Covid 19 & challenge of Health Insurance Claims

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Deepak Choudhhary, CEO, Insurance4life.in,

We are passing through extremely challenging times, particularly during the second wave of the Covid 19, which led to huge loss of life, all over. Probably, we lacked the preparedness for the second wave, thus were caught unaware. Hence, it turned out to be deadlier than the earlier one.

To counter the situation, as a first measure, everyone should take health insurance coverage, be it individual policy or family floater. If you already have, renew it, better still go for top-up or even super top-up, as costs of treatment have escalated. Not having health insurance may make a serious dent in your finances. Whereas having health insurance may sail you through this crisis.

 

So how does your policy work? How to make a claim? What all would be covered? What would make claim reject? Will you be compensated if the home quarantined? Etc. etc.

I will touch upon these points to help you understand the process of claim settlements. So, if Covid 19 has come knocking on your door, and you have to be hospitalised, you can avail of cashless or reimbursement benefit as may be the case. You would be covered for the entire treatment including the Oxygen cylinder, which would be reimbursed on MRP and not for any premium you have paid.

But considering the number of cases, and shortage of hospital beds, patients are advised home quarantine and treatment. This has helped in a big way in arresting the spread.  In this case, if you have to undergo home care treatment, then it’s better to check with the insurer if expenses incurred will be reimbursed or not. Coronavirus treatment requires special procedures and processes, the cost of which may not be covered under the basic policy.

Majorly, health insurance policies do not settle claims in case of home treatment, but a written communication to the insurer about the need for home treatment may help as the availability of hospitality beds is a concern. You can attach the doctor’s prescription, your policy number and specific cost heads that the insurer needs to cover. Maybe it is considered as a special case. As IRDA removed ‘home quarantine’ from coverage last November, it is not covered by the insurer.

To cover home care costs, there are Corona Kavach plans for persons aged between 18 – 65 years. These are short-term plans available for 3.5 months, 6.5 months and 9.5 months tenures and come with a waiting period of 15 days. The Home Care treatment expenses will be covered up to 14 days for the Corona Kavach policyholder, subject to the condition that any such treatment is prescribed by a medical practitioner. Cost of a Pulse Oximeter, Oxygen cylinder, Nebulizer, medicines prescribed in writing, consultation charges, and the nursing charges related to medical staff get covered, in case prescribed by the medical practitioner.

Even Covid survivors can take coverage, 45 days after detection which would come into force after 30 days.

For making the claim settlement process smooth to save patients from any financial stress, IRDA has taken some vital steps like insurers to communicate their cashless approvals to hospitals within 60 minutes of receipt of an authorization request, along with all requirements from the hospital. In the case of non-network hospitalization, a patient needs to send all the hospital papers including bills, discharge reports, etc. to the insurer for reimbursement of the bill amount.

The disaster management fund of Rs. 4 Lakh to the deceased’s family, even if he has tested negative and discharged from the hospital is a welcome move, implemented by some State Governments.

However, a rise in premium costs in the range of 30-140% is quite steep as these are extremely challenging times for individuals, families, businesses and indeed whole societies and economies. The insurance industry has a key role to play in supporting customers and societies through the crisis and the recovery.

  • Deepak Choudhhary, CEO, Insurance4life.in, writes regularly on personal finance related subjects.

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