove life-saving, having a health insurance policy is critical. Under the new rules of IRDAI, every health insurance policy now covers Covid treatment costs.

If you have a health insurance policy, irrespective of when you bought it, here’s how you can file a claim for coronavirus treatment expenses:

Reimbursement Claim in Non-network hospitals

If the Covid positive patient, covered under the health insurance policy, is admitted to a non-network hospital, you should inform your insurance company within 48 hours of hospitalisation. Once you notify the insurance company, you can follow these steps to file a reimbursement claim:

  • After the treatment, collect every invoice related to the coronavirus treatment. These can be room invoice, pharmacy bills, exit file, doctor’s prescription, medical/medicine bills etc.
  • The next step would be to contact your insurance broker and fill the reimbursement form by attaching all the original medical documents you have collected.
  • You will receive the payment in your selected mode once the company verifies your claim. It usually takes a few days to a week for the insurance company to approve and disburse payment.
Cashless Claim Settlement in Network Hospitals

You can avail of cashless treatment only in the network hospitals mentioned by the insurance company in your health insurance policy. If you have planned the hospitalisation, it is better to inform the insurance company as soon as you plan it. Furthermore, for filing a health insurance claim in-network hospitals, you should:

  • Bring your health card to show to the network hospital’s medical help desk to help the hospital verify your details with the insurance company.
  • Fill your pre-authorization form to submit it with the Third Party Administrator or the Insurance broker to start with the process of your claim.
  • In a new circular, IRDAI has made it mandatory for insurance companies to approve the cashless claim within a time period of 60 minutes after it gets your claim request.
  • Once your pre-authorization form is approved within 60 minutes, the insurance company will send the approval letter over mail to your attending hospital.
  • After the approval letter is received, the hospital starts with the cashless coronavirus treatment by settling all the expenses directly with the insurance company.
  • If the insurance company denies your claim for cashless treatment, it will reimburse you for all the payments once you or the patient gets discharged.
Other Things to Remember

Most health insurance policies have some exceptions in covering the cost of consumables such as PPE kits up to a particular amount. Exceptions also include other medical equipment such as thermometers, attendants, private nurses etc.

Although some coronavirus related expenses are generally not covered under a traditional health insurance policy, the policyholder can add these expenses by paying a little extra premium. One of the best things you can do at this time is to contact your insurance broker and do a thorough review of your policy to add extra protective features that can prove life-saving amid the pandemic.

While you take care of yourself during the quarantine period, we will take care of you. Do not let unprecedented incidents affect your mental health and create an imbalance in your financial stability. Explore yourself while we have got you covered. Being composite brokers in India, we at PINC Insurance provide a range of insurance and risk advisory services. We help you buy, renew, and compare insurance that suits your needs and budget. We ensure hassle free and seamless insurance purchase and insurance claims process. So, leave all your insurance related worries to us and start exploring yourself.

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