Will the insurer settle COVID-19 claims for treatment at ‘make-shift or temporary hospitals’? IRDAI says this

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Updated: Jul 16, 2020 6:05 PM

The recent guideline has been issued to the insurers on the settlement of claims for COVID-19 treatment at ‘make-shift or temporary hospitals’.

 IRDAI guidelines, settlement of claims, COVID-19, health insurance, Corona Kavach Policy, Corona Rakshak PolicyCOVID Claims Insurance: Earlier, the IRDAI had asked insurers to offer Corona Kavach and Corona Rakshak, to cover COVID-19 hospitalisation expenses.

Since the outbreak of COVID-19, the IRDAI has taken several steps and issued guidelines for the insurance companies to ensure a smooth claim settlement process for the policyholders of health insurance policies. The recent guidelines have been issued to the insurers on the settlement of claims for the COVID-19 treatment at ‘make-shift or temporary hospitals’.

In its note, IRDAI observes that in view of an increase in the number of COVID-19 cases and in order to leverage on the extant healthcare systems put in place, it is important to recognise the make-shift or temporary hospitals permitted by Government for settlement of health insurance claims for insurance companies.

Therefore, in this backdrop and in order to ensure that the costs of treatment of COVID – 19 are covered as per the terms and conditions of policy contract, a make-shift or temporary hospital permitted by Central or State government shall be regarded as a hospital or network provider and insurers shall settle the claims as per the following norms.

  1. Where a policyholder who is diagnosed as Covid-19 positive is admitted into any such make-shift or temporary hospital on the advice of a medical practitioner or appropriate Government authorities, notwithstanding the definition of hospital specified in the terms and conditions of policy contract, the treatment costs shall be settled by insurers.
  2. Where any network provider has set up any such make-shift or temporary hospital, such make-shift or temporary hospital shall be regarded as the extension of the network provider and cashless facility shall be made available.

So, even if it is a make-shift or temporary hospital, the treatment cost will be covered by the insurance company or the TPA, for the policyholder.

Also Read: 7 differences between Corona Kavach Policy and Corona Rakshak Policy

Earlier, the IRDAI had asked insurance companies to offer short-term health plans called Corona Kavach Policy and Corona Rakshak Policy, that will cover hospitalisation expenses related to the treatment of COVID-19. This will help individuals buy specific health cover for meeting hospital costs due to Coronavirus.

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