5 Obstacles In Claiming Health Insurance For COVID-19 Treatment

Health insurance policy has never seemed as important as now, in the middle of a pandemic. People are taking policies more seriously, including insurance companies, who have launched new policies specific to COVID-19.

Since demand for health covers have increased after the outbreak, experts suggest that this buying insurance trend will continue in the post-COVID-19 era, as the pandemic brings to light the uncertainties of life.

As more and more claims are being made, insurance policies are being framed to exclude certain expenses or have pre-conditions attached to them to make a valid claim. There are also some COVID-19 specific costs that may nor may not be covered in your health insurance. It is, therefore, important to read the fine print of the policy papers and also speak to your insurance company's representatives to check if your policy will sufficiently cover your COVID-19 treatment.

While it is the responsibility of the insurance company to inform the customers on what expenses are covered and what is not, you as a customer will suffer the consequences of inadequacy. It is wise to ask and understand what your health insurance cover entails.

1. Non-medical consumables

If you had purchased your health insurance policy before the pandemic, your treatment is still covered, however, it will most likely not include the cost of a majority of consumables used to treat coronavirus patients. Consumables in health insurance mean single-use items like gowns, tissues, syringes, etc, that are used in medical procedures but considered as non-medical items due to their nature.

For COVID-19 treatment, there are added costs of consumables that are generally not needed in other medical treatments like the requirement of hospital staff to use personal protective equipment (PPE) kits, that includes N-95 mask, nitrile gloves, face shield, shoe covers, etc, plus sanitisers and disinfectants. Each of these items in the PPE kits, sanitisers, disinfectants are considered as separate consumables, and not covered by your general medical insurance.

Most policies, existing before the coronavirus pandemic will not cover these expenses.

In July, per IRDAI's mandate, insurance companies have launched standard COVID-19 specific policies called 'Corona Kavach' and 'Corona Rakshak' that cover PPE Kit, gloves, mask and ventilator charges. Thes are now available with almost health insurance players in India.

2.Exclusions

If the insurance policy specifically mentions that it does not cover pandemics, your claim for COVID-19 treatment will be rejected. Diseases not covered under the health insurance policy will be mentioned under the head exclusions or 'not covered.'

It is best to inquire about these exclusions as well as the claim process before you purchase the policy.

Also, some policies do not cover home care expenses and pre or post hospitalisation expenses like costs of diagnosis of COVID-19.

3. Wrong documentation

Wrong information, suppression or misrepresentation of facts could also lead to rejection of the insurance policy. Partial or wrong disclosure of important details regarding age, medical history, occupation, income, etc can easily lead to rejection of any insurance claim and not just related to COVID-19 treatment.

4. Timings

Timing for making claims on treatment is important. In the case of most health insurance policies, you can claim expenses if hospitalised for a minimum period of 24 hours. In case of emergency, you can go ahead with the treatment and inform the insurer within 2 to 3 days of hospitalisation.

If it is planned hospitalisation, you can ask for the insurer's approval in advance.

5. Treatment at authorised centres

Health insurance policies specify their conditions for cashless treatment. These can only be availed at pre-approved hospital networks that the insurance company is tied-up with.

The insurance company will reject your claim if hospitalised in a non-approved hospital. Ideally, before you purchase a health insurance policy, you can make the decision on your choice of insurance provider based on their tie-ups and customer response timing.

In the case of COVID-19, there are further complications like treatment received in makeshift arrangements of hospitals. As per IRDAI mandate, insurers are required to cover treatments in these temporary bedding arrangements made by hospitals due to shortage of bed and social distancing measures for the pandemic.

Further, your insurance claim could be rejected if the diagnosis for COVID-19 was not made at a government-authorised diagnostic centre.