Filing Health Insurance Claim for Coronavirus? Here is a Step-by-Step Guide

Many people who hold a coronavirus-specific health insurance policy feel confused about filing a claim for the expenses incurred. Read on to know more about the coronavirus claim process.With the onset of the COVID-19 infection or the coronavirus in India and worldwide, the importance of health insurance has increased considerably, especially since many people are looking for a coronavirus-specific insurance cover. With the number of people buying COVID-19 health insurance plans increasing, the queries related to coronavirus insurance policy claims have also increased.So, to help our customers, we list down the stepwise process for filing a claim for a coronavirus-specific health insurance policy.

You can avail of the cashless claim benefit only if you get treatment at any of the hospitals that are part of the insurer’s network. In case of an unplanned hospitalisation, you must inform the TPA (Third Party Administrator) appointed by the insurer within 24 hours of getting admitted. If it is a planned hospitalisation, you must notify the TPA in advance.Once you inform the insurer, follow the below process:

• Show your health card at the hospital desk while you get admitted and inform the authorities that you will avail cashless claim facility.
• The hospital will verify your insurance details.
• Next, you must submit a pre-authorisation form duly filled and signed to the TPA.
• After verifying the form, the TPA will provide an approval letter to the hospital.
• The hospital will then send the bills and receipts to the insurer to support the claim, and the insurer will settle the bill directly with the hospital.
• If your request for a cashless health insurance claim is denied, then the TPA will inform you about the same and provide a reason for the same.

If you get treatment at a non-network hospital, you must inform the insurance company or the third-party administrator within 48 hours of getting admitted to the hospital. After you inform, follow the below process:

• When you are admitted to the hospital, ensure that you keep track of all the expenses incurred and collect all the COVID-19 treatment-related bills, invoices, receipts, etc. This will help file your claim request without any hassles.
• Before you start the health insurance claim process, ensure that you verify the expenses list with the bills and ensure that you have a proof for all the expenses you want to claim.
• Next, review your policy’s terms and conditions and check the exclusions. If you find certain expenses are not covered under the agreement, avoid claiming the expenses as it will delay the settlement process.
• Submit the reimbursement claim form duly filled and signed along with the copies of the medical documents to the insurer or the TPA for verification.
• After the insurer has verified, they will approve the claim, and you will receive the approved amount.
• If the claim request is rejected, the insurer will send a rejection stating the reason for rejection.

Amid the ongoing COVID-19 pandemic, it is advisable to have a COVID-19 specific health insurance cover even if your existing policy covers the same. This will help you get maximum protection. Before you purchase a plan, it is a good practice to read the policy documents and know the inclusions and exclusions. This will make it easy for you to file a claim and save you from many hassles.

The information contained herein is generic in nature and is meant for educational purposes only. Nothing here is to be construed as an investment or financial or taxation advice nor to be considered as an invitation or solicitation or advertisement for any financial product. Readers are advised to exercise discretion and should seek independent professional advice prior to making any investment decision in relation to any financial product. Aditya Birla Capital Group is not liable for any decision arising out of the use of this information.