Not following these 7 points will make Covid-19 claim difficult for you

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Updated: May 27, 2021 11:27 AM

Unexpected Covid-19 deaths have devastated families across the country. Not just emotionally, Covid has destroyed families financially as well.

health insurance policyRepresentational image/pixabay

Unexpected Covid-19 deaths have devastated families across the country. Not just emotionally, Covid has destroyed families financially as well. In times like these, an insurance cover against Covid-19 may provide some respite. But even then, making a Covid-19 claim may not be easy, considering the technicalities and complexities of insurance claim process. There are certain points that need to be considered before making a Covid-19 claim. Take a look:

1. Try choosing Network / Empanelled Hospital instead of going for reimbursement claim

According to Ankit Agrawal, CEO and Co-founder, InsuranceDekho, going to a panelled hospital helps ease the process as in that case, the hospital’s dedicated Insurance help desk /TPA raises a cashless settlement request with the insurance company which also helps resolve many document and other discrepancies then and there only. Customers should avoid going to any non-listed/blacklisted hospital.

In case the insured chose to avail services of non-network hospital, a prior approval should be taken from insurer by submitting the information (Test report, Medicine prescribed, Consultant cost, Nursing charges, Cost of oxygen, nebulizer etc), Agrawal suggested.

Following the government’s guidelines, a certain amount can only be claimed for covid patients and hospitals cannot overcharge for the same.

2. Continuous line of treatment

For Covid claim, there should a continuous line of treatment with monitoring each day throughout the duration of home care treatment. The document should be signed by the medical practitioner, Agrawal told FE Online.

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3. Waiting period

Customer should be aware of waiting period, if applicable, which is generally of 15 days for Covid protection policies. Insurance company do not take any liability for illness during that period.

4. No claim on expenses incurred on verbal advise

Agrawal said that expenses incurred against a verbal advice given by doctor will not be considered (For e.g. Teleconsultation without prescription which advises bed rest and routine tests like CBC, Urine or Routine health check) This can be also classified as unproven treatment.

5. Treatment outside India

Also, no claim can be made on Diagnosis/Treatment outside the geographical limits of India.

6. Costs to be covered

Cost of maximum two covid tests as per govt approved rates will be paid. The second test should be supported by the prescription. Cost of PPE kit up to 1500 per day is payable only if a qualified nurse is hired by the insured subjected to doctor’s advice.

7. Home Isolation during the covid conditions:

“The claim here also comes with an underlined condition that customer can only look for a home isolation claim if the same has been prescribed by the doctor that the patient under certain conditions has the following plan for home isolation. There are further 3 conditions that are attached in relation to the condition of the patient – Oxygen saturation, Temperature level and other associated conditions of the patient basis the govt regulations. What insurance companies are facing is that customers testing positive are self-isolating themselves and are opting for insurance claims which in turn leads to their own dissatisfaction and further chaos,” said Agrawal.

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