Undergoing treatment for Covid-19? Here is how one can claim health insurance

With the rapid rise in coronavirus cases, the number of health insurance claims have also been increasing. India reported the highest single-day spike of covid cases with over 2.73 lakh fresh infections and 1,619 deaths in the last 24 hours. If you have basic health, Covid Kavach or Covid Rakshak policy here is a quick low-down on what all you need to do to start a claim process. Knowing these details in advance such as what documents are needed and how to start the process can help you during the time of emergency.

Claim treatment for Basic Health Insurance Policy/Corona Kavach

While basic health insurance policy covers you against all kinds of hospitalisation, Corona Kavach is specifically for the treatment of Coronavirus. Corona Kavach is a hospitalisation policy but you can also claim expenses up to 14 days for home treatment of coronavirus but the same is not available under comprehensive policies.

There are two ways of making health insurance claims:

Cashless basis: For a claim on a cashless basis the treatment has to be done in a network hospital. You can check the website of the insurer or get the details in your policy document about the network hospitals. Once you decide on a network hospital show your health card at the desk. After your identification details get verified, you need to fill and submit the pre-authorisation form which is then verified by TPA and sent back to the hospital desk. You might need to pay some advance deposit at the time of hospitalisation and KYC documents along with policy number. Here the insurance company directly pays to the hospital and you don’t have to wait for reimbursement. If the hospital denies you a cashless facility then you need to go for the reimbursement process, where you get paid later post-discharge.

Reimbursement basis: If you get treatment in a non-network hospital then you have to pay from your pocket and later make a claim from an insurance company. There is generally a period of 15-30 days after the discharge during which you have to make a claim. After hospitalisation, ensure that you have kept all documents such as claim form, discharge summary, prescriptions and bills ready that are needed for submitting a claim.

For home care treatment expenses under Corona Kavach you need to submit the following documents to your insurer:

• Duly filled and signed claim Form
• Copy of insured person’s passport, if available
• Photo identity proof of the patient (if insured person does not own a passport)
• Medical practitioners’ prescription advising hospitalisation
• A certificate from medical practitioner advising treatment at home or consent from the insured person on availing home care benefit.
• Discharge certificate from medical practitioner specifying date of start and completion of home care treatment.
• Daily monitoring chart including records of treatment administered duly signed by the treating doctor is maintained.

In case of hospitalisation due to Covid 19, one needs to submit the following documents to the insurer: 

• Duly filled and signed claim form
• KYC (Identity proof with Address) of the proposer, where claim liability is above Rs 1 Lakh as per AML Guidelines
• Copy of insured person’s passport, if available
• Photo identity proof of the patient (if the insured person does not own a passport)
• Medical practitioner’s prescription advising admission
• Discharge summary including complete medical history of the patient along with other details
• Investigation reports including insured person’s test reports from the authorised diagnostic centre for COVID.
• NEFT details (to enable direct credit of claim amount in the bank account) and cancelled cheque
• Legal heir/succession certificate, wherever applicable

For Corona Rakshak, which is a benefit plan, the insurer pays a lump sum on the basis of the above-mentioned documents, which needs to be submitted with the due date. But remember it requires hospitalization for a minimum continuous period of 72 hours.