The claims for COVID-19 are now treated under the general health insurance claim and with the insurance regulator’s guidelines, the turnaround time for its claim settlement has been reduced by most insurers. Consumers though should be aware of the documents required for the claim settlement.
For hospitalisation cover
According to Balachander Sekhar, CEO and Co-Founder at RenewBuy Insurance, the policyholder should submit duly filled and signed claim form, KYC (identity proof with address), medical practitioner’s prescription advising admission, original bills with an itemised break-up, payment receipts, insured person’s test reports from the authorised diagnostic centre for COVID-19, NEFT details, cancelled cheque, legal heir/succession certificate, wherever applicable or any other relevant document required by company/TPA for assessment of the claim to their health insurance company.
Policyholders, as per Amit Chhabra, Head- Health Insurance at Policybazaar, should also keep their discharge summary papers with them while the claim is being settled.
"It provides the insurer with information about the number of days they were admitted to the hospital, including ICU and the general room stays. In the case of network hospital claims, the settlement is in the form of reimbursement, whereas in cashless and non-network hospital claims, the settlement is in the form of reimbursement," Chhabra elaborates.
For home treatment
In the case of
domiciliary treatment, Sekhar tells that the number of documents to be submitted are comparatively less.
“Documents like a certificate from the medical practitioner, advising treatment at home or consent from the insured person on availing home care benefit, discharge certificate from medical practitioner specifying the date of start and completion of home care treatment are required,” he explains.
While applying for these claims, there are other things too one should keep in mind. These include: Notifying the insurance company early
According to Chhabra, if a policyholder notices any symptoms that could be related to COVID-19, they should get the test done only at government-approved labs.
“To avoid any confusion during claim settlement, they must inform the insurer about the type of treatment they are receiving—whether it is at home, in quarantine, or in a hospital. In this manner, the insurer will assess the claim in accordance with the policy's terms and conditions,” Chhabra states.
Pre and post-hospitalization expenses must be submitted
The policy covers pre-and post-hospitalization expenses, ambulance charges, and treatment costs associated with COVID-19. So, policyholders must ensure that they have submitted all documents prior to hospitalization as well as a follow-up treatment after discharge, along with the bills.
As a policyholder, Chhabra suggests one to confirm the
cashless treatment with the insurer and also check if the hospital is empanelled with the insurer to ensure a smooth claim settlement process.
"However, in these times, an emergency can happen at any time, so the other option is to seek reimbursement if the hospital is not on the list," he advises.
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