While getting your claim settled, you must keep your discharge summary papers with you. It helps the insurer know the number of days you were admitted to the hospital, including ICU and general room.
Covid claims are treated under the general health insurance claim and with the insurance regulator’s guidelines around covid claims, claim settlement turnaround time has been reduced by most insurers
NEW DELHI : It is important to know about covid-19–related claim settlement procedures so that you don’t face trouble in getting your claim settled in case you or members of your family contract the disease and require hospitalization. In this piece, we take a look at all the things you must know when filing a claim so that it gets settled without hassles.
“Covid claims are treated under the general health insurance claim. With the regulator’s guidelines around covid claims, the claim settlement turnaround time has been reduced by most insurers,” said Aatur Thakkar, co- founder and director, Alliance Insurance Brokers
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Inform your insurer
If you notice any symptom related to covid-19, you must first get your test done only at government authorized labs.
You must inform the insurer about the nature of treatment you are undertaking—whether it is under home care, quarantine, or treatment in a hospital—to avoid any confusion during claim settlement. This way, the insurer will assess the claim as per the terms and conditions of the policy the insured is covered under and reimburse accordingly.
Submit pre- and post-hospitalization expenses
Normally, the policy provides coverage for pre- and post-hospitalization expenses, ambulance charges, and treatment cost related to covid-19.
Thakkar said, “In case of hospital admission related to covid cases, there is pre-authorization approval and fewer questions are raised by the insurer or the third-party administrator (TPA) desk in hospital.”
Thus, you must ensure that you have submitted all documents before hospitalization and follow up treatment after discharge along with bills.
Discharge summary record
While getting your claim settled, you must keep your discharge summary papers with you. It helps the insurer know the number of days you were admitted to the hospital, including ICU and general room.
Thakkar said, “In case of network hospital claims getting settled, in cashless and in a non-network hospital, the settlement comes as reimbursement, and once the document is submitted to TPA/insurers’ claim is settled in a maximum of 15 working days. People should carry their RT-PCR report, PAN card, Aadhaar Card and medical health card while getting admitted to the hospital (in covid related cases). This will help in the fast-tracking process of claims.”
Point to note
Bajaj said, “As a policyholder, in order to keep the claim settlement process smooth, it’s better to confirm the cashless treatment with the insurer and also check if the hospital is empanelled with the insurer. However, in these times, an emergency may arise anytime and hence the other option left is to go for reimbursement in case the hospital is non-empanelled. Still, in the event of denial of the cashless facility at any such enlisted hospitals, the aggrieved policyholder may send a complaint to the concerned insurance company, raise it with insurance ombudsman and even send the grievance to the Insurance Regulatory and Development Authority of India (Irdai). It is crucial at this stage that insurers and hospitals ensure that no genuine cashless claim gets delayed or held up resulting in a grievance of the policyholder.”
