Need to File Health Insurance Claim for Coronavirus? Here is a Step-by-Step Guide

Since the widespread of Coronavirus in India and globally, the demand for health insurance and insurance policy for COVID-19 have also increased. With more and more people buying a COVID-19 health insurance plan, the queries related to Corona insurance policy claims also seem to be a concern for insurance holders. So, here is quick rundown with the step-by-step guide to filing Coronavirus treatment related medical insurance claims:

Cashless Claim Settlement Process

Cashless treatment can only be availed at the network hospitals that are listed by the insurance company. You need to inform the insurance company with 24 hours of hospitalization, if it is unplanned. For planned hospital admission, inform your health insurance provider in advance. Though the process may vary from one insurance company to another, but this a common procedure that is followed by most Health Insurance Companies in India:

Steps are as followed-

• Show your health card at the help desk of the network hospital
• Your identity details will be then verified by the hospital
• You need to submit your pre-authorization form as duly filled and signed by you to the TPA of the insurance company
• Once pre-authorization request is verified, the approval letter will be sent over mail to the network hospital
• The cashless coronavirus treatment request will be then processes and the network hospital will settle the medical bills directly
• If your request for cashless claim settlement is denied, then you will be reimbursed for your hospital expenses, once you are discharged

Reimbursement Claim Settlement Process

For treatment in a non-network hospital - then you shall inform your insurer within 48 hours of hospitalization. The process is as follows -

• Once the treatment is done, collect all your COVID-19 treatment hospital bills, invoices etc. Once you are discharged, take your exit file with all the treatment details, medical bills, discharge summary, doctor’s prescription, pharmacy bills etc.
• Submit the duly filled reimbursement claim from along with original copy of the medical documents to the insurance company
• Once the complete verification is done, and approval is granted, the proposer or insured person will receive the claim amount in a few days of receipt of all the necessary documents
• If the insurance company denies your claim request, then you will receive a rejection letter in which the reason for rejection will be mentioned as well

Documents Required for Coronavirus Medical Insurance Claims

When filing claim for Corona insurance policy the following documents along with the discharge needs to be furnished to the TPA or the Insurer. The list of documents goes as follows:

• Submit your medical bills, receipts and discharge certificate, in Original
• Copy of Identity proof and Passport
• Other important documents like Coronavirus medical  reports, COVID-19 consultation, medicine prescription letters, Chemist cash memos
• The insured patient also needs to furnish the hospital records with medical history
• Pathological/ radiology tests with Doctor’s letter and Original receipts
• Original receipts, bills, and diagnostic reports from attending medical consultants, anesthetists, and, specialists
• Surgeon’s Original certificate confirming COVID-19 diagnosis and the nature of operation/surgery done
• Discharge summary 
• Successors certificate, if required
• KYC details if the claim amount is more than Rs 1 Lakh
• Death or disability certificate ( if any) 
• Any other document demanded by the insurer and TPA 
• Once all the documents are submitted, the Health Insurance Company or the TPA will share the claim status with you.

Documents need to be submitted for COVID Treatment at Home

• Just like every other health plan the claim form needs to be filled and signed and submitted to the TPA or the Insurer
• Submit the Copy of Identity Proof/Passport
• A medical practitioner’s prescription suggesting COVID-19 treatment at home
• The insured also need to submit the COVID treatment and daily monitoring report that is signed by the treating doctor Medical reports along with daily monitoring charts by the doctor
• The insurer also needs the insured patient to submit the Medical Discharge Certificate once the treatment is completed

How to Claim if you Two Health Insurance Policies

If you have two health insurance policies, which you have taken from two insurance companies, and the sum insured is Rs 3 Lakh and Rs 10 Lakh for the other policy. You have one health insurance policy for COVID-19 like Corona Kavach or Corona Rakshak medical insurance policy, and the other policy is a top-up health insurance plan then you can use your top-up plan upon exhaustion of the sum insured over and above the deductibles, provided it covers the cost of Coronavirus treatment. Please check the policy wordings or with the insurer for the same.

Let’s assume the hospitalization bill amounts to Rs 7 Lakh then you can use Rs 3 Lakh from the first policy and the remaining Rs 4 Lakh from the other policy. You would need to handover original copy of your bills, along with your documents to the first insurance service provider. Make sure that you tell the amount clearly to your insurer from which you are taking the claim first.

Once it is cleared, you would need to handover the Xerox of the claim settlement bills which are attested by the hospital, to the second insurance company.

Things to remember

• You need to begin this well on time, as making a claim can take up to one month to 45 days.  For cashless claim, there will be some mandatory deductions by your first insurer within the sub-limits. You can claim the remaining amount by your second insurer who will deduct the amount claimed by the first insurer. 
• If you have Corona Kavach or Corona Rakshak health plan then the insurer will also cover the cost of PPE kits, ventilators, masks, gloves, etc. and the cost of these consumable items, which is essential for Coronavirus treatment may not be covered in your basic health plan
• If you compare between a group and individual cover, you can claim your group health policy first, if it covers COVID-19.

To Conclude

Amid the ongoing SARS CoV-2 pandemic, it’s always a wise decision to buy more than two health insurance policies to cover maximum health risks. And before you make the decision, it’s important to assess what all your policy covers and what all is excluded. If you knowledge beforehand, it makes it easier for you to file a claim and saves you from running pillar to post.