How are Claims for COVID-19 Handled?

The pandemic has definitely taken its toll on the country and with each passing day, several thousand new cases of the virus are being reported. With number of infections holding steady, the only solution is healthcare. Getting treatment in time has helped many recover from the virus, but this isn’t the case for everyone. Lack of healthcare infrastructure in several states has been a roadblock for many and for many others, the lack of funding is another problem. Thankfully, in March, 2020, the Insurance Regulatory and Development Authority of India (IRDAI) issued a guideline guaranteeing treatment for COVID-19.

This applies to COVID-19 cases that require hospitalisation, including expenses incurred during quarantine as applicable within the policy. In addition to that and in an effort to expedite delivery of funds, the IRDAI also stated that insurers must decide on cashless claim authorisation in under two hours from the receipt of the authorisation request. Such a mandate is greatly beneficial to the policyholder as there are healthcare centres that will not provide care until the finances are in order. Urging insurers to communicate this decision in a timely manner ensures that treatment is availed without any delays.

Now that you know the time window in which you can expect coverage on medical treatments for COVID-19, the next step is to learn how to file a claim. Whether it’s a government or private hospital, once you test positive for COVID-19, here are 3 steps you need to follow to file an insurance claim.

1. Gather all the required documentation:

   a. Customer ID proof

   b. Health insurance card or policy

   c. Complete treatment records

   d. Claim form

   e. Cancelled cheque

   f. ECS form

2. Stay informed on the type of claim you’re making

   Typically, there are two types of claims. They are either cashless or reimbursement claims. Both of these are different from each other and boils down to a convenience factor. Ideally, you should ensure that you have the option to make a cashless claim because it is much simpler in an emergency.

3. Contact the insurer and fill the forms

   Regardless of the type of claim you’re making, you will need to fill forms in order to make a claim. This process is much simpler with cashless claims because the hospital already has all your information on hand. However, with reimbursement claims, you first need to contact the insurer and get a claim acknowledgement number, which is important all through the process.

Following these simple steps will help you handle the claims process with relative ease and minimal error. During the claim process, you may also have the option to interact with third-party administrators (TPAs). TPAs generally help speed up the claims process and have several benefits too. For instance, many TPAs have technical support and infrastructure that allow you to furnish all claim-related documentation online. These can then be processes and assessed as per the insurer’s protocols. The benefit here is that certain insurers may process claims based on these documents whereas others usually require original documentation to do so.

Additionally, given the fact that hospitals have approached the IRDAI regarding quick claim settlement, which results in time-effective healthcare, TPAs have instructions to process claims at an expedited rate. Within three to four days, claims must be processed so insurers can settle these in a timely manner too.

With a clear picture of the claims process, here’s a quick overview of the 2 types of health insurance claims you can make.